https://wendy664.substack.com/p/republicans-are-enthusiastically
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A helluva way to treat other human beings. Is this the kind of society we want??
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Art Credit: Untitled Social Realist Mural, artist unknown, in the tradition of Diego Rivera. A nation reveals moral failure when Republican elites take pleasure in suffering caused by policies designed to preserve wealth and power.
Republicans did not reform American healthcare. They built a system where the sick are discarded and profiteers rewarded. Pride in that cruelty reveals a political culture ordered by systematized indifference.
The call came into the shelter on August 3, 2023. A woman had been dumped on the sidewalk out front. Staff found her using a walker. She was incontinent. She was carrying a large bag of medications. She was unclear of what was going on, scared, and could not tell staff who had dropped her off. Federal inspectors later pieced the story together from facility records. She had diabetes. Her tibia had not finished healing. Alcohol-related dementia had compromised her memory. Eastland Rehabilitation and Nursing Center had deposited her without advance notice to the shelter, without prescriptions, without a plan. Shelter staff called the fire department because the healthcare system had left them a medically fragile woman on concrete and no number to dial.
The Centers for Medicare and Medicaid Services filed her in a federal database as Resident #83.
That number is the first line of a clinical diagnosis. The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision, defines Antisocial Personality Disorder by three operational criteria. Persistent disregard for the rights of others. Absence of remorse for harm inflicted. Instrumental use of human beings as tools for institutional gain. Forensic psychiatry calls the full presentation sociopathy. The DSM specifies the pattern must be pervasive, enduring, and uncorrected by the remorse that restrains the non-disordered.
No framework exists in the clinical literature for assessing whether a political party exhibits the disorder at the level of institutional governance. The gap is not a gap in the evidence. The Republican Party satisfies every definitional criterion. The One Big Beautiful Bill Act is the diagnostic artifact. Resident #83 is the first corpse the disorder has produced at scale. The enthusiasm the party expressed at the signing ceremony is the clinical tell.
I write from inside the system under analysis. My orthopedic surgeon operates on me in a few days. The hospital finance office called this past Friday. Billed charges on my insurance estimate exceed six figures. I carry coverage that will absorb most of the total. The hospital still demanded a $1,000 copay before the surgeon’s scalpel moves. Uninsured Americans who need identical surgery cannot access care at all because six-figure charges cannot be produced upfront. The calculus destroys mobility and employment, and it shortens lifespans. Uninsured patients stop walking. Jobs disappear. Disability pipelines begin. The pipeline terminates at a nursing home bed Medicaid will soon stop funding under the OBBBA. The copay is not the outrage. The copay is the proof of the outrage.
Andrew Witty, former UnitedHealth Group chief executive, received $26.3 million in 2024, or 348 times the company’s median employee pay. The six largest national health insurers paid their chief executives $159.4 million that same year. A financing system that delivers $26.3 million to one executive while blocking an insured patient over $1,000 and excluding uninsured patients altogether is operating on the developing nation model in plain sight.
On April 13, 2026, Signal Ohio reporter Jake Zuckerman published CMS reports showing seven Ohio facilities dumping medically fragile patients at homeless shelters. That same day, South Africa’s National Prosecuting Authority charged officials in the scheme that killed 144 psychiatric patients. The mechanism is the same. When governments withdraw payment from licensed care, institutions expel human beings into settings unable to keep them alive.
Ohio shows the mechanism beginning. South Africa shows the mechanism completed.
Resident #83 was not alone. Meadowbrook Manor in Trumbull County sent a patient to a shelter twenty days into a federally required thirty day notice. New Lebanon Rehabilitation expelled a woman with spinal and neurological disorders within twenty four hours of insurance termination. The industry calls the practice involuntary discharge. The honest term is structural abandonment. Ohio housing advocate Marcus Roth said shelter discharges surged across the prior six months. State ombudsman Leilani Pelletier traced the pressure to Medicaid and Medicare terminations after federal reimbursement cuts. Even the Ohio Health Care Association conceded the pattern had gone national.
President Donald Trump signed the OBBBA on July 3, 2025. The law extracts roughly $1.02 trillion from Medicaid over ten years. The Congressional Budget Office projects 7.5 million Americans will lose coverage, the largest rollback of public health insurance since Medicaid began in 1965. More than 300 rural hospitals now stand within reach of closure. CMS Administrator Mehmet Oz imposed six month redeterminations, doubling the prior annual cycle, while work requirements function as coverage termination traps. The statute also restricts provider taxes and state directed payments long used to keep hospitals solvent. The Senate passed the package 51 to 49 with unanimous Republican support, a recorded vote for mass medical attrition.
This is the causal architecture public health theorist Paul Farmer called structural violence: policy choices that systematically produce preventable deaths among populations the political economy has rendered unprofitable.
In Gauteng, South Africa, the same policy architecture reached its terminal form. In October 2015, Health MEC Qedani Mahlangu ended a forty year contract with Life Esidimeni under the rhetoric of fiscal discipline. Patients were bound with bed sheets, loaded into trucks, and transferred without records. 144 died from starvation and neglect, while 44 disappeared. Former Deputy Chief Justice Dikgang Moseneke classified the deaths as systematic torture. On April 13, 2026, prosecutors charged Mahlangu and Makgoba Manamela.
India offers the second documented pattern. In Jalandhar, Civil Hospital has become the physical remainder of a system with nowhere to place the abandoned. Medical Superintendent Rajiv Sharma said the facility holds two to four permanent dumped residents at any time, patients stranded for months because no state rehabilitation center or private ashram will admit them. Activist Surinder Saini repeatedly rescued abandoned women from sidewalks and brought them there. Human Rights Watch found women and girls with psychosocial disabilities confined in mental hospitals where electroconvulsive therapy was administered without consent. Private hospitals transfer uninsured poor patients to public wards when care stops paying. The same user fee model shifted health risk from the state to households.
The pattern has reached every doorstep. Insured households, uninsured households, parents, children, and families carrying diabetes, dementia, failing joints, or diagnoses requiring long term care already live inside the danger zone. The OBBBA is not a distant policy dispute. The law is a blueprint for nursing home beds millions will need, with removal scheduled before demand.
The OBBBA imports the Gauteng model into American law. Work requirements function as user fees, six month redeterminations accelerate coverage loss, and provider tax limits drain hospital financing. Gauteng killed 144 in nine months. The statute distributes similar casualties across a decade, concealing authorship while damage compounds.
Every Republican who voted yes endorsed an American dumping regime. Susan Collins joined Mitch McConnell, Lisa Murkowski, and the party line behind a financing structure South African prosecutors now classify as criminal negligence.
Return the diagnosis to the party. The DSM locates the defining trait not in cruelty, which at least perceives the victim, but in indifference, which dispenses with recognition altogether. Republicans received passage with applause on the Senate floor, issued triumphal statements as each barrier fell, and converted the cuts into fundraising copy marketed as governing success. Party leaders ignored the Columbus shelter where Resident #83 was abandoned and neglected the Gauteng Health Ombud report. Such incuriosity is the marker, while public jubilation supplies the confirmation.
The woman left on the Columbus sidewalk has not been publicly named. Somewhere in Ohio, that woman may still be alive, or already gone beyond public record. One fact remains fixed: the Republican Party built the machinery that placed an unnamed patient on concrete, then celebrated the mechanism as legislative success. You hold the diagnosis now. Send this analysis to readers who still mistake DSM policy for governance. Support Glass Empires so warning arrives before the next casualty.
Sources
Signal Ohio / Associated Press. Jake Zuckerman. Ohio’s nursing homes are dumping patients at homeless shelters. April 13, 2026. https://signalohio.org/ohio-
Centers for Medicare and Medicaid Services. Facility inspection reports, 2023 to 2024.
Congressional Budget Office. Cost estimate and coverage analysis of the One Big Beautiful Bill Act. July 2025.
S&P Global Market Intelligence, citing UnitedHealth Group proxy filing. Former chief tops U.S. managed care CEO pay list in 2024. August 2025.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition, Text Revision. 2022.
Health Ombud of South Africa. Report into the Circumstances Surrounding the Deaths of Mentally Ill Patients in Gauteng Province. 2017.
National Prosecuting Authority of South Africa. Criminal prosecution announcement in the Life Esidimeni matter. April 13, 2026.
Paul Farmer. Pathologies of Power: Health, Human Rights, and the New War on the Poor. University of California Press, 2003.
Human Rights Watch. Treated Worse than Animals: Abuses against Women and Girls with Psychosocial or Intellectual Disabilities in Institutions in India. 2014.
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