Dr. Cohen raises concerns about trust, corporate influence, and the trajectory of United States (U.S.) healthcare. Those worries are real, shared widely among physicians, and deserve an answer grounded in democratic principles and practical steps that strengthen medicine as a public good.
Our founding ideals call us to “promote the general Welfare,” which, in modern society, must include equitable access to healthcare, robust science, and transparent communication. Recognizing healthcare as a constitutional value empowers democracies to ensure every person has access to optimal medical care, thus enabling individuals not just to live, but to thrive in health abundant as full participants in civic life. ,
What is health?
Health can be understood as a state of complete physical, mental, and social well-being, not merely the absence of disease. In this sense, health represents the penultimate goal of healthcare- an aspirational standard that should inform policy, practice, and resource allocation. In democratic societies around the world, healthcare is not only a technical enterprise but also a moral and political commitment. Democracy emphasizes equity, participation, and accountability-values that align with the pursuit of health as a shared societal good ( www.publichealth.com.ng/world-health-organizationwho-definition-of-health ; accessed December 12, 2025). This perspective raises critical questions: How do democratic institutions ensure that healthcare policies reflect the collective aspiration for health? And how do they balance individual rights with public health priorities?
First and foremost is by trust. Trust in medicine grows when science is protected and communicated clearly. Democracy thrives on open inquiry, dissent, and evidence-tested answers; so does medicine. We must make known commitments to transparent study design, public-facing data dashboards, and community-engaged research, especially in cardiovascular disease, the nation’s leading cause of morbidity, mortality, impaired quality of life, and healthcare cost. These practices embody the democratic ethic of inclusive, accountable knowledge creation and ensure that discoveries translate into better outcomes for all communities. In a fitting context, an operational E Pluribus Unum.
Second, we must align incentives with the public interest without stifling innovation, designing Federal and State-wide policies that reward value and better health at lower total cost while disincentivizing relative value units (RVUs)- a standardized measure used in healthcare billing that is quantitative rather than qualitative in origin. Payment models that prioritize prevention, continuity of care, and outcomes (eg, risk-adjusted bundled payments with value-based designs) ( www.cms.gov/priorities/innovation/data-and-reports/2025/vbid-2020-2023 ; accessed December 12, 2025) will reduce fragmentation and restore public confidence that healthcare dollars serve patients first. A health-first policy framework integrates health impact assessments into major legislation and could encourage businesses through tax benefits for preventive programs and sustainable practices. Multisector coalitions, modeled on “Health in All Policies,” can unite health advocates, businesses, and policymakers ( www.who.int/activities/promoting-health-in-all-policies-and-intersectoral-action-capacities ; accessed December 12, 2025). Moreover, these are policy instruments aligned with a 3-branch government with democratic checks and balances that harness markets where they work, correcting them where they don’t, and keeping people at the center ( www.hks.harvard.edu/power-people-transforming-civic-participation-public-health ; accessed December 12, 2025).
Third, investing in people is foundational ( Table ). A healthy research ecosystem and a diverse workforce are not luxuries; they are democratic necessities and norms. We must expand insurance coverage for preventive services and remove financial barriers. Similarly, we must invest in health maintenance and prevention, working with law makers, healthcare practitioners, insurers, economists, the private sector, and community leaders to develop policies and financial models where health and prevention are paramount (healthpolicy.duke.edu/sites/default/files/2025-03/Margolis; accessed December 12, 2025) and also attractive to health systems that find themselves in the cross hairs of corporate incentives, overtly or covertly permitting treatable conditions to mount while expensive diagnostics, treatments and procedures await downstream to “fix the problem”.
Table Investing
in primary prevention, health, and wellbeing: strategies and themes
| Strategy | Description | |
|---|---|---|
| Invest in preventive Care services | Preventive care includes vaccinations, screenings, and lifestyle counseling to reduce chronic diseases. | |
| Shift to value-based care | Aligns payments with health improvements, incentivizing prevention. | |
| Community-based Prevention programs | Invest in community initiatives to promote physical activity and nutrition, leading to substantial savings. | |
| Workplace wellness & onsite clinics | Employers offering preventive services see a strong ROI in medical costs and absenteeism. | |
| Using technology & data analytics | Utilize digital health tools and predictive analytics for early intervention. | |
| Policy & coverage reform | Expand insurance coverage and eliminate financial barriers for preventive services. | |
| Education & behavior change | Promote healthy habits through campaigns and programs to reduce drivers of chronic diseases. |
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