Americans are dying in droves. Deaths due to avoidable causes in the United States –which could be dealt with via prevention or proper healthcare – far outpace those in most of country’s peers in the industrialized world. Most notably, Americans die of treatable conditions at nearly twice the rate as Spaniards, French, Japanese and Australians.
They would most likely live longer if they enjoyed better access to healthcare. Americans are the most likely to skip a doctor’s appointment due to its cost, the most likely to skip a medical test and to skimp on prescription drugs. This is unsurprising, given the extraordinary lack of public health insurance in the United States. Americans face the highest out-of-pocket expenses for medical services in their peer group.
Donald Trump evidently does not believe this is an issue for the world’s richest nation.
If the budget for 2027 the White House proposed last week is anything to go by, healthcare is not the government’s problem: the Department of Health and Human Services (HHS) could see its budget cut by over $15bn, 12% less compared with this year.
The cut comes on top of the evisceration of the healthcare budget last year, when the president’s “big, beautiful bill” (BBB) cut more than $1tn over 10 years from Medicaid and the Affordable Care Act marketplaces, largely by imposing onerous work requirements on Medicaid that will push 15 million Americans to lose health insurance, according to some analysts.
Unattainable healthcare is not the only challenge Americans face that Trump has decided is not his problem. The lack of affordable childcare is a key reason why American women’s labor participation is among the lowest in the industrialized world. But government spending on early childhood education and care is also among the stingiest among affluent nations.
What does Trump care about? The BBB communicated his overarching interest in cutting the tax bill of the well-to-do, offering up a $4.5tn tax cut over 10 years that will boost the after-tax income of the richest 10% of the population by 2.7%, a cool $13,622 per household, according to the Congressional Budget Office.
double quotation markTo the average American, it must be hard to understand Trump’s budget proposal as anything but a betrayal
Trump’s other interest is hard power, to better crush his foes. The BBB last year included $165bn for the Department of Homeland Security to “deliver on the President’s mandate to arrest and deport criminal illegal aliens and make America safe again”. Last week, he bet the house to pay for a bigger military. As he put it at an Easter lunch reception last week: “We have to take care of one thing: military protection. We have to guard the country.”
That is proving expensive. By some estimates, the Pentagon spent $12.7bn in the first six days and $28bn in a little over five weeks on the war against Iran, which appears to have next to nothing to do with guarding the country. His budget proposal, released last week, the one that cut the budget for HHS by 12% and the entire non-defense budget by 10%, was transparent about the Brobdingnagian sums Trump wants to spend on this kind of stuff: $1.5tn in 2027 alone. About three times Iran’s entire GDP and 42% more than the budget for 2026.
The message to everyday Americans is: beware. The cuts to the non-defense budget in the 2027 proposal are nowhere near enough to cover this increase in defense spending. Given Trump’s and the Republican party’s aversion to taxes, they are all but certain to come after the rest of the safety net to cover the bill.
Trump was even willing to go on the record, if only momentarily, in a message that will surely become the basis for Democratic attack ads as this year’s midterm elections get into full swing. “It’s not possible for us to take care of daycare, Medicaid, Medicare, all these individual things, they can do it on a state basis,” he said at a White House Easter reception. “All these little scams you have to let states take care of them.” The message was so outrageous that after posting the video of Trump’s remarks on its YouTube page, the White House deleted it. To no avail, of course. Things on the internet live for ever.
The White House claims corruption justifies cutting the non-defense budget: it said it cut $4bn from a program to ensure poor households’ access to electricity because dead people were getting benefits, among other fraudulent things. It took $5bn from the budget of the National Institutes of Health because it “broke the trust of the American people with wasteful spending, misleading information, risky research, and the promotion of dangerous ideologies that undermine public health”.
To the average American, however, it must be hard to understand Trump’s budget proposal as anything but a betrayal. He won the presidency twice, largely by promising help for America’s beleaguered working stiffs, forever ignored by cosmopolitan elites in power, invested in foreign trade agreements and open borders policies. The budget proposal confirms that, if it ever was sincere, this commitment has by now been forgotten.
The data carries a warning for the president, though. If he keeps ignoring the needs of his base, he may soon no longer have one. This is not just about his sagging poll numbers. This is about American men and women dying. They are also his voters. He might show them some care.
