President Donald Trump came into office with great ambitions. “America will start winning again, winning like never before,” he promised during his Inaugural Address. Nearly ten months later, Trump is still without a major legislative achievement. With the 2018 midterm elections just a year away, the proposed Republican tax plan may be his last chance to secure a long-promised victory.
At this point, two things are clear about the plan: it will cost a lot of money, and Republicans will pay for it by increasing the national debt.
This is highly concerning. The US gross federal debt, at over $20 trillion, is now larger than the size of the economy. As the national debt continues to grow, a rising share of the federal budget will be used to pay interest costs to bondholders. Any further increases in the debt today threaten our ability to make crucial investments in the nation’s infrastructure, military, and schools in the future. At some point, this situation will become untenable, and the federal government will be forced to adopt some mix of spending cuts and tax increases to pay down its debt. Spending on programs like Medicaid, Medicare, and Social Security would be at risk. Aside from destabilizing our economy, these fiscal austerity measures will have a devastating effect on our health.
History has shown that these policies boost unemployment, which has been linked to an array of negative health outcomes. Unemployed workers are more likely to experience psychological problems, engage in unhealthy activities, and report being in poorer health than employed workers. They also experience higher mortality rates. A 2009 study of 26 European countries found that increases in the unemployment rate between 1970 and 2007 were linked to increases in suicides and homicides.
But we don’t have to look at distant history to get a sense of what could happen if the United States government were to adopt a program of spending cuts and tax increases. A number of European countries adopted such measures in the aftermath of the 2008 financial crisis. The collective impact of these policies on public health has been grim.
As austerity measures drove economies into crisis, poverty soared. As a result, child malnutrition rates and infectious disease transmission increased. In Greece, the number of new HIV infections jumped nearly 3,000 percent, and locally transmitted malaria, absent since the 1970s, re-emerged. At the same time, medical budgets were not shielded from draconian cuts, which increased barriers to accessing medical care. The ranks of the uninsured swelled, and co-payments, and patient waiting times surged. Significant numbers of patients had to forego necessary treatment.
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Unsurprisingly, mental health suffered in this environment, reflected in higher rates of depression, substance abuse, and suicide. A 2015 study that examined Greece, Ireland, Italy, Portugal, and Spain between 1968 and 2012 found a link between suicides and reductions in government spending. Elderly men were worst off, experiencing a 3.3 percent increase in long-term suicide risk for each 1 percent reduction in spending.
Of course, America is not Europe, and the experience of every country that implements fiscal austerity measures is different. But considering the impact that austerity could have on America’s health isn’t just a theoretical exercise. President Trump’s 2018 budget, for example, proposed slashing more than a trillion dollars from Medicaid over a decade, and cutting the budgets of the Supplemental Nutrition Assistance Program (SNAP, formerly known as the Food Stamp Program) and the Children’s Health Insurance Program (CHIP) by 25 percent and 20 percent, respectively. Combined, these cuts would dramatically increase the number of people without health insurance in the United States and weaken the country’s safety net. The age of austerity, it turns out, may be closer than we care to admit.
Moreover, there's a real risk that our current budgetary woes are here to stay. With an aging population contributing to growing Medicare and Social Security costs, federal budget deficits are projected to balloon over the next several years, raising the national debt to more than $30 trillion by 2027. And despite perennial bipartisan concern about the size of the national debt, little has been done about it. From 1967 to 2016, a period spanning 50 federal budgets, the United States recorded an annual surplus only five times.
Given the tremendous health burden that fiscal austerity could impose, we should question whether the costs of any deficit-increasing legislation would be justified. In the case of Trump’s tax plan, the answer is clearly no. The US economy is on its best footing since the financial crisis began a decade ago. The unemployment rate is at its lowest level in nearly two decades, gross domestic product is expanding, and the stock market is booming. A tax cut, at this stage, is not necessary. In fact, it would be wasteful, and the Federal Reserve has even hinted that it would raise interest rates to counteract any stimulatory effects of Trump’s plan.
Trump has repeatedly promised better healthcare. But wasteful increases in the national debt threaten the health of every American. After all, today’s tax cut is tomorrow’s tax increase and spending cut, and prior experience shows that such a mix could lead to increased rates of poverty and malnutrition; the spread of infectious diseases; decreased access to medical care; declines in mental health; and higher mortality rates. With so much at stake, Congress should roundly reject the President’s plan. The health of the nation depends on it.
Kunal Sindhu is a resident physician in New York City. Follow him on Twitter @sindhu_kunal .
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