Inside RFK Jr.’s Unprecedented Reset of HHS: David Mansdoerfer

[RUSH TRANSCRIPT BELOW] David Mansdoerfer served as deputy assistant secretary for the Department of Health and Human Services (HHS) during the first Trump administration. Now, he’s chief strategist at the Independent Medical Alliance and describes himself as the MAGA-MAHA Connector.

“We have seen a complete reset of a federal agency within 60 days of Secretary Kennedy getting there. To me, that is unprecedented, and it is going to be one of the most impactful approaches to public health and the health economy in the United States,” he says. “We have not won this fight. We’ve begun the fight. And we have industry forces, which I would say [have] unlimited money, that are going to try to do everything to protect their bottom line, but also limit good policy ideas of a Secretary Kennedy and a President Trump.”

What reforms are already underway since Health Secretary Robert F. Kennedy Jr. took over HHS? What pushback has he faced? And will the administration be able to reconcile and even merge the disparate agendas of the MAGA and MAHA movements?

“You basically get to put an entirely new, fresh face of career leaders that are aligned to the president’s agenda and the secretary’s agenda in positions of authority that could be and will be longer lasting than just this administration,” says Mansdoerfer. “Even in terms of the unknown, it is better to have leadership that’s willing to take these bold actions than it is to continually lead Americans down a poor health outcome path.”

Views expressed in this video are opinions of the host and guest and do not necessarily reflect the views of The Epoch Times.

RUSH TRANSCRIPT

Jan Jekielek:

David Mansdoerfer, such a pleasure to have you on American Thought Leaders. 

David Mansdoerfer:

Thank you.

Mr. Jekielek:

At HHS, what’s being described as a historic opportunity, perhaps a once-in-a-lifetime opportunity, is in play. Bobby Kennedy Jr. has been made HHS secretary, and there are a number of other what you would call disruptors in the system, in the sub-agencies now. Give me a sense of what you see as the opportunity here and why it’s rare.

Mr. Mansdoerfer:

Secretary Kennedy came in on a movement that was combined with President Trump’s agenda, which gives us a disruptor-in-chief and then also a disruptor of health at the same time. As we’ve seen, even with the combination of all of the doge work that’s happening, we have seen a complete reset of a federal agency within 60 days of Secretary Kennedy getting there. To me, that is unprecedented, and it is going to be one of the most impactful approaches to public health and the health economy in the United States.

Mr. Jekielek:

Give me a sense of the scale of this agency. You know, a complete reset. That’s kind of hard to imagine what that looks like. 

Mr. Mansdoerfer:

When I was there in Trump 1.0, the agency was about 80,000 folks, full-time equivalents, and 150,000 contractors that supported the mission of the agency. At HHS, it is the entire gamut of health. So we all know the big agencies, but I’ll go through some of them. 

We have NIH, which really focuses on research and has a lot of interactions with Congress about specific disease pathways. You have CDC, which is focused on surveillance and, to a certain extent, global health. Then you have the FDA, which is really centered around bringing your drugs to market or bringing your products to market within the health space. 

Then you have the payer system, which is your Medicare and your Medicaid systems, which serves anyone over the age of 65, or typically the poor through the Medicaid system. It is the largest cost driver of the federal government. I don’t know what the exact number is, but when I was there, it was about $3 trillion worth of expenditures, which has again ballooned during the Biden administration. Now, we’re really seeing a reset back to 2019 levels through these administrative reorganization actions.

Mr. Jekielek:

What is a reset? 

Mr. Mansdoerfer:

There were really two big components of the reset. There was a public health reset, and then there was a business operations reset within the agency. They took divisions that were part of the larger HHS infrastructure, SAMHSA, the mental health division, and HRSA, which is your federally qualified health center or your local community health center that the government runs. 

Then with my old office in OASH, they combined that to be this new department, the AHA. That department is going to have much greater visibility and impact on public health because it brings together disparate resources that weren’t talking to each other and puts them all in the same direction. So I am extremely excited about it. 

Then on the other side, you had an operational reorganization where we all heard about Medicare fraud. We all hear about the different things that HHS enforces through either civil rights and HIPAA or through Medicare or through payment systems, whether we’re overpaying or underpaying folks. They created a new system of enforcement that’s going to greatly operationalize the ability to protect taxpayer resources by making sure that one person is governing and leading over those specific agencies as opposed to three, where it was before. 

Mr. Jekielek:

Let’s look at that $1.3 trillion annual budget. Can you give me a broad sense of where the money goes? 

Mr. Mansdoerfer:

The biggest is going to be CMS, the Centers for Medicaid & Medicare Services. That is your payment system, essentially, for either the Medicaid system, which typically goes out to states, or the Medicare system, which is your elderly care, essentially. So that’s the biggest chunk of it. 

Another large chunk is NIH and the grants that it pushes out to local organizations and to higher education institutions to study different disease research. Within NIH, you’re seeing significant restructures on the types of grants that they’re focusing on to better align them to the secretaries’ and the president’s agenda. You’ve already started to see some reforms there.

Other big pockets of money are HRSA, which is your federally qualified health centers or your local community health center. That’s really direct patient care for the poor in certain communities. Then you have a whole slew of other grants like at CDC, as we learned during COVID, where they do surveillance on disease pathways, infectious disease, and other things like that. 

It’s a pretty broad agency in terms of the types of things that it funds. But at the end of the day, this reorganization action is going to be better for the taxpayer because it’s going to take parts of that agency that have historically not talked to each other but dealt with similar topics and actually get them all on the same page and push them forward. 

Mr. Jekielek:

Does this make it easier for the secretary to implement his vision?

Mr. Mansdoerfer:

It does. HHS has a secretary. It has division directors or assistant secretaries. We’ve seen Dr. Bhattacharya over at NIH. We’ve seen Dr. Oz at CMS. Then underneath that, you have roughly 180 to 200 political appointees that support the principles in many different ways. And what this organization does with the political appointees is it basically puts folks over specific divisions underneath SAMHSA, OASH, HRSA, all of these acronym words that don’t make sense maybe to the general public but have integral parts to the health economy system in the United States. The secretary, by reorganizing this, has basically leveled the career bureaucracy in the agency. 

What I mean by career bureaucracy are the folks that last beyond an administration. Political appointees are attached to the president. These are the 80,000, now 62,000, folks that typically last no matter who is in charge in the executive office. By resetting the agency, you get to now pick the leadership for all of these new divisions that you’re creating. And unlike the status quo, where we saw very little turnover in the agency, you basically get to put an entirely new fresh face of career leaders that are aligned to the president’s agenda and the secretary’s agenda in positions of authority that could be and will be longer lasting than just this administration. 

Mr. Jekielek:

Broadly speaking, how is this agenda different from the past agenda? 

Mr. Mansdoerfer:

When President Trump first took office in 2017, repeal and replace was on the agenda. It was a very high priority. Obviously, we weren’t successful on that occasion. But we really had to deal with the political dynamics of the Affordable Care Act [ACA], which is mostly focused on the health economy. It’s health insurance. It’s getting folks to health outcomes. 

But this time, we are infusing a new era of public health, which Republicans and conservatives have typically not talked a lot about. Republicans and conservatives stay very strong on the health economy. We love to talk about, you know, payments. We love to talk about hospital, rural health, which is everything from the mRNA vaccine to food dye in your foods and chemicals within your food to environmental factors.

These have traditionally not been topics that your normal historical Republican agenda would focus on. A disruptor-in-chief, in the president, and then a public health disruptor sets this time for changing the course of American history from more expenditures, worse health outcomes, to more efficient expenditures, better health outcomes. 

Mr. Jekielek:

How were you appointed to this role of assistant secretary? What were the necessary qualifications? 

Mr. Mansdoerfer:

I was lucky to be called upon very early in the first administration as a generalist. My first job at the department was actually the director of boards and commissions. That sounds very innocuous until I tell you that there are over 280 advisory boards at the agency. Those 280 advisory boards are some that your listeners might have heard of, like the President’s Council on Fitness and Sports, the old Arnold Schwarzenegger council, now called PCSFN, or the Presidential Advisory Council on HIV/AIDS.

But each one of these advisory councils feeds policy into the agency. So if the members on that council aren’t aligned to the secretary’s or the president’s agenda, then there’s some conflict and friction there. And so I had the opportunity to really get a crash course on the agency, looking at all these policy advisory councils on behalf of the secretary and, to a certain extent, the president when I was a more operations-focused person, so a lot of folks in health policy or political appointees, they’re great at certain topics that are really good MDs that know specific disease pathways. They have great clinical backgrounds. 

I can tell you how to get a contract done and go from A to B, and so having that relationship with high-level, highly intelligent political appointees was great because I got to operationalize some of the things that they wanted to accomplish. Those topics ranged from ending HIV, fentanyl, and opioids to reorganizing the department for the first time, in which I had a hand.

When you’re a political appointee, you get tasked with duties as assigned. Given that I was more operational, I had the opportunity to negotiate the labor contracts for HHS. I had the opportunity to reorganize the district offices and some of the public health functions the first time. And I had the opportunity to really work with high-level leadership on driving home presidential agendas on issues like veteran suicide, which was very important in the first administration and is going to be important in the second administration as well, and just having the opportunity to be a Swiss Army knife on a number of programs within HHS. 

Mr. Jekielek:

How did you come to be an operations guy? 

Mr. Mansdoerfer:

Luckily, I’ve worked for almost every type of government at this point. I started off working for Orange County out in California. I worked for a county supervisor out there, John Moorlach, from whom I learned a lot. He was then promoted to the California State Senate, so I had the opportunity to see local government in action and then state government in action. 

Due to some connections that we had within Senator Moorlach’s office, half of our office got called to D.C. to work for the Trump administration. So I had the opportunity to work at the state and local levels and then realize all the things that we complained about at the state and local levels at the federal level. Having that knowledge really gave me an inside scoop on how to address operational issues within some of the theoretical issues that we have in policy.

Mr. Jekielek: 

Broadly speaking, an organization like HHS is mostly composed of these career people. And is the issue that they have just a particular vision of what it needs to accomplish, and that is sometimes at odds with the vision of the executive branch? 

Mr. Mansdoerfer:

Yes. Before Elon took over Twitter, there was a hard way to define what a presidential administration turnover looks like. But given the visibility of what Elon did at Twitter, think about the same actions where he came in with the kitchen sink to the front doors. But an organization that doesn’t know you doesn’t particularly align with you, and yet, now you’re in charge. 

Think about if they fired the 180 top leaders at any Fortune 500 company in one day, and then 180 new leaders showed up the next day and said, hey, we don’t like what the last group was doing, and we’re here to give you new direction. So you have that as a dynamic to start with. 

Then you have the normal cultural dynamic where if you did political polling within the agency, you would probably see 80 to 90 percent would be more Democrat-oriented and much fewer would be Republican-oriented. That plays out in the District of Columbia going 85 to 15 Democrat to Republican. Those are the folks that are working in these agencies, so you’re walking into an ideological culture battle the moment you come into these agencies.

Now, there are some wonderful career appointees at HHS. They were actually some of the folks that gave me the best ideas, but they were never allowed to be empowered to be impactful because they were a minority in their thought processes of what needed to be done. I don’t want to paint a broad brush that the entire agency is inefficient and ineffective because there are many parts of the organization that are great and many people within, but they are silenced when Republicans are not in charge.

Mr. Jekielek: 

The spoils system is a side effect of politics, and it’s actually intentional. What are your thoughts? 

Mr. Mansdoerfer:

Elections have consequences. If you look at the ideological pendulum over the last 20 to 25 years, you had presidents that were closer to ideologically aligned, even if they were in different parties. With Bush and Clinton, I would say, their policy differences back then weren’t nearly as stark as we are seeing between Obama, Trump, Biden, and Trump. The pendulum is swinging much more significantly with the policy agendas of each of these different administrations. So with that, it is much more stark when it comes to the outcomes for when a president wins. 

For agencies like HHS, you have wild changes in policy on areas like the pro-life agenda, on areas for interpretation around gender, which is a big part of what HHS does, to even how you view the healthcare marketplace. I don’t think it’s necessarily what the Founding Fathers didn’t expect. I think it’s just more extreme as we get further and further away from political leadership that kind of ideologically agrees on 60 to 70 percent and then has their own platforms. But when you have an 80 to 90 percent difference in ideology, the differences in a presidential agenda are very, very stark. 

I’m a big believer in diversity of thought and diversity of opinion, and having the ability to have different vantage points come in and structure government is so crucial at a time when government has just been living on its laurels. Before Obama, it was plus 3%. It doesn’t matter which administration you were in; every year, the agency would get the same amount of money, plus 3%. We’re excited about it; we can continue on. 

When Obama got here, we had obviously the Affordable Care Act, which represented a significant increase in expenditures to the health economy. Then we had President Trump come in and create some efficiencies around that. And then you had President Biden come in and just blow it out of the water again. Right now, you have a reset that would be normal in any corporate business. 

I like to talk about that because we hold public employees differently than corporate employees. That’s how we’ve been trained here in the United States, public service is a great calling. It is a great calling, but it doesn’t mean that our governmental entities shouldn’t be treated in similar ways every now and then in order to reset them to make sure that they align with both the president’s agenda and better health outcomes. 

How can you argue that this arcane system, where we have 80,000-plus employees and 150,000 contractors and are spending trillions of dollars yet receiving some of the worst health outcomes, is what’s best for the American public? I can’t make that argument. I’m really interested to see how the Democrats are going to try to make that argument over the next few months.

Mr. Jekielek: 

In Trump 1.0, most people weren’t aware that something like MAHA existed. All these people were into different ways of approaching health than the standard allopathic model. It’s not obvious that MAGA and MAHA would have such a common interest.

Mr. Mansdoerfer:

I’ve had the pleasure of getting to know folks in this second round, you know, whether working on transition or just talking to folks about what to expect when they get to the Department of Health. As the operations guy, I can’t tell you what policy you want to focus on, but I can tell you, okay, look for this, this, and this when you want to try and start doing things. 

What I have found is an incredible synergy between folks that were in the first administration who are now there and the incoming MAHA team. To me, you need that pragmatism that comes with, we’ve been here, we’ve been through the grind, we know how to do this, combined with the idealism of, this is our first time here, this is our biggest shot, and we’re going to go above and beyond to make sure that we make an impact. To me, you have two factions, but they are very strong together in ways that they wouldn’t be strong if they were solely apart. 

I can go into a lot about the internal management dynamics, but right now what I know is that the office of the secretary has some incredible leadership in it, ranging from Heather Flick, who was the former general counsel and assistant secretary for administration, who serves as Bobby’s chief of staff, to the new incoming team that has the trust and relationships with Bobby. There are going to be some hiccups like there are with every administration, and there will be some difficulties, but they are perfectly positioned. They did a once-in-a-lifetime reorganization of the largest federal department in 60 days. You cannot tell me that the synergy inside is not working great, because there’s no way they would have been able to pull that off in that amount of time.

Mr. Jekielek: 

But it’s not necessarily obvious that would be the case. Is it obvious to you?

Mr. Mansdoerfer:

No, because they’re actually different agendas. The MAGA agenda and the MAHA agenda don’t necessarily mesh on a lot of issues. MAGA and Trump 1.0 is the healthcare economy, the economics of healthcare. MAHA is really public health-focused. So to me, they are complementary to each other. As long as they don’t start to try and drive each other’s business, they’re going to have a lot of paths to success. 

Because the MAHA team sees the public health indicators. We’re feeding folks terrible stuff starting from childhood. We have obesity problems. We have diabetes problems. We have all these chronic disease problems. That’s a public health argument. The health economy argument is, why are we paying so much for all of these things, and how do we merge them all together?

Secretary Kennedy is going to be very prevention-focused, which saves taxpayer money. Because if we can prevent you from getting said disease, then we save Medicare and Medicaid on that type of payment at the end of the day. Then you have the Trump 1.0 team, who’s really going to be focused on making sure that Americans have access to health in rural America, mental health, addiction treatment, and other things. 

So to me, the synergies are incredible, and it’s really getting them to be collaborative in this process, which we’ve seen. Because again, reorganizing a department of that level in two months is astronomically difficult, and they’re not going to get credit for it. But I want to just let everyone know that that’s the first step. I expect by the end of these four years, we’re going to see better health outcomes in a number of topics ranging from addiction to mental health to obesity. Those are going to be core tenets in a very significant way, as I understand it.

Mr. Jekielek: 

You’re aware of that process, and it almost didn’t happen. What actually happened under the hood in these agencies? 

Mr. Mansdoerfer:

Yes. The dietary guidelines are at HHS. The division that oversees them is the Office of Disease Prevention and Health Promotion. They work with the US Department of Agriculture to review the dietary guidelines I think every four or five years. And what happens between administrations is every time an administration turns over and the opposite party is coming in, they try and cram through as much policy within the days between the November election and January 20th. And that’s what we saw with the dietary guidelines.

Essentially, what the Biden administration released for comment through the Federal Register was an updated dietary guideline that would have solidified that process very early on in the Kennedy secretaryship and Trump administration. Dietary guidelines have a controversial history, but they’ve been pretty stagnant for a while. But things that you know are within them are, do we love salt or do we hate salt? There are all these different conversations? 

In this instance, the incoming secretary’s team realized what was happening and put out a call to groups like the Independent Medical Alliance to provide input on the dietary guidelines, which this organization was able to do, providing thousands of comments on what Kennedy would be more aligned with, which will then allow them to rewrite those dietary guidelines in a way that will get better health outcomes. Because what folks don’t understand is we all think about the food pyramid, but how does that operationally impact our lives? 

The dietary guidelines go directly to school lunches and how we pay for school lunches. So it’s very impactful for businesses and consumers and the way we educate our public school students in the lunches that we give them. If we’re feeding them very heavily on sugar or feeding them very heavily on things that aren’t going to be nutritionally beneficial to them, that all starts with the dietary guidelines. The fact that Secretary Kennedy’s team realized that so early on gives me significant hope that not only do they know what they’re doing, but they are really making sure that the Secretary’s and the President’s agenda is being fulfilled. 

Mr. Jekielek:

How could the dietary guidelines be codified without the new administration realizing that it happened? 

Mr. Mansdoerfer:

In this instance, you have an advisory committee. You bring together industry, you bring together nutritionists, you bring together clinical folks and researchers to talk about what the dietary guidelines should be. That all started happening about a year ago. And you take the last report and you make your changes and you write the report. And due to disclosure notices, what you do is you publish that report and you say, this is our preliminary report. Please provide us feedback on what you think we missed or didn’t have or whatever. 

Essentially, what happened at the very end of the administration was they had drafted the report already and put it into the clearance process, which means that we’re putting it out to the Federal Register to have folks’ comments on it, and we are basically circulating that this is the draft that we’re going to go with unless we get overwhelming evidence that we need to do something different. And so they did that right before the new administration came in. 

What I was telling folks earlier about 180 to 200 political appointees, that doesn’t happen on day one. Day one is typically only 25 to 30 political appointees. When you’re an agency of $1.3 trillion dollars, it’s hard to catch all of the policies that the previous administration was trying to jam through before you even get there, unless you know what you’re looking for. It relies on the career staff who may or may not want to tell you about certain priorities and what’s coming down the pipeline. It happens in every administration. It’s not a Republican or Democrat thing. But this was one very stark example where if they hadn’t been on their game, they could have had to spend more time walking back something that they didn’t agree with.

Mr. Jekielek:

It’s just the sheer scale of the agency that creates this situation. There’s so many important things to fix, and what do you focus on? We’re here at the Independent Medical Alliance conference in Atlanta, where you’ve recently come on as an advisor. How did you come to join them? 

Mr. Mansdoerfer:

One of the things that I noticed in Trump 1.0 is that there were very few folks on the outside that could talk about public health. There we had again, as I’ve talked about, the health economy well taken care of. Lots of think tanks, lots of great organizations that handle the health economic side of what conservatives think. But there wasn’t really anything on the public health side. 

So as part of my first job,which was to oversee the advisory boards and commissions, if I have to find a practitioner that’s aligned with the public health agenda of the secretary and the president, they’re much more difficult to find because they’re either quiet about it, because academic health science settings aren’t really favorable to conservatives, or they didn’t agree with our agenda.

I really noticed that when we have to talk about certain topics, whether it’s fentanyl or whether it’s HIV, who on the outside has the ability to support the secretary and the president’s agenda from a public health perspective? This time, I noticed that in the IMA, we had this organization, formerly the FLCCC Alliance, that had incredible science and healthcare capacity to have some of these conversations. Just through the happenstance of getting connected, I gained a vision of an organization that can fight for honest medicine on a number of topics from chronic disease to informed consent to restoring trust in medicine to changing the culture of health. 

It was an existing structure that already had 50-plus fellows and multiple specialties, hardcore researchers that understand how to bring bench science to policy. It then created an infrastructure to provide both offense and defense to an administration that’s going to inevitably be attacked by every major corporate structure around health, whether it’s the AMA, the hospital association, or the public health associations. There’s already a cadre of organizations set up to defend the status quo. We needed an organization that provides evidence in a way that we didn’t have in the first administration to push and defend good policy, but also push against bad policy as it comes out beyond the federal level, at the state and the local level.

Mr. Jekielek:

Secretary Kennedy invited a group of food executives to HHS. Could this be done with Big Pharma? At this IMA conference, there is a lot of criticism of Big Pharma.

Mr. Mansdoerfer:

Yes. If I were to be advising anyone who’s concerned about what Secretary Kennedy and the administration are going to do to their bottom line, I would be bringing options to help America get healthier again. That’s what we’ve seen in the food industry. You see that Steak and Shake just came out with beef tallow. I think In-N-Out Burger just did it a couple of days ago as well. But you’re starting to see the food industry trend in the right direction around making proactive changes that I’m hearing many of them agree with. 

Again, there’s the business reason for doing things, but as they start to really look at it, I see a lot of support from the food industry to rally around some of Secretary Kennedy’s ideas and to do it proactively. Again, I think Secretary Kennedy and President Trump have demonstrated that if you don’t come towards us, we’re going to make it happen. To me, pharma is very much the same thing. What are ways that pharma can engage an agency where they have the status quo for how they’ve been relating to them, but you have a new secretary who really cares about chronic disease prevention? 

How does that align with the pharmaceutical industry? There will be places that it would, and then there will be areas that it won’t. There might be some benefits there that both sides don’t understand. How do you make America healthy again at the end of the day and bring proactive solutions to an administration that wants to see health outcomes increase, not necessarily line the pockets of organizations that have increased or decreased life expectancy here in the United States?

Mr. Jekielek:

Explain to me what is known as the revolving door.

Mr. Mansdoerfer: 

There are two types of revolving doors. The first type of revolving door is what the career bureaucracy goes through. And that’s, they get trained in an organization like the FDA, and then they leave the FDA and go work directly for an organization that they were regulating. And so I see that as having some significant conflicts of interest issues.

Then you have the political dynamic. And what folks need to understand is that there’s actually a very intensive ethics vetting process for political appointees. And so when you come from industry, you’re typically recused from working on those subjects for a year or two or five, depending on the types of subjects and the monetary value that you’ve gotten. But what’s concerning is when you get towards the end of an administration, like in the Biden administration’s case, where we know we’re not continuing, we know that, you know, January 20th at 11:59 is the last minute that I’m employed. 

That whole time period where you know you’re being run out of office and you’re searching for a job at the same time, and you are pushing every policy through you can before the next administration gets there, so there are tons of conflicts and revolving door issues. But the ones that concern me the most are the ones at the very end of administrations where everyone knows they’ll be unemployed at a certain point in time, and there’s an incredible rush to put policy agendas through before the new administration gets there. So to me, that’s ripe for conflict when you see a lot of policies enacted at the very end of an administration.

Mr. Jekielek:

Basically, because you can enact policy for your future employer. 

Mr. Mansdoerfer:

Basically, yes. There are rules to try and stop that, but they are very hard to adjudicate. 

Mr. Jekielek:

What was the role of the Covid pandemic and everything that came with it in ushering in this sea change in HHS?

Mr. Mansdoerfer:

If you’ve seen polling about the government, both starting in 2020, but also the next two to three years, where it enforced unscientific mandates, it enforced draconian policies. And so there’s been this incredible relationship divide between the public and the average American. Because I used to talk about government arrogance. There are the many, many high-level, highly trained folks at the agency that had so many letters behind their names that they could be credentialed on any topic. Then they’d go out and say, thou shalt do this. But they’ve not built any relationship with the person that they’re yelling at and saying, thou shalt do this. 

You had that normal government arrogance and public health arrogance coupled with a party that saw the ability to completely transform the health economy and the world through their draconian measures, ending up with, now we have a significantly higher level of distrust in both government and health. We’ve always had distrust in public health. There’s always been a number of reasons why. You can remember certain demographics about the Tuskegee Study. You can think about all of these different things that lead folks to distrust either health, science, or the government. 

At the end of the day, you took an unapologetic, draconian public health apparatus, and you basically punished average Americans with comments that came out of the White House like, a long winter of death for unvaccinated Americans. How am I supposed to react to that when you have essentially beaten me up over the last three to four years? Now, Secretary Kennedy gets the opportunity to really take that frustration with a public health and governmental apparatus that mistreated so many Americans during the Covid pandemic and right-size it. To me, without Covid, you don’t get Secretary Kennedy.

Mr. Jekielek:

What do you mean by right-sizing it? 

Mr. Mansdoerfer:

In the reorganization that came out, what they did was the methodology that I’ve heard they’ve done is they’ve taken HHS back from the current levels, which were extremely exacerbated in hiring during the COVID pandemic, and brought it back to 2019 minus 10% of the entire Biden administration hiring process, and a little bit from the Trump administration, obviously with 2019, but the entire hiring process of the last administration minus 10%. So to me, that brings that back more into alignment with almost after the Affordable Care Act days, but a little bit before where you saw an expansion of HHS growth during the Affordable Care Act.

Mr. Jekielek:

What substantively and permanently could HHS accomplish in four years, given a very real possibility that the pendulum swings the other way?

Mr. Mansdoerfer:

The reorganization is a good first start. That’s changing the culture of the management of the agency to move it much more aligned with better health outcomes as opposed to better bureaucracy. That’s an excellent first step, but there are all the derivative topics that happen beyond that. How do we fundamentally program and spend money as a government health agency? 

One of the things that you might see in the coming days is combining SAMHSA, which is the Mental Health Association part of HHS, with HRSA, which is the Federally Qualified Health Center portion. Having them combined is going to provide better direct primary care and direct access for poor communities because you’ll be able to layer on issues like mental health in ways that the general providers weren’t doing historically. So that’s one small subset. 

When you have a mental health crisis here in America, and we’ve seen that in a number of capacities, and we have an addiction crisis here in America, it makes absolute sense that the federal government should be funding programs in communities that are the most impacted and doing it in ways that you don’t have one grant for mental health and one grant for making sure that you can have your normal primary care within these communities. Why is that not combined? 

It’s putting together opportunities to struggle with mental health issues or beginning to struggle with addiction. It’s much easier to course correct over here than it is after you’ve had decades or years of dealing with specific issues. Now, not everything is going to be caught in that particular approach, especially even with the combination of folks like HRSA and SAMHSA together. The way that the federal government has continued to spend money and get worse health outcomes on so many of these topics needed a disruption and a change like this to try something different.

Mr. Jekielek:

What is the biggest possibility for failure?

Mr. Mansdoerfer:

That’s a big guess. When you do reorganizations, you bring theory to practice, and you have taken a static organization and significantly disrupted it. There are really two potential opportunities there. There’s a, we were correct, and we’re going to see better health outcomes because we’re going to have more efficient and effective spending. The other is, we weren’t correct and the infrastructure on health kind of struggles to re-acclimate in this new environment. 

When you continually see poor health outcomes with the other environment, I would argue that even if they were incorrect in certain ways, and actually Secretary Kennedy mentioned a couple of days ago that they may bring some folks back and course correct, that you’re still having the opportunity to provide that kind of scientific method to management. Which is why we had to restructure this. We were getting the worst health outcomes with more spending. We need to do something different. 

Is this going to be 100% perfect and work, and are we going to have incredibly different health outcomes at the end? Maybe, maybe not. But if you don’t at least try, then you’re going to continue to get the same worst health outcomes. Having the political gumption to go in and disrupt, which has historically not happened, should be championed, because at the end of the day, it’s not like we’re getting healthier.

Mr. Jekielek:

Historically, it has never happened?

Mr. Mansdoerfer:

It hasn’t happened at this level. There have been other attempts, and you’re starting to see it. It’s actually really interesting to see clips of Senator Schumer and other former Democratic leaders who have all talked the game of reducing the size of government. President Clinton talked about it. President Obama talked about it. But President Trump and Secretary Kennedy at the Health Department have actually done it. 

During the Biden administration, they claimed they were going to reorganize the CDC. They all realized that the CDC was in need of significant reorganization. Can anyone name one actual thing that the Biden administration reformed at the CDC? You can’t. And yet already within 60 days of a new administration, everyone is beginning to see what true reform and true impact look like with good management and leadership of that department. 

Mr. Jekielek:

There’s a lot of resistance to the change. There’s always a lot of forces aligned to support the status quo. But is there something beyond that? 

Mr. Mansdoerfer:

Yes. At the end of the day, it’s the bottom line of many of these corporate infrastructures, whether it’s higher education, which has been, I would argue, running research that should never have been started.

Mr. Jekielek:

Anything in particular?

Mr. Mansdoerfer:

Yes, look at all of the weird DEI research that was being done by the NIH that would not help your average American citizen live a healthier life. When you’re thinking about public good, great, there’s absolutely space to look at research that impacts portions of the population. And the portion of the population can be small, but when a disproportionate amount of that money is being spent on small subsets of the population and on areas that won’t increase health outcomes, why are we funding it? So there was that. 

So there’s a big pushback from higher education around the grants that they’ve been receiving, though many of them have shown little to no outcomes. There’s conversations with groups like the American Medical Association. Most folks don’t understand that the AMA is integrated into the healthcare economy. They have CPT codes that are basically the diagnosis of an individual that gets coded in the system for reimbursements. 

They license that to CMS. But we all know that the AMA is an incredibly activist organization pushing agendas that don’t align with this new administration. We have organizations like the AMA, which are deeply embedded both within the HHS infrastructure, but also within just the general health economy. So they’re going to push back because they’re concerned about their bottom line and their influence.

Mr. Jekielek:

But they would say, we’re just concerned about the health of Americans.

Mr. Mansdoerfer:

That’s absolutely true. And that’s the fight that you’re going to have. But when you have an organization that is entirely built on making sure that other healthcare providers aren’t able to practice at the fullest extent of their scope, which is what the AMA and all of the different state associations do, which is we are clinical professionals, we are MDs or DOs, and we don’t like the fact that nurse practitioners, physician assistants, chiropractors, and others get to practice with what their training is. I think that really limits your ability to argue about why we feel that our way is a better approach for America when you are intentionally making sure that other professions don’t get to practice to the full extent of their abilities. 

Mr. Jekielek:

You mentioned higher education and also these physician advocacy organizations. Where else is that resistance coming from? 

Mr. Mansdoerfer:

It’s going to come from the industry of health in general. It’s going to come from food. In the last couple of days, we saw the American Beverage Association putting out money to conservative influencers to support things that aren’t healthy for American children. We have these institutes that are trying to embed from within the conservative apparatus to other aspects where anytime you change something at the HHS level and it impacts the bottom line of pharmacy benefit managers, which is the weird middleman between how people get their drugs in America today. That’s going to be a big conversation as well. So you’re going to have a lot of forces with a lot of money start to spend significantly to limit the impact of Secretary Kennedy.

Mr. Jekielek:

What is the strategy to deal with that? 

Mr. Mansdoerfer:

The strategy really revolves around a movement, MAHA and MAGA, not taking a break now that we’ve won. We are in a place where historically the American electorate will get really up in arms, win a political battle like we did when President Trump got into office, and then they go away for the next 18 months. They gear back up for the midterms. They gear back up for the next presidential cycle. We have not won this fight. We’ve begun the fight. 

We have industry forces, which I would say have unlimited money, that are going to try to do everything to protect their bottom line, but also limit good policy ideas of Secretary Kennedy and President Trump. And when you have that, you need your rural health mom to your Santa Barbara mom who are politically aligned around MAHA issues and put them in the right direction to hold government accountable no matter who’s in office. We saw that with what IMA did during the Kennedy confirmation. 

That was a close call. We really had to use organizations like the Independent Medical Alliance to do advocacy in states like Louisiana and Senator Cassidy to make sure they realized that this is what the population and the American citizen want. They want a change to the status quo around health, and they want to have better health outcomes for themselves, for their kids, and for their families. What’s next for the IMA? 

The IMA is now positioned to talk about a number of different topics. We have a four-pillar strategy that ranges from chronic disease prevention, restoring trust in medicine, provider empowerment, and focusing on changing the culture of health. Each one of those is going to have a tactical plan to feed good policy into the administration using the incredible clinical and scientific experts that they have aggregated over the last few years. So we’re going to play offense by providing good healthcare policy. Then we’re going to provide defense to the administration when they do the right thing and take on the corporate interests that are going to spend incredible amounts of money to make sure that they’re not successful.

Mr. Jekielek:

What if they do the wrong thing?

Mr. Mansdoerfer:

With a nonpartisan organization, there’s always an opportunity to hold everyone accountable. There will be things that there are differences of opinion on, no matter who’s in charge. There is the soft power with foreign policy. But when it comes to the movement that cares about these topics, you would be best to continue to move this in that direction to the hard power, which is, hey, we don’t agree with what you’re trying to accomplish here. How do we get to a better outcome? 

Because we have this movement of folks that deeply care about these topics. They want to say because they’re part of the reason that you’re in this position to begin with. So IMA, while generally agreeing with a lot of what Secretary Kennedy and President Trump are doing, also has the ability to have that conversation if there are some disagreements there in the future.

Mr. Jekielek:

There are a lot of different ideas, a lot of opinions, and the policy is very far-reaching, even within these first 60 days. There are lots of people here saying, why are they doing this? Why are they not doing that? Why is this happening?

Mr. Mansdoerfer:

There is no one better than Secretary Kennedy to push this agenda forward, and we need to show a little bit of grace when things don’t happen as soon as we possibly want them. I say that because having been on the inside, you are up against so many forces to try and accomplish what are going to be precedent-setting and never-been-done-before type policy actions. I understand that you have an American public that is very action-reaction oriented. We won, so why have we not won entirely? But at the end of the day, Secretary Kennedy and his team are laying the groundwork for true transformational change within the United States and globally. 

Mr. Jekielek:

Any final thoughts as we finish up today? 

Mr. Mansdoerfer:

I very much applaud President Trump and Secretary Kennedy for doing the right thing and disrupting an organization and an apparatus that has continually led to bad health outcomes. No matter what the outcome is, I am excited to see what we learned during this process that will improve the lives of everyday American citizens. I personally think it’s going to be a resounding success. But even in terms of the unknown, it is better to have leadership that’s willing to take these bold actions, than it is to continually lead Americans down the path of a poor health outcome. 

Mr. Jekielek:

David Mansdoerfer, it’s such a pleasure to have you on the show. 

Mr. Mansdoerfer:

Thank you.