A big part of the widespread anxiety over a second Donald Trump administration is simply because his unrestrained desire to knock things down — with or without a plan — is so widespread in his promised attacks on how things work.
Even those who want Big Directional Change seem to want it in understandable, swallowable bites under the belief that our variegated society can make incremental adjustments and go on with the job of everyday life. Voters chose Change without knowing much of what it will mean beyond fossil fuel drilling, deportations and “retribution” against political enemies.
What we’re seeing play out in the aftermath of a monumental and somewhat surprising election is the very breadth of promised changes that we face in economics, international relations, immigration and families, religious life, education, our environment, and, importantly, our access to health.
Adding to the sheer volume of promised changes is the idea that there will be no one ready to say “No” to Trump, who tells us he will be ridding his executive branch of any director or manager who does not accept his programs. With both houses of Congress and the Supreme Court majority heading for Trump-alignment, it is an open question about who effectively will speak out when changes inevitably run into conflicts of interest or law or just contrary to the literal health of the nation. It is noteworthy, for example, that Team Trump has declined so far to sign a legally required ethics document meant to block conflicts of interest in the White House.
The names surfacing to date as advisers either are throwbacks to the earlier Trump 1.0 team or reflective of those who contributed to his political win — including billionaire Elon Musk, whose personal and business conflicts will be many, and Robert F. Kennedy Jr., the flawed health and environment advocate whose adversity to vaccines and traditional health oversight have run straight into conspiracy theories.
Enter Robert F. Kennedy Jr. on Health
Trump apparently has promised Kennedy a major, if undefined role in dictating policy to the national public health complex of agencies and say over what will pass as administration policy about our health safety, vaccines, and food agency. Kennedy, generally an opponent of vaccine mandates even for Covid, has no such appointment yet, but already is promising to clear out “entire departments” at the Food and Drug Administration (FDA) and turn the Centers for Disease Control and Prevention on its head.
Kennedy, who has told us he has brain injuries that were “caused by a worm that got into my brain and ate a portion of it and then died.” has suffered serious health problems and been caught up in bizarre public behavior, including dumping a dead bear in Central Park. As an environmental lawyer, he has been active for years in campaigns that erroneously link vaccines to autism, and any number of conspiracies that have included associating Wi-Fi and cancer, water treatments that turn kids trans, and de-linking AIDS from HIV. He is a political character, not a medically trained specialist, but his records of lawsuits and advocacy is one that insists that he knows better.
But apparently, he will be given free rein to “go wild” with health and food regulation.
His first announced target is the nutrition department at FDA, one of those ” that are not doing their job,” he told NBC. His example, the cereal Froot Loops, which is allowed to use 18 or 19 ingredients — mostly food colorings — in the U.S., as compared with two or three in Canada. OK, this saves us from what? Is there some unreported Froot Loops death trend, or is this just a tweak of bureaucratic and industrial noses? If we drop regulators, how do we get the cereal company to comply with eliminating the extra ingredients. How does this help America’s health? There have been studies about the use of “red dye 40” and disease links, but authorities ordered it replaced — presumably a good thing.
Kennedy says he will not eliminate health agencies if congressional approval is required but aims “to get the corruption out of the agencies.” He added that Trump wants him to do three specific things — “clean up the corruptions of the agencies” and any conflicts of interest; “to return those agencies to gold standard, science, empirically based, evidence-based medicine,” and “to make America to end the chronic disease epidemic, particularly among kids.”
Curious goals for someone who wants to eliminate mandates for, say, school vaccinations for rubella, measles and mumps — diseases for which there are decades-long records of health improvement. Public health doctors suggest that it is exactly because of mandates that individual immunity to such diseases increases geometrically with mandates — whether for childhood disease or possible pandemics like Covid.
Even now, we are experiencing a slow increase in Asian bird flu jumping from species to species, with several human deaths among farm workers. Trump shut down the White House office of pandemic prevention, which Joe Biden re-opened.
Overall, Kennedy said he “would not take any vaccine that is currently on the market,” just the mandate. He wants a society in which individual do research and decide for themselves — or what public health experts would deem a certainty for contagion. Kennedy has told interviewers that despite the Covid vaccines, the U.S. “had the worst record of any country in the world.” He wants to shake up the CDC and public health, but we’re left guessing at what that means.
Instead, we’re going to debate whether to ban fluoride in the U.S. water supply, despite dental research showing it to be effective at stopping tooth decay — and dental costs. “There is a lot of new science out there. In fact, there’s a federal judge decision by an Obama-appointed judge on October 4th of this year in which he’s going to send the EPA back to the drawing board,” he said.
Trump as Health Protector
Throughout, there is an element here that “populism” or pushback against “elites” is more important in health (and other issues) than medical research. Individuals should decide for themselves, he argues, not health officials or states — apparently unless a health decision involves abortion.
Trump and Speaker Mike Johnson repeatedly and casually talk of eliminating Obamacare and making substantial changes in Medicare and Medicaid without looking at medical consequences. They don’t outline the changes they might consider, but clearly see continuing costs as a burden.
Now that will have an effect on Americans’ health — a bad one, for sure, since it will knock millions from health availability.
Over time, Trump has spoken about dropping costs for younger workers, whose contributions through taxes are supporting the seniors as the most health-costly group. The Affordable Care Act has operated on the notion of covering existing medical conditions based on the guarantee of national support for the insurance.
Clearly, Trump sees more and more of health, including decisions about abortion services and reproductive health as the province of states rather than the feds. States vary widely, and the recent campaign has highlighted the many inequities of vague laws regarding abortions. Sates stand posed now to push for more intrusive laws governing out of state travel for abortions or prosecutions of doctors and hospitals who come up with treatments that work around abortion laws. Again, one must wonder how this contributes to better health in this country rather than to fealty to a particular partisan political philosophy.
The most charitable view of Big Change for health in Trump’s return is uncertainty about his goals and his ability to achieve those goals. Because of politics, Trump felt obliged to criticize Biden and Kamala Harris over expanded prescription caps and bigger rolls of Medicare patients, but it is exactly the sort of thing that he himself suggested he would do and protect.
Trump has offered no plans about hospital consolidations and the health deserts being created by abortion laws, no opinions about maternal and infant morbidity that are double the next industrialized country, no good explanation of how to reduce the price of prescription drugs. Drugs come up only as a subject in the crime file, not the health file.
We actually have no idea whether Trump will move against legal distribution of abortion medications or intervene when federal protections for patients run afoul of state abortion laws, or whether a vacillating Trump will undercut IVF treatments with support for fetal personhood bills or be “the father of IVF” as he also has declared.
The only things that is clear about Trump and health are that we don’t have clarity about what’s ahead that his administration needs to be held to account for any changes that are forced on the system.
