In light of the Trump administration’s ongoing reshaping of US health policy, an academic journal has brought a fresh perspective to healthcare reform, urging policymakers to “think bigger” and invest significantly in communities. The recent issue of Health Affairs Scholar calls for a radical change in the way health policy is approached, with experts suggesting that the nation’s healthcare system needs to be reimagined entirely if it is to address the multitude of challenges currently faced.

Rising Concerns Amid Political Turmoil

Under the Trump administration, US health policy has undergone dramatic shifts that have affected healthcare institutions across the country. From early in his tenure, President Trump and his allies took a combative stance towards the country’s health infrastructure. The administration implemented widespread cuts to funding and introduced policies that critics argue are detrimental to the health of American citizens. These efforts include massive layoffs, funding freezes, and scientific reviews skewed to align with political ideologies rather than public health interests.

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Some of the most high-profile moves included erasing government health websites of important information about women and racial minorities, while heavily scrutinizing billions of dollars in scientific grants. Additionally, the confirmation of Robert F. Kennedy Jr. as the head of the Department of Health and Human Services sent a signal to many that the administration was intent on rejecting established public health science in favor of ideologically driven health policies. Most significantly, Trump’s proposal to withdraw the US from the World Health Organization (WHO), the body that the US helped to establish in 1948, has raised alarms about the country’s commitment to global health.

Another critical issue has been the Trump administration’s push to cut Medicaid, the health insurance program that covers approximately 72 million low-income Americans, as a means to extend tax cuts benefiting the wealthiest individuals. With such policy shifts, many are left questioning how the nation will address its ever-growing healthcare crisis, especially given that the US spends more on healthcare than almost any other developed nation yet faces some of the worst health outcomes.

The Call for a New Health Policy Framework

In response to the ongoing challenges and political volatility, Health Affairs Scholar has called for a radical rethinking of the approach to US healthcare. Dr. Victor Roy, a family physician and director of the health and political economy project at the New School in New York City, emphasized the importance of thinking “bigger” in addressing healthcare issues. He argues that people are increasingly frustrated with the status quo and that a more profound transformation of the healthcare system is needed—one that focuses on investing in communities rather than merely adjusting existing frameworks.

Roy referenced the public outcry surrounding the death of the CEO of UnitedHealth Group, one of the largest health insurers in the country. He suggested that this event symbolized a growing desire for fundamental change. As Americans are expressing more visceral feelings about their healthcare struggles, there is a palpable sense that the solutions offered thus far have been inadequate.

“It’s not about tinkering around the edges anymore,” Roy remarked. “We need to look upstream, at the root causes of health problems, and reconsider how we approach them.” He stresses that the healthcare debate should move away from narratives of “deserving-ness” and focus on systemic, scalable solutions that prioritize the well-being of communities.

Reimagining Healthcare: Radical Local Initiatives

Rather than relying on traditional policy changes that have not yielded satisfactory results, Health Affairs Scholar suggests that new, local-level innovations may provide viable alternatives. One such example highlighted in the journal is the Philadelphia Joy Bank, a small but impactful program that offers pregnant and postpartum women a $1,000 basic income. Unlike traditional welfare programs, this initiative provides unconditional financial support, which contrasts sharply with the limitations of Temporary Assistance for Needy Families (TANF) that have become increasingly ineffective since the Clinton-era reforms.

In Connecticut, lawmakers have also introduced a groundbreaking initiative known as “baby bonds.” This program provides low-income children with a small investing account worth $3,200. The funds are intended to be used for long-term goals such as buying a home, starting a business, or pursuing higher education or retirement. This innovative approach aims to address the root causes of inequality and provides a foundation for financial security for future generations.

Another noteworthy example is the reform effort led by the American Economic Liberties Project, which has advocated for a “Glass-Steagall for healthcare” proposal. This initiative, drawing inspiration from the New Deal-era Glass-Steagall legislation, seeks to break up monopolistic healthcare giants and separate different facets of the industry, similar to how Glass-Steagall once separated commercial and investment banks.

These programs are not isolated instances but are part of a growing movement aimed at radically rethinking healthcare in the US. Other ideas discussed in the Health Affairs Scholar issue include home care cooperatives that would provide better working conditions for home care workers as the aging population grows and the expansion of public hospitals and the local production of pharmaceuticals. An example of this is California’s $100 million investment in public insulin production, which aims to reduce reliance on expensive insulin produced by monopolistic pharmaceutical companies.

Focusing on Marginalized Communities

Throughout the journal’s discussion, there is a strong emphasis on addressing the needs of marginalized communities. The prevailing health policies in the US have often failed to account for the realities faced by low-income, rural, and historically marginalized groups. Health Affairs Scholar editor-in-chief, Kathryn A. Phillips, echoed this sentiment, stating, “Prevailing approaches to health policy are leaving people in America behind.”

Phillips argues that policymakers must prioritize investing in patients, communities, and healthcare workers. Rather than relying on top-down solutions that have failed to make significant changes, it is time for policies that recognize the fundamental needs of individuals and communities.

Programs that target community-based solutions have been shown to improve health outcomes. These local efforts offer valuable insights into what works, but they need to be scaled up to create long-lasting systemic change. By shifting the focus to community investments—such as improved social safety nets, local healthcare infrastructure, and policies aimed at reducing social determinants of health—there is hope that America can begin to reverse its troubling health trends.

A Shift in National Health Priorities

The ideas presented in Health Affairs Scholar represent a shift in how health policy in the US is viewed. It is no longer enough to merely tweak existing systems or rely on traditional models that have shown limited effectiveness. The call for a radical change in the healthcare system is a recognition that current efforts have been inadequate in tackling the complexity of American healthcare. As Dr. Roy and other scholars argue, addressing the root causes of health problems requires a fundamentally different approach—one that prioritizes long-term investments in communities and individuals.

The Trump administration’s policies have drawn sharp criticism, but in many ways, they have also sparked a conversation about what truly needs to change. As the US grapples with the challenges of healthcare reform, the ideas put forward by Health Affairs Scholar provide a glimpse into a new way forward—one that doesn’t shy away from bold, systemic change but instead embraces the necessity of looking upstream to tackle the larger issues facing the nation.

In conclusion, the call to “think bigger” on healthcare is not just a critique of the current system but also a plea for a reimagined future—one where policymakers invest in communities, challenge the prevailing narratives, and work to build a more equitable, sustainable, and effective healthcare system for all Americans. As health policy continues to evolve, it is clear that transformative change will require a broader, more inclusive approach—one that ensures no one is left behind.