As Donald Trump retires from the campaign trail to the halls of his Mar-a-Lago court, the hollowness of his alleged populism is resurfacing. The president-elect has so far named a corporate lobbyist as his chief of staff, invited a cast of neoconservative war hawks to serve in his cabinet, chosen climate deniers to head up the Environmental Protection Agency and Department of Energy, and designated billionaire hedge fund manager Scott Bessent to lead the Treasury. The results will no doubt be devastating for the American working class — and it will hurt in few places worse than in health care.

Many health care experts worry that Trump will slash Medicaid funding, placing millions of poor Americans at risk of losing coverage and putting serious financial pressure on local hospitals. The Affordable Care Act marketplace could collapse when key subsidies run out in 2025, especially since Trump has long sought to dismantle these supports, while his plan to force seniors into private Medicare Advantage plans threatens to gut traditional Medicare and drive up costs. Drug companies are likely to see their profits soar under Trump’s looser regulations, reversing Joe Biden’s attempts to rein in the pharmaceutical industry. We are watching in real time as the Republican Party reasserts its dominance and pushes further on the path toward privatization.

Of course, the march of privatization is not Trump’s doing alone. It has been fairly steady for the last half-century of American life, spearheaded by both Republicans and Democrats to varying degrees. There was only one reprieve in recent memory: COVID-19 created the conditions for a temporary expansion of public investment in citizens’ well-being. During the pandemic in 2020, over two hundred million citizens received stimulus checks, and about sixty million children benefited from the child tax credit, while the pain of pandemic unemployment was eased by programs targeting their predicament. For many Americans, this was a novel experience.