Trump 2.0.

Trump 2.0
Does the new administration intend to make American health better? A more commonsense approach is to make improvements, not chaos.
In 1994, Newt Gingrich, leading a new and immodest Republican congressional majority, tried to cut government down to a new size. What he found—although he didn’t know it, or at least wouldn’t admit to it in the first days of this new power—was that many of the government programs he despised had large Republican constituencies. For instance, Food Stamps, the program he believed supported the weakest and least self-sufficient of Americans, was likely feeding at least as many Republican voters as Democratic ones. In addition, Big Agriculture and the food processing industry (many of which are based in what we now consider to be “red” states) were dependent on the income from the Food Stamps program, so their lobbyists fought against cuts. Most of Gingrich’s dream, burn-down-the-house plans couldn’t get passed by Congress. That outcome may be in the cards again with the incoming administration thwarted by competing interests. Yet for public health—as both a set of institutions and as an outcome tied to government function—the next several years promise to be rocky.
The second Trump administration could, in the name of “efficiency,” cut programs blindly, trying to hack up the “deep state” by laying off thousands of employees and gutting the social safety net. Like Gingrich, eventually the Project 2025-inspired Trump administration may be forced to reinstate some government agencies and policies once they learn more about the actual costs: jobs, revenue, health, and safety, to name a few. We all want “efficiency” in our government, as well as at work and at home, but we ignore the costs at our peril.
Most Americans are convinced that the federal government is too large; we should be worried though if our new leaders, out of frustration, rage or impatience, cause irremediable destruction of our governmental capacities. Reform is difficult; slash and burn is easier. If you believe that industry, on its own, will clean its toxic waste, and never poison the ground, water, and air—basic drivers of our health—you should eliminate the EPA of course. But most of us would agree that a more commonsense approach is to make improvements, not chaos.
For those of us in public health who believe much of what government does and provides is important, an immediate concern is the fate of the administrative workforce and its elimination or substitution by inexperienced employees. We envision most federal employees going to work in palatial buildings in Washington, D.C. However, the vast majority of the Federal government workforce is scattered across 50 states. Wholesale lay-offs would occur not only in the District of Columbia, but across the country, affecting our neighbors and communities.
An additional worry for those of us who believe in the work of government (even without its perfect efficiency) is that the incoming administration will make unreasonable demands, possibly even illegal, of its workers. While the President is essentially immune from prosecution, the bureaucracy and its workers are not. Many of these workers will be put in difficult spots going forward, asked to do actions that will have no legal protection once this administration passes. It may be hard to do the right thing.
The question for us at SPH is – does the new administration intend to make American health better? And if so, how? Where amidst the early proposals will improvement come from? Emotions are already running high. Many good minds are tired, even now. For those who believe that destructive attacks on government are cyclical, we may be about to enter a low point, just as we were thirty years ago. We in public health schools must hope and advocate for, case by case, discrete and particular decisions by the new leaders at FDA and CDC that are based on evidence, and not politics. We will continue to provide data that is truthful. When we disagree how this data is used, or misinterpreted, we will say so. Some argue that there will be changes that ultimately benefit public health that only could have been done by a truly disruptive administration. Thus far Trumpism 2.0 has been a style and a story; now we will see the policies played out.
George Saunders in his short story Love Letter writes, “History, when it arrives, may not look as you expect.” It is hard to know what to expect tomorrow when the nameplates outside the office doors change. But we will be looking.
Michael Stein, MD
Dean Ad Interim
Boston University School of Public Health
mdstein@bu.edu
Previous Public Health Matters are archived at: https://www.bu.edu/sph/news/articles/category/public-health-matters/
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