RFK Jr. Is a Feature, Not a Bug
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professional measure. Rules and restrictions may apply. The PC gave us computing power at home, the internet connected us, and mobile let us do it pretty much anywhere. Now generative AI lets us communicate with technology in our own language using our own senses. But figuring it all out when you're living through it is a totally different story. Welcome to Leading the Shift.

Good morning. This hearing will come to order.

I'm willing to bet that between Dan Diamond and myself, we have logged hundreds of hours in congressional hearings. I covered Washington for about a decade, and Dan is a White House reporter for The Washington Post. Before that, he covered health care for nine years. I thank my colleagues and Mr. Kennedy for being here today. Mr. Kennedy, congratulations on your nomination.

I talked to Dan on Wednesday after the Senate Finance Committee hearing. That's the committee that has the power to move his nomination forward. It felt like a circus, Lizzie. There were people there to protest RFK Jr., to interrupt the proceedings. There were many fans of RFK Jr. who lined the halls, wore pro-Kennedy paraphernalia, and often booed or cheered the senators based on whether they agreed with them.

It was pretty remarkable, both for what it showed about Kennedy and the Trump administration's approach to public health, including this moment where Kennedy whiffed a key question. Democrat Catherine Cortez Masto asked what would happen if a pregnant woman with an incomplete miscarriage went to the ER needing an emergency abortion to save her life. But she's in a state where abortion is banned.

You would agree also as an attorney that federal law protects her right to that emergency care, correct? I don't know. I mean, the answer to that is I don't know. Let me ask you this as an attorney. The reason I play that clip for Dan is that it made me wonder if Kennedy is prepared because that very issue of emergency abortion was litigated in the Supreme Court just last year.

It's hard to listen to that exchange and not wonder if RFK Jr.'s inexperience is actually part of the plan. Robert F. Kennedy Jr. was not tapped for this role because he's an expert of health policy. He is a 70-something activist who's focused mostly on environmental law. When he's come into the healthcare space, it's been to challenge people.

Big Pharma, he said, or raised questions about vaccines. He's not someone who has studied the intricacies of Medicare, of Medicaid, of a lot of the different programs that would come under HHS, the sweeping $2 trillion agency. So the fact that Kennedy

is testifying for this job, it's not because he's a health expert. It's because he is allegedly a reformer who isn't part of this system, who can come in and has no ties to establish interests and can turn things around in an America that does have bad health outcomes. So that's part of the pitch. I think also, Lizzie, we know that this Trump administration, the second Trump administration, wants to run a lot of policy out of the White House.

So it might not matter what Robert F. Kennedy Jr. thinks about Medicare or what Pete Hegseth at the Pentagon thinks about some of the defense budget. There are functionaries in the Trump administration who don't get a lot of attention, who are drawing up plans for what this administration would do. And it might fall to the cabinet secretaries who used to have a lot of independent authority to be more rubber stamps on the Trump agenda these next couple of years. ♪

Today on the show, why RFK Jr. is a feature, not a bug, and what that shows us about how Trump 2.0 will treat public health. I'm Lizzie O'Leary, and you're listening to What Next TBD, a show about technology, power, and how the future will be determined. Stick around. Have you heard about double nomics? It's okay if you haven't. It's extremely niche and practiced by Discover.

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It brings people together in meaningful ways. Kuhnle and his team are building a Wi-Fi experience that connects one billion devices every year. Learn more about how Comcast is redefining the future of connectivity at ComcastCorporation.com slash Wi-Fi. Perhaps not surprisingly, given RFK Jr.'s decades-long record of public statements, senators, especially Democrats, came prepared to challenge him this week. Here he is with Colorado's Michael Bennett.

So I'm asking you yes or no, Mr. Kennedy. Did you say that COVID-19 was a genetically engineered bioweapon that targets black and white people but spared Ashkenazi Jews and Chinese people? I didn't say it was deliberately targeted. I just quoted an NIH-funded, an NIH-

published study. Did you say that it targets black and white people, but spared Ashkenazi? I quoted a study, Your Honor. I quoted an NIH study that showed that. I'll take that as yes. I have to move on. I have to move on. I wanted Dan to talk me through some of Kennedy's record, because while Kennedy said at this hearing that he supports vaccination and that his children are vaccinated, his past shows something different.

Kennedy founded a group, Children's Health Defense, that has been among the most prominent anti-vaccine organizations.

Kennedy has questioned again and again the value of vaccines. He suggested that the coronavirus vaccine was causing mass harm at a time when there was all evidence that the coronavirus vaccine was saving many, many lives. You can go through his statements over the years and find again and again examples of him questioning vaccines. So even as he sat before the Senate and insisted that he was pro-vaccine and favored it for his family,

It doesn't negate the years and years of questions and advocacy on the other side. A major focus of Democrats in the hearing was Kennedy's visit to the island nation of Samoa about five years ago. There had been a tragedy where two young children were killed because of an improperly prepared vaccine. Kennedy and other vaccine skeptics seized on that moment, called attention to what they said was a potential crisis of vaccines.

Kennedy visited the country, met with anti-vaccine activists. And several months after that visit, Samoa was dealing with a full-blown measles outbreak. Roughly 5,700 people in Samoa got measles. 83 died. It wasn't all that surprising that Kennedy got questions about vaccination. But he also seemed to struggle with questions like this one from Republican Bill Cassidy, who's also a doctor.

Kennedy seemed to mix up Medicaid, which provides low-income health coverage, and Medicare, which is generally for seniors. Two very different programs. Republicans, again, are looking at ways to potentially reform Medicaid to help, you know, pay for President Trump's priorities, but to improve outcomes. What thoughts do you have regarding Medicaid reform? Well, Medicaid is not working for Americans, and it's specifically not working for

or the target population. Most Americans, like myself, I'm on Medicare Advantage and I'm very happy with it. Most people who are on Medicaid are not happy. The premiums are too high. The deductibles are too high. The networks are narrow.

I want to zoom out here and talk about RFK Jr. and his nomination as sort of a symptom of something, right? Like we've talked about him as a cause, a cause potentially for people who have turned away from vaccines. But if we think of him as a symptom of how both the Trump administration and a swath of Americans are thinking about health and health care right now, I think that creates an interesting prism. So,

I want to start that by asking, prior to the COVID pandemic, how would you characterize kind of the way Americans think broadly about public health and public health institutions? Prior to the pandemic, public health institutions were among the most trusted agencies in the federal government. I don't have the numbers right in front of me, but Gallup has been tracking this for years and years. And I believe CDC was among the most trusted agencies of all the ones that Gallup pulled on.

That trust has fallen for CDC, for FDA, the Food and Drug Administration, for just the general concept of listening to public health authorities. Polling came out this week from KFF, a nonpartisan healthcare group that found about 53% of Americans now trust FDA's recommendations. A similar percentage trust public health authorities' recommendations overall.

That wasn't the case before the pandemic. And I think you're right, Lizzie, that that skepticism, that doubt, fueled in part perhaps by some aggressive measures to respond to the pandemic, but also misleading information about what public health authorities were doing. It is all combined to weaken trust in these essential authorities. And I think that's part of what explains Robert F. Kennedy Jr.'s rise.

Another key part of Kennedy's rise is that some of what he talks about, chronic disease, ultra-processed foods, the pharmaceutical industry, are things many other politicians don't want to reckon with.

I did a story at the Washington Post over a year ago. It was the first time I'd spoken to Robert F. Kennedy Jr. for a story about how politicians had ignored America's rising problem of essentially early death. We did a whole series of the Washington Post, in fact, on this problem that we called "dying early."

of too many people in America die young compared to our counterparts in wealthy countries abroad. And Robert F. Kennedy Jr. was one of the rare politicians I wrote in my article calling attention to this problem.

that Americans suffer from chronic disease, from this high rate of cancer. These preventable problems, hopefully, were ones that we can intercede on earlier than we do. And if you take a lot of his commentary on America's chronic disease problem and just strip his name from it, Lizzie, it looks like the same thing that Senator Bernie Sanders might say or Senator Cory Booker, a Democrat, a number of Democrats, in fact.

It's a real problem, and Kennedy should be applauded for focusing on it. The question is, is he, as he promises that he's the right guy to fix it, does he actually have the ability, the track record, the trust to do that if he's empowered? Or would he go a different direction, given his predilection in the past for repeating things that just aren't true about healthcare?

When we come back, even if Kennedy doesn't get confirmed, his nomination tells us a lot about how the Trump administration thinks about science and health care. Imagine what's possible when learning doesn't get in the way of life.

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The Trump administration has also taken some steps in its first week to change public health policy and communication. And I want to be clear, as I am talking to you, there are a lot of moving parts. There's a lot of confusion in this area, whether certain things are being defunded, not being defunded. So, so far...

What changes are you able to tell me about that affect public health? I'm thinking about the World Health Organization, gender affirming care. What are we seeing so far?

There are quite a few. Let's start with the ones that we know for sure. So the United States has been pulled out of the World Health Organization. This is the arm of the United Nations that helps coordinate the response to global health crises, played a role during the coronavirus pandemic, major role. But President Trump at the time said,

blamed the World Health Organization, said that it was shielding China and China's potential role in sparking the outbreak and had been unhelpful to the United States. Another move that the Trump administration made early was shutting down health agency communications. Now, they have defended that as just part of the presidential transition, but Lizzie, it went much, much further than any transition we've seen before.

researchers that were waiting on approval for grants to work on, say, researching cancer, those meetings got canceled or postponed at best for some indeterminate amount of time. There

There were officials who just couldn't answer basic questions about, say, the spread of avian flu. They weren't responding to reporters. They weren't updating websites. So it had practical implications to shut down the health department so quickly and abruptly. And then, as you noted, there have been these broad measures across the federal government, like cutting down on the DEI diversity measures.

equity and inclusion efforts, and that has affected healthcare too. Getting rid of some staffers. I got word right before we started doing this podcast that CDC grantees were told that if they had any DEI elements in their grants, that that could be big trouble for them. So that is continuing to ripple. Even the things that were short-term, like a disruption to Medicaid payment that happened this week as part of the Trump administration's broad freeze on federal funding,

That that may have only been a number of hours, but it was still pretty disruptive. It ate up the time of Medicaid officials and speaks to just the acts of the Trump administration and how quickly they can disrupt efforts across the country. This may be an impossible question to ask, but I wonder, having covered the first Trump administration, covered the pandemic very deeply.

If there's anything that you have gleaned about the Trump administration's approach to health care this time and how Robert F. Kennedy Jr. fits into that overall picture.

It's a very different approach because Robert F. Kennedy Jr., until fairly recently, was a Democrat who had very different views on abortion access. For instance, he defended access to abortion during his presidential campaign. The lawmakers that were tapped to be health secretary under Donald Trump...

were very critical of abortion and had different agendas and different lieutenants at the Department of Health and Human Services who pursued those objectives. A lot of those more junior functionaries are still going to be at HHS regardless of who's the secretary, but the secretary does put

put a stamp on it and his personnel or her personnel are going to be informing what the strategy might be moving forward. So I'm not exactly sure. This is a little bit of a punt, but I'm not exactly sure, Lizzie, where we're going because I don't know who the health secretary is going to be.

If Robert F. Kennedy Jr. doesn't make it and someone like Bobby Jindal, the former Louisiana governor, comes in in his place, we will have a more traditional Republican administration like we had the first time. If Robert F. Kennedy Jr. is there and truly wants to tear everything down while also pursuing investigations into vaccines, that is a big departure from where we were the first time. I guess one of the things I'm trying to understand is whether we're talking about a coordinated effort

kind of plan to do what Elon Musk and his compatriots are doing with Doge, i.e. intentionally try to shrink the footprint of some federal organizations, or if this is maybe a little more of a one-off situation where we're talking about a nominee who may not be familiar with some inner workings of an agency, like,

That's what I'm trying to parse out. Is this we're coming in and we're going to just cut down this great big spender of federal dollars? I think all of the above in that Robert F. Kennedy Jr. has said he wanted to get rid of numerous civil servants at the federal health agencies. He says that they've been captured by the pharma industry, that they have these conflicts of interest. He wants them to go. He was pressed on that in a Senate hearing.

But also, the Trump administration is making big moves with perhaps total forethought of what the ramifications could be. And if there's damage or danger to these agencies and the work that they do, that seems to be very much an afterthought. And perhaps that does lead to people leaving or the agencies being weaker. There are people in the Trump administration who would be very happy with that outcome.

What does that mean if you, I don't know, run a health center or a clinical trial or have a federal grant? How are you doing your work right now? Are you doing your work? I think you're doing it very nervously in some cases. The Medicaid freeze that we saw briefly this week could have led to delayed payments, may still lead to delayed payments to a lot of hospitals and doctors, depending on how quickly they're able to sort out the back end on that.

And if you are someone who has been depending on federal grants that may never come now, you may be trying to look now to the private sector, which is not going to be able to make up for the loss in federal funding. It could be extremely disruptive. We saw a number of changes in health care the first Trump administration, but we also saw a major political backlash to those changes. So I have to be honest, Lizzie, I'm a little surprised that

that the Trump administration has been even dabbling with anything that could lead to blowback in healthcare because that was such a damaging issue for Donald Trump his first time.

That was an undercurrent that I did pick up in these hearings because members of Congress of both parties know that their constituents rely on health care that comes from the federal government, whether they are getting Social Security disability payments, whether they're getting Medicare, whether they're getting Medicaid. These are programs that are broadly very popular programs.

with the people who have them. And so that's where I wonder if the administration might be running into some speed bumps that it did not expect on Capitol Hill.

Maybe. It is so early in this administration that I'm not sure that anyone is thinking too much about the midterms. But the idea that health care issues motivate voters more than, and just to pick an example, the war in Ukraine, it is very real. It's an everyday pocketbook issue. And sometimes the federal government may not actually do something, but the outcome gets blamed on the federal government.

We saw this a lot after the Affordable Care Act. Oh my God, I went to those town hall meetings. There were some angry people there. I think even in this past week, there were some viral claims that I saw on social media that someone's cancer treatment, for instance, was canceled. I looked into that. It didn't appear to be

from the Trump administration's actions, but because the Trump administration had done so many things so quickly to freeze decisions across healthcare, it made some sense why there would be this perception that any problem in healthcare was suddenly the Trump administration's problem. So I think the more you meddle in a system and promise to make changes, you then own whatever damage and uncertainty might result, even if it isn't directly from something the government did.

There was a story you wrote that was really intriguing to me, that RFK Jr. skipped a meeting on pandemic preparation. And this is like a thing where the incoming and outgoing administrations sit together, talk about what they do in various scenarios. They used, I believe from your story, bird flu and the terror attack in New Orleans as examples. Why did he skip out on that? And what does that tell you?

He skipped out on it because he was on Capitol Hill trying to shore up support for this controversial nomination. He has argued somewhat, and I heard that this morning that he told Ron Wyden, a top Senate Democrat, that he wasn't actually invited to this exercise, that he didn't even know about it apparently, which is hard to believe because Biden officials very much wanted him there and invited virtually the rest of Trump's cabinet did show up. So the idea that...

his priority was trying to bolster his nomination rather than prepare for, say, a potential bird flu. I think that is revealing.

We might find ourselves in a pandemic-like crisis again, and the health secretary will be a central part of that. Robert F. Kennedy Jr. doesn't have any real-world experience preparing for a crisis like that. This exercise was meant to be some of that preparation, a rare opportunity where everybody is in the same room and can talk through what they would do. He wasn't there. Hopefully, that won't come back to be a problem in the future.

The MAHA Make America Healthy Again movement that Kennedy champions seems to have gained traction, not just because of the pandemic, but because of some of the other things that we have talked about. This complex, expensive health care system that does not necessarily guarantee better outcomes compared to other developed countries.

And as I was listening to this conversation, I was struck by how many of the things that were being talked about were the exact same things being talked about in 2009 when I was covering the debate over the Affordable Care Act and when it was going through the legislative process. And it just made me wonder, like, is there a way to get out of that? Because

Americans are obviously frustrated with their health care system, and yet it feels a bit like a game of Jenga that if you pull one of these pieces, it all falls apart. Is there a way to have these conversations?

Well, the Affordable Care Act illustrated, Lizzie, what I think more and more politicians are acknowledging. Just having health coverage is not a guarantee that you're going to have health care access, let alone good health care. So more Americans are insured than

than they were before the Affordable Care Act, and we now have protections that help make sure that people can get that coverage. But the outcomes aren't matching up to where they could be. So to fix that, to actually make things better here, would probably require tearing down that Jenga tower and the massive political pain in trying to build a better system from the ground up. The Affordable Care Act was just like putting more

in the Jenga tower. It helped in some ways, and it certainly improved the situation for uninsured Americans. But the actual incentives remain slanted away from primary care and prevention in our country. Some of that is around the funding and the payment incentives. Other issues are just about general health and our diet.

Robert F. Kennedy Jr. put his finger on a lot of those problems. There is some truth to the idea that someone who doesn't care about the political damage, who has no ties to healthcare, might be the right person to come in and tear it all down and make things better. But that's also a hard thing to balance with. Robert F. Kennedy Jr. has been the avatar of so many disproven theories about healthcare. So can we really turn all of this over to him and trust that he will make it better for the rest of America? I don't think the evidence is there to support that.

Dan Diamond, thank you so much for talking with me. Lizzie, thanks for bringing me on on such an interesting day. And that is it for our show today. What Next TBD is produced by Evan Campbell and Patrick Fort. Our show was edited by Paige Osborne. And TBD is part of the larger What Next family. We'll be back on Sunday with another show about the Chinese AI app DeepSeek and why American AI companies are freaking out. All right. I am Lizzie O'Leary. Thanks so much for listening.