Among all of Donald Trump’s controversial cabinet selections, Robert F. Kennedy Jr. is particularly notable for eliciting strong emotional responses—both supportive and critical—as head of one of Washington’s most influential agencies, the Department of Health and Human Services.
Kennedy’s decision to cut roughly one-fourth of his agency’s staff amid the spread of measles in Texas and the potential for a bird flu pandemic has sparked anger within the healthcare community. However, he has also rallied a significant following—dubbed MAHA, inspired by a term from the Trump era—that shares this indignation towards what they argue is the least efficient healthcare system globally, delivering poor results relative to their expenditures.
One of MAHA’s prominent figures is Calley Means, the best-selling co-author of Good Energy And previously a lobbyist for both food and pharmaceutical industries, this individual currently functions as a "special government employee" alongside Kennedy. This person has spent considerable time pondering—especially if you've caught them speaking frequently on the Joe Rogan podcast—about strategies the Trump administration could employ to tackle the rapidly growing issue of chronic diseases in the U.S.
I spoke withMeans for the Playbook. Deep Dive podcast On Wednesday at the 'Healthcare Summit,' they aimed to clarify what MAHA stands for and precisely what he and Kennedy intend to alter in Washington. The discussion occurred with an audience that strongly expressed their profound mistrust towards the MAHA initiative. In response, Means sharply criticized those whom he accuses of managing "a system of complete failure."
When I selected 'Means,' we discussed how reducing the HHS staff significantly aids my supervisor in reaching his objectives. We also touched upon the challenges of providing nutritious food to areas without such access, along with my belief that decreasing funds would enhance the scientific foundation for the healthcare changes I'm proposing.
This discussion has been condensed and clarified by Deep Dive Producer Kara Tabor and Senior Producer Alex Keeney. To hear the entire Playbook Deep Dive podcast interview, click here:
[DEEP DIVE EMBED]
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Given that the MAHA revolution has come to power, how would you define success? What is the bare minimum you aim to accomplish over the next four years?
I believe this is quite crucial since we have many stakeholders present here today, and there are numerous queries regarding Secretary Kennedy.
I believe we should all grasp his intentions along with those of the Trump administration, aiming for a future where history books will depict this period as when the battle against chronic diseases began turning around. Currently, 38% of teenagers suffer from prediabetes, and half of them are either overweight or obese. Among 212 nations, we hold the top spot for having the highest cancer rates globally. Our healthcare spending per person is quadruple that of Italy but still leaves us living seven fewer years compared to them. It isn’t because Americans lack discipline; rather, there must be an issue within our healthcare framework.
Ultimately, our aim is to create a healthcare landscape where hospitals benefit from having vacant beds rather than filled ones; where pharmaceutical firms focus on developing treatments that cure and prevent illnesses, enhance lifespan, instead of merely managing diseases; where insurers are motivated to encourage wellness, unlike their current incentive structure which drives them to increase specific expenses. Our objective is to initiate discussions about establishing a healthcare framework centered around reversing and preventing illness.
To achieve our goals, we begin by engaging with widely supported initiatives and concentrating on areas such as increased transparency, minimizing conflicts of interest, and enhancing benefit flexibility—topics the administration has emphasized. However, it’s crucial that we secure victories along the way.
Right now, the main focus appears to be making significant reductions. This week brought reports of substantial cutbacks at HHS. Currently, around one-quarter of HHS’s 82,000 workers have either departed or are anticipated to lose their jobs. Large portions of departments handling vaccine and pharmaceutical development, HIV/AIDS studies, artificial intelligence initiatives, support for senior citizens and those with lower incomes, as well as programs aimed at preventing sexually transmitted diseases and improving rural healthcare, have also been affected.
How would you address members of the public who are worried about medication safety and our readiness for future pandemics, considering these rapid and severe budget reductions?
To the journalists and lobbyists present here, certainly put forth your arguments, but I would genuinely urge you to show some modesty regarding what the electorate intended when they placed Bobby Kennedy Jr. in such an influential role; demonstrate some restraint in questioning why both Bobby Kennedy and President Trump stand out as overwhelmingly favored compared to others in American politics.
What voters want to convey is that the current system is seriously misguided. The NIH was directly involved in the emergence of a pandemic. Despite its mission to enhance public well-being in America, the NIH has presided over significant deterioration in national health over the last two decades, with diseases surging at alarming rates across the country.
There hasn’t been much advancement in small-scale pharmaceuticals when it comes to bringing innovative therapies through the FDA approval process. This typically requires around one billion dollars. Notably, the Centers for Medicare and Medicaid Services operates with a significantly bigger budget compared to the Defense Department; however, this agency falls under the control of the American Medical Association—a body often associated with pharmaceutical lobby groups.
So, we have some serious issues here. When you switch on CNBC, it feels like one endless advertisement for pharmaceuticals. You get an ad for Skyrizi, then Dr. Scott Gottlieb talking about how someone named Bobby is causing harm, followed by urgent reports on a measles outbreak, with absolutely no reference to the ongoing mental health crisis and...
But, Calley, how does reducing the workforce at HHS address that issue?
It’s ludicrous to suggest that the obstacles preventing improved healthcare are additional government officials. This notion is clearly irrational.
It isn’t just bureaucrats. There are many scientists, researchers, and individuals ensuring that our system remains secure.
These scientists basically have a history marked by complete failure.
[A member of the audience shouts: "That's not correct."]
Is that amusing? Isn’t that claim inaccurate? Could you provide some metrics demonstrating how quadruple the healthcare expenditure per person in America compared to other nations has fostered medical advancements? Can you think of even one instance where a chronic illness drug introduced within contemporary American medicine has reduced the incidence of such diseases? Shouldn't it be concerning that the American Academy of Pediatrics, which receives 90% funding from pharmaceutical companies, is advocating for the use of Ozempic among children as young as six years old?
Why not utilize the influence you possess to guide the current infrastructure toward improvement rather than completely cutting it down?
It isn’t considered slashing; instead, it’s reverting to the levels seen in 2017. That doesn’t constitute slashing.
Actually, it's closer to 2002 levels.
Actually, it isn’t a large amount, yet it is significant. Isn’t it around 20,000 individuals? This reduces the HHS workforce to approximately 68,000 employees.
Is that the last of the cutbacks?
The notion that Bobby Kennedy shouldn’t swoop in and drastically alter the leadership and staff at these organizations responsible for overseeing the dire decline in American public health is misguided. These same lobbyists in attendance lack the integrity to acknowledge that our approach has been entirely flawed. They even chuckle as we grapple with having the sickest children among all developed nations.
Is this really your stance? You're implying that the views of the MAHA mothers aren't valid, suggesting that significant reforms to the U.S. healthcare system aren't necessary? If you believe it's invalid for someone like Robert F. Kennedy Jr., who was prevented from making substantial alterations due to individuals such as Peter Marks—someone known for dismissing prominent vaccine researchers at the FDA for opposing mandatory COVID-19 vaccinations, consistently siding with pharmaceutical companies over experts—to enact meaningful change, then clearly something must shift. It would certainly align better with public sentiment if he could remove figures like Marks and bring aboard influential voices including Marty Makary, Jay Bhattacharya, and Dr. Mehmet Oz to overhaul these organizations and appoint his own team dedicated to genuine progress. This is precisely why they cast their ballots; expecting nothing less than transformative action.
Let me pose this question to you, Calley. Many individuals support reducing bureaucratic processes and eliminating excessive regulations within governmental operations. However, what happens when employees engaged in vital public health initiatives find themselves locked out of their workplaces and unable to properly hand over responsibilities to incoming staff members? Is it fair or compassionate toward those who have committed their careers to these causes?
We find ourselves at a critical juncture in American history. Our children are among the unhealthiest in the industrialized world.
However, my question is about how these modifications will be implemented within this plan.
You have the ability to create thrilling tales filled with amusing stories continuously. Essentially, Bobby's action amounts to taking charge of a division that had previously been unsuccessful. In isolation, the CMS boasts a significantly bigger budget compared to the Defense Department. Regarding Medicaid, its growth rate is twice as fast as that of the defense budget; moreover, when considering only Medicare and Medicaid together, they constitute an even larger financial commitment. As this expenditure escalates progressively, children find themselves encountering health issues increasingly often.
If your preference includes reducing benefits for Medicare and Medicaid,...
Ninety percent of NIH funds are directed towards researching pharmaceutical R&D treatments aimed at benefiting the pharmaceutical sector due to the prevalence of illness among Americans. Currently, only a small fraction of these funds supports fundamental investigations into why people fall ill. The FDA severely restricts innovation; it serves mainly as an approval mechanism for established big corporations seeking to launch conventional medications. There are minimal avenues available for novel therapeutic approaches, including those utilizing artificial intelligence, which could aid in diagnosing issues within one's body and promote preventative care.
These organizations are flawed. Why aren't you focusing on how we might revamp them instead?
Sure, let me get this straight. My main query is as follows: You enter with the aim of cutting out excess, correct? That’s your basic idea. But could you explain how exactly you manage to steer the course toward your objective?
You appoint Marty Makary, the first FDA commissioner in the last thirty years who stated he won’t be heading to a pharmaceutical industry role afterward—unlike eleven out of twelve prior FDA chiefs. Next, you choose Jay Bhattacharya, embodying unparalleled scholarly bravery. Then comes Dr. Oz, a remarkable individual leading an exceptional group poised for transformative change. These individuals are prepared to collaborate with various sectors, discuss advancements in preventing long-term diseases, promote regulatory simplification, enhance transparency, and mitigate conflicts. This is your approach.
If any company worldwide faced escalating expenses and declining performance under their oversight similar to what the Department of Health and Human Services (HHS) has experienced, they would undoubtedly dismiss several individuals and bring in fresh leadership. This organization aims to collaborate with businesses yet firmly asserts that a change in direction is essential.
Let’s discuss food since that falls within your area of expertise. Currently, in the U.S., healthier options tend to be pricier, which poses a significant obstacle for low-income individuals who often face the poorest health outcomes. What strategies do you propose to make healthy eating more affordable across America?
Bobby Kennedy will not tolerate remarks from food industry lobbyists who use price concerns as justification for continuing to harm children. Many of you are engaging in this practice, and I believe such arguments are inherently malicious. The sole defense the food industry has left is to assert that high prices prevent them from addressing the fact that Americans are being harmed. Essentially, they're threatening to maintain these prices rather than challenge the notion that people are being poisoned.
We have 10,000 chemical substances in our food that aren’t permitted in any other nation. Essentially, U.S. food businesses use distinct ingredients compared to those used in other countries. For instance, American corporations manufacture items within the country using petroleum-based food coloring but produce the identical goods for sale in Canada utilizing beet juice and carrot juice instead.
Currently, the FDA doesn’t maintain an inventory of ingredients found in our food; it relies on self-regulation. Kennedy plans to collaborate with the NIH and the FDA to create a comprehensive list of these components and implement post-market evaluations for such substances.
A significant amount of lobbying aims to hinder transparency regarding ingredients in food. Industries are aggressively pushing back against such openness because they believe it could be embarrassing and damaging to their image. It is crucial that we possess precise scientific information about the chemicals present in our food supply.
You're discussing the importance of holding corporations responsible and ensuring transparency. President Trump is known as a pro-business leader who aims to simplify operations for enterprises so they can focus on maximizing profits. Given this stance, how compatible are these views with regulating businesses? To what extent has he granted authority to Secretary Kennedy to oversee and manage these companies?
President Trump is the central political icon of our era due to his commitment to fighting corruption. The Make America Great Again (MAGA) movement opposes the influence of special interest groups that harm the well-being of Americans. Therefore, both President Trump and former Secretary Kennedy oppose programs such as Supplemental Nutrition Assistance Program (SNAP), which predominantly fund sugary drinks like soda. They also reject systems that encourage and promote highly processed foods. Under President Joe Biden, the U.S. Department of Agriculture (USDA) guidelines suggest giving sugar to toddlers. These guidelines even claimed last year that diets consisting mostly of ultra-processed foods—up to 93% for children—are considered healthy. However, neither President Trump nor Secretary Kennedy advocate from a stance that is purely pro-business or anti-business; their focus remains on eradicating corruption.
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Has President Trump provided Secretary Kennedy with the freedom to take strong action against these corporate interests if it means improving the health of Americans?
I believe it should say "Let's get Americans the truth" instead of "Go to town on corporate interests." The aim of MAHA involves significant efforts and lobbying regarding Medicare and Medicaid reimbursement rates. However, there's an inherent issue with how incentives function within our healthcare system. This becomes evident when examining charts showing our spending compared to our outcomes.
However, a significant part of it stems from corporate interests, doesn’t it?
I'm not sure what you're referring to when you say corporate.
I'm talking about businesses that peddle unhealthy snacks aiming to...
I believe President Trump and Secretary Kennedy would argue that if your business profits from children’s illnesses, you should be concerned. Corporate interests ought to focus on stopping and curing diseases among Americans. However, this perspective seems absent in the current discussion. Neither President Trump nor Bobby Kennedy have addressed this issue.
You mentioned that these businesses are harming children.
No, what I'm indicating is that these businesses are benefiting economically from the poor health of American children, which is an evident factual claim about their financial gain.
Exactly. That implies Kennedy might force them to alter their current activities.
Sure, here's a rephrased version: There is an evident public demand for a healthcare system focused on reversing and preventing diseases. Let me make myself very clear: I do not perceive Secretary Kennedy as vindictive or particularly hostile towards corporations. Instead, I believe there is a sense that everyone needs to work together. This situation does not involve looking back with punishment in mind. Right now, Americans collectively recognize that we face a complex issue. The root cause lies in the billion-dollar agricultural subsidies from the last ten years, which have resulted in 70% of American children consuming highly processed foods compared to just 10% in Japan. Clearly, something isn't right about these statistics. These disparities stem from misguided incentives; however, they aren't aimed at blaming specific industries directly.
What strategies can be used to engage industries?
It’s safe to say that most people support the idea of nurturing healthier children. There is broad consensus around the objective of achieving a decade-long initiative aimed at reversing and preventing diseases. We can all concur that within ten years, our healthcare industry should be booming, primarily through efforts focused on disease reversal, prevention, and enhancing lifespans for Americans.
Today, achieving this requires numerous steps. My advice to the industry is: How can we begin securing immediate successes? Currently, there's substantial dialogue between us and the industry. Hospitals are aiming to advocate for more value-driven frameworks, pushing towards a model where payments occur based on patient wellness rather than just treating illnesses. Many stakeholders seek greater adaptability within healthcare services. As Robert F. Kennedy suggested, instead of implementing a rigid top-down approach focused solely on medicating unwell children through programs like Medicare and Medicaid, why not establish an environment where these initiatives include Health Savings Account (HSA) type options? This way, mothers dealing with issues such as depression and obesity in their children might opt for both medication and holistic treatments including functional medicine plans and additional laboratory testing.
However, the aim is to broaden access to various treatment options through Medicare and Medicaid?
Two major points Secretary Kennedy has highlighted are providing patients with accurate information, ensuring top-tier scientific data, and subsequently trusting the American people to make informed decisions alongside their healthcare providers.
Let's promote openness. Many people here desire greater transparency. Pharmaceutical firms believe they possess valuable information and wish for wider dissemination of their data. Therefore, we should advocate for transparency and encourage bold questioning.
Let's discuss SNAP for a moment. Are you saying that SNAP benefits aren’t supposed to include sodas?
Yes.
So what about looking at this from another angle? How can we ensure that nutritious options become easier to access? Currently, many individuals participating in SNAP find themselves shopping primarily at places where the choices are predominantly sodas and unhealthy snacks.
I completely disagree with the idea that removing soda from SNAP benefits will harm children.
That's not what I'm asking. What I want to know is whether you're considering the other aspect: not only avoiding negative actions but also enhancing access to healthier foods?
Bobby Kennedy was alongside the governor of West Virginia, who proposed creative exemptions regarding job conditions tied to purchasing sodas through SNAP benefits. He directly invited governors to seek such exemptions from him. Currently, some governors are engaging with him concerning novel exemptions aimed at boosting funds specifically for nutritious foods. Significant flexibility exists among states when it comes to administering SNAP; this serves as an excellent illustration of collaborative federal-state initiatives.
Could you implement that model across the country?
Bobby Kennedy is urging all governors—both those from Republican-leaning ("red") states and Democratic-leaning ("blue") ones—to collaborate with him through Agriculture Secretary Brooke Rollins, who shares his commitment to promoting state-level innovations. These efforts could involve removing certain controversial foods from SNAP benefits. Many lobbyists present argue that subsidized sodas play an essential role in children's diets. However, we believe that debate is over. Instead, we're advocating for each governor to remove soda from SNAP and introduce novel strategies aimed at either incentivizing healthier eating habits or possibly increasing funding for nutritious options.
Could you discuss particular initiatives your team has to simplify things for low-income Americans trying to adopt healthier lifestyles and gain access to nutritious foods? Currently, numerous individuals reside in areas lacking fresh food options. Many can't afford higher-quality provisions.
The concept of food deserts can be attributed mainly to the Supplemental Nutrition Assistance Program (SNAP). As one of the major programs out there, it has a budget of around $120 billion, making it the fourth-biggest entitlement initiative. Its influence significantly skews global agricultural incentives. Notably, 67% of all SNAP funds go towards ultra-processed foods, which is unparalleled across the globe.
However, my core question remains: how do we transport people safely? And how can we ensure they arrive in good health?
If you remove sodas and unhealthy foods from SNAP benefits, this frees up tens of billions of additional funds for nutritious options. This addresses the food desert problem since these areas lack fresh produce primarily due to recipients using most of their SNAP allotment on highly processed items.
Secondly, food acts as medicine. Currently, we allocate $4.9 trillion towards healthcare expenses annually. Over 90% of these costs can be attributed to diseases related to poor diet choices, primarily focusing on chronic ailments, which often intertwine with one another. Traditionally, the medical field has treated issues such as diabetes, obesity, and dementia as separate conditions requiring distinct medications and individual National Institutes of Health (NIH) departments.
We discuss healthcare adaptability. We emphasize providing Americans greater authority over their healthcare. This approach aims to direct healthcare funds towards the most effective clinical interventions for each illness. Clinical evidence shows that many conditions are frequently linked to diet.
When discussing the efforts of lobbyists aiming to administer Ozempic to 30% of six-year-olds, one might contend that from a clinical standpoint, there could be instances where using Ozempic makes sense. However, frequently what that child truly requires is improved nutrition. That young individual may benefit more from having access to a dietary consultant as well as undergoing functional medicine blood tests to identify potential nutritional gaps they might have.
The administration’s ultimate objective is to prioritize scientific approaches. As Jay Bhattacharya explicitly stated, his aim is to identify the fundamental causes of diseases, frequently linked to dietary factors, and subsequently allocate medical funds toward the most effective methods for preventing and reversing those conditions.
This implies financing issues, then. So, would you prefer to maintain current levels of funding for Medicare and Medicaid, or do you support reducing their budgets?
There’s $4.9 trillion allocated for funding. How does this relate to reducing Medicare and Medicaid benefits? No one disputes that these programs should fund the most effective treatments aimed at reversing and preventing illnesses among Americans. Everyone agrees with this objective. However, my concern doesn't lie with the policies surrounding Medicare and Medicaid themselves. Instead, I'm questioning the underlying medical rationale guiding them. Currently, the approach seems to be: prescribe statins for children with high cholesterol, SSRIs for those feeling down, and Ozempic for kids who are overweight. This cycle continues unabated. Today, 35% of teenagers take medications for long-term conditions, and the prevalence of such ailments keeps climbing sharply.
What then is the policy solution?
Achieve superior NIH research that pinpoints the causes of diseases and discovers effective prevention methods as well as cures.
Therefore, will the reductions in funding for NIH research be reversed? Since financial resources are necessary to undertake such endeavors.
Medicare and Medicaid are guided by scientific research that establishes the benchmark for care. Currently, this benchmark is flawed. The American Medical Association leads this benchmark. Medicare and Medicaid’s effectiveness relies solely on the soundness of their underlying logic.
What strategies can be employed to develop more effective treatments and promote the concept of "food as medicine"? While NIH research has identified factors contributing to diseases, we lack substantial studies examining how dietary habits and lifestyle choices influence illness progression. There should be increased FDA approval processes for therapies targeting underlying causes, along with preventive screenings and treatments. Additionally, loosening regulations within the FDA coupled with expanded NIH investigations into how fundamental lifestyle changes affect health could integrate these findings into standard medical practices, ultimately affecting reimbursement policies set by insurers.
But Calley, I'm not doubting that part at all. What I'm challenging is how you manage to conduct all that research and put in so much effort when you're trimming and editing it.
Have NIH funds been reduced?
Yes. [Audience laughter]
No. The research funding has not been reduced.
The funds have been reduced.
The allocation for research funds remains intact; however, the administration has issued directives aimed at redirecting resources from indirect costs toward direct funding instead. This shift essentially ensures increased financial support directly reaches front-line investigators. It sends a strong message: bureaucratic control is diminishing, with greater emphasis placed on supporting genuine researchers. As of today, additional funds will specifically benefit these researchers rather than administrative bodies within universities or governmental entities. Importantly, every allocated dollar continues to fund pure research efforts without reductions directed towards service provisions.
Harvard received only 70 cents per dollar—not from research grants, but due to administrative expenses. Reducing overhead costs allows more funds to reach researchers directly. This administration has a strong focus on supporting researchers, ensuring funding reaches scientists without dictating their findings or areas of inquiry, encouraging ambitious studies into why people fall ill.
A significant amount of worry has emerged regarding the measles outbreak. Secretary Kennedy faced some backlash as he wasn’t particularly vocal or proactive about addressing this problem, leaving many to question his reasons.
The press might focus on narratives surrounding Bobby Kennedy stepping up as head of the biggest governmental department and various operational challenges. However, my sense is that Bobby Kennedy is deeply worried about the measles epidemic, with the administration dedicated to mounting the most effective response through the CDC. He’s assembling his team for this purpose. The dedication to top-notch measures against contagious diseases cannot be overstated. What strikes me though, is how much coverage a single measles fatality receives compared to the near-absent attention here and in the media toward the alarming statistic that nearly two-fifths of teenagers suffer from prediabetes. It's disheartening not to see more concern regarding the countless Americans grappling with long-term health conditions.
Yet, why was there such a delay before the American people heard from the Secretary of Health and Human Services during an actual crisis?
During his initial week, he released a statement and reacted swiftly. I am unable to discuss the details of those few days.
Why hasn't HHS taken the lead in advocating for vaccination and emphasizing prevention of this disease?
They have been quite explicit about their stance on that.
I would like to inquire once more about the bigger picture: How has American healthcare changed over the past four years?
The NIH has changed focus to inquire about understanding what is leading to illnesses among Americans. eighty Percent of their budget is now dedicated to genuine innovations aimed at reversing and preventing diseases, rather than just managing them.
The FDA has become significantly less regulated, fostering greater innovation among therapy developers and preventive device manufacturers. We have witnessed a pivotal moment regarding AI and technology and their potential role in preventing diseases at the FDA. Additionally, we've eliminated conflicts of interest within the FDA, issues that were truly outrageous.
This effort has prompted the CMS department to collaborate with Medicare, Medicaid, and private insurers to advance the standard of care based on scientific evidence. Currently, we face challenges due to interrelated lifestyle issues that our healthcare system fails to adequately encourage reversing or preventing through incentives. Meanwhile, the CDC excels in managing infectious diseases but is increasingly concentrating on strategies to thwart or undo chronic illnesses as part of its core mission.
In our setup here, everybody in this space who believes Bobby Kennedy is insane will likely be giving some thought to disease reversal and prevention within four years.
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