Shortly after midnight, a few hours after the horrifying collision between an airplane and a helicopter at Reagan National Airport, President Donald Trump felt the time was right for a shocked nation to hear his insights into the tragedy. “It is a CLEAR NIGHT, the lights on the plane were blazing, why didn’t the helicopter go up or down, or turn,” he wrote on Truth Social. “Why didn’t the control tower tell the helicopter what to do instead of asking if they saw the plane. This is a bad situation that looks like it should have been prevented. NOT GOOD!!!”

While you might question the sophistication of his analysis, Trump was correct about both the physics of the collision (namely, that it could have been avoided if the helicopter had gone either up or down) and the moral valence of the mass casualty event (bad, not good).

But, by midday today, without the benefit of any important conclusions about the cause of the crash, Trump adopted a different perspective. “We do not know what led to this crash, but we have some very strong opinions and ideas,” he told reporters in a rambling press conference. His strong opinion was that the cause was a “diversity push” in the Federal Aviation Administration’s hiring process.

Lest that comment be dismissed as the half-formed musings of a president reacting in real time to a developing event, a few hours later Trump doubled down. In a live broadcast from the Oval Office, he signed an executive order that, in the words of an off-camera Vice President J. D. Vance, pinned responsibility for the crash on “the Biden administration’s DEI and woke policies.”

The purpose of Trump’s wild finger-pointing appears to be twofold: first, to avoid taking any blame for a disaster; and second, to exploit the tragedy while it is in the public’s mind, using it to advance the notion that his administration is replacing favoritism toward minorities with pure, race-blind merit. “As you said in your inaugural, it is color-blind and merit-based,” said Defense Secretary Pete Hegseth, joining Trump at the press conference. “The era of DEI is gone at the Defense Department, and we need the best and brightest, whether it’s in our air-traffic control or whether it’s in our generals or whether it’s throughout government.”

This was rich coming from a man who might be the least qualified secretary of defense in American history—a Cabinet official whose professional qualifications include mismanaging two small lobbying organizations and whose alleged history of drinking and mistreatment of women led his own sister-in-law to urge the Senate to reject his nomination, as it very nearly did.

[Jonathan Chait: Donald Trump’s most dangerous Cabinet pick]

And Hegseth is hardly an outlier. Trump has already done more to abandon the ideal of meritocracy than perhaps any presidential administration since the Progressive Era. He is going to war against the civil-service system, which was established more than a century ago to ensure that federal jobs go to qualified civil servants, rather than as rewards for party hacks, as had been the case previously. Trump, who believes that nonpartisan civil servants constitute a “deep state” conspiracy against him, would rather lose their expertise than risk it being deployed in ways that thwart his personal ambitions.

He has gone even further in this direction in selecting his Cabinet. Every president tends to fill such roles with supporters, but Trump has elevated loyalty to an almost comical degree. Not only must Trump’s Cabinet officials have supported him in the election, but they must endorse, or at least refuse to contradict, his infamously false claim to have won the 2020 election. The driving logic behind many of his most high-profile Cabinet picks appears to be a desire to find individuals who will stand behind the president if and when he violates norms, laws, or basic decency.

That is how Hegseth, despite his miserable record of management experience, was elevated to run the Pentagon. It is how Kash Patel, the author of a ridiculous children’s book portraying himself as a wizard and Trump as a king, was nominated to run the FBI. And it is how Robert F. Kennedy Jr., who has waged a pseudoscientific war against vaccines and appears to not know basic facts about Medicare and Medicaid, was tapped to run the federal department that oversees those programs.

One problem with discussing Trump’s opinions on fast-moving matters like the plane crash is that, in the absence of a completed investigation, it’s impossible to say for sure what did cause the disaster. Investigators haven’t even determined which errors were made, let alone why they occurred. It is possible that the entire fault rests with the helicopter pilot, as Trump himself suggested the night of the crash.

It’s true that the federal civil service has many problems, not least the extreme bureaucratic hurdles that stand in the way of both hiring qualified candidates and firing low-performing employees. It’s true, too, that the FAA has been sued over a clumsy program to boost minority representation. That effort arose out of an understandable desire to broaden the overwhelmingly white hiring pipeline for air-traffic controllers, but is alleged to have included perverse hiring criteria that unfairly filtered out qualified applicants.

There is no evidence yet that the FAA, let alone its hiring practices, had any responsibility for the crash. But to the extent that Trump thinks the underlying issue is an insufficient focus on merit, his moves to purge the government of non-Trumpist civil servants is all but guaranteed to make the problem worse. When you are not only selecting for loyalty, but defining that loyalty to mean “affirming morally odious values and factually absurd premises,” you are reducing your hiring pool to the shallowest part.

[David A. Graham: Blind partisanship does not actually help Trump]

And to be sure, when loyalty itself is the job requirement, this makes a certain kind of sense. La Cosa Nostra does not recruit its members very widely, because, as with Trump, its fear of betrayal outweighs its interest in hiring and promoting the most skilled racketeers and leg-breakers. When you are trying to run a government along Mafia hiring and promotion principles, you are necessarily forfeiting expertise and intelligence.

If Trump has his way, over the next four years, the political composition of the people engaged in directing air traffic, testing food for safety, preventing terrorism, and other vital public functions will change dramatically. The ones who have a serious problem with January 6 will be gone, replaced by people who are willing to repeat Trump’s lies—if they are replaced at all. You can justify that process as the president’s prerogative to shape the executive branch. What you can’t call it is an elevation of merit.

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Americans keeping close track of political news may have been toggling their screens today between Senate confirmation hearings: the second day of Robert F. Kennedy Jr.’s for secretary of Health and Human Services, and the first for Tulsi Gabbard’s for director of national intelligence and Kash Patel’s for FBI director. But each of those three hearings deserves the public’s full attention: Donald Trump’s nominees offered new glimpses into their approaches to policy, truth, and loyalty to the president.

Robert F. Kennedy Jr., Day Two

Ahead of Kennedy’s first day of hearings, our colleague Nicholas Florko noted that the HHS nominee is no stranger to conspiracist statements: “RFK Jr. has insinuated that an attempt to assassinate members of Congress via anthrax-laced mail in 2001 may have been a ‘false flag’ attack orchestrated by ‘someone in our government’ to gin up interest in the government preparing for potential biological weapon threats. He has claimed that COVID was ‘targeted to attack Caucasians and Black people,’ and that 5G is being used to ‘harvest our data and control our behavior.’ He has suggested that the use of antidepressants might be linked to mass shootings.”

“If Republican senators skirt around [Kennedy’s] falsehoods during today’s confirmation hearings,” Nicholas wrote, “it will be evidence of their prevailing capitulation to Trump. And it also may be a function of Kennedy’s rhetorical sleights … He’s capable of rattling off vaccine studies with the fluency of a virologist, which boosts his credibility, even though he’s freely misrepresenting reality.” But Kennedy’s sleights didn’t serve him quite as well today as he might have hoped.

At several points, senators encouraged Kennedy to acknowledge that vaccines are not the cause of autism, but instead of confirming what numerous studies have shown to be true, Kennedy insisted that he would need to “look at all the data” before coming to any conclusions. “The room went silent today during Senator [Bill] Cassidy’s closing questions,” Nicholas noted when we spoke this afternoon. “Cassidy was practically begging Kennedy to recant his previous statements on vaccines. Kennedy, like everyone else in the room, had to know this was a make-or-break moment for his confirmation. But despite the potential fallout, Kennedy refused, promising only that he would look at any studies presented to him disproving a link between vaccines and autism.”

The nominee for HHS secretary also showed, for the second day in a row, his lack of understanding about basics of the Medicare system, fumbling his answers to a series of rapid-fire questions from Senator Maggie Hassan, a Democrat from New Hampshire. Hassan also shared that she is the mother of a 36-year-old with cerebral palsy, and accused Kennedy of relitigating settled science on the fact that vaccines do not cause autism. “It’s the relitigating and rehashing and continuing to sow doubt so we can’t move forward, and it freezes us in place,” she argued.

Cassidy, whose vote could prove key to whether RFK Jr. is confirmed, said after today’s hearing that he is “struggling” over whether to confirm Kennedy.

Tulsi Gabbard

Gabbard came into her confirmation process with a history that raises questions about her commitment to national security (she has, among other things, met with former Syrian President Bashar al-Assad and expressed sympathetic views toward Russian President Vladimir Putin). As our colleague Tom Nichols wrote in November, “Gabbard has every right to her personal views, however inscrutable they may be. As a private citizen, she can apologize for Assad and Putin to her heart’s content. But as a security risk, Gabbard is a walking Christmas tree of warning lights. If she is nominated to be America’s top intelligence officer, that’s everyone’s business.”

The topic that ultimately received much attention in her confirmation hearing today was her refusal to say whether Edward Snowden is a traitor. Despite pressure from Democratic and Republican senators, Gabbard refused to answer the question, repeating that Snowden had broken the law and that she would take steps to make sure whistleblowers know how to properly make a complaint. Gabbard also revealed that she was unable to extract any concessions in her 2017 meeting with Assad. “I didn’t expect to,” she said.

Gabbard’s potential confirmation will depend on how her somewhat incoherent set of policy views sits with Republican senators. Last week, our colleague Elaine Godfrey explored the one through line—besides ambition—that has guided Gabbard’s otherwise inconsistent political career.

Kash Patel

Donald Trump is not always clear about what he means when he refers to “DEI,” but presumably it involves how someone’s identity is taken into consideration during the hiring process. In this morning’s press conference addressing the tragic plane crash last night, Trump asserted, without evidence but crediting his “common sense,” that DEI hiring at the Federal Aviation Administration was at fault.

It was odd, then, that a few hours later, Republican senators used Patel’s confirmation hearing to highlight his identity: Senator Lindsey Graham of South Carolina asked about examples of racism Patel has experienced, and Senator Mike Lee of Utah acknowledged the struggles Patel and his father must have faced as racial minorities in the United States and Uganda, respectively. Senator Thom Tillis of North Carolina, as if he were reading from a book report about the Gujarati people, lauded the religious diversity in Gujarat, India, where Patel’s family is originally from, omitting the state’s extreme tensions and violent history. Patel opened his own remarks by acknowledging his family’s journey from abroad. He invoked the phrase Jai Shri Krishna, a standard greeting for a sect of Hindus seeking blessings.

Patel was calm and still—he became riled up only when questioned by Senator Amy Klobuchar about his past suggestion that he would “shut down the FBI Hoover Building on day one and reopen it the next day as a museum of the ‘deep state.’” But he was walking a tightrope. Today’s hearing may be the rare instance when Patel has publicly broken with Trump, to whom he has otherwise been unequivocally loyal. He refused to explicitly state that Trump lost the 2020 election, but he also said, “I do not agree with the commutation of any sentence of any individual who committed violence against law enforcement.”

Overall, Patel seemed to be trying to carefully toe a line, answering questions about the culture-war issues that Trump and congressional Republicans care about—Senator Marsha Blackburn, for example, asserted during the hearing that the FBI prioritizes DEI and “counting Swiftie bracelets” over conducting investigations—while attempting not to alienate the employees he hopes to lead. Pressed by Blackburn, Patel made a vague statement about the “high standards” FBI employees must meet.

Related:

RFK Jr. has a lot to learn about Medicaid. What everyone gets wrong about Tulsi Gabbard

Here are four new stories from The Atlantic:

The memo that shocked the White House The near misses at airports have been telling us something. Donald Trump is just watching this crisis unfold. Jonathan Lemire: “What I saw at Trump’s first press conference”

Today’s News

Officials announced that there are no survivors in the crash last night between a U.S.-military Black Hawk helicopter and a regional American Airlines passenger jet landing at an airport near Washington, D.C. Three soldiers were aboard the helicopter, and 64 people were on the flight from Wichita, Kansas. Donald Trump appointed Christopher Rocheleau as the acting administrator of the Federal Aviation Administration. The agency had not had an administrator since the start of Trump’s new term. Eight hostages were released from Gaza by Hamas, and Israel released 110 Palestinian prisoners.

Dispatches

Time-Travel Thursdays: Don Peck interviews Nicholas Carr about h​​ow online life has rewired our brains.

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More From The Atlantic

“The ‘exciting business opportunity’ that ruined our lives” Trump’s war on meritocracy If Iranian assassins kill them, it will be Trump’s fault, Tom Nichols writes. Don’t politicize aviation safety. The return of snake oil Why Meta is paying $25 million to settle a Trump lawsuit

Evening Read

Illustration by Ben Kothe / The Atlantic. Source: Getty.

Your FOMO Is Trying to Tell You Something

By Faith Hill

I feel deeply haunted by the thought that if I don’t go to the party or the dinner or the coffee stroll, my one wild and precious life will be void of a joyful, transformative event—one I’d surely still be thinking about on my deathbed, a friend at my side tenderly holding my hand and whispering, Remember? That time we went bowling and the guy in the next lane over said that funny thing? Every year, my New Year’s resolution is to keep one night of the week free from social plans. Almost every week, I fail.

Read the full article.

Culture Break

Illustration by The Atlantic. Source: Jamie McCarthy / Getty.

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Stephanie Bai contributed to this newsletter.

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In a Massachusetts cellar in 1873, Lydia Pinkham first brewed the elixir that would make her famous. The dirt-brown liquid, made from herbs including black cohosh and pleurisy root, contained somewhere between 18 and 22 percent alcohol—meant as a preservative, of course. Within a couple of years, Pinkham was selling her tonic at $1 a bottle to treat “women’s weaknesses.” Got the blues? How about inflammation, falling of the womb, or painful menstruation? Lydia E. Pinkham’s Vegetable Compound was the solution. Pinkham’s matronly smile, printed on labels and advertisements, became as well known as Mona Lisa’s.

Lydia E. Pinkham’s Vegetable Compound was one of thousands of popular and lucrative patent medicines—health concoctions dreamed up by chemists, housewives, and entrepreneurs—that took the United States by storm in the 19th and early 20th centuries. These products promised to treat virtually any ailment and didn’t have to reveal their recipes. Many contained alcohol, cocaine, morphine, or other active ingredients that ranged from dubious to dangerous. Dr. Guild’s Green Mountain Asthmatic Compound was available in cigarette form and included the poisonous plant belladonna. Early versions of Wampole’s Vaginal Cones, sold as a vaginal antiseptic and deodorizer, contained picric acid, a toxic compound used as an explosive during World War I. Patent-medicine advertisements were unavoidable; by the 1870s, 25 percent of all advertising was for patent medicines.

After the Pure Food and Drug Act was passed in 1906, the newly created Food and Drug Administration cracked down on miracle elixirs. But one American industry is still keeping the spirit of patent medicine alive: dietary supplements. In the U.S., vitamins, botanicals, and other supplements are minimally regulated. Some can improve people’s health or address specific conditions, but many, like the medicines of old, contain untested or dangerous ingredients. Nevertheless, three-quarters of Americans take at least one. Some take far more. Robert F. Kennedy Jr., the longtime conspiracy theorist and anti-vaccine activist who’s awaiting Senate confirmation to run the Department of Health and Human Services, has said he takes a “fistful” of vitamins each day. Kennedy has in recent years championed dietary supplements and decried their “suppression” by the FDA—an agency he would oversee as health secretary. Now he’s poised to bring America’s ever-growing supplement enthusiasm to the White House and supercharge the patent-medicine revival.  

The newly created FDA eventually required all pharmaceutical drugs—substances intended for use in the diagnosis, cure, mitigation, treatment, or prevention of disease—to be demonstrably safe and effective before they could be sold. But dietary supplements, as we call them now, were never subject to that degree of scrutiny. Vitamins were sold with little interference until the “megadosing” trend of the late 1970s and ’80s, which began after the chemist Linus Pauling started claiming that large amounts of vitamin C could stave off cancer and other diseases. The FDA announced its intention to regulate vitamins, but the public (and the supplement industry) revolted. Mel Gibson starred in a television ad in which he was arrested at home for having a bottle of Vitamin C, and more than 2.5 million people participated in a “Save Our Supplements” letter-writing campaign. Congress stepped in, passing the 1994 Dietary Supplement Health and Education Act, which officially exempted dietary supplements from the regulations that medications are subject to.

Since then, the FDA has generally not been responsible for any premarket review of dietary supplements, and manufacturers have not usually had to reveal their ingredients. “It’s basically an honor system where manufacturers need to declare that their products are safe,” says S. Bryn Austin, a social epidemiologist and behavioral scientist at the Harvard T. H. Chan School of Public Health. The agency will get involved only if something goes wrong after the supplement starts being sold. As long as they disclose that the FDA hasn’t evaluated their claims, and that those claims don’t involve disease, supplement makers can say that their product will do anything to the structure or function of the body. You can say that a supplement improves cognition, for example, but not that it treats ADHD. These claims don’t have to be supported with any evidence in humans, animals, or petri dishes.

In 1994, the dietary-supplement industry was valued at $4 billion. By 2020, it had ballooned to $40 billion. Patent-medicine creators once toured their products in traveling medicine shows and made trading cards that people collected, exchanged, and pasted into scrapbooks; today, supplement companies sponsor popular podcasts, Instagram stories are overrun with supplement ads, and influencers make millions selling their own branded supplements. The combination of modern wellness culture with lax regulations has left Americans with 19th-century-like problems: Pieter Cohen, an associate professor of medicine at Cambridge Health Alliance, has found a methamphetamine analogue in a workout supplement, and omberacetam, a Russian drug for traumatic brain injuries and mood disorders, in a product marketed to help with memory.

Last year, Kennedy accused the FDA of suppressing vitamins and other alternative health products that fall into the dietary-supplement category. But “there is no truth about the FDA being at war on supplements over the last several decades,” Cohen told me. “In fact, they have taken an extremely passive, inactive approach.” Experts have repeatedly argued that the FDA needs more authority to investigate and act on supplements, not less. And yet, Kennedy continues to champion the industry. He told the podcaster Lex Fridman that he takes so many vitamins, “I couldn’t even remember them all.” Kennedy has vocally opposed additives in food and conflicts of interest in the pharmaceutical industry, but has failed to mention the dangerous additives in dietary supplements and the profits to be made in the supplement market. (Neither Kennedy nor a representative from the MAHA PAC responded to a request for comment.)

In an already permissive environment, Kennedy’s confirmation could signal to supplement manufacturers that anything goes, Cohen said. If the little regulation that the FDA is responsible for now—surveilling supplements after they’re on the market—lapses, more adulterated and mislabeled supplements could line store shelves. And Americans might well pour even more of our money into the industry, egged on by the wellness influencer charged with protecting our health and loudly warning that most of our food and drug supply is harmful. Kennedy might even try to get in on the supplement rush himself. Yesterday, The Washington Post reported that, according to documents filed to the U.S. Patent and Trademark Office, Kennedy applied to trademark MAHA last year, which would allow him to sell, among other things, MAHA-branded supplements and vitamins. (He transferred ownership of the application to an LLC in December. Kennedy’s team did not respond to the Post.)

A truly unleashed supplement industry would have plenty of tools at its disposal with which to seduce customers. Austin studies dietary supplements that make claims related to weight loss, muscle building, “cleansing,” and detoxing, many of which are marketed to not just adults, but teenagers too. “Those types of products, in particular, play on people’s insecurities,” she told me. They also purport to ease common forms of bodily or mental distress that can’t be quickly addressed by traditional medical care. Reducing stress is hard, but ordering the latest cortisol-reducing gummy on TikTok Shop is easy. Your doctor can’t force vegetables into your diet, but a monthly subscription of powdered greens can.

Judy Z. Segal, a professor emerita at the University of British Columbia who has analyzed patent-medicine trading cards from the 19th and 20th centuries, told me that supplement-marketing strategies “have not changed that much since the patent-medicine era.” Patent medicines appealed to ambient, relatable complaints; one ad for Burdock’s Blood Bitters asserted that there were “thousands of females in America who suffer untold miseries from chronic diseases common to their sex.” And the makers of patent medicine, like many modern supplement companies, used friendly spokespeople and customer testimonials while positioning their products as preventive care; according to one ad for Hartshorn’s Sarsaparilla, “The first deviation from perfect health should receive attention.”

In 1905, the muckraker Samuel Hopkins Adams lamented that “gullible America” was so eager to “swallow huge quantities of alcohol, an appalling amount of opiates and narcotics, a wide assortment of varied drugs ranging from powerful and dangerous heart depressants to insidious liver stimulants; and, far in excess of all other ingredients, undiluted fraud.” Compounds and elixirs go by different names now—nootropics, detoxes, adaptogens—but if Adams walked down any supplement aisle or browsed Amazon, he’d still find plenty of cure-alls. He could even pick up a bottle of Lydia E. Pinkham’s Herbal Supplement, which is sold as an aid for menstruation and menopause. Pinkham’s face smiles at buyers from the label, though its advertised benefits are now accompanied by a tiny disclaimer: “This statement has not been evaluated by the FDA.”

Senators grill Trump nominee to lead intelligence community over support for Edward Snowden, meeting with al-Assad.

Democrats push Patel to account for his calls to prosecute journalists and dismantle the FBI's headquarters.

Yesterday, the United States suffered the first fatal crash of a U.S. airliner in 16 years. American Airlines Flight 5342, a regional jetliner, originated in Wichita, Kansas. Just before landing at Ronald Reagan Washington National Airport in northern Virginia, it collided with a military helicopter over the Potomac River. Scores of people were feared dead late Tuesday. Authorities haven’t yet determined the cause of the collision. The National Transportation Safety Board will lead an investigation, hoping to determine what happened and prevent any similar accidents in the future.

There is no reason to believe that the dramatic changes to the federal government made by the Trump administration, or the chaos they introduced, played any role in this tragedy. But the success of regulators in improving the safety of commercial aviation is among the great triumphs of the last half-century. And in its first week in office, the Trump administration did take one unrelated step that suggests a cavalier disregard for the consequences of politicizing those efforts: it dismissed all of the members of the federal Aviation Security Advisory Committee, a body which advised the Transportation Security Administration.

“The aviation security committee, which was mandated by Congress after the 1988 PanAm 103 bombing over Lockerbie, Scotland, will technically continue to exist but it won’t have any members to carry out the work of examining safety issues at airlines and airports,” the Associated Press reported last week. “Before Tuesday, the group included representatives of all the key groups in the industry — including the airlines and major unions — as well as members of a group associated with the victims of the PanAm 103 bombing. The vast majority of the group’s recommendations were adopted over the years.”

My colleague James Fallows, a longtime pilot who has reported on aviation for decades, noted yesterday that dismantling the committee one week ago “wasn’t part of tonight’s tragedy,” but argued that it is a thoughtless destruction of a taken-for-granted institution that will erode safety over time, when the United States should instead be conserving the gains of recent decades. Pointing his readers to a list of the board’s former members, Fallows wrote that it “was collaborative; it combined public, private, military, civilian, academic, and other institutions to pool knowledge; it avoided blame; but it focused relentlessly on lessons learned.”

I favor a smaller federal government, and will likely cheer some cuts that the Trump Administration makes. My hope is for a bureaucracy that does fewer things and does them well.

But aviation safety in America is the envy of the world––it’s among the few things that was working well, having improved significantly in recent decades under a status quo that Trump is disrupting. To what end? Perhaps the Trump administration has some compelling rationale that it hasn’t shared for disbanding the Aviation Security Advisory Committee. If so, it should speak up.

Instead, a Department of Homeland Security official offered a vague and unpersuasive statement to Aviation International News: “The Department of Homeland Security will no longer tolerate any advisory committee which pushes agendas that attempt to undermine its national security mission, the President’s agenda, or Constitutional rights of Americans,” he said.

Congress should demand better answers, for the sake of the due diligence that airline safety warrants, and because stripping a mandated board of all its members would seem to thwart its legitimate power with a technicality. If Congress judges that the board is still useful, it should use the power of the purse to force its restoration, rather than giving in to the president.

Will Republicans, who hold a majority in the House and the Senate, jealously guard the legislature’s powers and diligently discharge its oversight responsibilities? Perhaps not. Deferring to presidents from one’s own party is a bipartisan sin, however derelict it makes legislators in their duties. While Trump undoubtedly has a popular mandate for aspects of his agenda, however, no voter sent him to Washington to end an aviation safety committee. He is owed no deference on that move.

Trump is making a lot of changes very quickly. If GOP legislators won’t probe this one to see if it is arbitrary or ill-considered, it’s hard to imagine what will spur them to exercise their oversight responsibilities––after all, most members of Congress are frequent flyers.

Kennedy Jr denied and downplayed past controversial comments during his hearing for HHS secretary.

Here’s what we know about the Guantanamo Bay announcement, upcoming hearings and other key developments.

Put on the spot, a lot of Americans might hesitate over the difference between Medicaid and Medicare. People who aren’t affected by one of these programs, which together enroll about 150 million people in the U.S., don’t generally have a need to be well versed in their intricacies, and the two programs sound quite similar. The names don’t really hint that Medicare is a federal program that covers older Americans and Americans with disabilities, and that Medicaid covers low-income people in the United States.

Most Americans, though, are not nominated to become secretary of the Department of Health and Human Services. Robert F. Kennedy Jr. is. And yet today, at his confirmation hearing before the Senate Finance Committee, he made clear that he also does not know very much about Medicare and Medicaid.

As HHS secretary, Kennedy would oversee a suite of government agencies, including the FDA, CDC, and National Institutes of Health, that are focused on improving American health. He also would oversee the Centers for Medicare and Medicaid Services, which, as the name implies, manages those two programs. HHS services, in other words, touch the lives of every American—and Medicaid and Medicare are, in particular, two of the most common ways for people to directly benefit from the government’s services.

During the three-and-a-half-hour hearing, in which the Senate committee pressed Kennedy on a range of issues—his anti-vaccine views, endorsements of conspiracy theories, stance on abortion, potential financial conflicts—senators grilled Kennedy on various aspects of the two government programs. In his new role, Kennedy could be charged with overseeing substantial changes to one of them. Donald Trump has pledged to preserve Medicare. He has made no such promise about Medicaid, which health-policy experts anticipate may be targeted for spending cuts. (On Tuesday, Medicaid reimbursement portals abruptly stopped working after the Trump administration ordered a freeze on federal grants and loans; states have since regained access to the portals.) Some Republicans have argued that an increased focus on public-health insurance in the U.S. won’t make Americans healthier, and Kennedy appeared to echo that viewpoint today when he criticized Medicaid, saying “our people are getting sicker every single year,” and lamented the program’s expansion to people with higher incomes. “The poorest Americans are now being robbed,” he said.

But Kennedy also seemed to mix up the two programs when he described them. Part of the issue with Medicaid, he said, is that “the premiums are too high, the deductibles are too high.” The majority of people enrolled in Medicaid don’t pay premiums or deductibles; federal law actually prohibits premiums for the program’s lowest-income enrollees. (He did seem better versed in Medicare Advantage, a program that provides private insurance coverage for older Americans and that he himself is enrolled in.)

To be fair, Kennedy was in a high-pressure situation. But being HHS secretary is a high-pressure job. Kennedy had time to prepare in advance of today’s hearing. If confirmed, he won’t need to master every minute detail of Medicare and Medicaid, but he will need to be able to navigate both programs—their differences, their weaknesses, and how they might evolve. People who are eligible for both programs, for instance, have created sticking points in the health-care system, in part because coordinating coverage between the two is difficult and can complicate care. When pressed by Senator Bill Cassidy of Louisiana on how to deal with that issue, Kennedy suggested that the programs should be “consolidated” and “integrated”—but when asked how that might happen, said, “I’m not exactly sure.”

Kennedy struggled with other policy specifics, too. One of his goals, Kennedy said, is to fulfill Trump’s directive to improve the quality of care and lower the price of care for all Americans. But he was vague on any plans to reform Medicaid, explaining that he’d “increase transparency” and “increase accountability.” When pushed by Cassidy to clarify, Kennedy said, “Well, I don’t have a broad proposal for dismantling the program.”

Nor did Kennedy have a clear sense of how he would approach one of the more contentious and legally sensitive health questions of the past few years: whether women whose lives are threatened by pregnancy should be able to receive emergency abortions under EMTALA, the law that requires emergency rooms that receive Medicare funding to provide care to anyone in a life-threatening situation. The Biden administration argued that this federal law supersedes state abortion bans, and in 2024, after the Supreme Court demurred on the issue, the administration made clear to doctors, in a letter co-authored by Health and Human Services Secretary Xavier Becerra, that abortions could qualify as emergency treatment. Kennedy admitted this morning that he didn’t know the scope of the authority he’d have to enforce the law in his new job.

Jacinda Abdul-Mutakabbir, a clinical pharmacist at UC San Diego, told me that Kennedy's apparent failure to understand the intricacies of the two programs wasn’t just a harmless fumble. If the health secretary is not well versed in the programs he’s tasked to run, he might not appreciate the impacts of his decisions. Should health coverage for some of the most vulnerable Americans be altered—perhaps even taken away—then health disparities in this country would likely widen. And if any part of his agenda does include increasing transparency, as Kennedy described in today’s hearing, expertise will have to be a prerequisite. “You can’t increase transparency on something you don’t have clarity on,” Abdul-Mutakabbir told me. (Kennedy’s press team did not immediately return a request for comment on his performance at today’s hearing.)

During the hearing, Kennedy’s more radical views on vaccines and infectious disease did come up. He copped to describing Lyme disease as “highly likely a militarily engineered bioweapon.” (The bacterium, which has been around for at least tens of thousands of years, is not.) He stood by his assertion that the measles vaccine killed two children in Samoa in 2018. (The vaccine did not; those children died following the administration of an improperly mixed vaccine by two nurses who were ultimately sentenced to five years in prison for the act.) He said that young children are at “basically … zero risk” from COVID-19. (Young children are at risk, especially babies under six months of age, who have similar hospitalization rates from the disease as adults 65 to 74 years old.) Kennedy’s falsehoods about infection and immunity were already well known, though. What the country learned today was that he may lack basic competency in some of the most wide-reaching aspects of his future job—and didn’t take the time to prepare answers for Congress, which he’ll ultimately have to answer to.

The great federal-grant freeze of 2025 is over, but don’t expect it to be gone for good.

The Office of Management and Budget, which issued a memo freezing grants on Monday, has revoked it, The Washington Post first reported. The whole thing went so fast that many people may have never had a chance to sort out what was happening. Yesterday, amid widespread confusion about what the order did or didn’t do, White House Press Secretary Karoline Leavitt was unable to answer specific questions about it. State and local officials of both parties were bewildered, and yesterday afternoon, a federal judge blocked the order. Today, OMB folded—at least for now. The White House says that it has withdrawn the grant freeze in the memo, but not the executive orders mentioned in it, some of which assert a freeze on spending. Part of the goal appears to be to short-circuit court proceedings that might produce an unfavorable ruling.

This episode resembles the incompetent fumbling of the first Trump administration, especially its earliest days. But this was no fluke and no ad hoc move. It’s part of a carefully thought-out program of grabbing power for the executive branch, and this week’s drama is better understood as a battle over priorities within the Republican Party than as unmanaged chaos.

The abortive grant freeze is an example of the second Trump administration’s strategy to drastically deploy executive power as part of a bigger, and somewhat paradoxical, gambit to shrink the federal government as a whole. “The great challenge confronting a conservative President is the existential need for aggressive use of the vast powers of the executive branch to return power—including power currently held by the executive branch—to the American people,” the current OMB head, Russell Vought, wrote in Project 2025, the blueprint for a conservative administration convened by the Heritage Foundation, a Trump-aligned right-wing think tank. The strategy is to seize power and dare both Congress and the courts to stop it. This tactic is unpredictable, as this week’s misadventures show, but it’s also relatively low-risk. The ideologues inside the administration want to see what they can get away with, and if it doesn’t work, so be it.

[Read: ‘It’s an illegal executive order. And it’s stealing.’]

But the administration has other staffers who are more responsive to politics. President Donald Trump, for example, has relatively weak ideological commitments. The court injunction yesterday was a nuisance, but what really seems to have done in the freeze was the backlash—not so much from the public, but from state and local officials, including many Republicans, who were outraged about the withdrawal of funds and lack of communication. The political team won this round over the ideologues, but there will be more.

At a mechanical level, the fight over the freeze was a battle over impoundment, the power of the executive branch to not spend money appropriated by Congress. Federal law on this is as settled as any: A law passed in 1974 prevents impoundment, except in cases where the president seeks permission from Congress. But Trump and some of his aides argue that that law is unconstitutional.

In a letter to Congress in the last days of the first Trump administration, Vought (then the head of OMB) wrote that the law “is unworkable in practice and should be significantly reformed or repealed.” In September, the attorney Mark Paoletta co-wrote a report for Vought’s nonprofit, the Center for Renewing America, arguing that the power of impoundment was constitutional; Trump has now appointed Paoletta the general counsel of OMB, a position he also held in Trump’s first administration. And as my colleague Russell Berman reported yesterday, Vought refused to commit to abiding by the Impoundment Control Act during his confirmation hearings. And Vought and his allies had a plan for how to knock it down.

“President Trump will take action to challenge the constitutionality of limits placed on the Impoundment Power,” the Trump presidential campaign said—in other words, he planned to disobey the law, litigate any challenges, and hope to get a favorable ruling from the Supreme Court. It’s worked in the past.

This all goes to show that sometimes the chaos has a strategy behind it. Things just didn’t shake out the way Vought’s crew had hoped this time.

One curiosity is why the administration wouldn’t just try to go through Congress to rescind funding passed during Joe Biden’s presidency. After all, Republicans now control both the House and Senate. The White House might have a few reasons for wanting to do it on its own. First, legislation is slow, and Trump prefers to show results fast. Second, Republican margins are narrow, and although GOP elected officials and voters favor cuts in the abstract, they don’t always favor cuts to particular things that voters like, so the White House might struggle to get even the requisite simple majority to rescind some of the spending it tried to freeze this week. Third, impoundment per se is not the only goal—it’s also a means to the ideological end of seizing power for the executive branch.

In Project 2025, Vought laments that Congress has yielded too much power to the presidency. “The modern conservative President’s task is to limit, control, and direct the executive branch on behalf of the American people. This challenge is created and exacerbated by factors like Congress’s decades-long tendency to delegate its lawmaking power to agency bureaucracies,” he wrote. Paradoxically, his plan for limiting the executive branch is to give it more muscle.

[Jonathan Chait: Trump’s second term might have already peaked]

As if to prove Vought’s point about congressional deference, Speaker Mike Johnson has backed the White House thus far. Just a decade ago, conservatives were furious that then-President Barack Obama was using executive orders to do things that congressional Democrats had failed or declined to do. Now the use of much more radical executive orders is the first recourse of the Republican president.

Because this effort is core to the ideological agenda of Project 2025 principals such as Vought, the revocation of this executive order likely won’t be the last effort we see along these lines. And having to back down for political reasons tends to make the internal battles only fiercer. Trump’s attempts to decimate the civil service and clear out career bureaucrats are well known, but Project 2025’s authors reserved special animus for those whom they expected to be on their side during the first Trump administration.

“I had a front-row seat on many of these issues and importantly [saw] how bad thinking would end up preventing what we were trying to accomplish, from less-than-vigorous political appointees who refused to occupy the moral high ground, particularly in the first two years of the president's administration,” Vought said in a 2023 speech. He has no intention of letting that happen again.