URGENT: Poll, reader thread, and podcast discussion today on what the ouster of Vinay Prasad means for the FDA and the future of medical reform in the United States

Is our $5 trillion healthcare system just too entrenched to fix?

MAHA (Make America Healthy Again, if you’ve been under a rock) is not a term I like.

It means too many things to too many people. Is MAHA about healthy foods and lifestyle changes? Or the hidden incentives in medicine that can lead to bad outcomes for patients? Are its goals primarily cultural, political, or medical?

A couple of specific examples: does being MAHA mean opposing all vaccines and all vaccine mandates? What about patients’ “right to try” unapproved medicines - and if companies and physicians can profit from those uses?

But though MAHA’s lack of definition bothers me, I agree the movement’s sudden rise is a crucial sign of the crisis in American medicine.

The United States now spends $5 trillion a year on healthcare, far more per-capita than any other country, a crushing burden for many families. Yet our medical outcomes often lag other rich countries, including an overdose crisis that began as the direct result of federally-backed, medically-driven policies to encourage opioid use.

Under the circumstances, is no surprise ordinary Americans are fighting the healthcare bureaucracy and trying to find answers and solutions for themselves. Thus MAHA.

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(And thus Unreported Truths. Helping in the search for answers… for pennies a day.)

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But MAHA has struggled to find a political home.

Democrats have only one solution to our medical crisis: to throw yet more money at it, by expanding insurance company subsidies and Medicaid coverage. They want to further divorce Americans from the cost of healthcare.

The practical impact of this stance is to drive up prices by offering an unlimited government backstop. The philosophical impact arguably runs even deeper. In arguing that unlimited medical care under all circumstances is a basic human right, Democrats are essentially taking a position that no one should ever face any responsibility for the medical cost of unhealthy or even dangerous choices. MAHA generally encourages individuals to take at least some responsibility for their own health and thus challenges this assumption.

In any case, we have already tried the Democratic strategy, and it has failed. Whatever the answer to the American medical crisis may be, more money cannot be the answer. If it were, the United States would already have the best healthcare in the world by far.

Meanwhile, the Republican party has no solution at all, at least not one the national party has coalesced around. Many mainstream Republicans appear simply too beholden to big drug, insurance, hospital, and agriculture companies to accept meaningful changes to the system.

But President Trump’s decision to bring in Robert F. Kennedy Jr. to run the Department of Health and Human Services suggested he was willing to try. Kennedy is more associated with MAHA than any other national figure.

As I wrote last September: Kennedy wasn’t brought in to keep the trains running. He was brought in because the trains are running over a cliff.

And Kennedy’s first hires suggested he intended to force real reform on the medical-industrial complex — particularly drug and biotechnology companies that have made fortunes manipulating clinical trials and charging exorbitant prices for medicines that hardly work (or hardly work better than older, cheaper drugs).

Kennedy said he would crack down on the direct-to-consumer advertising that drives pharmaceutical demand. And he brought in a new regime at the Food and Drug Administration. His most crucial hire of all was Dr. Vinay Prasad, an aggressive critic of the industry.

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(Message in a bottle)

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Now Prasad is gone, while drug ads remain.

Kennedy is backing off major agricultural reforms too. Whatever one thinks of glyphosate, the idea that the Trump administration would specifically try to protect it is hardly what anyone would have expected a year ago.

Prasad’s ouster feels like a pivotal moment. So I want to know what you think about how the Trump administration has handled medical reform — and what the future of MAHA may be. Poll is below, and I hope we will have a lively (subscriber-only) reader discussion in the comments. (Sign up here.)

Poll:

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Meanwhile, I am joining Emily Kopp, who now runs Matt Taibbi’s Racket News, for a podcast discussion at 4 p.m. Eastern today (less than three hours from now) to discuss Prasad’s ouster, the future of the FDA, and where MAHA goes from here.

We’re still getting the technical details together, but it will be hosted on Substack, and I’ll probably send out a link when it begins so you can find it easily.

I hope you will join us!