The Congressional Budget Office estimates that the legislation would slash Medicaid spending by more than $1 trillion and that nearly 12 million people would lose their health insurance. Senate Republicans added a last-minute infusion of funding for rural hospitals to assuage moderates skittish about the Medicaid cuts,

Meanwhile, cultural attitudes around concepts like “rugged individualism” and “freedom of choice” have long been deployed to resist public solutions. In the postwar decades, while European nations built national health care systems, the U.S. reinforced a market-driven approach.