Editors note: As The New Republic reported on Friday, the Los Angeles Times—currently in a race to the bottom with The Washington Post to determine which of the two venerable institutions can sell out to Donald Trump the hardest—found itself in a fresh controversy after contributor Eric Reinhart accused the paper of making significant edits to a piece of his that was largely critical of Robert F. Kennedy, Jr. into one that depicted the president’s pick to run the Department of Health and Human Services with an “optimistic tone,” largely “suggesting that the virulent conspiracy theorist could be an answer and solution to the American public’s bubbling resentment toward the health care industry.”
Reinhart exposed the shady goings-on on X (fka Twitter). “Editing out the most urgent point of an OpEd in the minutes before sending to press while then also assigning a title and image that suggest an argument entirely opposite to the author’s clear intent is pretty shitty,” he wrote. In light of this lamentable journalistic malpractice, The New Republic has agreed to run Reinhart’s piece as he intended it to be read.
RFK Jr’s Wrecking Ball Won’t Fix Public Health
Trump’s health officials should pursue fundamental transformations of U.S. health systems, but destruction alone won’t deliver what we need. We should demand a genuinely populist solution.
Trump’s nomination of Robert F. Kennedy Jr. to lead the nation’s health agencies and the assassination of UnitedHealthcare CEO Brian Thompson are both reflections of the same reality: anger at the wanton greed underlying America’s health systems has reached a fever pitch, and it will not be held back any longer. Major changes are coming, but they may leave us even worse off than we already are.
For decades, our capitalist health systems shaped by the doctor lobby, for-profit insurance, and now private equity have been antithetical to effective public health. Despite spending two to three times more per capita on health care than other high-income nations, the U.S. lags far behind on outcomes while trust in medicine, government, and science have hit historic lows.
As public health scholars have long observed, the root of our collective problem lies in gross overinvestment in profitable medical interventions, which account for only 10–20 percent of what shapes health in the U.S., alongside massive underinvestment in the far more consequential political-economic determinants of health: housing, working conditions, basic income, environmental and food regulation, and everyday social support. Yet, instead of prioritizing these issues, the Biden administration called for a “return to normal”—a boon for the healthcare industry but a death sentence for the approximately one million U.S. residents who die from preventable causes each year. Despite an historic opportunity to rally the public behind bold changes, Biden––and then Kamala Harris too—chose to defend an indefensible status quo.
Donald Trump, by contrast, has risen to power on the promise of wide-ranging disruption. What unites Trump’s chosen health officials are their militant critiques of entrenched public health norms shaped by technocratic experts who have allowed mass preventable death for corporate profits to become our national norm. But while Trump’s health nominees have been loud in their criticisms of the status quo, they have so far offered no coherent vision for rebuilding the nation’s public health on a new basis. Many worry their agenda will ultimately be purely destructive and simply further feed the private profit-making machine. After all, destruction is easy, but building new systems and improving existing institutions requires competence, vision, and hard work.
If they hope to do more than simply destroy and leave mass preventable death in their wake, then Trump’s health officials should look to the convergence of their own criticisms with parallel critiques of neoliberal health policy that have long emanated from the political left. In the process, they should embrace a genuinely populist model of public health. This approach would prioritize providing immediate, tangible benefits to working people and empower them as both recipients and providers of care rather than simply consumers inside a perverse system that serves the rich by abandoning the poor.
A populist public health agenda could unite left and right by addressing the everyday needs of ordinary Americans while combating the alienating elitism and shameless profiteering upon which our current health systems are built. For conservatives, it appeals to values of local control, personal liberty rather than restriction, and trust in local community actors rather than distant bureaucrats. For progressives, it offers a pathway to address economic inequality and to build systems of care that prioritize people over profits. This model for building national health doesn’t dictate what people should do or shame them for their circumstances. Instead, it empowers individuals by ensuring them the relationship-based care needed to be able to shape the conditions of their own lives.
Towards a New Normal
For decades, U.S. public health policy has been dictated by neoliberal principles that prioritize privatization, deregulation, ‘free’ markets, and associated profits over public care systems. This approach values experts rather than working people, reactive medical treatment over prevention through non-medical social care, philanthropic charity as a substitute for government-guaranteed rights, and individual moral responsibility for health in place of public responsibility to address the systemic drivers of disease.
Illness is framed as a matter of individual behavior and personal failure—poor diet, sedentary lifestyles, or smoking, for example—rather than the result of policies that undermine rights to healthy environments. Public health messaging alienates, shaming individuals instead of addressing root causes. For instance, debates about mask mandates and obesity focus on personal behavior while ignoring structural failures like unsafe and exploitative workplaces, lack of air-quality regulation, or cheap unhealthy foods that have crowded out affordable access to healthy alternatives.
Meanwhile, social problems like poverty, isolation, and trauma are medicalized, treated as individual pathologies requiring individualistic interventions, like often-ineffective pharmaceuticals or psychotherapy that cannot touch root causes, while ignoring the necessity of investing in systemic, collective solutions. This diverts resources from community-based social care and prevention, generating profits for industry while leaving patients with endless bills and disappointments.
Populist public health rejects this long-standing but deadly “normal” in America. Instead of focusing on individual behaviors and doubling down on costly medical interventions, it delivers direct benefits to working people on an everyday basis to address the political determinants of health.
For example, policies like universal childcare, housing-first initiatives, and direct cash transfers improve health outcomes while reducing poverty and economic insecurity. During the pandemic, expanded child tax credits and direct payments helped millions of families and brought dramatic health and safety improvements to communities—proof that public investments can make an enormous difference for public health.
A populist approach emphasizes violence and disease prevention, not punishment and reactive treatment. To reduce spread of infectious diseases, it invests in paid sick leave, air filtration in public spaces, cost-free vaccination provided by trust neighborhood health workers, and free high-quality masks in high-flow spaces—policies that enhance individual freedom rather than restricting it via behavioral mandates or forced business closures. To promote healthier diets and to prevent chronic diseases, it subsidizes small farmers, neighborhood grocery co-ops, and fresh produce for working-class individuals and families instead of propping up multinational corporations and factory farms that flood our communities with designed-to-be-addictive ultra-processed foods.
Populist public health is not imposed on people but is instead built with them. And in the process, it earns public trust rather than just demanding it on the flimsy, often-alienating basis of claims to “expertise” alone.
In this spirit, this approach to public health centrally prioritizes community-based, non-professional care services that have 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 everyday services like chronic disease management and prevention, elder care, mental health support and non-police crisis response, and supportive community living arrangements for people with serious mental illness. These workers, rooted in the same communities as those for whom they care, would provide trust-building relationships and strengthen community fabric, benefiting both health and safety for everyone. They should, in turn, be compensated and afforded labor protections on levels comparable to what police officers are currently provided and, again like police, be regarded as essential public infrastructure.
In times of crisis like epidemics or natural disasters, an already-existing and trusted peer-to-peer care infrastructure like this would be invaluable for rapid responses that can identify highest-risk individuals in need of emergency support. But, importantly, the benefits of community care worker programs extend far beyond emergencies. They foster trust in public health, government, and one’s neighbors by addressing the everyday needs of our communities at all times rather than only in periods of acute need.
Such an approach, which should supplement and support universal healthcare via Medicare for All, would help to demedicalize care by shifting resources toward prevention and social support rather than overreliance on expensive medical treatments. It would challenge a medical industry that is financially incentivized to undermine public health and would instead empower ‘ordinary’ people to determine the systems that affect their lives. By doing so, populist public health would restore public health to what it always should have been: a project by and for the people that makes full use of government resources to empower communities.
It is time to demand fundamental transformations in how we approach health in America, but a wrecking ball alone won’t deliver what we need.
Although RFK, Jr., and Luigi Mangione are both responses to the same underlying problem of US healthcare corruption, there is a major difference between them: one allegedly operated outside the law to kill one person in defense of millions, whereas the other—via his egomaniacal disregard for scientific evidence—seeks to use law itself to inflict preventable death on those millions.
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