Bettino is a volunteer in White Plains, N.Y., for Wolf-PAC, which seeks to build grassroots support for a constitutional amendment permitting more regulation of money in politics.
Imagine emerging from a life-saving medical procedure only to receive bills totaling $80,000 — despite having health insurance. Or, like Californian Tom Saputo, getting a surprise bill for $51,000 after being air-lifted to a hospital for an emergency double-lung transplant. After insurance, he still owed $11,000.
Many of you may not have to imagine these nightmare scenarios, but they're all too real. And whether or not you've experienced horror stories like these, we've all been victimized by the exorbitant costs of health insurance. Legalized bribery is the reason.
The United States now has the only profit-driven health care system in the world, so it's unsurprising we also have the most expensive medical care of any country. In fact, 18 percent of our entire economy ($3.2 trillion) went to health care in 2015, averaging about $10,000 a person.
Why is health care and insurance in this country so much more expensive than elsewhere? It's the intrusion of big money in politics.
We use the euphemism "campaign contributions" to disguise the nefarious truth. Corporations can now make unlimited contributions to elected politicians through the use of the political action committees.
Four of the biggest health insurance companies — Blue Cross Blue Shield, UnitedHealth Group, CVS Health and Cigna— and their employees gave $4.5 million to 2020 presidential and congressional campaigns, with just over half of the cash to Democrats.
Paco Fabian, director of campaigns at Our Revolution, told The Hill, "they're influencing both sides and they're doing it so that regardless of who wins, they continue to influence politics and policy." The same was true four years before, when Donald Trump received $1.3 million from the insurance industry while Hillary Clinton brought in a cool $3.3 million. Donations from the health sector at large were gargantuan: $26.4 million for Clinton and $5.8 million for Trump.
Donations made to politicians are not random charity; they are strategic and expected to procure a hefty return on investment. Recipients are not naïve to this, and they frequently cater to the interests of their most generous donors.
How do "campaign contributions" impact health costs? Quite directly, it turns out, in the form of legislation. In each of the previous two years, the Trump administration allowed insurance companies to raise their premiums 15 percent with no explanation, increasing the likelihood of price spikes for consumers. The previous president, backed by Congress, also weakened regulation of insurers, increased their allowed profit-margins and permitted more flexibility in scaling back benefits — all policies promoted by the health insurance lobby.
Chairman Richard Neal of the House Ways and Means Committee, a gatekeeper of all health legislation, has been the third largest recipient of insurance money in the House. But health insurance companies aren't the only ones with a vested interest in health care industry profits: Private equity group Blackstone and various for-profit hospital groups were major contributors to the Massachusetts Democrat in the last election. Blackstone has lobbied hard to prevent a resolution on surprise medical billing because it owns the physician-staffing company TeamHealth, which profits mightily from this practice.
In 2019 Neal blocked a bipartisan bill aimed at controlling hospitals' ability to send these huge out-of-the-blue bills to patients. In early December Neal once again defended the interests of his private equity donors, putting forth a proposal they endorsed as an alternative to the more aggressive original bill.
As the unfortunate truth of our corrupt system, politicians acting on behalf of their donors is the rule, not the exception.
The average deductible for Americans in 2019 was $4,544, meaning millions of insured patients still paid almost $5,000 out-of-pocket for their health care. Furthermore, many plans don't cover mental health, dentistry or life-saving surgeries deemed "elective" by the insurance companies. For families, the cost of health coverage now exceeds a whopping $20,000. In the past decade, health insurance costs skyrocketed 55 percent, almost double the increase in the median wage over the same time period.
Predictably, health costs are the number one reason Americans declare bankruptcy. It was estimated in 2019 that two-thirds of all bankruptcy filers cited medical expenses or illness-related work loss, not dissimilar to rates before implementation of the Affordable Care Act. The health insurance companies, meanwhile, raked in $35.7 billion in profits the same year.
Regardless of your preferred solution for outrageous health insurance costs, we can all agree that progress is not being made. To address this and all the issues we face, my organization is tackling the root cause: political corruption. Most Americans agree that big donors have outsized influence and want to limit campaign spending. With the grip special interests have on Congress, an amendment to the Constitution ensuring elections free from corruption is the only proven solution.



















image of U.S. President Donald Trump is displayed on a digital billboard in Times Square in New York on April 8, 2026.
Trump is stuck between two realities. Neither serves the American people
Normally, I worry that events may overtake a column. But not so with the Iran war.
I don’t worry about running afoul of a headline or Truth Social post from the president because what is said about the situation is no longer very relevant to the reality.
On April 8, Nick Catoggio, my Dispatch colleague, dubbed an earlier stoppage with Iran “Schrödinger’s ceasefire.” This was a reference to the famous thought experiment by the physicist Erwin Schrödinger, who was trying to explain the weirdness of “superpositionality” in quantum physics. A cat in a box is both dead and alive at the same time until you open the box. Schrödinger meant to illustrate the absurdity of the idea that particles aren’t any one thing, but a “cloud of probabilities.”
The Trump administration is stuck in a word cloud of probabilities of his own making. The war is over. The war is on. The war isn’t a war. We have a deal, but we don’t have a deal, but we’re about to have a deal. We destroyed Iran’s military. No, we left it intact. We want regime change. No we don’t. We already accomplished it. We “obliterated” Iran’s nuclear program a year ago. We had to go to war in February to prevent nuclear war. The Strait of Hormuz is open, closed, or something in-between. No deal without “unconditional surrender.” Let’s make a deal!
This everything-all-at-once vibe can be disorienting, particularly since most Americans didn’t have a war with Iran on their bingo cards until the shooting had already started. President Trump didn’t prepare the country or consult with Congress beforehand because he thought it would all be a smashing success in a matter of weeks.
The miscalculation that started it all: killing Iran’s Supreme Leader, Ayatollah Ali Khamenei, and much of Iran’s senior leadership, on the first day of the war. To “the great proud people of Iran, I say tonight that the hour of your freedom is at hand,” Trump announced on Feb. 28. “When we are finished, take over your government. It will be yours to take. This will be probably your only chance for generations.”
I support regime change in Iran and shed no tears for Khamenei or his goons. But when you start a war by killing the regime’s top leaders, it’s not unreasonable for the remaining ones to conclude that you really intend regime change.
Khamenei was a murderous fanatic, but he was a fairly cautious one. He liked to threaten closing the Strait of Hormuz or attacking our regional allies, but he was reluctant to actually do it, fearing it would invite a regime change war. The mullahs and IRGC goons believed, not unreasonably, that if they lost their grip on power, they’d be lynched by the Iranian people they’ve brutalized for decades.
By starting with a regime change war, Trump removed any reason for the regime not to go for broke. When you have nothing to lose — particularly when you are a millenarian religious fanatic — a Persian Alamo strategy makes a lot of sense.
So Iran closed the Strait of Hormuz and attacked its neighbors.
But it turns out this wasn’t the Alamo. In the contest of wills, Trump blinked. The Iranian regime’s tolerance for punishment proved — so far — to be greater than Trump’s and that of our gulf allies. Militarily we could finish the job, but that would require ground troops and much greater economic turmoil. In a conflict Trump launched unilaterally without the prior support of Congress, NATO or the American people, Trump doesn’t have the political capital for that.
But that’s only half the problem. Trump wants the war over, but he doesn’t want to pay — militarily, economically, politically — what that would cost. So he wants to make a deal that ends it. But there is no deal available that wouldn’t come at an equally undesirable cost. Any deal that looks like what President Obama struck with the Iranians would be too embarrassing to bear. But the Iranians are convinced that they can get just such a deal, and they’re willing to drag things out as long as it takes.
The result: Trump’s in a box of his own making. He thinks he can talk his way out by simply asserting a reality that doesn’t exist. When the financial markets get nervous, he announces a breakthrough that is, at best, a possibility. When the Iranians agree to a deal that looks similar to one Obama might negotiate, Trump goes back to his threats.
It can’t go on forever. But I’m sure it’ll last until long after this column is forgotten.
Jonah Goldberg is editor-in-chief of The Dispatch and the host of The Remnant podcast. His Twitter handle is @JonahDispatch.