National news is abuzz with Jay Bhattacharya’s nomination to director of the National Institutes of Health — the world’s preeminent health research agency with a $48 billion budget. Four years ago, Bhattacharya was widely denounced within professional medical and public health communities as a reckless, fringe figure. What has happened since in our national health landscape such that he could now be set to assume a position with such enormous influence over the nation’s health, and what does his nomination portend for its future?

When Joe Biden became president of the United States, an ongoing pandemic had exposed the nation’s public health and health care systems as failures. After decades of delusional thinking inside US medicine, media, and politics shaped by health care–industry propaganda that claimed Americans enjoyed “the best health care in the world,” no one could continue denying — not with a straight face, anyway — an obvious truth: health capitalism, in which profit rather than people is the priority and thus privatization rather than strong public institutions is the goal, is conducive to neither good medical care nor effective public health.

Despite spending roughly two times more per capita on health care than other high-income countries, US health outcomes were far inferior. Compared to peer nations, life expectancy was considerably worse. Our premature death rate topped the list. And public distrust of medicine, science, and government had reached historic highs. America’s deeply unpopular health systems were ripe for disruption and reconstitution on a fundamentally different model.