The stark impacts of the One Big Beautiful Bill Act — the official name of HR 1 — are beginning to sink in. Yes, it’s true: Congress has just voted to cut health care and food benefits by well over $1 trillion so the richest among us can continue to enjoy historically low tax rates.

If you polled Americans even now on these questions separately, it’s highly unlikely majorities would favor putting more tax dollars into the pockets of millionaires, or cutting off health care to citizens who are, almost by definition, struggling to make ends meet. We continue to go through cycles of Democratic Congresses expanding “welfare” benefits and Republicans just as readily cutting them back. The question is why.

We forget how close Republicans came in 2017 to repealing the Patient Protection and Affordable Care Act, the most notable Democratic legislation of the 21st century, just four years after it took full effect. That congressional-led effort saw Speaker Paul Ryan coaxing a 217-213 vote — sound familiar? — from the House, followed by a dramatic Senate debate.

Repeal had momentum until Sen. John McCain strode into the chamber and signaled thumbs-down. McCain, the 2008 GOP presidential nominee, undoubtedly voted his conscience, but was also paying back Donald Trump, exempted from military service, for ridiculing McCain — a Vietnam War hero — during Trump’s 2016 presidential campaign.

Eight years later, with Trump fully in charge of the congressional agenda, Republicans opted to cut back Affordable Care Act benefits rather than eliminate them. Nonetheless, state legislatures — most, like Maine, having already finished their sessions — now face the Hobson’s choice of raising taxes to keep people on Medicaid (MaineCare) or eliminating their insurance, further straining rural hospitals and forcing emergency room visits for basic care.

We may be coming to — one hopes — the end of a 30-year federal effort to privatize health care, the dire consequence following failure of President Clinton’s health care legislation in 1994. We must try something else.

The costs of privatization are all too plain in our daily lives, including huge, profitable health care giants accountable to no one. Revenue is now the measure of success; delivering health care equitably to all who need it ranks far down the priority list.

We need to focus on an idea that sounds radical but is actually basic common sense: Create a universal national system providing care to everyone, just like every other developed country. Nothing else will work.

Privatization afflicts every part of our system, including Medicare for those over 65 — the one universal access program we’ve had from 1965 onward. But Medicare is now at the mercy of private insurers, subsidized by taxpayers, offering better benefits than “traditional” Medicare.

It’s also victimized by pharmaceutical companies charging us whatever they want; Joe Biden made only a dent in this bizarre system. Nor can we reliably get drugs our doctors prescribe; insurance company algorithms deny coverage with no effective appeal process.

Maine’s situation is not much better, as local hospitals are absorbed by large statewide nonprofits, also publicly unaccountable, with continuing cuts to rural hospitals and elimination of vital services like birthing centers.

The obvious model for universal care is Canada, where Medicare — its version — covers everyone, patients receive no bills, drug prices are much lower and the inevitable battles between providers are settled by supervising government agencies, not taken out on consumers who rightly fear, post-Trump, they won’t be able to afford premiums.

Democrats who stop short of embracing universal care don’t recognize that patchworks like the Affordable Care Act don’t work either. Privatized Medicare provisions were added in 2007 under George W. Bush, and Barack Obama didn’t try to undo them two years later. Medicare, the one American model for universal care, is no longer a good one in its current form.

Medicaid, mostly federally funded but state-administered, is an inviting target for Republican budget-cutters because it serves the poor, the most powerless part of the population — much like smokers recently targeted by Maine budget-writers for a 75% cigarette tax increase.

“Reforms” advocated by Republicans, such as work requirements, are worse than useless. Georgia recently spent $90 million administratively enforcing such requirements to produce a $28 million reduction in benefits; no one wins.

Ideas, however flawed, are powerful, so the notion Americans must “deserve” health care, unlike anywhere else in the world, can only be overcome by a comprehensive system. We need to channel Social Security’s universal retirement benefits, and not the Medicare amendments to the same Social Security Act.

Crafting the new system will be complicated and difficult and take years. But we’ve reached the point in our national life where we have no good alternative. Candidates take note.