The Long Roots of Trump’s Assault on Public Health

Of all the slash and burn terminations U.S. President Donald Trump and billionaire Elon Musk are inflicting on public agencies, few will have a more far-reaching, devastating impact than the frontal assault on Americans' health, safety, and living standards.

Dr. Georges Benjamin, head of the American Public Health Association, warned that the shock and awe cuts of Health and Human Services (HHS) staff—a 25% decimation—and programs, "will increase the morbidity and mortality of our population, increase health costs, and undermine our economy." It also advances a decades-long dream of the far-right.

For half a century, extremist libertarian, corporate, and Republican ideologues have sought demolition of public safety net programs, regulations, and reforms, and elimination of personnel to carry them out. But it has required the authoritarian collaboration of Project 2025, Trump, Musk, and HHS Secretary Robert F. Kennedy Jr. to begin to implement this program.

"It is clear to union nurses that the goal of this administration and congressional Republicans is not to improve health, but to slash services and ultimately privatize the goods and services that are meant to serve all of us, so that their billionaire donors can boost their profits."

Public protests and legal challenges were already underway as the first round of layoffs and forced retirements undermined healthcare. The widespread scope of the latest mass firings, especially at the National Institutes of Health (NIH), Food and Drug Administration (FDA), and Centers for Disease Control and Prevention (CDC), reinforces the urgency of a response.

It included the agencies responsible for medical research, tracking disease, drug approvals, and regulating food safety, said TheAssociated Press. The Bullwark's Sam Stein termed it "an absolute bloodbath" with a "generation of scientists, healthcare officials being wiped out," Common Dreams noted.

Union officials said CDC layoffs eliminated programs focused on smoking, lead poisoning, gun violence, asthma and air quality, and occupational safety and health, AP added.

Entire departments studying chronic diseases and environmental protections were gutted, The New York Times reported. Officials responsible for minority health and infectious disease prevention were told their offices were being eliminated. HIV prevention was a target. Funding cuts for the healthy aging program apparently eradicated the government's Alzheimer's program, noted Rachel Maddow. Layoffs also hit people working on bird flu and measles.

The cruel spirit of the actions was evidenced by ultimatums given to multiple health experts to relocate to remote areas of the continent from Indian Health Services territories to Alaska. Or leave their jobs, in malicious messaging characteristic of Trump's reign, as voiced by Commerce Secretary Howard Lutnik that only "fraudsters" would complain about Social Security recipients losing their earned monthly checks. Among them were directors at the National Institutes of Health and the directors of the National Institute of Allergy and Infectious Diseases and the National Institute of Nursing Research.

"The FDA as we've known it is finished, since most of the leaders with institutional knowledge and a deep understanding of product development and safety no longer employed," former FDA Commissioner Robert Califf wrote on LinkedIn. Dr. Georges Benjamin, head of the American Public Health Association, said the HHS cuts, paired with an $11 billion cut in funding to state and local health departments announced this week, "will increase the morbidity and mortality of our population, increase health costs, and undermine our economy."

"It is clear to union nurses that the goal of this administration and congressional Republicans is not to improve health, but to slash services and ultimately privatize the goods and services that are meant to serve all of us, so that their billionaire donors can boost their profits," said National Nurses United.

"From a policy perspective, the changes initiated at HHS by the second-term Trump administration are far-reaching. Since coming to office, the Trump administration has aggressively sought to reshape the U.S. public health agenda," wrote Simon Haeder, Texas A&M University public health professor.

In addition to the mass firings, the Trump administration is pursuing plans to weaken the Affordable Care Act and challenge state programs focused on health disparities. And the House is moving forward with its plans to devastate Medicaid with up to $880 billion in cuts to help pay for its $4.5 trillion tax gift for billionaires.

The scheme is particularly manifest in plans to roll back numerous regulations on "everything from clean water to safe vaccines," Haeder emphasizes. "Regulation has emerged as the most prolific source of policymaking over the last five decades, particularly for health policy...Vast cuts to the HHS workforce will likely curtail this capability, resulting in fewer regulatory protections for Americans... With fewer experienced administrators on staff, industry influence over regulatory decisions will likely only grow stronger."

Putting 'Democracy in Chains'

Corporate titans and the libertarian far-right have long pushed deregulation and privatization. In her seminal work Democracy in Chains, historian Nancy MacLean profiles right-wing economist James M. Buchanan who for half a century promoted a definition of "liberty" that insulates private property rights from government. Through his "public choice theory," for which he won a Nobel Economics Prize, he condemned majority rule as self-centered voting rights that results in "overinvestment in the public sector" and subjects the minority, meaning corporations and the elite, to "discriminatory" taxation and legislation.

Buchanan established a libertarian think tank at the Mercatus Center at George Mason University, enthusiastically funded by oil magnate Charles Koch. Its goals included destroying Social Security, Medicare, and Medicaid. Buchanan showed his disdain for anyone harmed by writing that people who failed to save money for the loss of public protections "are to be treated as subordinate members of the species, akin to… animals who are dependent." Tyler Cowen, Buchanan's successor at Mercatus, MacLean notes, projected "rewriting of the social contract" that included slashing Medicaid. Compensation for a "fiscal shortfall" from the handouts to the elite, "will come out of real wages as various cost burdens are shifted to workers."

Buchanan would see his views come to fruition in Chile, MacLean notes, after Gen. Augusto Pinochet's murderous coup in 1973. It was followed by a rewriting of the country's constitution, advised by Buchanan, so that post-Pinochet the "capitalist class would be permanently entrenched in power" in which, adds Sam Tanenhaus, "labor unions were banned and social security and healthcare were privatized."

With the Project 2025 blueprint, Trump, Musk, and their Republican Party followers embracing similar authoritarian rule, that program is on speed dial. A populist uprising, which ultimately deposed Pinochet and other dictators, is the challenge to all of us. Fortunately, street protests are increasing, as is a voter response, demonstrated by the electoral trouncing of Trump and Musk's handpicked candidate for the Wisconsin Supreme Court Tuesday, a positive sign in troubled times.