Bulwark Takes - The Worst Cabinet Secretary! | Bulwark on Sunday

Episode Date: May 4, 2025

This week on Bulwark on Sunday, Jonathan Cohn joins Bill Kristol to discuss why RFK Jr. is the worst cabinet secretary and what he's doing to America's public health.

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The UPS Store. Visit a store today. It's on. The biggest Maytag sale of the year at Lowe's. Buy two select laundry appliances and get up to a $100 bonus via instant rebate. Shop all things Maytag, including the new stackable PetPro laundry system that removes pet hair from clothes. Lowe's. We help. You save. Offer valid through 531. See store for pricing and offer details. Advertise savings on all major Maytag appliances through Maytag.com and participating retailers. Prices may vary. Additional terms and conditions apply. Hi, Bill Kristol here. Welcome to Bulwark Sunday Live. Very glad to be joined today by my colleague, Jonathan Cohn. We're going to discuss the, I think he's the wackiest cabinet secretary, Robert F. Kennedy Jr.

But Jonathan's been writing terrifically about health care and public policy in general, health care in particular, maybe Robert Kennedy a fair amount on his newsletter, The Breakdown, which you need to be subscribing to. We can also go to the website and read the latest, very good one on Governor Whitmer of Michigan and the dilemmas of opposing Trump, but governing your state while he's president, right? That's something she's really grappling with, it seems like. Yeah, yeah. Well, it's a tough call. I mean, people may remember she was in the news this week because of this visit to an Air Force base. And there's all these jobs tied up with it. She wants to appear there. She she worked hard to get him to, you know, get this agreement to bring the jobs. But now she's, you know, standing alongside Trump and she opposes all these other things he's doing.

And, yeah, I mean, it's a it's it's a version of the dilemma that university presidents face, law firms, you know, you know, when you're the governor, you know, there's pretty high stakes. And so, you know, I, you know, I do, I think it's, it's a genuinely tough, tough situation. It's an interesting newsletter. Good, good corrective slightly to my impatience with the standing next to Trump and a little more wishing for a little more Janet Mills, you know, standing up to him. But it's different when you've got to actually, you do have to work with the federal government, obviously, if you're responsible for the citizens of your state. Anyway, we're going to talk about HHS today, Department of Health and Human Services, its secretary, cabinet secretary, Robert F. Kennedy Jr. I thought we could, we'll get to Kennedy personally, who's genuinely kind of extraordinary in my view, that he's

HHS secretary, as it is, I think, in yours, but we'll get to that in a little bit. But let's just begin with the more sort of straightforward public policy side of things, which has gotten a little overshadowed by his kookiness in a way. They released their budget, the Trump administration, was that

just the end of this week, right? Friday, Thursday, Friday, their budget. The Trump administration was at just the end of this week, right? Friday, Thursday, Friday. Yeah, it was Friday. Friday, OMB's budget, which, you know, that's the big document that really, and it's, it wasn't even much commented on because Walz is being fired and, you know, everything else is going on. But it's pretty striking, pretty radical, I guess, just now it's just a real public policy point of view in terms of what it does to health and human services in general and Medicaid in particular. Yeah. Yeah. I mean, it's a remarkable budget document. Somebody, a few people actually have kind of, you sort of look at the graph of where spending would go in the budget and, it's, it's, you know, there's this big, you know, new investment in Homeland Security. And there is a increase in defense. And then there's this big, you know, taking away money from, from global aid, you know, state, which I think a lot of that is

global aid, right? USAID, PEPFAR, and then big chunk taking out of HHS. And so that's the president's budget. As you said, it didn't get a lot of attention. I think in part because people feel like that's, you know, the president, as you know, the president's budget is his wishlist. Um, you know, certainly in a first year presidency, you would think it would have a lot of influence, but, um, people are treating it like maybe it's so extreme that maybe Congress, you know, cause members of Congress have to vote on this and, and, you know, they have to answer for those votes.

And I don't know. But as this is all going on, you reference Medicaid. You know, Congress is back and the Republicans are trying to write the big, beautiful bill. Right. That's what we're calling it with the tax cuts that are then going to be paid for by spending cuts or partly paid for by spending cuts at least. And the big chunk of those, it looks like are going to come out of Medicaid. So that work is now beginning. And it's, you know, it's an interesting, it's a big deal, you know, on the spending side, hundreds of billions of dollars over a 10-year period at stake here. That's right. That's real money, even in Washington. But also in health insurance for literally millions of people at stake, depending on what they do. And in general, the more money they want to take out of Medicaid, the more people who are going to lose health insurance. So that's

where we are going with this. So that's the reconciliation fight, I guess. Yeah. And they've already passed a budget, which implies, I guess, to pay for the tax cuts. Pretty massive cuts in Medicaid. And just say a word about what people know Medicaid. Some people maybe aren't. Yeah. For various reasons. But say a word about what this isn't money sloshing around for some extra nice things at some community health centers mostly. Right.

This is pretty fundamental health care for lots of people. Yeah mean look medicaid is a huge program nowadays you know more than 70 million americans um get coverage through medicaid um it actually pays for more than 40 percent of live births in america um huge reach um uh it is the know, it also underwrites a huge part of our healthcare system, especially in rural areas, hospital, rural hospitals, which typically struggle financially. It's become a real lifeline for them, the money they get from Medicaid. It has gotten very expensive. It's grown. It started in 1965. It was part of the Great Society, LBJ. It was the same legislation that created Medicare, created Medicaid. It was a much narrower program then. It's a much bigger program now. And that's part of what the debate is, you know, it into sort of a pillar of what they hope will someday be a universal coverage system and that was the big change that happened with the affordable care act um the critics uh republicans um uh they they they didn't like it then they don't like it now

um it is expensive it is an intrusion you know it's public it's a government program right it's a big government program interfering in health care so they they want to, you know, downsize it, get it closer to where it was. And that's really what the debate we're having right now. And this bill going through would, in effect, you know, depending on the details and they're negotiating over them, and it could be going about 10 different ways. But, you know, one way or another, they are looking to take hundreds of billions of dollars out of the program and, you know, downsize it in effect. So it would look more like it used to look. The flip side is that, you know, because, you know, several million people will lose insurance. And these are people who were added to the program very deliberately because the thought was, okay,

we want to get to universal coverage. Let's build on Medicaid as one of the ways to do that. So that's, in an abstract, you know, that's the debates, the debate, you know, left and right have been having for decades. The debate over universal coverage that goes, you know, back to like 100 years ago. So, I mean, it's just the latest iteration of this debate. And, you know, we'll see how it turns out. But it's a more radical, isn't it, proposal by Trump? That's like the first term after McCain gave the famous thumbs down on the big health care reform they were pushing then, my impression is they kind of receded for three years and didn't make, maybe they nominally were in favor of cutting it, but they didn't do much about it, certainly,

and then they lost Congress anyway. Obviously, Biden did nothing in that direction. Bush expanded, actually, elements of Medicare with prescription drugs and so forth. So I do feel like with a Republican president and a Republican Congress and the incredible pressure on them to pay for the tax cuts, this is more of a real debate in a way on the actual, on a pretty important part of Obamacare, which was the expansion of Medicaid and the federal government picking up, what is it, 90 percent of it. And a lot of conservative states, if I'm not mistaken, went along with this. And so they have this embedded in their budgets. And if the federal share gets cut back, more goes to the states who do or don't pick it up. So it's a pretty real, it's abstract, as you were saying, in the sense that it's a familiar debate, but it's pretty real right now, right? I guess of all the things they're going to

change in the federal government, it strikes me as one of the biggest ticket items that could actually get changed. Oh, yeah. Super real. This would be if, you know, again, depending on the details of what they decide to do. But very conceivably, this could be the single biggest retrenchment of a government health care program we've seen in American history. And, you know, would affect millions of people. It would affect hospitals. It would affect the whole, um, healthcare system. And you alluded to the politics of what makes this politically, um, interesting, tricky for the Republicans, um, is that they have very thin margins. A lot of their states, um, are, are, have expanded Medicaid now, and they've done it because, you know, in some cases they've done it because, in some cases, they've done it because

Republican governors or lawmakers and the legislature said, hey, we're not the biggest fans of Medicaid. But on the other hand, these people are here in our state. They're showing up at our hospitals. This is a way to get federal money into the hospitals to pay for it, especially, again, in rural areas. That's true in rural states. It's true in rural districts of blue states who account for the house majority, right? You know, you know, we're talking rural parts of New York, Pennsylvania, Michigan, where I live. So, you know, that is tricky. And, and, you know, different states are in different positions. So some states actually, again, this was, of the Medicaid expansion, which you alluded to.

The way it works, Medicaid is a joint federal state program. So as you said, the federal government puts up most of the money. If that money goes away, some states, the law they passed to expand Medicaid, there's a trigger in it. So if the federal money gets reduced, right off the bat, automatically the expansion goes away unless they act to replace it. And it's the assumption is in most of those states, it's a huge budget item for a state to pick up. So they probably won't. And then what's really interesting is you have three states, one of which is Missouri, where they the Medicaid was expanded because the voters approved it and put it in their constitution. And there's no provision for taking it back out.

So if the federal money goes out in Missouri and two other states, the state's going to have to find that money. And they don't have a choice unless they can somehow repeal a constitutional amendment, which, as you know, is hard. So that's why, interestingly, surprisingly, among, you know, you look at, you know, Capitol Hill, what Republicans were really vocal against this. It's Josh Hawley has been, you know, early, loud, very clear, like he does not want that money to go away. So that's the, that's where we are on that.

No, that's so interesting. And I do think, I mean, I myself have focused much more on the rule of law issues and some of the foreign policy issues. but i think we're about to move to um just on the calendar to a couple of months where the reconciliation bill will be a very very big story don't you think i mean up till i guess they want to get it through the house by july 4th and so that gives us what's two months basically and and uh and maybe go into the summer obviously further and then uh and the go into the summer obviously uh further

and then uh and the reconciliation bill would you really get down to it in the big items is the tax cuts on the one hand and the medicaid cuts on the other is that is that basically right that is all correct um you know two other things to keep in mind um at least you know the the the the assumption is the hard deadline here is the debt ceiling um because they're going to have to vote to raise the debt ceiling. And that's, as you know, as our listeners, many of them know, that's a really tough vote for a lot of Republicans. And the thought is wrapping it into this bill that also has the tax cuts. Other Republican priorities is the way to kind of, you know, get that through. You know, what is an interesting, you know, get that through. The other thing is, you know, what is an interesting,

you know, slightly unexpected, and I think something to watch. I mentioned that Josh Hawley was skeptical. Trump has been, and the Trump White House, or at least part of the Trump White House. I mean, again, it's, you know better than I do, there's camps there and, you know, different camps that, but, you know, early on, Steve Bannon, a couple months ago, was on his show. He's like, don't cut Medicaid, you know, or be real careful. And then we've had this like three separate leaks of internal polls saying that Republican, you know, Republican voters don't want to cut Medicaid. And I, and you've, and the reporting and the bits I've heard suggests that the Trump or people around Trump are very aware this is politically dangerous for them.

They are not excited about it, which is different from 2017 when it was all about we want to repeal Obamacare, whatever you want to do. And Paul Ryan always wanted to sort of, you know, transform Medicaid. So he went on. Trump does not seem that enthusiastic about this, which I do think is important because the end of the day, if he really, really pushes for it, just given recent history, right, we have to assume House Republicans probably go along or there's a good chance they do. But it's not clear to me he's going to push the Medicaid cuts per se. At the very least, I think he's watching to see how unpopular this would be, which is, you know, if you're somebody who wants, you know, to keep the Medicaid expansion in place, a reason to make some noise, because I do think that's going to register. And the response, when I've said that I don't think he's going to go through with it, actually, is, well, you don't understand, Bill, the way reconciliation works, they have to, because they

have to pay for it. They don't have to do anything. I mean, the parliamentarian will say that because of the reconciliation rules, you have to balance spending and taxes and, you know, they have to pay. But the parliamentarian could be overruled with 51 votes. So I'm actually more inclined, given that they don't right, because this is a key part of, as you said, of a more traditional but conservative Republican critique of sort of the expansion of the government under the Affordable Care Act. Yeah, very interesting thing to watch going forward. Some things I say that some of us have not been as focused on, but it will come front and center here and be a congressional story. It will be an intra-administration story, as you say. I think that's a very good point to make. I had a congressional story. I guess it's not been a Kennedy thing. It's an OMB thing, really, not a Kennedy-HHS thing, right, in terms of this is a budget thing, not a healthcare debate, this funny way.

Yes. Of course, it's a healthcare debate, but I mean, the driving of it, I'm just thinking of Kennedy now as Secretary of HHS. He's not, it would be the same of Kennedy if someone we'd never heard of a secretary of HHS. Yeah. Yeah. I mean, I know we'll talk about Kennedy in a bit. I just don't think this is on his radar screen at all. This is not of interest to him, which, you know, is an interesting thing to say about someone who's, you know, you know, you look at the money that goes through HHS, the vast majority of it is going through Medicare and Medicaid. And I don't think he's particularly interested in either. But that does, I think, also speak to the extent to which the White House and OMB will be driving the administration views on this.

Yeah, that'll be interesting. Well, let's get to the second, what has been a bigger story in the healthcare HHS side of things, which is the cuts, quite dramatic, in NIH, in CDC, the Center for Disease Control, whatever it's called, and well-known parts of the research establishment that exist. And the cuts there have been more immediate or attempted to be immediate. The courts have held up a fair amount of them. What's, I mean, why? That's not something Trump, to my knowledge, focused on in the first term. We got, there was fights in the pandemic,

obviously with Fauci and stuff. So maybe it's now a different story, but Trump seemed perfectly happy to preside over NIH and CDC. And, you know, I assume Trump's buddies from New York and big donors are okay with funds flowing to Sloan Kettering and MD Anderson and so forth. They seem to give a lot, right? Some of them write, Trump doesn't,

but he's a cheapskate, but some of them write big checks to those organizations to, you know, pay for the new buildings and so forth. And suddenly he's cutting that. He's cutting $7 billion. He thinks from Harvard, which goes to from that from seven to the $9 billion from Harvard is medical, I believe. And so how, how real is that? How big is that? What do you, what do you make of that?

Yeah. Yeah. Well, let me start with that in terms of how big it is. It's a little hard to be certain. And just for the side comments, I mean, this is, and I've been writing about government for a long time. You've been in and writing about government for a long time. You know, government typically when they make changes, right, they sort of announce that here's what we're going to do. And then they do it and, you know, it gets studied in Congress and whatever. I've never seen anything like this. I mean, there have been waves of firing, waves of cancellations of grants, waves of programs suspended, but frequently with no

announcement, no public announcement, you find out about it because news organizations suss it out. And then even then it's hard to get details. I mean, a couple of weeks ago, I was trying to find out what had happened to a particular office at HHS, which runs the early childhood programs like Head Start. And I asked, you know, what do you do when you're a reporter? I went to OMB, I went to HHS. Can you tell me how many, what divisions were cut? How many, you know, people, no answer, no answer. Eventually the only information that it turns out that a bunch of former employees together kind of group sourced with their contacts, a spreadsheet that they were sending around that had a pretty, what they thought was a pretty accurate read.

And it does look like it was an accurate read, but I mean, so that's the kind of information we're operating here. It's really quite difficult to be certain about any of this, just to be clear before I, you know, before we described it. But they are very significant. You know, we have seen, you know, Kennedy has said, and it does seem like they're on their way to reducing the staff at the, into the staff, the staff at the Department of Health and Human Services overall by 25%, you know, with heavy, heavy cuts to the staff of the National Institutes of Health, Centers for Disease Control, and again, many smaller offices as well, like the child care office I was just describing. In addition, there's been a dramatic reduction in the grants going out the door. NIH considered, I think, around the world as,

you know, the crown jewel of America's biomedical research establishment, you know, responsible for literally endless, you know, countless lists, you know, numbers of medical breakthroughs, life-saving breakthroughs. They've dramatically cut down the money going out, both through direct cancellations of grants, but also layoffs of people who manage the grants, restrictions on the activities of people who manage the grants, you know, restrictions on the activities of people who manage the grants, just kind of really throwing sand in the gears. Cutting back the overhead for, that was a very early, remember, announcement kind of across the board, huge restriction and cutback, which would require people to really cut back their own efforts, obviously, if they're using it to pay for the building and keep the electricity

on, pay for the staff and so forth. Yeah. Yeah. And, you know, look, I always say this. I mean, nobody who has seen NIH, nobody who has seen government up close would deny that you can't make it more efficient. And there's been a lot of efforts over the years that have been, you know, frustratingly slow. And, you know, there was, you know, you can imagine a version where an administration, Democratic or Republican, comes in and says, we really want to reorganize NIH and consolidate it. You know, they have all these different centers and institutes. And, you know, I mean, I know Democrats and liberals who have called for that in the last five to 10 years. I know Republicans who have called for that in the last five to 10 years. I know Republicans who have called for that. So there was a version of that, that you could see playing out and leading to a more efficient operation and better funding choices, et cetera. You can see a version of

that where, you know, you would expect, you know, they won the election. When you win the election, you get to sort of change the direction and priorities to some extent of the way government works. And you could, you know, I can imagine whether or not I like it, other people like it, you know, them coming and saying, look, we don't want to be, you know, we think we're now doing too much on disparities or diversity or whatever it is that they want to reduce the studies for. I mean, that you do have, you know, that's when you win the election, that's part of what you get to do within, you know, certain parameters.

What they've done, though, is just, you know, it, you know, there were several ways. So there was the kind of doge wave, which just, you know, it's, it's still impossible to know exactly what I'm, but I mean, I, I think it's entirely possible. We, you know, we were in a situation where you had 20 something, you know, former Tesla employees or tech, you know, gurus coming in and saying, why do we have, you know, tesla employees or tech you know gurus coming in and saying why do we have

you know three different procurement office let's just close two of them which you know might make sense but it may be because one of them actually specializes in actual lab equipment and one does like contracting with you know research scientists and one land and actually they don't do the same thing and now you know you can't get supplies which is a real thing that's happened by the way nih does some of his own research and there was a there are stories about uh you know, you can't get supplies, which is a real thing that's happened, by the way. NIH does some of its own research. And there was a there are stories about, you know, internal emails like, hey, do you have a couple of these, you know, reagents? Can we swap some test tubes? I mean, it sounded like saying if you remember that you probably remember the show MASH, you know, the TV show.

Now they're always like bargaining for supplies. You know, you do have bandages. I mean, it felt like that. The National Institutes of Health. I mean, it's crazy. So you had that. Then you had overlapping that, you know, a wave of cuts science, nature, stat news, KFL health news have been doing just heroic work trying to keep track of all of this. You know, the single biggest category of grants that got cut out were related to HIV. The second biggest were related to trans care. The third was related to COVID. And the fourth was related to climate. So, you know, there was that wave. And, you know, and again, whatever you think of the merits of more or less, number one, it was a complete, it wasn't like, we should do less of this. It's like, we're getting rid of anything,

you know, that's got the word HIV in it. I mean, that's a whole, there's a whole mini story about the end, like the amount of HIV related programs and projects that the federal government has run for years are just getting wiped out across the federal government. But there was also, again, this speaks to the sort of clumsiness of it, there were grants that got cut of biodiversity. Not because you were a DEI, but because someone did a word search and picked up the word diversity and, you know, you ended up cutting, you know, biodiversity. So you had that range of, you had that level of cuts. Then you had the cuts that were targeting particularly universities and universities, so like Columbia, Harvard, et cetera. And yeah, so it's just, you know, it's just this, this, this sort of wide swath of destruction. Again, you know, whatever you think of the agenda, whether you think, yeah,

we should be doing more to maybe think it's, you know, it's too big. It should be directed differently. There's places to make it more efficient, you know, whatever you think. It was clearly done in the clumsiest haste, know most hasty you know way possible why people i don't think i think it's pretty clear didn't know what they're doing the reporting backs that up and i think the attitude was this is our chance we can just you know do all of this and you know if we need to build things back up well okay fine and they sort of said that but you know i know you know when you have medical studies that have been going on for 20 years, you interrupt them. You can't just start them up again. Institutional knowledge,

you fire people, they're going to get other jobs. They're not going to come back to the government. You lose that. And, you know, there was, there was a sensible way to do all of that. And I don't feel like there's zero reason to feel like that's what they're actually doing right now. I've been struck talking to people who are very experienced in scientific biomedical research, not hysterical, have their own criticisms of NIH over the years or CDC, you know, for all kinds of bureaucratic and other reasons, who really think, I mean, just the most basic stuff, nothing, nothing biodiversity, I mean, cancer research, you know, Alzheimer's research, I mean, things that presumably are very important for biomedical research, are going to be set back considerably.

I mean, I'm sort of struck at how alarmed they are. You talk to probably more people in this area than I. You agree with that? Or is this kind of a blip, and it goes down 5%, and we get back on trend, so to speak? I mean, I don't know. What do you think? Well, I mean, I'm hearing, is apocalyptic too big a word? I'm not sure. I mean, you know, when you add up the sort of senior, senior people who are, you know, titans in their field who are being pushed out of government and some who are very, you know, public figures, you know, like, you know, Peter Marks, who was the head of, you know, the top vaccine state, but a lot of people less well-known who, but do things like, you know, monitoring of lab protocols and things like that, that you really need to have that

expertise around so people can do it. So you add up the sort of loss of expertise, the loss of funding for studies that either won't get done or will get interrupted and stopped, all the money that's not going to bring in the next generation of scientists, which is so important. And that's, you know, not just at HHS, but National Science Foundation, which is something else I wrote about, has this very famous early graduate student fellowship program, like something I don't remember the exact number of, I want to say it was since it was after World War II was established.

And I think 40 Nobel laureates have gone through that program. I mean, it's, you know, founder of Google, you know, mother of artificial intelligence. I mean, it's, you know, founder of Google, you know, mother of artificial intelligence. I mean, just incredible alumni network. We're cutting that. And, you know, that is when you think about innovation, future developments. I mean, that's 10 years from now. That's 20 years from now. Those are the discoveries we won't have, the innovations, the scientists that won't be there or to some extent which is so ironic

it will be the innovations that were you know discovered and developed in china you know or canada or france because those countries are are now you know they're like trying to get those bring those scientists over there and i don't think they'll do as good a job because we actually had a pretty good system here all warts and all but um you know for a for a agenda and a program that supposedly is about making america great and the leader of the world we are i mean we're i i feel like we are giving away our one of our greatest strengths as a country and it's just it's mind-boggling it is and it very much dovetails with the hostility to immigrants and making it not a welcoming place, not just for people trying to come across the border or undocumented people from Central America, but also for people, postdocs who are just take a job, as you say, in France. I'm from France or I'm from Estonia.

I heard one story, very promising, the great dream. If you're a very good undergraduate in Estonia and in some medical, you know, pre-med medical or medical student there, many of them, their dream is to come here and maybe stay here, but certainly contribute here for a while, maybe go back. And that is just a pure loss, it seems to be of, I mean, yeah, all these breakthroughs we've had, I don't know what percentage of them, I'm not sure anyone could do this math too accurately because it's kind of complicated, but come from people who were not born in the United States who immigrated to the United States,

partly because they were attracted by the idea of doing medical and scientific research, practicing medicine here, but it's not a, that's not a small percentage. I'm going to just, you know, I I'm pretty confident of, right? So they, to the degree they don't come here, as you say, hopefully the breakthroughs happen elsewhere, because just for the sake of humanity, you know, but it's kind of mind boggling, actually. I do think to make America great, again, people think all great breakthroughs in America have come from people who were born here and maybe have been here for a couple of generations which is not true if you go back to the manhattan video who exactly developed the nuclear bomb here i mean kind of important world war you know to

end world war ii and for the cold war it wasn't uh anyway not worth that's so there's that part of it and now we've left a little less time than i hope but it's enough time to really capture i think the and we can go a little long, the Bobby Kennedy, Robert Kennedy Jr., Secretary of HHS, a vaccine skeptic to say the least. I mean, when it was confirmed, I think people thought, I even thought a little, he'll pull back. He's not going to go ahead out of these various wacky mini crusades and, you know, anti-science and kind of crackpot theories that he's indulged in for 20, 30, 40 years. Well, has he? I mean, what's the story of Kennedy as Secretary of HHS? Yeah, I think for people who were worried that he would use the position as Secretary to

undermine America's, you know, to undermine vaccines in the broad sense, by, America's, you know, the, the sort of, you know, are, you know, the, to, to, to undermine vaccines in, in the broad sense by which I mean, you know, uh, undermine public faith in them, uh, you know, slow down or, you know, stop the process of sort of, you know, approving and distributing them, you know, discouraging their development. Um, I don't want to say it's the worst case scenario. I don't think it's that far from the worst case scenario. You know, to me, I mean, the easiest way to sort of point it out is how he has been, you know, his public actions in the face of this measles outbreak, which is, you know, well on its way to becoming the worst measles outbreak in decades. You've already had two children die. And, you know, I always say this, but children should not die of measles. We have a vaccine that will prevent people from getting the measles.

It will save lives. Measles used to kill a lot of people. It does not anymore. It certainly doesn't kill a lot of children because they get the vaccine. There is vaccine skepticism out there. RFK, before he got into government, played no small part, I think, in spreading that skepticism. Then he gets to Congress. Trump appoints him.

He has those confirmation hearings. He makes his statements. I won't undermine vaccines. I'll go with the science. There was that very famous set of hearings with Senator Cassidy from Louisiana, who's a physician who very much believes in vaccines. And he famously voted for Kennedy saying, well, I've gotten assurances. And Kennedy won't undermine vaccines.

So here we are in this measles outbreak. He's really never kind of, you know, you would expect this is the biggest measles outbreak, you know, in decades. Again, the first children's death in quite some time. You would expect an HHS secretary to make a, to aggressively be out there saying, this is what we want to do. We want people to get vaccinated. He's done nothing of the sort. On a handful of occasions, he's made statements that say vaccination is good and it's the best way to prevent measles. But if you look closely, most of them were written. So who knows if he wrote it or somebody wrote it for him and said, you have to put this out. And he's made

a handful of statements more than well, the other way, right? We don't know what's in these vaccines. We're not sure what their effects are and so forth. Yeah. I mean, the ratio, I think I haven't done the math, but I feel like it's a two or a three to one ratio of state public statements that are skeptical of vaccines one way or another, outweighing the ones that are, you know, pro vaccine. And of course, you know, he that are, you know, pro-vaccine. And of course, you know, he's also, you know, what is he actually doing? Well, he's commissioned this study to get to the roots of what is causing autism, which, you know, and he has said, we're going to get to the roots of, you know, vaccine safety, as if there were questions about whether vaccines cause autism, as if there were questions about whether vaccines are safe.

And there aren't. I mean, this has been studied extensively. The latest thing just this past week, I think it was this week. Do you find it hard to keep track of what happens when I just... Totally, yeah. Dog ears kind of under Trump, right? Yeah. So I think it was this week.

I apologize if I'm getting this wrong. I think it was this week he announced that all new vaccines would have to be placebo tested, which implied that vaccines, new vaccines were not placebo. Actually, new vaccines are placebo tested. What is true is that when you sometimes are, you know, when you're developing a kind of, you know, modification of an existing vaccine for, say, the measles, it will be tested against, you know, you know, once, you know, once, you know, once the safety is sort of, you know, assured, you know, they will test it against the existing vaccine, for example. Or, you know, the flu vaccine doesn't get placebo tested, but, you know, it's a flu year, right? Yeah. I mean, it just isn't tying. If by the time you were done placebo testing, we'd have a new flu, you know,

new flu strains. So, but, you know, that is just an example. And I want to be careful. I'm trying to be careful not saying too much on the science side, because I'm not a scientist, you know, I don't want to get over my skis, but, you know, I feel very, you know, comfortable saying vaccines are safe. And every time he gets up there and he says, you know, comfortable saying vaccines are safe. And every time he gets up there and he says, you know, introduces questions, you know, he's validating a skepticism that exists for a whole bunch of reasons. Although again, I think he did more than a little to spread that, you know,

in past years. And it's just, it's just, it's, it's, it's grossly irresponsible for the nation's top healthcare leader to do that, especially at a time when we have people getting in, in the worst cases, dying from the measles. And COVID and the flu and all these other things haven't gone away. And to say nothing of the fact that my impression is, and again, you know the science better than I do, neither of us as a scientist, I'll hasten to say that as you just did, that the progress on mRNA and so forth on vaccines was really promising in other areas. People I know in that world thought this could be a huge thing over the next few years, that just as we made much more progress against COVID than people expected, much faster, with a safe, actually, and effective vaccine after that nightmarish first year of not having a vaccine.

Again, pick up hasn't been what it could have been. Fewer people would have died if it had been, but I don't know how much progress we're now going to make in the future. And people are going to think there's a hostile federal government. Are Pfizer going to spend quite the money they were going to spend? Are doctors going to do the work they were planning on doing. So I think the, as in these other areas, the sort of unseen costs, opportunity costs, I guess, maybe what economists will call it, are going to be pretty great as well. Yeah, yeah, I know. I mean, mRNA research suddenly, you know, into question when, as you said, there are lots of, you know, it was, there were lots of promising uses coming forward. And I continue, I don't know. I mean, we've all talked about this,

but I just continue to be amazed. I mean, when I look back at the first Trump administration, things they got right or they could legitimately claim credit for. Warp speed, I mean, that was amazing. I mean, what an accomplishment. And the fact that they basically now disown it. It's just, again, mind boggling. And the other was the actual progress on,

in war speed on the vaccine. Trump could have taken one or both, or he could have tried to straddle as he did in 2020 and sort of be for both. I see none of the warp speed side of them. I mean, is there anyone in the U S government who's sort of like invested in that side of it? That could be in theory, but you know, but it doesn't sound like there is the, ONB wants to cut everything and Kennedy wants to discredit the science, I guess. Yeah. And look, and that's, I think another case

where you can imagine, I think, you know, the public health establishment got a lot of things wrong. It turns out, you know, policy wise, rhetoric wise, and, you know, you'll hear that from people in public health, you know, and you can imagine a version of, okay, we're going to work to, you know, we're really going to look at what we got right and wrong, try to get it, you know, someday this hope, you know, hopefully we don't get another COVID like, but you know, it's nature, the world, you know, these things happen, you know, you can imagine a version of going through and trying carefully to, to, to, to understand the errors, to correct the errors, while still keeping the good. But that's just, I mean, this is not what we're doing.

Yeah. I do feel, if I may close with this, I'm curious on your thoughts. I sort of feel like this set of issues, both on the kind of macro, if you want, side of the kind of just cuts in healthcare, for government-provided health care at least, combined with the cuts in research, people sometimes, you know, I kind of feel that will be visible to people. Different people will see different things. I mean, Medicaid will affect, though it's not only for poor people, will affect more, as you say, rural areas and people who will lose health insurance. Presumably the, you know, people who know about the failure to make progress in scientific research is a little more of a well-educated strata of people who are physicians or relatives of physicians or moving that world, the university world and so forth, the research institute world. But I feel like in both cases, actually, there'll be real world.

I mean, I feel maybe I'm wrong, six months, 12 months from now. I feel like this issue is going to be, this set of issues will be, six months, 12 months from now, I feel like this issue is going to be, this set of issues will be as big or bigger than they are now, not the opposite. Do you agree, or do you think they sort of, it's too complicated, and that we sort of, we adjust to a new normal? No, I agree with you. You know, two things that come to mind. Number one, you were mentioning Medicaid, how many people, there's a statistic, I think it's from KFF, their polling or their studies, which is a research group based in California, they're national, everybody trusts them. Something like, I want to say about two

thirds of Americans personally know someone who has benefited from Medicaid. A big part of that is that it's the single biggest financier of nursing home care in America. Yeah. Say a word about that. It's just, people do not appreciate that. Yeah. Yeah. So, you know, nursing homes are, if any of you have, you know, I'm certainly in my life, you know, you have elderly relatives or people with disabilities who need long-term full-time care. It's extremely expensive. It's expensive. If you're going to go into an institution, it's going to expensive. You're going to have someone come to your house. Medicaid is the single biggest source of that

spending for people. You have to qualify for income. So typically, you know, what often happens and this is all other, you know, people will spend down their assets or whatever, but at some point you qualify. And that's how most people, the entire nursing home industry of America, both the industry itself and the people who go there, depend on Medicaid. You take Medicaid cuts, even if they're not directly, even if the cuts only affect the able-bodied, which is one of the, they don't affect the, you'll hear Speaker Johnson say, well, we're going to protect the vulnerable. The problem is that's not how Medicaid works. You know, once the, you know, once the states have less money to work with, they're going to find ways to cut. They could, you know, nursing home care can get cut.

A real, another, you know, area can get cut. Medicaid pays, has programs that pay for home care, which is what most people would prefer. You know, most people, if they can age in place, if they could stay at home, that's what they would want. Medicaid pays for that, not as well, you know, not as much as widely as a lot of us would like, but it does pay a lot of that. The thing is, that's what's called in the parlance is an optional benefit for states, meaning they don't have to cover it. They don't want to, and states have that kind of leeway. So if states start losing the federal match, you could see that being a place where they'd cut. So, you know, people, you know, who need help at home, you know, you know, with the daily, you know, living at home,

living in a nursing institution, you know, that they will feel that they'll feel that, you know, rural hospitals will feel the cuts to Medicaid, I do think all that will get cut. I think the research, you know, will be seen to I think that's an easy thing to visualize in the context of a campaign. I mean, you can imagine the ads, you know, people who, you know, waiting for a breakthrough, what's happening to it. And I do think politically, you know, because I do think, you know, what issue, you know better than I do, but I tend to think that when, you know, issues become salient when they work to a party's clear advantage.

And, you know, there are all kinds of issues where Republicans have a natural advantage, right? I think crime is probably one of them. Immigration, it doesn't matter. You really, the people's default position is, I want to, you know, I want to control crime. I'm going to trust the Republicans more than the Democrats, right? The default position on health is to trust the Democrats.

For better or worse, right or wrong, that's I think the voter perceptions are. So if you get into this fight, the more salient that issue becomes, the more it helps Democrats. Democrats know that, so they are then going to elevate that, I do think. And so I do think that will become a cycle. I do think we're going to hear a lot more about that. So interesting that 2026 is an election year. And so we heard a lot about it in 2018, the last midterm election during a Trump presidency, obviously, after the attempt to cut Obamacare and McCain's scotching it. But I don't know if they're better off failing to cut or then they get accused of having tried something or succeeding in cutting and then people are looking at the consequences. But we will have to follow this. So, no, this has been very interesting. And actually, as I say, I sort of intended to talk a little more about Kennedy personally,

but I think the actual substance of the issues is so important. And, of course, it overlaps a lot, too. I mean, we have, again, an HHS secretary who seems uninterested in the actual trillions, I don't know, of dollars that are flowing through HHS and very interested in his also, I think, somewhat irresponsible views about vaccines and just health itself as opposed to healthcare financing. But to have that one-two punch could be, that's something we haven't really seen before, I guess, right? Yeah. Well, I imagine we'll have more. We will have more to talk about.

People should need to read your newsletter and watch other discussions with you and others of our correspondents who cover aspects of this too at the Bulwark. So thank you, Jonathan, for taking the time on Sunday to join me

and thank you all for joining us on the Bulwark on Sunday.