SUNDAY CLERKING

🇺🇲🤔 WTF is Going On With American Healthcare: Explained To A Brit

Trump! Tariffs! NIH Defunded! USAID Abolished! Elon! DOGE! America! 
Buzzwords! Headlines! Every day, a new move from the Trump administration—made, unmade, and then re-made with a new logo and a worse acronym.

It’s frankly exhausting trying to keep up with it all. And it doesn’t even affect me. I’ve sold my soul for free medication and an 8-month-wait for a physio appointment.
No regrets. Mostly.

But it’s true. Americans are loud. Like my pub next door on Saturday. You try to tune it out, but the drama is so juicy, it’s impossible to ignore. 

So here’s my attempt on a whistle stop tour of all that's gone since just January—under the bigger and badder Trump administration.

Wait, how does their healthcare system work again 🤔?

American Healthcare is the definition of “a lil bit of this, a lil bit of that” system. Real Frankenstein vibe going for it. 

They operate on a fee-for-service model(they charge for everything). They’ll send a bill for the ambulance, the MRI, the bed and the paper used for the discharge letter. Who pays depends on who you are, where you live and if your boss likes you.

The main players are:

• Private employer-sponsored insurance - Around 55% of the US population is covered here.

• Medicare - Main public insurance programme. They serve the elderly(65+) and disabled

• Medicaid - Public programme for low-income Americans.

• Other options - ACA(Obamacare) marketplace, military coverage, CHIP etc

Then there are the uninsured. This is around 8.5% of the American population. Around 27 million Americans have to pay out of their own pocket for services. Crazy thing is, this is an improvement. In 2010 before the Affordable Care Act, it was a whopping 16%.

What’s Trump done this time round?

The Administration's objectives are to shift emphasis from treatment to prevention, Enhance personalised care, reduce drug costs(how implementing tariffs aids this idk) and implement regulatory and market reforms. 
Here’s the rundown:

January 2025: Return of Order 13813

Trump wasted no time. In a classic Republican vs. Democrat tug-of-war, he cancelled Biden’s cancellation of his own Executive Order 13813. (Yes, we’re back to undoing the undoing. Politics is just CTRL+Z on fire.)

EO 13813 sounds nice. “More healthcare choice and competition”. Until you realize it just greenlights short-term, low-coverage insurance plans. The kind that proudly don’t cover pre-existing conditions and maternity care. 

Nobody likes a snake-oil salesman, but Trump has made it into an official business model.

February 2025: Project 2025 Goes Live

Next up, Project 2025. The Heritage Foundation’s dystopian vision board. It’s a 900-page conservative blueprint for how to reshape the entire U.S. government, and the Trump administration is going full steam ahead with it. Which is kind of funny, because during his campaign, Trump claimed to have “no idea what Project 2025 even is.” 🤷

I’m not sure if it’s good or bad that the President is this open to new ideas…
Especially since the changes including:

• NIH Funding Cuts: Massive cuts to the National Institute of Health budget. $5.5 billion reduction targeting university research grants and overhead costs. 

• Restructuring Proposal: Calls to "break the NIH monopoly on directing research" with an explicit goal of reducing "federal taxpayer subsidisation of leftist agenda”

But of course with most things, Trump's brazen actions have opposition. Medical institutions and 22 states sued. So, by Feb 10th a federal judge VAR checked his action and halted the funding cuts.

March 2025: The Healthcare Hunger Games

So much chaos, so so many cut attempts:

• 10,000 job cuts from federal health agencies

• FDA and CDC downsized - saving an alleged $1.8 billion

• Proposed ban on ACA plans covering gender-affirming care

• Planned Parenthood targeted (again): coalition pushing to cut off Medicaid funding entirely

TLDR: if you need healthcare in March 2025, bring cash and a prayer.

What are the implications of all this?

Trump has officially channelled his inner Oprah Winfrey:
“You get affected! You get affected! Everyone gets affected!”

For Patients: 

• Medicaid cuts mean more people falling through the cracks, with uninsured rates likely to rise

• Slower research = slower cures: Reduced funding could lead to slower drug innovation; affecting those with rare/complex conditions.

• Public health damage: Vaccine misinformation from key figures like RFK Jr, have tanked in vaccination rates. Leading to a measles outbreak in 19 states. I thought we left that in the 1800’s?

• Drug prices down, out of pocket costs up: While some policies aim to reduce drug prices, insurance changes may increase out-of-pocket costs for patients. Especially those with chronic conditions.

For Healthcare Providers:

• Administrative Nightmare: Changes to regulation may complicate an already complex billing and reimbursement process.

• Research rug-pull: Academic physicians and research-focused providers will face increased barriers to grant funding

• Market gets weird: Reduced barriers to cross-state insurance and new association health plans may reshape competitive dynamics

Conclusion: Still Confused? Same tbh.

Goodness gracious me, even explaining all this has me dizzy. I’m sure by next week all this information will be obsolete and redundant.
Oh, the futility of life 😣. 

The Trump administration says it wants to reform the system, cut costs, and increase access. And maybe some of that’s true. But when the reforms look like a bonfire of public health programs, slashed research budgets, and policies written by people who treat insurance like a religion. It’s hard not to feel like the patient being left behind in the waiting room.

Bottom line: Shout out to the NHS. Eight months for physio never looked so luxurious.

If you like writing like this and want to step up your med general knowledge. Join The Handover

Hope you liked this Sundays Deep Dive. Please let me know what you thought in the poll below:

Sources:

1. The Commonwealth Fund. (n.d.). United States. International Health Policy Center. https://www.commonwealthfund.org/international-health-policy-center/countries/united-states

2. MCSO. (n.d.). Public vs. Private Healthcare: Understanding the Dichotomy in the USA. https://www.mymcso.com/public-vs-private-healthcare-understanding-the-dichotomy-in-the-usa.html

3. Medicare Rights Center. (n.d.). Medicare and Employer-Based Insurance: The Basics [PDF]. https://www.medicarerights.org/PartB-Enrollment-Toolkit/Medicare-and-Employer-Based-Insurance-The-Basics.pdf

4. UPakWeShip. (n.d.). Healthcare System in UK vs USA. https://upakweship.com/blog/healthcare-system-in-uk-vs-usa/

5. Wikipedia. (n.d.). Executive Order 13813. https://en.wikipedia.org/wiki/Executive_Order_13813

6. KFF Health News. (2024, March 28). Trump and Project 2025: The Health Policy Stakes. https://kffhealthnews.org/news/article/trump-project-2025-health-policy-abortion-medicaid-usaid/

7. Reuters. (2025, March 5). US judge bars Trump administration from cutting NIH research funding. https://www.reuters.com/business/healthcare-pharmaceuticals/us-judge-bars-trump-administration-cutting-nih-research-funding-2025-03-05/

8. BBC News. (2025). US measles cases rise sharply, says CDC. https://www.bbc.co.uk/news/articles/c15zypvgxz5o

9. Callaway, E. (2025, March 28). Measles surges in the US — here’s why and what scientists are doing about it. Nature. https://www.nature.com/articles/d41586-025-00827-4

10. The Guardian. (2025, March 28). Measles cases surge in the US, CDC warns. https://www.theguardian.com/us-news/2025/mar/28/measles-cases-us-cdc

11. PwC Health Industries. (2024). Trump health agenda: Implications for 2024 election and beyond. https://www.pwc.com/us/en/industries/health-industries/library/election-2024-trump-health-agenda.html