I’ll never forget the dentist appointment I had when I was 18. It was supposed to be a routine cleaning, the kind of thing you do every six months without a second thought. After my teeth were polished, the dental assistant took me to get X-rays. As I sat in the chair, I couldn’t help feeling nervous. I’d had plenty of cavities before, and I knew what I’d be in for if I needed more fillings. I asked the assistant if everything looked ok. He glanced at the images on the screen and shrugged. “I don’t see anything troubling,” he told me reassuringly.
A few minutes later, the dentist came in. He peered at the X-rays, did a quick exam, and then delivered the verdict: I had 19 cavities. I didn’t even know it was possible to have that many cavities at once without your teeth crumbling out of your mouth. I sat there in stunned silence, feeling as though the floor had dropped out from under me. When the dentist left the room, I turned to the assistant. How could he have missed 19 cavities? How could I have that much tooth decay without any pain at all?
He didn’t hesitate. He looked me straight in the eye and said, “You have Medicaid. That’s a dollar sign on your forehead.”
That sentence has stuck with me ever since. In that moment, it explained exactly why so many Medicaid patients receive such subpar care. I walked out of that office and never went back. However, the reality was that I didn’t have many options. Despite living in the middle of New York City, where you can find a dozen Thai restaurants on every block, I found it nearly impossible to find a dentist who accepted Medicaid and wasn’t running some racket. When I searched for reviews of the practices that did take Medicaid, they were flooded with one-star horror stories: botched procedures, rude staff, endless upselling, and billing scams. It felt like the only dentists willing to participate were those who had graduated last in their class or kept their doors open by defrauding the system, such as the one I had just seen.
I was so put off that I didn’t see a dentist again for three years until I finally got a job with private insurance. When I finally did go back, bracing myself for the inevitable discovery of those 19 cavities, something miraculous happened: They were gone. The new dentist reviewed my X-rays and couldn’t find a single cavity that needed to be filled. All 19 cavities had apparently vanished, because they had never existed in the first place.
This experience wasn’t an anomaly. It was a window into what happens when a massive government program is run with little accountability and plenty of perverse incentives. Medicaid was created with the best of intentions: to provide healthcare to Americans in need. But good intentions don’t always lead to good outcomes, especially when government bureaucracies grow beyond their original purpose.
Medicaid is back in the news this week because of the One Big Beautiful Bill Act, Republicans’ new budget, and healthcare proposal, which aims to trim the program back to what it was originally intended to be. Originally, Medicaid was designed to serve low-income children, older people, and people with disabilities who couldn’t work. Today, it has expanded so far beyond those groups that in many states, it functions like a single-payer healthcare system in all but name. Enrolled in Medicaid are millions of able-bodied, working-age adults, many of whom could obtain private insurance if they chose to. In some cases, states have opened the doors to illegal immigrants as well.
As expected, Democrats are howling that this is an attack on the most vulnerable Americans. Sen. Amy Klobuchar (D-MN) shared the story of Claire, a disabled girl who relies on Medicaid for in-home care. Sen. Mark Warner (D-VA) posted about a meeting he had with a 14-year-old disabled boy named Ben, warning that Republican cuts would leave children like Ben and Claire without health insurance.
These stories are intended to do one thing: tug at the public’s heartstrings. They are meant to paint Republicans as cartoon villains who wake up every morning dreaming of ways to harm children and people with disabilities. But the reality is just the opposite. Children such as Claire and Ben are exactly the people Medicaid was created to help, and precisely the ones who suffer when the program is stretched to cover millions of people it was never designed to serve.
Right now, Medicaid has been diluted so thoroughly that people with disabilities are forced to compete for care with healthy, able-bodied adults. Resources are finite. When states spend billions covering people who can work or who entered the country illegally, there are fewer caregivers and dollars left for those who truly cannot survive without help. It’s not compassion to pretend the program is sustainable in its current structure. It’s cowardice.
This playbook from Democrats isn’t new. For decades, Democrats have used the same tactic whenever Republicans propose even modest reforms. They declare that any attempt to rein in a bloated entitlement program will literally kill people. If you believe their rhetoric, Republicans have supposedly been killing Americans by the millions every year, whether by ending net neutrality, confirming a Supreme Court justice, passing tax cuts, or letting states set their own abortion laws. The hysteria has become so predictable that it has lost the power it once held.
Consider the failed effort to repeal and replace Obamacare. In 2017, after nearly a decade of promising to dismantle the Affordable Care Act, Republicans finally had the votes in the House to pass a repeal bill. But multiple efforts in the Senate collapsed under the weight of coordinated Democratic messaging and a relentless media campaign declaring that millions would die if the ACA were undone. Ultimately, only the individual mandate penalty was repealed, while the core of the law remained intact. Republicans learned the hard way that if you don’t control the narrative, you will lose, even if your policy is right on the merits.
They aren’t making that mistake again. This time, Republicans are prepared to defend their proposals and to call out the lies in real time. During a press conference earlier this week, President Donald Trump was asked whether 11.8 million Americans would lose their healthcare under the new plan. He didn’t dodge.
“It’s going to be a smaller number than that, and that number will be waste, fraud, and abuse,” he said. He reminded the press that Democrats have created a system so inefficient and overextended that it’s already failing the people it was meant to help. “We are going to save it,” he continued. “Democrats are going to destroy Medicaid and Medicare, and they have to, because their numbers don’t work. They have made it so bad already.”
Vice President J.D. Vance was equally blunt, responding to liberal pundit Matt Yglesias on social media: “This guy wants to bankrupt Medicaid by importing millions of illegal immigrants and giving them healthcare that ought by right go to his fellow citizens. Now he pretends to care about them. The dishonesty is off the charts.”
But perhaps the most powerful argument isn’t from politicians but the people themselves. We have been subjected to so many apocalyptic warnings over the years that we no longer flinch when the next one arrives. The boy who cried wolf has cried himself hoarse. The public is starting to understand that real compassion isn’t measured by how many people you can cram into a failing program. It’s measured by whether the people who truly need help are actually able to get it.
If Republicans want to finish this argument once and for all, they shouldn’t stop with trimming the Medicaid rolls. They should also address the aspects of the program that deter good doctors. Currently, Medicaid reimburses providers at rates often half of what private insurers pay. Most reputable physicians can’t afford to keep their doors open at those rates, so they limit Medicaid patients to a handful of charity slots or opt out entirely.
That’s why so many patients end up in practices such as the one I fled as a teenager, places that prey on desperation and profit from volume billing. Republicans have a chance to deliver a one-two punch: clean out the waste and fraud, and then raise reimbursement rates enough to attract quality doctors back into the system. If they do both, they won’t just be known for cutting Medicaid; they’ll be remembered for saving it.
That isn’t cruelty. It’s sanity. And if we’re ever going to build a safety net that actually works, this is the long-overdue first step. Republicans can seize the moment to become the party that rescued Medicaid from collapse and returned it to its original purpose: caring for the truly vulnerable with dignity and respect.
Bethany Mandel (@bethanyshondark) is a homeschooling mother of six and a writer. She is the bestselling co-author of Stolen Youth.