Over the last century, the historically conservative US medical profession has doggedly opposed investment in public health systems that public health requires, often justifying itself on the basis of appeals to political neutrality. This has been a huge blunder, contributing to the highest health care spending alongside the lowest life expectancy among all wealthy nations.

When the first Trump administration’s incompetence led to pandemic disaster, it appeared this anti-political medical tradition was finally set to change. American physicians and medicine’s professional leaders began engaging the politics of care as never before, with influential academic journals issuing unprecedented editorials in opposition to Trump and a wave of doctors rallying behind the Democratic Party. Mass preventable death accelerated the recognition of two basic truths: effective care systems cannot be limited to medical treatment, and health is always tied to politics and power.

The Democratic Party presided over the deflation of this momentum, as the Biden administration repeatedly urged Americans to “get back to our more normal routines” –– and medical professionals eagerly complied. In the process, high rates of health care exclusion alongside preventable disability and death caused by decades of market-oriented policy were once again normalized.

PQL: Until we force our political representatives to radically remake America’s health systems, we will continue to suffer from large-scale preventable disease.

Joe Biden’s and then Kamala Harris’s refusal to offer a meaningful alternative to a status quo that amounted to a death sentence for thousands of US residents each year fueled widespread nihilism. These dynamics set the stage for Trump’s return to power on the promise of disruption and destruction –– a promise on which he is now making good.

Until we force our political representatives to radically remake America’s health systems, we will continue to suffer from large-scale preventable disease. We will also continue to foster political conditions for the continued rise of the extreme right and its decimation of what few public care resources remain.

We need universal health care — but we need far more than that. When access to medical care represents only 10 to 20 percent of what determines health in the United States, our demands must address the even more important political-economic determinants of health: safe working conditions (including universal paid sick leave), income and housing security, elder care infrastructure, environmental regulations and consumer protections, ending mass incarceration, and building community care worker and non-police crisis response systems.

Social medicine, which focuses on the origins of disease and early death, teaches that patients cannot be treated effectively without addressing root causes like poor housing, poverty, and inequality shaped by long-standing bipartisan commitments to profit-generating “free markets” in place of public systems and rights. Although much of this should be obvious, the lessons of social medicine remain marginal in American medical education. And they typically constitute only empty rhetoric in the most powerful public health circles, where endless research on the social determinants of health has long operated as a substitute for actually changing them.

Social medicine has had even less influence in American politics — a reality that has long been true under both Democrat and Republican administrations. This is in part because of the reluctance of many of medicine and public health’s institutional leaders to appear political for fear that they might lose the status, credibility, and funding they enjoy as “neutral” scientific authorities. As the Trump administration’s weaponization of control over federal funding is now making exceptionally clear, this is dangerously irresponsible and has always been based in indefensibly naive illusions.

PQR: Social medicine has had even less influence in American politics — a reality that has long been true under both Democrat and Republican administrations.

American doctors, politicians, health care lobbies, and business interests have for decades characterized health as a matter of personal choice rather than of public policy. This stance has been key to protecting an enormously profitable market-based American health care industry from the threat of “socialized medicine” — a term often used derogatorily to refer to the far more effective health systems enjoyed by residents of every peer nation. These individualistic, apolitical frameworks are now supplying the basis for Trump’s crusade against public health.

What is actually killing people, then, is not the politicization of public health but rather the lack of effective political organizing to oppose health care profiteering, public health underinvestment, inadequate environmental regulations, and exacerbating economic inequality.

Our health crises can only be effectively countered by a mass political movement for care  –– something that neither major party currently represents and that both, each beholden to wealthy donors and lobbyists focused on maximizing business opportunities, in fact oppose. But we should not allow for false equivalences: only one party is, via both domestic policy and cuts to essential global health programs, openly embracing eugenicist agendas targeting poor and disabled people, immigrants, people of color, and LGBT people.

The leaders who brought us to this point will not be the ones to deliver us from it. We can’t wait on either political party to save us, nor on philanthropists, consultants, or medical lobbies. Health workers must instead embrace political struggle as a basic caregiving responsibility.

PQL: Our health crises can only be effectively countered by a mass political movement for care  –– something that neither major party currently represents.

We should take heart from recent increases in unionization campaigns and strikes by health workers, and help to expand such efforts to address not only the working conditions of doctors and nurses but also the needs of patients too. For our part, health workers must insist not simply on protecting our own interests but on building broad coalitions with working-class Americans with the goal of stopping Trump’s destruction of our fragile and already-inadequate care systems.

But simply condemning the Trump government will not be enough. We must also acknowledge the legitimate basis of widespread anger at US health care corruption and reroute it into constructive forms of expression. We must offer an alternative, inspiring vision for a society with  a politics of care at its center. This requires fighting to ensure that every single person in this country is guaranteed essential social and medical care: living wages and guaranteed basic income, paid sick leave, guaranteed housing, clean air and water, community care workers, excellent education, and, yes, top-quality health care.

These are the kinds of ambitious shared projects needed to recruit and productively transform –– rather than vainly attempt to repress –– the mass energy linked to current widespread discontent that has been so successfully channeled by destructive far-right politics. With such a movement, we could collectively realize what I have described elsewhere as a truly populist approach to public health rather than the false health populism represented by RFK Jr and Trump’s other viciously opportunistic health officials.

Although much of the American medical profession has often sought to disavow this reality, the fact is that public health and medical care are not — and have never been — apolitical domains.

For the sake of public health and the future of democracy, we must generate a sustained politicization of public health that insists on building systems for care regardless of party, class, or crisis.