““He could be misinterpreted that vitamin A will save your suffocating suffering child,” Brett Giroir, a first-term Trump health official now advising Kennedy on infectious disease policy, wrote in a post on X. “It will not.”
In Texas, some local officials have grown concerned that Kennedy’s messaging risks diluting their own communication efforts. They warn that his equivocations could undermine their only hope of ending the outbreak: persuading people to get the measles vaccine.
“We don’t want to diminish the primary message,” Phil Huang, director of health and human services in Dallas County, Texas, said in an interview. “It’s the vaccines that are the most important.”
Katherine Wells, director of public health for the city of Lubbock, Texas, echoed that sentiment.
“We need to make sure that we’re all talking about the importance of vaccination, and although there’s some focus on treatment, preventing the disease in the first place is really what public health works on.”
Since President Donald Trump nominated him to run HHS late last year, Kennedy has labored to convince skeptics that he is not anti-vaccine, despite his past as an activist who repeatedly raised doubts about the safety and effectiveness of various immunizations.
As recently as 2021, Kennedy suggested without evidence that measles outbreaks may have been fabricated to “inflict unnecessary and risky vaccines on millions of children.” But now confronted with a high-risk, real-world opportunity to demonstrate whether his views have changed, the HHS secretary has instead appeared to seek a middle ground — calling the measles vaccine protective for individuals and broader communities, yet stopping well short of the full-throated endorsement public health experts say is necessary from the nation’s top health official.
“What he should be saying is that these kinds of outbreaks are fully preventable and unacceptable, and that as secretary he will do everything in his power to ensure the public that it never happens again,” said Lawrence Gostin, director of Georgetown University’s O’Neill Institute for National and Global Health Law. “It’s the first major public health crisis that he’s had to face, and he hasn’t reassured doubters about his ability to get on top of it.””
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“Most importantly, health experts said, Kennedy could simply hit the bar already set by health officials in Texas: Declaring unequivocally that vaccination is the central way to contain the outbreak.”
“Physicians elsewhere do not bear the same financial burden. I traveled in 2019 to the Netherlands, Australia, and Taiwan, which have three distinct health care systems that still manage to cover all of their citizens: universal private insurance, a public-private hybrid, and single payer, respectively.
In the Netherlands, physicians take three years of undergraduate studies, three years of master’s studies, and complete a one- to two-year internship before being licensed; certain specialties then require further training. Dutch university students typically graduate with much less debt (less than 25,000 euros on average, or about $26,200) than their American counterparts. In Australia, the training requirements would look familiar to US doctors — a decade or so of education and then on-the-job training — but the tuition would not, with annual medical school costs capped at less than $10,000 per year. Taiwanese doctors likewise spend significantly less money on their education, even relative to differences in cost of living, than US doctors.
What all of those countries have in common is more robust public support for higher education and generous loan repayment programs. The high cost of college is a longstanding issue in the US, and that contributes to the prohibitive cost of a medical education for reasons that have little to do with health care itself.”
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“There is another way in which the US health system places an unusual burden on doctors: the headaches of health insurance paperwork. As left-leaning policy analyst Matt Bruenig wrote on the recent brouhaha over insurers and doctors after the killing of Brian Thompson, at least some of the excess pricing of US medical services can be attributed to the administrative costs that providers incur while dealing with private insurers.
The demands of insurance claims on doctors’ time and attention not only make for a less pleasant working experience, they also take them away from patients, which can contribute to worse health outcomes.
Here is perhaps the most telling statistic, from the Commonwealth Fund’s 2024 international survey of doctors: 20 percent of US doctors said they spend “a lot” of time on paperwork or disputes over medical bills. That was nearly double the rate in the country with the next highest share; 12 percent of Swiss doctors said the same working in their country’s system, which also relies on private insurers to oversee benefits.
Only 5 percent of Dutch doctors and 9 percent of Australian doctors said paperwork and billing took up a large chunk of their time.
This wasteful activity affects both the cost and quality of our health system. Among wealthy countries, US patients have the fewest number of consultations with a doctor in a given year, with the exception of Sweden, and spend the least time with their physicians. Time and money spent on administrative work, for both insurers and providers, account for about 30 percent of the excess medical spending in the United States.”
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“The average physician salary in the US ranges from about $260,000 (for endocrinologists and pediatricians) to $550,000 (for certain surgeons). The most elite providers earn more than $1 million annually.
Dutch general practitioners, by contrast, make about 120,000 euros ($126,000). Even senior hospital surgeons typically earn about 250,000 euros. Australia, with a more robust private market, can be more generous: While primary care doctors earn between AUD$100,000 and $150,000 ($60,000 to $93,000) on average, senior practitioners make more and specialized surgeons can rake in as much as AUD$750,000 ($460,000) — much closer to the American norms.
Doctors in Taiwan — where, it should be noted, nationwide average incomes are about half of what you find in the United States — can make between $60,000 and $100,000 per year. The policy experts I spoke to there agreed that doctors are underpaid relative to the high number of patients they see, substantially more than a typical American physician will see in a day.
Whatever complaints American physicians may have, doctors in those countries feel undercompensated.”
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“The blame game between insurers and doctors is ultimately a distraction. Other countries have private health plans and private providers and yet don’t experience nearly the same waste and out-of-control price increases as the US has. The whole system — the prices and how they’re paid — will need to be addressed in the long run. As one landmark health economics paper put it 20 years ago: “It’s the prices, stupid.””
“Measles, mumps, and polio are supposed to be diseases of the past. In the early to mid-20th century, scientists developed vaccines that effectively eliminated the risk of anyone getting sick or dying from illnesses that had killed millions over millennia of human history.
Vaccines, alongside sanitized water and antibiotics, have marked the epoch of modern medicine. The US was at the cutting edge of eliminating these diseases, which helped propel life expectancy and economic growth in the postwar era.”
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“As long-accepted, lifesaving public health measures increasingly become politically polarized, routine vaccination rates are rapidly declining in much of the US. In the 2019–2020 school year, three states had less than 90 percent of K–12 students vaccinated against measles, mumps, and rubella. By the 2023–2024 school year, 14 states had fallen below that threshold. The number of states with more than 95 percent of schoolchildren vaccinated — the preferred level of coverage to prevent outbreaks — dropped from 20 to 11 during that same period.
It is no surprise then that the number of US measles cases more than quadrupled from 2023 to 2024. Nobody has died of measles in the US since 2015, but if vaccination rates continue to decline, this highly contagious disease (one person can infect more than a dozen other people) will spread with increasing ease, which raises the risk that American kids could die.
We know how to prevent that. We’ve had remarkably safe, effective shots for decades. We just need to keep using them.”
” In most rich countries, people don’t have to worry about sifting through a dozen different health plans — and they don’t live in fear of losing their health care after losing a job, and they receive more affordable, higher-quality care than Americans do. The paradox of the world’s wealthiest nation having one of the weakest health systems among developed nations has long been a vexing policy problem — without an easy solution.”
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“American health insurance, as we think of it today, started to take shape in the 1920s, as the medical profession was being standardized and modern hospitals were being built. Some employers started offering payments for hospital-based services as a perk for their workers. Companies had large groups of employees, some in good health and some in bad, to spread the risk and make the finances work much like modern-day insurance does.
This system soon became entrenched enough that President Franklin D. Roosevelt bypassed plans to include national health insurance as part of the New Deal. Then came World War II, along with government-mandated wage controls for employees in the private sector to keep the war machine moving. Barred from offering raises to motivate their workers, companies started pumping up their health benefits — and the government agreed to exempt those benefits both from wage controls and taxes.
By the 1950s, employer-sponsored insurance had become popular among those who received it and progressive labor unions urged the government to make the tax exemption permanent. Congress agreed, enshrining in 1954 the subsidy for company health plans in federal law. Doctors and hospitals, whose industry was growing into the leviathan that it is today, became accustomed to working with private insurers rather than with the government directly.
Today, these work-based health plans still cover roughly half of all Americans.”
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“The problem with the employer-based system was it left out too many people because they didn’t work or didn’t have a job that offered health insurance. To start filling in the gaps, in 1965, Congress created Medicare and Medicaid to cover two of the biggest groups of people who lacked coverage: seniors and people in poverty.
After that expansion, we had a system that covered most Americans — which made it hard to change, because people feared losing what they had.
Those fears, supported by the medical industry’s campaign against “socialized medicine,” doomed the health care overhauls proposed by presidents Richard Nixon and Bill Clinton that would have consolidated most Americans into a national insurance scheme. Certain tendencies in American culture — consumerism and trust in private markets — made it easier to persuade the public that they’d lose under a government-run health plan.
Meanwhile, the US health care system still had obvious holes. Rather than threaten the status quo, policymakers added new patches.
CHIP was approved in the 1990s, covering children of working-class families whose incomes were not low enough to get Medicaid. (Their parents, however, were often left without any coverage at all.) The 2010 Affordable Care Act, also known as Obamacare, was designed to fill that gap by covering people who didn’t receive health insurance through their jobs but didn’t qualify for Medicaid.
Yet even after a half-dozen rounds of incremental health reform over five decades, about one in 12 people in the US lack health coverage and Americans are much more likely than people in other developed nations to say they skip medical care because of the cost.”
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“Other countries built their health care systems more deliberately.
After World War II, the United Kingdom sought to extend medical security to all its citizens, creating the National Health Service; many other European governments followed suit.
A half-century later, another wealthy island nation made the same choice. Taiwan, building a modern democracy after decades of authoritarian rule, scrapped a fractured, inequitable health system to set up a national insurance program that would cover everyone. It was a proclamation of solidarity after a tumultuous military dictatorship had come to an end.
Not all countries have opted for a single government program, but their systems are still simpler than America’s and cover the entire population. In 2006, the Netherlands opted to trade a dysfunctional two-tiered insurance system for a universal program that relied on private coverage but was nevertheless designed to insure everybody. The uninsured rate there today is less than 1 percent (some people opt out).
But the US? We’ve never paused to build a fairer, simpler, uniform health system.”
“Vance’s sunny rhetoric here disguises his plan’s inegalitarian moral priorities.
It is true that the young and healthy have different medical needs than the old and sick. And before the Affordable Care Act’s regulations, the former could sometimes procure cheaper insurance tailored to their (currently) limited needs.
But this came at a social cost. Insurers were able to offer cheap health coverage to those who barely needed it by screening out those with preexisting conditions. In Vance’s terminology, they constructed low-risk pools: By only including people who were unlikely to require expensive treatments in their plans, they could profitably provide low-premium insurance to the young and well.
Meanwhile, sick and/or older Americans on the individual insurance market either went without coverage or were forced to pay dramatically higher premiums in order to cover the high cost of their care. Some state governments tried to defray this cost somewhat by subsidizing high-risk pools. But enrollees still paid much higher premiums than the typical market rate, and their coverage often excluded the treatments they needed most.
The Affordable Care Act effectively forced the healthy to subsidize the sick. It required insurers to include those with preexisting conditions in their plans and cover all medically necessary procedures. To guarantee that insurers could still turn a profit and that coverage remained (at least somewhat) affordable for all, the government provided consumers with insurance subsidies.
The upshot of all this was that coverage became a little more expensive for some healthy people, while growing much cheaper for the old and seriously ill.”
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“Vance’s vision for health care policy helps clarify the character of the right’s burgeoning “populism.” On trade and immigration, Vance’s ideology may prize a nationalistic conception of the common good above free markets. But on most economic questions, its iconoclastic rhetoric belies its fealty to conservative orthodoxy — and thus, to “the ruling class” whom Vance loves to deride.
As Trump’s running mate, Vance is campaigning on tax cuts for corporations and the wealthy and deregulation for health insurers. The rest of Trump’s economic agenda is rather hazy. But if his first term is any guide, it would also involve curtailing workers’ collective bargaining rights, reducing workplace safety standards, and attempting to throw millions off of Medicaid. Vance has not seen fit to criticize any aspect of this record.”
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“For Vance, deregulating insurance markets at the expense of the vulnerable is not neoliberal or anti-populist. But arguing that politicians should not spread incendiary lies about immigrants is.”
“Prior to COVID-19, Fauci had long supported funding pandemic research that other scientists found risky, if not downright dangerous.
In 2005, as NIAID director, he praised researchers who’d used a grant from his agency to resurrect the virus that had caused the Spanish flu pandemic. Better understanding that virus would help prevent future diseases, he argued. “The certain benefits to be obtained by a robust and responsible research agenda aimed at developing the means to detect, prevent and treat [future pandemics] far outweigh any theoretical risks,” he said in an October 2005 statement co-authored with then–CDC Director Julie Gerberding.
This wasn’t a universal opinion at the NIAID. The agency’s chief scientist described this approach to pandemic prevention as “looking for a gas leak with a lighted match.”
Fauci would continue to praise and fund this kind of research. In 2011, researchers at the University of Wisconsin and at Erasmus University Medical Center in the Netherlands managed to manipulate the virus H5N1 (which had been responsible for a 2004 bird flu epidemic in Asia) to transmit between mammals, a “gain of function” for a virus that had heretofore only been able to pass from infected birds to humans. One of the researchers involved in the work would say the enhanced pathogen they’d created was “very, very bad news” and “probably one of the most dangerous viruses you can make.” Fauci was more sanguine, telling The New York Times that “there is always a risk. But I believe the benefits are greater than the risks.””
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“In 2014, there was a series of embarrassing safety lapses at U.S. government labs, highlighting this risk.
Dozens of CDC employees were potentially exposed to live anthrax samples shipped by mistake to labs not equipped to handle them. At another CDC lab, a less dangerous version of bird flu was accidentally contaminated with deadly H5N1. Vials of smallpox capable of infecting people were stashed in a cabinet at an NIH lab, where they’d apparently been sitting for decades. None of these incidents were direct results of gain-of-function research. But they heightened the concern that researchers working to enhance deadly pathogens might do so in unsafe settings.”
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“In 2021, Fauci said the NIH “has not ever and does not now fund gain-of-function research in the Wuhan Institute of Virology.” That wasn’t true. What EcoHealth was doing in Wuhan clearly met the widely understood definition of gain-of-function research.
In his June 2024 testimony, Fauci dodged accusations that he lied by saying that while EcoHealth’s work might have met a generic definition of gain-of-function research, it didn’t meet the precise definition established in the P3CO framework.
Fauci said that every time he mentioned gain-of-function research, “the definition that I use is not my personal definition; it is a codified, regulatory and operative definition.” That definition, he said, “had nothing to do with me.”
On the contrary, regulatory definitions had quite a bit to do with Fauci. They were designed with the expectation that he and his fellow public health bureaucrats would use discretion and good judgment when making decisions. The relevant regulatory language included lots of “likelys and highlys and reasonably anticipated,” says Gerald Epstein, a former director at the White House Office of Science and Technology Policy who wrote the P3CO policy. “These words are inherently subjective. You can’t not be. You’ve got to be making judgment calls on something that does not yet exist.” Those subjective definitions gave Fauci and his NIAID underlings considerable room to decide what research required additional review.”
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“We probably won’t ever definitively discover the origins of COVID-19.”
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“Chinese officials obstructed any investigation into the Wuhan Institute of Virology. In September 2019, the Associated Press reported, the institute took its database of viruses offline. It also hasn’t made public lab notebooks and other materials that might shed light on exactly what kinds of work it was doing in the lead-up to the pandemic. In late 2019, the Chinese government also exterminated animals and disinfected the Wuhan wet market. If COVID did leap from animal to human in the Wuhan market, as many natural origin proponents argue, that evidence is gone.
What we’re left with is studying the structure of the SARS-CoV-2 virus itself and whatever information can be gleaned from the U.S.-funded research that went on at Wuhan leading up to the pandemic.
On both fronts, Fauci, his underlings at the NIAID, and NIAID-funded scientists involved with work at Wuhan have worked to conceal information and discredit notions that COVID might have leaked from a lab.
In late January 2020, Fauci’s aides flagged the NIAID’s support of EcoHealth’s Wuhan research in emails to their boss. A few weeks later, Fauci and Daszak would go on Newt Gingrich’s podcast to dismiss the idea that COVID-19 came from the Wuhan lab, calling such arguments “conspiracy theories.”
Both men also worked to shape the discourse behind the scenes away from any focus on a lab leak. Daszak organized a group letter of scientists in The Lancet, the U.K.’s top medical journal, declaring that they “stand together to strongly condemn conspiracy theories suggesting that COVID-19 does not have a natural origin.” Daszak did not disclose his relationship to the Wuhan lab when organizing this letter; The Lancet’s editor would eventually concede that this was improper.
In testimony to the House coronavirus subcommittee in May 2024, Daszak would claim the “conspiracy theories” mentioned in the Lancet letter referred only to such wild early pandemic notions that COVID had pieces of HIV or snake DNA inserted into it. He said a word limit prevented him from being more precise.
Fauci, meanwhile, would help corral virologists into publishing the widely cited “proximal origin” paper in early 2020. In the paper, the authors flatly declared that “we do not believe any type of laboratory-leak scenario is plausible.”
Yet troves of private messages and emails released by the House subcommittee’s investigation show that the authors privately expressed far more openness to a lab leak theory.
One of the paper’s authors, Scripps Research evolutionary biologist Kristian Andersen, privately rated a lab leak as “highly likely.” But Andersen had a pending $8.9 million grant application with the NIAID as the paper was drafted. That grant was later approved. In an email, one of the paper’s authors, Edward Holmes, references “pressure from on high” during the drafting process.
The authors of the proximal origin paper say they merely had their minds changed while drafting the paper. They were just following the scientific method.”
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“Fauci’s best defense is that he ran a sprawling agency that doled out billions of dollars in grants. Even the most detail-obsessed administrator couldn’t possibly keep track of every single program and project. And U.S. officials had limited control over what happened in the distant, opaque Wuhan lab.
But even if that’s true, it’s an admission of administrative negligence, since the oversight protocols weren’t followed. It also implies a dramatic failure of the risky research that Fauci championed for pandemic prevention. As Ridley says, the pandemic “occurred with the very viruses that there was the most attention paid to, in the very area where there was the most research going on, where there was the biggest program looking for potential pandemic pathogens, and yet they failed to see this one coming.” At a minimum, gain-of-function research didn’t protect the public from the pandemic.
Meanwhile, the more direct case against Fauci is strong: Not only was he an ardent supporter of research widely believed to be risky, but he manipulated bureaucratic protocols in order to avoid scrutiny of that research, then responded evasively when called to account for his actions. At least one of the programs born out of Fauci’s risky research crusade was pursuing exactly the type of viral enhancements that were present in COVID-19, and that research was conducted at the Wuhan virology lab in the very same city where the virus originated. Lab leak proponents cite the virus’s transmissibility as evidence for a Wuhan leak: After all, EcoHealth was trying to create pathogens primed to spread rapidly in humans.
The evidence is not fully conclusive. But it seems reasonably likely that Fauci pushed for what his peers repeatedly said was dangerous research, that some of that dangerous research produced a deadly viral pathogen that escaped the lab, and that Fauci helped cover up evidence and arguments for its origins.”
“The US does have significantly fewer doctors per capita than some other wealthy nations, such as Germany and Sweden. But America’s physician-to-patient ratio is actually about the same as other developed countries — Canada, the United Kingdom, Japan, France — that still generally rank better on measures of health care quality than the US does. So aggregate numbers alone are not enough to explain the access problems that patients face, and experts disagree over whether we need to boost the overall supply of providers in the short term.
The bigger problem is misallocation in the US physician workforce, Coffman told me last year. We know that we don’t have enough doctors in certain important specialties: primary care, obstetrics, and psychiatry, for example. We also don’t have nearly enough providers in a broad swath of specialties practicing in rural and other low-income communities. Between 2010 and 2017, while large urban counties added 10 doctors per 100,000 people on average, rural counties lost three. As a result, metro regions had 125 doctors per 100,00 patients, while rural areas had 60.
America is littered with doctor deserts, areas where there are not enough primary care providers, much less specialists or hospital-level services. The federal government estimates that 80 percent of rural Americans live in medically underserved communities.
In the long term, the US will undoubtedly need more doctors in rural and urban areas alike. Groups like the Association of American Medical Colleges continue to project long-term workforce shortages, as boomer-generation doctors reach retirement age and the population of seniors requiring medical care swells.”
“Imagine you’re eight months pregnant, and you wake up in the middle of the night to a bolt of pain across your belly.
Terrified you might be losing your pregnancy, you rush to the emergency room — only to be told that no one there will care for you, because they’re worried they could be accused of participating in an abortion. The staff tells you to drive to another hospital, but that will take hours, by which time, it might be too late.
Such frightening experiences are growing more common in the wake of the Supreme Court’s 2022 Dobbs v. Jackson Women’s Health decision, as doctors and other medical staff, fearful of the far-reaching effects of state abortion bans, are simply refusing to treat pregnant people at all.
It’s part of what some reproductive health activists see as a disturbing progression from bans on abortion to a climate of suspicion around all pregnant patients. “People are increasingly scared even to be pregnant,” said Elizabeth Ling, senior helpline counsel at the reproductive justice legal group If/When/How.
The fall of Roe has led to an ever-widening net of criminalization that can ensnare doctors, nurses, and pregnant people alike, leading to devastating consequences for patients’ health, experts say.
Complaints of pregnant women turned away from emergency rooms doubled in the months after Dobbs, the Associated Press reported earlier this year.”
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“The Dobbs decision has created an environment in which people experiencing miscarriage are treated as criminals or crimes waiting to happen, advocates say — or sometimes both.
In October 2023, an Ohio woman named Brittany Watts visited a hospital, 21 weeks pregnant and bleeding. Doctors determined that her water had broken early and her fetus would not survive, but since her pregnancy was approaching the point at which Ohio bans abortions, a hospital ethics panel kept her waiting for eight hours while they debated what to do. She eventually returned home, miscarried, tried to dispose of the fetal remains herself, and was charged with felony abuse of a corpse.
The charges were ultimately dropped, but experts say her case is part of a larger pattern.”