Health Fascism and the Anti-State State
In this special presentation, Beatrice and Artie discuss the damage done by the first year of Trump's agenda to "Make America Healthy Again," how the state's relationship to health is changing, and what it means for political movements today.
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Transcript by Kendra Kline. (Kendra is currently accepting freelance transcript work — email her if you need transcripts or visit her website)
[ Intro music ]
Beatrice Adler-Bolton:
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I’m Beatrice Adler-Bolton and I’m here with my cohost, Artie Vierkant.
Artie Vierkant:
Hello.
Beatrice Adler-Bolton:
And we have a very special episode today, one we’ve been working on for a while.
This is: 2025, Year of Health Fascism and the Anti-State State
I’ll let Artie take it away.
Artie Vierkant:
The last year has been emblematic of what we could call a “eugenic turn.”
You see it in pop culture—
[ CLIP ]
Sydney Sweeney: Genes are passed down from parents to offspring, often determining traits like hair color, personality and even eye color. My jeans are blue.
Advertisement voice over narration: Sydney Sweeney has great jeans.
Artie Vierkant:
You see it in industry—
[ CLIP ]
News Anchor: While the race for A.I. captures all of the headlines, there’s another one quietly brewing between silicon valley executives. The race to create a bio-engineered human being. A child. The Wall Street Journal has some extraordinary reporting out that a small company backed by none other than OpenAI chief Sam Altman has spent months pursuing a secret project for a genetically engineered baby.
[ CLIP ]
Kian Sadeghi, CEO Nucleus Genomics [note: a separate and unrelated company from the competing genomics startup funded by Sam Altman]: I’m so excited today to announce the launch of Nucleus Embryo, a genetic optimization software that helps parents give their children the best possible start in life. This announcement also marks the first time a company has openly partnered with a couple to help them optimize their embryos based on intelligence.
Artie Vierkant:
You see it in the media—
[ CLIP ]
Fox News Correspondent Lawrence Jones: They have given billions of dollars to mental health and the homeless population. A lot of them don’t want to take the programs. A lot of them don’t want to get the help that is necessary. You can’t give them a choice. Either you take the resources that we’re going to give you, or you decide that you’re going to be locked up in jail. That’s the way it has to be now.
Fox News Correspondent Brian Kilmeade: Or, uh, involuntary lethal injection.
Fox News Correspondent Lawrence Jones: Yep.
Fox News Correspondent Brian Kilmeade: Or something. Uh, just kill them.
Fox News Correspondent Ainsley Earhardt: Yeah, Brian, why did it have to get to this point?
Fox News Correspondent Brian Kilmeade: Right.
[ CLIP ]
Free Press Staff Writer Olivia Reingold: So you’ve probably seen these photos of skeletal kids in Gaza on front pages, all over social media, even in a UNICEF ad, they’ve become the symbols of famine. But we decided to look into these photos and the stories behind them, and what we found is that in case after case, these kids were sick, but not just with malnutrition. In every instance they were suffering with other conditions or illnesses.
Artie Vierkant:
And you see it, especially, in the state
[ CLIP ]
CMS Administrator Mehmet Oz (“Dr. Oz”): And it is your patriotic duty. I’ll say it again. The patriotic duty of all Americans to take care of themselves. Because it’s important for serving the military. But it’s also important because healthy people don’t consume health care resources.
[ CLIP ]
White House Press Secretary Katoline Leavitt: So when an illegal alien goes to the emergency room, who's paying for it? The American taxpayer.
[ CLIP ]
Secretary of Health and Human Services Robert F. Kennedy Jr. (hereafter RFK): President Trump has promised to restore America's global strength and to restore the American dream, but he understands that we can't be a strong nation when our people are so sick. A healthy person has 1000 dreams. A sick person has only one.
[ CLIP ]
Mehmet Oz: A healthcare cost per person in this country is twice that of other developed nations … [cut] Why is it costing us so much? Because of chronic disease, and those chronic diseases—and we made it easy to be sick in America—are linked to poor lifestyle choices
[ CLIP ]
Secretary of Commerce Howard Lutnick: Let’s say Social Security didn’t send out their checks—
Interviewer: Mhm.
Secretary of Commerce Howard Lutnick: —this month. My mother in law who’s 94, she wouldn’t call and complain.
Interviewer: Mhm.
Secretary of Commerce Howard Lutnick: She just wouldn’t. She’d think something got messed up, and she’ll get it next month.
Interviewer 2: Yeah.
Interviewer: Mhm.
Secretary of Commerce Howard Lutnick: —A fraudster, always, makes the loudest noise, screaming, yelling and complaining.
Interviewer: Mm.
[ CLIP ]
News Anchor: HHS plans to bar hospitals and doctors from providing puberty blockers, hormone therapy, and surgeries as a condition of participating in Medicare and Medicaid.
[ CLIP ]
President Trump: Don’t take Tylenol. Don’t give Tylenol to the baby. … [cut] Break it up. Because it’s too much liquid. Too many different f— things are going into that baby, at too big a — at too big a number. The size of this thing when you look at it.
[ CLIP ]
RFK: We are the sickest country in the world. That's why we have to fire people at the CDC. … [cut] And we are going to end the chronic disease epidemic. … [cut] because it's chronic disease that is bankrupting us and destroying our national security.
Artie Vierkant:
Now, to be clear: this turn did not occur out of nowhere. Over the last few years on Death Panel we’ve chronicled how a rhetoric of disposability has pervaded public life. And we’ve focused, specifically, on how the state response to the pandemic has acted as an accelerant to that shift: in everything from Paul Alexander, a science adviser to Trump’s first term, urging a top health official in 2020 that “Infants, kids, teens, young people, young adults, middle aged with no conditions … we want them infected” with covid — to former CDC director Rochelle Walensky, at the height of the Omicron wave in January 2022, dismissing covid deaths as only among “people who were unwell to begin with.”
And part of the reason we were so quick to identify those aspects of the covid response is because one of the main reasons we started Death Panel was to intervene in what we saw as, already, before the pandemic, a deeply violent culture around health and disability that frames the ill as a financial burden to society, and even as a threat to the human species itself. Throughout the 2010s, for example, some circles of academic health policy were focused on identifying so-called “super-utilizers”—people with chronic illnesses or disabilities that tend to encounter the healthcare system more frequently than other people. A 2011 essay for The New Yorker by physician, writer, and later senior official at USAID, Atul Gawande, illustrated this idea of the “super-utilizer” with a photograph of a man, wrapped head to toe in bandages, with a price tag hung around his neck — $3,500,000.
This kind of pervasive rhetoric is what led Bea and I to write our book Health Communism, which is about how these ideas — an economic valuation of life — are part and parcel to capitalism and all capitalist societies. That health and ability being tied up in value and social worth are a key myth the state relies on to keep capitalism afloat. A fantasy of health that has always drawn its boundaries along lines of class, race, gender, madness, disability, and anything the state decides is “deviant” in a particular moment, including political beliefs.
And that this ideology has a very long, very dark history. One that, crucially, never truly went away. That we have throughout the history of capitalism only seen it expressed in different ways. Sometimes dramatically, as in our collective understanding of Nazi eugenics programs; but often we have seen it more subtly.
Which brings us back to today. If the covid response has been an accelerant, the second Trump administration is where we have caught fire.
Beatrice Adler-Bolton:
And so today’s episode is about how we are rapidly falling into the dramatic end of health fascism, and the role of the state in that shift. We’re going to be looking at how the state’s relationship to health is changing, why it matters, and what it means for political movements today.
[ Transition music ]
Over the last year, the second Trump administration has been zealously pursuing its agenda to, as it says, “Make America Healthy Again” — a promise put forward by Trump’s Health and Human Services (or, HHS) Secretary Robert F Kennedy Jr., who Trump has given a wide degree of latitude to gut the agency.
[ CLIP ]
Trump: Robert F. Kennedy cares more about human beings and health and the environment than anybody … [cut] and I’m going to let him go wild on health. I’m going to let him go wild on the food. I’m going to let him go wild on medicines.
Beatrice Adler-Bolton:
And what this has meant is that, for the first time in decades, the right has managed to create for itself an ideology around health and healthcare that has allowed it to seize the narrative on health.
And at the heart of that agenda are two things which may at first seem contradictory, but have instead come to reinforce each other in ways we’re going to unpack.
The first aspect is Make America Healthy Again — MAHA — as exemplified by RFK Jr.
A movement that points to the prevalence of disability and chronic illness in our society and labels it the product of insidious external forces: that we’ve been lied to, that we’ve been made sick by the very things that were supposed to keep us well — from vaccines to Tylenol. That none of us used to be sick, not in the ways we are now. And that this diagnosis necessitates a return to a time before modern health interventions.
But the second aspect represents the inverse. Equally shaping the right’s new politics of health fascism is the decades-old tradition of austerity politics. The cutting of social spending and healthcare programs, the pursuit of alleged “drains” on the system and the castigation of the quote unquote “welfare queen.”
[ CLIP ]
Speaker of the House Mike Johnson: Working requirements—work requirements for Medicaid. That is a—something that—public opinion polls almost 90%. You don’t want able-bodied workers on a program that is intended for example for single mothers with two small children who’s just trying to make it, that’s what Medicaid is for. Not for twenty-nine year old males sitting on their couches playing videogames. We’re going to find those guys and we’re going to send them back to work.
Beatrice Adler-Bolton:
—A politics of health that tells the public they are sick because of an internal weakness. They have simply yet to pull themselves up by their bootstraps. That in order to deserve to live in our society one has to, in the words of CMS Administrator Dr. Oz, “prove you matter.”
Again, these two ideas may seem contradictory at first: how could my illness be at once the product of a systemic conspiracy and also the product of my inability to make myself well?
But of course, in the unity of these two ideas, as we’ve seen in the state over the last year, both of these narratives about health are only allowed to come to the same endpoint:
That it is, again in the words of Dr. Oz, “The patriotic duty of all Americans to take care of themselves. Because it’s important for serving the military. But it’s also important because healthy people don’t consume health care resources.”
Or, as RFK says, that the failure of the public to be fit, normative and productive is “a national security issue.”
That when it comes to health interventions, MAHA’s deregulatory agenda isn’t taking things away: it’s preserving people’s choice to exempt themselves from things like vaccination or pasteurization or fluoridation — because in their view the healthy, those they fantasize are the inherently biologically strong, don’t need those interventions. And that making oneself strong — freeing oneself from illness and “dependency” — is a matter of personal willpower and individual choice, whether through diet and exercise or through health tips or wellness products they present as secrets the state doesn’t want you to know about.
Which is why, outside of state actors, some of the most common information you see shared among MAHA influencers is personalized health hacks. Like when MAHA influencer Jessica Reed Kraus points to her circle—what she calls her “trusted MAHA crew”—being the first to tip her off to things like “salmon sperm facials and holistic doctors encouraging us to drink our own urine for its natural antioxidants.”
But the fact that both of these strains of thought dead end in personal responsibility is part of what makes it a classic fascist formulation: it doesn’t need to internally cohere in order to propagate order and discipline. The message merely needs to remain constant.
Artie Vierkant:
And we have already seen the results of this, playing out across the state over the last year.
— Programs that provide treatments and fund research have been slashed; cuts made to public health, cuts to health, labor, and environmental regulations. One in four employees at HHS pushed out — firing some 20,000 people. Attacks on basic vaccination and the approval pathways for new vaccines — which we discussed at length in last week’s episode, Covid Year Six.
— A federal initiative, DOGE — the so called Department of Government Efficiency — which rampaged through federal agencies for months, trying to root out anyone who wasn’t willing to enthusiastically embrace the administration’s agenda, under the pretense of locating “waste, fraud and abuse”; by which they meant, programs funding services or research they didn’t like, or welfare recipients they unilaterally decided weren’t worthy of receiving benefits.
— A new federal budget that promises to strip Medicaid from millions of people and one trillion dollars out of the program, while adding work requirements that only exist to purge people from the rolls. A budget that through these Medicaid cuts will take so much money out of one of the biggest sources of health coverage in the US that entire hospitals and health clinics will close, and many that don’t will contract, deepening existing crises of under-resourcing and understaffing. Then turning around to use that funding to build one of the largest expansions of the security state in our lifetimes — set to turn ICE alone into the 16th biggest military force in the world, while the Trump administration sends ICE into hospitals.
— Major attacks on trans life and trans healthcare — from this year’s Supreme Court’s decision in Skrmetti, to Trump’s HHS manufacturing anti-trans research and threatening providers with pulling Medicare and Medicaid funding, to the fact that the One Big Beautiful Bill had a totalizing, Hyde amendment style ban on Medicaid covering trans care in it up until the very last moment — and we can’t assume they won’t circle back for it
— The return of the “public charge rule” — an unresolved piece of Trump’s first term wish list — a directive that the US will deny visas to anyone it sees as a drain on state resources, or a quote unquote “public charge” — with the State Department directing embassy and consular officials, in November: “You must consider an applicant’s health,” … “Certain medical conditions – including, but not limited to, cardiovascular diseases, respiratory diseases, cancers, diabetes, metabolic diseases, neurological diseases, and mental health conditions – can require hundreds of thousands of dollars’ worth of care.” Which amounts to a declaration by the state that the disabled and the ill are not welcome here.
— And finally: a directive from the Trump administration that involuntary commitment must be expanded. That in an attempt to quell what it calls “endemic vagrancy” — always the allusion to infectious disease, portraying the unhoused as a biological threat — that the federal government must force the mentally ill and “homeless individuals into long-term institutional settings” — an implicit call for the return of the era of the asylum; the era when as many as 559,000 people were incarcerated in state mental hospitals.
We’ll be talking about these today — but only a few at length. Because with the speed of the second Trump administration’s attacks on health, we felt it necessary to focus on the scope of the larger picture today, to try to make sense of the direction of the state.
So instead, we’re going to be talking about what’s going on behind these attacks. What does MAHA actually think it’s doing? Why are they willing to throw so much money in pursuit of what they call “waste fraud and abuse,” when it will cost them more to enforce added paperwork than they could ever possibly find in so called “fraud”? What is the structure or pattern underneath what could otherwise seem like chaos, as though they’re just taking a crowbar to anything load bearing they can find? And most importantly: how can we stop it?
[ Transition music ]
Beatrice Adler-Bolton:
But first, let’s return to the animating principle behind all of this. Let’s talk about the language behind “Make America Healthy Again.”
MAHA works, in large part, because it promises sweeping change and improved health, even when in practice what it delivers is benefit cuts, deregulation, and increased spread of contagious disease.
On the surface, MAHA sounds like it’s about healing, about fixing a broken system. Its appeal is rooted in a widespread, deeply felt experience of abandonment by our healthcare system, a system that feels extractive, cruel, expensive, and overall indifferent to everyday suffering.
People are angry, and that anger is real. But MAHA redirects it away from the structural forces that create this crisis toward conspiracy and scapegoating. MAHA is seductive because it speaks to real pain. The pain of being abandoned. But it offers no solidarity, only self-management. Not justice, only blame. Not transformation, only cruelty disguised as wellness. MAHA says: don’t change the system—change yourself. Purify your body. Deny your kid vaccines. Blame the sick for their sickness. It’s magical thinking for a carceral state.
Robert F Kennedy Jr., the figurehead of the MAHA movement, likes to portray his mission as one of transforming our healthcare system “from a sick care system to a wellness society”
And his chief culprit in pursuit of this is chronic disease—a term that, it’s important to say, he has rarely been asked to define. But we can easily deduce from his statements that his targets include a host of things that are not, in fact, diseases, or illnesses. When Kennedy waxes on about chronic disease he most often transitions into broad statements about things like autism, or about so-called “obesity.” A far cry from what this rhetoric is supposed to evoke, which could be read as an intent to address more pressing chronic conditions, like long covid or ME/CFS, or something like Crohn’s.
On November 2nd 2024, before Trump was re-elected, Kennedy told the audience at a Tucker Carlson live event that Trump had given him a broad mandate to pursue his vision for chronic disease.
[ CLIP ]
RFK: As soon as Donald Trump started talking about giving me the power, he asked me to do three things. He asked me to root out the corruption … [cut] and then he asked me to end the chronic disease epidemic in this country. And he said, I want to see results, measurable results in the diminishment of chronic disease within two years. And I said, Mr. President, I will do that"
Beatrice Adler-Bolton:
While this might all seem harmless to some, this alarmed disability activists when it happened, and for good reason. For one: there are only a few ways to dramatically reduce rates of chronic illness in a short period of time. One of the most expedient is to make it dramatically harder for the ill and disabled to live — which health policy changes over the last year have certainly threatened.
The other issue is that this is not unlike when people say they hope to quote unquote “end disability.” It raises important questions: who defines disability? What if what constitutes a disability or an illness, to you — to me is a fact of life, or a part of our natural diversity. In the past — and even today! — some have tried to portray things as simple as being gay or trans as “mental illness.” Who decides they’re not? And these questions aren’t metaphorical. Many autistic [and neurodivergent] people are engaged in a fight to stop people from referring to the way they are as a “disease.” As just mentioned, Kennedy is one of those people they have to actively fight against.
[ Transition music ]
Artie Vierkant:
Central to Kennedy’s mission to defeat chronic disease is a hallmark of fascist world building: the assertion of halcyon days of good health. This is a favorite refrain of Kennedy’s, something he’s repeated in a variety of contexts in just the last year.
For example, at his Senate confirmation hearing:
[ CLIP ]
RFK: Mr. Chairman, I had 11 brothers and sisters. I had dozens of first cousins. I was raised in a time where we did not have a chronic disease epidemic. When my uncle was president, 2% of American kids had chronic disease. Today, 66% have chronic disease. We spend zero on chronic disease during the Kennedy administration. Today we spend $4. 3 trillion a year with 77% of our kids cannot qualify for military service. When I was a kid, the typical pediatrician would see one case of diabetes in his or her lifetime, a 40 or 50 year career. One out of every three kids who walks through her office store is diabetic or pre-diabetic. The most recent data from NIH shows 38% of teens are diabetic or pre-diabetic. Autism rates have gone from 1 in 10,000 to 1 in 1500 … [cut] This is not just a economic issue, it's not just a national security issue. It is a spiritual issue and it is a moral issue. We cannot live up to our role as an exemplary nation, as a moral authority around the world, and we're writing off an entire generation of kids.
Artie Vierkant:
Later adding:
[ CLIP ]
RFK: There's no issue that should unite us more than this chronic health epidemic. There's no such thing as Republican children or Democratic children. These are our kids. 66% of them are damaged. I know what a healthy kid looks like because I had so many of them in my family. I didn't know anybody with a food allergy growing up. Peanut allergy. Why do five of my kids have allergies?
Artie Vierkant:
Now, there are many important refutations to be made of this utopian vision of the past.
One is simple, and it applies to not just kids but to the entire population.
The first is that since Kennedy was a child, quite a bit has changed in medicine. Chronic illnesses that we now have names, diagnostic criteria, and—in many cases—treatments for, were in the past often dismissed as hysteria or hypochondria.
Which is, of course, not to say that that doesn’t happen anymore. This still happens to people, especially people who get labelled with a “functional neurological disorder” when their condition either can’t be identified or a doctor just runs with it as their preferred explanation.
But the time period Kennedy is talking about — when he was between maybe 7 and 10 years old — is the early 1960s. Hysteria wasn’t even added to the DSM until 1968, in its second edition.
So Kennedy is very much referring back to a time that is inappropriate for comparing rates of chronic illness, if only because our entire paradigm for understanding, recognizing, and treating chronic illness is really still in its relative infancy.
The other issue with this is something that’s less often integrated into refutations from health or public health experts, which is that while we may not be able to know what the scale of contemporary forms of chronic disease was in the 1950s and 60s, we do know the scale of the mass confinement of the ill and disabled.
For much of the 20th century and before, all manner of disabled, chronically ill, neurodivergent, queer, gender nonconforming, racialized, and even, simply, politically unruly people, were swept up into state mental health hospitals or other asylums or congregate settings.
This includes, of course, people who were swept up into this system because they were misdiagnosed as, simply, “hysterics.” And it certainly includes many people who today would be diagnosed with autism, but at the time of Kennedy’s youth would be very likely given a psychiatric label and disappeared into a state mental health hospital.
And we know the scale on which this occurred.
According to Liat Ben-Moshe’s 2020 book Decarcerating Disability: Deinstitutionalization and Prison Abolition, “In 1955, the state mental health population was 559,000, nearly as large on a per capita basis as the prison population today.“
—meaning the scale of disabled, mad, ill, and neurodivergent people who were disappeared from society in the mid 20th century was comparable to the scale of our contemporary era of mass incarceration.
RFK’s own aunt was one of these people. Rosemary Kennedy, RFK Jr.’s aunt, the sister of JFK and of Bobby Kennedy Sr., was lobotomized in 1941 and institutionalized. From that point the family spoke of her, including in public speeches by JFK, as having had what they called “mental retardation,” but in the 1990s, the doctor who carried out the lobotomy told a biographer that he believed she had depression, if anything.
So there’s a lot of obfuscation in any of these claims he ever makes about rates of illness and dreams of there being a healthier body politic in the past.
It’s just not true. And even if certain forms of illness, certain cancers for example, have grown more common over time, that only tells us about the time period in which those rising metrics were measured — not anything about a golden yesteryear.
And some of the metrics that we do have that carry over that entire period directly contradict Kennedy’s claims.
For example, heart disease. According to the CDC, in 1950, 588 out of every 100,000 people died of heart disease. By 2019, that number had dropped to 161 out of every 100,000 people — still the leading cause of death, but at a substantially lower rate.
Beatrice Adler-Bolton:
Nevertheless, in other contexts, Kennedy has pushed this argument further.
Here’s Kennedy speaking this June at an FDA roundtable:
[ CLIP ]
RFK: —but more importantly we have a sick population. We have—when my uncle was President, I was a ten year old boy. 3% of Americans were—had chronic disease. Today 60% do. And it’s debilitating our country. It’s an existential threat. Not only because of the economic costs, 75% of American kids can’t qualify for military service. We have a fertility crisis where American teenagers, teenage boys, have half the sperm count, half the testosterone as 65 year old men. Our girls are reaching puberty six years early. We have a diabetes and obesity crisis that are rivaling the Pentagon budget. So—and we can’t continue. We need to transform ourselves to a healthcare system rather than a sick care system.
This makes it more clear where Kennedy is going with this — a perceived crisis of fertility and vitality. A classic framing for any empire in waning influence, like the US. And a leering, voyeuristic mode Kennedy defaults to often, sometimes in ways that would make a transvestigator blush. Like this statement in August:
[ CLIP ]
RFK: And I know what a healthy child is supposed to look like. I’m looking at kids as I walk through the airports today, as I walk down the street. And I see these kids that are just overburdened with mitochondrial challenges, with inflammation, you can tell from their faces, from their body movements, um, and from their, their lack of social connection. And I know that that’s not how our children are supposed to look.
Beatrice Adler-Bolton:
But back to that June FDA roundtable. Kennedy went on to add, moments later:
[ CLIP ]
RFK: —lifetime treatments—Mehmet [Oz] often points out, that you know, when my uncle was President, there was—we spent zero on chronic disease in this country. We now spend $1.7 trillion a year. The first chronic disea—er, uh—continual treatment was the birth control pill. Nobody was taking pills every day. But now 60 or 70% of our population is taking pills every day, just to live. Just to get up in the morning, to have energy, to be able to be barely functional. And we need to change that. And we’re going to change that through changing the incentives, but then more importantly, unleashing innovation.
Beatrice Adler-Bolton:
Taken together, it’s clear Kennedy’s vision of a golden past for American health is little more than a traditional fascist fantasy: a time of my youth, when men were men and women knew their place.
But this complaint about the birth control pill is telling; especially with Kennedy going on to extend the complaint to any kind of daily or regular medication.
It suggests an enormous fixation on keeping any kind of substance from entering the body — and the idea that bodies are pure and self-regulating, and should be able to purge themselves of disease, or else, perish; a fundamentally eugenic premise.
Artie Vierkant:
It is almost too on the nose to say it’s a version of the classic Kubrick character, General Jack D. Ripper, come to life:
[ CLIP ]
General Jack D. Ripper: It's incredibly obvious, isn't it? A foreign substance is introduced into our precious bodily fluids without the knowledge of the individual. Certainly without any choice. That's the way your hard-core Commie works.
Group Capt. Lionel Mandrake: Jack, tell me—tell me Jack. When did you first make up—well—develop this theory?
General Jack D. Ripper: Well, I, uh, first became aware of it, Mandrake, during the physical act of love. Yes a, uh, a profound sense of fatigue, a feeling of emptiness followed. Luckily I was able to interpret these feelings correctly.
Artie Vierkant:
It may sound over the top to claim that Kennedy seems to have an issue with anything that enters the body, but it would certainly make some of the Trump administration’s attacks on vaccines this year make more sense.
Take for example, Trump’s comments in September, at the press conference where he announced that people shouldn’t take Tylenol.
[ CLIP ]
Trump: It's too much liquid. Too many different things are going into that baby at too big a number. The size of this thing when you look at it. It's like 80 different vaccines and beyond vaccines. And—80.
While the press largely focused on the grand pronouncements about Tylenol at the time, that speech also meandered into statements that sound like Kennedy and HHS staff had been trying to explain to Trump their plans to disrupt the childhood vaccination schedule by forcing key childhood vaccines to be spaced out across separate visits—an anti-vaxxer tactic we discussed last week in the episode Covid Year Six.
Kennedy’s general stance against daily medications, or maintenance therapies, also resonates with the beliefs put forward by his deputies.
Beatrice Adler-Bolton:
Take for example, Mehmet Oz’s comments when he was sworn in as CMS Administrator in April. We heard part of this earlier — his claim that it’s our patriotic duty to be healthy, because “healthy people don’t consume healthcare resources.”
[ CLIP ]
Mehmet Oz: What are we going to do? First, we’re going to reduce chronic disease. How do you do that? 70% of the health care expenditures of this country are driven by chronic disease. And it is your patriotic duty. I’ll say it again. The patriotic duty of all Americans to take care of themselves. Because it’s important for serving the military. But it’s also important because healthy people don’t consume health care resources.
Beatrice Adler-Bolton:
But Oz went on to say:
[ CLIP ]
Mehmet Oz: The best way to reduce drug spending is to use less drugs. Because you don’t need them because you’re healthy. And it feels a lot better as well.
Beatrice Adler-Bolton:
This attitude is also reflected in other key MAHA staff at HHS, like Vinay Prasad — Kennedy’s Director of the Center for Biologics Evaluation and Research, the FDA office overseeing vaccines; and Tracy Beth Hoeg — who at the end of this year was appointed head of the Center for Drug Evaluation and Research, the FDA office overseeing a huge swath of drug safety, from prescription drugs to biosimilars, as well as any number of over the counter items like antiperspirants and sunscreen.
Before joining the Trump administration, both Prasad and Hoeg were already regular subjects of critique on Death Panel for their advocacy against vaccinating children and quote unquote “healthy adults” against covid. The recent controversy where the FDA claimed without any evidence that the covid vaccine had contributed to the deaths of ten children is just the latest phase of that advocacy — following years of both of them making huge leaps in logic based on junk data to claim that the risks for young people taking the covid vaccine outweighed the benefits.
Over the years of the pandemic, they have each expanded that crusade into more avenues, advocating that we further drop modern health interventions — as when Hoeg advocated against vaccinating infants for Hepatitis B in a December meeting of ACIP, the CDC’s vaccine advisory committee.
[ CLIP ]
Acting Director of the Center for Drug Evaluation and Research Tracy Beth Høeg: It’s really important to keep in mind that the U.S. is an outlier, uh, at, as, in—in recommending a universal birth dose of the Hepatitis B vaccine. … [cut] So we are working with very low, um, low level evidence here. And we have very limited confidence in what we say when we say these vaccines are safe.
Beatrice Adler-Bolton:
Prasad has gone so far as to label the covid vaccine as “a universal campaign to medicalize all of society.” This clip is from Prasad’s YouTube channel, and I pulled it from the Death Panel archives, from fall 2023.
[ CLIP ]
Director of the Center for Biologics Evaluation and Researchh Vinay Prasad: The question is, is Pfizer making more money from the people they’re saving, or are they making the bulk of their revenue from their universal campaign to medicalize all of society? And it looks increasingly like the latter. Ok? It looks like the latter.
Beatrice Adler-Bolton:
Other key MAHA staff have echoed similar language about long covid — a condition that would actually be an important target for any administration pretending to care about chronic illness.
In September 2023, Marty Makary, now head of the FDA, wrote in the New York Post that, “Mild fatigue or weakness weeks after being sick, inactive and not eating well can be normal. Diagnosing many of these cases as long COVID represents the medicalization of ordinary life.”
Going on to complain that, “At the same time, our government is pouring more than a billion dollars into the long-COVID testing-industrial complex. The Biden administration is absolutely fixated on it, spending more than $1.2 billion on the condition.”
[ Transition music ]
Beatrice Adler-Bolton:
It’s no coincidence that these statements mirror each other, because they point to the next aspect of the MAHA ideology that we need to address.
Artie Vierkant:
Both of these statements stake their claims of over-medicalization—something that isn’t true, and wasn’t true fifteen years ago, either, when Atul Gawande was writing about “superutilizers”—to something that resonates more with people as having a ring of truth: that the healthcare system is expensive, and that people are spinning profit out of their role as gatekeepers to health.
Kennedy’s rhetoric on this gets more explicit. Here he is at that FDA roundtable again, in June:
[ CLIP ]
RFK: And we can’t continue. We need to transform ourselves to a healthcare system rather than a sick care system. And, um. And in order to do that we need to unravel all of these perverse incentives. That really this whole agency is a bundle—our whole healthcare system—is a bundle of perverse incentives. Where people make money by doing bad things. People, we’re not—at every level, the doctors, the other providers, the hospitals, the pharmaceutical companies, the insurance companies, all make money by keeping us sick.
Artie Vierkant:
This is another favorite refrain of Kennedy’s. In a profile in The Atlantic published in November, Kennedy told the author that HHS is “a $1.73 trillion bundle of perverse incentives” … “The doctors, the hospitals, the insurance companies, the other providers, the pharmaceutical companies are all incentivized to make money by keeping people sick.”
Now, these statements need a lot of unpacking. Because what Kennedy is saying isn’t completely wrong. The problem is the conclusions this leads him to, and what he thinks the bad actors are, and where he thinks the problem is located.
Kennedy portrays the health system as a network of individual bad actors, each profiting off of illness, and each incentivized to make us more sick so we purchase more healthcare — from vaccines to, as Kennedy complains about, the daily birth control pill. It’s an image of the world as an open conspiracy, and one that a singular savior figure—Kennedy himself—can step in to heroically regulate, effectuating his plan to quote “Make America Healthy Again.”
The problem is, there is a word for the conspiracy they name. It’s capitalism. And Kennedy isn’t actually interested in touching that at all; nor do he or his acolytes appear to see it.
Beatrice and I wrote a whole book about this. In Health Communism we wrote,
Profit lives in the interstitial spaces between bodies, in the counting of bodies, in the measuring of bodies, in the creation and destruction of bodies, in every locus where capitalism touches illness, disease, disability, and death. This relation, in and of itself, is not intent to harm; instead, it is the capacity to levy harm at the population level, as driven by clearly defined socially constructed parameters of race, ability, health, and class. Public money guarantees a fixed amount per body, leaving public and private entities (long-term care and nursing home corporations, prisons, jails) to find or create the opportunity for growth and revenue. This totality of motivations and relations, defining the intersection and incorporation of health with capital, is what we have elected to call extractive abandonment. In a political economy built on systems of extractive abandonment, the state exists to facilitate a capacity for profit, balanced always against the amount of extractable capital or health of the individual subject.
In other words, we can look to an idea of individual bad actors, or imagine a conspiracy of illness, but it means nothing if we don’t take aim at the system itself.
And that system has many ways it inflicts harm and produces poor health. Friedrich Engels called this “social murder,” a process by which capitalism creates and orchestrates vulnerability to premature death.
Or how, as our friend Nate Holdren has described it,
“Capitalism kills, continually, in its normal operations, by subjecting working class people to harmful conditions which vary in their specifics over time and place.”
And it’s a process that we’ve argued is a core component of capitalism, a key feature that maintains class relations under capitalism.
We see this in all of the kinds of things that MAHA rhetoric claims to address, like environmental exposure to toxins and pollutants, while in reality we’ve seen them strip regulations and regulatory capacity from the agencies that are supposed to stop it — the state functions that exist to slow social murder, or at least to direct it toward one avenue or another.
And we’ve seen this borne out even just in the last few weeks, with Trump’s EPA dropping key clean air regulations, and the FDA announcing it’s dropped a proposed rule to require asbestos testing in cosmetics.
They were open about this, by the way — that they were going to be stripping industry regulations even as they claimed not to.
Here’s that clip again from one of Trump’s first speeches alongside RFK, before he was inaugurated:
[ CLIP ]:
Trump: —and I’m going to let him go wild on health. I’m going to let him go wild on the food. I’m going to let him go wild on medicines. The only think I don’t think I’m going to let him even get near is the liquid gold that we have under our feet. I don’t know, Elon [Musk], he might not like liquid gold—it’s oil and gas, sometimes referred to as oil and gas. J.D. [Vance] I think we’re going to have to keep him away from the oil and gas, what do you think? Howard [Lutnick], yes?
Beatrice Adler-Bolton:
Kennedy’s central claim, of course, is about our for profit healthcare system. But in not naming the actual problem—the ability for private, profit driven companies to not only participate in the healthcare system but constitute it almost entirely—and in instead pointing the finger at a network of bad actors, RFK’s conspiracy of illness — Kennedy effectively deflects the very real anger and abandonment that people feel from the healthcare system away from the actual problem and towards ghosts and shadows.
If the FDA’s Vinay Prasad, for example, was actually worried about whether the company Pfizer was engaged in a profit driven “campaign to medicalize all of society”—meaning, to get everyone to take the covid vaccine—then one would think he would be, instead, drawing attention to how, in our political economy, pharmaceutical companies enjoy monopoly power over things that are enormously, fundamentally valuable to society and thus subject to commodity capture.
If they actually wanted to meaningfully address any of the issues Kennedy is pointing to, they would be talking about, at a minimum, single payer, or universal healthcare, Medicare for All.
Instead, Kennedy explicitly denies this truth, and explicitly denounces communizing health, pointing the finger at chronic disease as the driver of high healthcare costs. Here’s Kennedy during his confirmation hearing:
[ CLIP ]
RFK: For a long time the nation has been locked in a divisive healthcare debate about: who pays? Well when healthcare costs reach 20% [of GDP] there are no good options, only bad ones. Shifting the burden around between government and corporations and insurers and providers and families is like rearranging deck chairs on the titanic. Our country will sink beneath a sea of desperation [and] debt, if we don’t change the course and ask: why are healthcare costs so high in the first place? The obvious answer is chronic disease. The CDC says 90% of healthcare spending goes toward managing chronic disease. Which hits lower income Americans the hardest.
Beatrice Adler-Bolton:
In this way, our own for profit healthcare system has been one of the central drivers of modern day eugenics, and of anti-vax ideology, MAHA conspiracies, and wellness grifters.
It denies people care or makes them go into exorbitant levels of debt to get it, and it pushes people into the arms of conspiracists who can point to outrageously wealthy executives—who should not exist—so that they can then say, you don’t need medical intervention, it’s survival of the fittest, they’re lying to you, they’re poisoning you — but if you’re still in pain, try this supplement, try unpasteurized milk, drink your own piss, excersize more.
—
Artie Vierkant:
Of course there is another aspect underlying all of this.
The way that Kennedy and others in the MAHA side of the Trump coalition speak about the cost of the healthcare system focuses rhetorically on pointing to the sick as a burden on society —
[ CLIP ]
Mehmet Oz [confirmation hearing]: So here are some painful truths that should concern everyone in this room. I'll list them quickly. Healthcare expenditures are growing 2 to 3% faster than our economy, not sustainable. The Medicare Trust Fund will be insolvent within a decade. That's the 2.9% taken out of your paycheck. Medicaid is the number one expense item in most states, consuming 30% of those state budgets, and that's crowding out essential services, like schools and public safety, that many of you spent your careers trying to develop. A healthcare cost per person in this country is twice that of other developed nations, so it's not just about the money. We're already putting twice as much money into the system. Why is it costing us so much? Because of chronic disease, and those chronic diseases—and we made it easy to be sick in America—are linked to poor lifestyle choices, and they drive 3/4 of the $1.7 trillion that CMS spends a year to support Americans' health. … [cut] These are some of the reasons why our life expectancy is now five years shorter than comparable countries. This public health crisis threatens our national security. Why? Because it adds to the national debt that is defeating us from within, crowding out other essential services.
Artie Vierkant:
And this is where the two sides of the second Trump administration’s health rhetoric unite. Because this ideology of blaming the sick for their own illness, and blaming the ill and the disabled for high spending, or for trouble in the economy, merges perfectly with the other ideology Trump officials have been pursuing with religious zeal: austerity in social programs.
The second Trump administration opened with a dramatic salvo against a familiar Republican boogeyman: so-called “waste, fraud and abuse.”
This started with representatives of DOGE — the newly appointed, “Department of Government Efficiency” being set loose on every federal agency imaginable in pursuit of spending cuts, including within the Social Security Administration.
[ CLIP ]
Karoline Leavitt: President Trump has directed Elon Musk and the DOGE team to identify fraud at the social security administration. They've not dug into the books but they suspect there are tens of millions of deceased people who are receiving fraudulent social security payments.
By February, Trump and his allies were claiming without evidence that “millions and millions of people” were claiming false Social Security payments:
[ CLIP ]
Trump: But, when I saw the Social Security numbers, I said “wow” … [cut] We have millions and millions of people over 100 years old—everybody knows that’s not, so. We have a very, uh, corrupt country.
Artie Vierkant:
Once DOGE successfully infiltrated the Social Security Administration, including briefly installing a DOGE loyalist as its acting Director, they set about acting on these assertions, unilaterally purging four million people from the Social Security rolls by moving them to Social Security’s “death master file.”
As the New York Times wrote:
“The effort hinges on a surprising new tactic: repurposing Social Security’s “death master file,” which for years has been used to track dead people who should no longer receive benefits, to include the names of living people who the government believes should be treated as if they are dead.”
By April 4th, DOGE had removed four million people from the Social Security rolls in this fashion.
As our friend Nathan Tankus noted at the time, four million people
“ … is more than 1% of the United States’ population. If all those people are social security beneficiaries that would amount to just under 5.6% of social security beneficiaries”
and that, to make matters worse —
“ … when someone is declared dead by social security, their social security benefits can be “reclaimed” without any due process.”
Their defense of this, at this time?
On March 19th, Elon Musk tells Fox News’ Sean Hannity:
[ CLIP ]
Elon Musk: It turns out, when you take away people’s, uh, the frau—the money they’re receiving fraudulently, they get very upset. And they, um, they basically want to kill me because I’m stopping their fraud. … [cut] this terrible waste, uh, and corruption in the government. And, uh, well I guess they’re bad people, uh, bad people will do bad things.
Artie Vierkant:
On March 21st, Howard Lutnick — the Secretary of Commerce — echoes the same:
[ CLIP ]
Secretary of Commerce Howard Lutnick: Let’s say Social Security didn’t send out their checks—
Interviewer: Mhm.
Secretary of Commerce Howard Lutnick: —this month. My mother in law who’s 94, she wouldn’t call and complain.
Interviewer: Mhm.
Secretary of Commerce Howard Lutnick: She just wouldn’t. She’d think something got messed up, and she’ll get it next month.
Interviewer 2: Yeah.
Interviewer: Mhm.
Secretary of Commerce Howard Lutnick: —A fraudster, always, makes the loudest noise, screaming, yelling and complaining.
Interviewer: Mm.
Artie Vierkant:
This is rhetoric the Trump administration continues to extend to any and all social programs when it deems it convenient: that there is a class of welfare cheaters out there, people who do not deserve benefits or who, as was said, “should be treated as if they are dead” — and where the sanctity and continuation of our welfare programs demands that we expel them.
Nowhere was this more extreme this year than in the rhetoric around cuts to Medicaid in Trump’s budget.
Because in the run up to the bill’s passage, we saw a profound united front from Republicans as they portrayed Medicaid — the healthcare program for the very poor, and far and away the single most important provider of long term care for disabled people in this country — as a system rife with fraud, rife with layabouts and welfare queens, and in need of a mass purge.
[ CLIP ]
Senator Roger Marshall (R-KS): So when they talk about people not being on Medicaid anymore, half of those people are on it because of fraud or some kind of abuse of the system. The other half is because they’re unwilling to work.
[ CLIP ]
Rep. Ashley Hinson (R-IA-02): We are eliminating the waste, fraud and abuse in Medicaid. … [cut] They shouldn’t be going to a twenty-nine year old guy who’s living in his mom’s basement choosing not to work.
[ CLIP ]
Speaker of the House Mike Johnson: —that’s what Medicaid is for. Not for twenty-nine year old males sitting on their couches playing videogames. We’re going to find those guys and we’re going to send them back to work.
[ CLIP ]
Senator Jim Banks (R-IN): And then there are five million Americans who get Medicaid who are able bodied, they sit at home, they don’t work, they’re not taking care of a sick kid, or a sick mom, and they’re still on Medicaid. Medicaid is expanding every day, and there’s a big cost to that.
[ CLIP ]
Mehmet Oz: But it hurts the federal government, it hurts the taxpayers, and it actually creates an incentive for people not to participate in life. That’s why these work requirements—which was the most important thing that the house pushed forward are so critical, and … [cut] and when you don’t ask that of people you end up with generational poverty. And I’ve spoken to governors who in a quiet moment will admit that there are people in their state who will not work because they have never worked, because their parents didn’t work, they don’t know what it feels like—
[ CLIP ]
Senator Markwayne Mullin (R-OK): What is so hard about having a work requirement there with someone that has no medical condition and no dependents? We don’t pay people in this country to be lazy.
Interviewer: Yeah.
[ CLIP ]
Mehmet Oz: Go out there, do entry level jobs, get into the workforce. Prove that you matter. Get agency into your own life.
[ CLIP ]
Rep. Andy Harris (R-MA-01): Look, if you’re able bodied without dependents and you choose not to work? Well, you shouldn’t be on a public welfare program. That’s the bottom line. If you’re one of the 1.4 million illegal immigrants who are here, who are on Medicaid, you shouldn’t be getting it. … [cut] You should be off the public dole. … [cut] Yes, you will lose your Medicaid coverage. Get a job and get coverage through a job if necessary.
[ CLIP ]
Rep Lisa McClain (R-MI-09): We want to make sure that you deserve. That you don’t have to stand in line behind an illegal, an MS-13 gang member, or an able bodied working adult. … [cut] So we are eliminating the waste, fraud, and abuse, the dual enrollment. We are eliminating and trying to keep illegals off the Medicaid rolls.
[ CLIP ]
Interviewer: Can I ask you though about the CBO [Congressional Budget Office] score and the idea that 11 million 12 million Americans—
Rep. Troy Nehls (R-TX-22): —I don’t, I don’t—
Interviewer: —may lose health insurance?
Rep. Troy Nehls (R-TX-22): I don’t have faith or confidence in the CBO. Their scoring, they’re wrong half the damn time. I don’t give any—nah. I’m not worried about the CBO.
Interviewer: So you’re not worried at all that Americans may lose their healthcare because of this bill?
Rep. Troy Nehls (R-TX-22): Oh, well. Just some Americans that aren’t Americans. And that is: the illegals.
Artie Vierkant:
Right wing press was even more blunt, with the National Review writing in February:
Medicaid is well on its way to costing taxpayers $1 trillion per year. Congress must find a way to get able-bodied Americans back on their feet and off Medicaid. With the right incentives in place, these Americans can leave this life of poverty and dependency to set out on a pathway toward success.
They conclude this thought by echoing the infamous Nazi slogan, "arbeit mach frei” — work will set you free:
A person without a job is not healthy. He’s not happy. He’s not free. Who really wants to be a slave to some government entitlement program?
Beatrice Adler-Bolton:
Now, the actual cost of these cuts is dramatic.
Some 11.8 million people are projected to lose Medicaid under the new bill. Causing, by one estimate, 50,000 additional deaths a year just from creating new uninsured — the bill has the same burden as the average influenza season.
We’ve talked at length about both of these in the past — the cuts to Medicaid and the chaos wrought by DOGE. But today gives us a chance to talk about how all of these things work in concert with the MAHA agenda to form a coherent theory of governance.
The DOGE cuts, the Medicaid cuts and new work requirements, and even the cuts to government research and public health funding across HHS all share something in common: as many people have pointed out, they cost, or will cost, more than they claim to have “saved.”
For example, this year one nonprofit estimated that, by April, staffing cuts made by DOGE had cost the government $135 billion — an estimate that didn’t take into account the cost of defending the lawsuits against DOGE’s actions or lost tax revenue from IRS cuts.
Medicaid is a similar story. The argument behind work requirements has been that the government will “save money” by pushing people off the program. But in order to push people off the program, state Medicaid agencies will have to staff up—or, more likely, outsource to private management consulting firms—in order to process renewal paperwork at twice the frequency they used to—a new requirement—and in order to process the immense administrative load of trying to verify every Medicaid recipient’s employment status.
This isn’t a projection either, it’s been observed: when the state of Georgia instituted work requirements in an offshoot of its Medicaid program, a program called Georgia Pathways, they ended up spending $25 million on administrative costs, compared to just $7 million actually spent on covering people’s healthcare. That’s more than three times as much money spent scrutinizing people’s deservingness for the program as was spent actually providing healthcare, what Medicaid is supposed to be for.
The same principle applies to the entire Trump budget, the so-called One Big Beautiful Bill. Even as the rhetoric around its cuts to welfare programs focused on the need to drive down “the deficit” — another imaginary, or self-constructed boogeyman of the American state — the Congressional Budget Office estimates that the bill will cost an additional $2.8 trillion.
Artie Vierkant:
For many this would seem to be a contradiction. The rhetoric is all about saving, is all about waste, is all about the enormous cost of services. So why pour so much money into something so fundamentally wasteful as needless administration and policing benefit recipients?
And this is where an abolitionist perspective and an abolitionist theory of the state provides a key insight into why the Trump administration’s attacks on the state look the way they do.
Because the Trump administration’s actions so far have been emblematic of what Ruth Wilson Gilmore [and Craig Gilmore] call, “the anti-state state” — “a state that grows on the promise of shrinking.”
and as Ruthie writes in the essay “In the Shadow of the Shadow State,”
“we are faced with the ascendance of anti-state state actors: people and parties who gain state power by denouncing state power. Once they have achieved an elected or appointed position in government, they have to make what they do seem transparently legitimate, and if budgets are any indication, they spend a lot of money even as they claim they’re “shrinking government.” Prison, policing, courts, and the military enjoy such legitimacy, and nowadays it seems to many observers as though there was never a time when things were different. Thus, normalization slips into naturalization, and people imagine that locking folks in cages or bombing civilians or sending generation after generation off to kill somebody else’s children is all part of “human nature.”
…
“While neoconservatives and neoliberals diverge in their political ideals, they share certain convictions about the narrow legitimacy of the public sector in the conduct of everyday life, despite the US constitutional admonition that the government should “promote the general welfare.” For them, wide-scale protections from calamity and opportunities for advancement should not be a public good centrally organized to benefit everyone who is eligible. Anti-state state actors come from both camps and insist that the withdrawal of the state from certain areas of social welfare provision will enhance rather than destroy the lives of those abandoned.”
Beatrice Adler-Bolton:
In other words, Trump—and indeed Kennedy—are the latest in a long line of politicians who have risen to power admonishing the supposed overreach of the federal government. Overreach that they locate in, in Trump’s words from an executive order this year, federal spending on “Marxist equity, transgenderism, and green new deal social engineering” — or in Kennedy’s view, supposed over-prescription and over-vaccination.
But once in power, these figures don’t shrink or dismantle the state so much as they re-organize it.
They direct it to different priorities.
When Medicaid cuts happen the way they have, for example, through added paperwork burdens, people will lose their healthcare. But where the state gives up its capacity to provide that care it expands its capacities for denying that care — often in the form of paying out lucrative contracts to private companies like Deloitte to take on part of that new workload. Which is why, when the budget was passed this year, one commentator called it “welfare for Deloitte.”
This explains the seeming contradiction of spending money to, allegedly, save it: it’s never really about shrinking the state, it’s about reorganizing it — wielding power to mold the state in their image, a kind of white supremacist control society.
And in order to do this, as Ruthie says, they still have to marshal legitimacy.
As Ruth Wilson Gilmore and Craig Gilmore further articulate in their essay, “Restating the Obvious,”
“Capitalists have always understood the usefulness of the state for their practices, and their constant groaning against “the state” is against particular ways that the social wage is collected rather than against the kinds of institutions necessary to negotiate and guarantee currency and trade, ensure open markets, raise tariffs, seize oil fields, build infrastructure, regulate competition, educate workers, support retirees, open or close borders, and so forth. The development of any state capacity is the outcome of struggle, and that struggle includes governmental actors who enliven and enforce the policies of their institutions and agencies. We can say that the state is a “relatively autonomous”19 institution, whose economic role is complicated and to some degree doubles back on itself since its ability to perpetuate itself (via access to adequate resources) depends on how well it achieves legitimacy through guaranteeing economic capacities for certain workers or capitalists.
At the same time, state legitimacy is not the outcome of simply calculated economic benefit, and the appearance of benefits of other types can offset seemingly broadly held beliefs about what the state “should” do. Thus, for example, under today’s neoliberal regimes, the “problem” of immigrants and nonimmigrant poor people is rhetorically posed as economic in nature—competition over scarce jobs or costly social welfare benefits—whereas the anti-state resolution of the problem—criminalization and incarceration—provides no economic security (or any other safety, for that matter) for most of those who are allegedly the proper objects of the state’s care.”
And everything we’ve talked about so far today is an example of how they pursue that legitimacy: claims that the essential medicines they’re taking away are illegitimate and in fact dangerous; reassurances that you, the person listening to their message, are a strong and healthy subject who doesn’t need those medicines in the first place; asserting that the people they’re taking healthcare away from fundamentally did not deserve to have that social good—whether because they are able bodied but unemployed, the new “welfare queen” as a loafer playing videogames on the couch; or because they’re a migrant the state is marking for expulsion and detainment in a concentration camp—in camps and detention centers this year’s Trump budget explicitly funds through cuts to Medicaid and social services; or because they simply did not do their “patriotic duty” to not “consume healthcare resources.”
And then once the anti-state state actor has admonished their audience in this way they then, as Ruthie says in that quote, “insist that the withdrawal of the state from certain areas of social welfare provision will enhance rather than destroy the lives of those abandoned.”
[ CLIP ]
Trump: But, when I saw the Social Security numbers, I said “wow” … [cut] We have millions and millions of people over 100 years old—everybody knows that’s not, so. … [cut] We’re figuring it out. Now, the good thing about Social Security, and what I read, is if you take all of those numbers off—because they’re obviously fradulent. Or incompetent. But if you take all of those millions of people off Social Security, all of a sudden we have a very powerful Social Security. You know, so it’s a very positive thing—[turning to a reporter] how about over here, yeah?
[ CLIP ]
Interviewer: How do you reassure people that what you all are doing is not going to effect their benefits?
Elon Musk: No, in fact, what—what we’re doing will help their benefits. Legitimate people will, as a result of the work of DOGE, receive more Social Security, not less. I want to emphasize that. As a result of the work of DOGE, legitimate recipients of Social Security will receive more money, not less money.
Interviewer: Alright—
Elon Musk: I want to emphasize that point. And let the record show that I’ve said this.
[ CLIP ]
Rep. Andy Harris (R-MA-01): No one who the core Medicaid program was designed for, that is, the disabled, the elderly, pregnant women, children—none of them are going to lose their coverage under any of these plans.
TV host: No, and if you do? It’s because you didn’t deserve to have it in the first place.
[ CLIP ]
Mehmet Oz: When you walk in to the Health and Human Services building not far from here, there’s a quote from Hubert Humphrey for whom the building is named. And it says, “It is the moral obligation of government”—that’s what we’re doing here today—“It is the moral obligation of government to protect those who are at the dawn of their life”—our children—“those at the twilight of their life”—our seniors—“and those living in the shadows.” … [cut] I want to applaud all of the agencies that collaborated today, because when President Trump signed the executive order on fraud, waste and abuse—a pledge to crush this reality. This is exactly what he had in mind. … [cut] The American government at its best. Making sure all of us work together for the same common purpose. In this case especially, expressly, to protect those who are our most vulnerable. Because all great societies are judged by how they take care of those who are vulnerable. And we are great people. We will do that.
[ Transition music ]
Artie Vierkant:
Indeed, as Mehmet Oz says, societies should be judged on how they treat their most vulnerable, and by this standard, we are monsters. But we are only so by the direction of the state. Which is something that we all have the power to refuse.
This year may have been emblematic of a turn inwards to health fascism, and an ascendance of the anti-state state—a state that is growing its capacities for violence and extraction on the basis of appeals to reduce social spending and a crusade against “waste, fraud and abuse.”
But it is only the first year of the second Trump presidency. And while we will conclude with talking about a few of the things we must to do stop this, some of the only things that can end this eugenic turn, it’s important to say that it is very clear where all of this is going if it is not stopped.
Our public health infrastructure was allowed to collapse in the first years of the covid pandemic, and the current makeup of HHS is clearly intent on beating it into the ground.
While, as of this recording, it’s unclear what, if anything will come of the end of year fight over the Affordable Care Act, the current trajectory based on Medicaid cuts, cuts to hospitals, staffing shortages, threats to Medicare including its encroaching privatization, and the soaring cost of health insurance both in the ACA marketplace and in the plans people get through their work — means that our healthcare system as we know it may, too, collapse, within just the next few years.
The Trump administration has made its antagonism towards trans people clear. All year it has released fabricated and propagandistic statements and reports against trans life, everything from a November document HHS called a “Peer-Reviewed Report Discrediting Pediatric Sex-Rejecting Procedures” to the FBI reportedly preparing to label trans people as “violent extremists.”
HHS also plans to punish hospitals who provide transition care for youth by revoking their eligibility for reimbursement by Medicare and Medicaid, something they would almost certainly comply with at risk of going bankrupt, as these are key revenue streams for hospitals — in this case, the state using the same mechanism that Medicare used to compel hospitals to desegregate in the 1960s — but this time, to retrench civil rights, instead of advance them. But many states, and many healthcare providers, haven’t waited for the Trump administration to act, and have unilaterally pulled this care already out of a fear of it being targeted. Out of cowardice, really. There is a great piece on this by friend of the show Melissa Gira Grant, from August, called “The Blue-State Hospitals Carrying Out Trump’s Anti-Trans Agenda.”
What’s more —
This year’s budget has made ICE the 16th largest military in the world — as one immigration policy analyst noted, it will make ICE “the single largest federal law enforcement agency in the history of the nation,” “with more funding for detention than the entire Federal Bureau of Prisons.”
Migrants have been pointed to as the cause of high social spending and a threat to the health of the nation, a trend that will only grow more violent if left unchecked.
As mentioned at the top, just in November the Trump administration resumed its first administration push to instate “public charge” rule for immigration, with the State Department directing embassy and consular officials, in November: “You must consider an applicant’s health,” … “Certain medical conditions – including, but not limited to, cardiovascular diseases, respiratory diseases, cancers, diabetes, metabolic diseases, neurological diseases, and mental health conditions – can require hundreds of thousands of dollars’ worth of care.”
They formalized this weeks later with a November 19th proposed rule posted to the Federal Register that non-citizens can be denied entry into the US “if in the opinion of the consular officer or immigration officer, as applicable, the alien is [they are] likely at any time to become a public charge”
On November 27th, Trump posted to Truth Social that he would seek to “remove anyone who is not a net asset to the United States” … “denaturalize migrants who undermine domestic tranquility, and deport any Foreign National who is a public charge, security risk, or non-compatible with Western Civilization. These goals will be pursued with the aim of achieving a major reduction in illegal and disruptive populations”
And this same logic, of course, is being turned inward to citizens and residents the state views as welfare drains, especially the disabled, the mad, and the unhoused.
With Trump’s July executive order, “Ending Crime and Disorder on America’s Streets,” the administration has begun a call to dramatically expand involuntary commitment as a federal directive, and we fully expect it only to be a matter of time until the administration expands this to a push for new mental institutions — a threat that could mean the imposition of yet a second layer of mass incarceration, operating in parallel to our existing regime of carcerality.
Trump himself called for this towards the end of his first term. Here is Trump in 2019:
[ CLIP ]
Trump: There are more than—if you look at it—over 100,000 homeless individuals with serious mental illness. And we must give major consideration to building new institutions. You know, when I was growing up in Queens, in New York, we had a number of mental institutions. And I’d look and I’d see these big buildings. And all of a sudden, you go and you don’t see them anymore. And you say, “What happened to all of those beds? What happened to all of that work? And where are those people?” And in many cases, those people are living on the streets.
Artie Vierkant:
And with this administration successfully picking up the loose threads from when he was last in office, the prospect that he could get something like this funded is a very real, and very dangerous one.
Beatrice Adler-Bolton:
We say all this because it is important that we are clear about what we are up against
We are not just up against the current administration ripping and tearing through the federal government. We can’t just fight to reset the baseline to a pre-Trump health regime.
To beat health fascism we will need a new, liberatory politics of health that gives no quarter to the health politics of the past, which has remained obsessed with “deservingness” and keeping costs down. You cannot defeat fascism with a tax subsidy on Obamacare plans. You cannot defeat fascism by simply converting police into mental health police.
But it is not impossible to act.
The collapse of the healthcare system and the rise of health fascism is a moment when it is clear we all need to come together to fight for health and disability justice. Whether that means aggressively, unrelentingly, pursuing a vision for health communism or for Medicare for All.
We are encouraged to think of these things, health and disability justice, as siloes—but they are not. The struggle for health justice is the struggle for disability justice, is the struggle for the total abolition of the carceral state, is the struggle to protect our friends, our neighbors, and, yes, people who are still yet strangers from us—from apprehension and expulsion; whether by ICE or by encampment sweeps, or by disappearance into psychiatric hospitals.
But it is not just defense. To build a new liberatory politics of health we actually have to build it ourselves, to begin to map out what care can look like as our plan of escape from fascism. We can practice those forms of care together, now; as many of us already are.
What it will require however is that we take tremendous risk together.
We don’t need to invent this world from scratch. It’s already being built. Let me tell you where care lives. Right now, today. And where our struggle continues.
A trans person gets HRT from a friend-of-a-friend. Someone helps a teen get Plan B across state lines. Someone else ships abortion pills to a locked-down state. A mutual aid crew delivers some leftover meds to someone post-surgery. A community clinic runs out of a church basement and doesn’t ask for ID.
A long-hauler crowdsources treatment protocols because their doctor won’t listen. A disabled person builds a spreadsheet network to redistribute mobility aids, medications and groceries. An insulin sharing group chat. An overdose reversal is coordinated over text. A harm reduction team walking the encampment at dawn, handing out clean syringes and checking wounds.
A healthcare worker refusing to let ICE kidnap their patients. A sex worker organizes a peer health clinic. A rural town with no clinic, but with an entire informal network of aunties and retired nurses keeping each other alive. It’s community fridges, land and water defenders, mobile clinics, street medics, home visit networks, meal trains, gray-market meds, DIY air filtration.
It’s not the kind of care that makes it into policy briefs—but it's what keeps people alive. This is not theoretical, this is real. Most of it is not legal, none of it is covered. And yet, it's functioning. It’s lifesaving. Nothing is recognized as care by our system. But it is care. And, this is the site of struggle. Not only inside institutions, but in the shadows they cast. It’s in every act of defiance that says: we will care for each other anyway. The site of struggle is in that gap just as much as it is on the floor of congress, the back and forth of prior authorization, or the streets of New York in the early hours of a December morning.
So what do we do with that? If the site of struggle must go beyond merely making the system better, but also build what we need despite the system, how do we fight?
First: we fight by demanding more than what is politically acceptable. We cannot let the boundaries of what is feasible or electable define our demands. We don’t need means-tested scraps or access to broken programs. We need universal care, no strings attached.
Because if we let the system set the terms, we’ll always be asking for permission to survive. We’ll be told to settle for coverage, not care, inclusion instead of transformation. Care is not a reward for good behavior, it is not merely a line item in a budget. It is a non-negotiable condition of life. And the truth is that people already believe in this. Most people want everyone to have what they need. What’s missing is not public will, it’s political imagination. And that is our job: to make the horizon visible. To remind each other day in and day out that we deserve more than what we’ve been told to expect. To fight like we actually believe everyone deserves to live.
Second: we fight by recruiting defectors from inside the house. This is a call to healthcare workers: betray your training when your training demands cruelty. If it means someone gets what they need to live—betray your bosses, your licensing board, your EMR, your scope of practice. Care is not your credential, it’s your calling, your skills, your knowledge, your access, your obligation to your community. And sometimes that obligation will mean disobedience.
If we are to build the world we need, we need you on our side, not on the side of your administrator. We need you willing to take risks, not just for your reputation, but for the material survival of those around you. The struggle is already here and you can either enforce the harm or interrupt it. We need insurgent care. And we needed it yesterday. If you have access pass it on. If you have knowledge, share it, weaponize it. If you have creativity, run with it.
This is where the real transformation begins. Not just in asking the system to care, but also in building the world we wished we lived in. A world where care is not determined by billing or zip code, or citizenship, or employment status, or formulary, or diagnosis codes. A world where no one is surplus. Where illness is not a source of shame or debt or punishment—but simply a part of life, and a part of being and feeling cared for.
They want us to think care is something we have to qualify for. That it belongs to the insured. The compliant. The deserving. But we win everyday when we reject all of that. When we remember care is a promise. Older than any institution. More powerful than any system. We win when we remember care is a practice, passed hand to hand. When we claim it as ours together, without apology.
All care for all people. That’s what health communism is. Not a slogan. Not a party line. But a strategy. A way of understanding that health is the terrain—not just the issue. That it’s the lever and the battleground. That it is where capital extracts value and where we can begin to sever its hold.
In July, we spoke to hundreds of people at the Socialism Conference in Chicago, and we ended one segment of our speech with a series of questions we’re also going to end with here—
These are questions equally for our discussion together today, as they are for each of you listening. Questions we all should be asking ourselves today and as we try to think bigger about what we can do together:
Where is the site of struggle in health? Where are the sites of struggle? Where can we act? What can I do, from whatever position I’m in? What is a skill I have that I can offer outside of the system as it exists, even if it means taking on risk? What do I need to survive? What does my comrade need to survive? Can I give it to them? Can I mix estrogen? Can I distribute N95s, or just start wearing one in public again if I stopped? Can I learn to do home care to keep just one comrade alive? Can I teach my friends to do the same? What can I do to keep my comrades from being put in a psych hold? I could go on. These are all sites of struggle just as important as our fights against big systemic federal policy changes. And many of them are things we can take action on today.
[ Transition music ]
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As always,
Medicare for All now. Solidarity forever. Stay alive another week.
[ Outro music: “Tezeta” by Time Wharp ]