Back to the Future with Doc(tor Oz) and Marty (Makary)
What will U.S. healthcare leadership look like under the new Trump administration?
“I would take us all back a thousand years, when our ancestors lived in small villages and there was always a healer in that village—and his job wasn’t to give you heart surgery or medication but to help find a safe place for conversation.” - Dr. Oz, The New Yorker, 2013
In these last few weeks of 2024, President-Elect Donald Trump has named his nominees to lead the nation’s most prominent federal healthcare organizations. While the nominees share a penchant for espousing contrarian views that are often critical of the medical establishment, they differ in their actual views (where they have expressed any) on health and health policy, as well as their respect for data and evidence. This complicates attempts to predict how the healthcare landscape might evolve under an incoming Trump administration.
As our new healthcare leaders attempt to “Make America Healthy Again,” will they “take us all back a thousand years” Doc Brown-style, as CMS Administrator nominee Dr. Oz has suggested? Or could they bring us into a future of better, more evidence-based health, as FDA Commissioner nominee Marty Makary (pronounced, it seems, like “Mc-Cary”, a la Marty McFly) has propounded in his public talks and bestselling books? A look at the nominees’ track records and the agencies they would lead sheds some light on how they might use their power to influence our healthcare landscape.
RFK Jr. for HHS Secretary
The healthcare media has focused the most attention on Trump’s nomination of the infamous vaccine-skeptic and Kennedy clan heir, RFK Jr., to lead the Department of Health and Human Services (HHS). With a $1.84T 2025 budget and 85,000 employees, HHS oversees the nation’s key healthcare agencies including the Centers for Medicare & Medicaid Services (CMS), the Food & Drug Administration (FDA), the Centers for Disease Control & Prevention (CDC), as well as several others (explained well in the HHS budget). In a recent interview on the Tradeoffs podcast, former Obama-era HHS Secretary Kathleen Sebelius explained that the HHS Secretary is the most prominent public spokesperson for health in the U.S. and abroad and is therefore incredibly influential over not just the department’s official mandate to implement regulations passed by Congress, but also over the public’s understanding of healthcare issues.
RFK Jr.’s story is that of a lifelong philanderer with a history of serious drug addiction, sexual assault, and spreading debunked claims about public health issues such as vaccines and water fluoridation – while lacking experience in governmental, executive leadership, or healthcare policy roles. In a WSJ op-ed earlier this year, he outlined his healthcare policy ideas, a mix of broad public health measures, some of which are outside the HHS Secretary’s authority (e.g., reforming crop subsidies and SNAP aka food stamps), alongside oddly specific suggestions for FDA funding, HSA expansion, and presidential fitness tests. His stated priorities, Sebelius notes, suggest a lack of understanding of the role and its purview – for instance, Trump’s Agriculture Secretary nominee Brooke Rollins will have oversight over issues such as crops, food stamps, and school lunches. And in incorrectly linking childhood vaccines to autism, she points out, the nominee could influence state decisions around school vaccination requirements that could end up leading to more child deaths. A recent KFF review concurred, warning:
“While both President-elect Trump and Kennedy have said they won’t take at least certain vaccines away from people, and the federal government cannot impose or revoke vaccine requirements for children in school, or enforce other broad vaccine mandates at the national level (with potential exceptions in limited cases during times of a declared public health emergencies), federal officials do have significant authority to affect vaccine policy and access. This includes the ability to: influence or bypass federal advisory committees regarding vaccine approvals and recommendations; adjust criteria for vaccine approvals and reviews; change federal vaccine-related liability policies, which could weaken or eliminate liability protections for vaccine manufacturers; end emergency use authorization, currently granted under section 564 of the Federal Food, Drug, and Cosmetic Act, of certain COVID-19 vaccines; make some state or local funding contingent on certain policies (such as ensuring no vaccine mandates for schools); and communicate to the public in ways that question the value and safety of vaccines, which in turn could contribute to growing mistrust and further reductions in vaccine coverage.”
Similarly, RFK Jr.’s stated intent to remove fluoride from the public water supply – based on debunked claims that childhood exposure to the FDA’s currently approved levels of fluoride could lead to lower IQ – could lead to worsened dental outcomes. According to the economist Emily Oster, “recent data from Israel — where water fluoridation was ended in 2014 — shows an increase in dental work for 3-to-5-year-olds.” Yet, as KFF explains,
“Kennedy has said the incoming administration will recommend that fluoride be removed from public water on day one. While the federal government cannot require state and local communities to fluoridate their water or remove fluoridation requirements already in place, the Environmental Protection Agency regulates maximum allowable fluoride levels and the Centers for Disease Control and Prevention provides guidance to state and local communities on optimal levels of fluoride. Both agencies could seek to re-evaluate regulations (in the case of EPA) or guidance (in the case of CDC), which could affect fluoridation practices across the country.”
Could there be a silver lining in RFK Jr.’s desire to take on known health culprits such as processed foods and other harms in the nation’s food supply – as some former health officials have lauded, despite HHS’s limited authority in these areas? Or are his disregard of data and evidence and his broader track record simply too concerning for a potential HHS Secretary? His approval for the role requires support from the Senate Finance Committee and the Senate Health, Education, Labor, and Pensions (HELP) Committee and then a simple majority vote in the Senate, in which Republicans lead by a slim margin (53 to 47). Some Republican senators have expressed doubts about RFK Jr.’s positions on vaccines and his support for abortion; however, the recent right-wing pressure campaign on Sen. Joni Ernst to back Trump’s even more controversial Defense Secretary pick, Pete Hegseth, suggests that similar dynamics might lead politicians to back RFK Jr.’s nomination despite their reservations. Moreover, Trump could potentially circumvent confirmation hurdles by having his nominees approved through recess appointments, a process by which the President fills cabinet vacancies for the duration of a Congressional session (in this case 2025-2027) without Senate confirmation, while the chamber is in recess.
If there’s any silver lining here, perhaps it’s Sebelius’s reminder that the HHS Secretary is largely a figurehead. The agency heads reporting into the Secretary will have real influence and should also be considered carefully.
Dr. Mehmet Oz for CMS
By far the largest line item on HHS’s budget is the Centers for Medicare and Medicaid Services (CMS). The agency’s 2025 budget is $1.60T out of HHS’s total budget of $1.84T.
Note: Data sourced from HHS FY25 Budget
*ACF = Administration for Children and Families, HRSA = Health Resources and Services Administration, SAMHSA = Substance Use and Mental Health Services Administration, ASPR = Administration for Strategic Preparedness & Response, ACL = Administration for Community Living, AHRQ = Agency for Healthcare Research & Quality. Other includes Office of the Inspector General, Medicare Hearings & Appeals, budget for Departmental Management, No Surprises Act Implementation Fund, etc.
As its name suggests, CMS oversees the Medicare and Medicaid programs, as well as the ACA Marketplace and Children’s Health Insurance Program (CHIP). In effect, CMS is both a regulatory agency and the nation’s largest insurance provider. The vast majority of CMS (and HHS)’s overall budget goes towards medical care provided by Medicare and Medicaid.
Overseeing such an agency is an ideal job for someone well-versed in healthcare policy. CMS is currently led by Chiquita Brooks-LaSure, whose experience includes working as an OMB analyst focused on Medicaid and Medicare spending, a staffer on the House Ways & Means Committee, and a managing director at the well-regarded healthcare law & advisory firm Manatt.
Trump’s nominee to lead CMS, Dr. Mehmet Oz, doesn’t fit this archetype. Despite his gold-plated pedigree – Harvard undergrad, Penn MD/MBA, heart surgeon at Columbia – Dr. Oz is notorious for peddling quackery to everyday Americans through his popular daytime television show. The Dr. Oz Show, which ran from 2009-2022, picked up 10 daytime Emmy awards and famously pushed snake-oil medical treatments for ailments such as aging, cancer, and weight loss. The show also promoted and generated significant ad dollars from questionable organizations such as a supplements company being investigated as a pyramid scheme. Oz’s former employer, Columbia University, scrubbed his presence from their website after numerous scandals related to him spreading misinformation.
A 2013 New Yorker profile of Dr. Oz portrayed him as a once-respected clinician who compromised facts and evidence in order to gain attention and build his entertainment following. His former mentor and colleague, Dr. Eric Rose, is quoted saying he would no longer send patients to Dr. Oz for a surgery because “Mehmet is now an entertainer….But that is a different job. In medicine, your baseline need has to be for a level of evidence that can lead to your conclusions. I don’t know how else you do it. Sometimes Mehmet will entertain wacky ideas—particularly if they are wacky and have entertainment value.” Dr. Eric Topol, a prominent cardiologist, geneticist, and thinker on AI in medicine, is similarly cited saying: “He is keenly intelligent and charismatic. Mehmet was always unique, but now he has morphed into a mega-brand. When he tells people the number of sexual encounters they need each year to improve their lives in a specific way, or how to lose weight in three days—this is simply lunacy. The problem is that he is eloquent and talented, and some of what he says clearly provides a service we need. But how are consumers to know what is real and what is magic? Because Mehmet offers both as if they were one.” Of Oz’s unusual practice of bringing a Reiki master into his operating rooms, the writer of the profile states, “I told Oz that I was aware of no evidence showing that Reiki works. He cut in: ‘Neither am I, if you are talking purely about data.’” Ultimately, the author concludes, “All facts come with a point of view. But [Oz’s] spin on it—that one can simply choose those which make sense, rather than data that happen to be true—was chilling. ‘You find the arguments that support your data,’ he said, ‘and it’s my fact versus your fact.’”
Although Dr. Oz’s use of alternative facts even predates the moniker, it’s unclear whether he believes what he propounds. The article points out that “Oz doesn’t follow any of the miracle cures or fad diets that he trots out so regularly for his audience. He eats like a Paleolithic hunter-gatherer and exercises daily.”
Oz’s views on healthcare policy, and what he might do as CMS Administrator, are not well understood. In the past, he has publicly supported universal healthcare coverage, and a company he co-founded in 2010, Sharecare (acquired by private equity in 2024 for ~$500M), serves Medicare and Medicaid enrollees. While his wife was historically an anti-vaxxer who refused to immunize their children against the H1N1 strain of influenza back in 2009, Dr. Oz publicly advocated for the flu vaccine on his show around the same time period.
But Oz’s agenda has veered towards more policitized extremes in recent years. When he ran for US. Senate in Pennsylvania in 2022 – famously mocking his opponent, Senator John Fetterman, after Fetterman had a stroke during the campaign – Oz was described as a supporter of continuing 2020 election denial efforts, restricting abortion access, and enabling drilling on public lands. More recently, Oz posted a video on his Youtube channel promoting Medicare Advantage plans, an area that policy and investment analysts expect to receive a boost under the Trump administration.
Dr. Oz’s nomination to lead CMS appears to have the support of several influential Senate Republicans, including Senator Bill Cassidy, incoming chair of the Senate HELP committee. So while it’s unclear what he might do in this important role, there seems to be a reasonable likelihood he will take it on. With Oz’s track record of promoting magic cures and miracle treatments, the public can only hope Doc won’t have us time travel into a past without the evidence-based advancements that continue to modernize and improve medicine.
Dr. Marty Makary for FDA
If Dr. Oz could lead us into the past, there is reason to be optimistic that Trump’s nominee for FDA Commissioner, Dr. Marty Makary, can bring us back to the future.
The FDA has an outsized impact on U.S. health relative to its $3.8B annual budget. In addition to reviewing and monitoring the quality and safety of pharmaceuticals, medical devices, and diagnostic tests, the FDA “ensures the human and animal food supply is safe, sanitary, wholesome, and accurately labeled…[and] also ensures the safety and proper labeling of cosmetic products.” Managing this agency calls for someone who is adept at evaluating data about new and innovative products and using it to make informed decisions to safeguard health.
A gastroenterology surgeon from Johns Hopkins, Makary might initially come across as a prototypical MAGA nominee: while not a talk show host, he has appeared repeatedly on Fox News as a commentator and has vocally criticized the government and the medical establishment. In a 2024 Senate roundtable discussion, he emphasized that “increasingly we have a misinformation police, although the greatest perpetrator of misinformation has been the United States government…” Makary became known during the COVID-19 pandemic for incorrectly predicting in a WSJ op-ed that COVID-19 would be mostly gone by April 2021 and for opposing broad vaccine mandates and certain public health restrictions.
Yet Makary’s latest book, Blind Spots, depicts a highly qualified, intellectual clinician who cares deeply about making decisions based on rigorous evidence and a compassionate approach to patients. The book laments a medical establishment that too often embraces dated dogma instead of sound evidence – one in which he states “a consensus can sometimes be the product of strong internal lobbying by a few highly influential people”, and as a result has repeatedly made huge mistakes that led to unnecessary illness and death. Makary details many examples of how this has happened time and again: when the American Association of Pediatrics ignored evidence and actually caused the development of food allergies after incorrectly recommending parents avoid feeding kids peanuts; when a large NIH-funded study of women’s health misrepresented its own findings and incorrectly stated that hormone replacement therapy (HRT) for menopause increases the risk of breast cancer, leading to decades of physicians denying patients HRT when they could have benefited from its prevention of cognitive impairment, fractures, colorectal cancer, menopause symptoms, and more; or when the American Heart Association endorsed the false belief that dietary consumption of fat and cholesterol elevates the risk of cardiovascular disease. In each instance, Makary discusses the clinical evidence underpinning his own conclusions, as well as the cultural and political dynamics and incentives that led the medical establishment to conclude otherwise and perpetuate unsafe medical practices.
Makary’s agenda in the FDA role has not been discussed extensively, But according to the NYT, “In a note to investors, Brian Abrahams, head of global health care research with RBC Capital, said that compared with Mr. Kennedy, Dr. Makary is ‘less apt to dismantle’ the F.D.A. and would be expected to leave core agency work to existing staff. But he added that Dr. Makary seems likely to ‘evolve the agency toward a more industry-unfriendly stance.’” In the aforementioned Senate roundtable, Makary discussed the importance of chronic disease prevention as well as his concerns about chemicals in the food supply, the proliferation of processed food, and misinformation spread by the USDA’s iconic Food Pyramid – areas that will largely be outside of his purview within HHS, but that the FDA could potentially influence somewhat through its oversight of food packaging and labeling. He also decried the overmedicalization of healthcare in his comments on drug pricing, stating that “The best way to lower drug costs in the United States is to stop taking drugs we don’t need” and characterizing the Inflation Reduction Act drug price negotiations as a distraction with minimal impact (projected $6B savings in year 1). Interestingly, Makary is involved with a few startups, including as Chief Medical Officer of Sesame Health, a telehealth company that sells compounded GLP-1s among its offerings, and as an adviser to insurtech startup Sidecar Health.
Like the other nominees, Makary will also have to go through a Senate confirmation process. For anyone who is scared of a future in which a new administration might stray from evidence-based healthcare, we can hope Marty hops in the DeLorean and brings us back to science, data, and progress.
h/t Kanye