2017. The year health reform took it on the chin. The year the middle-class, individual health-insurance buyer was abused by President Donald Trump and the entire Republican Party.

In Iowa, where we almost had no insurers in the individual market, we were left with one for 2018, Medica. One is not a choice. Who knows whether we will have insurers in 2019.

All year the Republicans attempted, in one way or another, to repeal the Affordable Care Act (ACA). Over time, their more-than-50 attempts failed, in large part because of projections that as many as 20 million individuals would lose health-care coverage. Because the Tax Cuts and Jobs Act, otherwise known as the tax-reform bill, was projected to lead to only 12 million people losing coverage with the repeal of the individual mandate of health insurance, the Republicans were able to move forward with passage of the tax bill by only three votes in the Senate.

Take these actions down to the patient level. A patient of mine is a small-business owner, and his level of income does not allow him to receive a subsidy through the ACA. He is paying a $2,000 monthly premium for himself, his wife, and their 22-year-old daughter, and the policy has a $10,000 deductible. As I have said before, I do not think high deductibles for health insurance allow for adequate health-care coverage. People avoid seeking health care to avoid paying high deductibles. Given the consequences of the tax bill, with fewer individuals signing up for individual health insurance, every health economist is projecting higher premiums for 2019. My patient is frustrated; I am frustrated.

I believe 2017 will be the year that sealed the deal for single-payer health-care coverage in the United States. It will not happen this year or next, but it will happen. The combined efforts of the insurance industry, which for years has not cared about the individual marketplace, and the Republicans, who either do not understand or care about individual insurance buyers, has led to unmitigated calamity for the individual health insurer for years to come.  Sooner or later, in my opinion, the only solution is single-payer health care. In the meantime, hold on. It will be a wild ride where Americans, including some of my patients, will surely suffer and may well not survive. This is not supposed to happen in America — the wealthiest country in the world.

One final thought: House Speaker Paul Ryan wants to cut or otherwise curtail Medicare and Medicaid benefits in 2018.