'the Sickest Children In The Developed World': A Maha Loyalist Defends Rfk Jr.'s Assault On The Medical Establishment

Of all Donald Trump’s contentious cabinet picks, Robert F. Kennedy Jr. stands out for the visceral reactions (positive and negative) he has engendered as leader of one of Washington’s most powerful bureaucracies — the Department of Health and Human Services.

Kennedy’s willingness to slash about a quarter of his agency’s workforce while measles is spreading in Texas and bird flu threatens a new pandemic has met with outrage among the health establishment. But at the same time, Kennedy has massed a veritable movement — with its own Trump-derived acronym, MAHA — that is equally outraged at an establishment that they say delivers worse outcomes dollar-for-dollar than any health care system in the world.

One of MAHA’s leading voices is Calley Means, the bestselling co-author of Good Energy and former lobbyist for food and pharma, who now serves as a “special government employee” at Kennedy’s side. Means has done a lot of thinking — and if you’re on the Joe Rogan circuit, a lot of talking, too — about how the Trump administration can confront exploding chronic disease in America.

I interviewed Means for the Playbook Deep Dive podcast on Wednesday at POLITICO’s Healthcare Summit to get to the heart of what MAHA is and what exactly he and Kennedy want to change in Washington. Our conversation took place before an audience that loudly demonstrated its deep suspicion of the MAHA movement, and Means delivered his own stinging rebuke of the people he says have overseen a “system of utter failure.”

I pressed Means on how the massive cuts to the HHS workforce help his boss achieve his goals, the difficulty in bringing healthy food to communities that lack access to it and why he thinks cutting funding will improve the science behind his proposed health care reforms.

This conversation has been edited for length and clarity by Deep Dive Producer Kara Tabor and Senior Producer Alex Keeney. You can listen to the full Playbook Deep Dive podcast interview here: 

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Now that the MAHA revolution has been swept into power, what is success for you? At a minimum, what do you want to achieve in the next four years?

I think this is really important because there’s a lot of stakeholders in this room and I think a lot of questions about Secretary Kennedy.

I think we should all just understand what he’s trying to do and what the Trump administration is trying to do, which is that in 50 years, the history books [will] look back at this moment as the time the chronic disease crisis started to reverse. Right now, 38 percent of teens have pre-diabetes, 50 percent of the teens are overweight or obese. We have, out of 212 countries, the highest cancer rates of any country in the world. We spend four times more per capita on health care than Italy and live seven years less. We’re not lazier than Italians. There’s something wrong with our system.

So fundamentally what we’re building towards is a world where hospitals are incentivized for beds to be empty, not full; where pharmaceutical companies are incentivized to be creating therapeutics that reverse and prevent disease, promote longevity, not just manage disease; where insurance companies are incentivized to promote health, not as they are today [where they’re] really incentivized to get certain costs to go up. We’re trying to start the conversation, where we have a health care system that promotes disease reversal and prevention.

How we get there is we start doing very popular things, start focusing on issues like transparency, conflict of interest reduction, benefit flexibility and some core concepts that the administration has talked about. But we’ve got to start getting wins.

Well, right now, it seems like the first priority has actually been to make a lot of cuts. This week, there’s news of massive cuts to HHS. At this point, about a quarter of HHS’s 82,000 employees have left or are expected to be terminated. You’ve laid off big chunks of offices in charge of vaccine and drug research, HIV/AIDS research, AI, funding for services for the elderly and low-income people, STD prevention and rural health. 

What do you say to people in the public who are concerned now about drug safety, about whether we’re prepared for the next pandemic when these cuts have happened so hard and so fast?

I’d say to the reporters in the room and the lobbyists in the room, obviously make your case, but I’d truly ask for a little bit of humility about what the voters were trying to say by putting Bobby Kennedy Jr. in this position of power; a little bit of humility to ask why Bobby Kennedy and President Trump are the two most popular political figures in America by far.

What the voters are trying to say is that the system is really on the wrong track. The NIH oversaw the literal creation of a pandemic. The NIH, whose goal is to promote American health, has overseen just an abject devastation in American health over the past 20 years, with disease rates skyrocketing in America.

There’s been very little innovation with small pharma, with innovative therapeutics at the FDA. It costs a billion dollars to get through the process. The Centers for Medicare and Medicaid Services is an agency that has a much larger budget than the Defense Department, that’s controlled by the American Medical Association, which is a pharmaceutical lobbying group.

So, there’s real problems. And, you know, when you turn on CNBC, it’s a non-stop infomercial for pharma. It’s a Skyrizi commercial, followed by Scott Gottlieb saying how Bobby’s killing people, followed by breathless coverage of the measles outbreak, and no mention of the mental health crisis and…

But, Calley, how does cutting a bunch of HHS [workers] solve that problem?

It is insane for you to insinuate that the things standing between us and better health is more government bureaucrats. Like that is demonstrably insane.

It’s not all bureaucrats. It’s a lot of scientists, it’s researchers, it’s people who are making sure that our system is safe.

Those scientists fundamentally have overseen a record of utter failure.

[Audience member yells: “It’s not true.”]

Is that funny? Is that not true? So what metrics would you guys point to for how the scientific community, how the four times more per capita on health care spending that we spend in America versus other countries, has produced innovation? Has there been one single chronic disease medication in modern American history that has lowered rates of the chronic disease? Is it appropriate that the American Academy of Pediatrics right now, which is 90 percent funded by pharma, is pushing Ozempic on six-year-olds?

Why not then use the power that you guys have to push the existing infrastructure in that direction instead of slashing it all together?

It’s not slashing. It’s taking it back to 2017 levels. That’s not slashing.

It’s more like 2002 levels, actually.

It’s actually just not that much, but it is cutting, what is it? 20,000 people? It’s taking the HHS back to 68,000 employees.

Are the cuts going to stop there?

The idea that Bobby Kennedy should not come in and make dramatic changes to the leadership and the personnel at these authorities that have overseen an abject devastation of American health, which the lobbyists in this room do not have the humility to admit that we have gone completely wrong. The lobbyists in this room [are] laughing when we have the sickest children in the developed world.

If that is your attitude? Your attitude is to tell the MAHA moms that their votes and their voice is not legitimate, that we [don’t] need dramatic changes to American health care? If you think it is illegitimate for Bobby Kennedy to not make big changes to people like Peter Marks — who fired the two top vaccine scientists at the FDA for suggesting that we shouldn’t mandate Covid shots for soldiers, who continually went against expert opinion in favor of the pharmaceutical industry, who many people here were collaborating with — the fact that somebody like that can’t be fired and he can’t install tremendous people like Marty Makary and Jay Bhattacharya and Dr. Oz to start reforming these agencies and put in their people, of course he should do that. That’s what people voted for.

But let me ask you this, Calley. I think there are a lot of people who agree with taking away some of the bureaucracy and the red tape in government. But when people who are working on projects that are critical to people’s health are walking into their offices and suddenly can’t get in, can’t do the proper transition to the new folks who are coming in — is that responsible and humane to the people that have dedicated their lives to this cause?

We are in an existential moment in American history right now. We have the sickest children in the developed world.

But I’m asking how these changes are going to execute on this agenda.

You can paint breathless stories with anecdotes all the time. Fundamentally, what Bobby has done is taken over a department that has utterly failed. The CMS, in and of itself, has a much larger budget than the Defense Department. On Medicaid, it’s growing two times faster than the defense budget and larger, just Medicare and Medicaid alone. And as that spending happens at a higher and higher rate, kids are getting more and more sick.

So if you want to see cuts to Medicare and Medicaid…

Ninety percent of NIH funding goes to studying pharmaceutical R&D treatments to profit the pharmaceutical industry off the fact that Americans are already sick. Very little NIH funding right now goes to actual core research about why we’re getting sick. The FDA completely boxes out any innovation. It’s a tool for large companies to get their large drugs approved, with very little pathways for new therapeutics, AI therapeutics — therapeutics that actually can help you diagnose and understand what’s going on inside your body and be more preventive.

These institutions are broken. Why aren’t you asking about how we can reform these?

Well, I am. That’s my question. So you come in and you’re trimming the fat, right? That’s the premise for you guys. So how then do you actually turn the ship towards what you’re talking about? 

You install Marty Makary, who is the first FDA commissioner in the past three decades who said he’s not going to go to a pharma job right afterwards, as 11 of the 12 previous FDA commissioners have done. You install Jay Bhattacharya, who is the pinnacle of academic courage. You install Dr. Oz, who’s an incredible human being, who has put together an incredible team, who’s ready to reform. People that are ready to engage with industries, people that are ready to talk about improvements in chronic disease prevention and deregulation in transparency, and in conflict reduction. That’s what you do.

Any business in the world, if you went into it with the metrics that the HHS has overseen with skyrocketing costs and worse and worse outcomes, you would of course fire a bunch of people and you would, of course, install new leadership. This is a group that wants to work with industry but is absolutely defiantly saying we need a new direction.

Let’s talk about food, because that is an area of expertise for you. Right now in America, getting food that is better for you costs more, and it is such a barrier for lower-income Americans that also have the worst health outcomes. So how are you planning to bring down the cost of being healthier in America?

One thing Bobby Kennedy is not going to do is entertain comments from food industry lobbyists using food prices as an excuse to continue poisoning children. And I know a lot of you guys are doing that. And I think that’s an evil argument. That’s the only argument the food industry is making right now. They’re trying to hold a gun on food prices to literally not even dispute the premise that Americans are being poisoned.

We have 10,000 chemicals in our food that are not allowed in any other country. Fundamentally, American food companies make their food with different ingredients than other countries. American companies are making their products here with crude oil-derived food dyes and making the exact same product shipped into Canada with beet juice and carrot juice.

The FDA currently does not have a list of what’s in our food. It’s self-policing. So [Kennedy] is going to work with the NIH, work with the FDA to have a list of what is in our food and have post-market review of those chemicals.

There’s a lot of lobbying to actually prevent transparency about what’s in food. There’s voracious lobbying from industry about preventing [transparency]. “Oh, that’s going to embarrass us. That’s going to make us look bad.” We have to have accurate science on the chemicals in our food.

You’re talking about holding corporations accountable, making them be transparent. President Trump is a pro-business president. He wants to make it easier for businesses to basically do whatever they need to do for their bottom line. How does that jibe and how much has he empowered Secretary Kennedy to try to regulate some of these companies?

President Trump is the defining figure of our time politically because he stands for anti-corruption. The MAGA movement stands for combating the swamp whose interests are against the American people. So what President Trump and Secretary Kennedy do not stand for is things like the food stamp program, SNAP, the number one item going to soda. It doesn’t stand for, frankly, a system that has really incentivized and recommended ultra-processed food. The USDA guidelines under [President Joe] Biden recommend sugar to two-year-olds. It actually said just a year ago that a diet [that is] 93 percent in ultra-processed food for a child can be healthy. So what President Trump and Secretary Kennedy have talked about is not pro-business or anti-business. It’s anti-corruption.

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Has President Trump given Secretary Kennedy the leeway to go to town on these corporate interests if it means making Americans healthier?

I don’t think it’s “Go to town on corporate interests.” I think it is, “Let’s get Americans the truth.” What MAHA is trying to do — there’s obviously going to be a lot of work and a lot of lobbying on the Medicare/Medicaid reimbursement rates — but there’s something fundamentally broken with the incentives of our health care systems. Clearly, that’s the case when you look at the graphs about what we spend versus our outcomes.

But a big piece of that is corporate interests, right? 

I don’t know what you mean by corporate.

I mean, companies that sell junk food wanting to…

I think President Trump and Secretary Kennedy say if your corporate interests are profiting from children being sick, you should be worried. Your corporate interests need to be preventing and reversing disease for the American people. I don’t see it in this frame. President Trump and Bobby Kennedy never talk about it.

You said these companies are poisoning kids.

No, I’m saying these companies are profiting from American children being sick, which is a demonstrable statement of economic fact.

Right. So that means that Kennedy will be potentially making them change what they are doing.

Well, there’s a clear voter mandate to have a health care system that reverses and prevents disease. I want to be really clear. I don’t see Secretary Kennedy being vengeful or really anti-corporation in any degree. I think there’s actually a feeling that this is a group effort. There is no backwards-looking retribution. There is a moment we all have in America right now to acknowledge that we have a problem and acknowledge that the problem is multifaceted. That problem is because of a trillion dollars of agriculture incentives over the past decade that have led to 70 percent of American children’s diet being ultra-processed food, when it’s 10 percent in Japan. It’s not right. That’s because of incentives. They’re not pointing a finger at industry.

How do you get industry on board though?

Everyone can agree with the goal of having healthier kids. I think everyone can agree with the 10-year goal of a system that reverses and prevents disease. Everyone can agree that in 10 years we want to have a thriving health care sector which is making a lot of money by promoting disease reversal and prevention and longevity for the American people.

Now, there’s thousands of steps to get there. What I would say to industry is: What can we do to start getting wins right now? There’s a lot of great communication that’s happening with industry right now. There’s hospitals that want to promote more value-based systems, that want to promote a system where they’re paid when patients are healthy. There’s many interests that want to see more health care flexibility. Bobby Kennedy said, let’s get Medicare and Medicaid, not to a top-down system where you jab certain pills down kids’ throats who are sick, but actually have a system where there’s more HSA-type accounts for Medicare, Medicaid, where a mom with their kid who’s depressed and obese could take the pills but also get that kid on a functional medicine program, get more blood tests.

But the idea is to expand access to different kinds of treatments via Medicare and Medicaid?

Two big principles Secretary Kennedy has talked about is let’s get patients the right information, let’s get gold-star science and then let’s trust the American people to make the best decision with their doctor.

Let’s have transparency. I think there’s a lot of interests in this room that would like more transparency. There’s pharmaceutical companies that feel like they have great data, that actually want that data to be out there more. So it’s transparency. It’s asking fearless questions.

Let’s talk about SNAP for a second. You all are suggesting that SNAP benefits do not cover soda, right? 

Yes.

What about the flip side of that? How do you make healthier foods more accessible? Because right now, for a lot of people who are on SNAP, those stores that they’re going to, it is mostly soda and junk food.

Well, I disagree fully with the premise that it’s going to hurt kids to take away soda from SNAP.

That’s not what I’m asking. I’m asking, are you also thinking about the flip side of not just taking away, but also making healthier food more accessible?

Bobby Kennedy stood with the governor of West Virginia who submitted innovative waivers on work requirements on taking soda off SNAP. He explicitly encouraged governors to come to him for waivers. There are now governors speaking to him about actually innovative waivers to increase funding if you steer it to healthy food. There’s a lot of state latitude with SNAP, it’s a great example of a state-federal…

Can you use that model nationally?

Bobby Kennedy is encouraging every single governor — and he’s talking to red and blue governors — to call him to work with [Agriculture] Secretary Brooke Rollins, who’s tied at the hip with him on this and they’re encouraging state innovation, which can include taking objectionable food off of SNAP. A lot of lobbyists here are arguing that it’s important for child nutrition to have government-subsidized soda. That ship has sailed. We’re encouraging every single governor to take soda off of SNAP and bring innovative ideas of how to incentivize or potentially even bring more money to healthy food.

Can you talk about any specific plans you guys have to make it easier for especially low-income Americans to build healthier habits and have access to healthy foods? Right now, so many people live in food deserts. People don’t have the ability to afford better food.

Well, the food deserts, I’d argue, are largely an invention of SNAP. This is a large program. This is a $120-billion program. It’s the fourth-largest entitlement program. This is a huge distorter of worldwide agriculture incentives. The fact that 67 percent of SNAP goes to ultra-processed food with no other country in the universe…

But again, my fundamental question, how do you get people there? How do you get people healthy?

If you take soda and unhealthy food off of SNAP, that opens up tens of billions of dollars of more money to healthier food, which then correct the food desert issue because the food deserts are there because the majority of their money go to SNAP and SNAP goes to ultra-processed food.

Secondly, food is medicine. We spend $4.9 trillion now on health care. Ninety-plus percent of health care costs go to food-borne illnesses essentially, go to chronic disease, which are interconnected. The medical system said diabetes, obesity, dementia, other conditions are siloed conditions which we need different pills for, different NIH institutes.

We talk about health care flexibility. We talk about giving Americans more control of their health care. That does get to a system where we drive health care dollars to the clinically best intervention for that disease. It is demonstrable clinically that often these diseases are food- related.

So when you talk about the lobbyists here trying to jab Ozempic into the arms of 30 percent of six-year-olds, I would argue clinically, maybe sometimes Ozempic’s warranted. But often that six-year-old needs better food. Often that six-year-old needs a diet coach, some functional medicine blood tests to understand their nutrient deficiencies.

The long-term goal of this administration is to have science. And Jay Bhattacharya said this very clearly: He wants to understand the root cause of disease, which often goes to food, and then have the medical dollars go to the most efficacious way to prevent and reverse that disease.

That means funding though, so do you want to keep the money for Medicare and Medicaid steady or do you want to see cuts to Medicare and Medicaid?

There’s $4.9 trillion in funding. What does this have to do with cutting Medicare and Medicaid? I’m saying nobody disagrees that Medicare and Medicaid should be going to the most efficacious treatments to reverse and prevent the diseases Americans have. Nobody would disagree with that. The problem isn’t the Medicare and Medicaid policy. I’m not talking about that. I’m talking about what’s the clinical logic that oversees Medicare and Medicaid? Right now, the clinical logic is that if a kid has high cholesterol, statin. If a kid is sad, SSRI. If the kid is obese, Ozempic. That’s the treadmill that we’re on. Thirty-five percent of teens are on a chronic disease medication, and the chronic disease rates are skyrocketing.

What is the policy solution to that though?

Have better NIH research that identifies what’s causing and what can prevent and reverse disease.

So the cuts to NIH research, will they be restored then? Because you need money to do that kind of thing.

Medicare and Medicaid is driven by scientific inquiry that sets the standard of care. Right now, the standard of care is wrong. The standard of care is led by the AMA. Medicare and Medicare is only as good as the logic that underlies it.

How to solve that, how to create more efficacious treatments and more “food is medicine”? You have NIH research that shows what’s causing disease. We have very little research on how food and lifestyle interventions relate to disease. You have more FDA approval pathways for root-cause therapeutics, for preventative scans and treatments. And then you have deregulation at the FDA, more NIH research about how root cause lifestyle interventions impact disease, that folds into standards of care that underlie the payouts for insurance.

But Calley, I’m not questioning that piece. I’m questioning how you do all of that research and work when you’re slashing it and cutting it.

Has NIH funding been slashed?

Yes. [Audience laughter]

No. Research has not been cut.

The funding has been cut. 

Research funding has not been cut. The administration has put out guidance that they want to direct and cut indirect funding. That fundamentally means more money is going to frontline researchers. There is a very clear signal: Government bureaucrats are being disempowered and more money is going to actual researchers. Today, more money will be flowing to actual researchers, not university bureaucrats, not government bureaucrats. Actual research, there’s not a dollar of services that has been cut.

Harvard was getting 70 cents on the dollar — not for research with a grant, but for bureaucracy. Cutting indirect costs gets more money to researchers. There is an absolute fixation in this administration on empowering researchers, on getting money to scientists and not telling them what the answer should be, not telling them what to study, asking them to do bold research on why we’re getting sick.

There’s been a lot of concern about the measles outbreak. Secretary Kennedy received some criticism because he was not really out front on this issue and people are wondering why.

The media can write process stories about Bobby Kennedy taking over the largest department in government and different operational issues. But I think Bobby Kennedy is very concerned about the measles outbreak and the administration’s committed to the best possible responses from the CDC and he’s getting his team together. There’s an absolute commitment to best-in-class infectious disease responses. I would also say that it’s interesting to me, the level of reporting on one measles death and the utter lack of interest in this room and in the media, quite frankly, about the 38 percent of teens who have pre-diabetes and the hundreds of millions of Americans that are being savaged by chronic disease.

But why did it take so long for Americans to hear from the Secretary of Health and Human Services in the midst of a real crisis?

In his first week, I think he put a statement out and responded quickly. I can’t talk to the process of the couple of days…

Why hasn’t HHS been out front saying to get vaccinated, make sure we’re preventing this disease?

I think they’ve made very clear statements on that.

I just want to ask again, big picture, how is American health care different four years from now?

The NIH has shifted to asking how can we understand what’s causing American sickness. Eighty percent of the NIH budget is going to true innovations to reverse and prevent disease, not figuring out how to manage disease.

The FDA is much more deregulated, encouraging innovation from therapeutic makers, from preventative device makers. We’ve overseen the true inflection point for AI and technology and how it can help prevent a reverse disease at the FDA. We’ve rid the FDA of conflicts of interest, which are an absolute scandal.

And that work has led the CMS department to work with Medicare, Medicaid and private insurance to evolve the standard of care towards the science, which is that we are being hobbled by an interconnected set of lifestyle conditions that our medical system currently does not incentivize reversal and prevention techniques for and the CDC has best-in-class infectious disease procedures while also focusing more on their remit to prevent or reverse chronic disease.

We have a system where everyone in this room who thinks Bobby Kennedy is crazy, in four years is thinking a little bit more about disease reversal and prevention.

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