{"id":784067,"date":"2026-05-09T10:46:20","date_gmt":"2026-05-09T10:46:20","guid":{"rendered":"https:\/\/www.europesays.com\/us\/784067\/"},"modified":"2026-05-09T10:46:20","modified_gmt":"2026-05-09T10:46:20","slug":"new-yorks-childcare-fundraising-bet-what-new-york-city-can-learn-from-nairobi","status":"publish","type":"post","link":"https:\/\/www.europesays.com\/us\/784067\/","title":{"rendered":"New York’s Childcare Fundraising Bet: What New York City Can Learn from Nairobi"},"content":{"rendered":"

~Sheldon Whitehouse<\/a>, U.S. Senate, August, 2025<\/p>\n

The test of our progress is not whether we add more to the abundance of those who <\/p>\n

have much; it is whether we provide enough for those who have too little.<\/p>\n

~Franklin Roosevelt<\/a>, January 20, 1937<\/p>\n

Donald Trump and the Republican Party have begun surreptitiously privatizing Medicare.<\/p>\n

That should elevate Saving Medicare as a Democratic Party priority in 2026. <\/p>\n

Americans pay twice<\/a> as much for health care as Canadians, Australians, or the French. One in three<\/a> Americans had to scrimp in 2025 to pay medical costs \u2013 driving less, selling blood<\/a> plasma, even delaying having children or buying a home. Health care prices rank<\/a> at the top<\/a> of the list when it comes to Americans\u2019 affordability worries, with 82%<\/a> dissatisfied with its costs – the highest frustration level ever recorded by Gallup. That is, until they turn 65. Then they delightedly enroll in Medicare, the extremely popular health program for seniors<\/p>\n

But Medicare has a problem, a big problem. Well, two problems actually. <\/p>\n

Medicare Insolvency in 2032 <\/strong><\/p>\n

First, the program is insolvent. <\/p>\n

Medicare\u2019s huge Hospital insurance<\/a> program covers more than 60 million seniors (and 7 million younger disabled people) but is running at a deficit, burning through cash reserves. Program trustees project that those reserves will be exhausted by 2032. Thereafter, Medicare payroll tax income will cover just 88% of hospital and hospice bills, forcing an immediate 12%<\/a> reduction in benefits and services. And the cuts will grow deeper thereafter. Some 81%<\/a> of Americans, including 78% of independents, worry about those benefit cuts. (Medicare\u2019s smaller insurance programs covering physician services and medicines are on sounder financial footing.)<\/p>\n

Republicans Privatizing Medicare <\/strong><\/p>\n

Medicare\u2019s second big problem is that the Republican Party and its billionaire<\/a> donors really despise it. They are ideologically opposed<\/a> to government spending on health<\/a> care, instead believing that good health should be auctioned by profit-maximizing providers to the highest bidders.<\/p>\n

Republicans have opposed Medicare since its original establishment by President Johnson in 1965. They have been gradually privatizing<\/a> it for years \u2013 replacing traditional government administered Medicare with Medicare Advantage (MA) plans run by private insurance companies. MA insurers profit by curtailing seniors\u2019 choice of physicians and hospitals, and by limiting care, including requiring preapproval of needed care. MAs have lured seniors in the past away from traditional Medicare thanks to a 20%<\/a> bonus. But going forward, Republicans are proposing to automatically<\/a> enroll new 65-year-olds in private MA plans. <\/p>\n

Moreover, using obscure budget rules<\/a>, the Republicans in 2025 cut Medicare benefits \u2013 raising enrollee out-of-pocket costs \u2013 cuts which the Congressional Budget Office found will total $536 billion<\/a> over ten years. The money was used instead to fund Trump\u2019s tax cuts for corporations and elites.<\/p>\n

This privatization means abandoning the 60-year pillar of Medicare to provide guaranteed coverage for a sweeping set of essential, standard medical benefits to all seniors. <\/p>\n

In stark contrast, since the New Deal, Democrats have viewed affordable, accessible nationwide health care as a basic human right akin to clean water. They established Medicare and other government-coordinated health care programs for veterans, children<\/a>, lower-income<\/a> families, and military personnel<\/a>. In 2021, for instance, President Biden\u2019s Medicare upgrades included lowering<\/a> drug prices<\/a> and capping out-of-pocket drug costs at $2,000 annually, including capping insulin at $35\/month. <\/p>\n

Saving Medicare in 2026<\/strong><\/p>\n

These dynamics \u2013 a popular<\/a> program being dismantled by Republicans in order to fund tax cuts for the 1% \u2013 present a tantalizing 2026 political opportunity for Democrats. Some 58%<\/a> of pivotal independent voters<\/a>, for instance, believe health care will become even less affordable in 2026. And 44% say health costs will have a \u201cmajor impact on which party\u2019s candidate they would support.\u201d <\/p>\n

Saving Medicare begins with establishing a solid financial foundation through a variety<\/a> of steps. The Medicare payroll tax and the net investment income tax rate on incomes over $400,000<\/a> could be increased, for instance, as proposed by President Biden in 2024. And a number of Republican tax cuts for corporations and elites in the 2017<\/a> law ($1.5 trillion<\/a> over a decade) and<\/a> the 2025<\/a> law ($4.1 trillion<\/a>) can be reversed<\/a>. That additional revenue would allow the Republicans to restore their 2025 benefit cuts to Medicaid and other<\/a> programs. It would allow the establishment of an out-of-pocket<\/a> annual spending cap for all Medicare enrollees. And it would permit adding vision, hearing, and dental benefits to Medicare, favored by 92%<\/a> of Americans. <\/p>\n

Expand Medicare: Pathway to Affordable Health Care <\/strong><\/p>\n

Working-class<\/a> voters are particularly important to Democrats, defined as the bottom two-thirds of the income distribution without four-year college degrees. They are the most economically stressed Americans, and notably, three-quarters (72.4%) of them favor expanding Medicare. Independents are another key voter cohort (with much overlap), and 62%<\/a> of them also favor expanding Medicare. <\/p>\n

A number<\/a> of specific<\/a> expansion proposals<\/a> have been<\/a> suggested, including lowering<\/a> the Medicare eligibility age to 60 or offering Medicare as an option on the Obamacare exchanges. Any expansion of Medicare would include maintaining the present subsidized employer-linked private health insurance market that provides coverage to 180 million<\/a> people under age 65 – 77%<\/a> of whom are satisfied with that system. <\/p>\n

Reform is needed to address the uniquely American system where a majority of care is provided by profit-maximizing corporations. Its central defect is reliance on corporate care providers, incentivized to skimp on care, which sharply conflicts with the altruistic motivation of health professionals who strive to put patient care above institutional profits. As Nobel economist Kenneth Arrow has pointed out, physicians are not \u201csalesmen<\/a>.\u201d A first reform step would be to ban<\/a> private equity (PE) firms from owning physician and other medical groups. The pernicious PE business<\/a> model \u2013 \u201cbuy and bust<\/a>\u201d \u2013 is toxic<\/a> to good medical practice. For instance, hospitals owned by PEs have experienced a 25.4%<\/a> increase in hospital-acquired adverse medical events (falls, infections) \u201csuggesting poorer quality of inpatient care.\u201d <\/p>\n

Cost Containment<\/strong><\/p>\n

Another benefit of Medicare expansion would be to corral prices. <\/p>\n

It is significant that the basic elements of Medicare are also the centerpieces of foreign<\/a> health care systems that effectively corral costs. These rigorously regulated blue-ribbon systems in Europe, for instance, feature quality and cost parameters designed by medical professionals, with most care provided by private practitioners \u2013 at just 50-60%<\/a> of American costs. <\/p>\n

Medicare reimburses some procedures at high prices, but overall, its cost management keeps reimbursement rates at 48%<\/a> of private commercial rates. That success is why the nation\u2019s second-largest physician organization \u2013 the American College<\/a> of Physicians – supports Medicare expansion.<\/p>\n

A majority of American health care is delivered by giant hospital chains, PEs, insurance conglomerates, and pharmaceutical companies, relentlessly maneuvering<\/a> to raise prices. Government cost caps, reforms to Medicare Advantage<\/a> risk adjustments, rules to prevent pharmaceutical firms from gaming patents, and vigorous antitrust enforcement to limit health market concentration are important. But the expansion of low-cost Medicare will play a central role by creating market forces<\/a> that reduce commercial health care prices through meaningful competition<\/a>. <\/p>\n

An important further step to corral costs is expanding the supply of health care providers. That includes expanding medical and nursing schools, physician residency programs, physician assistants, and nurse practitioners. <\/p>\n

Saving Medicare<\/strong> <\/strong><\/p>\n

Other topics, such as affordability and Trump’s corruption<\/a>, will be important in the 2026 and 2028 elections. But stabilizing and expanding Medicare in a fiscally sound fashion is a compelling political issue in its own right. <\/p>\n

And success in those elections will give the Democratic Party a mandate to deliver Americans affordable, accessible medical care.<\/p>\n

George Tyler<\/strong> is a former deputy assistant treasury secretary and World Bank official. He is the author of books including Billionaire Democracy and What Went Wrong.<\/p>\n","protected":false},"excerpt":{"rendered":"~Sheldon Whitehouse, U.S. Senate, August, 2025 The test of our progress is not whether we add more to…\n","protected":false},"author":3,"featured_media":784068,"comment_status":"","ping_status":"","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[5122],"tags":[5229,25090,147153,405,403,5226,5225,5228,5227,256,67,586,132,5230,130292,68,2969],"class_list":{"0":"post-784067","1":"post","2":"type-post","3":"status-publish","4":"format-standard","5":"has-post-thumbnail","7":"category-new-york","8":"tag-america","9":"tag-childcare","10":"tag-nairobi","11":"tag-new-york","12":"tag-new-york-city","13":"tag-newyork","14":"tag-newyorkcity","15":"tag-ny","16":"tag-nyc","17":"tag-philanthropy","18":"tag-united-states","19":"tag-united-states-of-america","20":"tag-unitedstates","21":"tag-unitedstatesofamerica","22":"tag-universal-childcare","23":"tag-us","24":"tag-usa"},"share_on_mastodon":{"url":"https:\/\/pubeurope.com\/@us\/116544221196978491","error":""},"_links":{"self":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/784067","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/users\/3"}],"replies":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/comments?post=784067"}],"version-history":[{"count":0,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/posts\/784067\/revisions"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media\/784068"}],"wp:attachment":[{"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/media?parent=784067"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/categories?post=784067"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/www.europesays.com\/us\/wp-json\/wp\/v2\/tags?post=784067"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}