The ACA death spiral is here, and establishment Democrats are pretending they had nothing to do with it.
Matt Stoller laid it out plainly: insurance companies know the ACA subsidies are expiring, so they’re jacking up premiums by 20% on top of losing those subsidies. They expect healthier people to drop coverage, which means sicker people stay in the pool, which means premiums go up even more. It’s a spiral, and everyone saw it coming.
Now Elizabeth Warren is on Twitter telling us this is “Trump’s economy” that enriches the wealthy and screws workers. As if this just started in 2025.
This is the woman who wrote The Two Income Trap; she knows better. The issue isn’t Trump’s economy. The problem is THE economic system. The one we’ve been living under since before I was a kid. I’m 45 years old, and working-class people have been in a slow spiral my entire life.
This is what status quo Democrats don’t want to admit. Trump is a symptom, not the problem. He’s a reflection of people’s rage at a system that stopped working for them long before he came down that escalator ten years ago. And as long as Democrats keep pointing at Trump as the problem instead of a symptom of the system itself, they’ll never capture the energy of the American working class. Because people know better. In their bones, they know Trump didn’t break this. It was already broken.
Corporate Democrats Bragged About It For 15 Years
For 15 years, every time someone called out Democrats for failing to deliver, they shouted back one word: Obamacare. That was the answer to everything. The proof that Democrats fight for working people.
“This is a big fucking deal,” Joe Biden told Obama when it passed. And they believed it. They truly believed they had done something historic.
Now those same people are screaming with equal certainty that what’s coming is cruel, destructive, and preventing it is an emergency worth shutting down our government.
Here’s the crazy part: what they are fighting against is a return to the original Obamacare.
What they’re fighting to prevent is what they bragged about for 15 years. The ACA subsidies expiring? That’s not some new Republican cruelty. That’s a return to the original system. The system Democrats built. The system they defended. The system they told us worked.
They once called what is coming a victory; now they’re treating it like a disaster. Both can’t be true.
The reality is simpler and uglier. Obamacare never worked. It was designed to prop up a fundamentally broken private insurance system. It required massive, ongoing subsidies just to keep people from going bankrupt.
Removing those enhanced subsidies that came about durning COVID and going back to the original Obamacare is just giving Americans a taste of what this healthcare system really is. What it actually costs. It’s a real representation of the cash vacuum disguised as healthcare that exists in America today.
Because here’s the thing nobody wants to say out loud: what we need is more healthcare and less insurance.
Insurance doesn’t heal anybody. Insurance doesn’t set a broken bone. It doesn’t cure cancer. It doesn’t deliver a baby or fight an infection. Doctors do that. Nurses do that. Hospitals, rural clinics, research, and pharmaceutical production do that. Healthcare does that.
We built a system where the money goes to insurance companies first, and whatever’s left over trickles down to actual care. And now that the subsidies are ending, people are seeing the real bill. They’re seeing what we’ve been paying for all along. And it’s not healthcare. It’s insurance
Establishment Democrats are watching it collapse in real time and acting shocked that a bandaid didn’t heal a gunshot wound.
This Is What Defending Broken Systems Gets You
The problem isn’t that Democrats didn’t fight hard enough for Obamacare. The problem is that they fought for the wrong thing in the first place.
They took a system designed to extract profit from sick people and tried to make it nicer. They added subsidies and protections and exchanges. They made it less bad. But they didn’t fix it. They couldn’t fix it, because the system itself is the problem.
Matt Yglesias is out here saying progressives need to embrace a big tent. He wants Joe Manchin types in the party. Moderate Republicans who feel uncomfortable with Trump. People who think the system basically works, it just needs some adjustments.
But he draws the line at candidates like Saikat Chakrabarti or Graham Platner or Kat Abughazaleh who actually want to change things. Why? Because they aren’t interested in managing the current system better. They’re interested in building something different.
That’s the real divide. Not left versus right. Not progressive versus moderate. It’s between people who think the system can be reformed and people who understand it needs to be replaced.
The people Yglesias wants in the tent are the ones who think our healthcare system is fundamentally sound. That it just needs tweaking. More subsidies here, better regulation there. They’re fine with insurance companies sitting between sick people and doctors as long as we can make that relationship slightly less exploitative.
The people he wants to keep out are the ones saying we need to build actual healthcare infrastructure. Public hospitals. Government pharmaceutical production. Systems designed to deliver care, not profit.
Status Quo Democrats Are Telling On Themselves
The ACA collapse is establishment Democrats telling on themselves. For 15 years, they told us this system worked. That it was transformational. That it was a big deal.
Now they’re telling us that going back to the plan as it was designed is a crisis. That it will destroy people. That it must be stopped at all costs.
That’s the system they built. That’s what they defended. And that’s what they’re now desperate to prevent us from experiencing again, because if people see what Obamacare actually is without all the extra subsidies, they’ll realize it was never the victory Democrats claimed.
This is what happens when you defend broken systems instead of building new ones. You end up in the absurd position of fighting to prevent your own policy from taking effect.
Elizabeth Warren knows better. She wrote the book on this. But it’s easier to blame Trump than admit the system itself is the enemy.
Trump is incapable of fixing this. He’s completely disinterested in fixing it. But he’s not the reason it’s broken. Democrats helped build this economy. Republicans did too. And until we stop pointing at individual villains and start pointing at the system, we’re going to keep losing.
The ACA death spiral isn’t a Republican attack. It’s a Democratic policy coming home to roost. And the longer they pretend otherwise, the harder it’s going to be to build something that actually works.
And what is something that actually works, you might ask?
Public Competition! If you’ve been along for the ride here, you know that I believe that government must play a direct competitive role in the markets by providing access to essentials at much lower costs then extractive, for-profit corporations.
I go into a lot more detail on this in a previous post called Curing Healthcare with Public Competition which I encourage you to check out. When we harness our resources to deliver for all of us, we can create better outcomes at lower costs.
And low cost accessible healthcare is just one of the building blocks of a country that works for all Americans. At America’s Undoing, we’ve been tracking what Americans really want and developing a framework for a unified movement to build legislative power for the benefit of the many, not the few.
If you’re interested in what you’re hearing, please like and share widely.
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Together, we can stop the slide into authoritarianism and put this country on track toward shared prosperity and real economic freedom for all Americans
Let me know what you think in the comments.
Corbin Trent
"Because here’s the thing nobody wants to say out loud: what we need is more healthcare and less insurance."
Sorry. I've been saying it out loud for decades. Insurance, aside from catastrophic, doesn't belong in healthcare, at all. I get silence and a blank face, every time. The same silence as I got when I told people back in the late 70s, early 80s that the religious right was planning, literally planning, to infiltrate government, education, etc. I overheard them with my own ears.
Maybe now people will be more open to hearing, which will maybe lead to doing something about both. Because that's the other thing I keep saying, and you are right: He's a symptom not a cause. It's the entire, sick mindset that has to be recognized and stomped out through eternal education. We must literally educate the stupid out of ourselves. On a communication and relationship level, we are dumber than dumb. But will we face the truth of ourselves and become better, or will we keep heaping blame and doing nothing?
Systemically: we don't have a healthcare system in America, we have a healthcare industry which is a cornerstone for profit in this economy. We profit off of human suffering. If we had had a single payer health care system that the republicans were attacking, everyone would be in the streets over the issue. Most people find it difficult to navigate this system, because it is intentionally incomprehensible. Except they know they are getting less for more.