Politics is medicine on a large scale
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In February 1848, a 26-year-old doctor named Rudolf Virchow arrived in Upper Silesia, a poor, rural corner of Prussia that’s now part of Poland. A typhus epidemic was killing thousands, and the Berlin government wanted a doctor to assess how to contain this pathogen, advise local authorities, and propose a plan.
Virchow spent a few weeks going from village to village. He found typhus, but he also found families barely eating because of years of failed harvests. People slept huddled together for warmth and rarely changed or washed their clothes. These were ideal conditions for the body lice that carry typhus from one person to the next. (Although no one would make that connection for another 60 years.) The government had mostly ignored this population for years.
In his final report, he said treating individual sick people with medicine wasn’t necessarily the long-term solution; what was needed was education, jobs, better housing, fairer taxes, and “full and unlimited democracy.” He wrote: “Medicine is a social science, and politics is nothing but medicine at a large scale.” (The government thanked him with sanctions, including pay cuts and the loss of his hospital-provided housing.)
Nearly 180 years later, his point still holds. According to my tally (which may be off because this is hard to track), health is on the ballot or in campaign slogans in at least 29 states. Governors, state legislators, and attorneys general are the officials who pick personnel, run Medicaid, fund public health departments, and set state rules on everything from vaccines to abortion.
Even if your state is gray in the figure above, health is still on the ballot in between the lines. For example, county commissioners fund local health departments, and school boards set policies on everything from school meals to vaccine requirements. It also matters on the federal level. Whichever party wins the Senate, for example, controls the Health, Education, Labor and Pensions (HELP) Committee, which oversees the CDC, FDA, and NIH.
The midterms have brought endless predictions and endless ads, and endless bickering. It’s really tempting to tune it all out. Especially when, time and time again, the promises rarely come to fruition.
But my biggest plea is this: Go vote like your health depends on it. Because it does.
Politics shapes health from different angles
Politics can impact our health in two different ways:
Care and access: It shapes who’s insured, what drugs cost, how far a hospital is, whether there’s a doctor or nurse to see you, what care is legally allowed, which research gets funded and what drugs get approved, and how quickly.
Conditions we live before we need care: Politics shape the cleanliness of the air we breathe, the water we drink, and whether we can afford and access nutritious groceries. These social determinants drive far more of our health outcomes than medical care does.
Right now, medical debt, measles outbreaks, and coverage losses are climbing, while food assistance has dropped to its lowest point in 17 years, research funding is being cut, and access to medical care is being depleted. A very large swath of Americans are also angry at the ridiculous drug prices, how far it is to drive to a rural hospital or how hard it is to find a primary care doctor, rising chronic diseases, and industries having enormous influence in Washington.
Look closely at these trends, and you’ll find the same thing Virchow did in the 1800’s: decisions and power drive these, not just diseases.
Science informs, but values decide
So, who decides and on what basis?
Data and science can tell us the measles vaccine is safe and works. It can tell us what happens to people’s health when they lose insurance coverage. But it can’t tell us how much individual freedom we should trade for collective protection.
As we have written in YLE before, science’s authority comes from its objectivity. But science is only one input into policy. Values, ethics, priorities, resources, culture, and psychology also shape it. Much of the frustration during Covid-19 came from this gap, where people expected science to settle questions that were really about values.
And a pandemic isn’t the only example. Vaccine requirements, smoking bans, soda taxes, and school masking. These are all trade-offs, and reasonable (and unreasonable) people weigh them differently. By voting, you are telling people how you want to be represented in those trade-offs.
What I’m listening for
According to the 2026 United States of Care survey, three in four voters say health care will be one of the top three issues shaping their vote, and 78% support a larger government role to make health care more affordable, reliable, and responsive to people’s needs.
I am frustrated with the health ecosystem, too. So when I listen to candidates, I’m listening for three things I’m desperately craving:
Listening. I want candidates who truly understand the people who disagree with them: their fears, their frustrations, and how they weigh freedom, safety, cost, and fairness. Can they explain why a reasonable person might disagree with them, and what that person is worried about?
A plan to move forward. We have moved backward in health: measles outbreaks are climbing, and more people are losing coverage. It’s time to provide an alternative pathway forward. Voters want leaders to deliver change that is drastic, but not destructive. Do they have a specific plan, or just a list of complaints about the other side?
Accountability. Politicians know what words to say; they are smart and strategic. However, to me, the biggest problem is that politicians are not held accountable. So, as Ben Miller brilliantly wrote, “Before you vote, ask the candidates on your ballot one question: how will you help with health reform, and how will I know by next fall?If they can’t answer, maybe you have yours.”
Bottom line
The health ecosystem has long treated politics as the third rail: don’t touch it lest you get burned. But the third rail is what powers the train. Politics decides who pays, how much, and who gets left out. Just look around, and the consequences (or benefits) are obvious. Nearly 180 years later, Virchow’s conclusion still holds.
Health is on almost every midterm ballot this year, whether you notice it or not. Go vote like your health depends on it. Because it does.
Love, YLE
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