Make America Healthy Again (MAHA), the movement led by Department of Health and Human Services (HHS) Secretary Robert F. Kennedy Jr., is at its zenith of political power and influence and confident in its ability to improve the health of Americans. Kennedy sat for his first network interview as secretary this week and was asked how it feels to finally be an insider after decades on the fringes of the medical system. “It’s good,” he answered.
“In 50 years, the history books [will] look back at this moment as the time the chronic disease crisis started to reverse,” Calley Means, a former food and pharmaceutical industry lobbyist turned MAHA influencer and now a White House adviser on health policy, said in an interview earlier this month. He rose in prominence in Trump world leading up to the election, helping broker a call between Kennedy and Trump before Kennedy endorsed the president—Means and his sister, a Stanford-trained physician, coauthored a best-selling book on metabolic health and appeared on Tucker Carlson’s show in September.
Kennedy and allies like Means have spent much of their careers criticizing a health care and pharmaceutical system they see, at best, as failing to keep people healthy and, at worst, actively corrupt and co-opted by corporate interests. But now, as leaders inside that system, they are faced with the challenge of translating their criticisms into policy change to achieve their goals. So far, they appear to be struggling to articulate a concrete plan as sweeping cuts have been made to HHS.
Meanwhile, former officials and health policy analysts worry their efforts will mainly serve to hobble large swaths of critical work at HHS rather than improve the agency.
The changes to HHS, which include a massive reorganization and the firing and incentivized exits of roughly 20,000 of the agency’s 82,000 staff, seem driven by Department of Government Efficiency (DOGE) personnel and contract slashing, Kennedy’s pet inclinations like vaccine skepticism, and the broad contours of the MAHA agenda. “The overhaul will implement the new HHS priority of ending America’s epidemic of chronic illness by focusing on safe, wholesome food, clean water, and the elimination of environmental toxins,” an agency release said last month when the cuts and restructuring were announced.
When speaking about the staff and program reductions, Kennedy has mainly emphasized that the restructuring will streamline departments within HHS and eliminate redundancies in a department that has grown steadily over the last two decades—the cumulative staff reductions will take the department back to levels not seen since the Bush administration. But the cuts have gone deeper than bureaucratic bloat, gutting whole offices, including ones working on chronic health issues.
Dr. Robert Califf, the FDA commissioner during the Biden administration who left in January, said in an interview Thursday that the agency could handle some personnel cuts but not the announced 20 percent. “At 20% loss, there’s going to be critical public health functions that don’t get done,” he said. “This is nonsensical to me.”
At the Centers for Disease Control and Prevention (CDC), staff were slashed at the National Center for Chronic Disease Prevention’s Office of Smoking and Health, and at the Food and Drug Administration (FDA), cuts occurred at the Center for Tobacco Products. “From a public health perspective it makes absolutely no sense,” Mitch Zeller, the former FDA tobacco chief who spearheaded the agency’s tobacco regulatory regime, said regarding cuts at the center, which included entire offices that draft tobacco product regulations.
The cuts imperil successful smoking reduction programs like the Tips From Former Smokers ad campaign that drove smokers to quit. “The only winner here is the tobacco industry and cancer cells,” said Dr. Tom Frieden, who was CDC director during the Obama administration when the ad campaign began.
Dr. Scott Gottleib, the FDA commissioner during Trump’s first term, said the cuts across other FDA offices could hinder pharmaceutical innovation and stymie new drug approvals. “Through a generation of congressional actions, investments in expertise and hiring, and careful policymaking, we built the FDA into the most efficient, forward-leaning drug regulatory agency in the world—and established the U.S. as the global center of biopharmaceutical innovation,” he said earlier this month. “The cumulative barrage on that drug-discovery enterprise, threatens to swiftly bring back those frustrating delays for American consumers, particularly affecting rare diseases and areas of significant unmet medical need.”
Kennedy himself admitted that the terminations may have gone too far, saying earlier this month that about 20 percent of the people cut from HHS would need to be reinstated, although reporting suggests there’s no current plans for large reinstatements.
In his Wednesday interview with CBS News, Kennedy seemed to not be fully aware of the breadth of the cuts to HHS programs and research. “In almost every situation, the cuts we made were administrative cuts, and they were redundancies,” he said of the restructuring. When asked about an $11 billion cut to COVID-era federal grants to state and local health agencies helping fund infectious diseases control—including measles and bird flu—childhood vaccination efforts, and mental health and addiction programs , Kennedy said, “I’m not familiar with those cuts.”
When presented with the example of a $750,000 grant to study childhood diabetes that was canceled, Kennedy said, “I didn’t know that, and that’s something that we’ll look at.” He added, “There were a number of studies that were cut that came to our attention and that did not deserve to be cut, and we reinstated them.” But he also claimed the cuts to medical research funding were “mainly DEI cuts,” likely referring to DOGE’s purge of National Institutes of Health grants on projects involving sexual and racial minorities.
Means, the Kennedy ally and White House adviser, has maintained a similar stance regarding research cuts. “Research funding has not been cut,” Means claimed at a recent summit hosted by Politico, adding that the Trump administration’s proposed changes to indirect—administrative and facilities expenses—cost rates in NIH grants would result in more money going to research. “Not a dollar of services has been cut,”he claimed of funding going to researchers. But beyond indirect costs, HHS has directly terminated hundreds of millions of dollars in research grants, and hundreds of millions more have been delayed and slow-walked.
During the interview, Means was pressed multiple times on how the cuts to HHS personnel and research would make the system operate better or further MAHA’s goals, but he repeatedly pivoted to describing his view of the failings and perverse incentives of the status quo. “The NIH, whose goal is to promote American health, has overseen just an abject devastation in American health over the past 20 years, with disease rates skyrocketing in America,” he said. “The Centers for Medicare and Medicaid Services is an agency that has a much larger budget than the Defense Department, that’s controlled by the American Medical Association, which is a pharmaceutical lobbying group.”
He did articulate a general vision of reforming the health care system—something he says crystallized for him when he took a dose of psychedelics—that at a high level overlaps with many traditional goals of health care reformers. “Fundamentally, what we’re building towards is a world where hospitals are incentivized for beds to be empty, not full; where pharmaceutical companies are incentivized to be creating therapeutics that reverse and prevent disease, promote longevity, not just manage disease; where insurance companies are incentivized to promote health, not as they are today [where they’re] really incentivized to get certain costs to go up,” he said. Health officials and researchers have spent decades now working on value-based care—a reform model that compensates health care providers based on patients’ health outcomes rather than simply the health care services provided.
Means’ continued focus on critiques of the system even as he’s been elevated to a powerful position in that system is a common challenge for outsiders, or “iconoclasts,” as Andy Smarick argued in an essay for The Dispatch earlier this year. “We seem to have lost the distinction between those who talk about politics for a living and those who actually take responsibility in positions of authority,” he wrote. “But experience in criticizing, speculating, and agitating is not sufficient preparation for devising and implementing the myriad reforms our institutions require.” Kennedy spent the last week on a MAHA tour to tout his agenda, emphasizing initiatives like removing fluoride from tap water and improving wellness through healthier eating, but he had little to say about the HHS cuts or the growing measles outbreak.
The challenge of governing involves not simply identifying a problem or envisioning a better future, but figuring out the practical reforms to move the system in that direction without compromising its already successful functions. “We can walk and chew gum at the same time—prevent chronic illnesses and treat them better,” Frieden wrote in an op-ed last fall about the MAHA agenda. “Even if all effective prevention policies are implemented, millions of people will still need treatment.”
