At a rally in Las Vegas in September, the reggaeton star Nicky Jam came onstage in a Make America Great Again hat and endorsed Donald Trump. “We need you. We need you back, right? We need you to be the president,” he said. But after a comedian at Trump’s rally at Madison Square Garden last month called Puerto Rico “a floating island of garbage,” the singer—whose father is Puerto Rican and who was raised partly on the island—had second thoughts.

“Never in my life did I think that a month later, a comedian was going to come to criticize my country and speak badly of my country, and therefore, I renounce any support for Donald Trump,” Nicky Jam said.

He had no right to be surprised. Trump himself had previously gone after Puerto Rico—he punished its leaders for criticizing him after Hurricane Maria, and sought to swap it for Greenland—but even if Nicky Jam had missed or forgotten that, he had to know who Trump was.

Nicky Jam was ahead of the curve. Since the election, Trump has moved swiftly to do things he’d said he’d do, and yet many people—especially his own supporters—seem stunned and dismayed. This is absurd. Surprise was perhaps merited in late 2016 and early 2017, when Trump was still an unknown quantity. But after four years as president, culminating in an attempt to erase an election he lost, Trump has demonstrated who he is. Somehow, the delusion of Trump à la carte—take the lib-owning, take the electoral wins, but pass on all of the unsavory stuff—persists.

In an article about how Trump’s transition is “shocking the Washington establishment,” Peter Baker of The New York Times writes: “Nine years after Mr. Trump began upsetting political norms, it may be easy to underestimate just how extraordinary all of this is.” He’s right that the aberrant nature of the picks may be overlooked, as I have warned, yet it is also true that the actual unpredictability of them is overestimated.

[From the January/February 2024 issue: Trump isn’t bluffing]

On K Street, Politico reports, health-care-industry lobbyists can’t believe that Trump has nominated Robert F. Kennedy Jr. to lead the Department of Health and Human Services. They were “expecting a more conventional pick,” even though Trump emphasized Kennedy’s “Make America Healthy Again” agenda late in the campaign, and even though Kennedy said that Trump had promised him control of HHS. To be sure, Kennedy is a shocking and disturbing pick, as Benjamin Mazer and my colleague Yasmin Tayag have recently written for The Atlantic, but his nomination should not come as a surprise—especially for people whose entire business proposition is being highly paid to advise clients on how Washington actually works. (The influence peddlers reportedly hope that senators will block Kennedy. The fact that they’re still waiting for someone else to solve their problems is further evidence of how little they’ve learned, years into the Trump era.)

Meanwhile, the New York Post, a key pillar of Rupert Murdoch’s right-wing media juggernaut, is similarly jittery about the Kennedy choice. Back when Kennedy was a thorn in President Joe Biden’s side, threatening to run against him in the Democratic primary, the Post’s editorial board was all too happy to elevate him. Now the board condemns his nomination and tells us that it came out of a meeting with him last year “thinking he’s nuts on a lot of fronts.” The columnist Michael Godwin, who beamed on November 9 that Trump’s victory “offers the promise of progress on so many fronts that it already feels like Morning in America again,” was back a week later to complain that “it’s not a close call to say” that Kennedy and Matt Gaetz, Trump’s pick for attorney general, are “unfit” for the roles.

The lobbyists and editorialists are in good company, or at least in some sort of company. On Capitol Hill, Republican senators say they are shocked by many of Trump’s Cabinet picks. Senator Susan Collins of Maine, who notoriously professed surprise when Justices Neil Gorsuch and Brett Kavanaugh voted to overturn Roe v. Wade, is “shocked” at the Gaetz nomination. Gaetz’s House Republican colleagues are “stunned and disgusted.”

Reactions to Pete Hegseth’s nomination as secretary of defense are less vitriolic, if no less baffled. “Wow,” Senator Lisa Murkowski of Alaska told NBC. “I’m just surprised, because the names that I’ve heard for secretary of defense have not included him.” Senator Bill Cassidy of Louisiana was even blunter. “Who?” he said. “I just don’t know anything about him.”

[David A. Graham: The Trump believability gap]

If this is true, the senators could perhaps do with some better staff work. Hegseth was a real possibility to lead the Department of Veterans Affairs in the first Trump administration; more to the point, he was a prominent figure on Fox News, which is a dominant force in the Republican Party, from whose ranks Trump has repeatedly drawn appointees.

Staffers at the affected agencies have also expressed shock and horror at the prospect of an Attorney General Gaetz, a Defense Secretary Hegseth, or a Director of National Intelligence Tulsi Gabbard.

Ordinary Americans may also be taken aback. As I reported last month, Trump critics were concerned about a “believability gap,” in which voters opposed some of Trump’s big policy ideas, sometimes quite strongly, but just didn’t trust that he would really do those things. Although they perhaps deserve more grace than the Republican officials and power brokers who are astonished, they also had ample warning about who Trump is and how he’d govern.

Throughout his presidential campaign, Trump vowed to deport undocumented immigrants en masse. He’s appointing officials such as Stephen Miller and Tom Homan who are committed to that, and yesterday morning, Trump confirmed on Truth Social a report that he would declare a national emergency and use the military to conduct mass deportations. And yet, when the roundups start in January, many people are somehow going to be taken by surprise.

When I was taking German in college in the early years of this millennium, I once stumbled upon a word that appeared foreign even when translated into English: Diphtherie, or diphtheria. “What’s diphtheria?” I wondered, having never encountered a single soul afflicted by this disease.

Diphtheria, once known as the “strangling angel,” was a leading killer of children into the early 20th century. The bacterial infection destroys the lining of the throat, forming a layer of dead, leathery tissue that can cause death by suffocation. The disease left no corner of society untouched: Diphtheria killed Queen Victoria’s daughter, and the children of Presidents Lincoln, Garfield, and Cleveland. Parents used to speak of their first and second families, an elderly woman in Ottawa recalled, because diphtheria had swept through and all their children died.

Today, diphtheria has been so thoroughly forgotten that someone like me, born some 60 years after the invention of a diphtheria vaccine, might have no inkling of the fear it once inspired. If you have encountered diphtheria outside of the historical context, it’s likely because you have scrutinized a childhood immunization schedule: It is the “D” in the DTaP vaccine.

Vaccine breakthroughs over the past two centuries have cumulatively made the modern world a far more hospitable place to be born. For most of human history, half of all children died before reaching age 15; that number is down to just 4 percent worldwide, and far lower in developed countries, with vaccines one of the major drivers of improved life expectancy. “As a child,” the vaccine scientist Stanley Plotkin, now 92, told me, “I had several infectious diseases that almost killed me.” He ticked them off: pertussis, influenza, pneumococcal pneumonia—all of which children today are routinely vaccinated against.

But the success of vaccines has also allowed for a modern amnesia about the level of past human suffering. In a world where the ravages of polio or measles are remote, the risks of vaccines—whether imagined, or real but minute—are able to loom much larger in the minds of parents. This is the space exploited by Robert F. Kennedy Jr., one of the nation’s foremost anti-vaccine activists and now nominee for secretary of Health and Human Services. It is a stunning reversal of fortune for a man relegated to the fringes of the Democratic Party just last year. And it is also a reversal for Donald Trump, who might have flirted with anti-vaccine rhetoric in the past but also presided over a record-breaking race to create a COVID vaccine. Kennedy has promised that he would not yank vaccines off the market, but his nomination normalizes and emboldens the anti-vaccine movement. The danger now is that diseases confined to the past become diseases of the future.

Walt Orenstein trained as a pediatrician in the 1970s, when he often saw children with meningitis—a dangerous infection of membranes around the brain—that can be caused by a bacterium called Haemophilus influenzae type b or Hib. (Despite the name, it is not related to the influenza virus.) “I remember doing loads of spinal taps,” he told me, to diagnose the disease. The advent of a Hib vaccine in the 1980s virtually wiped these infections out; babies are now routinely vaccinated in the first 15 months of life. “It’s amazing there are people today calling themselves pediatricians who have never seen a case of Hib,” he says. He remembers rotavirus, too, back when it used to cause about half of all hospitalizations for diarrhea in kids under 5. “People used to say, ‘Don’t get the infant ward during diarrhea season,’” Orenstein told me. But in the 2000s, the introduction of rotavirus vaccines for babies six months and younger sharply curtailed hospitalizations.

To Orenstein, it is important that the current rotavirus vaccine has proved effective but also safe. An older rotavirus vaccine was taken off the market in 1999 when regulators learned that it gave babies an up to one-in-10,000 chance of developing a serious but usually treatable bowel obstruction called intussusception. The benefits arguably still outweighed the risks—about one in 50 babies infected with rotavirus need hospitalization—but the United States has a high bar for vaccine safety. Similarly, the U.S. switched from an oral polio vaccine containing live, weakened virus—which had a one in 2.4 million chance of causing paralysis—to a more expensive but safer shot made with inactivated viruses that cannot cause disease. No vaccine is perfect, says Gregory Poland, a vaccinologist and the president of the Atria Academy of Science & Medicine, who himself developed severe tinnitus after getting the COVID vaccine. “There will always be risks,” he told me, and he acknowledges the need to speak candidly about them. But vaccine recommendations are based on benefits that are “overwhelming” compared with their risks, he said.

The success of childhood vaccination has a perverse effect of making the benefits of these vaccines invisible. Let’s put it this way: If everyone around me is vaccinated for diphtheria but I am not, I still have virtually no chance of contracting it. There is simply no one to give it to me. This protection is also known as “herd immunity” or “community protection.” But that logic falls apart when vaccination rates slip, and the bubble of protective immunity dissolves. The impact won’t be immediate. “If we stopped vaccinating today, we wouldn’t get outbreaks tomorrow,” Orenstein said. In time, though, all-but-forgotten diseases could once again find a foothold, sickening those who chose not to be vaccinated but also those who could not be vaccinated, such as people with certain medical conditions and newborns too young for shots. In aggregate, individual decisions to refuse vaccines end up having far-reaching consequences.

Evolutionary biologists have argued that plague and pestilence rose in tandem with human civilization. Before humans built cities, back when we still lived in small bands of hunter-gatherers, a novel virus—say, from a bat—might tear through a group only to reach a dead end once everyone was immune or deceased. With no one else to infect, such a virus will burn itself out. Only when humans started clustering in large cities could certain viruses keep finding new susceptibles—babies or new migrants with no immunity, people with waning immunity—and smolder on and on and on. Infectious disease, you might then say, is a necessary condition of living in a society.

But human ingenuity has handed us a cheat code: Vaccines now allow us to enjoy the benefits of fellow humanity while preventing the constant exchange of deadly pathogens. And vaccines can, through the power of herd immunity, protect even those who are too young or too sick to be effectively vaccinated themselves. When we get vaccinated, or don’t, our decisions ricochet through the lives of others. Vaccines make us responsible for more than ourselves. And is that not what it means to live in a society?

Robert F. Kennedy Jr., the bear-fondling, gravel-voiced Camelot scion, is President-Elect Donald Trump’s pick to lead the Department of Health and Human Services, where presumably he will “go wild on health,” to quote Trump. His nomination has raised concerns among public-health experts because many of Kennedy’s views on health are, well, wild.

To be sure, among Kennedy’s battier ideas are a few reasonable ones, such as reducing obesity and cracking down on direct-to-consumer drug commercials and conflicts of interest among researchers. But these are eclipsed by some troubling ones, such as the ideas that common cooking oils are poisonous, that fluoride doesn’t belong in tap water, and that childhood vaccines are questionable.

What if Kennedy did, in fact, go wild on health, get his way, and remake America in his own image? If his worst ideas come to pass, experts tell me, heart attacks might increase, dental infections might spike, and children might needlessly die of completely preventable diseases.

[Read: RFK Jr. collects his reward]

Even if he is confirmed as health secretary, Kennedy’s influence on some of these domains might be limited. Most public-health measures—including water fluoridation and vaccines—are a matter for states and localities, not the federal government. (This is why different states had such different COVID-19 responses.) But even so, a Secretary Kennedy would have a prominent perch from which to espouse his ideas, and his position would give him a veneer of credibility that he has not earned. Right-leaning states and judges might listen, and adapt local policies to suit his worldview. At the very least, parents who support Trump and Kennedy might take the administration’s views into account when making decisions for their families.

Let’s begin with seed oils, which keep popping up in Kennedy’s speeches and media clips. (He even mentioned them while suspending his presidential bid.) Kennedy has called seed oils, which include common cooking oils such as canola oil and sunflower oil, “one of the most unhealthy ingredients that we have in foods,” and says Americans are being “unknowingly poisoned” by them.

Kennedy believes that seed oils cause “body-wide inflammation” and disease. But this isn’t true, Christopher Gardner, a nutrition scientist at Stanford, told me. In fact, replacing foods high in saturated fat, such as butter, with those high in unsaturated fat, such as canola oil, has been proven again and again to lower cholesterol levels and reduce the risk of heart disease. To the extent that seed oils are bad, Gardner said, it’s because they often show up in highly processed junk and fast food.

And Kennedy’s solution to this supposed health crisis—to replace seed oils with beef tallow—is troubling. (Several of his seed-oil clips end with a promo of red Kennedy swag that reads MAKE FRYING OIL TALLOW AGAIN.) Whatever you do with seed oil, “don’t replace it with beef tallow,” Gardner said. “That’s friggin’ nuts.” Replacing all the oil you eat with beef fat can cause cholesterol to pile into plaques in your arteries, impeding the flow of blood. “That’s how you get a heart attack,” Gardner said.

Kennedy has also said he wants to remove fluoride from tap water, claiming that the compound is an “industrial waste associated with arthritis, bone fractures, bone cancer, IQ loss, neurodevelopmental disorders, and thyroid disease.”

There is some risk associated with excessive fluoride intake: Consuming fluoride above a level of 1.5 milligrams a liter—about twice the level that’s in most fluoridated tap water—has been linked to lowered IQ in children. Fluoridated water can also cause light stains on teeth, which affect about 12 percent of people in the United States.

But researchers say these risks are generally worth it because the consequences of removing fluoride from the water are much worse. Fluoride helps strengthen tooth enamel, and it also fights off the acid that attacks our teeth any time we eat carbohydrates. If the teeth lose this battle, decay can set in—and if the decay goes untreated, it can cause excruciating pain and, in extreme cases, pus-filled abscesses. “There will certainly be an increase in dental decay if fluoride is removed from the drinking water,” Gary Slade, a dentistry professor at the University of North Carolina at Chapel Hill, told me. Slade found in a study that fluoride in drinking water reduces decay by 30 percent in baby teeth and 12 percent in permanent teeth.

Some cities and countries have removed fluoride from the water, and kids’ dental health suffered as a result. After Israel ceased water fluoridation in 2014, dental treatments in a clinic in Tel Aviv increased twofold across all ages. In Canada, after Calgary ceased water fluoridation in 2011, second graders there experienced more cavities than those in Edmonton, where water was still fluoridated. After Juneau, Alaska, ceased water fluoridation in 2007, children younger than 6 underwent more cavity-related dental procedures—at a cost of about $300 more a year per child. Some cities have even reintroduced fluoride into the water supply after noticing an uptick in tooth decay among children.

Kennedy is perhaps most infamous for his skepticism of vaccines, and this is also likely the issue where his views are most consequential and worrisome. Although Kennedy sometimes shies away from calling himself anti-vaccine, he is the founder of the anti-vaccine group Children’s Health Defense and once wrote a (now-retracted) magazine story on the (false) link between vaccines and autism. He’s called vaccines “a holocaust” and has claimed that “there’s no vaccine that is safe and effective.” A co-chair of the Trump-Vance transition team has said that Kennedy would be given access to federal health data in order to assess the safety of vaccines.

Though school vaccine requirements are determined by states, a prominent national-health figure casting doubt on vaccines’ safety can influence both state policy and individual parents’ decisions to vaccinate. If vaccination rates do drop, among the diseases that health experts worry will return is measles, the most contagious of the vaccine-preventable diseases.

A person infected with measles is most contagious right before they develop symptoms. They can infect others simply by sharing their air space; tiny droplets infected with measles can hang in the air for two hours “like a ghost,” Paul Offit, the director of the Vaccine Education Center at the Children’s Hospital of Philadelphia, told me.

Kids with measles are sick and miserable. They’re photophobic—afraid of the light—and may struggle to breathe. Before the measles vaccine came along in 1963, 48,000 people were hospitalized with measles each year in America, many with pneumonia or inflammation of the brain. Five hundred of them died each year. When Samoa suffered a measles outbreak in 2019, 83 people died, out of a population of just 200,000.

Measles can also weaken the immune system, Matthew Ferrari, a biology professor at Penn State, told me. For two to three years after contracting measles, you’re likely to be hit harder by flu and other viruses. In rare cases, measles can cause a chronic form of brain inflammation that leads to a gradual loss of mental faculties and motor skills, and eventually, death.

[John Hendrickson: The first MAGA Democrat]

Measles is such a menace, in fact, that giving people “a choice” about whether to vaccinate their kids, as Kennedy often suggests, is not sufficient. People who have received two doses of the MMR vaccine are 97 percent protected against measles. But about 9 million people, including kids who are undergoing chemotherapy or who are on some kinds of immunosuppressants, can’t get vaccinated. These individuals rely on herd immunity from other vaccinated people, and when more than 5 percent of people choose not to be vaccinated, herd immunity suffers.

“Is it your right to catch and transmit a potentially fatal infection? No, it’s not,” Offit said. “You are part of this society, and you have to recognize that what you do affects other people.” Offit told me he’s already talked with pediatricians who say parents are hesitant to get their children vaccinated because of what they’ve heard Kennedy say.

Of course, there is a way to prevent Kennedy from having this much influence over public health: The Senate could reject his nomination. But that would require Republicans to stand up to Trump, which is a wild idea in itself.

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Robert F. Kennedy Jr., the nominee to be the next secretary of Health and Human Services, is America’s most prominent vaccine skeptic. An advocacy organization that he founded and chaired has called the nation’s declining child-immunization rates “good news,” and referred to parents’ lingering doubts about routine shots as COVID-19’s “silver lining.” Now Kennedy may soon be overseeing the cluster of federal agencies that license and recommend vaccines, as well as the multibillion-dollar program that covers the immunization of almost half the nation’s children.

Which is to say that America’s most prominent vaccine skeptic could have the power to upend, derail, or otherwise louse up a cornerstone of public health. Raising U.S. vaccination rates to where they are today took decades of investment: In 1991, for example, just 82 percent of toddlers were getting measles shots; by 2019, that number had increased to 92 percent. The first Trump administration actually presided over the historic high point for the nation’s immunization services; now the second may be focused on promoting vaccines’ alleged hidden harms. Kennedy has said that he doesn’t want to take any shots away, but even if he were to emphasize “choice,” his leadership would be a daunting test of Americans’ commitment to vaccines.

In many ways, the situation is unprecedented: No one with Kennedy’s mix of inexperience and paranoid distrust has ever held the reins at HHS. He was trained as a lawyer and has no training in biostatistics or any other research bona fides—the sorts of qualifications you’d expect from someone credibly evaluating vaccine efficacy. But the post-pandemic era has already given rise to at least one smaller-scale experiment along these lines. In Florida, vaccine policies have been overseen since 2021 by another noted skeptic of the pharmaceutical industry, State Surgeon General Joseph Ladapo. (Kennedy has likened Ladapo to Galileo—yes, the astronomer who faced down the Roman Inquisition.) Under Ladapo’s direction, the state has aggressively resisted federal guidance on COVID-19 vaccination, and its department of health has twice advised Floridians not to get mRNA-based booster shots. “These vaccines are not appropriate for use in human beings,” Ladapo declared in January. His public-health contrarianism has also started spilling over into more routine immunization practices. Last winter, during an active measles outbreak at a Florida school, Ladapo abandoned standard practice and allowed unvaccinated children to attend class. He also seemed to make a point of not recommending measles shots for any kids who might have needed them.

Jeffrey Goldhagen, a pediatrics professor at the University of Florida and the former head of the Duval County health department, believes that this vaccine skepticism has had immense costs. “The deaths and suffering of thousands and thousands of Floridians” can be linked to Ladapo’s policies, he said, particularly regarding COVID shots. But in the years since Ladapo took office, Florida did not become an instant outlier in terms of COVID vaccination numbers, nor in terms of age-adjusted rates of death from COVID. And so far at least, the state’s performance on other immunization metrics is not far off from the rest of America’s. That doesn’t mean Florida’s numbers are good: Among the state’s kindergarteners, routine-vaccination rates have dropped from 93.3 percent for the kids who entered school in the fall of 2020 to 88.1 percent in 2023, and the rate at which kids are getting nonmedical exemptions from vaccine requirements went up from 2.7 to 4.5 percent over the same period. These changes elevate the risk of further outbreaks of measles, or of other infectious diseases that could end up killing children—but they’re not unique to Ladapo’s constituents. National statistics have been moving in the same direction. (To wit: The rate of nonmedical exemptions across the U.S. has gone up by about the same proportion as Florida’s.)

All of these disturbing trends may be tied to a growing suspicion of vaccines that was brought on during COVID and fanned by right-wing influencers. Or they could be a lingering effect of the widespread lapse in health care in 2020, during which time many young children were missing doses of vaccines. (Kids who entered public school in 2023 might still be catching up.)

In any case, other vaccination rates in Florida look pretty good. Under Ladapo, the state has actually been gaining on the nation as a whole in terms of flu shots for adults and holding its own on immunization for diphtheria, tetanus, and pertussis in toddlers. Even Ladapo’s outlandish choice last winter to allow unvaccinated kids back into a school with an active measles outbreak did not lead to any further cases of disease. In short, as I noted back in February, Ladapo’s anti-vaccine activism has had few, if any, clear effects. (Ladapo did not respond when I reached out to ask why his policies might have failed to sabotage the state’s vaccination rates.)

  

If Florida’s immunization rates have been resilient, then America’s may hold up even better in the years to come. That’s because the most important vaccine policies are made at the state and local levels, Rupali Limaye, a professor and scholar of health behavior at Johns Hopkins University, told me. Each state decides whether and how to mandate vaccines to school-age children, or during a pandemic. The states and localities are then responsible for giving out (or choosing not to give out) whichever vaccines are recommended, and sometimes paid for, by the federal government.  

But the existence of vaccine-skeptical leadership in Washington, and throughout the Republican Party, could still end up putting pressure on local decision makers, she continued, and could encourage policies that support parental choice at the expense of maximizing immunization rates. As a member of the Cabinet, Kennedy would also have a platform that he’s never had before, from which he can continue to spread untruths about vaccines. “If you start to give people more of a choice, and they are exposed to disinformation and misinformation, then there is that propensity of people to make decisions that are not based on evidence,” Limaye said. (According to The New York Times, many experts say they “worry most” about this aspect of Kennedy’s leadership.)

How much will this really matter, though? The mere prominence of Kennedy’s ideas may not do much to drive down vaccination rates on its own. Noel Brewer, a behavioral scientist and public-health professor at the UNC Gillings School of Global Public Health, told me that attempts to change people’s thoughts and feelings about vaccines are often futile; research shows that talking up the value of getting shots has little impact on behavior. By the same token, one might reasonably expect that talking down the value of vaccines (as Kennedy and Ladapo are wont to do) would be wasted effort too. “It may be that having a public figure talking about this has little effect,” Brewer said.

Indeed, much has been made of Kennedy’s apparent intervention during the 2019 measles crisis in Samoa. He arrived there for a visit in the middle of that year, not long after measles immunizations had been suspended, and children’s immunization rates had plummeted. (The crisis began when two babies died from a vaccine-related medical error in 2018.) Kennedy has been linked to the deadly measles outbreak in the months that followed, but if his presence really did give succor to the local anti-vaccine movement, that movement’s broader aims were frustrated: The government declared a state of emergency that fall, and soon the measles-vaccination rate had more than doubled.

As head of HHS, though, Kennedy would have direct control over the federal programs that do the sort of work that has been necessary in Samoa, and provide access to vaccines to those who need them most. For example, he’d oversee the agencies that pay for and administer Vaccines for Children, which distributes shots to children in every state. All the experts I spoke with warned that interference with this program could have serious consequences. Other potential actions, such as demanding further safety studies of vaccines and evidence reviews, could slow down decision making and delay the introduction of new vaccines.

Kennedy would also have a chance to influence the nation’s vaccine requirements for children, as well as its safety-and-monitoring system, at the highest levels. He’d be in charge of selecting members for the Advisory Committee on Immunization Practices, which makes recommendations on vaccines that are usually adopted by the states and result in standardized insurance coverage. He’d also oversee the head of the CDC, who in turn has the authority to overrule or amend individual ACIP recommendations.

Even if he’s not inclined to squelch any determinations outright, Kennedy’s goal of giving parents latitude might play out in other ways. Brewer, who is currently a voting member of ACIP (but emphasized that he was not speaking in that capacity), said that the committee can issue several different types of rulings, some of which roughly correspond to ACIP saying that Americans should rather than may get a certain vaccine. That distinction can be very consequential, Brewer said: Shots that are made “routine” by ACIP get prioritized in doctor’s offices, for instance, while those that are subject to “shared clinical decision-making” may be held for patients who ask for them specifically. Shifting the country’s vaccination program from a should to a may regime “would destroy uptake,” Brewer told me.

Those would seem to be the stakes. The case study of vaccine-skeptical governance that we have in Florida may not look so dire—at least in the specifics. But Kennedy’s ascendancy could be something more than that: He could steer the public-health establishment off the course that it’s been on for many years, and getting back to where we are today could take more years still.

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Donald Trump appears to experience the world through the glow of a television screen. He has long placed a premium on those who look the part in front of the camera. Paging Dr. Mehmet Oz.

Trump has picked Oz to lead the Centers for Medicare and Medicaid Services. CMS, as the agency is known, falls under the Department of Health and Human Services (HHS). Last week, Trump nominated Robert F. Kennedy Jr. to serve as HHS secretary. As you may have guessed, Kennedy and Oz are not only friends but kindred spirits. Oz is a global adviser at iHerb, a for-profit company that offers “Earth’s best-curated selection of health and wellness products at the best possible value.” He and Kennedy, two relative outsiders, are now positioned to enjoy a symbiotic relationship within Trump’s chaotic ecosystem.

Oz was last seen running for a Pennsylvania Senate seat in 2022. He lost to John Fetterman, who, despite dealing with the aftereffects of a stroke, carried the state by five points. Throughout that race, Oz struggled to combat the perception that he was a charlatan and carpetbagger who primarily lived in New Jersey. (Fetterman’s team repeatedly tagged Oz as an out-of-touch elitist, trolling him, for example, when he went grocery shopping for crudités and lamented high prices.) After that electoral defeat, Oz’s political dreams seemed all but dashed. But he wisely remained loyal to Trump—a person who has the ability to change trajectories on a whim.

In the pre-Trump era, it might have been a stretch to describe CMS administrator as an overtly political position. But Oz’s objective under Trump couldn’t be clearer. In a statement, Trump, using his reliably perplexing capitalization, telegraphed that Oz will bring a certain ethos to the job—a little MAGA, a little MAHA. Oz, Trump promised, will “cut waste and fraud within our Country’s most expensive Government Agency, which is a third of our Nation’s Healthcare spend, and a quarter of our entire National Budget.” And, because he’s Trump, he mentioned Oz’s nine daytime Emmy Awards.

Some 150 million Americans currently rely on the agency’s insurance programs, including Medicaid, Medicare, and Obamacare. Oz has been a proponent of Medicare Advantage for All. Though that sounds like the Medicare for All initiative championed by progressives such as Senator Bernie Sanders, the two programs are quite different. At its core, Medicare for All would set the U.S. on a path toward nationalizing health care. Trump would never go for that. But Medicare Advantage already exists within America’s patchwork private/public system, and Oz might push to strengthen it. He could also face budgetary pressure to weaken it. Oz’s own health-care views haven’t remained consistent. Though he once praised the mandatory universal models of Germany and Switzerland, as a Republican politician he threw his support behind privatized Medicare.

When asked about Oz’s nomination, Fetterman, his former opponent, told CNN: “As long as he’s willing to protect and preserve Medicaid and Medicare, I’m voting for the dude.” Some people were pissed. Victoria Perrone, who served as the director of operations on Fetterman’s Senate campaign, called out her old boss on social media: “Dr. Oz broke his pledge to ‘do no harm’ when he said red onions prevent ovarian cancer. My sis died of OC in 6/2022. This is a huge personal betrayal to me. We know he won’t protect the Medicaid that paid for her treatments,” Perrone posted on X. “I feel like I’ve been duped and 2 years of working on your campaign was a waste,” she added.

The above argument is illustrative of another reality Trump acknowledged in announcing his pick: “Make America Healthy Again” keeps growing. Oz, Trump declared, “will work closely with Robert F. Kennedy Jr. to take on the illness industrial complex, and all the horrible chronic diseases left in its wake.” He went a step further, promising that Oz will bring “a strong voice to the key pillars of the MAHA Movement.” Oz holds degrees from Harvard and Penn, and he worked as a professor of surgery at Columbia. In spite of that pedigree, Oz has spent years facing credible accusations of medical quackery for his endorsement of dietary supplements. In 2014, he received a dramatic dressing-down on Capitol Hill. Senator Claire McCaskill read three statements that Oz had made on his eponymous show:

“You may think magic is make-believe, but this little bean has scientists saying they’ve found the magic weight-loss cure for every body type: It’s green coffee extract.”

“I’ve got the No. 1 miracle in a bottle to burn your fat: It’s raspberry ketone.”

“Garcinia cambogia: It may be the simple solution you’ve been looking for to bust your body fat for good.”

Oz’s defense that day was that his job was to be a “cheerleader” for the Dr. Oz audience. “I actually do personally believe in the items I talk about in the show. I passionately study them. I recognize oftentimes they don’t have the scientific muster to present as fact, but nevertheless, I would give my audience the advice I give my family,” he testified.

He emerged from that hearing largely unscathed. Two years later, Oz would go on to read what he claimed were Trump’s medical records on that same show. He famously praised Trump’s testosterone levels and supposed all-around health. Four years after that, once Trump was president, Oz sent emails to White House officials, including Trump’s son-in-law Jared Kushner, pushing them to rush patient trials for hydroxychloroquine, an unproven treatment for COVID.

In the next Trump administration, those are the sorts of exchanges Oz could be having with Kennedy—or with Trump himself. How did we get here? Oz landed this gig because he’s good on TV, yes, but also because, when he entered the political arena, he fully aligned himself with Trump. The 47th president rewards loyalty. If there’s one thing that’s become clear from his administration nominations so far, it’s that.

Some of Trump’s appointments will be less consequential than others. Anything involving the health and well-being of tens of millions of Americans is inarguably serious. Oz’s confirmation is not guaranteed, but his selection has already confirmed that nothing about Trump 2.0 is mere bluster.

Related:

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Video by Joanne Imperio / The Atlantic. Sources: Archive Films / Getty; Internet Archive; Prelinger Associates / Getty.

Put Down the Vacuum

By Annie Lowrey

The other night, a friend came over. A dear friend. A friend who has helped me out when I’ve been sick, and who brought over takeout when I had just given birth. Still, before he arrived, I vacuumed.

I thought about this while reading the Gender Equity Policy Institute’s recent report on gender and domestic labor. The study finds that mothers spend twice as much time as fathers “on the essential and unpaid work” of taking care of kids and the home, and that women spend more time on this than men, regardless of parental and relationship status. “Simply being a woman” is the instrumental variable, the study concludes.

Read the full article.

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Stephanie Bai contributed to this newsletter.

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A Nestle executive said on Tuesday that the company is not too worried about the possibility of Robert F. Kennedy Jr., who has been highly critical of packaged and processed food in the U.S., becoming the next leader of the Department of Health and Human Services (HHS).

Read more...

This is an edition of The Atlantic Daily, a newsletter that guides you through the biggest stories of the day, helps you discover new ideas, and recommends the best in culture. Sign up for it here.

As president-elect, Donald Trump has the right to name the people he wants in his Cabinet. Some of Trump’s nominations, such as Senator Marco Rubio to lead the State Department, are completely ordinary. A few are ideological red meat for Republicans. Others are gifts to Trump loyalists.

Four of these nominees, however, are dangerous to the security of the United States and to the well-being of its people: Pete Hegseth (Defense), Tulsi Gabbard (Office of the Director of National Intelligence), Matt Gaetz (Justice), and Robert F. Kennedy Jr. (Health and Human Services). The Senate must turn back these nominations, and do so en bloc.

The Gaetz and Kennedy nominations are apparently already in trouble, and more than enough has been written about them. Gaetz is an accused sexual predator (he has long denied the allegations); ironically, he is the least dangerous of this pack. Yes, as attorney general he would green-light every raving demand from MAGA world for investigations into Trump’s enemies, but in a strange blessing, he is also likely to be completely incompetent. The Department of Justice, as Trump himself learned during his first term, is packed to the rafters with very sharp lawyers who would almost certainly jam up any of Gaetz’s unconstitutional orders. Gaetz’s tenure at Justice would be a national humiliation and destructive to the rule of law, but it would also likely be very short.

The RFK Jr. nomination is, in a word, pathetic. Most of his views are little more than pure anti-science kookery, and if he is confirmed, Americans—and especially their children—will be in peril from this anti-vaccine crusader. But he would be a danger to the health of individual Americans (especially those who watch too much TV and spend too much time on the internet) rather than to the continued existence of the United States.

Which brings me to Gabbard and Hegseth.

Tulsi Gabbard, as I wrote last week, is unqualified for the job of DNI, but she is also a security risk: I have held security clearances for most of my adult life, and had I worked in any federal office next to her, I would have had no compunction about raising her as an “insider threat” because of her political views and her shady international connections. (As a member of Congress in 2017, she held meetings with the Syrian dictator Bashar al-Assad outside of U.S. government channels—an obvious problem for anyone seeking a senior role in national security.)

Gaetz, Kennedy, and Gabbard are terrible choices. The Hegseth nomination, however, is easily the most dangerous and irresponsible of all of Trump’s picks. (Gabbard is a significant hazard, but she would not have a gigantic army at her disposal, and she would not be involved with the control of nuclear weapons.) Like the other three in this group, Hegseth is shockingly unqualified for the job he’s been asked to take, but in this case, the Senate is faced with a proposal to place a TV talking head at the top of the Pentagon and insert him into the nuclear chain of command.

Hegseth has made personal choices that make him unfit to lead the DOD, including his extramarital affairs (which apparently helped tank his chances to lead the Department of Veterans Affairs in Trump’s first administration) and a payoff to a woman who claimed that he’d sexually assaulted her. He denies the assault allegation, but in any case, adultery is a criminal violation of the Uniform Code of Military Justice and can be a career-ending mistake for a member of the armed forces.

I will leave aside whether Hegseth’s tattoos identify him as a white supremacist. Hegseth denies the claim. But some of Hegseth’s ink is popular with extremists; that’s why one of his own military comrades reported him as an insider threat in the first place—and not, as Hegseth and some whining conservatives claim, because he is being persecuted as a Christian. I knew many people in federal service with patriotic tattoos. (I have one myself, and no, it’s none of your business where it is.) I am also a Christian who wears a cross—one that I had blessed in a church—every day. That’s not what any of this is about.

Hegseth’s defenders seem unable to understand that neither Hegseth nor anyone else has a right to be the secretary of defense: If the nominee made choices earlier in life that would now undermine his effectiveness in the job, then that’s his problem, not the Pentagon’s. But even if Hegseth were not an example of a sexist, MAGA-bro culture—his statements about women in the military are particularly noxious—the Senate is still faced with the problem that he’s utterly unqualified.

A former Army major, he has no serious background in national-security or defense issues beyond his military service. (And how that service ended is apparently now a matter of some dispute.) He has not worked anywhere in the defense world: not in any of its agencies, not with any of its industries, not with any of its workforce in any capacity. He has never managed anything of any significant size.

Not only would he be incapable of administering America’s largest government department, but he’d also be in a position of terrifying responsibility for which he is unprepared. Imagine an international crisis, perhaps only a year or two from now. President Trump is facing a situation that could be rife with danger to the United States and our allies—perhaps even one that involves nuclear threats. At this dire moment, Trump turns to …

Pete Hegseth and Tulsi Gabbard?

The Senate must do everything in its constitutional power to stop this. Trump won the election, but no president has an absolute right to his Cabinet nominations: The Constitution requires the Senate to consent to those nominations. Trump has already warned that if the Senate balks, he will subvert this process by using “recess appointments,” in effect a demand that the Senate take a walk and let Trump do whatever he wants—to consent, in other words, to autocracy.

Incoming Majority Leader John Thune and others who still might care about their duty to the nation have time to go to Trump, right now, and tell him that these four nominations are DOA. They could tell Trump that it is in his own interest—the only interest he recognizes—not to risk multiple defeats. And if the Senate folds and decides to take these up one at a time, Trump will wear them down, likely accepting that Gaetz must be a Succession-style “blood sacrifice,” in return for which Trump gets everyone else. For Thune—who, one assumes, does not wish to begin his tenure as a statelier version of Senator Tommy Tuberville, the MAGA obstructionist who held up military promotions for months—accepting such a deal would be a huge strategic error.

Whomever Trump nominates as replacements will likely be dangerous in their own way. But these four nominees have to be stopped—and right now.

Related:

The thing that binds Gabbard, Gaetz, and Hegseth to Trump The perverse logic of Trump’s nomination circus

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He was the world’s longest-held death-row inmate. He was also innocent. How Trump could make Congress go away for a while Thomas Chatterton Williams: Is wokeness one big power grab? Europe braces for Trump.

Today’s News

President Joe Biden authorized Ukraine yesterday to use U.S.-supplied long-range missiles for strikes inside Russia, according to U.S. officials. Russia said today that the decision would escalate international tensions and add “fuel to the fire” of the war. Trump confirmed on Truth Social that his administration is planning to declare a national emergency and enlist the military to carry out a mass-deportation program targeting undocumented immigrants. Trump picked Brendan Carr, a member of the Federal Communications Commission and a Project 2025 contributor, to lead the FCC.

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Justin Chung for The Atlantic

How Jimmy O. Yang Became a Main Character

By Shirley Li

Jimmy O. Yang had been trying to make it as an actor for years—cobbling together bit parts in network sitcoms, auditioning for nameless roles such as “Chinese Teenager #1”—when he was cast in a new HBO series. The show, Silicon Valley, was a comedy about a group of programmers at a Bay Area start-up incubator; his character, Jian-Yang, was an app developer who spoke in broken English.

It was a small guest role, but he saw it as an opportunity.

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Examine. In a market with thousands of dog toys, Lamb Chop, the 1960s puppet, has somehow become ubiquitous.

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Stephanie Bai contributed to this newsletter.

When you buy a book using a link in this newsletter, we receive a commission. Thank you for supporting The Atlantic.

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.

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Among Donald Trump’s recent Cabinet nominations is a pick that has alarmed the scientific community: Robert F. Kennedy Jr. for secretary of Health and Human Services. With this choice, Trump has further elevated a conspiracy-minded vaccine skeptic with no medical background, whose views are often not rooted in science. I spoke with my colleague Yasmin Tayag, who covers health, about the damage RFK Jr.’s proposals could do to Americans’ trust in public health—whether he is confirmed or not.

The Elevation of Fringe Beliefs

Lora Kelley: As you’ve written, some of Robert F. Kennedy’s concerns—such as taking on ultra-processed foods and removing toxins from the environment—seem appealing to Americans across the political spectrum, yet his proposed solutions for these problems could pose a danger to Americans. Could you help me understand the gap between some of his seemingly commonsense proposals and the fringe ideologies behind them?

Yasmin Tayag: A lot of Kennedy’s health proposals actually make sense to me: investing in regenerative agriculture, and increasing access to preventive health care, and even removing toxins from the environment are things that sound good to pretty much anyone, regardless of their political party. Kennedy, of course, was until recently a Democrat, and a lot of his environmental and health concerns do reflect the things that the left has historically worried about.

The problem is that when you start looking at how he’s going to execute on these goals, you realize that his track record of proposing solutions is not based in science. We can all agree that it’s a good idea to take toxins out of the environment, but we might not all agree that fluoride is a toxin, as Kennedy seems to suggest. And so you have to ask: How is Kennedy going to make these decisions?

He’s a science skeptic, even though he claims to be a champion of science that lets people make their own decisions about their health. His view is that science as an institution has been so corrupted by corporate influence—he’s always railing against Big Pharma—that anything that comes out of the science institution that we’ve long relied on is bad.

Lora: Even if he doesn’t get confirmed, could Kennedy’s nomination still have an impact on Americans’ trust in public health?

Yasmin: Kennedy being so publicly considered for such a prominent health role has already given legitimacy to the fringe ideas that he’s entertained over the years. He’s said in the past that he believes 5G cellular technology controls our behavior, and he has implied that antidepressants are linked to mass shootings.

For a lot of the public, this might be their first time really having to think about health topics such as fluoridation. If this is not something you think about normally, and all of a sudden, here’s this guy all over the news, talking about his doubts about things that have long been accepted as scientific fact, I think it’s reasonable that people would also start feeling confused. The fact that he is in the public eye and getting a lot of airtime to discuss his skepticism is, at the very least, putting a spotlight on these fringe beliefs and, at worst, making them seem more legitimate than they are.

Lora: Given that bird flu may be a growing threat, how do you anticipate Kennedy might respond to a pandemic as the head of HHS?

Yasmin: It’s unlikely that we would see anything close to a streamlined public-health response, in part because Kennedy is so skeptical of vaccines. That could mean a hesitation to invest in the production of vaccines, or a lack of encouragement for Americans to use them. But I think the broader impact might be if he continues to legitimize the view that vaccines are something to be afraid of. People may refuse to take them.

During the height of the coronavirus pandemic, we had people who believed in science leading HHS, and the response was pretty mediocre: inconsistent communication, inadequate testing, little coordination between state and federal agencies. But at least the interventions made sense from a scientific perspective. With someone who does not believe in basic health principles, we may see an unpredictable response—or even no response.

Lora: What kind of power does this role actually come with?

Yasmin: If Kennedy becomes secretary of HHS, he’s going to have an enormous influence on American public health—he would oversee the Food and Drug Administration, the Centers for Disease Control, the National Institutes of Health, Medicare and Medicaid, and the Administration for Children and Families, among others. And on top of overseeing all of those departments, he would also be the primary adviser to the president on health. So he would be the one telling Donald Trump what health priorities should be. That’s a really scary prospect, because a lot of Kennedy’s perspective on the world doesn’t seem to be rooted in any kind of scientific reality, at least not a mainstream one. He wouldn’t always be able to implement his ideas directly—removing fluoride from water, for example, can happen only at the state and local level—but his endorsement alone could go a long way.

His appointment, though he still needs to be confirmed, seems plausible to me. Kennedy’s audience is a big one—MAGA meets woo-woo, as our colleague Elaine Godfrey has called it—that could further expand support for Trump. But there are still a number of Republican senators he’ll have to win over. Some might take issue with his views on health. Others may feel threatened by his plans to remove corporate influence from the government—Big Pharma, for example, has long provided campaign money to both parties. Kennedy’s plans to overhaul food and pharmaceuticals would also require a ton of regulation, which is exactly what Republicans don’t want. The biggest pitfall for Kennedy would be if his goals run up against Trump’s economic priorities. He was an environmental lawyer, so he’s very anti-oil, whereas Trump is deeply pro-oil. In his past speeches, Trump has said that Kennedy can do whatever he wants, as long as he doesn’t “touch the oil.” I could see Trump or others in the party pushing back on him for that reason.

Related:

RFK Jr. collects his reward. The sanewashing of RFK Jr.

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The Onion’s most trenchant headline Israel is fighting a different war now. Get ready for higher food prices. Amazon Haul is an omen.

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Speaker Mike Johnson reportedly urged the House Ethics Committee to not publicly release its probe into former Representative Matt Gaetz’s alleged sexual misconduct and illicit drug use. Russian President Vladimir Putin and German Chancellor Olaf Scholz had a call about the future of the Ukraine war. It was their first conversation since late 2022. Trump selected North Dakota Governor Doug Burgum to be the Interior Department secretary last night; if confirmed by the Senate, Burgum would oversee the country’s public lands.

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Illustration by Diego Mallo. Source: Mark Peterson / Redux.

The Man Who Will Do Anything for Trump

By Elaina Plott Calabro

Kash Patel was dangerous. On this both Trump appointees and career officials could agree.

A 40-year-old lawyer with little government experience, he joined the administration in 2019 and rose rapidly. Each new title set off new alarms.

When Patel was installed as chief of staff to the acting secretary of defense just after the 2020 election, Mark Milley, the chairman of the Joint Chiefs of Staff, advised him not to break the law in order to keep President Donald Trump in power. “Life looks really shitty from behind bars,” Milley reportedly told Patel. (Patel denies this.)

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A month after his election in 2016, Donald Trump chose Andrew Puzder, a longtime fast-food-company CEO, to be his secretary of labor. Most of Trump’s Cabinet picks moved smoothly through the confirmation process, but Puzder’s nomination languished amid allegations of wage theft, sexual harassment, and spousal abuse, as well as his acknowledgment that he had hired an undocumented immigrant as a nanny and not paid her taxes. By February 2017, he gave up and withdrew his nomination.

Being a president’s most troubled or scandal-ridden nominee is dangerous—like being the weakest or sickest member of the herd when predators start to circle. Republican senators probably calculated that if they rejected Puzder, Trump would send a pick with less baggage and higher qualifications, which is exactly what he did: Alex Acosta, the eventual selection, had a long government résumé and easily won confirmation.

Something very different is happening with Trump’s Cabinet picks this time. Less than two weeks have passed since the election, but the president-elect has already put forward a batch of nominees so aberrant by historical standards that any one of them would have been a gigantic story in the past. (Hello, Attorney General–designate Matt Gaetz.) Each one barely holds the media’s attention for an hour or two before the next nomination eclipses them. (Whoops, I didn’t see you there, Robert F. Kennedy Jr., nominee to lead the Department of Health and Human Services.)

If Senate Republicans reject one of these unqualified nominees, how can they justify saying yes to any? And yet, how could they reject the whole slate of nominees by a president from their own party, who is so popular among their own voters? Perversely, the sheer quantity of individually troubling nominees might actually make it harder for the Senate to block any of them.

[Elaine Godfrey: Either way, Matt Gaetz wins]

The list of wild picks also includes Tulsi Gabbard, the walking embodiment of horseshoe theory and Trump’s nominee to be director of national intelligence; Pete Hegseth, a square-jawed Fox News host tapped by Trump to lead the Pentagon; and Kristi Noem, a governor with no national-security experience, selected to head the Department of Homeland Security. By the time anyone gets around to noting that Trump is appointing his personal lawyers (who defended him in his several criminal trials) to top legal posts in the government, who will have the energy to be shocked?

We don’t know yet if the Senate will confirm any or all of these nominees, but weariness is apparent in the voices of Republican senators, who face a choice between approving Trump’s nominees and allowing Trump to use a dubious constitutional work-around to appoint them without requiring a Senate vote. Many have gasped or raised pained questions about Gaetz, and some have even predicted that his nomination will fail, but none has publicly pledged to vote against him.

Senator Bill Cassidy of Louisiana is a medical doctor who has shown a willingness to buck Trump and even voted to convict him during Trump’s second impeachment; he’s the incoming chair of the Health, Education, Labor, and Pensions Committee. Yet Cassidy responded to the preposterous HHS nomination by posting on X that Kennedy “has championed issues like healthy foods and the need for greater transparency in our public health infrastructure. I look forward to learning more about his other policy positions and how they will support a conservative, pro-American agenda.”

This isn’t how things used to work. In 1989, President George H. W. Bush nominated former Senator John Tower to be secretary of defense. Few could question Tower’s credentials. A World War II veteran, he’d served nearly 20 years on the Armed Services Committee; he later investigated the Iran-Contra affair. But allegations of womanizing and alcohol abuse led the Senate to reject his nomination, even though the body tends to give former and current members an easy ride. Hegseth, by comparison, is a veteran but has no government experience, has a history of infidelity and was in 2017 accused of sexual assault, and has expressed various extreme views, including lobbying Trump to pardon American soldiers accused of murdering prisoners and unarmed civilians. (Trump granted the pardons.)

Or consider Tom Daschle, the former Senate majority leader, whom President Barack Obama nominated to lead HHS in 2009. Daschle was forced to withdraw his nomination over $140,000 in unpaid back taxes. That was a serious lapse, yet it feels quaint compared to Kennedy’s or Gaetz’s dubious résumé.

[Franklin Foer: Why the Gaetz announcement is already destroying the government]

A clear sign of how much things have changed may come from Puzder, whom Trump is reportedly considering nominating as labor secretary again. If Senate Republicans are willing to approve the same guy they rejected eight years ago, the advice-and-consent guardrails will be well and truly gone.

The circuslike bombardment of freakishly unqualified personnel picks calls to mind Steve Bannon’s notorious insight that the press can handle only so much information, real or fake, without being overloaded. Uncovering, verifying, debunking, and explaining information takes time and resources. “The real opposition is the media,” Bannon told the journalist Michael Lewis in 2018. “And the way to deal with them is to flood the zone with shit.” Something similar might apply to U.S. senators who might otherwise be tempted to show some independence.

Ascribing too much strategic intent to Trump is always a risk. The president-elect works from impulse and intuition. Trump selected Gaetz on a whim during a two-hour flight, according to The New York Times; Politico has reported that Susie Wiles, Trump’s campaign manager and incoming chief of staff, was on the plane but was unaware of the Gaetz pick. Even if Trump is not consciously following Bannon’s directive, however, the effect is the same. Intentionally or otherwise, the shit level is high and rising.