Your hospital bill — and the rent check, the insurance premium, the medical debt that follows you into bankruptcy — is what’s stripping dignity from American families. Zohran Mamdani is not. Zoning rules and consolidated insurers are already doing the bleeding.
In a recent Fox News op-ed, Cuban-born commentator Yali Nuñez, writing under the title “As a Cuban survivor, I know there is no dignity with socialism. But we all pay the price”, argues that any government role in healthcare, housing, or wages is a path to misery. She lived sixteen years under Cuban socialism. She anchors the case in her childhood in Havana and in a new White House Council of Economic Advisers report putting the cost of seven Democratic Socialists of America proposals at $49 trillion over ten years — roughly $355,000 per American household — with Medicare for All accounting for $47.4 trillion of that figure. Dignity, she concludes, belongs to the individual, not the state, and a free market with lower taxes and fewer regulations is the only path to it. She treats the number as the price of government overreach. The argument mistakes the price of changing a rigged system for the price of keeping it.
Cuba is not the relevant comparison. Cuba is a one-party state under a six-decade U.S. embargo, and its failure — central planning of most of the economy, generalized price controls, no way to vote the planners out — is real, and Ms. Nuñez lived it. But nobody running for office in New York or Washington is proposing a one-party state, an end to private business, or the nationalization of farms. Comparing a public insurance option to Castro’s Cuba is like comparing a municipal library to the Spanish Inquisition because both involve books. Medicare for All does not put the DMV in charge of your prescriptions. Zoning reform does not seize your factory. The mechanism is different. The freedom is different. The outcome is different.
The $49 trillion deserves a closer look than Ms. Nuñez gives it. The Council of Economic Advisers is a White House council, staffed by the party that opposes the proposals it is scoring. Even taking its number at face value, the accounting is gross spending, not net cost — it counts every new public dollar without subtracting the dollars that stop flowing to private insurers, hospital billing departments, and landlords extracting scarcity rents. The United States already spends more per capita on healthcare than any other country on earth, roughly twice the rich-country average, and produces worse life expectancy. The question is not whether the money gets spent. It does. The question is whether it goes through an insurance company with overhead near fifteen or twenty percent or through a public payer whose administrative overhead runs around two percent. Shift the same dollars through a cheaper pipe and the bill does not necessarily rise. It can fall. Static scoring is built to be blind to that.
And the CEA’s baseline is not free. It scores the next decade against one in which American healthcare costs keep climbing, single-family-only zoning keeps bidding up rents in the places where jobs actually exist, and concentrated employers keep flattening wages. A typical American family already spends roughly $20,000 a year on those two categories combined. Run that out over ten years and the price of doing nothing is itself in the tens of trillions — before you count what medical debt and homelessness cost in productivity and human misery. That is the bill the CEA scored as the status quo. It is the one already on your kitchen table.
I will concede the point the op-ed gets right. Government can fail people, and American licensing does strangle small firms. A cosmetology license that requires 1,500 hours of training in one state and 300 in the next is not protecting consumers from bad haircuts; it is keeping wages high for the people who already paid the barrier. A manicurist in many cities needs more permits than a doctor did a generation ago. A home-based bakery can be shut down by a zoning rule written to protect supermarkets. That regulatory thicket is a real dignity problem for the working poor who want to start something, and it belongs in any serious dignity agenda. Where it exists to lock people out, it should be cleared — and her side should be leading the fight.
The answer, though, is not to fold up the only institution with the standing to negotiate with the hospital chains, the pharmacy benefit managers, and the landlords. It is to fix the shop.
Dignity at human scale looks like a 64-year-old with a four-thousand-dollar deductible getting a public option that lets her keep her doctor and cuts her premium in half. It looks like a family of four in a city where the median rent has crossed two thousand dollars a month, with housing supply expanded by state-level zoning reform of the kind California, Massachusetts, and a dozen blue cities have already passed. It looks like a renter who can find a two-bedroom in the school district where they already work. It looks like a home-care worker in Mississippi with a union contract and a wage that keeps her above the poverty line without depending on tips. It looks like a hairstylist who does not need a 1,500-hour course to rent a chair.
So end single-family-only zoning on most of the residential land in your metro so small landlords can compete. Set a public health option large enough to negotiate the way Medicare negotiates, and let private plans undercut it on service. Prosecute the wage-fixing and no-poach agreements that let regional employers coordinate on pay. None of that requires dismantling private business, and none of it is Cuba. All of it makes the next decade cheaper than the one the CEA scored for you — because the one they scored for you is the one we are already living in. Dignity is not built by leaving working people alone with the bill. It is built by giving them a counterweight to the price-setters.