There are many ways to kill a healthcare system. You can starve it of money, dismantle its protections, privatise its responsibilities, or convince millions of people that medical care is somehow a privilege reserved for those who can afford it. Washington, under Donald Trump, appears increasingly determined to explore all of them.
On 14 November, World Diabetes Day arrives with an uncomfortable message for America: millions of people are expected to manage a chronic disease while navigating a political environment increasingly hostile to affordable healthcare. The celebration of medical progress becomes a grotesque exercise in contradiction when the political leadership undermines the very conditions that make survival possible.
Diabetes is not a political preference. Insulin is not a luxury. And a functioning pancreas is certainly not something Americans should be expected to purchase through political loyalty.
Yet American healthcare has long operated under a brutal contradiction. The country possesses extraordinary medical expertise, pharmaceutical innovation and technological resources, but millions remain trapped between insurance companies, prescription costs, deductibles and the terrifying arithmetic of staying alive.
Trump's administration has intensified the political assault on the public foundations of healthcare through its hostility towards federal spending, public health institutions and social protections. Its broader campaign against government programmes threatens to make healthcare insecurity even more severe, particularly for low-income Americans, older people and vulnerable communities.
The consequences are not abstract budgetary calculations. They are people rationing medication, postponing appointments, skipping laboratory tests and making decisions no human being should have to make: whether to buy groceries or purchase the insulin necessary to remain alive.
For someone with Type 1 diabetes, insulin is indispensable. For millions with Type 2 diabetes, treatment may also depend on insulin or other essential medication. Insufficient access can lead to devastating complications, including kidney failure, cardiovascular disease, blindness and amputations. The human cost of inadequate treatment is measured not in spreadsheets but in damaged bodies and shortened lives. And here comes the American pharmaceutical circus.
The United States has repeatedly demonstrated its capacity to turn essential medicines into enormously profitable commodities. Pharmaceutical companies defend their pricing structures with arguments about innovation, research and market incentives. Meanwhile, patients are left navigating a marketplace in which the price of survival can become an economic punishment.
There have been insulin price reductions and federal initiatives offering lower-cost options. Medicare's insulin cost-sharing protections have provided meaningful relief to eligible beneficiaries. These achievements matter. But they are not a substitute for universal affordability, comprehensive coverage or a healthcare system that treats patients as human beings rather than revenue opportunities.
The political danger is that Trumpism transforms healthcare into another ideological battlefield. Public expenditure becomes an enemy, social solidarity becomes suspicious, and government responsibility is dismissed as an invitation to dependency. The rhetoric is familiar: freedom, efficiency, individual responsibility.
But what freedom exists for someone who cannot afford insulin? What individual responsibility is possible when the pharmaceutical bill consumes the household budget? And what efficiency can possibly justify preventable hospitalisations, medical emergencies and premature deaths? World Diabetes Day should expose this obscene contradiction rather than decorate it with sentimental awareness campaigns.
Diabetes requires prevention, early diagnosis, continuous monitoring, accessible treatment, nutritional education and sustained public investment. It demands cooperation between healthcare professionals, governments, communities and patients. Above all, it requires political recognition that healthcare is a fundamental human responsibility, not an ideological indulgence.
The Trump administration should be judged not by its theatrical declarations about American greatness but by whether ordinary Americans can obtain the medication necessary to survive. A country capable of sending billionaires into space should not force diabetics to calculate whether they can afford another month of insulin. America does not need another slogan about making itself great again. It needs a healthcare system that makes staying alive affordable. On World Diabetes Day 2026, that should be the minimum demand. Not charity. Not political generosity. Not another presidential performance. Simply the right to live.
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