President-elect Donald Trump’s pick to oversee the Centers for Medicare and Medicaid Services (CMS) has reported owning as much as $600,000 in stock from companies benefiting from private Medicare services.

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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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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.)

Read the full article.

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Stephanie Bai contributed to this newsletter.

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Ironically, it may have been Donald Trump’s discipline that won him a return trip to the White House.

The former and future president is infamous for his erratic approach to politics, which was on flagrant display in the past couple of weeks of the campaign. But Trump consistently offered a clear message that spoke to Americans’ frustration about the economy and the state of the country, and promised to fix it.

Throughout the campaign, Trump told voters that President Joe Biden, Vice President Kamala Harris, and undocumented immigrants were responsible for inflation, and that he would fix the problem. His proposals were often incoherent and nonsensical. For example, Trump promised to both whip inflation and also institute enormous tariffs, a combination nearly all economists agree is impossible. The mass deportation that Trump has promised would also likely drive up prices, rather than soothing the economy. But in a country where roughly three-quarters of Americans feel that things are on the wrong track, a pledge to fix things was potent.

[David Frum: Trump won. Now what?]

Trump may be the most negative mainstream candidate in American history. Observers including my colleague Peter Wehner have noted the contrast between Trump’s disposition and Ronald Reagan’s sunny optimism. But in a strange way, Trump does offer a kind of hope. It is not a hope for women with complicated pregnancies or LGBTQ people or immigrants, even legal ones. But for those who fit under Stephen Miller’s rubric that “America is for Americans and Americans only,” Trump promised a way out.

“We’re going to help our country heal,” Trump said in remarks early this morning. “We’re going to help our country heal. We have a country that needs help, and it needs help very badly. We’re going to fix our borders, we’re going to fix everything about our country, and we’ve made history for a reason tonight, and the reason is going to be just that.”

You can contrast that with the message coming from Kamala Harris and the Democratic Party, which was more outwardly hopeful but suffered from a serious, perhaps unfixable, flaw.

[Read: The night they hadn’t prepared for]

Harris won praise for her positive campaign message, especially in the immediate weeks after Joe Biden dropped out of the race and she became the nominee. Biden had spent months warning darkly about Trump’s threat to democracy, but Harris offered something more forward-looking—explicitly. “We’re not going back,” she told voters.

Harris promised to protect things like Social Security and Medicare, and warned that Trump would ruin everything that was great about America. This was a fundamentally conservative answer, coming from a Democratic Party that, as I wrote last year, has become strikingly conservative, but it came at a time when too many voters were disgusted with the status quo.

Democrats may have been slow to take seriously the economic pain of inflation. In its first two years, the Biden administration was single-mindedly focused on revving and restructuring the economy after COVID, and treated inflation more as a transitory annoyance than a long-term danger. But also, it seems to have concluded that it lacked a good answer to inflation. The administration argued with frustration that inflation was a worldwide trend, caused by COVID, and pointed out that inflation in the U.S. had dropped faster than in peer countries, and that the American economy was running better than any other. All of this was true and also politically unhelpful. You can’t argue people into feeling better with statistics.

[David A. Graham: The Democrats are now America’s conservative party]

In theory, the mid-summer switch from Harris to Biden gave Democrats a chance to reset. But Harris struggled to create distance from Biden. When she was offered chances to do so, she demurred. In early October, the hosts of The View asked her what she’d have done differently from the president, and she replied, “There is not a thing that comes to mind in terms of—and I’ve been a part of most of the decisions that have had impact, the work that we have done.” Republicans were delighted and made that a staple of attack ads and stump speeches.

Whether this was out of loyalty to her boss or some other impulse, it’s not clear that Harris would have been able to pull off a more radical switch. She was still the Democratic nominee, and voters around the world have punished incumbent parties in recent elections. Her coalition meant she couldn’t run an aggressively protectionist or anti-immigrant campaign, even if she had been so inclined. Her strategic decision to court centrist and Republican voters closed off moving very far to the left on economics, though past campaigns do not offer clear evidence that would have been a winner either. Besides, Democrats had a good empirical case that what they had done to steward the economy was very successful. They just had no political case.

In a bitter turn for Democrats, Trump will now benefit from their governing successes. If he truly attempts to, or succeeds at, speedily deporting millions of people or instituting 60 percent tariffs, he will drive inflation higher and wreck the progress of Biden’s term, but Trump’s own political instincts and the influence of many very wealthy people around him may temper that. Having clearly promised to fix the problem and vanquished his enemies, he’ll now be able to declare a swift victory.

In a recent interview, the former Republican presidential candidate Vivek Ramaswamy made an offhanded comment that connected a few dots for me. Ramaswamy was talking with Ezra Klein about the potential for tens of thousands of government workers to lose their job should Donald Trump be reelected. This would be a healthy development, he argued. It could happen, he said, by reinstituting the Trump executive order Schedule F—which stripped certain civil servants of their job protections, allowing them to be fired more easily—and installing a government-efficiency commission to be led by Elon Musk. Ramaswamy said Trump should get rid of 75 percent of federal-government employees “on day one.” Up for debate, he argued, is whether some of those people would eventually be rehired. “That’s not the character of, certainly, what Elon did at Twitter, and I don’t think it’s going to be the character of what the most important part of that project actually looks like, which is shaving down and thinning down the bureaucracy.”

Ramaswamy’s invocation of Twitter is meaningful. In 2022, after acquiring the social network, Musk infamously purged Twitter’s ranks and fired 80 percent of its employees in the first six months, and then made a series of management decisions that ultimately threw the company into further financial disarray. Listening to Ramaswamy speak and hearing the respect in his voice as he cited the centibillionaire’s tenure, it became clear that he sees a blueprint for the Trump administration. Should Musk be appointed as a federal firing czar, it will likely not be because of his electric cars or rockets or internet-beaming satellites: It will be because he acted out the dream of draining the swamp, albeit on a smaller scale. Musk’s purchase of Twitter is not just a Republican success story; it is the template for the MAGA federal government. Even Musk’s mom said as much in a recent interview with Fox News: “He’s going to just get rid of people who are not working, or don’t have a job, or not doing a job well, just like he did on Twitter … He can do it for the government, too.”

Musk’s argument for gutting Twitter was that the company was so overstaffed that it was running out of money and had only “four months to live.” Musk cut so close to the bone that there were genuine concerns among employees I spoke with at the time that the site might crash during big news events, or fall into a state of disrepair. “I am fully convinced that if Musk does what he is saying he will do, it will be an absolute shitshow,” a trust-and-safety engineer at a different tech company told me in 2022. Musk did fire most of the trust-and-safety employees, as well as those in charge of curation and “human rights,” and the Machine Learning Ethics, Transparency, and Accountability team. The purge of these people in particular delighted some right-wing commentators, who saw Musk’s dismissals as a long-overdue excision of the woke bureaucracy inside the company. “Nothing of value was lost,” one MAGA account tweeted at the news of the firings.

[Read: I watched Elon Musk kill Twitter’s culture from the inside]

Twitter did not self-destruct as my sources feared it would (though parts of it have, perhaps most memorably when Musk tried to host Spaces events with Trump and with Florida Governor Ron DeSantis, only for them to glitch out). Small-scale disruptions aside, the site has mostly functioned during elections, World Cups, Super Bowls, and world-historic news events. But Musk’s cuts have not spared the platform from deep financial hardship. His chaotic managerial strategy for Twitter has been to rebrand the site as X, alienate many of its most important advertisers, institute a dubious paid subscription program, and dabble in AI features in the hopes of someday turning the platform into an “everything app.” The end result has been calamitous for the company’s bottom line. Soon after taking over, ad revenues plummeted 40 percent, and the bleeding hasn’t stopped. According to estimates, last year, X lost about 52 percent of its U.S. advertising revenue. A recent Fidelity report suggested that the company may have lost nearly 80 percent of its value since Musk bought it (for arguably way more than it was worth). If this keeps up, some have speculated that Musk may have to sell some of his Tesla stock to keep the company afloat. Musk’s financiers have also been left with massive loans on their balance sheets in what The Wall Street Journal has called “the worst buyout for banks since the financial crisis.”

Trump and Ramaswamy don’t seem to care about any of this. What matters is that Musk has turned X into a political weapon in service of the MAGA movement. X, as I wrote last week, has become a formidable vector for amplifying far-right accounts and talking points; it is poisoning the information environment with unverified rumors and conspiracy theories about election fraud. The far-right faithful do not care that his platform has occasionally labeled pro–Kamala Harris accounts as spam, temporarily banned journalists, restricted accounts that have tweeted the word cisgender, and complied with foreign-government requests to censor speech. Nor do Republican lawmakers seem to care that Musk is wielding his platform to get Trump elected, even after they spent the better part of a decade outraged that tech platforms were supposedly biased against conservatives. Their silence on Musk’s clear bias coupled with their admiration for his activism suggest that what they really value is the way that Musk was able to seize a popular communication platform and turn it into something that they can control and wield against their political enemies.

This idea is not dissimilar from the vision articulated by the Heritage Foundation’s Project 2025, the conservative policy proposal to reshape the federal government in a second Trump administration. Project 2025 is a dense, often radical, and unpopular set of policy proposals that, as my colleague David A. Graham notes, “would dissolve the Education Department and the National Oceanic and Atmospheric Administration, slash Medicare and Medicaid, ban pornography, establish federal abortion restrictions, repeal some child-labor protections, and enable the president to lay off tens of thousands of federal career workers and replace them with political appointees.” Put another way: If Trump were elected and decided to make Project 2025 a reality, his administration would take an existing piece of bureaucratic infrastructure, strip it of many of those who can check its power, and then wield that power to ideological ends and against their political enemies.

The parallels between this element of Project 2025 and Musk’s Twitter are stark. They should also be alarming. The federal government is not a software company, nor should it be run like one. Perhaps there is bloat in our departments and agencies, but civil servants labor over daily technical problems that are crucial to a functioning country—such as census taking, storm tracking, and preparing for pandemics. To simply cut these people with abandon (and replace others with political appointees) could have severe consequences, such as stifling disaster response and increasing the likelihood of corruption.

Consider also the financial dynamic. Last week in a virtual town hall, Musk said that the Trump administration’s second-term agenda—which includes tax cuts, slashing the federal budget, and tariffs on imports, “necessarily involves some temporary hardship,” but would ultimately result in longer-term prosperity. “We have to reduce spending to live within our means,” Musk added. The line is similar to his justification for the layoffs at Twitter, which at the time he called “painful” and necessary so that Twitter could balance its budget. But Musk bought the platform with no idea of how to turn it into a profitable business. His primary interest seems to be prioritizing shitposting and trolling rather than finding advertisers or making good on his ideas to turn X into a WeChat-style commercial app. Musk has never appeared interested in understanding the mechanics of a social network or the complexities of content moderation or even the specifics of the First Amendment. His incuriousness about the thing he ended up in charge of has been exceeded only by his desire to use it as a personal playground and political weapon.

Before Musk officially took over Twitter, the tech oligarch at least feigned an interest in running the company with an eye toward actual governance. “For Twitter to deserve public trust, it must be politically neutral, which effectively means upsetting the far right and the far left equally,” he tweeted in 2022. Trump, however, has made no effort to disguise the vindictive goals of his next administration and how he plans, in the words of the New York Times columnist Jamelle Bouie, to “merge the office of the presidency with himself” and “rebuild it as an instrument of his will, wielded for his friends and against his enemies.” In other words, he plans to run the Elon Musk Twitter playbook on the entire country.