Bulwark Takes: Will RFK Jr's Make America Healthy Again Get People Killed?
Release Date: March 31, 2025
In this compelling episode of Bulwark Takes, host Sam Stein engages in a critical dialogue with Jonathan Cohn, a newly minted member of the FAM and author of "When Make America Healthy Again Actually Means the Opposite," published in his latest newsletter, The Breakdown. Together, they dissect the alarming shifts within the Department of Health and Human Services (HHS) under Secretary Robert F. Kennedy Jr., scrutinizing the potential ramifications for America's public health landscape.
1. Scaling Back the Department of Health and Human Services (HHS)
Jonathan Cohn opens the discussion by outlining the Trump administration's broader agenda impacting federal agencies, with a particular focus on the HHS. Beginning in February, the administration initiated sweeping job cuts, eliminating all probationary employees and embarking on a second round of significant reductions.
"Secretary Robert F. Kennedy, Jr. announced a major overhaul of the entire department, which will include not just significant job cuts... reducing the agency from 80,000 employees to 60,000 employees. That's a 25% cut." [02:14]
These reductions are not merely numerical but also structural. Kennedy plans to consolidate smaller agencies within HHS into a single entity, ostensibly to enhance efficiency. However, Cohn expresses skepticism about the effectiveness and intention behind these moves.
"This is not what is happening here. This is not some thoughtful exercise." [03:18]
2. The Role and Impact of SAMHSA in the Opioid Epidemic
The conversation shifts to the Substance Abuse and Mental Health Services Administration (SAMHSA), a pivotal agency in combating the opioid crisis. Cohn details SAMHSA's origins in the early 1990s and its expanded role over the past decade in response to the escalating opioid epidemic.
"SAMHSA is now, through a series of laws... put a lot of federal money behind these efforts." [05:51]
Key functions of SAMHSA include administering grants to states, conducting the National Survey on Drug Use and Health, and providing training and support to regional offices. These efforts have been instrumental in the recent decline in overdose deaths, which Cohn attributes to comprehensive federal initiatives.
"Making sure that Narcan gets to everybody... which is a game changer." [12:47]
However, the impending cuts threaten to dismantle these critical structures. Cohn warns that reducing staff and closing regional offices will disrupt the essential dialogue between federal agencies and local communities, undermining data collection and effective policy implementation.
"It's going to be harder to do that... it's just going to be harder to do that." [07:45]
3. Diminishing Progress in the Opioid Fight
Reflecting on the progress made, Cohn acknowledges the significant strides in reducing overdose deaths over the past two years. However, he raises concerns that the current administration's rollback could reverse these gains.
"A lot of the federal government has really ramped up all this support... a lot of that is SAMHSA, and a lot of that is their guiding this." [12:56]
Stein parallels this issue with broader governmental shifts, noting a trend away from empathetic approaches towards more punitive measures.
"It's like, how much is healthcare in terms of our GDP? What is it? It's getting close to 20." [04:11]
This shift not only jeopardizes ongoing efforts but also signals a departure from the compassionate policies that initially garnered bipartisan support.
4. RFK Jr.'s Reorganization and Its Implications
Under RFK Jr.'s leadership, the reorganization of HHS is not just a bureaucratic reshuffle but a pivot with profound consequences. Cohn highlights Kennedy's anti-vaccine stance and his strategic moves to undermine public health initiatives.
"In 10 different ways, he is just reorienting our public health infrastructure away from vaccines." [18:57]
Cohn critiques the administration's opaque decision-making processes, noting the lack of communication with HHS staff and the abrupt implementation of job cuts without clear directives.
"There was no notice, not even like." [07:45]
The removal of key figures, such as Peter Marks from the FDA, underscores a broader agenda to weaken regulatory oversight, raising alarms about vaccine safety and drug regulation.
"He's just reorienting our public health infrastructure away from vaccines." [18:57]
5. Broader Consequences and Lack of Industry Pushback
One of the most striking observations in the episode is the surprising silence from major stakeholders, particularly Big Pharma, in response to these disruptions. Despite the pharmaceutical industry's vested interests in robust public health infrastructure, there is minimal resistance to the administration's dismantling efforts.
"The pharmaceutical industry would, like, freak out." [21:05]
Cohn speculates that this silence may be strategic, allowing the administration to enact long-term changes without immediate backlash. Additionally, cuts to the National Institutes of Health (NIH) and other research entities threaten to stifle innovation, potentially driving scientific talent away from the United States.
"This could really wreck the American ecosystem for developing new medical treatments." [20:29]
6. Conclusions and Final Thoughts
As the episode draws to a close, Stein and Cohn express deep concerns about the future of America's public health systems. The dismantling of SAMHSA, HHS, and other critical agencies under RFK Jr.'s leadership not only threatens to reverse the progress made in combating the opioid epidemic but also endangers the broader landscape of medical research and public health.
"This is when you mentioned the Wall Street Journal editorial... where are these interest groups who would, in theory, you know, want to push back strong against some of this stuff?" [19:08]
The hosts urge listeners to stay informed and engaged, highlighting the urgent need to address these policy shifts to safeguard public health advancements.
Notable Quotes:
- "We're going to do more with less." – Robert F. Kennedy Jr., Secretary of HHS [07:28]
- "It sent the message that we realize that this is a human tragedy and that people need help." – Jonathan Cohn [15:20]
- "He's just reorienting our public health infrastructure away from vaccines." – Jonathan Cohn [18:57]
Key Takeaways:
- The Trump administration's ongoing efforts to reduce HHS's workforce and consolidate agencies are deeply impacting public health initiatives.
- SAMHSA, a cornerstone in the fight against the opioid epidemic, faces significant cuts that could derail progress made over recent years.
- RFK Jr.'s leadership has introduced policies that undermine vaccine safety and drug regulation, signaling a regression in public health priorities.
- The lack of opposition from influential sectors like Big Pharma raises questions about broader systemic challenges and the future of healthcare innovation in the U.S.
- The episode underscores the critical need for vigilant advocacy to protect and advance public health infrastructures against detrimental policy shifts.
For a deeper dive into these issues, listeners are encouraged to subscribe to Jonathan Cohn's newsletter, The Breakdown, and explore the full article, "When Make America Healthy Again Actually Means the Opposite."