So Much for the ‘Best Health-Care System in the World’

Here’s a piece of Republican rhetoric that used to be ubiquitous but that you never hear anymore: America has the best health-care system in the world.

Republican politicians liked this line because it helped them dismiss the idea that the system needed major reform. American health care at its finest offered the most advanced treatments anywhere. Democrats wanted to expand coverage, but why mess with perfection? “Obamacare will bankrupt our country and ruin the best health-care-delivery system in the world,” then–House Speaker John Boehner said in 2012.

In Donald Trump’s second term, Republicans haven’t given up their opposition to universal coverage—far from it—but they have mostly stopped singing the praises of American health-care innovation. Indeed, they are taking a meat axe to it, slashing medical-research funding while elevating quacks and charlatans to positions of real power. The resulting synthesis is the worst of all worlds: a system that will lose its ability to develop new cures, while withholding its benefits from even more of the poor and sick.

The line about the world’s best health care always had a grain of truth. The United States has for decades languished behind peer systems in terms of access and outcomes. We are the only OECD country that lacks universal coverage, and the failure to provide basic care to all citizens contributes to our mediocre health. But America really was among the best countries at producing cutting-edge treatments. Those of us who have access to health insurance benefit from high-level technology and a for-profit system that generates incentives for new drugs and devices. There is a reason wealthy patients with rare conditions sometimes travel to the U.S. for care.

This was never a convincing reason that the United States could not expand health-care access to citizens who couldn’t afford it. But although the trade-off was false, the Republican Party’s support for medical innovation was genuine. Even during the height of anti-spending fervor during the Obama administration, Republicans in Congress approved large funding increases for the National Institutes of Health. During his first term, Trump tried and failed to repeal Obamacare, but he also engineered a spectacular success in Operation Warp Speed, which mobilized the pharmaceutical industry with unprecedented efficiency to bring effective COVID vaccines to market.

In the second Trump era, the party’s opposition to universal health care has, if anything, intensified. The signature legislative accomplishment of Trump’s second term thus far is a deeply unpopular budget bill that is projected to take health insurance away from 16 million Americans once fully implemented.

But now the party has turned sharply against innovation too. Trump has wiped out billions of dollars in federal support for medical research, including canceling a promising HIV-vaccine project. This week, Health and Human Services Secretary Robert F. Kennedy Jr. terminated hundreds of millions of dollars in grants for mRNA-vaccine research, one of the most promising avenues in all of medicine. The United States is going to forfeit its role as medical pioneer even as it recedes further behind every other wealthy country in access.

[Katherine J. Wu: How many times can science funding be canceled?]

Kennedy has made the party’s pivot explicit. He does not boast about the American health-care system. Instead, he calls it a disaster. “We spend two to three times what other countries pay for public health, and we have the worst outcomes—and that’s not acceptable,” he said on Fox News earlier this year. Kennedy is not wrong about the bottom line; American health care is costly, and the results are poor. But he is almost completely wrong about the cause of this failure. There are many reasons for Americans’ poor health, and shutting down vaccines and medical research, while depriving millions of access to basic care, will make all of those problems far worse.

It’s not that the entire Republican Party has abandoned its previous support for medical innovation. To the contrary, many Republicans in Congress have complained about cuts to medical research; last week, a key Senate committee voted overwhelmingly on a bipartisan bill to increase funding for the National Institutes of Health. But the anti-science wing of the party is in control of the agenda. Two main forces have driven the shift. One is the emergence of Kennedy’s “Make America healthy again” movement, a faction of gullible skeptics that Trump has brought into his coalition. RFK Jr.’s transition from left-wing kook to right-wing kook personifies the realignment of a certain strain of modern snake-oil peddlers into the Republican tent. Although they make up only a small share of the party, their intense interest in health and medicine has given them special sway—a classic instance of a tiny special-interest group determining policy for a larger coalition.

The second force driving this policy change is the rising power of the national-conservative movement. Natcons are a wing of almost fanatically illiberal culture warriors who believe that the Republican Party must use government power to destroy its enemies. The fact that cutting university medical research will harm the United States in the long run is, for the natcons, a minor consideration when weighed against the fact that universities and government-funded labs are full of Democrats.

The combined desire of both factions to attack the scientific elite has pushed the party into a retrograde opposition to medical innovation. Making matters worse, the unabashed corruption of the second Trump administration will further weigh down the sector’s innovation potential by elevating politically connected firms over market-competitive ones. As The New York Times reports, Trump delayed the implementation of a plan to reduce excessive Medicare reimbursements for “skin substitute” bandages after a co-owner of a company that sells them donated $5 million to a pro-Trump PAC and dined with Trump at Mar-a-Lago.

The traditional Republican position defended cutting-edge medical innovation while denying its benefits to those too poor or sick to afford access to it. Who could have guessed that liberals would one day look back at that stance with nostalgia?

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