Fighting for Our Patients

Former President Barack Obama once said, “elections have consequences.”¹ But historically, the consequences tend to be less dramatic than supporters of the winning candidate hoped for—and less than opponents feared. That’s because the American system of government, driven by the principles laid out in the US Constitution, explicitly establishes checks and balances designed to shield us from the domination of extremists of any political stripe.

For well over 200 years, those principles have held. But since the second inauguration of President Donald Trump, our country is facing an existential crisis of constitutional fragility² across every aspect of government and governing in the United States.

For doctors and for public and global health, the Trump administration’s executive orders and plans are beyond worrisome, as is the confirmation of Robert F. Kennedy Jr.³ as Health and Human Services (HHS) secretary. Proposed disruptions or elimination of vital healthcare access for vulnerable populations,⁴ massive cuts in critical medical research,⁵ and withdrawal from long-standing commitments to global health⁶ will affect all of us.

But with major medical organizations standing by rather than leveraging their influence to intervene, many physicians and other healthcare professionals are left wondering, “What can I do?”

An Attack on Public and Global Health

The impacts of these new policies regarding patient care and public health are neither accidental nor shambolic. The plans are organized and intentional, just as spelled out in Project 2025,⁷ the radical roadmap designed to upend the way the federal government prioritizes and functions (despite Trump’s claims that he had “nothing to do with”⁸ it).

Some of you may be thinking, “Well, good! The health ‘system’ is broken; it needs a wholesale shake-up.” Maybe you’re focused on the negative impact of bureaucrats on your practice, or the influence of health insurers on clinical decision-making, or how pharmaceutical companies may be exploiting you and the public. Maybe you think we’re spending too much money on the health and well-being of people outside the United States or on programs that appear wasteful.

There is some legitimacy to many of these concerns. We absolutely need positive reforms, more accountability for health-related expenditures, and the return of more control over medical practice to doctors. But that’s a far cry from what the new administration has in mind.

Here’s a sampling of health-related changes that are or could be on the table:

• Repealing key provisions of the Affordable Care Act, like Medicaid expansion,⁹ or removing protections for patients with preexisting medical conditions.¹⁰
• Reductions in Medicaid benefits,¹¹ like nursing home care and the Early and Periodic Screening, Diagnostic, and Treatment benefit for children living in low-income families.
• Cutting billions of dollars of funding¹² from National Institutes of Health–funded studies, including cancer, heart disease, and infectious disease research.
• Potentially drastic reductions in the Children’s Health Insurance Program,¹³ which has provided otherwise unattainable coverage for millions of children.
• A potentially dangerous overhaul of the Food and Drug Administration,¹⁴ as well as nonevidence-based messaging on vaccines, from known anti-vaccine advocate—and now HHS secretary—Kennedy.¹⁵
• Withdrawing from the World Health Organization, which has enabled beneficial collaboration with international colleagues on prevention and management of pandemics and a wide range of infectious diseases.¹⁶
• Eliminating the US Agency for International Development,¹⁷ which provides massive amounts of direct care for some of the poorest people in the world and conducts research to fight a host of chronic diseases.

Many of these proposals are already in play, and almost all of them are part of the Project 2025 playbook. In fact, one of the senior authors of that radical 900-page document, Russell Vought,¹⁸ is now the powerful head of the Office of Management and Budget.

Worried yet? You should be.

Taking a Stand

But what can be done? What is the proper role for health professionals to play in preventing or responding to some of these draconian “fixes”?

Let’s agree that what we don’t need are solutions that come from extremist ideologues on the political right or the political left.

It’s a matter of knowing when you need a scalpel, not a sledgehammer. This is a concept that seems to have eluded the new administration and most Republican members of Congress.

But now is not the time for us to feel overwhelmed and helpless. Now is precisely the time for health professionals to actively resist drastic, damaging changes heading our way.

Here are two specific ideas:

First, clinicians should be writing letters and op-eds in local and state newspapers, posting blogs and comments on social media, and calling the offices of your representatives and senators.* We need to strenuously object to every one of the health-related proposals that undermine our work, reduce access to care for vulnerable populations, and damage our well-deserved international reputation for compassion, innovation, and collaboration. Communications from actual constituents are taken very seriously.

Second, I realize that a number of doctor-led petitions and communications from relatively small or powerless organizations have been sent to the White House and Congress. This is a start, but what is really needed are powerful messages from the major organizations that have influence, lobbyists, and campaign contributions for members of Congress.

As I have written previously of the American Medical Association (AMA), “the AMA is inexplicably MIA.”¹⁹ Even the American Academy of Pediatrics (AAP) has not said a word about how HHS Secretary Kennedy’s anti-vaccine rhetoric and views threaten the lives of children everywhere. In fact, AAP President Susan Kressly was quoted in Roll Call saying, “We are pediatricians, not politicians,”²⁰ to explain why my pediatric colleagues in the AAP did not demand Kennedy’s nomination be withdrawn.

That argument just doesn’t cut it in 2025. In fact, the opposite is true! Physicians and all health professionals must now be political activists to protect what we know is right for our patients. The idea that vaccines are optional, as Kennedy proposes, reflects a deep misunderstanding of how population health works.²¹

Health professionals must not hesitate in confronting unqualified politicians and appointees who threaten the well-being of our patients, reduce equitable access to affordable care, or undermine the integrity of our profession.

As for major organizations, like the AMA and the many specialty associations with real influence in Washington, they must put aside their own special interests and do what’s right for our patients and the public good. To date, most have been silent, and look where that’s gotten us. Until then, health professionals should immediately resign their memberships to show them we mean business.

It’s now or never.

Irwin Redlener, MD, is a pediatrician and adjunct senior research scholar in the School of International and Public Affairs at Columbia University. He is also a senior advisor to the Clinton Global Initiative’s Ukraine Action Network, a cofounder of the Ukraine Children’s Action Project, and an adjunct professor of pediatrics at Albert Einstein College of Medicine in New York City. This article is adapted from “Public Health Is Under Assault. Here’s How Doctors Can Fight Back,” which he published on MedPage Today: go.aft.org/9cn.

*To find their contact information, visit congress.gov/members/find-your-member. (return to article)

Endnotes

1. WCCO Staff, “‘Elections Have Consequences’: Obama Praises MN’s 2023 Session Accomplishments,” CBS News, May 26, 2023, cbsnews.com/minnesota/news/elections-have-consequences-obama-praises-mns-2023-session-accomplishments.

2. A. Liptak, “Trump’s Actions Have Created a Constitutional Crisis, Scholars Say,” New York Times, February 10, 2025, nytimes.com/2025/02/10/us/politics/trump-constitutional-crisis.html.

3. J. Frieden, “RFK Jr. Confirmed as HHS Secretary,” MedPage Today, February 13, 2025, medpagetoday.com/publichealthpolicy/washington-watch/114201.

4. E. Palmer, “Donald Trump’s Deafening Silence on Medicaid,” Newsweek, March 5, 2025, newsweek.com/donald-trump-medicaid-cuts-gop-republicans-congress-speech-2039883.

5. L. Neergaard and M. Casey, “Judge Extends Temporary Block to Huge Cuts in National Institutes of Health Research Funding,” Associated Press, February 21, 2025, apnews.com/article/trump-nih-medical-research-funding-cut-indirect-costs-a75b8d7d56a29f1e880859d79ef744e4.

6. N. Yousif, “US Top Court Rejects Trump Bid to Withhold $2bn in Foreign Aid,” BBC, March 5, 2025, bbc.com/news/articles/c5y071kxwn8o; and J. Walson and S. Desmon, “The U.S. and the WHO: An Imperfect but Essential Relationship,” Johns Hopkins Bloomberg School of Public Health, January 30, 2025, publichealth.jhu.edu/2025/the-consequences-of-the-us-withdrawal-from-the-who.

7. P. Dans and S. Groves, eds., Mandate for Leadership 2025: The Conservative Promise; Project 2025 Presidential Transition Project (Washington, DC: Heritage Foundation, 2023), project2025.org.

8. Z. Kanno-Youngs and E. Green, “Trump Disavowed Project 2025 During the Campaign. Not Anymore,” New York Times, November 29, 2024, nytimes.com/2024/11/29/us/politics/trump-project-2025.html.

9. R. Levi, “Why Many Republicans Think Shrinking Medicaid Will Make It Better,” National Public Radio, February 10, 2025, npr.org/sections/shots-health-news/2025/02/10/nx-s1-5289001/trump-republicans-medicaid-proposals.

10. K. Brown, “Trump Has Created Health-Care Chaos,” The Atlantic, January 31, 2025, theatlantic.com/health/archive/2025/01/trump-health-care-chaos-nih-medicaid-pepfar/681529.

11. E. Park, “Project 2025 Blueprint Also Includes Draconian Cuts to Medicaid,” Georgetown University McCourt School of Public Policy, Center for Children and Families, June 17, 2024, ccf.georgetown.edu/2024/06/17/project-2025-blueprint-also-includes-draconian-cuts-to-medicaid.

12. O. Milman, “Trump Administration to Cut Billions in Medical Research Funding,” The Guardian, February 8, 2025, theguardian.com/us-news/2025/feb/08/trump-administration-medical-research-funding-cuts.

13. H. Hahn and H. Daly, “How Would Children Fare Under Proposed Cuts to Federal Spending?,” Urban Institute, February 4, 2025, urban.org/urban-wire/how-would-children-fare-under-proposed-cuts-federal-spending.

14. D. Smith, “Kennedy Wants to Overhaul the F.D.A. Here’s How Experts Would Change It,” New York Times, December 22, 2024, nytimes.com/2024/12/22/well/fda-rfk-jr-scientists-reform.html.

15. N. Mukherjee, “Instead of Vaccines, RFK Jr. Focuses on Unconventional Measles Treatments, Driving Worries About Misinformation,” CNN, March 5, 2025, cnn.com/2025/03/05/health/measles-rfk-vitamin-a-misinformation/index.html.

16. S. Bertozzi and M. Lu, “U.S. Withdrawal from WHO Could Bring Tragedy at Home and Abroad,” Berkeley Public Health, January 24, 2025, publichealth.berkeley.edu/news-media/opinion/withdrawal-from-who-could-bring-tragedy.

17. N. Totenberg, “Supreme Court Upholds a Lower Court Order to Force USAID to Pay Contractors,” National Public Radio, March 5, 2025, npr.org/2025/03/05/nx-s1-5309498/scotus-usaid-news.

18. A. Herman, “Russell Vought: Trump Appointee Who Wants Federal Workers to Be ‘in Trauma,’” The Guardian, February 10, 2025, theguardian.com/us-news/2025/feb/10/who-is-russell-vought-trump-office-of-management-and-budget.

19. I. Redlener, “The A.M.A. Is Inexplicably M.I.A.,” irwinredlener.org (blog), January 24, 2025, irwinredlener.org/posts/2025/1/28/the-ama-is-inexplicably-mia.

20. J. Hellmann, “Key Physician Groups Stay Silent on Kennedy Nomination,” Roll Call, February 3, 2025, rollcall.com/2025/02/03/key-physician-groups-stay-silent-on-kennedy-nomination.

21. C. Hibbert, “Could RFK Jr.’s Vaccine Skepticism Put Children at Risk for Preventable Diseases?,” Northeastern Global News, November 8, 2024, news.northeastern.edu/2024/11/08/rfk-jr-vaccine-choice; and P. McCausland, “What RFK Jr Could Do on US Vaccines, Fluoride and Drugs,” BBC, January 28, 2025, bbc.com/news/articles/c4gx3kkz8z3o.

[Illustrations by Nicole Xu]