Trumpism's healthcare fracture-lines
by Cory Doctorow
There was never any question as to whether Trump would implement Project 2025, the 900-page brick of terrifying and unhinged policy prescriptions edited by the Heritage Foundation. He would not implement it, because he could not implement it. No one could. It's impossible.
This isn't a statement about constitutional limits on executive authority or the realpolitik of getting bizarre and stupid policies past judges or through a hair-thin Congressional majority. This is a statement about the incoherence of Project 2025 itself. You probably haven't read it. Few have. Realistically, few people are going to read a 900-page group work of neofeudalist fanfic shit out by the most esoteric Fedsoc weirdos the world has ever seen.
But one person who did read Project 2025 was the leftist historian Rick Perlstein, who was the first person to really dig into what a fucking mess that thing is:
https://pluralistic.net/2024/07/14/fracture-lines/#disassembly-manual
Perlstein's excellent analysis doesn't claim that Project 2025's authors aren't sincere in their intentions to wreak great harm upon the nation and its people; rather, his point is that Project 2025 is filled with contradictory, mutually exclusive proposals written by people who fundamentally disagree with one another, and who each have enough power within the Trump coalition that all of their proposals have to be included in a document like this:
https://prospect.org/politics/2024-07-10-project-2025-republican-presidencies-tradition/
Project 2025 isn't just a guide to the masturbatory fantasies of the worst people in American politics – far more importantly, it is a detailed map of the fracture lines in the GOP coalition, the places where it is liable to split and shatter. This is an important point if you want to do more about Trumpism than run around feeling miserable and scared. If you want to fight, Project 2025 is a guide to the weak spots where an attack will do the most damage.
Perlstein's insight continues to be borne out as the Trump regime makes ready to take power. In a new story for KFF News, Stephanie Armour and Julie Rovner describe the irreconcilable differences among Trump's picks for the country's top public health authorities:
https://kffhealthnews.org/news/article/trump-rfk-kennedy-health-hhs-fda-cdc-vaccines-covid-weldon/
The brain-worm-infected-elephant in the room is, of course, RFK Jr, who has been announced as Trump's head of Health and Human Services. RFK Jr is a notorious antivaxer, chairman of Children’s Health Defense, a notorious anti-vaccine group. Kennedy's view is shared by Trump's chosen CDC boss, Dave Weldon, a physician who has repeated the dangerous lie that vaccinations cause autism. Mehmet "Dr Oz" Oz, the TV "physician" Trump wants to put in charge of Medicare/Medicaid, calls vaccines "oversold" and advocates for treating covid with hydroxychloroquine, another thoroughly debunked hoax:
However, other top Trump public health picks emphatically support vaccines. Marty Makary is Trump's choice for FDA commissioner; he's a Johns Hopkins trained surgeon who says vaccines "save lives" (but he peddles the lethal, unscientific hoax that childhood vaccines should be "spread out"). Jay Bhattacharya, the economist/MD whom Trump wants to put in charge of the NIH, supports vaccines (he is also one of the country's leading proponents of the eugenicist idea of accepting the mass death of elderly, sick and disabled people rather than imposing quarantines during epidemics). Then there's Janette Nesheiwat, whom Trump has asked to serve as the nation's surgeon general; she calls vaccines "a gift from God."
Like "Bidenism," Trumpism is a fragile coalition of people who thoroughly and irreconcilably disagree with one another. During the Biden administration, this resulted in self-inflicted injuries like appointing the brilliant trustbuster Lina Khan to run the FTC, but also appointing the pro-monopoly corporate lawyer Jacqueline Scott Corley to a lifetime seat as a federal judge, from which perch she ruled against Khan's no-brainer suit to block the Microsoft-Activision merger:
https://www.thebignewsletter.com/p/judge-rules-for-microsoft-mergers
The Trump coalition is even broader than the Biden coalition. That's how he won the 2024 election. But that also means that Trumpism is more fractious and off-balance, and hence will be easier to disrupt, because it is riven by people in senior positions who hate one another and are actively working for each others' political demise.
The Trump coalition is a coalition of cranks. I'm using "crank" here in a technical, non-pejorative sense. I am a crank, after all. A crank is someone who is overwhelmingly passionate about a single issue, whose uncrossable bright lines are not broadly shared. Cranks can be right or they can be wrong, but we're hard to be in coalition with, because we are uncompromisingly passionate about things that other people largely don't even notice, let alone care about. You can be a crank whose single issue is eliminating water fluoridation, even though this is very, very stupid and dangerous:
https://yourlocalepidemiologist.substack.com/p/the-fluoride-debate
Or you can be a crank about digital rights, a subject that, for decades, was viewed as by turns either unserious or as a sneaky way of shilling for Big Tech (thankfully, that's changing):
https://pluralistic.net/2024/06/18/greetings-fellow-pirates/#arrrrrrrrrr
Cranks make hard coalition partners. Trump's cranks are cranked up about different things – vaccines, culture war trans panics, eugenics – and are total normies about other things. The eugenicist MD/economist who wants to "let 'er rip" rather than engage in nonpharmaceutical pandemic interventions is gonna be horrified by total abortion bans and antivax. These cranks are on a collision course with one another.
This is on prominent display in these public health appointments, and we're very likely about to get a test of the cohesiveness and capability of the second Trump administration, thanks to bird flu. Now that bird flu has infected humans in multiple US states, there is every chance that we will have to confront a public health emergency in the coming weeks. If that happens, the Trump public health divisions over masking, quarantine and (especially) vaccines (Kennedy called the covid vaccine the "deadliest" ever made, without any evidence) will become the most important issue in the country, under constant and pitiless scrutiny, and criticism.
Trump's public health shambles is by no means unique. The lesson of Project 2025 is that the entire Trump project is one factional squabble away from collapse at all times.
https://pluralistic.net/2024/12/20/clinical-trial-by-ordeal/#spoiled-his-brand-new-rattle