Long ago, when most Americans left the house for mass entertainment, they flocked to carnivals that crisscrossed the country to delight small towns and big cities. Shows typically included a barker whose steady stream of superfluous oratory enticed folks to spend their hard-earned cash on sometimes dubious performances.

Too often today, our nation’s capital resembles that midway where a slick barker spouts enticements to assure people who want to believe what they want to believe that he will always give them what they want. That may be fine when the tickets sold are for harmless attractions, but what mostly seems for sale in 21st-century Washington is this country’s very soul.

One glaring example of our current predicament is an embarrassingly disappointing healthcare system that fails to meet the needs of millions of Americans who can neither afford adequate medical treatment nor a health insurance plan to help them pay for a doctor or the cost of a hospital stay.

Even as the Affordable Care Act (ACA) was being signed into law by President Barack Obama in 2010, it was clear it would need future adjustments. Unfortunately, that necessity has been ignored by President Donald Trump, who in both his first and current administrations has found it more beneficial politically to criticize rather than improve Obamacare.

The ACA has helped cut the percentage of Americans without health insurance from nearly 16% in 2016 to 8% last year. That means more work needs to be done. But while Trump keeps promising a better alternative to Obamacare, he’s barely delivered on even the “concept of a plan” to improve healthcare access for all.

Trump proposed an ACA alternative in January that he calls “The Great Healthcare Plan,” but it’s too weak to get the health insurance industry to become a better partner in extending coverage to more Americans. Trump’s plan would instead end the ACA subsidies that have helped millions of people pay for health insurance while cutting prescription drug prices and requiring insurance companies to do a better job reporting their costs and profits.

A National Institutes of Health study concluded the Obama administration “bowed to the demands of the medical industrial complex comprised of hospitals, insurance companies, and drug companies” to help it make the ACA law because “it was not politically feasible” to get the bill passed any other way. Unfortunately, the feasibility of improving Obamacare has become even more remote under Trump.

That’s a sign of the political strength of major health insurance companies, including UnitedHealth Group, Cigna, Kaiser Permanente, Elevance Health (the parent company of Anthem Blue Cross Blue Shield), and CVS Health, which acquired Aetna in 2018. Those firms have earned more than $9 trillion since the ACA was passed in 2010, and show no sign of wanting to ever voluntarily reduce any income derived from federally subsidized premiums paid by Obamacare customers.

It’s time to stop the giveaway to health insurance companies and reconsider an idea that has failed past attempts to survive Washington politics. Americans need a public option similar to Medicare that would allow eligible participants of all ages to pay adjusted health insurance premiums based on their incomes. Switzerland, Germany, and the Netherlands have similar programs, and President Harry S. Truman proposed a public option for the United States more than 70 years ago, but Congress wouldn’t approve it.

“Millions of our citizens do not now have a full measure of opportunity to achieve and enjoy good health,” Truman said in 1945. “Millions do not now have protection or security against the economic effects of sickness. The time has arrived for action to help them attain that opportunity and that protection.” That same speech could be made today, but this Congress and president seem even more in thrall to the powerful insurance companies that today employ more than three-fourths of all U.S. doctors.

The American Medical Association, in a recent report, cited Washington’s kowtowing to corporate healthcare interests trying to maximize profits as a contributing factor to a current statistic that one in five physicians in the United States say they plan to retire within the next two years. “Many physicians find themselves practicing in direct conflict with their own values, the values that led them to a career in healthcare in the first place,” said the AMA report.

With thousands of doctors abandoning their practices and millions of Americans still unable to afford health insurance, it’s time for a bolder, better healthcare system. This country is too prosperous to have so many Americans worrying themselves to death while trying to figure out how to afford decent medical care.

This nation cannot afford our president’s weak ideas to fill huge gaps in America’s healthcare delivery system. Franklin Delano Roosevelt showed how it’s done in steering the passage of the Social Security Act in 1935. Lyndon B. Johnson got both Medicare and Medicaid through Congress 30 years later. And Obama opened the door for a successor to craft the next phase of the Affordable Care Act. It’s time for Trump to stop promising something even better and produce it.

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