Healthcare was not a high-priority campaign issue for either candidate in 2024.
But Donald Trump’s nomination of Robert F. Kennedy, Jr, to head the Department of Health & Human Services, and Mehmet Oz, MD, to run the Centers for Medicare and Medicaid Services, as well as his promises to tame drug costs, eliminate Medicare fraud, and “make America healthy again,” indicate that healthcare and the agencies that oversee it could be in for a major shake-up under Trump 2.0.
Many within the holistic and functional medicine world view Trump, Kennedy, and Oz as allies—champions of health freedom who will challenge medical orthodoxy, tame the drug companies, and reform regulatory agencies that many view as corrupt.
Trump and Kennedy are stoking expectations of a thorough overhaul of the FDA, the Centers for Disease Control, the National Institutes of Health, and other bastions of federal health policy. They’ve promised sweeping changes to improve public health through nutrition and lifestyle, while constraining a rapacious junk food industry they hold responsible for a lot of nation’s medical woes.
The addition of Dr. Oz to the cast only confirms a sense that this administration wants to shift healthcare away from reactive, drug-based, end-stage disease treatment, and toward proactive, preventive, root-cause medicine—or away from science and toward quackery, depending on your views.
The opening notes of Trump’s new healthcare overture sound like music to the ears of many holistically-minded people. But it is far too soon to say how much meaningful change the incoming administration can actually deliver. As was the case in Trump’s first term, and throughout his campaign, it is difficult to differentiate pomp from policy, showbiz from strategy. Bold statements are quick and easy; major policy change is slow and difficult.
What’s in Agenda 47?
What can medical professionals expect from Trump 2.0?
Agenda 47, the Trump-Vance campaign’s official policy punch list, only hints at healthcare in a few broad strokes:
“Healthcare and prescription drug costs are out of control. Republicans will increase Transparency, promote Choice and Competition, and expand access to new Affordable Healthcare and prescription drug options. We will protect Medicare, and ensure Seniors receive the care they need without being burdened by excessive costs.”
Amid repeated appeals to “Common Sense” and button-pushing screed about mass deportations, stopping “woke and weaponized government,” and ending “Left-wing Gender Insanity,” Agenda 47 also promises, “a special Presidential Commission of independent minds who are not bought and paid for by Big Pharma, and I will charge them with investigating what is causing the decades-long increase in chronic illnesses.”
Trump vows to strengthen Medicare by preventing enrollment of millions of new immigrants; to support “active and healthy living” through a new focus on disease prevention and “benefit flexibility”; and to bolster at-home eldercare through tax credits for unpaid family caregivers.
But Agenda 47 is essentially a marketing piece, not a policy paper; it gives few indicators of how the new administration would actually accomplish its stated goals.
Clues in Project 2025
A close look at the Project 2025 healthcare agenda gives a more detailed picture of the ideological currents and positions that could influence the new administration’s approach in attempting to overhaul American medicine.
Published in April 2023 by the influential conservative think tank, The Heritage Foundation, Project 2025 is subtitled “A Mandate for Leadership” and positioned as “a governing agenda” to “rescue the country from the grip of the Radical Left.”
It is the work of roughly 400 conservative academics, former government officials and policy experts who want to rid the Fed of the “Wilsonian hubris” of the “highly educated managerial elite” that has “spread like a cancer” through American society.
Over 900 pages long, Project 2025 covers everything from agriculture and banking to foreign policy and defense. Its writers and compilers are highly educated men and women who, generally speaking, wear the whitest of white collars to work, yet forcefully remind haughty progressive elitists that “under our Constitution, they are the mere equals of the workers who shower after work instead of before.”
The healthcare section was written by Roger Severino, Senior Fellow at the Ethics and Public Policy Center—a DC-based think tank, founded in 1976, and dedicated to “applying the Judeo-Christian moral tradition to critical issues in public policy.” During the first Trump term, Severino was director of HHS’s Office for Civil Rights, and was among the aspirants Trump was considering to head HHS this time around.
Depending on your political and religious beliefs, you’ll either be delighted or horrified by Severino’s healthcare vision, though he does propose some middle-ground policies on which most reasonable people would agree, regardless of their political leanings.
Severino’s chapter, which reviews all of HHS’s 11 departments, seethes with heated rhetoric: it rails against Biden-era “agenda items focusing on LGBTQ+ equity, subsidizing single-motherhood, disincentivizing work, and penalizing marriage.” It labels “homes with non-related “boyfriends” present” as hazardous places for children, and demands “policies that support the formation of stable, married, nuclear families.”
Practically speaking, it calls repeatedly for restriction of abortion in all federally funded programs. In particular, it singles out medical abortions (mifepristone and misoprostal, aka “abortion pills”). “Now that the Supreme Court has acknowledged that the Constitution contains no right to an abortion, the FDA is ethically and legally obliged to revisit and withdraw its initial approval, which was premised on pregnancy being an “illness” and abortion being “therapeutically” effective,” Severino writes.
He proposes a similarly broad exorcism of gender transition treatments, whether chemical or surgical, from federal healthcare programs.
Project 2025 also recommends:
Restricting the powers of the CDC and the NIH: Citing what he deems egregious overreach during Covid, Severino wants to make sure “unaccountable bureaucrats like Anthony Fauci should never again have such broad, unchecked power” to issue public health guidelines that “trampled” human rights, freedom of choice, and practitioner-patient relationships, “without scientific justification.” Notably, House Republicans have already called for a broad 22% CDC budget cut.
Splitting CDC in Two: The idea is to cut CDC into two firewalled agencies, one for gathering and publishing data, with a legal requirement to publish all data from “states and other sources”; and a second, to guide public policy albeit with “a severely confined ability to make recommendations.”
Requiring Greater Transparency, Accountability, and Oversight within NIH, CDC, and FDA, to ensure research and regulatory agencies are “entirely free from private biopharmaceutical funding,” and “corporatism.”
Empowering patient choices by “allowing alternative insurance coverage options, and returning control of health care dollars to patients making decisions with their providers”
Implementing risk-adjustment for outcomes data in all HHS agencies, to account for discrepancies between healthcare facilities serving poor versus rich communities.
Strengthening hospital price transparency by requiring hospitals to post not just prices of common procedures, but also quality metrics.
Project 2025 also calls for: Increasing domestic production and use of generic drugs; Modernizing regulation of lab-developed diagnostic tests; Lifting restrictions on physician-owned hospitals; Increasing competition between Medicare Advantage and private sector plans; Reimbursement based on health status and intensity of service rather than treatment setting; Replacement of fee-for-service by value-based payment; and removal of barriers to direct-pay primary care.
Mixed Signals
Throughout his campaign, Trump gave mixed signals on Project 2025. In 2022, at a Heritage Foundation dinner, Trump lauded the group for establishing “the groundwork and detail plans for exactly what our movement will do … when the American people give us a colossal mandate.”
But during the campaign, Project 2025 drew negative media attention. Critics described it as a blueprint for fascism. Trump responded by distancing himself, stating he was not involved drafting it, and had scant knowledge of its details. He chastised opponents for claiming the document would dictate his policy decisions.
But it is clear that Trump and the Heritage Foundation are not strangers. Across the board—and certainly on many healthcare issues—the Foundation’s vision dovetails with Trump’s stated goals. The Foundation itself claims that during Trump’s first term, the administration enacted or attempted “nearly two-thirds” of its 2015 recommendations.
The 16-page Agenda 47 shares common themes with Project 2025. And on healthcare, many Project 2025 ideas—especially reining in Big Pharma, curtailing the CDC, purging the NIH, neutering the FDA, and eliminating “wokeness” across all agencies—find voice in Trump’s as well as Kennedy’s talking points.
Kennedy & the Future of HHS
For advocates of holistic medicine and dietary supplements, Trump’s nomination of RFK Jr. as HHS secretary is big, big news.
HHS mediates nearly $2 trillion worth of annual healthcare spending: whoever sits at the Secretary’s desk has great influence on a major sector of the economy. Many holistic practitioners, as well as millions of health enthusiasts, see in Kennedy a long-sought hero well-positioned to shift the levers of power and money their favor.
Kennedy’s vaccine skepticism and relentless criticism of vaccine mandates have won him a large, dedicated following who cherish his willingness to challenge expert consensus, and stand up for personal liberty on medical matters. He also draws equally strong animus from many in the medical and public health sphere who view him as a dangerous proponent of anti-science who could, potentially, undo more than a century’s worth of public health progress.
Unlike his likely future boss, who’s not exactly known for his healthy lifestyle, Kennedy walks his talk: he does regular high-intensity workouts, and can bench press 220 pounds—no small feat for a man of 70. He’s fastidious about his diet, opting for organic produce, lean meat, fish, and nuts, while generally avoiding sugar, gluten, dairy, and processed foods—habits that were mocked in his recent McDonald’s photo-op with Trump and company.
Mark Hyman, MD, a founder of the Cleveland Clinic Center for Functional Medicine, who is a long-time friend of Kennedy’s, views the HHS nomination as “a unique opportunity” for advocates of lifestyle medicine, food system reform, and root-cause healthcare to finally be able to influence federal policy. “Bobby is not looking for incremental change,” said Hyman in an interview with NPR.
RFK, Jr. views supplements, herbs, and psychedelics kindly, which has won him glowing accolades from supplement industry executives and thought leaders. They see in him a chance for the industry to finally take its place at the nation’s healthcare table.
The MAHA Man
Kennedy rightly points out that as a nation we are staggering under a burden of chronic cardiometabolic, autoimmune and psychosocial ills, most of which are driven by diet, lifestyle, and environmental factors. Our extravagant healthcare spending has not improved our scores on key public health metrics. In fact, most numbers point the opposite way. Kennedy, like many, contends that conventional medicine—and orthodox medical thinking– is part of the problem, which justifies challenging many of its tenets.
Under his Make America Healthy Again (MAHA) banner, RFK Jr. wants to eliminate processed foods from the nation’s school cafeterias, to force the food industry to stop using food dyes and other potentially toxic chemicals which are banned in other countries, and to close the revolving doors and conflicts of interest between the food, agriculture and drug industries, and the federal agencies that regulate them.
That all sounds wonderful, and even the most ardent of Kennedy’s medical critics would agree that reducing sugar and corn syrup in school lunches is a good idea.
Whether or not Kennedy, even with backing from the Trump administration, could actually deliver on such promises is a whole other question.
As nutritionist Marion Nestle (pronounced “Nessl” and no relation to the Swiss conglomerate) pointed out in a recent CNN interview, removal of food dyes and additives from cereals and other packaged foods would pose a massive problem for food companies. They’d have to retool their formulas, processes, and labeling. And the bottom line is, people like brightly colored, sweet, salty shelf-stable products. Any federal move that would crash sales won’t sit well with manufacturers, marketers, or retailers.
Besides, any move to force changes on big industry would require robust regulatory action, and that’s antithetical to the Trumpian anti-regulation fervor and the GOP’s traditional pro-business ideology.
The same conundrum applies to Trump’s promise for drug-price controls. He states that he “will tell big pharma that we will only pay the best price they offer to foreign nations.”
But drug pricing negotiations don’t just happen with the swoosh of a wand. Cutting drug prices would require sustained pressure, a strong regulatory framework, and bipartisan cooperation. And again, using government fiat to force mega-capitalist entities to change their ways runs counter to core Republican values, doesn’t it?
Yet, judging from stock market behavior, investors take the Trump/Kennedy saber-rattling seriously. According to a Reuters report on November 15, stock prices for major US packaged foods companies like Hershey, General Mills, Conagra, and Kraft Heinz fell by more than 3% following Kennedy’s nomination. Pharma and biotech stocks also suffered, with the S&P 500’s Pharmaceuticals index dropping by 2% overall.
Drug companies involved in vaccines definitely felt a pinch. In particular, Moderna’s stock dropped 7% after the Kennedy announcement, and that’s after an already dizzying 20% drop following Trump’s victory on November 5.
Eyeing the FDA
The FDA is a prime target for Kennedy’s vitriol—and Trump’s. A few days prior to his nomination, Kennedy issued this hyperbolic social media war cry:
“FDA’s war on public health is about to end. This includes its aggressive suppression of psychedelics, peptides, stem cells, raw milk, hyperbaric therapies, chelating compounds, ivermectin, hydroxychloroquine, vitamins, clean foods, sunshine, exercise, nutraceuticals and anything else that advances human health and can’t be patented by Pharma. If you work for the FDA and are part of this corrupt system, I have two messages for you: 1. Preserve your records, and 2. Pack your bags.”
He stated he was already working to replace roughly 600 positions in HHS. “We need to act fast, and we want to have those people in place by January 20, so that on January 21, 600 people are going to walk into offices at NIH, and 600 people are going to leave,” Kennedy said at a conference in Arizona earlier this month. But as NPR pointed out, it’s not entirely clear to which 600 positions Kennedy is referring. Across HHS, there are only 200 political appointees, and even fewer at NIH.
Maveric Bromance
There’s a measure of irony in the fact that the son of RFK and nephew of JFK has risen to high office under the wing of arguably the most right-wing president the country has ever elected.
If confirmed—and of course that’s still a big “If”– Kennedy will have jurisdiction over Medicare and Medicaid, the enduring legacy of his uncle’s presidency. Though John Kennedy was assassinated before Medicare became law, his was the vision behind it, and he carried it to the fore of domestic policy—epitomized in his impassioned speech at Madison Square Garden in April 1962.
Medicare and Medicaid are hallmark of the Kennedy presidency and sacrosanct to the Democratic Party ever since. Some analysts posit that Obama undertook healthcare reform early in his first term—a dicey move for a young, largely untested leader—because the DNC hoped to pass it while Edward “Ted” Kennedy—RKF Jr’s other uncle and an architect of Medicare—was still alive. He died on August 25, 2009.
So, it’s a strange twist of history that a Kennedy might soon be implementing significant changes to these programs, under the aegis of a Republican president whose vision would probably be anathema to JFK.
The Trump-Kennedy relationship is a curious one. They’ve become so chummy lately, it’s easy to forget Kennedy was running to challenge Trump—initially as a Democrat, then as an independent, or that—like VP-elect J.D. Vance–RFK Jr once likened Trump to Hitler and called his supporters “outright Nazis.”
Trump and Kennedy arose from opposite ends of the American political spectrum: one, the heir of a New York real estate magnate whose exploitative policies were immortalized by folk icon Woody Guthrie in his song “Old Man Trump” (sung here by the Missin’ Cousins), and the other, the scion of a family that’s practically synonymous with American mid-century liberalism.
Yet they have a lot in common: both come from wealth; both crashed into politics from far outside conventional party lines, with stances that upend traditional discourse. Both see the government as an incestuous network of corruption, and have attracted vast numbers of ordinary Americans who feel similarly. Trump and Kennedy delight in taking controversial positions that run counter to consensus opinions, and both like to project strength and fearlessness in the face of the criticism they evoke. Oh, and they’re both masters at working the media, despite oft-voiced contempt for it.
Call it a maverick bromance.
The Oz Effect
Enter Dr. Oz…the top tier cardiothoracic surgeon, turned holistic crusader, turned daytime TV star, turned political aspirant.
Unlike Kennedy, who is an environmental lawyer with no actual healthcare experience, Mehmet Oz is a highly skilled surgeon who spent years in the OR at Columbia Presbyterian Medical Center, directly treating the net result of our country’s collective metabolic dysregulation.
Oz comes from a medical family—his father Mustafa was chief of thoracic surgery at Emory, and his mother is the daughter of a pharmacist. His wife Lisa, a Reiki master with longstanding interests in meditation, homeopathy, and energy medicine, is the daughter of Gerald Lemole, a renowned cardiologist who worked closely with heart transplant pioneers Michael DeBakey and Denton Cooley.
In the 1990s, Oz was one of a small but growing cadre of MDs who recognized and spoke up about the limitations of drugs and surgeries as fixes for the lifestyle-driven diseases crippling and often killing their patients.
Risking his burgeoning reputation as Columbia’s cardiovascular superstar, he pushed the institution to consider “complementary and alternative” modalities. He even led his own trial looking at the impact of intraoperative Reiki on surgical outcomes. His sterling medical credentials gave weight to his views on the potential health benefits of diet, lifestyle, supplements, and spiritual practices.
He was a popular speaker at “CAM” conferences, but he was always interested in taking the discussion to the street. In 2003, he launched his first show—Second Opinion with Dr. Oz—on the Discovery Channel. It attracted the attention of Oprah Winfrey, who hired him as her on-air health expert. Winfrey’s Harpo Productions then launched The Dr. Oz Show as an independent program in 2009.
Love him or hate him for the sensationalist takes on supplements and diets on his show, there’s no questioning his influence. At its peak, The Dr. Oz Show reached 3.6 million Americans every day—a huge number in the pre social media era. In person and on screen, Oz has a genuine a talent for connecting with people, and for translating complex medical lingo into terms regular folks can grasp.
As his popularity soared, his on-air endorsements had seismic impact on the supplement industry, so much so that companies began to refer to it as “the Dr. Oz effect”—an overnight sales surge after the doctor discussed a particular product or product category on the show. But this effect also tarnished Oz’ reputation and stoked allegations of influence peddling, some of which proved true.
In 2022, the Daily Beast reported that Oz had arrangement with Usana Health Sciences, a massive network marketing nutrition company. Usana paid Oz over $50 million to promote Usana’s products on the show, a fact that was not disclosed to viewers.
The Trump-Oz alliance goes way back. Oz hosted Trump on his show during the latter’s 2016 campaign. He was an unofficial presidential advisor to Trump during the Covid pandemic, and his advocacy of hydroxychloroquine sparked considerable media attention, and condemnation from mainstream medicine. In 2022, during Oz’ ultimately unsuccessful run for a Senate seat, CNBC reported Oz owned roughly $630,000 worth of stock in Thermo Fisher and McKesson, both of which produce and distribute hydroxychloroquine.
Despite his strong talk about banishing conflict of interest from the halls of government, Oz’ shadow financial arrangements didn’t seem to bother Trump, who spoke for nearly 90 minutes at a Save America rally for Oz in Greensburg, PA.
With his characteristic charm, he lauded the aspiring senator as follows: “Dr. Oz….I’ve known him a long time. His show is great! He’s on that screen. He’s in the bedrooms of all those women, tell them good and bad. And they love ‘im!” He goes on to say Oz was running, despite Wall Street’s fierce opposition, “to save our country—just like I do—from the radical left lunatics and maniacs.”
Oz on the Issues
What can we expect from Medicare and Medicaid under the watch of Dr. Oz? Again, it is hard to say.
There’s no question that—unlike many Trump appointees—Mehmet Oz actually knows quite a lot about the field he may soon govern. But his views and positions on key health policy issues have changed valence over time, making it difficult to discern exactly where he stands.
For example, in 2009 during the Obamacare years, Oz stated: “It should be mandatory that everybody in America have healthcare coverage. If you can’t afford it, we have to give it to you.” He has praised the universal healthcare systems of Germany and Switzerland, and he starred in a 2010 ad promoting Obamacare.
But during his 2022 Senate run, he said that if elected, he would align with other Republicans and vote to repeal the Affordable Care Act. Regarding uninsured Americans, he said they “don’t have a right to health, but they do have a right to access,” for example, via 15-minute screening visits in a “festival-like setting” funded by local hospitals.
Oz’s stance on abortion has also flipped. Before entering politics, Oz had stated that while he personally felt averse to abortion, and wouldn’t want anyone in his family to have one, he supported a woman’s right to choose, noting “I don’t want to interfere with everyone else’s stuff.” In a 2019 interview on The Breakfast Club radio show, he said: “I went to medical school in Philadelphia and I saw women who’d had coat hanger events. They’re really traumatic events that happened, when they were younger, before Roe v. Wade. And many of them were harmed for life.”
Yet, his 2022 campaign website declared him “100% pro-life.” He has stated that life begins at conception, and on the campaign trail he supported overturning Roe v. Wade, saying he was categorically against abortion except in cases where a woman’s life is in danger or the pregnancy is the result of rape or incest.
Likewise, his climate position has flip-flopped. In 2017, he co-authored with Cleveland Clinic’s Michael Roizen an article documenting environmental degradation and human health risks associated with climate change. Yet during his Senate run, he shrugged off the notion that carbon emissions were problematic, and said he supported fracking and expansion of US natural gas extraction, something he had opposed in 2014.
One thing is very clear. Oz does not like Anthony Fauci.
At the outset of the Covid pandemic, Oz lauded Fauci as a “pro.” But by late 2021, when Oz announced his Senate run, he’d changed his assessment . Oz disagreed with Fauci on many things, including hydroxychloroquine, vaccine mandates, and prolonged masking and social distancing requirements.
“He is a petty tyrant. He got COVID wrong. He continues to get it wrong,” he told Newsmax. He called for Fauci to be fired, and threw down the gauntlet for a public scientific debate—an invitation the beleaguered NIH director ignored.
Although he challenged Covid-19 vaccine mandates, Dr. Oz is not categorically anti-vax. In fact, he endorsed the measles-mumps-rubella (MMR) shot on his show in March 2019. According to a study by University of Pennsylvania researchers, this one episode resulted in measurable increases in vaccine acceptability within Oz’ fan base.
From Reality TV to TV Reality
If Kennedy and Oz are confirmed–and again it’s a big ‘If,’ because some GOP legislators view both men with suspicion—the two will be in charge of healthcare for 66 million Americans enrolled in Medicare, and the 81 million in Medicaid and CHIP (Children’s Health Insurance Program).
They will likely play well together. Kennedy and Oz share iconoclastic views on many conventional medical issues, stand firmly for the concept of personal health responsibility, and advocate for nutrition and fitness as first-line approaches for preventing and reversing disease.
If those sound a lot like core values of holistic and functional medicine, because that’s exactly what they are. And it is why many practitioners and patients are unabashedly stoked about the nominations. Even if they can only make good on a small portion of their MAHA promises, they’d be big wins for the field.
But let’s keep in mind that those wins would be happening in a volatile, highly polarized political environment, under an administration that despite its success in electoral coalition-building, also overtly ostracizes entire segments of the population and threatens retribution against its opponents.
If we’re honest with ourselves, we must that we, in the holistic field, can be just as self-righteous and dogmatic in our assertions as the advocates of conventional medicine. Self-righteousness is all too common among health enthusiasts and holistic advocates.
And let’s stay alert to the possibility that under the pretext of “lifestyle first” and an anti-Rx agenda, a newly “holistified” HHS could end up denying needed medical care and pharmaceutical treatment to a lot of people. Cost-cutting is very much on the Trump 2.0 menu. Saving money and minimizing unnecessary or ineffective treatment is essential, but it needs to be done carefully by people who truly understand what’s at stake, and truly have peoples’ best interest in mind.
One thing is certain: with a reality TV magnate at the helm, and a pair of wealthy, charismatic, and telegenic commissars in key positions, healthcare policy—like everything else over the next 4 years–will be brimming with conflict and drama.
And the action will be played out on X and in the blogosphere, not in The New York Times and JAMA.
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