Health care has become politicized, with one side believing in wildly different things than the other. Health secretary RFK Jr. is a vaccine skeptic, for example. He is reportedly testing President Trump’s patience with his antiestablishment agenda. On the far left of the voter distribution, many people passionately believe medical care should be free at the point of service, paid for with progressive taxation. Purportedly, when having to reach for one’s wallet after receiving medical care is bad for your health.
One of the latest political disagreements is Medicaid. Medicaid expansion was controversial when it passed 15 years ago. Blue states quickly accepted the federal government’s offer to expand Medicaid to low-income families who were not actually poor. Red states were less enthusiastic about expanding Medicaid. Recent passage of One Big Beautiful Bill attempts to slow the growth of Medicaid spending. It also establishes work requirements for some Medicaid eligibility and phases out ACA enhanced subsidies for middle-income families. Research has shown that many of those receiving Obamacare subsidies did not file a single claim during the year. The same is likely true of Medicaid expansion populations. Both are covered by managed care (same companies in many instances) and enrollment of subsidized people not using benefits is pure profit at taxpayer’s expenses. This argument represents a fundamental political divide: is health coverage for its own sake good? Or is it acceptable for young, healthy people to go without coverage that they do not benefit from?
There are numerous other instances where medicine is politicized. The Association of American Medical Colleges (AAMC) is the only accreditation organization for medical schools. The AAMC has increasingly been accused of forcing a so-called woke political agenda on medical school curriculum. It is little more than unaccountable academics forcing their ideology on America’s supply of future physicians. Politics also determines who Americans can see for treatment. State medical boards and the American Medical Association (AMA) have fought tooth & nail to prevent independent practice by middle-level professionals, such as nurse practitioners (NPs) and physicians’ assistants (PAs). The AMA played a significant part in getting 75% of competing medical schools shut down more than 100 years ago claiming they were substandard. Hardest hit were medical schools willing to train physicians from racial minority communities. Almost 30 years ago the AMA also lobbied Congress to freeze the number of graduate medical training slots, called residencies, to 1997 levels. Their stated purpose was to avoid a surplus of doctors, but there is now a significant physician shortage. Those medical school graduates who are able to complete residency can command much higher salaries than if 200,000 more physicians had been trained since 1997.
The government plays a significant role in health care. In the early 1950s Congress passed legislation affirming employer-sponsored health benefits were nontaxable. That is largely what prompted the current system where most people get their coverage through work. It also severed the feedback loop that encourages price transparency and competition. In 1965 Congress passed legislation creating Medicare and Medicaid. When Department of Defense and federal employee health benefits are included along with various other health insurance tax subsidies, the government now pays more than half of health care expenditure. That has a huge political influence on medicine.
One area of medicine is probably more political than others, public health. Public health is largely funded by government. Its proponents tend to support Medicare for All, Medicaid expansion, and greater government intervention in Americans’ health care. For instance, years ago the public health community began to view gun violence as a public health issue rather than a crime issue. The public health community views grocery store location as a public health issue. Now the Kaiser Family Foundation reports that extremist views are a public health threat, saying:
In many cases, extremist activities and conduct throughout the U.S. over the past few years have been driven by the deepening chasm of political partisanship and disinformation-driven rebellion against responses to the covid-19 pandemic. More recently, backlash against immigration and diversity, equity, and inclusion initiatives has heightened tensions.
The continued escalations drove staffers at [American University’s Polarization & Extremism Research & Innovation Lab] PERIL and the Southern Poverty Law Center to approach the problem from a different angle: Treat extremism as a public health problem.
Suffice it to say public health advocates consider Republicans a public health threat. Also, do not forget that the Soviet Union used to label dissidents and political opponents as mentally ill, and sometimes used psychiatry to disable and remove political opposition. That is the ultimate in politicized medicine.