COLUMN: The Great Healthcare Heist — Trump Steals from the Poor to Pay for the Rich

The Candidate’s Promise

In 2016, Trump made a promise. He promised he wouldn’t touch Medicaid. He promised “universal coverage”—his exact words. He promised that everyone would be covered, “in a magnificent way.”

He had promised. He had lied. And nine years later, the same man is signing the largest cut to Medicaid in American history.

This comes as no surprise. It’s not a betrayal of his ideals—because his ideals were never what he claimed they were. Trump was never the champion of the forgotten. He was their mirror. Their reflected anger. And mirrors don’t heal anyone.

The Freedom Caucus: The Real Architects

Behind this vote are the hardliners of the Freedom Caucus—the most hardline Republicans, funded by libertarian billionaires who have been dreaming for forty years of dismantling the American welfare state. They’ve been waiting for this moment. They planned it. They got it.

Their donors are the Koch brothers and their ideological heirs. People who will never set foot in a Medicaid clinic. People whose children go to private clinics charging $500 per visit. People who have decided, from their offices in Washington, that 13.7 million Americans deserve less care.

The Crumbling Dam

The bill now moves to the Senate. A few Republican senators have expressed “reservations.” Lisa Murkowski. Susan Collins. Bill Cassidy. Familiar names—moderate Republicans who have sometimes stood up to Trump.

Sometimes. Not always. Rarely when it really mattered.

I wish I were wrong. I’d love to write in six months that the Senate held firm. That the “reservations” turned into votes. That those 13.7 million people kept their coverage. But I’ve read the Republican record of the past ten years. And history shows: reservations evaporate.

The reconciliation process

Trump and the Republicans are using the budget reconciliation process—a mechanism that allows this bill to pass with 51 votes in the Senate instead of 60. No possibility of a filibuster. No way for Democrats to block it.

It’s legal. It’s constitutional. It’s a massive demolition carried out by the book.

What Europe Understands but America Rejects

In Canada, France, Germany, and the United Kingdom—in every comparable Western democracy—health care is a right. Not a commodity. Not a privilege. A fundamental right, enshrined in collective values.

In the United States, healthcare is a product. You buy it if you can afford it. You’re denied it if you can’t. And those who can’t—the 13.7 million who will lose Medicaid—will go to the emergency room as a last resort, under substandard conditions, for care that will cost the system ten times more than if they had simply been covered from the start.

The ultimate irony of the American system is that it is both the most unequal and the most expensive in the developed world. The United States spends twice as much per capita on healthcare as France. And its health indicators—life expectancy, infant mortality, chronic diseases—are below the OECD average. This isn’t a problem of resources. It’s a problem of values.

The True Cost of Inhumanity

Every dollar cut from Medicaid ends up somewhere else. In overcrowded emergency rooms. In delayed hospitalizations that cost ten times as much as preventive care. In personal bankruptcies—medical debt is the leading cause of personal bankruptcy in the United States. In preventable deaths.

Preventable deaths. Not regrettable side effects. People who die because it was decided they weren’t entitled to care.

Eight Years of Sabotage

This isn’t the first time. In 2017, Trump attempted to repeal Obamacare—the ACA—and failed by a single vote, that of John McCain, at 1 a.m., when McCain flipped his vote. Since then, he has sabotaged the ACA through executive orders, administrative cuts, and the appointment of ideologues opposed to universal coverage to lead government agencies.

Robert F. Kennedy Jr. at the helm of the Department of Health. A man who believes that vaccines cause autism—a claim refuted by thousands of scientific studies. A man who has spent twenty years sowing distrust of preventive medicine. This is the man in charge of public health for the world’s leading superpower.

There are moments when disbelief takes over. RFK Jr. at the Department of Health. It’s like appointing an arsonist as fire chief. Except that the consequences are no metaphor.

The Attack on Science

Under Trump, the CDC was stripped of its experts. The budget for the NIH—the National Institutes of Health—was slashed. Research programs on cancer, diabetes, and cardiovascular disease were halted. Epidemiological data that had guided public health policies for decades was removed from government websites.

Not revised. Not updated. Deleted.

The Truth Behind the Project

Trumpism is not right-wing populism that has gone off the rails. It is an oligarchic agenda disguised as a popular revolt. The disguise is the anger of the forgotten. The substance is the protection of the interests of the ultra-rich.

Cutting Medicaid to fund tax cuts for billionaires is no accident. It’s the plan. It’s why Republican Party donors have funded thirty years of libertarian foundations, think tanks, and handpicked candidates.

What breaks my heart isn’t Trump. We knew about Trump. What breaks my heart are the millions of people who voted for him, believing he would protect them. Who saw him as the only man capable of standing up to an elite that despised them. And who, in eighteen months, will find themselves without a Medicaid card, in an emergency room waiting room, wondering why.

Democracy as a Weapon

The bill is legal. The vote is democratic. 215 elected representatives said yes. That, too, is democracy—it can vote against its own citizens. It can be used as a tool to dismantle what it has built.

Montesquieu feared the tyranny of the prince. Tocqueville feared the tyranny of the majority. What we’re seeing here is even more subtle: the tyranny of an organized minority that uses democratic mechanisms to impose its vision on a majority that doesn’t want it.

The 13.7 million

Mia, 34, is a nursing assistant in Columbus, Ohio. She earns $28,000 a year. She has a seven-year-old son with asthma. His inhaler costs $380 a month without insurance. She has been on Medicaid for three years. If the bill becomes law, she will lose her coverage on January 1, 2026.

Mia isn’t a statistic. Mia is a person. And there are 13.7 million Mias in this country.

I don’t know Mia. But I know people like Mia. Everyone knows people like Mia. That’s the cruelty of this vote: it’s abstract in the committee rooms of the Capitol, and it’s painfully real in a Columbus pharmacy on a Tuesday morning.

The midterm election is approaching

The Republicans are doing the math. They think the pain of the cuts will be spread out over time, that voters will forget, that other issues—immigration, crime, culture wars—will take center stage. They did it in 2017. They did it in 2019. They think they can do it again.

They may be right. Voters’ memories are short. Two years is a long time.

The American Model as a Counterexample

In France, Quebec, and throughout the West, voices are calling for “streamlining” public healthcare systems—to introduce more “market forces” and to “hold patients accountable” through deductibles, copayments, and variable premiums.

What we see in the United States is the logical outcome of this line of reasoning. It is not an extreme version of a reasonable idea. It is the natural destination of this path.

Every time a politician, here or elsewhere, talks about “leaving healthcare to market forces,” I think of Mia and her son with asthma. I think of the 13.7 million. I think of the vote on May 22 at 4:17 a.m. And I get really angry.

Healthcare is not a luxury

A commodity is something you can do without if you can’t afford it. The latest model phone. A trip to Europe. A Michelin-starred restaurant. Healthcare isn’t like that. Healthcare is the prerequisite for everything else. Without healthcare, there’s no work. No education. No participation in community life.

Treating health as a luxury is treating the poor as second-class citizens. It’s saying—without saying it—that their lives are worth less.

The Verdict

215 votes to 214. Just one vote. That’s all it took to decide that 13.7 million Americans deserved less. To confirm that Trumpism was never a movement for the forgotten—it has always been a movement for those who forget them.

The “Big Beautiful Bill.” Big. Beautiful. A magnificently packaged disgrace.

We’ll watch. We’ll comment. We’ll express outrage on social media for 48 hours. And then the news cycle will move on. But those 13.7 million people will remain without health insurance. Their reality doesn’t just move on.

What Remains

One question remains. Just one. Not rhetorical. Real.

When democracies vote against their most vulnerable citizens—legally, constitutionally, with a smile and a poetic name—what mechanism for resistance remains? The Senate? The courts? The next election cycle?

Or do we silently accept, at 4:17 a.m., that this grand and beautiful bill is the one that decides that certain lives are too costly?

215 votes to 214. Just one vote. And 13.7 million people who no longer count.

Signed, Maxime Marquette