Last spring and summer, The Fulcrum published a 30-part series on Project 2025. Now that Donald Trump’s second term, The Fulcrum, has started, Part 2 of the series has commenced.
Without a strategic plan, a conspiracy theorist at the helm, and a ransacking of its workforce, can America become healthy again? Doubtful.
Every four years, the Department of Health and Human Services (HHS) updates its Strategic Plan, “which describes its work to address complex, multifaceted, and evolving health and human services issues.”
President Donald Trump’s administration's strategic plan for HHS is still “forthcoming,” but certain trends are already evident.
On Feb. 13, 2025, Robert F. Kennedy, Jr. was sworn in as the 26th Secretary of Health and Human Services (HHS). Immediately following the ceremony, Trump, with Kennedy by his side, signed the “Establishing the President’s Make America Healthy Again Commission” Executive Order in order “to investigate and address the root causes of America’s escalating health crisis, with a focus on childhood chronic disease.”
The commission has 100 days to report childhood health issues to the president. The report will assess “the threat that potential over-utilization of medication, certain food ingredients, certain chemicals, and certain other exposures pose to children.”
Both Trump and Kennedy have suggested that the national focus should be on reducing chronic disease rates in the U.S., pointing to rising rates of cancer, obesity, diabetes, asthma, and autism spectrum disorder.
While Kennedy should be lauded for his commitment to the health and well-being of Americans with chronic illnesses, he seems to be dropping the ball on preventable diseases.
In less than a month from that declaration, and under the direction of long-time vaccine skeptic Kennedy, a mostly childhood disease, measles, is ravaging communities in Texas and has moved into New Mexico.
NBC News reports that as of March 7, the measles outbreak in West Texas has soared to 198 cases, per the Texas Department of State Health Services, and in New Mexico, 30 cases have been reported in Lea County, which borders Gaines County. A 6-year-old in Texas died, and Lea County health officials reported a suspected measles death in an adult.
Since becoming secretary, Kennedy’s statements on vaccines have been inconsistent, to put it graciously.
As Secretary of HHS, Kennedy oversees the following operating divisions: The National Institutes of Health (NIH), the Centers for Disease Control and Prevention (CDC), the U.S. Food and Drug Administration (FDA), and the Centers for Medicare and Medicaid Services (CMS).
While there is always some level of waste and fraud in large bureaucracies, the cuts to the agencies we have witnessed are like taking a chainsaw to what could be removed with a scalpel.
Dr. Reshma Ramachandran, a Yale health professor and researcher, board-certified family physician, and the Chair of the FDA task force of the nonprofit Doctors for America, told Politico, “On day one, the new HHS secretary is gutting the agencies that would be necessary to make America healthy again.”
CBS News reported on the day of this writing that “All employees in the U.S. Department of Health and Human Services (HHS) were notified Friday of the option to voluntarily resign in exchange for a $25,000 payment.”
Thousands of HHS employees had already been terminated before the buyout was offered.
Reuters said the Trump administration laid off 1,165 people from the NIH.
Between 700 and 750 employees were terminated at CDC, although recently, 180 of them were asked to return to work.
Reuters also reported that the Trump administration fired over 1,000 FDA employees over Presidents Day weekend.
Leaders at CMS, the federal agency that oversees Medicare, Medicaid, and other major healthcare programs, think at least 300 of the agency’s 6,700 employees have been let go.
The jobs that these terminated employees do cover a wide range of activities that keep Americans safe and healthy and include things like: oversight and administration of the health programs that care for half of Americans, research of chronic illnesses like Alzheimer’s, responsiveness to threats like the bird flu, and reviews of medical devices and drug safety, to name a few.
Arielle Kane, a terminated CMS official, told Politico she was working on a Medicaid pilot program active in 15 states to improve maternal health outcomes, an area in which the U.S. is lagging compared to other Western countries.
According to HHS.gov, “The mission of the U.S. Department of Health and Human Services (HHS) is to enhance the health and well-being of all Americans by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.”
How an agency can deliver on its mission when emptying those sound, sustained scientific advances remains to be seen.
In December 2024, as a Project 2025 follow-up, I wrote that it was ironic that President-elect Trump rejected most of Project 2025’s proposals with his pick of Kennedy for secretary of HHS. Still, the choice of Kennedy as the top protector of America's health might even be worse.
I am afraid it looks even worse than I thought.
Lynn Schmidt is a columnist and Editorial Board member with the St. Louis Post-Dispatch. She holds a master's of science in political science as well as a bachelor's of science in nursing.
image of U.S. President Donald Trump is displayed on a digital billboard in Times Square in New York on April 8, 2026.
Trump is stuck between two realities. Neither serves the American people
Normally, I worry that events may overtake a column. But not so with the Iran war.
I don’t worry about running afoul of a headline or Truth Social post from the president because what is said about the situation is no longer very relevant to the reality.
On April 8, Nick Catoggio, my Dispatch colleague, dubbed an earlier stoppage with Iran “Schrödinger’s ceasefire.” This was a reference to the famous thought experiment by the physicist Erwin Schrödinger, who was trying to explain the weirdness of “superpositionality” in quantum physics. A cat in a box is both dead and alive at the same time until you open the box. Schrödinger meant to illustrate the absurdity of the idea that particles aren’t any one thing, but a “cloud of probabilities.”
The Trump administration is stuck in a word cloud of probabilities of his own making. The war is over. The war is on. The war isn’t a war. We have a deal, but we don’t have a deal, but we’re about to have a deal. We destroyed Iran’s military. No, we left it intact. We want regime change. No we don’t. We already accomplished it. We “obliterated” Iran’s nuclear program a year ago. We had to go to war in February to prevent nuclear war. The Strait of Hormuz is open, closed, or something in-between. No deal without “unconditional surrender.” Let’s make a deal!
This everything-all-at-once vibe can be disorienting, particularly since most Americans didn’t have a war with Iran on their bingo cards until the shooting had already started. President Trump didn’t prepare the country or consult with Congress beforehand because he thought it would all be a smashing success in a matter of weeks.
The miscalculation that started it all: killing Iran’s Supreme Leader, Ayatollah Ali Khamenei, and much of Iran’s senior leadership, on the first day of the war. To “the great proud people of Iran, I say tonight that the hour of your freedom is at hand,” Trump announced on Feb. 28. “When we are finished, take over your government. It will be yours to take. This will be probably your only chance for generations.”
I support regime change in Iran and shed no tears for Khamenei or his goons. But when you start a war by killing the regime’s top leaders, it’s not unreasonable for the remaining ones to conclude that you really intend regime change.
Khamenei was a murderous fanatic, but he was a fairly cautious one. He liked to threaten closing the Strait of Hormuz or attacking our regional allies, but he was reluctant to actually do it, fearing it would invite a regime change war. The mullahs and IRGC goons believed, not unreasonably, that if they lost their grip on power, they’d be lynched by the Iranian people they’ve brutalized for decades.
By starting with a regime change war, Trump removed any reason for the regime not to go for broke. When you have nothing to lose — particularly when you are a millenarian religious fanatic — a Persian Alamo strategy makes a lot of sense.
So Iran closed the Strait of Hormuz and attacked its neighbors.
But it turns out this wasn’t the Alamo. In the contest of wills, Trump blinked. The Iranian regime’s tolerance for punishment proved — so far — to be greater than Trump’s and that of our gulf allies. Militarily we could finish the job, but that would require ground troops and much greater economic turmoil. In a conflict Trump launched unilaterally without the prior support of Congress, NATO or the American people, Trump doesn’t have the political capital for that.
But that’s only half the problem. Trump wants the war over, but he doesn’t want to pay — militarily, economically, politically — what that would cost. So he wants to make a deal that ends it. But there is no deal available that wouldn’t come at an equally undesirable cost. Any deal that looks like what President Obama struck with the Iranians would be too embarrassing to bear. But the Iranians are convinced that they can get just such a deal, and they’re willing to drag things out as long as it takes.
The result: Trump’s in a box of his own making. He thinks he can talk his way out by simply asserting a reality that doesn’t exist. When the financial markets get nervous, he announces a breakthrough that is, at best, a possibility. When the Iranians agree to a deal that looks similar to one Obama might negotiate, Trump goes back to his threats.
It can’t go on forever. But I’m sure it’ll last until long after this column is forgotten.
Jonah Goldberg is editor-in-chief of The Dispatch and the host of The Remnant podcast. His Twitter handle is @JonahDispatch.