“Too Important for the Games that You’re Playing, Mr. Kennedy” — Michael Bennet, Colorado

In 2022, President Trump held a news conference focused on the COVID epidemic then taking the lives of one of every 300 Americans. During it he proposed his modest solutions to the epidemic, including bringing “[ultraviolet] light inside the body” and injecting bleach into people’s veins in the hope of killing off the virus.

The ignorance exhibited by the President about the nature of disease, and about basic science itself, was so gob smacking that most of us wrote it off as another example of “Trump being Trump”—he really didn’t mean what he was saying and wouldn’t act on it. Even his science advisor, Dr. Deborah Birx, perhaps fearful of his propensity for rash actions and retribution if you crossed him, sat in stony silence when he turned to her for affirmation. We took solace that, certainly, he would be educated by those around him and not act on his “ideas.”

We soon learned that we were wrong as the President and his political allies lent their support to the rejection of basic public health advice, passing laws and reversing regulations by the Occupational Safety and Health Administration (OSHA) and other agencies that encouraged vaccination and sometimes mandated the use of masks and social distancing as a means of limiting the spread of this deadly virus.

Now that he’s been reelected, we see even greater evidence of his ignorance: the appointment of Robert F. Kennedy Jr. as Secretary of Health and Human Services, the agency that controls the Food and Drug Administration, the Centers for Disease Control and Prevention, the National Institutes of Health, and other central pillars of our public health infrastructure. Here we have someone whose past statements and actions confirm that his ideas about vaccination, the President’s Emergency Plan for AIDS Relief (PEPFAR) and worldwide AIDS prevention campaigns, and disease prevention and epidemic preparedness are manifestly off the wall. Just a snippet from his confirmation hearings gives a sense of the person the Senate is putting in charge of our vast public health infrastructure:

Senator Michael Bennet of Colorado confronted Kennedy with some of his past comments, asking if it was accurate that Kennedy had said that COVID was a “biologically engineered bioweapon that targeted black and white people but spared Ashkenazi Jews,” to which Kennedy answered that he didn’t deny saying it but that he didn’t say it was “deliberate.” When confronted with his past statements “that Lyme disease was a highly likely militarily engineered bioweapon,” he admitted that he “probably did say that.” He avoided answering whether he had said that pesticide exposures led to transgendered youth and waffled over whether he had written that “it’s undeniable that African AIDS is an entirely different disease from western AIDS.” “I’m not sure,” he responded.

Senator Bernie Sanders asked if he still believed that climate change was a hoax, to which Kennedy was unable to answer. Senators Warren, Whitehouse, and Young questioned him on a score of issues from health insurance to disease surveillance to which he gave either evasive or non-answers. Kennedy would not condemn slogans on baby clothing that discouraged mothers from trusting vaccines. Using a variety of truths and half-truths to gain some legitimacy, Kennedy turned to his history as an environmentalist suspicious of the food industry and its effect on the health of Americans to make his ideas more palatable. Under the mantle of “Putting people in charge of their own health care” he turned to popular ideas about personal freedom and responsibility to raise questions as to whether government had the authority to regulate unhealthy behaviors. Smoking was a personal decision, he maintained, and might mean that a smoker is not entitled to the same level of insurance as a non-smoker.

He seemed to make a point when he argued that thousands of chemicals, dyes, and ultra processed foods in our food supply were a root cause of chronic diseases from obesity and diabetes to autoimmune disease.  And in “educating” the population and asking for “more testing” as reasons to not commit to vaccinations and other science. While not having any trouble “linking antidepressants [rather than the availability of guns] to school shootings,” when it came to women’s reproductive technologies, he demanded “that our science [be] gold-standard science,” i.e., more (and more and more) testing of proven contraceptives and mifepristone before making them available to women.  Since there is a “high level of uncertainty in science,” he argued, “we need to tell the public what we don’t know.” Public health agencies “haven’t been trustworthy” and infectious diseases aren’t a big problem.

As we reflect on the sad spectacle of the Senate confirmations hearings, it is worth looking back to see how we got to this place. It’s clear that the destruction of the health infrastructure is part of a larger effort to dismantle the institutions of the modern American state, which the political right sees as the “liberal” post-World War II agenda. It is an effort that once had some intellectual and political logic but which has in recent years become unhinged, losing connection with whatever philosophical and intellectual base it once had.

In our new book, Building the Worlds that Kill Us: Disease, Death and Inequality in American History, Gerald Markowitz and I review some of the history of the post-World War II decades that led us to this dismaying point where science is questioned, our elected officials see health as a political football to be used for their partisan ends, and where peoples’ suffering is but collateral damage in a broader war. While Republican policies have always targeted African Americans and the poor, arguing that social service programs like Social Security and Medicaid took away their incentive to work, promoting laziness and the like, attacks on their health generally have been indirect. However, since the beginnings of the Tea Party in 2007 and the destruction of traditional conservative attitudes among the conservative political establishment, their policies on all levels, but particularly with respect to health, have become unhinged.

How Did We Get Here?

In the early 1970s, with the establishment of OSHA and the Environmental Protection Agency (EPA) and the movement for distributive justice in health care, a corps of relatively young activists went about their work with an enthusiasm and energy that sent shivers up the spines of many corporate leaders. What had seemed like abstract and distant threats to the autonomy of industry suddenly became quite real and palpable. Some conservatives saw this as part of a larger attack on capitalism itself.

A 1969 New Yorker article by Charles Reich, called The Greening of America, opened with the words: “There is a revolution under way.” The article spelled out how the greater regulation in health care was, as conservatives feared, part and parcel of the efforts to stop the war in Vietnam, end poverty and racism, oppose the war machine, regulate technology, and execute control over corporate power.

The modern corporate state with its imperative on profit, was destroying democracy itself, by putting the environment, workers, and consumers at special risk, he argued. As Reich explained, “a manufacturer would dump wastes into a stream but pay nothing to take care of the pollution, leaving the public to share in the costs but not the profits.

In response to the perceived threat to free enterprise that Reich articulated, Lewis Powell wrote a detailed memo in 1971, shortly before he was nominated to become a Supreme Court Justice. The memo was addressed to the Education Committee of the U.S. Chamber of Commerce and began, “No thoughtful person can question that the American economic system is under broad attack.” Powell argued that the critiques of capitalism were coming from “college campuses, the pulpit, the media, the intellectual and literary journals, the arts and sciences, and from politicians….” Powell then laid out a plan to counteract this “threat.” Corporations and businesses must wage war in the halls of Congress and the political arena. They must reorient the intellectual life of the nation to ideas consistent with business beliefs by supporting conservative scholars in the social sciences  and creating a system for evaluating, and censoring, textbooks based on their adherence to traditional American business beliefs. He suggested the establishment of think tanks as an alternative to the university, which had been captured by the left, where a coherent conservative ideology could be established, where lobbying and political pressure on Congress could neutralize the liberal agenda, and muster crass political power to stymie legislative and popular efforts of regulatory and environmental reform.

In short order, several think tanks (still powerful today) were founded in the 1970s to roll back progressive reform efforts and to create an intellectual and political cadre to “protect” free enterprise and promote libertarian ideas and anti-government ideologies —the Cato Institute (1974), the Heritage Foundation (1973), the Ethics and Public Policy Center (1976), the Manhattan Institute (1977), and the Free Congress Foundation (1977).

Industry also heeded Powell’s call to arms. Over the next decade, sophisticated efforts were made to reshape American attitudes and political power. OSHA and the EPA were seen as institutional manifestations of the broader attack on “free enterprise.” The trade associations of the business community, feeling their profits in danger, set about undermining the EPA and OSHA. For example, the asbestos, chemical, and plastics industries, as well as the automobile and petroleum industries, began to lobby Congress, to attack critics, and to pillory science and scientists it objected to. OSHA, in particular, was attacked as a prime example of government intrusion into the “free market” system and a purported cause of the economic downturns of the 1970s and early 1980s.

At first, industry’s response to the threat of regulatory action was defensive and fairly disorganized—sometimes it tried to cooperate with OSHA, but more often it lobbied for industry-friendly standards, attacked the whistle blowers who reported on safety violations, and dismissed and flouted the authority.

With the election of Ronald Reagan, the fight to undo the work of OSHA and the EPA became political.  Reagan appointed Thorne Auchter, owner of a Florida construction company, as head of OSHA and Anne Gorsuch, a Colorado attorney, as head of the EPA. They both began campaigns to undercut their own agencies by reducing their budgets and staffs and limiting their regulatory efforts, leading to general demoralization and limited regulatory efforts.

By the early 21^st century, the give and take between industrial interests as represented in the Republican Party and the more traditional liberal views had frayed. With the advent of the Tea Party, populist elements in the right gained greater attention and were characterized by a deep antagonism to government itself.  Soon it would morph into the type of anarchic efforts not only to limit the strength of what had been identified as the anti-business “left” but also, by the second decade of the new century, attacks on the government itself. It was no longer a movement to limit the EPA or OSHA, or the overreach of the liberal state, but was now aimed at virtually every aspect of political established power. That is the origins of Trumpism and its seemingly random and destructive efforts to dismantle all government institutions, whether health related or not.

We’re barely one month into the new administration and we can already feel the weight of the inchoate agenda that Trumpism represents. Every day, we learn of new attacks on all the structures of the postwar liberal state: the dismantling of the USAID program, the attack on the FBI, the tariffs aimed at our closest trading partners, the appointment of unelected billionaires to positions of power without the assent of Congress, and many other efforts large and small. For the most part, these activities will not directly undermine the health of the nation. While high tariffs may not directly lead to deaths and illness, it is clear that the appointment of Robert F. Kennedy Jr., Dr. Oz, and their ilk to the CDC, FDA, EPA and other health agencies in the Department of Health and Human Services will.

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