American Thought Leaders - Inside RFK Jr.’s Unprecedented Reset of HHS: David Mansdoerfer

Episode Date: April 13, 2025

David Mansdoerfer served as deputy assistant secretary for the Department of Health and Human Services (HHS) during the first Trump administration. Now, he’s chief strategist at the Independent Medical Alliance and describes himself as the MAGA-MAHA Connector.“We have seen a complete reset of a federal agency within 60 days of Secretary Kennedy getting there. To me, that is unprecedented, and it is going to be one of the most impactful approaches to public health and the health economy in the United States,” he says. “We have not won this fight. We’ve begun the fight. And we have industry forces, which I would say [have] unlimited money, that are going to try to do everything to protect their bottom line, but also limit good policy ideas of a Secretary Kennedy and a President Trump.”What reforms are already underway since Health Secretary Robert F. Kennedy Jr. took over HHS? What pushback has he faced? And will the administration be able to reconcile and even merge the disparate agendas of the MAGA and MAHA movements?“You basically get to put an entirely new, fresh face of career leaders that are aligned to the president’s agenda and the secretary’s agenda in positions of authority that could be and will be longer lasting than just this administration,” says Mansdoerfer. “Even in terms of the unknown, it is better to have leadership that’s willing to take these bold actions than it is to continually lead Americans down a poor health outcome path.”Views expressed in this video are opinions of the host and guest and do not necessarily reflect the views of The Epoch Times.

We have seen a complete reset of a federal agency within 60 days of Secretary Kennedy getting there. To me, that is unprecedented, and it is going to be one of the most impactful approaches to public health and the health economy in the United States. David Mansdorfer served as HHS Deputy Assistant Secretary during the first Trump administration. Now he's chief strategist at the Independent Medical Alliance and describes himself as the MAGA-MAHA connector. We have not won this fight. We've begun the fight, and we have industry forces that are going to try to do everything to limit good policy ideas of a Secretary Kennedy and a President Trump. What reforms are already underway since Secretary Kennedy took over the Department of Health

and Human Services? What pushback has he faced? And will the administration be able to reconcile or even merge the disparate agendas of the MAGA and MAHA movements? Even in the terms of the unknown, it is better to have leadership that's willing to take these bold actions than it is to continually lead Americans down a poor health outcome path. This is American Thought Leaders, and I'm Jan Jekielek. David Manstorfer, such a pleasure to have you on

American Thought Leaders. Thank you. At HHS, what's being described as a historic opportunity, perhaps a once in a lifetime opportunity, is in play. Bobby Kennedy Jr. has been made HHS secretary, and there's a number of other what you would call disruptors in the system and the sub-agencies now. Give me a sense of what you see as the opportunity here

and why it's rare. Well, Secretary Kennedy came in on a movement that was combined with President Trump's agenda, which gives us a disruptor in chief and then also a disruptor of health at the same time. As we've seen, even with the combination of all the Doge work that's happening, we have seen a complete reset of a federal agency

within 60 days of Secretary Kennedy getting there. To me, that is unprecedented, and it is one of, going to be one of the most impactful approaches to public health and the health economy in the United States. Give me a sense of the scale of this agency. You know, a complete reset. That's kind of hard to imagine what that looks like.

Yeah, so when I was there in Trump 1.0, the agency was about 80,000 folks, full-time equivalents, and 150,000 contractors that supported the mission of the agency. At HHS, it is the entire gambit of health. So we all know the big agencies, but I'll go through some of them. We have NIH, which really focuses on research and has a lot of interactions with Congress about specific disease pathways.

You have CDC, which is focused on surveillance and to a certain extent, global health. Then you have FDA, which is really centered around bringing your drugs to market or bringing your products to market within the health space. And then you have the payer system, which is your Medicare and your Medicaid systems which as we know anyone over the age of 65 or typically the poor through the Medicaid system. So it is the largest cost driver of the federal government.

of the federal government. I don't know what the exact number is, but when I was there, it was about $1.3 trillion worth of expenditures, which has again ballooned during the Biden administration, which we're really now seeing a reset back to 2019 levels through this administrative reorg action. Explain to me what a reset actually means here.

There were really two big components of the reset. There was a public health reset, and then there was a business operations reset within the agency. And so they took divisions that were part of the larger HHS infrastructure. So SAMHSA, which is your mental health division, essentially. HRSA, which is your federally qualified health center, or your local community health center that the government runs.

And then my old office in OASH, and they combine that to be this new department, the AHA. And so that department is going to have a much greater visibility and impact on public health because it brings together disparate resources that weren't talking to each other and putting them and putting them all into the same direction. And so I am extremely excited about it. And then on the other side, you had an operational reorganization where we all hear about Medicare fraud. We all hear about the the different things that HHS enforces through either civil rights and HIPAA or through Medicare or through you know payment systems and you know whether we're overpaying or underpaying folks.

They created a new division on enforcement that's going to greater operationalize the ability to protect taxpayer resources by making sure that one person is governing and leading over those specific agencies, as opposed to three where it was before. Let's use that $1.3 trillion annual budget. Can you give me a broad sense of where money goes in that $1.3 trillion? Yes. So the biggest is going to be CMS, so the Center for Medicaid and Medicare. That is your payment system, essentially, for either the Medicaid system, which typically goes

out to states, or the Medicare system, which is your elderly care, essentially. And so that's the biggest chunk of it. Another large chunk is NIH and the grants that it pushes out to local organizations and to higher education institutions to study different disease research. Within NIH, you've seen significant restructures on the types of grants

that they're focusing on to better align them to the secretaries and the president's agenda. And so you've already started to see some reforms there. Other big pockets of money are, you know, I mentioned HRSA, which is your federally qualified health centers or your local community health center. That's really direct patient care for the poor in certain communities.

And then you have a whole slew of other grants like at CDC, as we learned during COVID where they do surveillance on disease pathways, infectious disease and other things like that. And so it's a pretty broad agency in terms of the types of things that it funds. But at the end of the day, this reorganization action is going to be better for the taxpayer because it's going to take parts of that agency that have historically not talked to each

other but dealt with similar topics and actually get them all on the same page and push them forward. Does this also somehow make it easier for the secretary to implement his vision? It does. HHS has a secretary. It has division directors or assistant secretaries. So we've seen Dr. Bhattacharya over at NIH. We've seen dr. Badacharya over at nhh. We've seen dr. Oz at cms. Underneath that you have Roughly 180 to 200 political appointees that support the

Principles in many different ways. What this organization does of The political appointees is it basically puts folks over specific divisions underneath SAMHSA, OASH, HRSA, all of these acronym words that don't make sense maybe to the general public but have integral parts to the health economy system in the United States. And so the secretary, by reorganizing this, has basically level set to the career bureaucracy in the agency. And what I mean by career bureaucracy are the folks that last beyond an administration.

Political appointees are attached to the president. The career bureaucracy or the 80,000, now 62,000, are folks that typically lost no matter who is in charge in the executive office. By resetting the agency, you get to now pick the leadership for all of these new divisions that you're creating. And unlike the status quo, where we saw very little turnover in the agency, you basically get to put an entirely new fresh face of career leaders that are aligned to the president's agenda and the secretary's agenda in positions of authority that could be and will be

longer lasting than just this administration. Broadly speaking, how is this agenda different from the past agenda? If folks remember, when President Trump first took office in 2017, repeal and replace was on the agenda. It was a very high priority. Obviously we weren't successful in that occasion, but we really had to deal with the political dynamics of the Affordable Care Act. Well the Affordable Care Act again is mostly focused on health economy, right? It's health insurance, it's getting folks to health outcomes, but this time we are infusing a new era of public health, which Republicans and conservatives have typically not talked a lot about. Republicans and conservatives

stay very strong on the health economy. We love to talk about payments, we love to talk about hospital, rural health, and how the economy is impacted by health. Right now we have a secretary who cares deeply about public health, which is everything from the mRNA vaccine to food dye in your foods and chemicals within your food to environmental factors. These have traditionally not been topics that your normal historical Republican agenda would focus on. And so to me having a disruptor in chief in the president and then a public health disruptor sets this time for changing the course of American history from more expenditures, worse health outcomes, to more efficient expenditures, better health outcomes.

I want to find out a little more about you. How is it that you came into this role of assistant secretary in the first place? What does that actually mean? What are the qualifications of such a person because you're not a doctor. I was lucky to be called upon very early in the first administration as a generalist. My first job at the department was actually the director of boards and commissions. That sounds very innocuous until I tell you that there are over 280 advisory boards at the agency. Those 280 advisory boards are everything that your listeners might have heard of from the Presidential Physical Fitness Council,

you know, the old Arnold Schwarzenegger Council, to the, it's called PACHA, or the President's Council on HIV and AIDS, but each one of these advisory councils feeds policy into the agency. So, if the members on that council aren't aligned to the secretary's or the president's agenda, then there's some conflict and friction there. And so I had the opportunity to really get a crash course

on the agency looking at all of these policy advisory councils on behalf of the secretary, and to a certain extent the president when I was there. That translated to okay, so David had an opportunity to view the agency and I'm a more operations focused person. So a lot of folks in health policy or political appointees, they're great at certain topics.

They're really good MDs that know specific disease pathways. They have great clinical backgrounds. I can tell you how to get a contract done and go from A to B. And so having that relationship with high level, highly intelligent political appointees was great because I got to operationalize some of the things that they wanted to accomplish.

Those topics ranged from ending HIV, fentanyl and opioids, to reorganizing the department the first time, which I had a hand in. And when you're a political appointee, you kind of just get tasked with duties as assigned. So given that I was more operational, I had the opportunity to negotiate

the labor contracts for HHS. I had the opportunity to negotiate the labor contracts for HHS. I had the opportunity to reorganize the district offices and some of the public health functions the first time. And I had the opportunity to really work with high level leadership on driving home presidential agendas from things like veteran suicide, which is very important in the first administration and I think going to be important in the second administration as well and just having the opportunity to be a Swiss Army knife on a number of programs within HHS. How is it that you came to be this operations guy?

Well I've luckily worked for almost every type of government at this point. I started off working for the County of Orange out in California, Orange County. I don't know why they have that differentiation, but I worked for a county supervisor out there, Senator Moorlach, where I learned a lot from. He was then promoted to the California State Senate. So I had the opportunity to see local government in action and then state government in action. And then due to some connections that we had

within Senator Moorlach's office, we all got, half of our office got called to DC to work for the Trump administration. And so I had the opportunity to work at the state and local and then go realize about all the things that we complained about at the state and local, and then go realize about all the things that we complained about at the state and local at the federal level. And so having that knowledge really gave me an inside scoop on how to address operational issues within some of the theoretical issues that we have in policy.

that we have in policy. Broadly speaking, an organization like HHS, it's mostly these, obviously, vast, vast, vast, vast majority, as we've discussed, is these career people. Is the issue that they have just a particular vision of what it needs to accomplish? And that is sometimes at odds with the vision of the executive? sometimes at odds with the vision of the executive? Yes. So I actually, before Elon took over Twitter, there was a hard way to define what a presidential

administration turnover looks like. But given the visibility of what Elon did at Twitter, think about the same actions where he came in with the kitchen sink, right, you know, to the front doors, but a organization that doesn't know you, doesn't particularly align with you, and yet you're now in charge. So think about if they fired the 180 top leaders at any Fortune 500 company on one day and then 180 new leaders showed up on the next day and says, hey, we don't like what the last group was doing and we're here to give you new direction. Okay, so you have that as a dynamic to start and then you have the normal cultural dynamic where I think if you did political polling

with inside of the agency you'd probably see 80 to 90 percent would be more Democrat-oriented and much fewer would be Republican-oriented. And that plays out where we see things like the District of Columbia, right, going 85, 15 Democrat to Republican. Those are the folks that are working in these agencies. So you're walking into an ideological culture battle the moment you come in to these agencies. So you're walking into an ideological culture battle the moment you come in to these agencies. Now, there are some wonderful career appointees at HHS.

They were actually some of the folks that gave me the best idea, but they weren't ever allowed to be empowered to be impactful, because they were a minority in their thought processes of what needed to be done. And so I don't want to paint a broad brush that the entire agency is inefficient and ineffective because there are many or parts of the organization that are great and many people within but they are silenced when Republicans are not in charge. Something a little more theoretical, and I recently realized that the spoils system, which is basically

what you've been describing here, I always thought it was sort of just a side effect of the realities of politics, but I only recently discovered that it's actually intentional. I wonder if you could speak on that since you since you probably have thought about this before. Elections have consequences. If you look at the ideological pendulum, over the last 20 to 25 years, you had presidents that were closer to ideologically aligned, even if they were in different parties.

Bush, Clinton, I would say their policy differences back then weren't nearly as stark as we are seeing between Obama, Trump, Biden, Trump. The pendulum is swinging much more significantly with the policy agendas of each of these different administrations. And so with that, it is much more stark when it comes to the outcomes for when a president wins. And so for agencies like HHS, you have wild changes in policy on areas like the pro-life agenda, on areas for interpretation around gender,

which is a big part of what HHS does, to even how you view the healthcare marketplace. And so I don't think it's necessarily what the four founders didn't expect. I think it's just more extreme as we get further and further away from political leadership that kind of ideologically agrees

on 60 to 70% and then has their own platforms. But when you have a 80 to 90% difference in ideology, the differences for a presidential agenda are very, very stark. I'm a big believer in diversity of thought and diversity of opinion. And having the ability to have different vantage points come in and structure government is so crucial at a time where government's just

been living on its laurels. Before Obama, it was plus 3%. Doesn't matter which administration you're in. Every year, the agency would get the same amount of money plus 3%. We're excited about it. We can continue on. When Obama got here, we had obviously the Affordable Care Act, which represented a significant increase in expenditures to the health economy.

And then we had President Trump come in, create some efficiencies around that. And then you had President Biden come in and then just blow it out of the water again. And so right now you have a reset that would be normal in any normal corporate business. We all don't like to talk about that because we hold public you know the public employee different than your corporate employee. You know because that's how we've been trained here in the United States is that public service is a great calling and it is a great calling, but it doesn't mean that our governmental entities shouldn't be treated in similar ways every now and then to reset them to make sure that they align with both the president's agenda but to better health outcomes. How can you

argue that this arcane system where we have 80,000 plus employees and 150,000 contractors and are spending trillions of dollars yet receiving some of the worst health outcomes is what's best for the American public. I can't make that argument. I'm really interested to see how the Democrats are going to try and make that argument over the next coming months. In Trump 1.0, as you call it, most people weren't aware that something like Maha existed. It existed in a more hidden way. All these people that were into different ways of approaching health than the standard allopathic model, I suppose, and millions of them. I didn't even really know how big

this was, even though at Epoch Times, we've been sort of servicing that sector for quite some time. It's not necessarily obvious that MAGA and MAHA would have such a common interest. So it's interesting because I've had the pleasure of getting to know folks in this second round, whether working on transition or just talking to folks about what to expect when they get

to the Department of Health. Because as the operations guy, I can't tell you what policy you wanna focus on, but I can tell you, okay, look for this, this, and this when you want to try and start doing things. And so what I have found is an incredible synergy between folks that were in the first administration who are now there and the incoming Maha team.

And to me, you need that pragmatism that comes with, we've been here, we've been through the grind, we know how to do this with the idealism of this is our first time here, this is our biggest shot, and we're gonna go above and beyond to make sure that we make impact. And so to me, you have two factions, but they are very strong together

and in ways that they wouldn't be strong if they were solely a part. And I can go into a lot about the internal management dynamics, but right now what I know is that the office of the secretary has some incredible leadership in it, ranging from Heather flick who was the former general counsel and assistant secretary for administration who serves as Bobby's chief of staff to the new incoming team that has the trust in relationships with Bobby and so to me having that there's going to be some hiccups like there is with every administration and there will be some difficulties but they are perfectly position they did a reorganization, once in a lifetime reorganization, of the largest federal departments in 60 days. You cannot tell me that the synergy inside is not working greatly, because there's no way they would have been able to pull that off in that amount of time. A hundred percent, right?

That's clear, but it's not necessarily obvious that that would be the case. This is, I guess, what I'm getting at. Is it obvious to you? No, because they're actually different agendas. The MAGA agenda and the MAHA agenda don't necessarily mesh on a lot of issues. MAGA and Trump 1.0, health care economy, the economics of health care, Maha is really public health focused. So to me, they are complementary of each other and as long as they don't start to try and drive each

other's business, they're gonna have a lot of paths to success because the Maha team sees, okay, here are the public health indicators. You know, we're feeding folks terrible stuff starting from childhood. We have obesity problems. We have diabetes problems. We have all these chronic disease problems. That's a public health argument. The health economy argument is why are we paying so much for all of these things and how do we merge them all together?

So you have a secretary Kennedy who's going to be very prevention focused, which saves taxpayer money because if we can prevent you from getting said disease, then we save Medicare and Medicaid on that type of payment at the end of the day. And you have the Trump 1.0 team who's really going to be focused on making sure that Americans have access to health in rural America, mental health and addiction treatments and other things. So to me, the synergies are incredible. And it's really getting them to be collaborative in this process, which we've seen because again, reorganizing a department of that level in two months, astronomically difficult. And they're not gonna get credit for it, but I want to just let everyone know that that's the first step.

I'm gonna expect by the end of this four years, we're gonna see better health outcomes in a number of topics ranging from addiction to mental health to obesity. Those are going to be core tenants of a Secretary Kennedy administration. And I bet by the end of this four years, we're going to see significantly better health outcomes in those areas. The dietary guidelines are being changed in a very significant way, as I understand it. And I want to get a little bit of a sense, maybe we can look under the hood a little bit, because I know you're aware of that process, and that it almost actually didn't happen.

Right? And so I think this just giving us a picture of what actually happened will give us a picture of how things work under the hood in these agencies. Can you sort of paint that story? Give me that story. Paint that picture. Yeah, so the dietary guidelines are at HHS, the division that oversees them is the Office of Disease Prevention and Health Promotion. They work with the US Department of Agriculture to review the dietary guidelines,

I think every four or five years. And what happens between administrations is every time an administration turns over and the opposite party is coming in, they try and cram through as much policy within the days between the November election in January 20th. And that's what we saw and updated dietary guidelines that would have solidified that process very early on in the Kennedy secretaryship and Trump administration. And dietary guidelines have a controversial history. But they've been pretty stagnant for a while. But things that are within them are, do we love salt or do we hate salt, are all these different conversations.

Well, in this instance, the incoming secretary's team realized what was happening and put out a call to groups like the Independent Medical Alliance to provide input on the dietary guidelines, which this organization was able to do, provide thousands of comments on what Kennedy would be more aligned with, which will then allow them to rewrite those dietary guidelines in a way that are going to get better health outcomes, because what folks don't understand is,

we all think about the food pyramid, but how does that operationally impact our lives? health outcomes because what folks don't understand is we all think about the food pyramid, but how does that operationally impact our lives? Well, the dietary guidelines goes directly to school lunches and how we pay for school lunches. So very impactful for business and consumers and the way we up bring our public school students in the lunches that we give them. So if we're feeding them very heavily on sugar or feeding them very heavily on things that

aren't going to be nutritionally beneficial to them, well, that all starts with the dietary guidelines and the fact that Secretary Kennedy's team realized that so early on, again, gives me significant hope that not only do they know what they're doing, but they are really making sure that the secretaries and the president's agenda is being fulfilled. Maybe explain this to me like I'm five, right? How would it even be conceivably possible that something as important as the dietary guidelines would somehow be

codified without the new administration realizing that it happened. There's something about the processes here that I don't understand. So what happens typically is, for this instance, you have an advisory committee, you bring together industry, you bring together nutritionists, you bring together clinical folks and researchers to talk about what do we think the dietary guidelines should be. That all started happening about a year ago. And you take the last report and you make your

changes and you write the report and due to disclosure notices, what you do is you publish that report and you say this is our preliminary report please provide us feedback on what you think we missed or didn't have or whatever so essentially what happened at the very end of the administration was they had drafted the report already and put it into the clearance process which means that we're putting it out to the federal you know register to have folks comments on it and we are basically circulating that this is the draft that we're going to go with unless we get overwhelming evidence that we need to do something different.

And so they did that right before the new administration gets in. And what I was telling folks about earlier, about 180 to 200 political appointees, that doesn't happen day one. Day one is typically 25 to 30 political appointees, that doesn't happen day one. Day one's typically 25 to 30 political appointees. And when you're an agency of 1.3 slash larger trillion dollars and multiple different things, it's hard to catch all of the policies that the previous administration was trying to jam through

before you even get there or are currently going on because it relies on unless you know what you're looking for, it relies on the career staff who may or may not want to tell you about certain priorities and what's coming down the pipeline. And so it happens in every administration. It's not a Republican or Democrat thing. But this was one very stark example where if they hadn't been on their A game, they could have had to spend more time walking back something that they didn't agree with. I got it. I mean, it's just the sheer scale of it creates a situation. There's so many important things. What do you focus on? It makes perfect sense.

Yes. Let's talk about how the IMA—we're here at the IMA conference. You've come on as an advisor to the IMA in the last six months. Tell me a bit about how you came to join them. Yeah, one of the things that I noticed in Trump 1.0 is that there were very few folks on the outside that could talk about public health. We had, again, as I've talked about the health economy, well taken care of, lots of think tanks, lots of great organizations that handle the health economic side of what conservatives think, but there wasn't really anything on the public health side.

So as part of my first job, which was to oversee the advisory boards and commissions, if I have to find a practitioner that's aligned with the public health agenda of the secretary and the president, they're much more difficult to find because they're either quiet about it, you know, because academic health science settings aren't really favorable to conservatives, or they didn't agree with our agenda. And so I really noticed that, hey, when we have to talk about certain topics, whether it's fentanyl, whether it's HIV, who on the outside has the ability to support the secretary

and the president's agenda from a public health perspective? Well, in this time, I noticed that we had this organization, formerly FLCCC, that had incredible science and health care capacity to have some of these conversations. So what we did, just through happenstance of getting connected, was I brought a vision of an organization that can fight for honest medicine on a number of topics from chronic disease to informed consent to restoring trust in medicine to changing the culture of health and took an existing structure that already had 50 plus fellows and multiple specialties, hardcore researchers that understand how to bring bench science to policy and

take that infrastructure and provide both offense and defense to an administration that's going to inevitably be attacked by every major corporate structure around health, whether it's the AMA, whether it's the hospital association, whether it's the public health associations, whether it's other subspecialty associations, there's already a cadre of organizations set up to defend the status quo. We needed an organization that provides evidence

in a way that we didn't have the first administration to push and defend good policy, but also push against bad policy as it comes out beyond the federal level, at the state and the local level. Bobby Kennedy Jr., the secretary, he invited a whole bunch of big food executives to HHS. I'm wondering, could there be something like that done with Big Pharma? At this event, there's a lot of criticism of Big Pharma. Yes. I think that if I were to be advising anyone that's concerned about what Secretary Kennedy and the administration is going to do to their bottom line, I would be bringing options to help America get healthier again.

And I think that's what we've seen in the food industry. I mean, you've seen Steak and Shake, right? That's the big one that it came out with beef tallow. I think In-N-Out just did it a couple days ago as well too. But you're starting to see the food industry trend the right direction around making proactive changes that I'm hearing many of them agree with. Again, there's the business reason for doing things, but as they start to really look at it, I see a lot of support from the food industry to rally around behind some of Secretary Kennedy's

ideas and to do it proactively because again I think Secretary Kennedy and President Trump have demonstrated if you don't come towards us we're going to make it happen. And so to me if pharma is very much the same thing what are ways that pharma can engage an agency where they have the status quo for how they've been relating to them, but you have a new secretary who really cares about chronic disease prevention. Well, how does that align with the pharmaceutical industry? And there will be places that it might, there might be some benefits there that both sides don't understand, and then there will be areas that don't. And how do you make America healthy again at the end of the day and bring proactive

solutions to an administration who wants to see health outcomes increase, not necessarily lie in the pockets of organizations that have increased or decreased life expectancy here in the United States. Explain to me how you see what they call the revolving door. So there's two types of revolving door. The first type of revolving door is what the career bureaucracy goes through and that's a they get trained in an organization like FDA and then they leave FDA and go work directly for an organization that they were regulating and so I see that as having some significant conflicts

of interest issues. And then you have the political dynamic. And what folks need to understand is that there's actually a very intensive ethics vetting process for political appointees. And so when you come from industry, you're typically recused from working on those subjects for a year or two or five,

depending on the types of subjects and the monetary value that you've gotten. But what's concerning is when you get towards the end of an administration, where like in the Biden administration's case, where we know we're not continuing, we know that January 20th at 1159 is the last minute that I'm employed.

That whole time period where you know you're being run out of office and you're searching for a job at the same time and you are pushing every policy through you can before the next administration gets there. So there are tons of conflict and revolving door issues, but the ones that concern me the most are the ones at the very end of administrations where everyone knows they'll be unemployed at a certain point in time and there's an incredible rush to put policy agendas through

before the new administration gets there. So to me, that's ripe for conflict when you see a lot of policies enacted at the very end of an administration. Basically, because you can enact policy for your future employer, basically for the benefit. Basically, yes. There's rules to try and stop that, but they're very, very hard to adjudicate. What was the role of the COVID pandemic and everything that came with it in ushering in this sea change in HHS? So if you've seen polling about trust in health and trust in science, it took a significant hit over the course of th

because the government bo were enforced unscientif there has been this incred And so there has been this incredible relationship divide between public health and the average American. Because I used to talk about government arrogance speak. And at the end of the day, I would love the many, many high level, highly trained folks at the agency that had so many letters behind their name that they could be credentialed on any topic. And then they'd go out and say, thou shalt do this. But they've not built any relationship

with the person that they're yelling at to say, thou shalt do this. And so to me, you had that normal government arrogance and public health arrogance coupled with a party that saw the ability to completely transform the health economy and the world through their draconian measures on control, ending up with now we have a significantly higher level

of distrust in both government and health. And we've always had distrust in health. There have always been a number of reasons why. You know, you can think about certain demographics in Tuskegee. You can think about all of these different things that lead into why folks can distrust either health, science, medicine, or the government. But at the end of the day, you took an unapologetic draconian public health apparatus and you basically punished average Americans with comments like, you know, the long winter of death that came

out of the White House, you know, for unvaccinated am I supposed to react to beaten me up over the las And now Secretary Kennedy to really take that frust health and governmental a that mistreated so many Americans during the COVID pandemic and right size it. And so to me, without COVID,

you don't get Secretary Kennedy. What do you mean by right size it? In the reorganization that came out, what they did was the methodology that I've heard they've done is they've took HHS back from the current levels, which were extremely exacerbated on hiring during the COVID pandemic and brought it back to 2019 minus 10 percent. And so you've essentially had a reset of the entire Biden administration hiring process and a little bit the Trump administration obviously with 2019-2020, but the entire hiring process of the last administration minus 10 percent. So to me that brings that back more into alignment with almost after Affordable Care Act days but but a little bit before, where you

saw an expansion of HHS growth during the ACA. During the ACA? Affordable Care Act. Of course, of course, the Affordable Care Act. I've just been juggling the acronyms. What substantively and permanently could HHS accomplish in four years, given a very real possibility that the pendulum swings the other way? The reorganization is a good first start. That's changing the culture of the management of the agency to move it much more aligned with better health outcomes as opposed to better bureaucracy. And so I think that's an excellent first step, but there are all the derivative topics that happen beyond that.

How do we fundamentally program and spend money as a government health agency. Well, one of the things that you might see in the coming days is SAMHSA, which is the Mental Health Association part of HHS, and then HRSA, which is the federally qualified health center portion. Having them combined is going to provide better direct primary care and direct access for poor communities because you'll be able

to layer on issues like mental health in ways that the general providers weren't doing historically. So that's one small subset. But to me, when you have a mental health crisis here in America, and we've seen that in a number of capacities, and we have an addiction crisis here in America and we've seen that in a number of capacities and we have an addiction crisis here in America. It makes absolute sense that the federal government should be funding programs into communities that are the most impacted and doing it in ways that you don't have one grant for mental health and one grant for making sure that you can have your normal primary care within these communities.

Why is that not combined? It's putting together opportunities to deal with the underlying issues, not the acute disease. Chronic disease prevention begins upstream. And so the more that we can catch folks that are beginning to struggle with mental health issues, or beginning to struggle with addiction, it's much easier to course correct over here than it is after you've had decades or years of dealing with specific issues.

Now not everything is going to be caught in that particular you know approach especially even with the combination of bringing folks like HRSA and SAMHSA together. But to me the way that the federal government has continued to spend money and get worse health outcomes on so many of these topics, it needed a disruption and a change like this to try something different. Where do you see, I guess, the biggest threat

or the biggest possibility of failure. It's a big guess. You know, when you do reorganizations, you know, you bring theory to practice and you have taken a static organization and significantly disrupted it. And so there's really two potential opportunities there. There's a, we were correct and we're going to see better health outcomes because we're going to have more efficient and effective spending. The other is we weren't correct and the infrastructure on health kind of struggles to reacclimate in this new environment. Well when you continually see poor health outcomes with the other environment I would argue that even if they were incorrect

in certain ways, and actually Secretary Kennedy mentioned a couple days ago that they may bring some folks back and course correct, that you're still having the opportunity to provide that kind of scientific method to management, which is we had to restructure this. We were getting the worst health outcomes with more spending. We need to do something different. Does this, is this gonna be 100% perfect in work and we're gonna have incredibly different health outcomes

at the end? Maybe, maybe not. But if you don't at least try, then you're going to continue to get the same worst health outcomes. So having the political gumption to go in and disrupt, which has historically not happened, again, should be championed. Because again, at the end of the day, it's not like we're getting healthier.

It's historically never happened? It's not happened at this level. There have been other attempts. And you're starting to see it. It's actually really interesting to see clips of like Senator Schumer see clips of other former Democratic leaders who have all talked the game of reducing the size of government. President Clinton did it. President Obama did it. But President Trump and Secretary Kennedy at the Health Department have actually done it. You know, I remember during the Biden administration, they claimed they were going to reorganize CDC. They all realized that CDC was in need of significant reorganization. Can anyone name one actual thing that the Biden administration reformed at CDC. You can't. And yet already within 60 days of a new administration,

everyone is beginning to see what true reform and true impact looks like with good management and leadership of that department. I guess the other piece is there's a lot of resistance to the change. And I guess part of it is just inertia. There's just always a lot of forces aligned to support the status quo. But is there something beyond that? Yeah. At the end of the day, it's the bottom line of many of these corporate infrastructures, whether it's higher education, who's been, I would argue, running

research that should never have been started. Anything in particular? Yeah, look at all of the weird DENI research that was being done by NIH that would not help your average American citizen live a healthier life. When you're thinking about public good, great, there's absolutely space to look at research that impacts portions of the population. And the portion of the population can be small, but when a disproportionate amount of that money is being spent on small subsets of the population and on areas that won't increase health outcomes, why are we funding it? So there was that. So there's a big pushback from higher education around, you know, the grants that they've been receiving, though many of them have shown little to no outcome. There's

conversations like group like the American Medical Association. Most folks don't understand like the AMA is integrated into the healthcare economy. They have what's called CPT codes. CPT codes are basically the diagnosis of an individual and how it gets coded in the system for reimbursements. Well they license that to CMS but we all know that AMA is an incredibly activist organization, pushing agendas that don't align with this new administration. And so we have organizations like the AMA, which are deeply embedded both within the HHS infrastructure, but also within just the general health economy. So they're going to push back because they're concerned about their bottom line and their influence. But they would also say, you know,

well, we're concerned about the health of Americans. Yeah, that's absolutely. And that's the fight that you're gonna have. But when you have an organization that is entirely built on making sure that other healthcare providers aren't able to practice at the fullest sense of their scope, which is what AMA and TMA and all of the different state associations do, which is we are a clinical

professional, we are an MD or a DO, and we don't like the fact that nurse practitioners, physicians assistants, chiropractors and others get to practice with what their training is. To me, I think that really limits your ability to argue about why we feel that our way is a better approach for America when you are intentionally making sure that other professions don't get to practice to the full extent of their abilities.

You mentioned higher education, you mentioned this advocacy organizations, position advocacy organizations. Where else is that resistance coming? It's going to come from the industry of health in general. It's going to come from food. I think we saw with the last couple of days, like the American Beverage Association, putting out money to conservative influencers to support things that aren't healthy for American children. And so we have institutes like that that are trying to embed it from within side

of the conservative apparatus to other aspects where any time you change something at the HHS level and it impacts the bottom line of say pharmacy benefit managers, which is the weird middleman between how people get their drugs in America today. That's going to be a big conversation in a row too. So you're going to have a lot of forces with a lot of money start to spend significantly to limit the impact of a secretary candidate. And so what is the strategy to deal with that? Because that sounds to me like unlimited money might be overselling it

a bit, but it feels like a lot of money is in this space. It is. So the strategy really revolves around a movement, Maha and MAGA, not taking a break now that we've won. We are in a place where, historically, the American electorate will get really up in arms, win a political battle like we did winning when President Trump got into office, and then they go away for the next 18 months. They gear back up for the midterms, they gear back up for the next

presidential cycle. We have not won. We have not won this fight. We've begun the fight and we have industry forces, which I would say unlimited money, that are going to try to do everything to protect their bottom line, but also limit good policy ideas of a Secretary Kennedy and a President Trump. And when you have that, you need your rural health mom to your Santa Barbara mom, who are politically aligned around Maha issues, and put them in the right direction to hold government accountable, no matter who's in office. And we saw that with what IMA did during the Kennedy confirmation. That was a close call. We really had to use organizations like the Independent Medical Alliance to do advocacy in states like Louisiana and Senator Cassidy to make sure they realize that this is what the population and the American citizen wants. They want a change to the status

quo around health and they want to have better health outcomes for themselves, for their kids, and for their families. What's next for the IMA? The IMA is positioned now to talk about a number of different topics. We have a four pillar strategy that ranges from chronic disease prevention, restoring trust in medicine, provider empowerment, and focusing on the changing the culture of health. And each one of those is going to have a tactical plan to feed good policy into the administration using the incredible clinical and scientific

experts that they have aggregated over the last few years. And so we're gonna play offense on providing good health care policy and then we're gonna provide defense to the administration when they do the right thing and take on the corporate interests that are going to spend incredible amounts of money to make sure that they're not successful. But what if they do the wrong thing? I think there's always, as a nonpartisan organization, there is always an opportunity to hold everyone accountable.

And there will be things that there are differences of opinion on, no matter who's in charge. And so to me, there is the soft power, right, when you go to foreign policy, but with soft power when it comes to the movement cares about these topics, you would be best to a better outcome? Because we have these movements of folks that deeply cares about these topics. They want to say because they're part of the reason that you're in this position to begin with. And so to me, and I may, while we may generally agree with a lot of what Secretary Kennedy

and President Trump are doing, also has the ability to have that conversation if there's some disagreements there in the future. The reason I mention this, of course, is a lot of different ideas, a lot of opinions about—and the policy is very far-reaching, even within this first 60 days. And there's lots of people here. I've talked to you saying, hey, why are they doing this? Why are they not doing that? Why is this happening? There is no one better than Secretary Kennedy to push this

agenda forward. And we need to show a little bit of grace when things don't happen as soon as we possibly want them. I say that because having been on the inside, you are up against so many forces to try and accomplish what is going to be precedent setting and never been done before type policy actions. And so I understand that you have an American public that is very action reaction oriented.

We won, so why have we not won entirely? But at the end of the day, Secretary Kennedy is laying, and his team are laying the groundwork for true transformational change within the United States and globally. Any final thoughts as we finish today? I very much applaud President Trump and Secretary Kennedy for doing the right thing and disrupting an organization and an apparatus that has continually led to bad health outcomes. No matter what the outcome is, I am excited to see what we learned during this process that will improve the lives of everyday American citizens. I personally think it's going to be a resounding success. But even in the terms of the unknown, it is better to have leadership

that's willing to take these bold actions than it is to continually lead Americans down a poor health outcome path. Well, David Mansdorfer, it's such a pleasure to have had you on. Thank you. Thank you all for joining David Mansdorfer and me on this episode of American Thought Leaders. I'm your host, Jan Jekielek.