Congress Is a Bust: The “No-Plan Plan,” the Power of the Purse, and the Theater That Keeps Americans Uninsured
Where is the Congress that represents us? They are not our trustees but guards for corporate trust. They are not like us. They are not like us. Our faith in them has turned to dust. Congress is a bust. My forthcoming book (releasing in January on ThePowerIsNow.com) is titled: The Affordable Care Act: The Structure of Failure, the Possibility of Reform, and the Responsibility of a Nation. That refrain above opens a poem in the book because it is the only honest way to describe what Americans are watching in real time: a legislative body that can solve the affordability problem, understands the consequences of refusing to act, and still treats the public like an afterthought. This is not a “healthcare debate” anymore. It is a trust crisis. Congress doesn’t own the nation’s money. Congress holds the purse for the people. Congress is a trustee of the public treasury—constitutionally empowered to tax and spend, and constitutionally required to appropriate funds before any money leaves the Treasury. When I say “purse,” I’m not being funny. I’m being literal. And trustees have a duty to the beneficiaries. When trustees repeatedly protect private interests while exposing beneficiaries to predictable harm, that is no longer “politics as usual.” That is a breach of trust. The Purse Is the Point The modern argument over the Affordable Care Act is dressed up in slogans: freedom, choice, socialism, dependency, personal responsibility, market discipline. All of that is smoke. The real question is simple: What does Congress choose to purchase with public money? Congress has the authority to extend affordability protections. Congress has the power to prevent a predictable coverage and premium crisis. Congress also has the power to do nothing—and pretend that doing nothing is neutral. It is not neutral. The Congressional Research Service (CRS) lays out the situation plainly: the Affordable Care Act’s premium tax credit continues, but the enhanced premium tax credit rules—expanded eligibility and larger subsidies—are scheduled to expire under current law, with the sunset date January 1, 2026, unless Congress extends them. If the enhanced help expires, the subsidy structure tightens: the 400% of poverty income cap returns and premium contributions increase for many households, and CBO expects fewer subsidized enrollees, lower federal expenditures, and a higher uninsured rate. That’s not ideology. That’s policy mechanics. So now, Americans are forced to watch a spectacle: lawmakers arguing as if the question is whether “Obamacare” deserves to live, while the operational reality is this—millions of real people will pay more, some will drop coverage, and Congress knows it. If Congress Knows the Outcome and Still Refuses to Prevent It, Congress Owns the Harm This is the sentence that ends the confusion: If Congress knows the outcome, has the authority to prevent it, and chooses not to prevent it—Congress is responsible for the harm. No one needs to keep asking, “Where is the plan?” That is the plan. The plan is the no-plan plan. The no-plan plan is not just the absence of policy; it is a strategy of avoidance. It precipitates a crisis by allowing a known deadline to arrive. It creates budget “savings” through expiration. It allows lawmakers to posture about fiscal discipline without taking direct ownership of the human cost. Every plan that produces a predictable disaster also comes with a PR plan. In this case, the PR plan is to blame the insurance companies. The Emotional Scapegoat: “Blame the Insurance Companies” Public relations is storytelling. Storytelling requires a protagonist and an antagonist. Movies run on it. Campaigns run on it. Cable news runs on it. The moment the story is framed, people stop thinking like analysts and start reacting like jurors hungry for a verdict. Americans love a villain with a logo. So the easiest political move is to paint insurers as the monster, point the cameras, and let the public’s anger do the rest. But I refuse to let emotion outrank evidence. Yes, insurance is part of the system and part of the problem. But the data does not support the fantasy that insurer profit is the primary explanation for America’s healthcare cost crisis. The National Association of Insurance Commissioners (NAIC) reported that in 2024 the health insurance industry’s profit margin fell to 0.8%, down from 2.2% in 2023, with net income dropping sharply—driven by increased medical costs and record-high utilization. That report also notes that total hospital and medical expenses rose significantly year over year. That is not a conspiracy. That is fact. And it also explains why people misunderstand “profit.” Thin margins can still produce enormous dollars at massive scale. That is how Walmart makes billions. That is how Costco makes billions. It’s volume. When everyone needs what you sell, you don’t require a fat margin to generate huge totals. Healthcare has the same scale dynamic. Millions need care. Premium dollars are enormous. That does not make insurers innocent. It does make one point unavoidable: “Insurer greed” is not a sufficient explanation for this national crisis. So why is Congress so comfortable hiding behind that story? Because the real power centers of healthcare spending are harder to confront. What’s Really Driving Costs: Provider Prices and Corporate Structure KFF’s comparative analyses across developed countries have made this point repeatedly: the United States spends far more per person on healthcare than peer nations, and a major reason is higher prices, not simply higher use of care. Prices are not an abstract concept. Prices come from bargaining power and market structure. When large health systems dominate regions, when hospitals acquire physician practices, when private equity and corporate consolidation reshape care delivery, pricing power increases. The patient does not negotiate. The patient is processed. Research coverage and peer-reviewed work have linked consolidation dynamics to price increases without matching quality gains in many cases. The pattern is not subtle: market power pushes prices up, and consumers pay—through premiums, deductibles, copays, taxes, and medical debt. So here is what Americans are watching: Congress avoids direct confrontation with the most powerful cost drivers—consolidation, pricing leverage, the corporate structure of care—then turns around and “saves money” by letting affordability