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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:

Trump is coming for Obamacare again. (From January) Why is Dr. Oz so bad at Twitter? (From 2022)

Here are three new stories from The Atlantic:

Another theory of the Trump movement What the men of the internet are trying to prove Arash Azizi: The problem with boycotting Israel

Today’s News

Republican members of the House Ethics Committee blocked the release of the investigation into the sexual-misconduct and drug-use allegations against former Representative Matt Gaetz. Jose Ibarra, who was found guilty of killing Laken Riley on the University of Georgia campus, was sentenced to life in prison without possibility of parole. Trump tapped former WWE CEO Linda McMahon, who previously led the U.S. Small Business Administration during Trump’s first term, to be the secretary of education.

Dispatches

The Weekly Planet: Drought is an immigration issue, and Trump’s climate policies are designed to ignore that, Zoë Schlanger writes.

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Evening Read

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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By electing Donald Trump again, the American electorate has made a bad decision, one that will expose our country to unreasonable risks in areas from foreign policy to public health. Fiscal policy will get worse—budget deficits will become even larger, keeping interest rates high, and programs that provide health care to the poor and elderly are likely to be trimmed back to finance tax cuts for rich people. Abortion rights are likely to be further restricted by a hostile administration that uses the powers of the FDA and the Department of Justice to make abortion harder to provide. And we’ll have another four years under Trump’s exhausting, mercurial, and divisive leadership, making our politics nastier and stupider.

I wish the election had gone the other way. I am annoyed. That said, when Trump won eight years ago, I was much more than annoyed. I was really upset and shocked. This time is different, because Americans have been through this before, and I expect we’ll get through it again. But it’s also different because there’s a big part of me that feels Democrats deserved to lose this election, even if Trump did not deserve to win it.

I write this from New York City, where we are governed by Democrats and we pay the highest taxes in the country, which doesn’t mean we receive the best government services. Our transportation agencies are black holes for money, unable to deliver on their capital plans despite repeated increases in the dedicated taxes that fund them, because building a subway line here costs four times as much per mile as it does in France, and because union rules force the agency to overstaff itself, inflating operating costs. Half of bus riders don’t pay the fare, and MTA employees don’t try to make them. Emotionally disturbed homeless people camp out on the transit system—the other day, I was on a bus where one shouted repeatedly at another passenger that he was a “faggot.” And even though police are all over the place (at great taxpayer expense), they don’t do much about these disturbances, and I can’t entirely blame them since our government lacks the legal authority to keep troubled people either in jail or in treatment. The city cannot stop people from shoplifting, so most of the merchandise at pharmacies is in locked cabinets. A judge recently said the city can’t even padlock the illegal cannabis stores that have popped up all over the place—that’s apparently unconstitutional, and so years into what was supposed to be the “wokest” legal cannabis regime in the country, our government still can’t figure out how to make sure that people who sell weed have a license to do so, even though they’ve done that with regard to alcohol forever.

[Read: The ‘stop the steal’ movement isn’t letting up]

Ever since the COVID shutdowns, Democrats here have stopped talking very much about the importance of investing in public education, but the schools remain really expensive for taxpayers even as families move away, enrollment declines, and chronic absenteeism remains elevated. Currently, we are under a state-court order to spend billions of our dollars to house migrants in Midtown hotels that once housed tourists and business travelers. Housing costs are insane because the city makes building anything very hard—and visiting here is really expensive, too, partly because so many hotels are now full of migrants, and partly because the city council made building new hotels functionally illegal. And as a result of all of this, New York is shedding population—the state will probably lose three more congressional districts in the next reapportionment. And where are people moving to? To Sun Belt states, mostly run by Republicans, where building housing and growing the economy is still possible.

Meanwhile, the voters of New York have just adopted an equal-rights amendment to the state constitution, which was put on the ballot by the Democrat-controlled state legislature. One effect of this amendment is to create a state constitutional right to abortion. Of course, abortion was already legal in New York, and a state constitutional provision will not override any new federal laws or regulations that Republicans might impose with their new control in Washington. This is exactly the sort of brain-dead symbolism that exemplifies the Democrats who rule our state: They pat themselves on the back for a formalistic, legal declaration of the rights of the people who live here, and meanwhile, people of all races and identities flee New York for other, officially less “inclusive” places where they can actually afford a decent quality of life.

I am unfortunately a Democrat, but as someone who lives in a place that is governed very badly by Democrats, I can easily understand why “Can you imagine what incompetent, lunatic shit those people will do if they get control of the government?” would fall flat as an argument against Republicans. It doesn’t surprise me that the very largest swings away from Democrats in this post-COVID, post–George Floyd, post-inflation election occurred in blue states. The gap between Democrats’ promise of better living through better government and their failure to actually deliver better government has been a national political problem. So when Republicans made a pitch to change all this (or even burn it all down), it didn’t fall flat.

Right before Election Day, Ross Douthat wrote a column for The New York Times that left me quite uneasy. It was about the campaign signs he was seeing all over New Haven that read Harris-Walz 2024: Obviously. Douthat started with a point that’s almost tautological: Because the election appeared close, by definition neither candidate was the obvious choice. And he looked at why the decision would not be obvious to so many voters, writing:

Let’s take one last survey of why some waverers might not yet be sold on Kamala Harris and Tim Walz, by returning to where this all began: The world of 2016, when Americans normally disinclined to vote for liberals were first informed that there was no other reasonable choice … the promise was that even if you disagreed with liberalism’s elites on policy, you could trust them in three crucial ways: They would avoid insanity, they would maintain stability, and they would display far greater intelligence and competence than Trump and his hangers-on.

Many voters believe these promises were broken. Of course, the most politically significant aspect of the instability has been post-COVID inflation—a global problem that has taken out incumbent governments of the right and left all over the world. Inflation is mostly not Democrats’ fault, though they did exacerbate it by overstimulating the economy with the American Rescue Plan, and then they failed to focus early enough on inflation as the key economic problem of this administration.

To be precise, the ARP, passed in early 2021, constituted an unnecessary $2 trillion stimulus that mostly produced inflation rather than real GDP growth. Then, throughout 2022, even as inflation started to bite, Democrats were still looking for every way they could find to spend as much money as possible to satisfy interest-group constituencies. Even the so-called Inflation Reduction Act, which was supposed to reduce inflation by reducing the deficit, is currently increasing the deficit by tens of billions of dollars a year and, if left unchanged, will continue to do so through 2027. The deficit reduction does not begin until 2028, far too late to be politically relevant for Joe Biden’s Democrats.

The other big destabilizer is the migrant crisis, which was born out of this administration’s fecklessness—Biden rapidly reversing Trump’s immigration executive orders upon entering office without any plan for controlling the border and apparently without realizing that migrants are smart, and will be more likely to come if you make clear that coming very likely means they will get to stay. (A failure to consider incentives is a running theme when Democrats fail.) Democrats did not pivot to enforcement until far too late—and not until after Texas Governor Greg Abbott made the crisis a blue-state issue by bussing migrants here en masse to fill Democrats’ hotels and consume Democratic budgets.

On the “insanity” front, Douthat cites the political movement in the aftermath of George Floyd’s murder, responses to COVID, and trans-youth medicine—all areas where liberals’ moral fervor has caused them to lose sight of whether the ideologically driven courses they had taken were actually producing the intended positive effects. Democrats know they paid a price for “Defund the police” and they have mostly learned their lesson, or at least they will now, because several high-profile “progressive” prosecutors lost their blue-city posts this week. On the COVID restrictions, Democrats have not really reckoned with how off-putting a lot of the busybody moralizing was, but this issue will likely simply fade with time.

As for trans issues, I have been skeptical about their political salience—although I don’t believe that Lia Thomas belonged on the Penn women’s swim team, I also can’t imagine casting a vote based on my views about that story. But Kamala Harris’s 2019 declaration to the ACLU that she would have the government pay for gender-affirming surgeries for prisoners and people held in immigration detention became a major attack line against her in this campaign. That’s because it highlights several problems with the party’s image all at once: Here was the Democratic nominee, bowing to pressure from interest groups to look for ways to spend your tax dollars on the most bespoke concern of a criminal, or of a noncitizen who isn’t even supposed to be here, before thinking about you and your interests. But the truly grim irony about the political cost of this promise is that, of course, the federal government that only got seven electric-vehicle-charging stations built in two years has performed zero transgender surgeries on detained migrants. That’s the Democrats in a nutshell: the party that promises trans surgeries for undocumented immigrants but doesn’t deliver them.

[Thomas Chatterton Williams: What the left keeps getting wrong]

And all of this is why I think Democrats’ approach to the cost-of-living issues that have dominated this campaign has fallen so flat. The Democratic argument is, more or less, “look at all my programs”—all of the things I’m going to have the government do to make life easier for you. In some cases, they have a clear track record to run on: The Affordable Care Act has gotten more popular over time, and the expanded subsidies that reduce the premiums most Americans pay to buy individual plans on the exchanges have increased enrollment. But mostly, I think Americans look around at how it goes when the government actually tries to help, and they have a healthy skepticism about how helpful the government is really going to be, and about whether the benefits are really going to flow to them. Democrats are making too many promises; they have tried to do a zillion different things and done them badly at great expense, as was the approach with the moribund Build Back Better Act. They instead need to pick a few things for the government to do really well, with a focus on benefits to the broad public rather than to the people being paid to provide the services.

Although I think Harris should have picked Pennsylvania Governor Josh Shapiro as her running mate, I don’t think choosing him would have changed the outcome. But Shapiro is a popular swing-state governor who will be a front-runner for the 2028 nomination. And Shapiro’s signature policy achievement is rebuilding a highway underpass. There is a lesson here: When government focuses on its core responsibilities and delivers on them quickly, efficiently, and with a laser focus on making sure people can go about their lives as normal, the voters reward that. You don’t need a grand vision; you need to execute.

Winning the next federal election is important. For that reason, it is important that Democrats get the voters to believe they deserve to win that election. They have two years to work on it before the midterms.

This article was adapted from a post on Josh Barro’s Substack, Very Serious.