Healthcare Under Trump: The Changing Faces of U.S. Public Health Leadership

When President Biden was elected in 2020, I got a bunch of paid (hooray!) consulting work before he even took office for my take on what this will mean for multiple entities in the US Healthcare Industry.?

Now, as President-elect Donald Trump prepares to take office next week, I’m reflecting on those experiences and the shifting dynamics of U.S. Healthcare policy.?

Here’s a quick review of what we know so far about the key appointments and priorities of Trump’s administration, organized by agency (HHS, CMS, FDA, CDC, NIH).

HHS: Department of Health & Human Services

President-elect Trump’s choice of Robert F. Kennedy Jr. as HHS Secretary is both bold and polarizing. Kennedy, best known for his last name, his environmental advocacy, and his vaccine skepticism, will bring a unique, albeit controversial, perspective to the role.?

RFK Jr. has proposed declaring a national emergency on chronic diseases, which significantly impact the health and well-being of millions of Americans. Here’s what I think are the 2 most pressing (and ameliorative - meaning they can be significantly improved with targeted interventions) conditions:

1. Diabetes:

Over 37 million Americans live with diabetes, with Type 2 Diabetes being the most common form. This condition increases the risk of heart disease, kidney failure, and blindness, contributing to reduced quality of life and early mortality.

Kennedy’s focus on ultra-processed foods and dietary reform could address some root causes of diabetes, such as poor nutrition and lack of access to healthy food options.? Still various studies point out socioeconomic factors that continue to plague Americans on this front. The next section of Obesity is the most important factor for Type 2 Diabetes as well.

2. Obesity

Nearly 40% of American adults are classified as obese, making it one of the most widespread chronic conditions. Obesity is currently defined by Body Mass Index (BMI), a system that categorizes individuals based on weight and height. According to BMI standards:

• Normal weight: Below 25 (underweight is below 18.5)
• Overweight: 25–29.9
• Obese: 30 or higher
• Morbidly obese: 40 or higher

While BMI is widely used, it is not without flaws. Critics point out that it fails to account for differences in muscle mass, body composition, or racial and ethnic variations. However, in extreme cases, such as morbid obesity, the health risks are clear and not easily explained away by these nuances.

Movements like HAES (Health at Every Size) have sought to challenge weight stigma and promote body positivity, but they often conflate these goals with rejecting BMI entirely. While BMI has its limitations, it can be a useful tool at both ends of the scale for identifying health risks in the general population. Any logical person can distinguish between an athlete, bodybuilder, or an obese person, even if their BMI values are similar.

Ilona Maher, as a recent example, is an Olympic rugby athlete who is 5’10” and 200 pounds. Her BMI would place her in the “overweight” category (29+), but her exceptional fitness and performance clearly defy this classification. No credible doctor would label an active Olympian as out of shape, despite the technical BMI classification.

Getting back to the point, Obesity is a significant risk factor for chronic conditions like diabetes, heart disease, reducing life expectancy.?

Perhaps there will be some systemic changes to address Obesity, but cultural and socioeconomic factors play more into this than medicine at this point.? There’s no ointment, cream, nor poultice that can… oh wait Ozempic exists.

In addition to the expensive injection that has been showing great results for weight loss, expect:?

1. Improved food labeling to help consumers make informed decisions (spoiler alert: they won’t make better decisions)
2. Stricter regulations on food additives and ultra-processed foods. (We just saw Red dye No. 3 banned this month, Maybe Yellow No. 5 is next!). Note: Despite being banned the dye will be available for years to come as food makers have until Jan 2027 to remove it and drugmakers until Jan 2028.
3. Public education campaigns emphasizing healthy eating and physical activity (I think this will look good on paper and spend a lot of money but results will be minimal). There's not much skepticism that eating less/working out will make you lose weight - people know this but it is difficult to motivate them to do it.

I’ve intentionally left out financial numbers, focusing only on the disease states, but chronic diseases are important to try to curb because they cost a lot of money down the line as well, when these risk factors become active issues.

The last thing to mention is Kennedy’s history of vaccine skepticism. His nuanced statements claim that he supports informed choice rather than outright opposition, but without a voice to quell concerns about vaccine trust I expect vaccination rates to decline and more preventable diseases to reemerge.? For his part, President Trump has said that the Polio Vaccine was great, the disease is terrible and he remembers people in his life affected by the disease.

HHS leadership under Kennedy will be navigating a $1.8 trillion budget and overseeing pivotal agencies that affect the lives of hundreds of millions of Americans. Whether this will lead to a healthier nation or spark more division remains to be seen.

CMS: Centers for Medicare & Medicaid Services

Dr. Mehmet Oz has been nominated as the Administrator of CMS, which pundits believe signals a shift toward privatized care models, but I mean, MORE towards private?? Is that just from the frying pan into the fire?

He’s a real-life surgeon and TV Personality and his priorities likely include:

• Medicare Advantage to all Americans - man I absolutely hate this.? It takes a message like Bernie Sanders’ Medicare for All (expand existing Medicare slowly by lowering the age to 60, then 55, then 50, then everyone for example), and basically hands all power back to insurance companies.? Well, like I said they already have all the power so I guess it's just a new avenue for the same stuff.?
• More partnerships with private insurers in care delivery.??Will this close gaps? Improve care? Maybe. Will it increase profits? Oh I bet it does.

He’s not a “bad guy” or anything, but his close ties, including financial interests in managed care companies, make me think he’s going to make himself even richer with this appointment. This likely comes at the cost of Americans.? Private Healthcare is already a terrible endeavor for Americans as we saw the people REJOICE publicly when a Healthcare Executive was assassinated in cold blood last month.? Don’t expect things to get better on this front.

FDA:? U.S. Food and Drug Administration

President-elect Trump’s choice for FDA Commissioner, Dr. Marty Makary is a pancreatic surgeon, professor, and advocate for transparency in healthcare. He is most well known for his critique of overprescribing medications and the regulation of food safety.? Here’s what I think he’ll focus on:

1. Food Safety and Pesticides - Dr. Makary has been outspoken about the risks associated with pesticides and “ultra-processed” foods. Under his leadership, the FDA could strengthen oversight of food production and promote regulations aimed at reducing harmful additives and chemicals in the food supply.
2. Telehealth and Drug Accessibility -? He was the chief medical officer at a telehealth startup, so virtual care and remote prescribing of medications, including Ozempic for weight loss should become easier. His appointment also should bring integration of telemedicine into FDA policy, improving access to essential drugs for underserved populations.
3. Vaccine Oversight - Again, a kind of borderline vaccine guy trying to appease both sides: “Although not opposed to vaccines…” Dr. Makary has raised questions about vaccine policies, including mandates and schedules for children. This nuanced stance may influence the FDA’s approach to balancing public trust with evidence-based vaccination guidelines.
4. Prescription Drug Oversight - Dr. Makary has advocated for reducing unnecessary prescriptions, suggesting that the FDA could play a larger role in curbing the overuse of medications that don’t add significant value to patient care. This aligns with broader calls for reform in the pharmaceutical industry to prioritize safety and efficacy over profits.? I like this especially inpatient, maybe reducing things like C.Diff also.??

For outpatient, I think televisits will be eventually usurped by just text messaging, maybe with the help of AI, so doctors can evaluate and ePrescribe acute cases needing standard antibiotics like Amoxicillin or Augmentin (and help with complex pediatric dosage).?Not everyone is in a chat group for fantasy football that includes a pediatrician friend that I just message my son's weight to get accurate dosage for antibiotics.

As the FDA continues to oversee food safety, drug approvals, and medical device regulations, Dr. Makary’s tenure could reshape the agency’s priorities toward a more consumer-centered approach while balancing public health advocacy and industry interests.

CDC: The Centers for Disease Control and Prevention

Dr. David Weldon's appointment as CDC Director signals a potential shift toward more conservative public health priorities. As a former Republican congressman from Florida (1995-2008) and a practicing physician, Dr. Weldon brings a background in health policy and clinical care. However, his nomination has drawn attention due to his past advocacy for studying a now-debunked link between vaccines and autism, supposedly aligning him with the vaccine skepticism associated with RFK Jr. 's views.? Here’s where he’ll probably focus:

1. Vaccines: This is the hot-button topic here as well.? Dr. Weldon will aim to rebuild public confidence by promoting "transparency and informed choice" in vaccine policies.? This will cause issues given his historical skepticism about certain vaccine components like thimerosal, which he once linked to autism despite overwhelming scientific consensus to the contrary.??
2. Chronic Disease Prevention: Similar to what I wrote for HHS, expect an emphasis on lifestyle changes and public health campaigns targeting conditions like obesity, diabetes, and heart disease. His experience in medical practice may lead to a more focused approach on prevention through personal responsibility and community health initiatives.
3. Pandemic Preparedness: With lessons from the COVID-19 response, Dr. Weldon will potentially prioritizing state-level decision-making and updating protocols to ensure better preparedness for future pandemics.
4. Conservative Reproductive Policies: Weldon's stance on reproductive health has been notably conservative. During his time in Congress, he was known for his pro-life positions, notably authoring the Weldon Amendment, which allows healthcare providers to refuse participation in abortion-related activities based on moral or religious objections. This amendment reflects a policy that could influence the CDC's approach to reproductive health issues, emphasizing "conscience" or "religious freedom" over patient access to certain services.

Dr. Weldon's appointment as CDC Director will usher in a new conservative flex into the CDC, affecting policy from top to bottom. With public trust in all government institutions at a critical juncture, Weldon faces the challenge of balancing public health priorities with political pressures while addressing pressing national health crises

Expect a shift towards policies that align more closely with conservative values on health, possibly impacting areas like reproductive health, chronic disease management, and how the CDC communicates with the public on sensitive topics. This could mean a stronger emphasis on individual responsibility in health, skepticism towards certain established medical practices, and perhaps a reevaluation of how the CDC allocates resources or sets health guidelines, particularly in areas where conservative viewpoints differ from established scientific consensus.

NIH: National Institute of Health

Dr. Jay Bhattacharya, a Stanford health policy expert with a history of challenging mainstream public health strategies, has been nominated to lead the NIH. Known for his role in co-authoring the Great Barrington Declaration, which advocated for focused protection during the COVID-19 pandemic, his appointment signals a potential shift in the NIH’s approach to fostering scientific discourse and setting research priorities. Here’s Where he’ll probably focus:

1. Encouraging Open Scientific Debate:? Bhattacharya has long advocated for fostering an environment where alternative and minority scientific views can be explored without fear of dismissal. Under his leadership, the NIH could prioritize funding research that challenges the status quo, particularly in controversial areas like public health policy. He may also work to revamp peer review systems to ensure greater inclusivity for unconventional studies, providing a platform for ideas that might otherwise be overlooked.?
2. Chronic Disease and Preventive Medicine:? With chronic diseases affecting millions of Americans, Bhattacharya is likely to prioritize research into cost-effective treatments and prevention strategies, potentially incorporating personalized medicine and community-based care.
3. Aging Populations and Economic Impact:? As the U.S. population continues to age, he may direct NIH resources toward understanding the long-term economic effects of aging on healthcare systems and social services. This could inform policy decisions aimed at creating sustainable models for an aging society.

What It Means:

Dr. Bhattacharya’s tenure at the NIH could redefine its role as a platform for diverse scientific voices, fostering new ideas and research approaches. However, I feel that prioritizing debate without clear boundaries just leads to public confusion or outright refusal to trust in institutions. His challenge will be to strike a balance - encouraging discourse robust enough to find new solutions that are dismissed by the status quo scientists, while ensuring the NIH remains a beacon of evidence-based research and scientific integrity.

Ultimately, Bhattacharya’s leadership has the potential to bring innovative perspectives to health policy and research on aging and chronic diseases. Whether this leads to meaningful breakthroughs or sparks further division and indecision will depend on how his vision is executed.

Surgeon General:

Unlike the major institutions like HHS or the CDC, the Surgeon General is just one person, but their influence can be significant as the public face of health advocacy in the U.S. While the office lacks the institutional power of larger agencies, the Surgeon General can shape national conversations and set the tone for public health priorities. Dr. Janette Nesheiwat will be fulfilling this role, she’s a frontline physician with global crisis experience and is known for her public health advocacy and practical, hands-on approach.

Her agenda emphasizes strengthening preventive medicine efforts, addressing health disparities, and promoting vaccination programs. By focusing on prevention and equity, she brings a patient-centered perspective that could resonate with the public and healthcare providers alike, helping to bridge gaps in care and improve health outcomes nationwide.?

While her role may not carry the weight of an institution, Dr. Nesheiwat’s leadership could set a strong example for addressing the country’s most pressing health challenges.

Final Take

The Biden administration focused on strengthening the ACA (Obamacare), expanding access, and responding to a pandemic. Trump’s team, by contrast, seems poised to tackle chronic diseases, rethink public health systems, and encourage debate on long-standing healthcare practices.

While some appointments could foster innovation, others raise concerns about public trust, conflicts of interest, and the direction of scientific progress. For those of us in healthcare, this is a critical moment for adapting to this change.

What do you think about the incoming administration’s healthcare agenda? Will it lead to meaningful reform, or create new challenges?? I think probably a little of both.