6 ways to make America healthy
Hint: you won't find them on a MAHA stage
RFK Jr’s MAHA website, which replaced his presidential campaign site, lists his top issues to tackle if he’s appointed to a cabinet position in the Trump administration:
Reverse the chronic disease epidemic
End the forever wars
Protect our Constitutional rights
Get corruption of out Washington
Two of these issues are tangential given Kennedy’s intense focus on food and medical issues. Perhaps the copy-paste intern from his campaign site missed a directive. Perhaps Bobby is just not as clear as he’d like you to believe. Perhaps both.
The latter rings true given the moment below, from the American Health and Nutrition Roundtable, when Jillian Michaels was asked the number one thing she’d do to make America healthier. She offered a wonderful reply: get rid of Citizens United. A reply stonewalled by an unmoved Kennedy while the event’s host, Senator Ron Johnson, moved on as quickly as possible because despite Bobby’s claims, getting money out of politics will never happen in a Trump administration.
Back to the first agenda item. It would take many people to accomplish this list, but here it is in full.
With President Trump’s backing, [Kennedy] will reorient federal health agencies toward chronic disease and rid them of Big Pharma’s influence. He will ban the hundreds of food additives and chemicals that other countries have already prohibited. He will change regulations, research topics, and subsidies to reduce the dominance of ultra-processed food. He will clean up toxic chemicals from our air, water, and soil. He will ensure that research into pharmaceutical drugs, pesticides, additives, and environmental chemicals is scientifically unbiased.
Quite a list of given this is only one of four MAHA pillars. Plus, there are two immediate problems:
He’s assuming Trump, possibly the most transactional man in history, will actually offer him a cabinet position—a notion that hasn’t stopped Kennedy from fundraising off the idea
Project 2025 calls for the downsizing, gutting, or disassembly of the FDA, CDC, HSH, FTC, and just about every other agency that could help accomplish these goals
Kennedy mostly appears to be focused on attention and donor dollars. The cohort he’s assembled, however, offers a range of bespoke solutions to America’s health crisis: supplements, continuous glucose monitor subscriptions, “natural” (though still processed) foods, books, podcasts, and a range of subscription services.
I’ve yet to identify any of them taking public health seriously. They invoke its name, then try to sell you on ice baths.
All of which creates a paradox: wellness influencers cite poor health statistics predominantly driven by poor and minority communities (since those communities experience the worst health outcomes) and then sell solutions that only richer, whiter communities can afford.
In More Than Medicine: The Broken Promise of American Health, adjunct professor of medicine at Stanford, Robert Kaplan, cites many issues with individualized medicine. While his book primarily focuses on an increasing reliance on genetic testing that’s driving biotech investment money, broader critiques of “personalized” medicine—also the promise of many alt-med fields—fit quite well into the surging wellness boom.
A few points Kaplan makes:
Individualized medicine, when taken to extremes, can lead to overdiagnosis and overtreatment. This sometimes means a cascade of unnecessary and potentially harmful diagnostic tests and procedures, mirroring the CGMs, blood draws, and “gut health” tests that many wellness folk are capitalizing on, especially when it comes to “biohacking.”
Also akin to wellness: Kaplan writes that the emphasis on individual responsibility inherent in individualized medicine can obscure the social determinants of health. It reinforces the narrative that places undue emphasis on personal responsibility for health, neglecting the powerful social, economic, and environmental factors that shape health outcomes.
Finally, focusing on individualized medicine may divert resources from more effective public health interventions. An overemphasis on finding cures, often through individualized approaches, comes at the expense of addressing the social, behavioral, and environmental factors that significantly contribute to health outcomes.
What about actual solutions?
Wellness influencers and Silicon Valley investors alike are focused on personalized solutions because they’re profitable. Yet most researchers, public health officials, and epidemiologists recognize that the best way to ensure individual health is to approach the issue systemically and address population health first.
Below are six potential solutions, followed by a short bibliography that has informed this list.
Strengthen primary care: By prioritizing primary care and preventative measures, which have a broader population focus, healthcare systems can address health issues earlier and reduce the need for expensive specialized care later on. This shift would require increased investment in primary care infrastructure and workforce, ensuring that all individuals have access to affordable and high-quality primary care services.
Address social determinants of health: Policy solutions must extend beyond the traditional medical model to include policies to reduce poverty, improve education and housing conditions, and promote healthy behaviors. Tackle these upstream factors and you have better results downstream. This would require political leaders to address such policies, which, given the upcoming election, would mean that Democrats would have to win the presidency and control the House and Congress, and be pressured into such legislation, since they’re also beholden to lobbying pressures.
Expand coverage: Fix inequalities in insurance coverage. Expanding coverage, whether through a single-payer system, a public option, or strengthening existing programs like Medicaid, is crucial for ensuring that all individuals have access to essential healthcare services, regardless of their income or employment status. My take: quit tying insurance to employment and implement socialized medicine (with a private option).
Address payment inequities: All individuals should have access to a similar standard of care regardless of insurance status. This could involve increasing Medicaid reimbursement rates, exploring alternative payment models that incentivize value-based care, and working to reduce administrative burdens that disproportionately impact safety-net providers.
Evaluate the value of treatments: Ever-newer and more expensive treatments often offer only marginal benefits over existing, less costly options. Have economists and public health officials duke it out and assess the clinical and economic value of new treatments. Then promote shared decision-making between patients and providers.
Improve price transparency: The lack of price transparency in the U.S. healthcare system hampers informed decision-making. Everyone should know what they’re paying for before visiting a doctor’s office; emergency medicine should be equally transparent.
Bibliography
An American Sickness: How Healthcare Became Big Business and How You Can Take It Back — Elisabeth Rosenthal
Betrayal of Trust: The Collapse of Global Public Health — Laurie Garrett
More Than Medicine: The Broken Promise of American Health — Robert Kaplan
Priced Out: The Economic and Ethical Costs of American Health Care — Uwe Reinhardt
Taming the Beloved Beast: How Medical Technology Costs Are Destroying Our Health Care System — Daniel Callahan
The Social Transformation of American Medicine: The rise of a sovereign profession and the making of a vast industry — Paul Starr
Tyranny of the Gene: Personalized Medicine and Its Threat to Public Health — James Tabery