What We Can’t Afford: Healthcare, War, and the Lie We Keep Believing

A shorter, edited version of this essay first appeared in HuffPost under a different title

Prefer to listen? Here’s a recorded reading of this piece by the author.

Nick Allison

Last year I had to have a fairly minor surgery to repair my badly deviated septum. According to what I read today on a few different websites, the surgery I had costs on average around $10,000 to perform. You might be wondering why I’m researching the cost of a surgery I already had instead of just looking at the medical bill. That’s a good question, with an easy answer. I never received a bill. I didn’t pay a dime for an elective surgery that I could have lived without but that still greatly improved my quality of life.

I broke my nose pretty severely 20 years ago while I was a young infantryman in the army. Being a hardheaded male whose prefrontal cortex hadn’t fully formed yet, I did what might be expected, and just took a deep breath, put my hands on either side of my crushed nose that was pointing a direction it’s not supposed to point, and shoved it more or less back into natural alignment. Problem solved, no downtime for surgery. Except it turns out there’s all kinds of complicated internal stuff going on in the nose that a few shots of whiskey and an impromptu resetting doesn’t quite fix. Weird.

By the time I got out of the army and into the corporate world, not breathing through my nose and not sleeping more than an hour or so at a time was already old news. It was my baseline and I was used to it, for the most part. Occasionally I would think about getting it fixed and even went to a doctor once who told me it would require about 10 days off of work, but I didn’t want to burn my vacation and sick time for the whole year convalescing with an ice pack on my face watching bad daytime TV.

But I didn’t actually come here to talk about my nose. I want to talk about the American healthcare system and the idea that we can’t afford to take care of each other.

For some reason I can’t quite explain, perhaps a combination of laziness, misplaced pride, and disillusionment with the system, I didn’t register for VA healthcare or file disability claims for service connected injuries until I was almost 40 years old. It took a close veteran friend of mine telling me I was an idiot, repeatedly, for not doing so, and eventually wearing down my deeply ingrained resistance to “handouts.” Long story short, he eventually won me over and I went to the VA, stuck with the process, which is aggravating, I’ll admit, but at the end of it I had a rating sufficient for free healthcare and a service connection for my deformed nose, among other old injuries. I requested an appointment with an ENT, had an MRI done, and was referred out to a community care surgeon. A few months later I went under the knife and have spent the months since kicking myself in the ass for not doing it sooner. Turns out that being able to take advantage of all this oxygen is actually pretty cool.

I was recently talking about this with a friend. When I told her I didn’t pay out of pocket for the surgery, she said I was “so lucky” to have VA healthcare. I didn’t correct her that luck didn’t have a lot to do with deciding to join the Army just as the GWOT was kicking off, because I knew what she meant. And she wasn’t wrong. I feel fortunate that I have access to healthcare that isn’t tied to my employer. I no longer work at that corporate job I gave 15 years of my life to, and that freedom has allowed me to do the kind of work I find satisfying instead of just increasing the bottom line for a multinational conglomerate that couldn’t give two fucks about the people who staff its ranks beyond their ability to be profit-increasing cogs in a big ass wheel.

The VA healthcare system I’m a part of is government run, and while I won’t sit here and tell you it’s perfect or that every veteran has nothing but glowing reviews, I will say that having paid into the scam that is commercial health insurance for almost two decades, this is better. When I need care, sometimes I’m seen at a VA facility and sometimes they refer me out to civilian doctors and private clinics through what’s called Community Care. There is real freedom in not having to work a job you hate for a company that doesn’t care about you just to have the privilege of being able to go to the doctor without going bankrupt, or hoping and praying that a for-profit insurance company will approve your claim for a procedure, and if they don’t, either trying to convince yourself the procedure isn’t needed or trying to figure out if you can possibly pay out of pocket. And the people who are part of that system are actually the ones who have it “good.” Plenty of Americans don’t have any health insurance at all.

***

Two friends of mine are going through some health problems. I’m obviously not going to use their names or get into specifics, but their stories say more about this system than any boring statistic I could dig up and cite.

One is a very close friend I’ve known for years. She has insurance through her employer and she’s been dealing with a serious autoimmune condition that’s affecting multiple organs. She’s on heavy medication, seeing specialists, going through treatment that could last months. She’s not dying, but she’s not okay either, and the bills are already rolling in. She has insurance, and she’s still getting buried. That’s the version of the system that’s supposedly working.

Another good friend recently left her job. Her employer cut her health insurance on her last day instead of at the end of the month, which was a nice parting gift. Her new coverage doesn’t kick in until next month. In the gap between those two dates, her daughter started having some concerning symptoms and had to go in for imaging at a children’s hospital. The hospital didn’t catch that the insurance had lapsed, so the appointment happened, the imaging got done, and now my friend is sitting at home waiting on results she’s terrified of while also knowing that whatever bill comes from that visit is entirely on her. On top of that she got sick herself and tried to go to urgent care but couldn’t afford the out of pocket cost. She’s sick, her kid might be sick, and she’s counting the days until her insurance kicks in and she’s allowed to see a doctor again.

These aren’t people who made bad decisions. These aren’t people who didn’t work hard enough. One was working in healthcare, which is its own kind of irony. They’re both doing everything right and the system is still failing them. Meanwhile I had a $10,000 surgery and never saw a bill, because I was smart enough to break my nose while I was still in the Army. The truth is I didn’t earn my healthcare any more than they failed to earn theirs. Healthcare shouldn’t be something you earn. It should be something you have. A basic service, like public education or the fire department, that we all pay into because it benefits all of us.

I said their stories say more than any boring statistic I could dig up. That’s true. But I changed my mind, because the statistics aren’t boring so much as they’re staggering, and my friends aren’t outliers.

More than 25 million Americans have no health insurance at all. Another 20 million watched their ACA premiums more than double overnight after Congress let enhanced subsidies expire at the end of last year. Last year alone, roughly 31 million Americans had to borrow money to pay for healthcare, totaling an estimated $74 billion in medical borrowing. Four in ten adults are currently carrying some form of medical debt. Half of all Americans say they couldn’t pay an unexpected $500 medical bill without borrowing money or going into credit card debt. And most of the people drowning in medical bills aren’t uninsured. They have coverage. They’re paying their premiums. Nearly half of insured adults say it’s still difficult to afford their healthcare costs, and more than a third have skipped or postponed care they needed because they couldn’t afford it. They’re doing everything they’re supposed to do, and the system is still burying them.

This should be unacceptable to anyone living in the wealthiest country in the world. And according to Pew Research, most Americans agree. Two-thirds of American adults say the federal government has a responsibility to make sure all Americans have healthcare coverage. That includes 90% of Democrats, which you’d expect. But it also includes 41% of Republicans, a number that’s been climbing steadily since 2021. Only 7% of Americans think the government should have no involvement in healthcare at all. Seven percent. We have broader consensus on this issue than we do on almost anything in this country, and yet nothing changes.

Because our elected officials keep trotting out the tired old line that it’s just too expensive. We simply can’t afford to make sure the basic health of our fellow Americans is a priority.

And yet. These same politicians managed to find the money for a war in Iran that nobody asked for. Operation Epic Fury has now been running for nearly a month and is costing taxpayers roughly a billion dollars a day, according to estimates from the Center for Strategic and International Studies. The first 100 hours alone cost $3.7 billion. The Pentagon burned through $5.6 billion in munitions in the first two days. Congress hasn’t authorized any of it. A majority of Americans oppose it, according to multiple polls, and 65% say the administration hasn’t clearly explained what the goals even are.

Which makes sense, because the goals keep changing. One day it’s regime change. Then it’s not regime change, but the regime sure did change and isn’t that great. Then it’s about eliminating a nuclear threat that the president told us he already eliminated last summer during Operation Midnight Hammer. Then Secretary of State Rubio let it slip that Israel was going to attack Iran anyway and we figured they’d retaliate against us, so we might as well go first. And then, when pressed on what imminent threat justified starting a war, the White House press secretary told reporters that the president “had a feeling” that Iran was going to attack. Pentagon officials later told congressional staffers in private briefings that the U.S. had no intelligence indicating Iran was planning a preemptive strike. Now the president says he’s considering winding things down, while simultaneously deploying more Marines and threatening to bomb Iranian power plants. The “goals” change by the day, if not by the hour.

This is, of course, the same president who ran as the anti-war candidate, who promised to end “forever wars” in the Middle East, who told his base that’s exactly why they should vote for him. And now whatever is left of his base cheers as he starts another one.

The truth is we already spend over $5 trillion a year on healthcare in this country, more than any nation on earth, and we still can’t manage to cover everyone. We can afford a trillion-dollar annual defense budget, and the $200 billion supplemental currently being requested on top of that. We can afford a billion dollars a day for a war in Iran. We can afford $220 million for former DHS Secretary Kristi Noem to shoot campaign-style ads of herself riding a horse in a cowboy hat in front of Mount Rushmore, ads paid for with border security money funneled through a no-bid contract to a company that was created eleven days before it got the deal. We can afford $300 million for her luxury jets, including one with a queen-size bed where she and her “special government employee” Corey Lewandowski could allegedly travel the country together in comfort. We can afford for the Pentagon to blow $93 billion in a single month just to use up its budget before the fiscal year ends, with Pete Hegseth’s Defense Department spending $22 million on ribeye steaks and lobster tails, $98,000 on a grand piano for a general’s house, and $22,000 for a custom-made Japanese flute. We can afford to spend billions a year maintaining tens of thousands of empty federal buildings while more than 30,000 veterans are sleeping on the street.

The list of things we can always find money for goes on pretty much forever. War. Subsidies for oil companies posting record profits. No-bid contracts for political allies. I could go on, but you’ve heard it all before. There’s always money for whatever the government decides to prioritize. Apparently our priorities are cruise missiles, tax cuts for the wealthy, and corporate welfare. Making sure a working mother doesn’t have to choose between filling her sick kid’s prescription and paying rent, that’s where we draw the line on fiscal responsibility.

The “too expensive” argument doesn’t even hold up. Twenty-two separate economic analyses have found that a single-payer universal healthcare system would save money. Even a study funded by the Koch brothers couldn’t avoid the math. Researchers at Yale estimated the savings at over $450 billion a year, and that universal coverage would save roughly 68,000 American lives annually. That’s not some policy abstraction. We’re talking about real people. People like my two friends. People like my father.

In a country where the top 1% controls roughly $55 trillion in assets, a sum roughly equal to the combined wealth of the bottom 90% of Americans, the idea that we can’t afford to take care of each other is a lie. It’s not a disagreement and it’s not a difference of opinion. It’s a lie, told by people who benefit from the way things are, repeated by politicians they’ve purchased, and accepted by the rest of us because we’ve heard it so many times we’ve stopped questioning it.

This didn’t start with Trump. The healthcare system has been broken for so long that decades ago Walter Cronkite famously described it as “neither healthy, caring, nor a system.” Some in Congress have tried to fix it, but the political will has never been there to finish the job. Right now it’s this administration’s budget, this Congress’s priorities, and they’ve made it pretty clear that there’s always money for bombs and luxury jets, and always room in the tax code for billionaires. Just not for your doctor’s visit.

***

I have government-funded healthcare because I joined the Army when I was twenty years old. I can go to any VA facility or Community Care provider in the country, get treated, and walk out without ever seeing a bill. The broken nose wasn’t the only thing I’ve had fixed. I’ve had multiple procedures over the past few years, most related directly to my service as a combat infantryman during the war in Iraq. It’s taxpayer funded, and you’d be hard pressed to find anyone who thinks it shouldn’t be. Nobody argues that veterans should have to pay out of pocket for injuries and illness they got while serving their country. That’s not controversial. It’s just basic decency.

My father is 70 years old and was diagnosed with chondrosarcoma at the end of 2024, cancer of the cartilage in his throat that required surgery to remove his voice box. What followed was one of the most medically complex and expensive ordeals I can imagine: an emergency surgery in Las Cruces, a fixed-wing air transport to a trauma center in Lubbock that cost just under $100,000 by itself, three weeks in the ICU, a nine-hour surgery at Baylor Scott and White in Temple performed by a specialist, followed by weeks of home health care and physical therapy, and ongoing medical devices he’ll need for the rest of his life. My mom told me they stopped counting the bills somewhere around $750,000, and that the total has almost certainly passed a million dollars since.

My dad is on Medicare. Medicare isn’t free—Part A and Part B run about $200 a month for both my parents combined. They also pay around $450 a month for a supplemental policy that covers what Parts A and B don’t. The supplemental isn’t required, but they chose to pay for it. All told, about $650 a month for comprehensive coverage for two people. That coverage just absorbed what was likely a million-dollar medical crisis and left them with $5,000 to $7,000 out of pocket—and most of that was an ambulance transfer from Lubbock to Temple that they chose to pay for because they found a specialist they wanted. Had they gone with the local surgeon, Medicare would have covered almost all of it. The average privately insured American family pays nearly $27,000 a year in premiums and still faces thousands more in deductibles and out-of-pocket costs when something serious happens. And four in ten of them are still carrying medical debt.

My mom, who is a writer and knows how to land a line, put it this way: “Without Medicare, there would have been no earthly way for us to cover any of this. I find it hard to imagine any surgeon or hospital donating their time and expertise for a laryngectomy, nor would the air transport company have donated $100,000 of their services—which would have likely meant your dad wouldn’t have survived.” She added something I’ve thought about many times since then: without that coverage, the best case scenario was a trach tube and a feeding tube until the tumor spread and killed him anyway. She ended her note with this: “Your dad’s life has intrinsic value, and he deserved to live. That the value is dollar-based in the American healthcare system is abhorrent and unconscionable.”

She’s right. And between Medicare and his supplement, his life wasn’t subject to that math.

The VA works. Medicare works. The argument that government can’t run healthcare is undermined every day by the fact that it already does for veterans, for seniors, and for members of Congress whose premiums are paid in part by the same taxpayers they just left without affordable coverage.

So if we can agree that the government has an obligation to take care of veterans and seniors, why can’t we extend that same basic decency to everyone else? American taxpayers already pay more per person for healthcare than taxpayers in any other country on earth, including every other major industrialized nation, all of which manage to cover everyone.

I said earlier that I’m grateful for the healthcare I get through the VA, and I am. But gratitude only goes so far when you’re watching people you care about suffer for no reason other than they didn’t join the military or weren’t old enough for Medicare. We should take care of people simply because they are people, and it’s the right thing to do. One friend is watching bills pile up while she fights an autoimmune disease. The other can’t afford to take her kid to the doctor. Sixty-eight thousand Americans die every year because they don’t have adequate coverage. Their lives had intrinsic value too. And somewhere in the Persian Gulf right now we’re spending a billion dollars a day on an undeclared, unauthorized war with no clear endgame that started because the president “had a feeling.”

I’d be hard pressed to find much of anything I agree with Donald Trump on these days, but in 1999 he told Larry King: “If you can’t take care of your sick in the country, forget it, it’s all over. I believe in universal health care.” Well said, Mr. President. You’ve been elected twice since then.

There’s plenty here we could argue over—how to fund it, how to structure it, who pays what, who administers what. But one thing feels certain to me: in the wealthiest country to ever exist, whether or not you can afford to see a doctor shouldn’t come down to your age, whether you have a seat in Congress, or your willingness to get shot at in your twenties. The money for universal healthcare is already coming out of your paycheck. You’re just not getting the benefits. The research says a single-payer system would save money. It could be done, but we just keep choosing not to do it. And if you’re wondering why that is, maybe go look into how much money the insurance and pharmaceutical industries spend every year lobbying Congress to make sure things stay exactly the way they are. You might find your answer there.

Nick Allison is a writer and editor based in Austin, Texas. His work has appeared in HuffPost, CounterPunch, The Fulcrum, and elsewhere. (@nickallison80.bsky.social)

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