Incompetence Can Kill

Or: How an inept president and cowed congressional Republicans are undermining public health.

Robert F. Kennedy Jr.’s assault on public health continues. After firing the experts who advice the C.D.C. on vaccines, he’s now listed their replacements – and it’s a politicized list that includes cranks and other non-experts.

This is no surprise to anyone who has been following this unfortunate saga, but that doesn’t make it any less alarming. And while Kennedy himself and those cranks are responsible for their own actions and their consequences, the Republican politicians who are allowing this almost certainly know better, and they too will be to blame when things start going wrong. And so many things are going to go wrong.

What makes this particular one frustrating, to me at least, is how unnecessary it is. Unlike almost all the other policy changes that Donald Trump and the Republican Congress are trying to push through, this one is neither something that Trump himself or GOP politicians and groups care about. Nor is it even arguably popular; Kennedy himself has dismal approval ratings as HHS Secretary, and vaccines – indeed, the whole broad set of health and safety policies Kennedy is attacking – are wildly popular.

So there’s a presidency story here and a Congress story.

The presidency story is pretty simple.

By backing a high-profile cabinet secretary who is trying to implement unpopular policies, Trump is taking on several risks. That starts with the basic popularity hit Trump is taking on, but it doesn’t end there. Kennedy is motivating existing organized groups to activate themselves against the administration. Yes, mainstream medical groups aren’t likely allies for Trump regardless, but there’s a difference between notionally opposing a president and actually trying to do something about it, and the public health community and some patient groups are going to care about these things. And then there’s a realistic possibility of something terrible happening which appears to be (whether it is or not) directly linked to the administration’s actions.

It’s hard to see the upside to balance that off. Yes, there is a constituency for Kennedy’s nonsense, and some of it is organized, but they could probably be satisfied with a lot less than what they’re getting here. I’d emphasize: Even if Kennedy was actually correct about everything (and there’s strong evidence that he’s not), Trump would still be taking on considerable opposition and even greater risk by backing what are seen by most people as extreme policies.

You might say: But Trump doesn’t think that way! And that’s true. But so far, through four years of one presidency and almost five months of another, it’s hard to see how his method of running the presidency helps him, given that he’s unpopular (again) and constantly gets rolled by others who realize what a paper tiger he is.

And once more: This isn’t a case of a policy that Trump personally cares about, such as tariffs or opposing wind power, or one that the GOP cares about such as tax cuts for rich people or opposition to abortion. Sometimes a president may decide that such things are worth supporting even if there are significant costs. That doesn’t seem to apply here.

As far as the Congress story is concerned: It’s pretty clear that many congressional Republicans are against this, particularly Louisiana Senator Bill Cassidy – who had previously only voted to confirm Kennedy after receiving assurances that he wouldn’t mess with vaccines.

The story here is that any handful of Republicans in either chamber have plenty of leverage to force a retreat on this issue. The thin GOP margins in both chambers (along with partisan polarization and an extremely partisan legislative agenda) mean that any threat by, say, five Republicans from the House or the Senate to derail bills or nominations has to be taken seriously.

Indeed, Cassidy could do it all by himself. He could put holds on executive branch nominations or, to really get the White House’s attention, on judicial nominations. It’s true that holds can be defeated if Majority Leader John Thune wants to press the issue, but that could undermine his own support within the Republican conference. He’s also Chair of the Senate HELP Committee, and he could use that position to throw wrenches in the way of GOP legislation. Again, that could be defeated if Cassidy was alone in his concerns, but it would be costly for Republicans to do so. And it’s unlikely he’s alone. Indeed, I’d guess a majority of Republican Senators are uncomfortable with Kennedy’s mishegos, and at least a dozen are fully against it.

Unfortunately, Republicans – Cassidy included – are not willing to use their leverage, even when the policy in question isn’t really important to the party or to the president. All politicians are paranoid; what matters is what they’re paranoid about. And Republican politicians are terrified of being called out not just by Trump, but by anyone in GOP-aligned media. Anyone who could accuse them of being insufficiently conservative. Even if it involved something that wasn’t seen as conservative at all until very recently.

So between a president who is terrible at his job and congressional Republicans who refuse to do their jobs, it appears that no one is going to stop the dismantling of public health institutions in the United States. And the rest of us just have to live with it. Or, I guess, hope to live through it.