Illegal tariffs, tax cuts for the wealthy, and an unauthorised war - Part 2
March 13, 2026
Cuts to healthcare and foreign aid, combined with an unauthorised war, reveal the human consequences of fiscal and political choices now measured in lives.
The same Congress that produced One Big Beautiful Bill Act (OBBBA) as one of only five bills signed into law during Trump’s first 100 days while the executive branch issued over 100 unilateral executive actions also enabled two simultaneous consequences whose human costs are now measurable in lives.
The first arm reaches across the world through the gutting of USAID and the cuts to Medicaid at home. The second arm reaches across the Middle East through an unauthorised war. The beneficiaries of the fiscal fraud that enabled both are on the record. And the dead, present and projected, are being counted.
Arm One: The domestic cost of the fraudulent ledger
OBBBA’s Medicaid cuts are the largest in the program’s history. The Congressional Budget Office projects 10.9 million Americans will lose health insurance as a result through loss of access to the Affordable Care Act. Boston University’s peer-reviewed modelling is more precise about what that means in practice: an American will die every 18 minutes from Medicaid funding restrictions. Medicaid funds more than one quarter of all behavioural healthcare in the United States, which means the cuts flow directly into the suicide and overdose pipeline. This is not a projection about the distant future. Coverage losses began January 1, 2026 – people are losing access to care now.
The fiscal predicate that “paid for” these cuts was, as we illuminated, doubly fraudulent. The Tax Foundation confirmed in March 2026 that the OBBBA reduces federal revenue by $5.2 trillion over the decade on a conventional basis, the same scoring methodology used by the Congressional Budget Office (CBO) and presented to Congress during the bill’s debate.
Even counting every tariff dollar collected, those revenues offset less than 13 per cent of that cost. After incorporating the CBO’s own estimates of spending cuts, the OBBBA still increases deficits by $4.1 trillion. The fiscal predicate that illegal taxation would finance a generational tax cut was a fabrication built on a constitutional violation. The people who designed OBBBA had access to that analysis and they passed it anyway. The 10.9 million Americans losing coverage are paying the price of a calculation that was known to be false before the first vote was cast. When we say pay, the cost is beyond dollars and cents.
Arm One, continued: The global cost of the DOGE cuts
For more than two decades, the United States gave operational form to its historic commitment to the welfare of people beyond its borders through USAID. That commitment, a defining expression of American values in the world for over a half century since John F Kennedy conceived of it, had over that period prevented more than 91 million deaths worldwide, including 25.5 million from HIV/AIDS, eight million from malaria, and 8.9 million from neglected tropical diseases.
It kept alive through direct program funding 20 million people living with HIV across 55 countries, supported 224,000 HIV tests daily, and employed 190,000 healthcare workers in the global response to infectious disease.
On 20 January, 2025, the same day as the swearing in ceremony, the Department of Government Efficiency froze that funding under a continuing resolution that was estimated to be $58.4 billion. The commitment it represented was not wound down. It was ended.
The ImpactCounter project at Boston University, tracking deaths in real time, found that more than 762,000 people died in the first year of USAID cuts alone, more than 500,000 of them children. The breakdown is specific: 158,000 adults and 16,000 children from HIV/AIDS. 164,000 children from pneumonia. 125,000 children from diarrhoea. 70,000 from malaria. 48,000 from tuberculosis.
These are not projections. These are deaths that have already occurred, tracked by peer-reviewed modeling against pre-cut baseline rates.
The forward projections are more devastating still. The Lancet projects more than 14 million additional deaths by 2030, including 4.5 million children under five. Harvard’s T.H. Chan School of Public Health and Boston University project an additional 2.5 million pediatric tuberculosis cases and 340,000 child TB deaths between 2025 and 2034 – rising to 1.5 million child deaths if Global Fund contributions also collapse. UNAIDS projects an additional four million AIDS-related deaths and 300,000 children dying of AIDS-related causes between 2025 and 2029. The hepatitis and HIV treatment infrastructure that USAID maintained were shared, their collapse cascades across every disease they touched.
Every one of these deaths was funded in the precise sense that the tax cuts that replaced USAID’s budget line went to those who needed them least. The Institute on Taxation and Economic Policy finds that the richest one per cent of Americans received a net tax cut in 2026. The children dying of tuberculosis in sub-Saharan Africa did not.
Arm Two: The unauthorised war
The strikes on Iran launched 28 February, 2026, Operation Epic Fury, were conducted without a declaration of war, without congressional authorisation, and in direct violation of the War Powers Resolution of 1973. Senators from both parties said so immediately when US bombs started falling on Tehran and elsewhere.
Since 28 February, the confirmed dead span nine countries: seven American service members, more than 200 Iranians including civilians and the reported victims of a strike on a girls’ primary school, and additional casualties in Israel, the UAE, Kuwait, Iraq, Bahrain, Saudi Arabia, and Lebanon, where Hezbollah opened a northern front against Israel in response. The total confirmed dead since Epic Fury began is 1,700. The true Iranian civilian toll, under a complete national Internet blackout that reached 168 hours, may bring that total higher.
This war is being funded by a military budget approaching $1 trillion dollars, the largest in American history, from the same Treasury that refuses to return $164.7 billion in illegally collected tariff taxes to 300,000 American businesses. The civilisation being struck has survived Macedonian conquest, Arab invasion, Mongol devastation, and the CIA-backed coup of 1953 that destroyed Iran’s democratic government and seeded the conditions for 1979. The historical record of what happens to powers that underestimate Persia is unambiguous. The American taxpayer is now underwriting the lesson.
The reckoning that has no accounting line
Trump stated on 9 March, 2026 in a CBS interview and at a GOP retreat in Florida that the war is "very complete, pretty much" and a "short-term excursion". After that, Iran launched new waves of missiles and drones into Israel, Bahrain, the UAE, and Turkey.
Hours after the first comments, Trump later made a conflicting statement that the US would “ not relent until the enemy is totally and decisively defeated”. The only thing for certain as these words and actions continue in these manners is that innocent lives are lost and forever impacted.
Read Part one of this series.
