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As you read this, Senate Democrats are considering picking an actual fight over a government shutdown. They are signaling that they might try to force Republicans to repeal recently adopted GOP healthcare cuts in exchange for a debt ceiling increase. Ok, that’s fine. I hope they do it and succeed. But it’s not enough. It’s too late and typical of recent Democratic “leadership”: defensive, small-ball, and not strategic. Democrats should absolutely pick this fight, but what follows is a case for something much bigger. Democrats should commit to making this the first shot in a much larger, louder, and more important battle for a new national healthcare system.
If you ask any American not in the 1% about what worries them most, the odds are that within a minute or two, stories of their healthcare fears and frustrations will flow like a river. Voters don’t need to be prompted, and unlike their takes on the Trump-driven cultural divides that are notoriously difficult for Democrats to wrangle, on health care, voters are clear and unified. That’s because healthcare is not partisan, conspiratorial, or regional. We all muddle through it together. We are all frustrated by insanely high costs or justifiably scared that a diagnosis or an accident will result in a morass of confusing medical bills that can quickly force us into bankruptcy.
Montana Dispatch -Truth, Beauty & Resistance - by Ryan Busse is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.
Our family is right in the middle of it, just like everyone else. Five years ago, I left a longtime job that included the benefit of healthcare coverage for our family. Sara and I were shocked to discover that maintaining this coverage through COBRA would cost us nearly $5k per month. It was too much, so we took a chance on what I thought was a risky plan and signed up for a medical cost-sharing program that cost us less $900 per month. The service has proven more reliable than we feared, and the customer service has been exceptional. But the kicker to the “coverage” is that every single incident (and we’ve had a few) has a $1k deductible. Essentially, it's major-medical insurance, and that has forced us to become experts on the underbelly of our system.
We’ve learned that much of the waste is driven by the insurance industry. We’ve learned how to avoid excessive lab tests and other expenses, how to finance hospital visits, how expensive an ambulance is, what each service and prescription costs, and what healthcare professionals think about it all. We’ve also learned that our worries are similar to those of most other Americans. People are struggling, and the situation is getting worse. Now millions are losing Medicaid coverage, many more are about to lose ACA subsidy payments (that’s what the budget fight will be about), and all of us are navigating a needlessly complex, bloated, and broken system. A recent bipartisan poll illustrates the breadth of Americans’ healthcare fears.
Key Findings:
83% of Americans say it is difficult to afford healthcare (up from 78% in 2021).
A majority (51%) of voters say it is personally difficult for them to afford healthcare, up from 41% in 2021.
Almost half of voters report that they or a family member have forgone healthcare because of cost.
71% of voters—72% of Trump voters and 70% of Harris voters—believe that the prices being charged by hospitals are unreasonable.
Proposals to shake things up have broad support from overwhelming majorities across the political spectrum.
Democrats need to wake up and smell the medical bills. There aren’t many opportunities like this anymore: an issue not rooted in media hyperbole, but in real-world experience that elicits unified, heartfelt emotion across the political spectrum.
If you want voters to see you differently, then you are going to have to make a move, so start with championing a new national coverage system that guarantees accessible, high-quality healthcare to all Americans. Make the proposed plan clean and straightforward. Let people keep their private insurance if they want it, but don’t apologize for offering something better to everyone else, because that’s what people need and want.
Here are five strong justifications for bold action on healthcare now:
The Trump storm is not just going to blow over; action must be taken to break it up. Those of us who are tuned into politics know how bad Trump and his enablers are. We understand that every weirdo in the Trump White House would sell your kid’s kidneys for a Don Jr. meme coin. (Stephen Miller probably has Hannibal Lecter fava beans in his briefcase waiting on the kidneys.) But you can’t just hide out and hope voters figure this out because for most of them, it’s not enough to be anti-Trump. In focus group after focus group and poll after poll, swing voters say things like “Well, at least Trump acts,” “Democrats are weak and woke,” or “I don’t know what they stand for.” So here is your chance. Do something big, bold, and affirmative to change it!
This is an 80-20 issue in the making, and the midterms are only 14 months away! You don’t have to explain this to people; we are all living it! Forget the ghosts of Hillary Clinton’s healthcare plan, which was another lifetime ago; stop being afraid of what Republicans will say. Have the courage to pick up this ball and run with it. You don’t need 50 poll-proven, mealy-mouthed test statements from the DNC to figure it out. The signs are all around you―this is important to real people, and it’s part of a larger winning message.
Speaking of that message, a national healthcare plan reinforces what should be the Democratic Party's strengths. Just look at the ready-made enemies: wealthy insurance companies making millions while they deny care, excruciatingly high costs, and huge bonuses for pharma executives. The truth is that many Democrats are too close to lobbyists who had far too much influence during the Obama-era ACA fight. Now is the chance to fix that and be for the people instead of those lobbyists. If we live in a country where billionaires take their rockets to space on the weekends, I think we can invest in healthcare for our citizens. Democrats need to stop just talking about this stuff and act because voters no longer believe the words.
It’s time to show Americans you care about something enough to sell it. Stop fearing the predictable GOP “free market” pushback. Healthcare is not, and never has been, a free market. Just ask a mother whose kid has cancer about how free she is to make informed decisions. She’ll pay anything, she’ll go bankrupt to save her child, and that’s a lot closer to criminal extortion than the free market.
Most importantly, here’s a chance to simplify the Democratic message and focus on fighting for what our healthcare system should be about: improving the lives of people. Citizens, through our government, should be the most powerful part of our system, but right now, it feels like we are just the currency. Don’t apologize for fighting anything that drives up pharma stocks, or pays insurance executives their monster bonuses. An effective healthcare system should not be designed for private equity or profit margin. It should be solely focused on people. Only the villains are going to argue with you on this. Welcome that fight. Take it to the people. It’s a winner.
If Dems don’t act, our healthcare situation will spiral into a crisis. The United States already pays far more for healthcare per person than all other similar countries, and our expenses are growing rapidly. We are one of the few developed nations that does not provide guaranteed coverage for our citizens. People are locked into jobs due to coverage, while others miss work or get sicker because they can’t afford hospital visits. Everyone is scared. None of this is sustainable.
Here’s the final kicker: Donald Trump is nothing if not opportunistic. Politically, he’s potent because he never walks by a potential 80-20 issue that he doesn’t pick up and exploit. Eventually, he’ll need another diversion. He’ll watch Fox News for three hours while he sits for his morning spray tan, and he’ll see The Five talking to a Republican voter who complains about healthcare costs. Then he’ll get a hare-brained idea to use this for his benefit. He’ll say, “Democrats saw the problem but did nothing.” He’ll be right, and then he’ll botch the system even worse, so that he can further divide the country and enrich himself.
For the good of this nation, don’t let that happen.
Montana Dispatch -Truth, Beauty & Resistance - by Ryan Busse is a reader-supported publication. To receive new posts and support my work, consider becoming a free or paid subscriber.

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