The Conversation

Happy Sunday − and welcome to the best of The Conversation U.S. Here are a few of our recently published stories:

• What does Israel’s strike mean for US policy on Iran and prospects for a nuclear deal?
• The forcible removal of Sen. Alex Padilla signals a dangerous shift in American democracy

The U.S. health care system has long been derided as complex, bloated and more about profits than keeping people healthy. Indeed, even though the U.S. spends more per capita on health care than any country in the world, it ranks at or near the bottom among developed nations on a host of measures, including access, outcomes and life expectancy. And while perspectives may differ, I have found broad agreement among friends and family across the political spectrum that the system is broken and needs fixing.

But the system’s many problems are largely by design, according to Zachary W. Schulz, a public health historian at Auburn University.

“My research and that of many others show that today’s high costs, deep inequities and fragmented care are predictable features developed from decades of policy choices that prioritized profit over people, entrenched racial and regional hierarchies, and treated health care as a commodity rather than a public good,” he writes in one of last week’s most popular stories with our readers.

Schulz traces the creation of today’s health care system to the emergence of employer-based insurance in the 1940s and explores how it has – and hasn’t – changed over the years into today’s system of complicated, costly deductibles, co-pays and a focus on procedures rather than prevention.

“Understanding what the U.S. health care system is designed to do – rather than assuming it is failing unintentionally – is a necessary first step toward considering meaningful change,” he writes.

Bryan Keogh

Managing Editor

Readers' picks

US health care is rife with high costs and deep inequities, and that’s no accident – a public health historian explains how the system was shaped to serve profit and politicians

Zachary W. Schulz, Auburn University

Research shows that decades of policy choices shaped today’s fragmented health care system – which is precisely why reform is so difficult.

‘Who controls the present controls the past’: What Orwell’s ‘1984’ explains about the twisting of history to control the public

Laura Beers, American University

Donald Trump aims to rewrite America’s official history. George Orwell − who wrote, ‘Who controls the past controls the future. Who controls the present controls the past.“ − would recognize that impulse.

From Kent State to Los Angeles, using armed forces to police civilians is a high-risk strategy

Brian VanDeMark, United States Naval Academy

As President Trump sends National Guard troops to Los Angeles, a military historian explains why crowd control is one of the Guard’s most challenging and dangerous missions.

Where is the center of the universe?

Rob Coyne, University of Rhode Island

As the universe expands, it feels like it must be spreading out from some initial point. But a physicist explains why that’s not how it works. Hint: space-time is involved.

Politics based on grievance has a long and violent history in America

Peter C. Mancall, USC Dornsife College of Letters, Arts and Sciences

President Trump’s politics of resentment recall the US colonial era, when grievances fueled rage and violence.

Editors' picks

US Army’s image of power and flag-waving rings false to Gen Z weary of gun violence − and long-term recruitment numbers show it

Jacob Ware, Georgetown University

Generations already suffering a shattered sense of safety from US gun violence do not see the military as a viable option, a terrorism scholar argues.

Federal R&D funding boosts productivity for the whole economy − making big cuts to such government spending unwise

Andrew Fieldhouse, Texas A&M University

Government R&D encompasses all innovative work the government directly pays for, regardless of who does it.

Family homesteads with tangled titles are contributing to rural America’s housing crisis

Jennifer Pindyck, Auburn University; Christian Ayala Lopez, Auburn University; Rusty Smith, Auburn University

Across the US, heirs’ property laws hamstring families that want to build housing or leverage their land for loans. One Alabama project shows how policy reform and savvy design can build a way forward.

Trump orders Marines to Los Angeles as protests escalate over immigration raids, demonstrating the president’s power to deploy troops on US soil

William C. Banks, Syracuse University

American troops may be used inside the country, but it is an extraordinary exercise of authority to deploy them domestically, says an expert on the domestic role of the military.

How school choice policies evolved from supporting Black students to subsidizing middle-class families

Kendall Deas, University of South Carolina

Modern school voucher programs, publicized as a tool to provide education options for low-income families, have harmed majority Black schools.

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