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There’s little doubt that America faces a health conundrum. We spent nearly 18 percent of GDP on health in 2023. The average per person was $13,400 dollars, roughly double the amount spent in comparable countries.

Meanwhile, the results are lacking. American life expectancy at birth is 78 years, about 5 years shorter than the average of similar countries. And nearly 75 percent of Americans are overweight or obese, with 12 percent having diabetes.

I could keep citing statistics, but you get the point.

The Trump administration has set out to, in its own words, “Make America Healthy Again.” And while the similarly named commission’s first report got a lot of attention for faulty citations, it’s also surprisingly blunt about some of the challenges the country faces. Perhaps more so than any other recent administration.

That blunt assessment, though, has been paired with changes that critics say pose more challenges to American health: funding cuts to the Food and Drug Administration, cuts to research on things like the impact of chemicals on health, changes to eligibility for medicaid, food stamps, and Affordable Care Act subsidies, and replacing the vaccine advisory panel at the CDC.

American health finds itself in a position not so different from other issues under President Trump. An administration that is more candid about naming the problem than many others in politics, but with some controversial and even self-defeating solutions.

With me to talk about it all is the dean of the school of public health at Washington University in St. Louis, Sandro Galea. He’s authored many books and also writes about public health on the Substack “The Healthiest Goldfish.”

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