The American experiment in democracy was born from a vision of liberty, justice, and collective responsibility. The Declaration of Independence asserts that all people are “endowed by their Creator with certain unalienable Rights,” including “Life, Liberty, and the pursuit of Happiness.” ( United States Declaration of Independence, 1776 ). These ideals were institutionalized in the United States (U.S.) Constitution ( United States Constitution, 1787 ), which established a system of checks and balances between the legislative, executive, and judicial branches to prevent tyranny and protect individual freedoms ( Articles I, II, III and the Bill of Rights 1st Amendment )-principles that charted the way to unify a diverse population under a shared commitment to civic participation and constitutional governance built on rights, responsibilities, and consent of the governed.

Healthcare, while not explicitly mentioned in the U.S. Constitution, is essential to the public good. The preamble’s commitment to “promote the general Welfare” has been interpreted by many as a moral and civic imperative to ensure access to health services. Specifically, “We the People of the United States, in Order to form a more perfect Union, establish Justice, ensure domestic Tranquility, provide for the common defense, promote the general Welfare , and secure the Blessings of Liberty to ourselves and our Posterity, do ordain and establish this Constitution for the United States of America.” ( U.S. Constitution, preamble, 1787 ).

Historically, the promotion of general welfare, including public health initiatives, education, and infrastructure was met through a combination of public programs and private charities, community clinics, and philanthropic foundations collectively playing a vital role in caring for the poor and vulnerable. Over time, government programs like Medicare, Medicaid , and the Affordable Care Act expanded access and opportunity for health and well-being, reflecting a growing consensus that healthcare was a public necessity.

Access to healthcare underpins a prosperous society by enabling individuals to live healthier, more productive lives, contributing to economic stability and civic engagement. It fosters goodwill by ensuring that care is extended to all citizens. Moreover, healthcare is essential to public health and safety, supporting disease prevention and early intervention as tangible means to lessen the perils-both personal and societal of chronic health conditions. Last, people, communities, and the U.S. work force depend on a physically, mentally, and emotionally healthy society.

Changes in public policy and economic priorities have begun to reshape the landscape of academic research, healthcare delivery, and societal welfare in the U.S. Federally orchestrated budget cuts and executive orders have destabilized the nation’s research infrastructure and undermined the role of science as a pillar of informed governance. As funding streams narrow and access to essential services become increasingly stratified, the near- and long-term consequences are impossible to ignore.

This editorial seeks to highlight the urgent need for a more balanced and comprehensive approach to healthcare—one anchored by a healthy democracy that safeguards the integrity of scientific inquiry, affirms healthcare as a universal right, and upholds sustainable practices that protect future generations. When these principles are honored, democracy thrives—not only as a system of governance but as a commitment to and promotion of communal health.

Democracy is a shared endeavor—a commitment to fairness, societal representation, and integrity that reaches beyond governance into the heart of civil society. It welcomes and promotes inquiry-based learning and cultivates critical thinking by affirming that every person matters, that diverse voices deserve to be heard, and that truthful answers to the most important questions that affect citizens must be pursued rigorously through open, ethical, and unobstructed inquiry.

In a democratic society, people care for one another not out of obligation, but from an inherent recognition of shared humanity. This care manifests in the creation of opportunities—for education, health, innovation, and participation—so that all individuals can contribute meaningfully to the common good. Democracy nurtures a culture where compassion and cooperation are not just ideals, but practices that shape everyday life.

Establishing and building on a foundation of mutual respect and broad representation is what enables freedom of inquiry. Science thrives when constructivism is protected, and knowledge is pursued without fear. Medicine advances when research practices honor community agency and needs-based inquiry traverses across socio-cultural landscapes.

Democracy, then, is more than a political system—it is the framework through which fairness becomes action, representation becomes voice, and integrity becomes trust. It molds our attention to policy as a distinguishing characteristic and actionable contrast to politics. In a free society, the act of asking “why” and cultivating reflective skepticism is foundational to civic progress. As Karl Popper argued in The Open Society and Its Enemies , freedom of thought and tolerance of dissent are essential to fostering a culture where questioning authority leads to societal advancement. ^, .

Similarly, democratic societies must also embrace questions posed by the people about science, medicine, and their applications. Indeed, communicating healthcare information accurately, effectively and in a forum tailored to the public is required to build trust and minimize misinformation. Similarly, when answers to questions are not available, an honest response must be provided.

Communicating science effectively to the public requires more than just simplifying complex ideas—it demands a thoughtful approach to language, tone, and audience understanding. The tone should be inclusive and respectful. Importantly, communicators must consider cultural context and educational background, ensuring that the message empowers rather than alienates. In a democracy, where informed citizens shape policy and public health outcomes, science communication must be a bridge—not a barrier—between knowledge and civic engagement.

The American Association for the Advancement of Science (AAAS), ^,, a highly respected and non-partisan scientific society based in Washington, D.C., that informs, and guides policy recently totaled the budgets of hundreds of federal agencies and programs that conduct scientific research or provide grants to universities and research organizations. It then compared the funding appropriated for the current fiscal year with the central government administration’s proposals for fiscal year 2026.

For basic science research, the association reported that the overall budget would fall to $30 billion from $45 billion, a drop of roughly 34 percent. For science funding overall- which includes monies for basic, applied and developmental work, as well as for the vital support of facilities actively engaged in human research, discovery, and new drug development, the analysis found that the federal budget would fall to $154 billion from $198 billion, a drop of 22 percent.

The recent reduction in federal grant funding by agencies like the National Institutes of Health (NIH) and the National Science Foundation (NSF), coupled with the cancellation of over 2,600 research grants, presents a troubling paradox to the ideals of academic freedom and democracy. These cuts will significantly impact patient-centered basic and clinical research, including financial retrenchment on cardiovascular disease research ( Table 1 ), the leading cause of death, disability, days off from work and healthcare expenditures in the U.S. and abroad.

Why would research that directly impact so many people’s lives and livelihoods, irrespective of political affiliation be terminated or revoked? Have each of the important questions about cardiovascular health, prevention, and treatment been answered? Are there no longer any reasons to conduct research in these areas? Is political ideology inherent to cardiovascular disease? In a democratic society, science serves as a critical space for inquiry, innovation, and dissent; functions that are stifled when funding is exploited to silence certain lines of research that often adversely affect many other related areas as well. It is the people who serve to lose the most when democracy fails. It is the people who suffer.

On July 31, 2025, senators from both parties endorsed a $400 million increase to the budget of the NIH, in an Appropriations Committee vote (vote 26-3 in favor) that represents a clear rebuke of the administration’s plan to dramatically reduce the agency’s spending (S.2587 [Report No.119-55]- Departments of Labor, Health and Human Services, and Education and Related Agencies Appropriations Act, 2026)(congress.gov; accessed August 12, 2025). The committee also retained all 27 NIH institutes and centers, rejecting a White House consolidation proposal, and rejected the administration’s plan to revamp the way NIH pays universities, medical schools, and other research centers for overhead costs. Congress holds the “power of the purse” under Article I, Section 9, Clause 7 of the Constitution, “The Appropriations Clause,” meaning no money can be drawn from the Treasury without a law passed by Congress. The President is constitutionally obligated under the Take Care Clause (Article II) to faithfully execute laws, including spending laws passed by Congress.

The President may attempt to impound funds—withhold or delay spending—but this is tightly regulated by the Congressional Budget and Impoundment Control Act of 1974. Under this law:

Deferrals (temporary delays) must be reported to Congress and cannot extend beyond the fiscal year.

Rescissions (permanent cancellations) must be proposed to Congress, which has 45 days to approve. If Congress does not act, the funds must be released ( constitutioncenter.org; Accessed August 12, 2025).

There are several steps required before the bill becomes law. After a committee approves the bill, it is reported to the full chamber, either the House or the Senate for debate, amendment, and voting. If the bill passes one chamber, it is sent to the other chamber, where it undergoes a similar process of committee review, debate, and voting. If both chambers pass the bill in identical form, it proceeds to the President. If there are differences between the House and Senate versions, a conference committee composed of members from both chambers works to reconcile the discrepancies. The revised bill must then be approved again by both the House and Senate.

Once the final version is agreed upon, the bill is enrolled and sent to the President, who has ten days (excluding Sundays) to sign it into law, veto it, or allow it to become law (by taking no action) if Congress is in session. If the President vetoes the bill, Congress can override the veto with a two-thirds majority vote in both chambers. If Congress adjourns during that 10-day window and the President does not sign the bill, it does not become law. This is known as a pocket veto, and it cannot be overridden by Congress because they are not in session to reconsider the bill. This mechanism is outlined in Article I, Section 7 of the U.S. Constitution, and is a way for the President to effectively veto a bill without formally returning it to Congress ( congress.gov. how our laws are made; accessed August 12, 2025 ).

A reasonable timeline for the bill is as follows: In September 2025, the House of Representatives is expected to begin work on its version of the appropriations bill, initiating subcommittee and full committee markups, followed by floor debate and voting. If the House and Senate pass different versions, a conference committee will be formed to reconcile discrepancies, and the resulting conference report must be approved by both chambers. Once finalized, the bill will be sent to the President, who may sign it into law, veto it, or allow it to become law without a signature if Congress remains in session. Updates on the Appropriations bill status can be followed on https://www.congress.gov/crs-appropriations-status .

The Senate Appropriations Committee’s FY2026 bill does not directly reverse the revocation of approximately 2,600 NIH grants. The administration has also proposed shifting NIH grants to a forward-funding model, which would reduce the number of new awards by front-loading multi-year grants into single-year payments.