Trump's Administration Is Slashing Healthcare

Why would a government defund cancer research, dismantle vaccine programs, and hollow out public health infrastructure? These are not peripheral services. They are the scaffolding that allows people to survive longer, live better, and remain part of civic life.

Yet under Trump’s administration, funding for NIH cancer trials has been slashed, CDC vaccine development undermined, and chronic disease surveillance quietly defunded. These are not budgetary accidents. They reflect a governing logic in which care is rationed, and survival is triaged according to economic utility.

At 80, I live simply. I walk desert trails with my dog, write, and play guitar in the evening. My wife is amazing—at 85, she still rock climbs. We’re in relatively good health, but I’m under no illusion: without healthcare insurance, that could change quickly.

A fall, a diagnosis, a sudden hospitalization—and the cost of survival becomes a negotiation. Under current policy, that negotiation is growing more brutal. Premiums are rising, benefits shrinking, and for many aging Americans, coverage is slipping out of reach. What was once a safety net is now a sieve.

This goes beyond austerity. It is necro-politics—the use of policy to decide who lives and who is left to manage their own decline. Medicaid is being restructured to include work requirements and eligibility audits designed to disqualify.

Medicare’s hospital trust fund faces automatic reimbursement cuts that will force providers to drop patients. Cancer research has been targeted not because it fails, but because it extends lives of populations deemed fiscally inconvenient. The logic is explicit: longevity is expensive, and aging is a problem to be contained.

Healthcare becomes the sorting mechanism. High-deductible plans function as debt traps. Algorithmic triage systems ration care by zip code, employment status, and credit history. Those who can pay, survive. Those who can’t, wait—or disappear. This isn’t a malfunction; it is a deliberate architecture designed to offload risk and privatize consequence.

Debt itself has become a gatekeeper of survival. In the U.S., medical bills are the leading cause of personal bankruptcy, and credit scores increasingly determine whether patients gain access to care or are turned away. Illness is transformed into leverage: the ability to pay becomes indistinguishable from the right to live.

We are witnessing a shift from public health to actuarial governance. The question is no longer what people need, but what they cost. Preventive care, chronic disease management, and long-term treatment are increasingly reserved for those who remain economically legible. The rest are managed through delay, denial, and disappearance.

This burden does not fall evenly. Life expectancy is already stratified by race, class, and geography, with Black, Indigenous, and poor Americans facing shortened lives not because of biology but because of accumulated neglect. In this system, inequality is not incidental; it is the mechanism through which necro-politics is enacted.

This logic extends beyond insurance. Hospitals are consolidating, rural clinics are closing, and elder care facilities are underfunded or shuttered. The infrastructure that once sustained aging populations is being dismantled, not because it failed, but because it no longer aligns with the priorities of a system that rewards short-term margins over long-term survival.

The language used to justify these shifts is familiar: personal responsibility, innovation, market discipline. But the outcomes are unmistakable. Those deemed unproductive—the elderly, the chronically ill, the disabled, and the poor—are increasingly portrayed as burdensome, politically obsolete, or economically inert. The narrative of demographic crisis is used to rationalize austerity, while the language of fairness is weaponized to pit generations and classes against each other.

This is not a cultural misunderstanding. It is a deliberate reframing of aging as pathology. In this worldview, to live longer is to become a liability. The more care one requires, the more one is seen as a threat to fiscal stability. In practice, survival itself is tolerated only when it is silent, self-funded, and non-disruptive.

The consequences are not abstract. They are visible in the lives of those who skip medications, delay screenings, or avoid hospitals altogether. They are felt in the quiet calculations families make when deciding whether to seek care or absorb the cost.

This is not a failure of governance. It is a redefinition of it. The state is not retreating—it is reallocating. It is shifting responsibility from public institutions to private markets, from collective obligation to individual risk. And in doing so, it is redrawing the boundaries of who counts, and under what conditions.

But survival could be treated differently. It could be recognized as a civic achievement—a sign that public health, infrastructure, and social cohesion have done their job. Lives extended by care are not liabilities but anchors of continuity, resilience, and possibility. That would require a different kind of politics—one that values survival not as a private accomplishment, but as a public good.

We needn’t be passive witnesses to this logic, or silent casualties of it. If we choose, we can be its undoers. The triage we see does not flow from scarcity; it is a political decision, made in boardrooms and budget committees, reinforced by policy and narrative. To challenge it requires more than critique. It demands refusal and the rebuilding of care as infrastructure—the kind that asks not what a life is worth, but whether it is protected. That is the work ahead. And it will not wait.

-James Greenberg

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