"Without data and a workforce, we are flying without GPS.” Joe Betancourt, M.D., President, Commonwealth Fund

Making America Healthy

April 4, 2025

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By Joseph R. Betancourt, M.D., President, The Commonwealth Fund

Since its founding in 1918, the Commonwealth Fund has been committed to affordable, high-quality health care for everyone. We have worked with all those who share this mission. We believe the health and well-being of the American people is a nonpartisan goal that should unify, not divide, us.

Over time, national leaders have had different perspectives and approaches to addressing our health care challenges, and so we have patiently watched — and taken stock of — how the new administration is shaping the health care landscape. While we have tried to be hopeful in the face of unprecedented disruption, we fear that many of the decisions and actions would do everything but make America healthy — and in fact may cause great harm.

Over the past 10 weeks, we have seen spending cuts proposed that have the potential to erode or eliminate health insurance coverage for millions of Americans. This comes on the heels of unprecedented coverage gains that have resulted in record-low uninsured rates. We’ve seen dramatic cuts to research funding — potentially mortal wounds to the crown jewel that is American science and innovation. And we’ve seen important public data sources withdrawn from view, despite their critical importance in tracking and improving health care access and affordability and ensuring everyone — no matter who they are or where they live — receives high-quality care and lives a healthy life.

During this time, we have been alarmed about the potential risk to the gains this nation has made and to the health care of our families and neighbors. And then, this week, the administration conducted the largest “reduction in force” ever at the U.S. Department of Health and Human Services (HHS), which provides Americans with critical public health, health care services, information, and protections. This historic, sweeping removal of thousands of the department’s employees puts everything at risk, including childhood vaccinations, maternal health, and community health centers. While the full measure of these cuts is still coming into focus, we can already say with certainty that every state, county, and community will be affected.

The work of HHS is central to the Commonwealth Fund’s century-long commitment to better health care, and we believe the ability to track, understand, and improve Americans’ health and well-being is foundational to our work. We know that policy is best constructed when it’s informed by reliable, high-quality data, produced and overseen by trained, skilled, professionals. Without data from the Medical Expenditure Panel Survey, for example, we will lack critical information around the cost and use of health care and health insurance coverage over time. Without the Consumer Assessment of Healthcare Providers and Systems survey, we will lose the ability to understand patients’ and providers’ experiences — an essential metric of health system performance crucial to improvement efforts.

Without these and so many other data sources that are at risk following the HHS reductions, we will be less able to understand trends, make needed changes to our health system, and determine if our nation’s resources — roughly 18 percent of U.S. gross domestic product (GDP) goes to health care — are being invested wisely. Simply put, without a workforce, and without data, we are flying with no GPS, and people’s lives hang in the balance.

While we at the Commonwealth Fund will never shy away from considering how to make government and health care operate more efficiently for all Americans, many of the administration’s actions to date are hard to reconcile with that goal. HHS personnel costs represent less than 1 percent of the agency’s total spending, and any nominal budgetary benefits from slashing staff will pale in comparison to the potential downstream costs and health consequences of removing government capabilities.

While the U.S. health care ecosystem is large and complex, the historical role of the federal government, including HHS, to guide health policy has been integral to providing health care to people in every corner of the country. We are not alone in this assessment.

It is our sincerest hope that a clearer, more strategic, and more thoughtful approach to making America healthy will emerge quickly. With recent actions, that hope grows a bit dimmer each day.

The Commonwealth Fund remains committed to engaging with all policymakers and stakeholders who want to have a constructive dialogue on ways to improve the health of our nation. More than ever, it’s incumbent on all of us to work together to make that happen.

Affordable, quality health care. For everyone.

The Commonwealth Fund, 1 East 75th Street, New York, NY 10021

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