Consider This from NPR - Trump nominates RFK Jr. to remake healthcare.

Episode Date: November 15, 2024

This week President-elect Donald Trump announced Robert F. Kennedy Jr. as his nominee to run the Department of Health and Human Services.The nomination comes after Trump promised to let Kennedy "go wild on health" during the campaign.Kennedy holds a number of controversial opinions on health, and promotes a number of scientifically debunked claims like vaccines cause autism, fluoride is poisoning the public water system and AIDS isn't caused by the HIV virus.Kennedy has long wanted to remake health and healthcare policy in the United States. Soon, he may get his chance. For sponsor-free episodes of Consider This, sign up for Consider This+ via Apple Podcasts or at plus.npr.org. Email us at [e-mail] more about sponsor message choices: podcastchoices.com/adchoicesNPR Privacy Policy

A month before the election, Donald Trump promised Robert F. Kennedy Jr. a lead role in health and health care in his administration. It's such a great honor. I've been friends of his for a long time. And I'm going to let him go wild on health. I'm going to let him go wild on the food. I'm going to let him go wild on medicines. Wild is how many health experts would characterize Kennedy's views on health and health care,

like Dr. Paul Offit of the Children's Hospital of Philadelphia, who spoke to NPR's Selena Simmons-Duffin. Robert F. Kennedy Jr. is a science denialist. He makes up his own scientific truths and ignores the actual truths. Kennedy has erroneously argued that vaccines can cause autism. That claim, like others, has been widely debunked by scientists. Among other questionable assertions Kennedy has made, fluoride in the public water system is poison and AIDS isn't caused by the HIV virus. These and other controversial or false claims could soon be at the center of federal U.S. health policy. A little bit of breaking news here. President-elect Trump has just announced on his social account false claims, could soon be at the center of federal U.S. health policy.

If the Republican-controlled Senate were to confirm Kennedy as the new head of HHS, he would oversee nearly $2 trillion in mandatory spending, as well as agencies like the Centers for Disease Control and Prevention, the Food and Drug Administration, and the National Institutes of Health. NPR's Stephen Fowler has been following the story. The role gives Kennedy the chance to actualize a vision that's often at odds with mainstream health and science, likely through a combination of scaling back existing programs and refocusing others to align with his quote, make America healthy again goals. Consider this, RFK Jr. has long desired to drastically transform health and health care

policy in the United States. Soon, he may get his chance. From NPR, I'm Juana Summers. chance. music app or visiting amazon.com slash ad free. This message comes from Pushkin. In Revenge of the Tipping Point, bestselling author Malcolm Gladwell returns to the subject of social epidemics and tipping points and the dark side of contagious phenomena. Available wherever books are sold and wherever you get your audio books. I'm Rachel Martin, host of NPR's Wild Card Podcast. I've spent my entire career learning what kinds of questions prompt the most honest answers. What's the biggest sacrifice you've ever made?

What's a belief you had to let go of? What's a goal you're glad you gave up on? Now I'm putting those soul-searching questions to guests like Jenny Slate, Bowen Yang, and Chris Pine. Follow Wild Card wherever you get your podcasts only from NPR. It's Consider This from NPR. This week, President-elect Donald Trump announced Robert F. Kennedy Jr. as his nominee to run the Department of Health and Human Services. It's a move that scared many science and health experts. Former HHS Secretary Kathleen Sebelius

spoke on CNN yesterday. To have someone coming into a scientific agency that is a vaccine skeptic and may well undo decades of public health work, I think is terrifying for the American public. HHS is a massive federal agency responsible for oversight, funding, and programs for public health and healthcare across the United States.

To get a sense of just what leading such a vast apparatus might entail and how Kennedy might oversee it, we brought in Julie Rovner, Chief Washington Correspondent for KFF Health News. Hey Julie. Hey Wanda. Hey, Juana. So, Julie, as we were just pointing out, HHS is just this massive agency with a budget of almost $2 trillion, some 90,000 employees. Help us unpack this.

What are some of the public health agencies that come under the HHS umbrella? Well, of course, we have the National Institutes of Health, the Food and Drug Administration, the Centers for Disease Control and Prevention, some smaller but still influential agencies like the Substance Abuse and Mental Health Services Administration, the Health Resources and Services Administration. They oversee programs like the Ryan White AIDS programs, community health centers, maternal and child health programs. Of course, HHS does more than just public health.

They oversee Medicare and Medicaid and the Affordable Care Act. And on the human services side, they oversee childcare and TANF, what used to be welfare payments, and Head Start and programs like Meals on Wheels for older Americans. So it is really a vast sprawling agency

that affects almost every American. I wanna just zoom in on one of the things you mentioned, and that's Medicare and Medicaid, of course, the federal health insurance programs for the elderly, the poor, and the disabled. What kind of power does the HHS secretary have over those programs? Fairly significant power. Now, those programs are what we call mandatory spending. So the secretary, and in fact fact many people at HHS have actually less power to change those programs. That really needs to be done by Congress. But they

can certainly influence how those programs are implemented. There is a lot of guidance and regulations that they can write. And they can also hire and fire employees. And I think we're going to be hearing a lot about that. I want to talk about this role from the management perspective. I mean, this agency is sprawling. It's got a huge budget, tens of thousands of employees. What kind of background have some of the people who have held this position previously had? More of them have had kind of a management background. It's only been fairly recently that we've seen actual doctors and public health professionals leading the agency. Those

tend to lead the sub-agencies at HHS because it is so large. Interestingly, I think Robert F. Kennedy Jr. might actually have more power to change policy if he were to have a role in the White House because in recent administrations much policy has been role in the White House, because in recent administrations, much policy has been determined by the White House. This is true for Republicans and Democrats. Power has been much more centralized at the White House. The secretary ends up doing much more kind of ministerial duties.

It's just such an enormous place, and there's so much to do that doesn't have to do with actual making of policy. Some of Kennedy's detractors they make the point that he doesn't have an obvious background in science, medicine, or policy. For the practical work of running HHS does that present obstacles for him if he's confirmed? Well yes and no. I mean certainly it is an enormous bureaucracy and it can be hard to make things happen. Even people who've worked there for years, who've become secretary, you know, like Alex

Azar, who was in the first Trump administration, have suggested that really the secretary can only take one or two of their own initiatives and the rest of what they do is determined by the day-to-day action to the agency and by the White House. Trump has said that he would allow RFK Jr. to, quote, go wild on medicines, food, and health. He's long talked about some of his ambitions to overhaul health in the U.S. a few examples. He's talked about removing fluoride from public water systems despite agreed upon health benefits. He's also a noted vaccine skeptic who wants to regulate their use. He wants to revamp the nation's food policy. If he is confirmed

as head of HHS, how achievable are those kinds of goals? Well, under existing norms, they wouldn't be very achievable. There are processes that you have to go through to do these things. Much of the workforce at HHS is protected by civil service rules. There are waves of people in between the secretary and where the policy gets made. What we don't know is in the incoming Trump administration whether they're going to try to throw all those things out. Whether RFK Jr. has said he wants to fire hundreds of people at both NIH and FDA. It's unclear whether he's going to try to do that and if he tries to do that, whether he's going to

succeed. So there's really a lot that's unknown right now. Lylea Salamon, Ph.D., Ph.D. Julie, to the extent that you've heard, what has been the response from workers within agencies that HHS oversees like the CDC or the FDA? They're frightened. I mean, a lot of them, you know, stuck it out during the first Trump administration, which was not a great place to be for a lot of scientists. They felt like science was not taken very seriously and that directions came down from on high that were not necessarily based on evidence. It was difficult for them to do their jobs. You know, I live in the Washington area. I work with a lot of people who work at these agencies, and a lot of them are talking about

retiring early, and that is a big concern, that there could be an enormous brain drain from some of these agencies. Even people who, you know, would not get fired just don't want to do this for another four years. Lylea Salamon, Ph.D., Ph.D., Ph.D. Many of RFK Jr.'s views are either controversial and many have been debunked by science and health experts. But to your knowledge, are any of his stances

actually supported by the mainstream? Yes, well, it's funny. A lot of his stances are generic and very popular. You know, things like getting rid of drug ads on TV that make everybody crazy, reducing industry influence in decisions that are made at the FDA and elsewhere in HHS, emphasizing chronic disease prevention, reducing food dyes and other, you know, consumption of ultra-processed foods. Those are things that are fairly popular and fairly mainstream. The question is how he would go about doing them and what he would replace them with.

Julie, I want to end with this. Here's a question I've got for you. We both have a deep knowledge of Capitol Hill. What are Kennedy's chances, do you think, of being confirmed? I honestly don't know. I think one of the wild cards that it's not really come out yet is that he's been in favor of abortion rights. And that, you know, one would think would be an absolute disqualifier for a lot of conservative Republicans. We'll have to see as this goes forward how it all shakes out.

Julie Rovner is the chief Washington correspondent for KFF Health News and host of the podcast What the Health. Julie, thank you. Thank you. This episode was produced by Mark Rivers and Megan Lim. It was edited by Courtney Dornig. Our executive producer is Sammy Yenigan. Thanks to our Consider This Plus listeners who support the work of NPR journalists and help keep public radio strong. Supporters also hear every episode without messages from sponsors. Learn more at plus.npr.org. It's Consider This from NPR. I'm Juana Sommers.

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