​If you or someone you know may be experiencing a mental health crisis, contact the 988 Suicide & Crisis Lifeline by dialing or texting “988.”

Someone in America dies by suicide every 11 minutes. It’s that common. But not normal.

Humans have evolved over centuries to survive. So when people try to kill themselves, something has gone wrong. Typically, the assumption is that something happened in the person’s mind — a mental illness.

But in recent decades, there’s been a growing movement to ask a different question: What went wrong in the world around that person?

For Chris Pawelski, it was a torrent of factors. His dad — one of his best friends, whom he worked with daily for decades — was diagnosed with renal cancer and died six months later. Pawelski was left as the primary caregiver for his mom, who had dementia.

His family’s multigenerational onion farm in New York’s Orange County — where he first worked as a 5-year-old, collecting onions that fell out of crates — was hemorrhaging money. Pawelski said he was growing roughly $200,000 worth of crops some years but took home only about $20,000, unable to negotiate higher prices with wholesale buyers that dominated the market.

Debt to suppliers and equipment vendors piled up, and the burden strained his marriage. He had little time for friends, working sunup to sundown seven days a week, desperately trying to preserve his family’s legacy.

“It’s all stuff collapsing down upon you,” he said. “It’s weeks, months, years of dealing with all sorts of pressures that you can’t alleviate.”

Pawelski started wondering what it would be like to get hit by a truck on the busy road in front of his house. “You think you’re already on your way out, so why wait?” he said.

  (Jeffrey Basinger for KFF Health News)

After his father died, Pawelski became his mother’s primary caregiver. Meanwhile he was struggling to preserve his farm — his family’s legacy. “It’s all stuff collapsing down upon you,” he says. (Jeffrey Basinger for KFF Health News)

Millions of Americans have serious thoughts of killing themselves, and tens of thousands die by suicide annually. Suicide repeatedly ranks among the top 10 leading causes of death — making the U.S. an outlier among developed nations.

Prevention efforts have typically focused on connecting individuals in crisis with treatment — despite therapy and medication being notoriously expensive, the healthcare system struggling to meet demand, and a consensus that suicide is caused by a host of factors, including but not limited to mental illness.

Now, many people working to prevent suicide, including some who have tried to harm themselves or lost a loved one to it, are calling for a broader approach. Some were galvanized by the covid pandemic, when rates of anxiety and depression spiked — not because everyone’s brain chemistry suddenly changed but because the world changed.   

​In this “How Would You Fix It?” interview, Julie Rovner, KFF Health News’ chief Washington correspondent and host of the What the Health? podcast, sat down with David Blumenthal — a physician, health policy expert, former Obama administration official, and author — to explore the dynamics that make fixing the nation’s health care system so difficult.

They discussed the pivotal role the president of the United States plays in health policy — whether it is building support for or opposition to new plans and proposals. “Presidents have a level of authority which is often underappreciated, especially in health care,” Blumenthal said.

Blumenthal and Rovner also discussed the historical reasons the U.S. has been unable to enact universal health care, incrementalism versus sweeping change, and what he described as “the dance” between proponents and opponents — usually a clear party-line split between Democrats and Republicans — of major health care reforms.

Today, the split seems to have come to a head, as public health, science, and expertise are being viewed by one end of the political spectrum as “the opposition,” Blumenthal said, which will complicate efforts. Still, he outlined ideas for moving forward.

An abbreviated version of this interview aired April 23 on Episode 443 of What the Health? From KFF Health News: “RFK Jr. vs. Congress.”

Blumenthal’s latest book, Whiplash: From the Battle for Obamacare to the War on Science, co-written with James A. Morone, offers a behind-the-scenes look at how three presidential administrations pursued very different health policy goals.

KFF Health News is a national newsroom that produces in-depth journalism about health issues and is one of the core operating programs at KFF—an independent source of health policy research, polling, and journalism. Learn more about KFF.This <a target=”_blank” href=”https://kffhealthnews.org/health-industry/health-care-policy-political-divide-david-blumenthal-interview/”>article</a&gt; first appeared on <a target=”_blank” href=”https://kffhealthnews.org”>KFF Health News</a> and is republished here under a <a target=”_blank” href=”https://creativecommons.org/licenses/by-nc-nd/4.0/”>Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License</a>.<img src=”https://kffhealthnews.org/wp-content/uploads/sites/8/2023/04/kffhealthnews-icon.png?w=150&quot; style=”width:1em;height:1em;margin-left:10px;”>
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​The Host

Julie Rovner

KFF Health News

@jrovner

@julierovner.bsky.social

Read Julie’s stories.

Julie Rovner is chief Washington correspondent and host of KFF Health News’ weekly health policy news podcast, “What the Health?” A noted expert on health policy issues, Julie is the author of the critically praised reference book “Health Care Politics and Policy A to Z,” now in its third edition.

Health and Human Services Secretary Robert F. Kennedy Jr. completed his marathon tour of House and Senate committees this week to defend President Donald Trump’s proposed budget for his department, but he got grilled on lots of non-budget matters as well, most notably his proposed changes to the childhood vaccine schedule.

Meanwhile, Trump made some of his own health policy, signing an executive order to facilitate the use of hallucinogens to treat mental health conditions. That action came just days after it was suggested to him in a text message from podcaster/influencer Joe Rogan, who was present in the Oval Office for the signing.

This week’s panelists are Julie Rovner of KFF Health News, Victoria Knight of Bloomberg Government, Alice Miranda Ollstein of Politico, and Sheryl Gay Stolberg of The New York Times.

Panelists

Victoria Knight

Bloomberg Government

@victoriaregisk

Alice Miranda Ollstein

Politico

@AliceOllstein

@alicemiranda.bsky.social

Read Alice’s stories.

Sheryl Gay Stolberg

The New York Times

@SherylNYT

Read Sheryl’s stories.

Among the takeaways from this week’s episode:

There were fewer fireworks than expected during Kennedy’s four-day, whirlwind tour of Capitol Hill. One thing that was clear is that Kennedy got the political memo that he is to watch his vaccine rhetoric and keep the focus on politically palatable topics such as chronic disease and healthy eating. Still, there were episodes of indignation and grandstanding, from the secretary and from lawmakers. Kennedy also sometimes struggled to defend administration proposals to cut funding.

Among members who pressed Kennedy on vaccines was Sen. Bill Cassidy (R-La.), who is facing a difficult primary challenge. Cassidy, a physician, has in the past clashed with Kennedy over vaccines and has been targeted by the Make America Healthy Again movement. In hearings, however, Cassidy led with questions on abortion issues, which fit more aptly into his red-state politics. Meanwhile, though Cassidy’s Senate seat is considered at risk, it’s not clear that the MAHA muscle on the ground is living up to the threat.

​The Host

Mary Agnes Carey
KFF Health News

@maryagnescarey

Mary Agnes Carey is managing editor of KFF Health News. She previously served as the director of news partnerships, overseeing placement of KFF Health News content in publications nationwide. As a senior correspondent, Mary Agnes covered health reform and federal health policy.

President Donald Trump this week nominated a former deputy surgeon general who has expressed support for vaccines to lead the Centers for Disease Control and Prevention. Considered a more traditional fit for the job, Erica Schwartz would be the agency’s fourth leader in roughly a year, should she be confirmed by the Senate. 

And Health and Human Services Secretary Robert F. Kennedy Jr. appeared on Capitol Hill this week in the first of several hearings discussing Trump’s budget request for the department. But the topics up for discussion deviated quite a bit from the subject of federal funding, with lawmakers raising issues of Medicaid fraud, measles outbreaks, the hepatitis B vaccine, peptides, unaccompanied minors, and much, much more. 

This week’s panelists are Mary Agnes Carey of KFF Health News, Anna Edney of Bloomberg News, Emmarie Huetteman of KFF Health News, and Joanne Kenen of the Johns Hopkins University Bloomberg School of Public Health and Politico Magazine.

Panelists

Anna Edney
Bloomberg News

@annaedney

@annaedney.bsky.social

Read Anna’s stories.

Emmarie Huetteman
KFF Health News

Joanne Kenen
Johns Hopkins University and Politico

@JoanneKenen

@joannekenen.bsky.social

Read Joanne’s bio.

Among the takeaways from this week’s episode:

Trump on Thursday named four officials to the CDC’s leadership team. Schwartz, whom he picked as director, is a physician and Navy officer who served as a deputy surgeon general during Trump’s first term. She has voiced support for vaccines and played a key role in the covid-19 pandemic response.

RFK Jr. testified before three committees of the House of Representatives this week on the president’s budget request for HHS. While the hearings touched on a wide variety of topics, notable moments included a slight softening of Kennedy’s stance on the measles vaccine, including the acknowledgment that being immunized is safer than having measles — although he also stood by the decision to remove the recommendation for the newborn dose of the hepatitis B vaccine.

New studies on the use of acetaminophen during pregnancy and the effects of water fluoridation on cognitive function refute Trump administration claims. And a White House meeting that brought together Trump, Kennedy, and other leaders of the Make America Healthy Again movement aimed to so  

​The number of babies born in the United States fell again last year.

This story also ran on CBS News. It can be republished for free.

According to new data from the Centers for Disease Control and Prevention, there were 3.6 million births in 2025, a 1% decline from 2024. The fertility rate dropped to 53.1 births per 1,000 women ages 15 to 44, down 23% since 2007.

The Trump administration has said it wants to reverse this trend. President Donald Trump has called for “a new baby boom,” and aides have solicited proposals from outside advocates and policy groups ranging from baby bonuses to expanded fertility planning. The administration is also proposing to reshape the federal government’s only dedicated family planning program: Title X.

For more than five decades, Title X has been geared — with bipartisan support — toward giving low-income women access to contraception, screening for sexually transmitted infections, and reproductive health care regardless of ability to pay. At its peak, the safety net program served more than 5 million patients a year. Six in 10 Title X clients have reported the program as their sole source of health care in a given year.

In early April, the Department of Health and Human Services invited nonprofit organizations to apply for Title X grants for fiscal year 2027, which begins in October. The 67-page Notice of Funding Opportunity included only one mention of contraception — describing it as overprescribed, associated with negative side effects, and part of a broader “overreliance on pharmaceutical and surgical treatments.”

The grant notification reshapes the program from its traditional public health intervention efforts to focus on fertility, family formation, and reproductive health conditions such as polycystic ovary syndrome, endometriosis, low testosterone, and erectile dysfunction.

While Title X will continue to help women “achieve healthy pregnancies,” the grant document does not explicitly reference preventing unintended pregnancies — a long-standing goal of the program.

Jessica Marcella, who oversaw the Title X program as a senior official in the Biden administration, said the new funding notice amounts to a wholesale redefinition of family planning.

“What we’re seeing is trying to use our nation’s family planning as a Trojan horse for an entirely different agenda,” Marcella said, noting that Trump has proposed eliminating Title X altogether.

Birth Rates and Fertility Trends

The administration is overhauling Title X in the context of declining birth rates. But researchers who study fertility trends say the decline is driven by forces that have little to do with contraception access and that restricting it is unlikely to produce more births.

The most important factors, according to demographer Alison Gemmill of UCLA, are timing-related. “Childbearing is increasingly delayed as part of a broader shift toward later a