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Donald Trump didn\u2019t run a campaign promising to slash health care funding, but in his first few months in office, his scorched-earth policies\u2014aided by billionaire Elon Musk and his Department of Government Efficiency (DOGE, which is neither government nor efficient) and Robert F. Kennedy Jr. at the U.S. Department of Health and Human Services (HHS)\u2014have upended medical research and direct health care provision alike.<\/p>\n
In March, HHS canceled more than\u00a0$12 billion<\/a>\u00a0in COVID-19-era federal grants to states used for tracking infectious diseases and other health care programs. An HHS spokesperson said, \u201cHHS will no longer waste billions of taxpayer dollars responding to a nonexistent pandemic that Americans moved on from years ago.\u201d But some of that money was helping to fund the response to the measles outbreak in places like Lubbock, Texas, which is fueled by\u00a0anti-vaccine<\/a>\u00a0sentiment. Layoffs of tens of thousands of staffers at\u00a0health agencies<\/a>\u00a0and the U.S. Department of Veterans Affairs (VA)<\/a>, including at the Veterans Health Administration, have been ongoing, and the administration\u2019s\u00a0proposal for HHS would\u00a0entirely eliminate<\/a>\u00a0programs aimed at HIV\/AIDS prevention and massively slash the National Institutes of Health.\u00a0Cuts to Medicaid<\/a>\u00a0are proving controversial even among Republicans, who recognize that, among other things, the program keeps hospitals afloat.<\/p>\n The administration\u2019s\u00a0assault on universities<\/a>\u00a0has included cuts and freezes for federal research grants that support academic work on cancer, Alzheimer\u2019s disease, HIV, and diabetes, among other illnesses. And many of those federal employees being laid off are themselves recipients of government health care benefits, as veterans make up some\u00a030 percent<\/a>\u00a0of the federal workforce and have been disproportionately affected by the cuts.<\/p>\n Health care workers around the country have been reeling from the ongoing assault, but they have also been preparing for this moment in their organizing in recent years. They have been at the forefront of the fight back, reminding us that even after decades of hacking away at the social safety net\u2014which has always been threadbare when compared with Europe and elsewhere\u2014the U.S. government nevertheless provides the backbone for the largely privatized system in which most of us receive care. And for years, health care workers, alongside public-sector workers like teachers, have embraced the framework of\u00a0Bargaining for the Common Good<\/a>\u00a0to challenge both private-sector hospitals and local, state, and national officials to do better by the people they serve.<\/p>\n Public-sector unions and other caring workers\u2019 organizations have\u00a0long fought<\/a>\u00a0for the people their members care for as well as their own bread-and-butter issues. Social workers have struck for better welfare benefits; teachers for smaller class sizes and\u00a0restorative justice<\/a>\u00a0practices; health care workers\u00a0demanded<\/a>\u00a0hospitals stop selling medical debt to third-party debt collectors. But, as scholar\u00a0Joseph McCartin<\/a> and Massachusetts teacher leader\u00a0Merrie Najimy<\/a> wrote<\/a>, \u201cGovernment workers had barely secured the right to bargain before they faced conditions that threatened to lock them in the iron cage of austerity politics.\u201d We see in DOGE the end point of decades of scapegoating public employees with the idea that the federal workforce is a mass of \u201cunelected bureaucrats\u201d who can be fired en masse without the public even noticing.<\/p>\n Musk and Trump have misjudged both the public and the public-sector workforce, though, particularly health care workers.\u00a0Nurses<\/a>, doctors, and other care providers are assumed to do their work for the love of it, and thus to endlessly be able to \u201cdo more with less.\u201d Yet those same workers have gotten pretty good at communicating to the broader public just what it is they do, and they\u2019re leading the fight against Trumpism.<\/p>\n In the United States, most hospitals are private, of course, but there are still remnants of an older system that had public care at its heart. In New Orleans, Louisiana, where I live, the ghost of Charity Hospital lives on in\u00a0University Medical Center<\/a>\u00a0(UMC), which is privately operated but publicly funded and retains the mission of Charity: to serve all who come, regardless of their ability to pay.<\/p>\n That\u2019s why Terry Mogilles works there, and why she was a leader in the campaign to unionize UMC nurses with National Nurses United (NNU). UMC\u2019s leadership, she says, was \u201cempowered\u201d by Trump to attempt to crack down on the nurses, but would suffer if Trump got the Medicaid cuts he sought. Trump\u2019s billionaire friends \u201care the ones making money off entitlement programs,\u201d she says.<\/p>\n Lauren Waddell, a nurse practitioner at UMC, compared the Trump Administration\u2019s cuts to \u201cmedical genocide.\u201d She says \u201cit\u2019s no coincidence that the patients that are most affected by this are the poor. They\u2019re the minorities. They\u2019re the forgotten, the indigent.\u201d<\/p>\n Those are the patients that Mogilles and Waddell are fighting for with their union: They\u2019re fighting for safe staffing levels and more support, for the ability to give the best care to their patients\u2014and to their financially struggling, majority Black city that has been through so much\u2014that they can.<\/p>\n \u201cI just think it\u2019s so important, especially at our hospital, that patients see providers and are acknowledged by providers that also represent the community,\u201d Waddell says. \u201cThat\u2019s why I continue to work here, because I feel like I\u2019m making a difference in their lives and showing that we can be the difference in spite of whatever challenges and institutionalized racism and oppression. I\u2019m still here, and I\u2019m still doing everything they say I couldn\u2019t, and I\u2019m in the rooms that I\u2019m in because I deserve to be there, not because it\u2019s just some kind of DEI [diversity, equity, and inclusion] propaganda.\u201d<\/p>\n The cuts and deliberate neglect that Mogilles has witnessed over a long career in New Orleans have made her more determined to change the outcomes for her patients. \u201cWe know what we\u2019re doing is right for the community, ourselves, our families,\u201d she says. \u201cWe are fighting for better health care in this city and ultimately to be an example for the rest of the state on how this can work.\u201d<\/p>\n The Trump Administration\u2019s moves should remind us all that health care\u2014and science itself\u2014is political. The choices to fund or slash a program, to provide masks and gloves to nurses, to prioritize one disease and not another are profoundly political choices deliberately being made to value the lives of some people over others. Scholar Ruth Wilson Gilmore\u2019s\u00a0definition of racism<\/a>\u00a0is useful here: \u201cthe state-sanctioned and\/or extralegal production and exploitation of group-differentiated vulnerability to premature death.\u201d<\/p>\n The administration is, of course, invoking science to its own ends, like the advocates of eugenics did in their time. Its attempt to biologically define transgender people out of existence, which I\u00a0wrote about<\/a>\u00a0in the last issue of\u00a0The Progressive<\/em>, is one example. Historian Jules Gill-Peterson has\u00a0noted<\/a>\u00a0the similarity between such attacks on trans people and other forms of eugenic policymaking. \u201c[I]f you believe that a population of human beings must be limited in their existence and reproduction, including social reproduction,\u201d\u00a0she wrote<\/a>, \u201cthen you are an advocate of eugenics, which is to say the selection of certain populations over others, where your care rests on the disposability of others.\u201d<\/p>\n Health care workers are also\u00a0fighting back<\/a>\u00a0against the attacks on trans people, which seek to deny gender-affirming care (or health care at all). Before Trump returned to office, twenty-four states had already banned or restricted care for trans youth, and the President has aimed to finish the job by cutting off, or threatening to cut off, funding. Hospitals have rushed to comply in advance, but workers and their unions are organizing to maintain services to their trans patients.<\/p>\n The Committee of Interns and Residents, part of SEIU Healthcare, has\u00a0pledged<\/a>\u00a0to defend affirming care and has organized actions like the one in February at Children\u2019s Hospital Los Angeles against the pausing of some of its services to trans youth. Nurses at Kaiser Permanente Medical Center locations in San Francisco demonstrated in support of trans and immigrant patients, calling for their designation as sanctuary hospitals and to keep providing gender-affirming care. Health care unions like\u00a0NNU<\/a> and 1199SEIU<\/a>\u00a0have also put out statements of solidarity with trans patients.<\/p>\n Legal cases\u00a0continue to score<\/a>\u00a0some wins for trans people against the Trumpists, and elected officials have spoken out\u2014and in the case of\u00a0Georgia Democrats<\/a>, even staged a walkout when yet another restrictive bill was put forward in the state legislature. But it is grassroots organizing that is\u00a0leading the way<\/a>.<\/p>\n Mark Smith is an occupational therapist with the VA in California, as well as president of the National Federation of Federal Employees Local 1 and a member of the new\u00a0Federal Unionists Network<\/a>\u00a0(FUN), a rank-and-file organization of federal government workers standing up for public services. (He spoke with me in a personal capacity, neither on behalf of the government nor his union.) In February, he explained that FUN\u2019s goal is to \u201cbuild a bit more of a fighting labor movement in the federal sector.\u201d<\/p>\n In the VA in particular, the second Trump Administration is piling cuts upon cuts. \u201cThe outsourcing and privatization has been increasing exponentially for more than a decade, including under both Democrat and Republican appointees,\u201d Smith said. \u201cWe\u2019re increasingly strapped in terms of staffing and budget for the direct care that we provide.\u201d And yet health care providers at the VA\u2014not just doctors and nurses, but also therapists like him, as well as psychologists, social workers, rehab staff, chaplains, health scientists, and pharmacists\u2014provide care to patients that far outstrips the private sector. And the VA both trains doctors who go on to the private sector and conducts research benefiting people who have never spent a day in the military.<\/p>\n Trump\u2019s funding cuts are, unintentionally, providing an education in just what the federal government\u00a0still\u00a0does<\/em>\u00a0for people. \u201cThe federal workforce is awakening,\u201d Smith said, and it\u2019s organizing in communities around the country to explain what it does and why the public will miss it when it\u2019s gone. It\u2019s a Bargaining for the Common Good campaign on a grand scale, a fight for the very idea that the government can do good things for people.<\/p>\n The VA is, in that way, an example of the high point of what the U.S. government does provide. The COVID-19 pandemic got health care workers talking about a truly universal health care system once again, run by providers for the good of patients, and the VA,\u00a0as I wrote at the time<\/a>, provided a model.<\/p>\n \u201cWe have the largest public health care system in the world . . . here in the VA,\u201d said Smith, who moved to the United States from Canada. \u201cI didn\u2019t really want to work in the private sector here. I think that is the case for a lot of folks who come to the VA. They come for the mission of serving veterans, and then also avoiding, in many cases, much of the moral injury that I think happens in the private sector, where you\u2019re not able to deliver the care that you would want to because people can\u2019t pay or the insurance company doesn\u2019t want to pay.\u201d<\/p>\n