Robert F. Kennedy Jr.’s movement has repeatedly been written off as a farce, a stunt, a distraction. Now Donald Trump has nominated him to lead the Department of Health and Human Services, where, if confirmed, he’ll oversee a life-and-death corner of the federal government.

RFK Jr.’s operation had been building toward this moment for months. On August 23, Kennedy suspended his independent presidential bid and endorsed Trump after what he described as “a series of long, intense discussions” that proved the two were ideologically aligned. Almost immediately, the “Make America Healthy Again” (MAHA) movement was born, as was a super PAC of the same name.

The group’s near-term goal was simple: persuade Kennedy’s coalition to vote for Trump. His former national field director, Jeff Hutt, became one of the MAHA PAC’s leaders, and throughout the fall, in his phone calls and meetings with Kennedy supporters, he kept hearing the same message: If RFK Jr. couldn’t become president, he should zero in on health reforms.

[John Hendrickson: The first MAGA Democrat]

“HHS is the place where they wanted Mr. Kennedy to be,” Hutt told me last night. He fully expects Kennedy to be confirmed. Hutt and his team have set up a “war room” and are identifying which senators will support the HHS nomination, and which will need coaxing. Either through standard procedure or via a recess appointment (an idea Trump has teased), Hutt said he was confident that Kennedy will land the job.

Kennedy was offered such a significant position—and will have such a “big rein,” as Hutt put it—because Trump returns favors. In 2016, Trump courted Christian voters by dangling the prospect of appointing conservative judges who would overturn Roe v. Wade. This year, Trump spent the final months of the election wooing the MAHA bros. How many Kennedy supporters actually voted for Trump is unclear, but Hutt and others I spoke with believe that Trump’s victory is partially on account of the RFK Jr. brigade showing up. “He got behind them, and he got elected,” Hutt said of Trump.

Kennedy’s acolytes are elated that he will have such a prominent position in the administration. In my conversations with former Kennedy volunteers and others in his orbit this week, I heard some skepticism as to whether he’ll actually be able to accomplish a revolution inside a sprawling government bureaucracy. But for now, Kennedy’s champions are hopeful that he’ll catalyze policy changes that would lead to a “healthier” society—even if they don’t all agree on what that means.

In late September, at a festival of “free thinkers” in Washington, D.C., where RFK Jr. was the star attraction, Mike Patton, a former campaign volunteer who lives in Florida, told me he was unsure about whether he could bring himself to vote for Trump after all the work he’d done for Kennedy.

This week, Patton told me that, in the end, he and his wife each wrote in Kennedy’s name on their ballot. He is happy that Kennedy is ascending to a place of power, and excited that Trump has promised to give Kennedy authority over health matters, but he’s dismayed that Trump apparently wants to keep him away from areas involving fossil fuels and renewable energy. Patton isn’t sure what Kennedy might be able to accomplish within Trump’s administration. The idea of fighting all manner of chronic diseases with cleaner food and water is a pillar of the MAHA movement. But this will be an uphill battle. “Even when he was campaigning, he was saying he was going to make a drastic reduction in chronic disease in his four years, and I can’t wrap my head around how you can make a measurable difference [that quickly],” Patton told me. “But he seems confident, and Bobby seemed confident before. So, pop some popcorn.”

Another Kennedy supporter, Jennifer Swayne, who served as his campaign’s Florida volunteer coordinator, told me she somewhat reluctantly voted for Trump. Swayne is the mother of a child with autism, and she believes that mothers like herself are searching for answers—that’s partly what drew her to Kennedy. “We want to know what's causing this,” she said of autism. “We want to prevent other moms from having to go through this.” She said she would define success for Kennedy’s HHS tenure as removing “dangerous products off the market” and holding drug manufacturers accountable for adverse effects and chemical dependency.

[Yasmin Tayag: ‘Make America healthy again’ sounds good until you start asking questions]

When I asked Hutt how he’d gauge Kennedy’s success, he had a range of ideas. “The amount of money flowing through government into corporations would be dramatically reduced. Government would be out of a lot of things, like health care. We would take the middleman out of a lot of things. We would have government agencies whose sole purpose is to publish and report facts and numbers in ways that educate the American people, not to convince them one way or the other of something,” he said. He envisioned Kennedy ushering in an era of more family farms, of citizens gardening and growing their own food. “I guess that's really what it looks like: sort of a health revolution, in a sense,” he said. “Nobody’s ever asked me that question before.”

In announcing the nomination, Trump echoed Kennedy’s core campaign messaging: “Americans have been crushed by the industrial food complex and drug companies who have engaged in deception, misinformation, and disinformation when it comes to Public Health.” Kevin Roberts, the president of the Heritage Foundation and one of the key people behind Project 2025, said in a statement that Kennedy’s nomination “sends a clear message to our failed public health establishment,” and that under Trump and Kennedy, “Americans will be in control of their health, not the commissars of three-letter health agencies.”

Many questions surround the HHS nomination, none more significant than whether Kennedy would use his authority to block or recall certain vaccines. Kennedy has spent years sowing doubt about their safety. In the early 2000s, he helped popularize the unproven theory of a link between vaccines and autism. More recently, he was an influential opponent of the COVID vaccines and accompanying mandates. Now he’s poised to inform drug policy at the highest level.

Kennedy’s spokesperson did not respond to my request for comment last night as to whether, as HHS secretary, RFK Jr. would move to outlaw any existing vaccines, and referred me to his victory-lap post on X, which did not mention the topic. Tony Lyons, who founded a different Kennedy super PAC, American Values 2024, said in a text message: “Bobby has said very clearly that he’s not going to take away anyone’s vaccines.” If, hypothetically, we faced another pandemic during Trump’s second term, I asked Lyons, would Kennedy stand in the way of a vaccine-development project such as Operation Warp Speed? Lyons didn’t offer a clear answer. “[Kennedy] believes in robust, transparent and independent science, rather than corporate science propped up by censorship and propaganda,” he wrote.

In my conversations with Kennedy’s supporters, I heard a lot about “medical freedom” and “personal choice,” but no one mentioned the word ban. Kennedy stiff-arms the “anti-vax” label, and his allies steadfastly maintain that he’ll use his position to scrutinize vaccine science—but not to institute a vaccine moratorium for the greater population.

[Benjamin Mazer: The sanewashing of RFK Jr.]

Perhaps the clearest way to understand Kennedy’s HHS aim is to listen to his musings on “corporate capture”: the idea that government agencies are overly influenced by the companies within the industries they’re supposed to be regulating. This is a long-standing liberal complaint, which Kennedy has built up to the status of a conspiracy theory. (Anthony Fauci, for instance, has not personally profited off of vaccines, as Kennedy has claimed.) His top-line goal is to sever the relationships between corporations and the federal government, but he has yet to explicitly state how he’ll do that. Reforming fast food may be his biggest source of tension with Trump. The future 47th president didn’t just serve fries at a (closed) McDonald’s as a campaign stunt; he seems to genuinely love Mickey D’s, while Kennedy sees it as a scourge—the antithesis of MAHA. But that’s just one company. Hutt conceded that his team faces a challenge in persuading senators from agricultural-heavy states to support the sort of reforms Kennedy is promising: fewer food chemicals, an emphasis on regenerative soil.

And some of what Kennedy speaks of accomplishing is well beyond his reach. For instance, he has called for removing fluoride from our drinking water—something even Republican dentists oppose. But such a change could occur only at the local level, not the federal level. In New York City, for example, Mayor Eric Adams has said he will follow the fluoridation recommendations of city and state health departments.

As Trump prepares to take office again, Kennedy remains a confounding presence: He’s a dreamer, but he’s destructive. Kennedy was never going to win the White House, but he’s now, at last, on his way to Washington. And we all have to live with it.

Although the plight of America’s 2.2 million federal bureaucrats seldom elicits public sympathy, spare a charitable thought for their future. Not since the congressional elections of 1882 has civil-service reform received so much political attention. President-Elect Donald Trump and his allies now face a fundamental decision: Will they listen to the loudest and most extreme voices in their party and be agents of chaos and disruption in upending the civil service? Or will they adopt a more measured, incremental approach that would deliver improvements and burnish their managerial credentials? The recent appointment of Elon Musk and Vivek Ramaswamy to lead the newly minted Department of Government Efficiency is a clear signal that Trump is leaning toward disruption. But the risks are significant—and the president-elect has other reform options that could be more effective at a far lower cost.  

Few would argue that the current federal civil service is perfect. In 2017 and 2018, the National Academy of Public Administration, an independent nonprofit chartered by Congress, issued a two-part white paper describing the government’s staffing system as “fundamentally broken,” with too many rules and too little flexibility. Its authors argued that firing nonperformers and attracting new talent can be too difficult. Other observers have bemoaned the bureaucracy for its cost, inefficiency, and unresponsiveness. Change is clearly needed, and would in fact be welcome in many corners of the federal government.

Although distinguished bipartisan commissions may agree on a path forward, Republican and Democratic politicians—buffeted by the interests and passions of their bases—have been unable to come together to address these problems. Under pressure from public-sector unions, Democrats have shied away from even modest reforms of their own and have focused instead on resisting GOP proposals—which have centered on removing protections from federal employees. Some on the hard right are working toward “deconstruction of the administrative state” and the “total destruction of the deep state,” as the former Trump strategist Steve Bannon has put it. But most Americans—including many moderate Republicans and Democrats—do not share this animus. They value government services and simply want to see them performed better.

Efficient and effective institutions are easy to degrade, difficult to build. The United States needs to retain the benefits of technical competence and impartial advice from a meritocratic civil service while ensuring that federal employees are accountable to political oversight. There are more constructive ways to achieve the objectives that both Republicans and Democrats claim to want, while retaining a high-performing, meritocratic civil service.         

[Read: Brace for the storm]

Late in his first administration, Trump used an executive order to introduce Schedule F, which sought to remove civil-service protections from any career official with a policy-making role, giving the White House much greater discretion in hiring and firing. Currently, there are about 4,000 political positions, out of which some 1,200 are subject to congressional approval. The number of positions that could be designated as Schedule F is unknown, but estimates suggest it could be 50,000 or higher. Trump’s campaign pledged to “immediately reissue my 2020 executive order restoring the president’s authority to remove rogue bureaucrats,” and he himself has promised to wield this power “very aggressively.”

He will have broad support from his party, which has sought to reap political benefit from stoking public hostility toward civil servants. In 2023, Florida Governor Ron DeSantis, then a presidential primary candidate, claimed that he would start “slitting throats” of federal bureaucrats from day one. Other prominent Republicans, such as Trump’s nominee for secretary of state, Marco Rubio, have indicated their openness to Schedule F. During the primaries, Ramaswamy denounced the administrative state as “an unconstitutional fourth branch of government,” and proposed firing more than three-quarters of federal employees. He later revised this mass-termination plan to cover just half the federal workforce, selected randomly: “If your SSN ends in an odd number, you’re fired.” More recently, Ramaswamy has expressed admiration for Musk’s drastic staff cuts at X (formerly Twitter) as a template for reducing the federal government.

In the Senate, Florida’s Rick Scott has been the Republican most aggressively pressing for a radical restructuring of the civil service. In 2022, he rolled out his 12-point Rescue America plan, which included a proposal for many government agencies to either move out of Washington or shut down entirely. Although about 85 percent of federal employees already work outside the greater Washington, D.C., area, the idea of moving staff out of the capital has caught on in Republican circles—the Trump campaign said he would move as many as 100,000 civil-service positions “to places filled with patriots who love America.” Cutting civil-service protections is also popular with the MAGA base: The Public Service Reform Act, which Scott introduced last year, proposed to place the entire workforce in “at will” employment status, allowing them to be terminated “for good cause, bad cause, or no cause at all.” (The bill has not yet passed through committee.)

And then there is the Heritage Foundation’s Project 2025. Tonally, the document is uncompromising. The federal government is a “behemoth” deployed against American citizens and conservative values; federal bureaucrats are “underworked, over compensated and unaccountable.” The project argues that the entire edifice of civil-service protections is a legacy of the American left: “Progressive intellectuals and activists demanded a more professionalized, scientific and politically neutral administration.” That statement is partly accurate but woefully incomplete. Republicans have historically been at the forefront of reform efforts, and the last major one, during the Carter administration, was a notably bipartisan affair.

Rhetoric aside, the project’s analysis of central agencies and federal personnel policy is more subtle and nuanced, grounded in a careful review of the relevant institutions and legal and regulatory frameworks. What influence Project 2025 will have on the second Trump administration remains to be seen. Tactically, the president-elect chose to distance himself from it during the campaign, but in office Trump may draw heavily on the document—as well as the personnel who drafted it.

As Francis Fukuyama has argued, the reintroduction of Schedule F will make the federal government “less competent and vastly more politicized.” The United States already has a much higher number of political appointees than any other advanced-industrial democracy—nearly 28 times the number in the United Kingdom, for example. Political appointments stretch down four or five levels of bureaucracy in some agencies (such as the Department of Defense).  

Republicans would be unwise to view Trump’s reelection as a mandate for completely uprooting the civil service. The most recent survey of public confidence in government by the nonpartisan Partnership for Public Service found disturbing evidence of reduced trust in government. Yet attitudes toward federal employees remain positive. A majority of respondents (55 percent) agreed with the statement that most civil servants are competent; a similar proportion agreed that most are committed to helping people “like me.” Only a quarter of respondents said that presidents should be able to fire “any civil servants that they choose for any reason,” whereas 72 percent disagreed with this statement.

[Read: Trump takes aim at Republicans]

Several measures could improve responsiveness, accountability, and performance at a much lower cost and risk than the ideas currently circulating in Republican circles. Departments and agencies should have more flexibility in managing their human resources, and be empowered to tailor their personnel policies to their particular business needs. The allocation of political appointees across the government needs regular review: A bipartisan commission should examine the current 4,000 such posts and make recommendations to the administration about streamlining and redistribution. Performance management is a key area for improvement: Currently, less than 0.5 percent of the federal workforce is rated “marginally satisfactory” or “unsatisfactory,” which at best stretches credence and at worst damages public trust. All government agencies ought to evaluate their staff’s performance on a standard curve, so that poor delivery is consistently identified and addressed. (Adjustments could be made so as not to penalize high-performing agencies and units.) Lastly, labor relations in the civil service need an overhaul: The processes and paperwork surrounding termination should be simplified; the window for appeals should be narrowed; and the role of unions in the grievance process for individual employees should be curtailed.

Such measures may disappoint the more fervent anti-government voices in today’s GOP. But a sober assessment would view Musk’s experience with X as a cautionary tale. Although the platform has functioned as a megaphone for its owner, it has also shed users; experienced repeated and embarrassing technical glitches; witnessed steep declines in advertising revenue; and may now be worth as little as a fifth of what he paid for it in 2022. In the private sector, such failures fall primarily upon owners and investors; in the public sector, they would affect us all. Do Americans want vital government services such as food inspection, air traffic control, or Social Security payments to suffer similar breakdowns? Dislocation and deconstruction may have a visceral appeal among elements of the MAGA base. But once the new Trump administration is in office, the American people will expect it to deliver the public goods and services they rely upon—and do so smoothly, fairly and efficiently. Disruption may sound trendy in Silicon Valley or tough in conservative think-tank circles, but delivery is what will ultimately determine the success or failure of these reforms.