Donald Trump didn’t run a campaign promising to slash health care funding, but in his first few months in office, his scorched-earth policies—aided 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)—have upended medical research and direct health care provision alike.
In March, HHS canceled more than $12 billion in COVID-19-era federal grants to states used for tracking infectious diseases and other health care programs. An HHS spokesperson said, “HHS will no longer waste billions of taxpayer dollars responding to a nonexistent pandemic that Americans moved on from years ago.” But some of that money was helping to fund the response to the measles outbreak in places like Lubbock, Texas, which is fueled by anti-vaccine sentiment. Layoffs of tens of thousands of staffers at health agencies and the U.S. Department of Veterans Affairs (VA), including at the Veterans Health Administration, have been ongoing, and the administration’s proposal for HHS would entirely eliminate programs aimed at HIV/AIDS prevention and massively slash the National Institutes of Health. Cuts to Medicaid are proving controversial even among Republicans, who recognize that, among other things, the program keeps hospitals afloat.
The administration’s assault on universities has included cuts and freezes for federal research grants that support academic work on cancer, Alzheimer’s 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 30 percent of the federal workforce and have been disproportionately affected by the cuts.
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—which has always been threadbare when compared with Europe and elsewhere—the 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 Bargaining for the Common Good to challenge both private-sector hospitals and local, state, and national officials to do better by the people they serve.
Public-sector unions and other caring workers’ organizations have long fought for 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 restorative justice practices; health care workers demanded hospitals stop selling medical debt to third-party debt collectors. But, as scholar Joseph McCartin and Massachusetts teacher leader Merrie Najimy wrote, “Government workers had barely secured the right to bargain before they faced conditions that threatened to lock them in the iron cage of austerity politics.” We see in DOGE the end point of decades of scapegoating public employees with the idea that the federal workforce is a mass of “unelected bureaucrats” who can be fired en masse without the public even noticing.
Musk and Trump have misjudged both the public and the public-sector workforce, though, particularly health care workers. Nurses, doctors, and other care providers are assumed to do their work for the love of it, and thus to endlessly be able to “do more with less.” Yet those same workers have gotten pretty good at communicating to the broader public just what it is they do, and they’re leading the fight against Trumpism.
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 University Medical Center (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.
That’s why Terry Mogilles works there, and why she was a leader in the campaign to unionize UMC nurses with National Nurses United (NNU). UMC’s leadership, she says, was “empowered” by Trump to attempt to crack down on the nurses, but would suffer if Trump got the Medicaid cuts he sought. Trump’s billionaire friends “are the ones making money off entitlement programs,” she says.
Lauren Waddell, a nurse practitioner at UMC, compared the Trump Administration’s cuts to “medical genocide.” She says “it’s no coincidence that the patients that are most affected by this are the poor. They’re the minorities. They’re the forgotten, the indigent.”
Those are the patients that Mogilles and Waddell are fighting for with their union: They’re fighting for safe staffing levels and more support, for the ability to give the best care to their patients—and to their financially struggling, majority Black city that has been through so much—that they can.
“I just think it’s so important, especially at our hospital, that patients see providers and are acknowledged by providers that also represent the community,” Waddell says. “That’s why I continue to work here, because I feel like I’m 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’m still here, and I’m still doing everything they say I couldn’t, and I’m in the rooms that I’m in because I deserve to be there, not because it’s just some kind of DEI [diversity, equity, and inclusion] propaganda.”
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. “We know what we’re doing is right for the community, ourselves, our families,” she says. “We 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.”
The Trump Administration’s moves should remind us all that health care—and science itself—is 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’s definition of racism is useful here: “the state-sanctioned and/or extralegal production and exploitation of group-differentiated vulnerability to premature death.”
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 wrote about in the last issue of The Progressive, is one example. Historian Jules Gill-Peterson has noted the similarity between such attacks on trans people and other forms of eugenic policymaking. “[I]f you believe that a population of human beings must be limited in their existence and reproduction, including social reproduction,” she wrote, “then 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.”
Health care workers are also fighting back against 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.
The Committee of Interns and Residents, part of SEIU Healthcare, has pledged to defend affirming care and has organized actions like the one in February at Children’s 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 NNU and 1199SEIU have also put out statements of solidarity with trans patients.
Legal cases continue to score some wins for trans people against the Trumpists, and elected officials have spoken out—and in the case of Georgia Democrats, even staged a walkout when yet another restrictive bill was put forward in the state legislature. But it is grassroots organizing that is leading the way.
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 Federal Unionists Network (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’s goal is to “build a bit more of a fighting labor movement in the federal sector.”
In the VA in particular, the second Trump Administration is piling cuts upon cuts. “The outsourcing and privatization has been increasing exponentially for more than a decade, including under both Democrat and Republican appointees,” Smith said. “We’re increasingly strapped in terms of staffing and budget for the direct care that we provide.” And yet health care providers at the VA—not just doctors and nurses, but also therapists like him, as well as psychologists, social workers, rehab staff, chaplains, health scientists, and pharmacists—provide 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.
Trump’s funding cuts are, unintentionally, providing an education in just what the federal government still does for people. “The federal workforce is awakening,” Smith said, and it’s organizing in communities around the country to explain what it does and why the public will miss it when it’s gone. It’s 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.
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, as I wrote at the time, provided a model.
“We have the largest public health care system in the world . . . here in the VA,” said Smith, who moved to the United States from Canada. “I didn’t 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’re not able to deliver the care that you would want to because people can’t pay or the insurance company doesn’t want to pay.”
It was the VA workers, according to Phillip Longman, author of Best Care Anywhere: Why VA Health Care Would Work Better for Everyone, that built the institution into what it is today and kept it going despite the seemingly endless attacks. “The VA is the place where you can go and you can get a heart stent or a liver transplant,” Longman tells me. “But you can also get a mortgage, you can get a student loan, you can get family counseling. It is addressed to the socioeconomic determinants of health, not just stitching people up when they get busted up in a car accident.”
And so, as Trump attempts to dismantle the very idea of public services, workers have a tremendous opportunity to step into the public eye and make their case for a very different vision of the country. It just might be possible, as Trump’s cuts reach so far and slice so deep, for Americans to be swayed toward a renewed interest in the common good.