I’ve got a genius business idea for people with few discernible skills. First you establish a “health insurance” company and get people to pay you large sums every month. Then, when a customer tries to use their insurance to cover medical costs, make a habit of denying their claim. While doing that, pay lobbyists to keep politicians amenable. Repeat this strategy until your company is worth billions.

I’m not saying this is exactly how the US health insurance industry works, but it’s close enough. There is a reason Americans spend the most on healthcare in the industrialised world, but have the worst health outcomes, according to an analysis by the Commonwealth Fund. Privatising a public good is great for a few well-remunerated executives but rarely benefits the masses.

Not that I’m criticising these insurance companies. No sir. I love the fact that my wife spends $750 a month on health insurance for our three-person family (with the rest of the astronomical bill being covered by her employer), and we still have to pay a minimum of $500 to visit the emergency room. I love the fact that, according to a 2024 YouGov poll, nearly a quarter of Americans didn’t call an ambulance during a medical emergency because they were worried about costs.

And, most of all, I love the fact that healthcare in the US is poised to become even more complicated and expensive. The roughly 154 million people who get health insurance through their employer are going to see their paycheck deductions rise by 6-7% on average next year, one analysis has found. Meanwhile, self-employed people who get insurance through the Affordable Care Act marketplace (often known as Obamacare) are going to see the cost of their cover go up by 26% on average next year because subsidies are set to expire and Republicans refuse to come up with a plan to address this. Back in 2018, before I got insurance through my spouse, I was paying $470 a month as a freelancer for my Obamacare plan. Now, that same plan would cost over $900 a month with $4,000 excess – and wages have only gone up a little bit.

How are people expected to handle increased health insurance costs when everything else in life has also become more expensive? I think the answer is: they’re not. Welcome to Trumpcare everyone: you may bankrupt yourself trying not to die, but at least you’re not living under socialism.

• Arwa Mahdawi is a Guardian columnist