The nomination of Robert F. Kennedy Jr. by President Trump signals a deep-seated frustration and anger toward the unchecked greed that permeates America’s healthcare systems. While major reforms are on the horizon, it’s crucial that these changes don’t end up putting us in a worse spot than we’re in now.
For years, America’s capitalist healthcare systems, driven by for-profit insurance, physician interest groups, and now private equity, have stood in stark contrast to effective public health practices. Despite spending two to three times more per capita on healthcare than other wealthy nations, the U.S. trails significantly in outcomes. Meanwhile, trust in healthcare and government institutions has plummeted to all-time lows.
Experts in public health have long pointed out that our collective problems stem from a massive overinvestment in profitable medical interventions, which contribute only 10-20% to health determinants. At the same time, there’s been a severe underinvestment in the far more impactful political and economic determinants of health such as housing, working conditions, income security, environmental regulations, and social support systems. Yet, after enduring the worst of the COVID-19 pandemic, instead of turning our focus to these crucial issues, the Biden administration opted for a “return to normal.” This move may bolster the healthcare industry, but it’s a dire outcome for the estimated 1 million Americans who die each year from preventable causes.
In contrast, Trump rose to power promising widespread disruption. His healthcare team has loudly criticized the entrenched norms of public health. However, while they vocally denounce the current state of affairs, they have yet to present a coherent vision for rebuilding our public health systems. Many fear that their intention might be purely destructive, potentially bolstering private profit interests even further.
To achieve more than just dismantling the existing system and leaving Americans even more vulnerable, Trump’s health officials should blend their criticisms with those from the left. They need to advance a truly populist model of public health that prioritizes immediate, tangible benefits for working people, empowering them as both caregivers and care recipients rather than as mere consumers in a flawed system.
A populist public health approach has the potential to unite both sides of the political spectrum by meeting the everyday needs of average Americans and combatting the elitism and blatant profiteering prevalent in current health systems. For conservatives, it aligns with values like local control and personal freedom, emphasizing trust in community actors over distant bureaucrats. For progressives, it provides an avenue to address economic inequality and create care systems that value people above profits.
For decades, U.S. public health policies have emphasized privatization, deregulation, free markets, and the associated profits, favoring experts at the cost of the working class. It has prioritized reactive medical treatment over preventive social care, relying on fickle philanthropy as a substitute for government-protected rights, and placing individual moral responsibility above addressing systemic causes of disease.
Illness is often framed as a personal failure—bad diets, inactive lifestyles, or smoking—rather than a consequence of policies undermining the right to healthy environments. For instance, debates around mask mandates and obesity during COVID often focused on personal behaviors, overlooking structural failures like unsafe working conditions, poor air quality regulations, and abundant unhealthy food options that limit access to healthy alternatives.
Simultaneously, social problems like poverty, isolation, and trauma have been treated as individual pathologies needing medical interventions, such as often-ineffective drugs or therapy. This approach diverts resources away from community-based care and prevention, benefiting industries while burdening patients with endless bills and disappointments.
Opposed to this, a populist public health model promotes policies like universal child care, housing-first initiatives, and direct cash transfers to improve health outcomes and alleviate poverty and economic insecurity. The success of expanded child tax credits and direct payments during the pandemic proved that public investments can significantly enhance people’s health.
Focusing on violence and disease prevention over reactive treatment, this approach enhances individual freedom by investing in paid sick leave, air filtration in public spaces, and cost-free vaccinations provided by trusted local health workers.
To encourage healthier diets and curb chronic diseases, this model supports local farmers, neighborhood grocery co-ops, and fresh produce availability for working-class populations instead of backing multinational corporations and factory farms flooding communities with addictive ultra-processed foods.
Prioritizing community-based, non-professional care services has been shown to improve both mental and physical health while reducing medical needs and healthcare costs. Publicly funded programs can train and employ local residents as community care workers to provide services like chronic disease management, elder care, mental health support, and crisis response, fostering supportive community living for individuals with serious mental illnesses.
Not only do these workers offer day-to-day benefits, but they also provide invaluable peer-to-peer networks in times of crisis, such as epidemics or natural disasters. Rooted within the communities they serve, they build trust and reinforce the social fabric, improving health and safety for everyone.
Such an approach would guide us away from excessive reliance on expensive medical treatments and toward true public health as it should be: a community-driven project utilizing government resources to empower people.
We must strive for a complete overhaul in how we perceive healthcare in America, but simply tearing down the current system won’t yield the results we desperately need. Eric Reinhart, who is a political anthropologist, social psychiatrist, and psychoanalytic clinician, provides us with these insights.
