What keeps hitting me is how far the public conversation is from the lived reality of getting care. Switzerland is an incredible country in so many ways, and one thing they get right is transparency: you’re told the costs up front, the procedure details up front, and you walk in knowing exactly what’s happening and why. It’s calm, orderly, and human.
And then you look at the U.S., where the system feels almost engineered for confusion. You’re given minimal information, you’re rushed through the process, and then months…sometimes a year later, the bills start arriving from providers you didn’t even know were involved. It’s not just inefficient; it’s disorienting by design.
What’s wild is that I’ve had smoother, more humane care in places people don’t expect: Italy, the UK, even China. Staff weren’t burned out, facilities were calmer, and the whole experience felt less like navigating a financial trap and more like being treated by actual humans.
Which is why the “healthcare plan” discourse always feels detached. Until the system is built around clarity, access, and dignity (not opacity and extraction) the branding will keep changing while the experience stays the same.
Several years ago, the father of a friend of mine who was a physician was in Italy on vacation and suddenly became quite ill. The passage of time does not allow me to recall the exact medical emergency but that's not important. Upon his return to the US, the doctor reported that the lifesaving care he received was excellent.
When it comes to so many things (sane gun safety laws, universal healthcare, a federal government that is not committing suicide before our very eyes) we are an outlier nation. The lunatic in the WH doesn't give a rat's ass about anything that doesn't line his, his family's or his billionaire sycophant bros pockets. When oh when will we stop listening to the deranged carnival barker and see him for what he truly is: a rotting empty shell with not one ounce of decency or empathy.
The infant mortality rate in America is at the bottom of stats involving all developed countries. This has been the case since long before Trump became president. American health care is a disgrace.
It's from the Shirley Jackson story, “We have Always Lived in the Castle.” The cat is a photo of my late gentleman cat, Mr. Bean, whom I adopted in 2013. He was a street cat who became my best friend when I was living in Egypt, and he passed away in 2022.
Italy can deliver remarkably grounded, humane care when it matters most. It’s a reminder that the U.S. isn’t struggling because excellence is impossible, but because the system is built around incentives that have nothing to do with patient experience or clarity.
On the broader point, I hear the frustration. When a system keeps producing outcomes that feel chaotic or extractive, people naturally look for someone to blame. My focus stays on the structure itself …the incentives, the design, the way power and profit shape what patients actually live through. That’s where the real leverage sits.
I agree with you- a recent procedure resulted in statements from the facility where it was performed, the radiologist, the lab, the pharmacy (had to pay separately for meds used during the procedure), and my physician.
I'm living in a healthcare desert here in western NY state, whether Gov.Hochul gives a damn or not. Despite an important teaching hospital 15 minutes away, there is a serious shortage of primary care physicians, and all hospitals are seriously understaffed and there's a dangerous shortage of beds in the midst of a serious flu outbreak. It's like a third world country inside one of the wealthiest states in the country. I had better health care when I lived in Egypt - and lots cheaper.
Johan, you make good points. I am in Germany and it is not a perfect system, but I am not worried about costs and coverage. In the US we had a PPO, and this was attached to a university health care system and hospital so we had excellent care. My mom is still part of that system at 91 through medicare. Just wonder what loosing a lot of patients because of loss of the ACA will do to the hospitals and their clinics. Still, I never trusted the US system, and this bill is why.
Conversations like this make me think that the uninformed voter is a danger to democracy.
Health care is complicated and Trump and his billionaire buddies aren't invested in it because they know that they can afford A-grade health care with no stress at all on their personal budget.
So I can't say I'm surprised at all that he comes up with a 'plan' that not only fails to pay attention to details but seems unaware that of any detail or even major feature of the subect.
He has no clue nor intention to do the work involved in actually bringing a true healthcare plan to fruition because he has never had to worry about the cost of healthcare, of the toll it takes on families if just one member of the family has a serious health condition or a medical crisis. He thinks that we aren’t smart enough to know the difference between “concepts of a plan “ and an actual solution to our seriously broken system!
There's a reason people on Medicare don't want it taken away. It works, and it works better and far less expensively than any of the private plans. Republicans don't want Medicare for all because they know that once Americans younger than 65 know that fact, the insurance companies will go out of business.
Thank you, Mr. Waldman. It’s disheartening that on two very basic issues, healthcare and gun control, the answers are available but ignored by politicians. This is actually a huge argument which gets back to money in politics. (Thank you tony scalia.)
Well, apparently all we have from the lunatic in the WH and the MAGAts is yet another mere "concept of a plan." His idiotic statement that "Nobody knew that healthcare could be so complicated" would be laughable if it weren't so telling. I mean, the devil is in the details so Drumpf has the perfect resume to qualify for the job (him being a devil and all). The problem is that he has the attention span of a spoiled toddler and these pesky meetings keep eating into his naptime so he takes them DURING the meetings. Resting his eyes they say. Spare me.
After WW2, most of the countries of the world decided that providing universal healthcare for their citizens was a basic human right. The US was inching towards achieving that lofty goal but the efforts were derailed when the AMA and insurance companies came out against it plus health insurance became linked to employment for millions of Americans. The idea fizzled out.
All this talk about the miracle of the market solving the healthcare problem is a fantasy. That's what we've been pursuing for 80 years and it has produced a great system for those rich enough to pay for it. However, access and affordability (Drumph likes to make fun of the latter for some bizarre reason) is out of reach for millions.
I'm gonna go out on a limb here and predict that the "concept of a plan" will not solve the healthcare problem. That would take a group of serious people working diligently to fix or reform the system and we sure as hell don't have that with these clowns.
“fully funds a long-neglected part of the law known as the Cost Sharing Reduction program"
So, we're all going to get money so that we can negotiate our own health care prices, AND the government is still going to "fully fund" an insurance program? K.
I can't even stand the negotiating you have to go through to buy a car. I'm certainly not, especially as an aging Boomer (although quite healthy), interested in negotiating every aspect of my health care.
Congress should lose their health care plans and have to deal with ACA if they want coverage just like the rest of us. Then, maybe it would be in their interest to do something that works for all. Ditto for pensions - make them have 401Ks to manage and hope the market doesn't decline when it is time for their own retirement.
Remember, there really is only one clap-back from those who resist movement to any solution the other developed nations have - the almighty “wait time” to see XYZ doctor.
Excellent as always. Aaron, a personal note of thanks to you for continuing this important work just now. You are living at Ground Zero and you must be worried for the safety of your family. Please know there are many of us out here who respect and admire you even more for the work you are doing. I am “safe” in a red state and sickened by daily horrors.
So, MAGA wants to cut SNAP and public assistance yet here's Trump claiming he's in favor of sending cash payments to people so they can buy their own insurance? Who is going to guarantee the money won't be saved up for a move to Canada, or Europe? And does he have any idea that Medicare for All would cost the government much less money? Of course, the insurance industry would collapse, as it's just as greedy and mendacious as the tobacco industry and the ghouls selling guns, but since when does Trump give a shit?
There's constant conflation of the terms "healthcare" and "health insurance." Trump implies that the money will go directly to people to get their own "healthcare" and not go to insurance companies. So a couple thousand dollars in a HSA is all one needs to cover any event requiring engagement of the healthcare system? How will that take care of even a minor outpatient procedure? What happens to health insurance providers, to whom current subsidies go? What about pre-existing condition coverage guarantees? I think there's really bad, misleading reporting of this issue and this "plan." With Trump it's always hard to sort the ignorance from the lies, but I suspect most people don't have a clue how the system was working or what he's proposing (which is vague nonsense).
For years, Republicans have wanted to privatize Medicare, but they will make it a mess with many retirees. I dealt with several when Medicare Part D came into effect. They were confused and had no way of knowing which plan was better for them. The same thing would happen under Trump's so-called plan to let people shop for their own plans. Confusion and expensive lessons would be learned when something ends up not being covered.
What keeps hitting me is how far the public conversation is from the lived reality of getting care. Switzerland is an incredible country in so many ways, and one thing they get right is transparency: you’re told the costs up front, the procedure details up front, and you walk in knowing exactly what’s happening and why. It’s calm, orderly, and human.
And then you look at the U.S., where the system feels almost engineered for confusion. You’re given minimal information, you’re rushed through the process, and then months…sometimes a year later, the bills start arriving from providers you didn’t even know were involved. It’s not just inefficient; it’s disorienting by design.
What’s wild is that I’ve had smoother, more humane care in places people don’t expect: Italy, the UK, even China. Staff weren’t burned out, facilities were calmer, and the whole experience felt less like navigating a financial trap and more like being treated by actual humans.
Which is why the “healthcare plan” discourse always feels detached. Until the system is built around clarity, access, and dignity (not opacity and extraction) the branding will keep changing while the experience stays the same.
Several years ago, the father of a friend of mine who was a physician was in Italy on vacation and suddenly became quite ill. The passage of time does not allow me to recall the exact medical emergency but that's not important. Upon his return to the US, the doctor reported that the lifesaving care he received was excellent.
When it comes to so many things (sane gun safety laws, universal healthcare, a federal government that is not committing suicide before our very eyes) we are an outlier nation. The lunatic in the WH doesn't give a rat's ass about anything that doesn't line his, his family's or his billionaire sycophant bros pockets. When oh when will we stop listening to the deranged carnival barker and see him for what he truly is: a rotting empty shell with not one ounce of decency or empathy.
The infant mortality rate in America is at the bottom of stats involving all developed countries. This has been the case since long before Trump became president. American health care is a disgrace.
As a childless cat gentleman, I love your pic and tag name. The last sentence of your reply pretty much sums it up in a nutshell.
It's from the Shirley Jackson story, “We have Always Lived in the Castle.” The cat is a photo of my late gentleman cat, Mr. Bean, whom I adopted in 2013. He was a street cat who became my best friend when I was living in Egypt, and he passed away in 2022.
Thank you for reading my comment.
Italy can deliver remarkably grounded, humane care when it matters most. It’s a reminder that the U.S. isn’t struggling because excellence is impossible, but because the system is built around incentives that have nothing to do with patient experience or clarity.
On the broader point, I hear the frustration. When a system keeps producing outcomes that feel chaotic or extractive, people naturally look for someone to blame. My focus stays on the structure itself …the incentives, the design, the way power and profit shape what patients actually live through. That’s where the real leverage sits.
I agree with you- a recent procedure resulted in statements from the facility where it was performed, the radiologist, the lab, the pharmacy (had to pay separately for meds used during the procedure), and my physician.
I'm living in a healthcare desert here in western NY state, whether Gov.Hochul gives a damn or not. Despite an important teaching hospital 15 minutes away, there is a serious shortage of primary care physicians, and all hospitals are seriously understaffed and there's a dangerous shortage of beds in the midst of a serious flu outbreak. It's like a third world country inside one of the wealthiest states in the country. I had better health care when I lived in Egypt - and lots cheaper.
Johan, you make good points. I am in Germany and it is not a perfect system, but I am not worried about costs and coverage. In the US we had a PPO, and this was attached to a university health care system and hospital so we had excellent care. My mom is still part of that system at 91 through medicare. Just wonder what loosing a lot of patients because of loss of the ACA will do to the hospitals and their clinics. Still, I never trusted the US system, and this bill is why.
Conversations like this make me think that the uninformed voter is a danger to democracy.
Health care is complicated and Trump and his billionaire buddies aren't invested in it because they know that they can afford A-grade health care with no stress at all on their personal budget.
So I can't say I'm surprised at all that he comes up with a 'plan' that not only fails to pay attention to details but seems unaware that of any detail or even major feature of the subect.
And of course his "plan" is bullshit.
He has no clue nor intention to do the work involved in actually bringing a true healthcare plan to fruition because he has never had to worry about the cost of healthcare, of the toll it takes on families if just one member of the family has a serious health condition or a medical crisis. He thinks that we aren’t smart enough to know the difference between “concepts of a plan “ and an actual solution to our seriously broken system!
Indeed, for the last decade, all his health care was free … that commie!
There's a reason people on Medicare don't want it taken away. It works, and it works better and far less expensively than any of the private plans. Republicans don't want Medicare for all because they know that once Americans younger than 65 know that fact, the insurance companies will go out of business.
How about this: give all Americans the same healthcare at the same cost that everyone in Congress receives?
Thank you, Mr. Waldman. It’s disheartening that on two very basic issues, healthcare and gun control, the answers are available but ignored by politicians. This is actually a huge argument which gets back to money in politics. (Thank you tony scalia.)
You can bet it won't go anywhere like all his lie on top of lies .
Well, apparently all we have from the lunatic in the WH and the MAGAts is yet another mere "concept of a plan." His idiotic statement that "Nobody knew that healthcare could be so complicated" would be laughable if it weren't so telling. I mean, the devil is in the details so Drumpf has the perfect resume to qualify for the job (him being a devil and all). The problem is that he has the attention span of a spoiled toddler and these pesky meetings keep eating into his naptime so he takes them DURING the meetings. Resting his eyes they say. Spare me.
After WW2, most of the countries of the world decided that providing universal healthcare for their citizens was a basic human right. The US was inching towards achieving that lofty goal but the efforts were derailed when the AMA and insurance companies came out against it plus health insurance became linked to employment for millions of Americans. The idea fizzled out.
All this talk about the miracle of the market solving the healthcare problem is a fantasy. That's what we've been pursuing for 80 years and it has produced a great system for those rich enough to pay for it. However, access and affordability (Drumph likes to make fun of the latter for some bizarre reason) is out of reach for millions.
I'm gonna go out on a limb here and predict that the "concept of a plan" will not solve the healthcare problem. That would take a group of serious people working diligently to fix or reform the system and we sure as hell don't have that with these clowns.
“fully funds a long-neglected part of the law known as the Cost Sharing Reduction program"
So, we're all going to get money so that we can negotiate our own health care prices, AND the government is still going to "fully fund" an insurance program? K.
I can't even stand the negotiating you have to go through to buy a car. I'm certainly not, especially as an aging Boomer (although quite healthy), interested in negotiating every aspect of my health care.
“Hey, negotiation is life, bub—look at all my peace prizes!”
Congress should lose their health care plans and have to deal with ACA if they want coverage just like the rest of us. Then, maybe it would be in their interest to do something that works for all. Ditto for pensions - make them have 401Ks to manage and hope the market doesn't decline when it is time for their own retirement.
Remember, there really is only one clap-back from those who resist movement to any solution the other developed nations have - the almighty “wait time” to see XYZ doctor.
Excellent as always. Aaron, a personal note of thanks to you for continuing this important work just now. You are living at Ground Zero and you must be worried for the safety of your family. Please know there are many of us out here who respect and admire you even more for the work you are doing. I am “safe” in a red state and sickened by daily horrors.
So, MAGA wants to cut SNAP and public assistance yet here's Trump claiming he's in favor of sending cash payments to people so they can buy their own insurance? Who is going to guarantee the money won't be saved up for a move to Canada, or Europe? And does he have any idea that Medicare for All would cost the government much less money? Of course, the insurance industry would collapse, as it's just as greedy and mendacious as the tobacco industry and the ghouls selling guns, but since when does Trump give a shit?
The Plan: Sick bad, no get sick!
There's constant conflation of the terms "healthcare" and "health insurance." Trump implies that the money will go directly to people to get their own "healthcare" and not go to insurance companies. So a couple thousand dollars in a HSA is all one needs to cover any event requiring engagement of the healthcare system? How will that take care of even a minor outpatient procedure? What happens to health insurance providers, to whom current subsidies go? What about pre-existing condition coverage guarantees? I think there's really bad, misleading reporting of this issue and this "plan." With Trump it's always hard to sort the ignorance from the lies, but I suspect most people don't have a clue how the system was working or what he's proposing (which is vague nonsense).
For years, Republicans have wanted to privatize Medicare, but they will make it a mess with many retirees. I dealt with several when Medicare Part D came into effect. They were confused and had no way of knowing which plan was better for them. The same thing would happen under Trump's so-called plan to let people shop for their own plans. Confusion and expensive lessons would be learned when something ends up not being covered.