Healthcare comprises almost 20% of the United States gross national product. In our effort to keep our readers informed about the topics that most impact on their lives we presented a writing last week by Dr. Robert Pearl entitled, “ In healthcare’s game of Monopoly, one player will control the board, ” in which Dr. Robert Pearl presented a private solutions to inefficiencies and problems that exist in America’s health care industry. Today we present a video from IssueOne examining the healthcare industry. Right now, healthcare lobbyists are legally allowed to buy our elected officials’ votes. As long as that’s the case, our representatives will continue to choose campaign donations over Americans’ lives. The healthcare industry spends more than anyone else lobbying politicians to rig the system on their behalf. That should be illegal, but it’s not.
Site Navigation
Search
Latest Stories
Join a growing community committed to civic renewal.
Subscribe to The Fulcrum and be part of the conversation.
Top Stories
Latest news
Read More
young person holds a Bernie 2016 sign while standing in a line of other young people.
Photo provided by the Kettering Foundation
The Myth of Youth Apathy
Apr 21, 2026
Every time I hear someone say, “Gen Z doesn’t care about democracy,” I wish I could have them spend a day in my shoes as a civically engaged college student. I’ve watched my fellow students negotiate with local election officials to open polling places on campus. Through my work with organizations like the Campus Vote Project, I’ve seen my peers at community colleges, research universities, and HBCUs build diverse coalitions across student government, cultural organizations, and service clubs to help get out the vote. Beyond campus, I’ve seen hundreds of my fellow Gen Zers choose public service careers, not because it’s easy, but because they’re tired of watching problems pile up in their community while our leaders do nothing.
According to Is Democracy Working? the first report from the Kettering-Gallup Democracy for All Project, young adults today are more skeptical of democracy than older generations. But we must not mistake skepticism for apathy. My lived experiences and a wealth of research show that the idea of Gen Z being apathetic about democracy is nothing more than a myth.
The Numbers Tell a Complicated Story
The data from the Kettering-Gallup Democracy for All Project is striking. Just 53% of adults aged 18 to 29 believe democracy is the best form of government compared to 80% of those 65 and older. Moreover, 52% of Gen Z survey respondents claimed that democracy is performing poorly, and only 19% stated that it was functioning well. Unfortunately, these findings are not outliers. Research from Gallup and the Walton Family Foundation found that Gen Zers had extremely low levels of trust in Congress, the news, the presidency, and other democratic institutions, while a recent Harvard Youth Poll revealed that only 13% of young Americans believed that the country was headed in the right direction.
But while Gen Z may have detached or negative feelings toward the current state of American democracy, that does not mean they are disengaged. The Center for Information and Research on Civic Learning and Engagement (CIRCLE) at Tufts University has historically tracked youth voting trends and found that both 2020 and 2024 were historically high years for young adult turnout. As a student at Vanderbilt University, I’ve seen my peers volunteering at tables outside of dormitories, dining halls, and classrooms to register hundreds of fellow students to vote and encourage them to go to the polls. If young people truly didn’t care, they wouldn’t be showing up!
Gen Z’s Skepticism Is Rooted in Experience
So, what’s actually going on? The Democracy for All Project finds that Americans who feel they lack meaningful opportunities to participate in democracy tend to hold less favorable views of the system overall. Among the participation metrics measured, younger adults lag significantly: only 59% of 18- to-29-year-olds believe local voting laws make it easy for people like them to vote, compared to 84% of those 65 and older. Similarly, a recent report from Protect Democracy and CIRCLE found that young people are significantly more likely to feel disconnected from democratic institutions and processes and, as a result, lose trust in the system’s ability to meet their needs.
These perceptions don’t emerge from nowhere. Research from the Movement Advancement Project and The Civics Center documents ongoing barriers that disproportionately affect young and first-time voters, including information gaps driven by a lack of experience, more frequent address changes, less predictable work schedules, and disenfranchising voter ID laws. Meanwhile, many young adults feel that elected officials and other public political figures don’t adequately represent their views. When I talk to my classmates about politics, I often hear them say that today’s politicians and political parties don’t resonate with them, which is precisely why the majority of Gen Z identifies as independents.
Unsurprisingly, the Democracy for All Project also suggests that views of democratic performance are “strongly linked to people’s assessments of their own financial situation.” Young people have real material reasons to doubt that the current system is delivering for them as they face record levels of student debt, a housing affordability crisis, a job market reshaped by the advent of artificial intelligence, and a growing wealth gap.
While Institutions Fail, Our Values Remain Steadfast
Clearly, Gen Z’s skepticism about democracy is not imagined but is grounded in lived experiences. However, despite our widespread pessimism about democratic performance, we still agree on the importance of fundamental democratic values. The Democracy for All Project found that young adults, like most Americans, believe that political leaders should compromise to get things done; that a diversity of races, religions, and cultures makes our country stronger; that political violence is never acceptable; and that every citizen should have the right to vote regardless of their views.
These are not the beliefs of a generation that has given up on democracy. Instead, they are the reflection of a group that understands democracy’s potential but is legitimately frustrated by its current execution. Nearly 62% of young adults report that the design and structure of our nation’s government needs significant change no matter who is elected, and the vast majority still want elected leaders to be chosen in free and fair elections.
How Gen Z Is Responding
So, democracy is not working for young people. The question that remains is, What are we doing about it?
For starters, two-thirds of Gen Zers have volunteered in their community in the past year, exceeding every other generation except for Baby Boomers. A recent survey from the United Way found that a majority of young adults have attended a rally or protest in support of a specific cause or social issue, while around one-third are regularly involved in activism or social justice work. And 90% of young people indicate they care about and feel responsible for their community, while the vast majority of those who are not currently involved expect to take on future roles improving their local area. On an individual level, Gen Zers are making political change by serving in their state legislatures, founding nonprofits dedicated to social impact, and testifying in front of Congress.
As a part of Gen Z myself, I have witnessed many of these efforts firsthand. I’ve seen classmates stand in lines at the polls for nearly 11 hours just to cast their ballot. I’ve watched them launch community literacy programs designed to combat the school-to-prison pipeline. And I’ve joined groups of youth social impact organization founders addressing everything from marine conservation to the decline in local journalism.
Young people are not waiting for democracy to hand them something. They are demanding that democracy live up to the promises it made.
Gen Z’s relationship with the current state of our government is complicated. The data shows real warning signs about young people’s trust in political institutions and policymakers alike. Many members of my generation feel that their voice is unheard and that this system is broken. But that does not mean we have abandoned democratic values, or that we are not taking action to change the world.
Gen Z is still showing up, in communities, at protests, and at the polls. But there is a real danger if we continue to build and maintain systems that make young people feel unable to participate or be effectively represented. And a democracy that does not work for its youngest citizens is a democracy doomed to fail.
Jason Vadnos is an undergraduate at Vanderbilt University and a 2025–2027 Obama-Chesky Voyager Scholar. As a civic impact assistant for Project Pericles, he investigates youth civic engagement in higher education.
This article was originally published as part of From Many, We, a Charles F. Kettering Foundation blog series that highlights the insights of thought leaders dedicated to the idea of inclusive democracy.
Keep ReadingShow less
Recommended
As midterm elections approach, betting markets favor Democrats—but voter distrust, anti-establishment sentiment, and demand for reform could reshape the party’s future.
Getty Images, adamkaz
Dems Favored To Win Midterms — Will They Run the Candidates Voters Want?
Apr 20, 2026
Donald Trump can dismiss his dismal approval ratings and the GOP’s sinking midterm odds as fake news – but he can’t ignore the betting markets. More accurate in predicting political elections than traditional opinion polls, Democrats are a heavy midterm favorite, with an 87% chance of taking the House, and winning the Senate, 52 seats to 48.
But for any Democratic victory to be more than a temporary restraining order on Trump and the GOP, the Democratic Party needs to start placing voters front and center, building a way forward focused on what millions of voters have made clear they need: a new type of candidate with character who will fight, not fold with a new agenda that puts them first – an agenda untethered to the political class(Democrat and Republican) who put the needs of special interests and billionaires over ordinary citizens. In short, they want candidates who are voter-centered, not donor-centered.
As a lifelong Democrat and political activist, I stand with them. Specializing in the rhetoric of social movements, I know that economic instability, social chaos, and efforts to deny some groups their fundamental rights are conditions currently in play that have historically triggered powerful social change.
More than eight million people took to the streets on March 28th for the Third No Kings March, the largest protest gathering in US history, calling for an end to Donald Trump’s assault on our democracy and economy, disastrous foreign policy, and most critically, his war on Iran. These public demonstrations are part of a larger political climate of disillusionment where, according to 2025 Pew Research Center data, just 17% of Americans express trust in their government.
During the past year, millions of American voters, through polling research, focus groups, and protests, have voiced their dissatisfaction and belief that the system is broken, our politicians are owned, and public policies favor billionaires over voters.
Regarding the Democrat Party in particular, just 27% of registered voters have a positive view of them; this includes the many Democrats who are angry and dissatisfied with their party’s leadership. Not only were the 2024 election results a dismal failure, but so too were their tepid efforts to oppose Trump’s policies. Elected Democrats left that job to ordinary citizens: Minnesotans, millions of No-Kingsprotestors, and community groups.
A recent poll of double haters – voters with unfavorable impressions of both major parties -- now favor Democrats by 6% in the midterms, “driven more by opposition to the GOP rather than enthusiasm for the Democrats.” Most importantly, 70% of Independents now disapprove of Trump. As the largest voter group, 45% compared to 27% Republican or Democrat, Independents have enormous clout and were a significant force behind Trump’s sweeping electoral victory.
Democrats have a rare opportunity to reinvent themselves, rather than gain the temporary upper hand in a broken system - to seize the moment by supporting new types of candidates pursuing a new agenda. For example, there is a preponderance of information on voters' beliefs that their representatives are “owned.” A voter-centered candidate would directly acknowledge this core problem and provide PLANS to fix it. What immediate steps can be taken to curb billionaires’ power in our elections? What long-term strategy do they propose for comprehensive campaign finance reform? Are they willing to fully disclose their own campaign contributions and financing? According to Pew Foundation research, there is strong support among voters for curbing career politicians by imposing term limits. How will a candidate work to make that happen?
Other issues, regardless of urgency, like the impact of AI on the workforce, are secondary to establishing a voter-centered agenda that drives solutions to specific problems. In the case of AI, how does the fix primarily benefit ordinary citizens rather than tech companies?
Occasionally, new types of candidates slip through the Democratic machine, but they are quickly sidelined if challenging the Old Guard, even though it’s under the Old Guard that the Democratic Party’s credibility has sunk to a new low.
Democrats have the odds going for them in November. Whether the party will seize this opportunity to get beyond the lesser of two evils and redefine itself with a voter-centered agenda is anybody’s guess.
Trudy Bayer is a specialist in the rhetoric of social movements. She was the founding director of the Oral Communication Lab at the University of Pittsburgh.
Keep ReadingShow less
An addiction medicine physician explores how policy changes could reverse progress and increase preventable deaths.
Getty Images, Cappi Thompson
Why Is Harm Reduction on the Chopping Block?
Apr 20, 2026
“Do you lick your needles when you inject?” This is one of the questions that I, an addiction medicine doctor, regularly ask my patients. The answer is often yes. Their reasons vary: checking needle patency, enacting an entrenched ritual, or, most poignantly, “cleaning” the needle.
I explain to my patients that licking introduces oral bacteria that can lead to life-altering complications, including sepsis, heart infections, paralysis, and death. Every day, I see the devastating complications that arise not just from inadequate access to sterile supplies but from a misunderstanding of how to reduce harm.
That misunderstanding extends all the way to the White House. Last summer, President Trump signed an executive order entitled “Ending Crime and Disorder on America’s Streets” that, among other things, ordered government agencies to stop funding “so-called ‘harm reduction’ or ‘safe consumption’ efforts that only facilitate illegal drug use and its attendant harm.” As a result, none of the $7.4 billion in federal funding to treat mental health and addiction can be spent on projects that include the words “harm reduction.”
The president’s order revealed a common, but in this case deadly, misunderstanding of harm reduction, a term used to describe a range of evidence-based practices that have been proven to reduce complications from substance use. Examples include needle exchanges, naloxone distribution, and providing medications that prevent HIV.
Because harm reduction does not always involve complete abstinence, some critics charge that these tactics encourage risky behavior. But study after study shows that rather than enabling drug use, harm reduction efforts keep people alive and provide a pathway to health and recovery. By meeting people where they are—not where we want them to be—these interventions reduce overdoses, connect people to addiction treatment, and decrease HIV rates.
For example, many of my patients started out by seeking free needle exchanges or a safe place to inject. After building trusting relationships with the staff, they felt comfortable beginning treatment for their substance use disorders. As for the common concern that overdose prevention centers lead to an increase in crime, studies have found that crime rates around these clinics either stay the same or go down.
Another example involves buprenorphine and methadone, two medications used to treat opioid use disorder that are sometimes considered to fall under the umbrella of harm reduction. Prescribed treatments like these dramatically reduce the rate of overdoses and deaths; for example, a study in JAMA found these medications are associated with a 76% reduction in overdose risk at 3 months.
Harm reduction saves money, too. Access to new needles can represent the difference between a healthy life and a lifetime of medical bills from complications of substance use, such as paralysis from a spinal infection. Unsanitary needles also cause heart valve infections, which on average cost almost $200,000 to treat. Buprenorphine treatment for opioid use disorder is associated with over $20,000 in healthcare savings per year per person.
As for HIV prevention drugs, a study calculated that just a 3.3% annual drop in coverage over the next 10 years in the US would result in so many new HIV infections that the estimated lifetime medical costs to treat them would be an astonishing $3.6 billion. With Donald Trump's goal of decreasing healthcare spending, investing in harm reduction is a cost-effective way to save taxpayer money.
Even if you do not use drugs, the new cuts affect your ability to help those who do. Roughly 75% of annual overdose deaths in the United States involve opioids. Almost all of these deaths could have been prevented if naloxone had been administered in time. I often see EMS bring in a patient who’d stopped breathing from an overdose and survived only because they received naloxone from bystanders. But efforts to make naloxone more widely available are also at risk of losing funding because they focus on harm reduction.
Without harm reduction initiatives, many of my patients with substance use disorders would be dead. These patients come from all walks of life, but they all have benefited from extensively researched, evidence-based strategies that we now know reduce complications of substance use. It is a joy to see them achieve their treatment and larger life goals: becoming actively involved parents, business leaders, community volunteers, artists, and more.
I grieve for the senseless deaths these cuts will cause. States are scrambling to find funds to fill in the gaps, and I worry about the ability to make up for the loss of federal support.
In one area, I agree with President Trump: we should exclusively fund evidence-driven treatment options and research. I just wish this administration would review the scientific literature on the groundbreaking successes of harm reduction initiatives to understand why harm reduction should not be on the chopping block.
Dr. Cara Borelli, DO is an addiction medicine physician who trained at Icahn School of Medicine in New York City. She works on an inpatient addiction medicine consult service and teaches in New Haven, Connecticut. She is the co-editor-in-chief of the Journal of Child and Adolescent Substance Use. She can be found on Twitter/X @BorelliCara. She is a Public Voices Fellow at The OpEd Project. This opinion piece reflects her personal views.
Keep ReadingShow less
U.S. President Donald Trump speaks in the Oval Office on April 18, 2026 in Washington, DC.
(Photo by Tasos Katopodis/Getty Images)
When Leadership Becomes a Liability — The Constitution Is Tested
Apr 20, 2026
In American government, loyalty is often praised. But the oath taken by public officials is not to a person or a party—it is to the United States Constitution. At a moment when Americans across the political spectrum are alarmed by the president’s increasingly unpredictable behavior on the world stage, that distinction matters. The framers anticipated moments when instability at the top could endanger the country, which is why the Constitution includes safeguards such as the Twenty‑Fifth Amendment.
Across the country, Americans from every political background are expressing concern that instability at the top is testing the constitutional guardrails of steady leadership, clear judgment, and respect for institutional boundaries. Strained alliances and impulsive communication in moments of global tension place additional pressure on those safeguards. Many Americans worry that the president’s increasingly unpredictable behavior—combined with the silence of those closest to him—is weakening the constitutional guardrails the framers put in place.
Recent polling shows that most Americans—and even many Republicans—believe the president’s behavior has become more erratic. That should prompt attention, not dismissal.
Reporting documented the President's public attacks on Pope Leo, a moment that drew international attention and raised questions among allies about U.S. leadership. Moments like this test the standards of responsible leadership — and even his supporters can care about the president while still insisting on responsible conduct, sound judgment, and the responsible use of power. That is not disloyalty; it is stewardship.
The presidency has long been understood as a stewardship. Theodore Roosevelt described the executive as a “steward of the people,” responsible for upholding democratic norms. Alexander Hamilton connected executive energy to the “steady administration of the laws.” Modern analysis notes that the office requires avoiding behavior that demeans the country, because a president’s conduct shapes national credibility.
These concerns are not occurring in a vacuum. The president’s approval ratings remain low, and polls show Americans uneasy about recent foreign‑policy decisions. A new AP-NORC poll found that 59% believe U.S. military action in Iran has gone too far and are worried about affording gasoline. This week, I paid a little over $95 to fill my gas tank — more than $20 higher than when this crisis began — a reminder that global instability reaches directly into the lives and budgets of ordinary Americans. New AP-NORC findings also show low trust in the President’s judgment on the use of military force overseas and only about one‑third approving of his handling of foreign policy.
Some Americans reassure themselves that the system will “hold” until the next election. But the presidency is not passive. Decisions are made daily, words can shift global events, and rhetoric can strain alliances, complicate diplomacy, and raise the risk of conflict. Recent reporting made those consequences impossible to ignore: news organizations documented a public threat toward Iran that shocked global leaders and unsettled some Republicans. Analysts described confusion over shifting objectives, and lawmakers questioned whether Congress had a clear rationale for the conflict. As former Labor Secretary Robert Reich wrote, ‘No civilized nation threatens to wipe out another civilization,’ a warning that underscores how dangerous such rhetoric becomes.
Those concerns deepened when the President and Secretary Hegseth publicly celebrated what they described as a major ceasefire "victory," even though independent fact‑checking showed that the administration’s four stated objectives had not been met. The contrast between the celebration and the facts was visible not only to Americans, but to foreign governments watching closely. In moments of global tension, that disconnect carries real consequences for national credibility.
That credibility was tested.
International institutions reacted quickly. NATO allies expressed concern about the president’s public statements. European leaders warned that unpredictable rhetoric increases the risk of miscalculation.
Foreign‑policy analysts have also noted that U.S. instability creates openings for strategic rivals. China has used the moment to expand its diplomatic influence, and Russian state media has amplified the turmoil to weaken Western unity. Both countries benefit when American leadership appears divided or unpredictable.
Legal scholars also raised alarms. Hundreds of international law professors argued that the U.S. strikes in Iran violated the UN Charter, and experts questioned whether the escalation was necessary. These assessments emerged alongside reporting confirming loss of life—including American service members and civilians.
Taken together, these patterns paint a picture of instability at the highest levels of government—instability that affects alliances, national security, and the safety of Americans at home and abroad. Several lawmakers, national security experts, and international allies have warned that the President’s escalating rhetoric is undermining U.S. credibility and placing the country at greater risk. Recent AP-NORC findings reinforce these concerns, with majorities saying U.S. military action has gone too far and expressing deep anxiety about the economic fallout.
That is why the Constitution provides guardrails.
The Twenty-Fifth Amendment outlines a clear constitutional process: the Vice President is the central actor, empowered to initiate a transfer of authority if a president is unable to discharge the duties of the office. A majority of the Cabinet must agree. If the president contests the action, Congress becomes the final arbiter, requiring a two‑thirds vote in both chambers. These roles were designed for moments when behavior—not ideology—raises questions about a president’s ability to lead safely.
This concern has become bipartisan. Reporting has noted that Republican lawmakers—including figures who have historically supported the president—have privately expressed alarm about his recent behavior, particularly in the context of the Iran conflict. A 2024 book reported former Republican Leader Mitch McConnell describing the president as having “every characteristic you would not want a president to have” and calling him “irascible” and “nasty.” Members in both parties have discussed the Twenty‑Fifth Amendment as a safeguard because they view the current unpredictability as dangerous.
When threats, celebrations, reversals, and false claims occur in rapid succession, the country is left without the steady leadership national security tests. What the president may view as strength is, to many observers, a sign of instability—a leadership style that appears reactive, unplanned, and disconnected from the facts. The United States is more vulnerable—diplomatically, strategically, and institutionally.
When leadership at the top is tested and the country grows vulnerable, citizens must use their voices—through calls, letters, public dialogue, and civic engagement—to reinforce the Constitution’s guardrails. Calls, letters, and emails to elected representatives are tracked, and they influence priorities. Asking for oversight, briefings, and transparency in presidential decision‑making is not a political act; it is a constitutional one. Public scrutiny—grounded in facts and democratic principles—helps counter misinformation and strengthens civic understanding.
Supporting institutions rather than individuals is another safeguard. The strength of the American system lies in its checks and balances, and citizens play a role in upholding them. It is also important to understand that the U.S. military is bound by law to follow only lawful orders. Under the Uniform Code of Military Justice, the Law of Armed Conflict, and the military’s oath to the Constitution, service members must refuse orders that are unconstitutional or manifestly illegal. Finally, participation in elections at every level—federal, state, and local—remains one of the most powerful tools available to the public.
The framers of the Constitution did not assume perfection in leaders. They assumed human fallibility—and built a system to account for it. But that system is tested by people: elected officials willing to act, and citizens willing to insist that they do.
Waiting is not a safeguard.
Engagement is.
Duty must come before loyalty—especially when the Constitution is tested.
Carolyn Goode is a retired educational leader and national advocate for ethical leadership and civic renewal. She writes on institutional trust, democratic responsibility, and the role of principled leadership in public life.Keep ReadingShow less
Load More