Wake-up call for the American Dream

Achieving the American Dream may take the painstaking toil of generations, yet it takes only two bills to shatter it: a health insurance premium and a college tuition statement.

For Yang Lin, a data scientist at a Bay Area tech company, this August feels particularly stark. Her daughter is heading to a private college this fall as a freshman while her husband has been out of work since last September. When their company-subsidised health insurance terminated, Lin shopped around the marketplace and got a monthly quote of $2,400. "Are you kidding me?" she said, adding that her daughter's college tuition alone runs $70,000 a year, with another $20,000 for room, board and a meal plan.

"I'm afraid we are going to go broke," she said quietly. A first generation immigrant, Lin is now the sole breadwinner for a family of three in one of the most expensive states in the US. "We are a living example of the working American family squeeze," she told China Daily. "I don't have an American Dream. If I have one, it's this: give me affordable health insurance now."

Lin is not alone. Elevated prices of healthcare expenses and rising costs of living in recent years have become a new normal, and have exerted financial strains upon millions of American families.

According to a 2025 West Health-Gallup Healthcare Indices Study, approximately 11 percent of US adults admitted that they could not "afford or access quality healthcare", which involved nearly 29 million Americans, the highest level since 2021.

Classified as "cost desperate" in the study, the group is disproportionately made up of Hispanic Americans at 18 percent, Black Americans at 14 percent, and households earning under $24,000 annually at 25 percent.

In her 2026 research, Munira Gunja, a leading scholar at the Commonwealth Fund, and her colleagues found that roughly 8 percent of the American population is uninsured, while 25 percent carries coverage so thin that it barely provides real protection. Due to high deductibles and out-of-pocket costs, Gunja found Americans are far more likely than people in comparable countries to skip filling a prescription, avoid a diagnostic test, delay treatment or abandon a care plan their doctor recommended.

Gunja concluded that the causes of America's "uniquely poor health performance" relative to its peers include the absence of universal coverage, a weak primary care infrastructure, steep out-of-pocket costs and an insurance system of bewildering complexity.

For those on the front lines of the American medical system, the frustration is visceral. Eric Yuan has operated a dental clinic in California since 2010. "We have a front-row seat to a worsening system," he said. "Premiums are insanely high, the billing system is so complicated and I cannot say the service is on par with the cost."

Yuan visits China at least once a year, using each trip to undergo comprehensive health screenings, ranging from MRIs, cancer screenings, to other tests that American insurers routinely deny. "I spent $500 to have myself examined head to toe," he said. "The care is thorough, efficient and the experience is remarkable."

The contrast has led him to a decision that would have seemed unthinkable a generation ago. "I will relocate to China when I reach 62," Yuan said. "It is a no-brainer. I want to have at least a basic medical safety net for my retirement."

Amy Liu, a registered nurse at a Santa Rosa, California-based medical facility, told China Daily that many patients she received during night shifts sought emergency care, for which hospitals are legally required under federal law to provide medical screening and stabilizing treatment, regardless of patients' insurance status or ability to pay.

"Both the patients and the hospitals understand that. I guess that is the only solution for some of the affected families to get some sort of medical assistance," Liu said. "But the cost will not go away. Ultimately, the taxpayers will foot the bill. I regret that the whole medical system is failing Americans, many of them."

Similarly, the college bill is another mountain that tens of thousands of American families are carrying uphill, one that has negatively affected public perception about the merits of undergraduate and graduate education. A recent poll from EAB, a higher education consulting agency, drew on responses from more than 9,500 students and concluded that 67 percent of those surveyed said they are "currently opting against college" due to cost-related concerns. Many reported worrying about the student loan trap, as well as costs for rent, food and other necessities.

"College education, especially attending high-ranking schools, has become a luxury only the rich and the elite can afford," said Yanzi Luo, a Michigan resident who had to convince her son to decline an offer from Harvard and attend the University of Michigan instead. "It was a hard decision for the family to make, but the difference between $90,000 and $30,000 a year is reason enough to choose," she said.

"Our students are facing challenges unlike anything we have seen before," said Stan Hicks, a high school educator in Fremont, California. "Whether they continue with college or enter the workforce right after graduation, the road ahead is hard, yet full of opportunities."

junechang@chinadailyusa.com