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How far should the great US health revolution go?

THE history of populist movements worldwide consists of unrecognised grievances being forced out into the open by ‘the governed’, followed by failure to convert those bottom-up, decentralised politics into sustainable long-term policy changes. Both MAHA (Make America Healthy Again) and MAGA (Make America Great Again) have accomplished political milestones almost unprecedented in American history. 

One has to reach back to Presidents Theodore Roosevelt and Andrew Jackson to find solid parallels to the Presidency of Donald J Trump: Jackson for his battle with the Second US Bank and eliminating the US Federal Debt, and Teddy Roosevelt for promoting a muscular expansionist US foreign policy and his commitment to health and exercise, in many ways foreshadowing a similar emphasis during the administration of John F Kennedy and now JFK’s nephew RFK, Jr.

Not to be negative, but the history of US populist political movements is littered with stories of unmet high expectations and subversion of those movements by established political power centres.

So what is populism, this pan-US and EU movement currently threatening to overwhelm and supplant the globalist ‘New World Order?’

The Dutch political scientist Cas Mudde says: ‘I define populism as an ideology that considers society to be ultimately separated into two homogeneous and antagonistic groups, “the pure people” versus “the corrupt elite”, and which argues that politics should be an expression of the volonté générale (general will) of the people. Populism, so defined, has two opposites: elitism and pluralism. Elitism is populism’s mirror-image: it shares its Manichean worldview, but wants politics to be an expression of the views of the moral elite, instead of the amoral people. Pluralism, on the other hand, rejects the homogeneity of both populism and elitism, seeing society as a heterogeneous collection of groups and individuals with often fundamentally different views and wishes.’

(For further reading on populism, consider my previously published essays here and here.)

There are fundamental fault lines between MAHA and MAGA, and in many ways they resolve into pro-regulatory big government initiatives versus promotion of deregulation/small government. 

It is worth noting that the MAHA movement exists outside Kennedy and the government, and encompasses many societal issues outside the focus of the Trump administration. For instance, homesteading, medical and personal sovereignty, and personal responsibility for healthcare choices may all be outside the MAHA whole-of-government approach. For this article, I am writing of MAHA directives within the government. But MAHA is much bigger than that.

MAHA has emerged mainly from the left and, out of frustration due to the Democratic Party’s corruption and rejection, has embraced the centre-right. In turn, MAHA has been enthusiastically endorsed by MAGA and centre-right populists, including many formerly associated with the Tea Party movement. 

The arc of the Presidential campaign of RFK Jr closely adheres to this narrative. Bobby started out seeking the Democratic party nomination as representing ‘Kennedy Democrats’ and announced a platform proposing a return to his legendary father and uncle’s pre-Carter, pre-Ronald Reagan ‘New Deal’ positions. But the Democratic party of today bears little resemblance to that of his father and uncle’s time, and the changes in national political thought on both left and right wreaked by Reagan, Carter, and then the succession of the military-industrial corporatist Bushes and Clinton(s)-Obama-Biden on the left.

To no one’s surprise, apparently other than Bobby and his team, today’s Democratic party made it abundantly clear that there was no room for this Kennedy in the tent. So he decided to make a run as an independent, and Nicole Shanahan stepped up to bankroll and prop up the drive to get Bobby on the ballot in all 50 states, which was amazingly successful, to the credit of all concerned. However, it was clear that, once again, an independent run would primarily function as a spoiler, in this case for the campaign of Donald J Trump.

After much advice, consideration and deep self-examination, and to the disappointment of many of his supporters, RFK Jr famously decided to pivot to endorsing and joining the candidacy of the once and future President Trump. The pivotal moment was RFK Jr’s empathetic phone call to DJT after the assassination attempt, which still reeks of a deep state operation much like what happened to Bobby’s uncle and father. And RFK Jr did so in a spectacular manner, with a ringing endorsement speech that will live in history.

So, MAHA largely originates from the left, but the appeal crosses all party lines. Who does not want to be more healthy? 

The initial MAHA mandate is to demonstrate measurable improvements in the health of US citizens within 12-18 months, with a particular focus on chronic disease and children’s health. One aspect of this effort will involve refocusing the US Department of Health and Human Services on health promotion and de-emphasising disease-specific treatment.

At its core, MAHA is predominantly pro-regulation. The logic is that we must use regulatory authority to improve transparency and eliminate that which leads to unhealthy outcomes. Examples include drugs with side effects that, when considered in whole, do not have a strongly favourable risk/benefit ratio. And glyphosate (Roundup) contamination of our grain and soybeans. 

However, there is also a deregulatory aspect to the MAHA movement. For example, is unpasteurised milk really a health risk, and what health promotion properties are associated with unpasteurised milk? Similarly, the move towards backyard poultry and eating locally slaughtered grass-fed beef. Or re-examination of the widespread US policy of fluoridating municipal water supplies. There is also an investigational research aspect: for example, what are the drivers behind the explosion of autism, obesity, and other childhood chronic diseases?

To date, the MAHA movement has primarily focused on things that big government can do to promote improved health of US citizens: removing known toxins from food, investigating causes of autism, questioning the paediatric vaccine schedule and revising the VAERS vaccine adverse event reporting system so that truly informed decisions can be made concerning the safety and efficacy of vaccine products. 

But behind that is the potential for the MAHA initiative, if institutionalised and bureaucratised, to morph into another overbearing set of nanny state mandates. To make the point, I often use the example of the person who loves McDonald’s hamburgers consumed with sugary Coca-Cola. Should the State mandate that a person should not eat these things, despite the clear-cut health risks? Should the State outlaw cigars? And what about regulating foods? Where should MAHA draw the line? What principles should be applied to guide these decisions? What is the proper role of small government as it relates to food and drug regulation?

This really involves the boundaries between individual sovereignty, libertarianism, Murray Rothbard’s anarcho-capitalism, and the utilitarian/socialist logic of modern ‘public health’. The modern ‘public health’ enterprise seeks the greatest good for the greatest number and is driven by narrow analysis of large data sets to identify, regulate, promote or mandate specific ‘health care’ interventions such as vaccines, while often disregarding other related issues including long-term, unanticipated or difficult to predict consequences. 

A ‘public health’ enterprise that seeks to achieve optimisation of collective health outcomes rather than optimising health opportunities coupled to respect for individual autonomy (choice). A ‘public health’ enterprise that has repeatedly used top-down management via government, insurer, and health management organisations to require and deploy pre-approved treatment protocols rather than individually optimised health management and promotion, reflecting each patient’s complexities. One size fits all, and do what you are told. 

Consider seatbelt mandates. Like many big government initiatives that stand at the top of slippery slopes, there is a consensus that it is right and proper for government to mandate seat belts be installed in cars. But is it right to mandate their use when driving? Next comes motorcycle helmets. Same issues, but slightly less clear. Cigarette smoking? In all three cases, the argument is made that irresponsible health behaviours by individuals cost all of society due to increased health care and insurance costs (including publicly subsidised costs), and loss of person-years.

The same logic then can be applied all the way down to whether the State should mandate your dietary choices, which is why I use the McDonald’s example. Should we ‘allow’ citizens to experiment with nutraceuticals and health supplements that are not officially endorsed by the FDA?

And there we go, straight to nanny-state medical fascism. But seatbelts save lives. Air traffic controllers save lives (most of the time, with some recent exceptions). You get my point.

If MAHA is to transition from merely a populist uprising and set of immediate grievances to a new, transformed and sustainable set of public health enterprise policies, we need to take some time to think about and define acceptable limits on the role of the State in promoting, advancing, and in some cases mandating limits on infringement of individual sovereignty and autonomy. 

Immediate short-term interventions are necessary, and I applaud the use of both the bully pulpit and executive orders. But if MAHA is to become more than just a populist uprising, and to result in sustainable long-term policy changes, it is also important to take the time required to examine, define, and develop public support for the boundaries between the proper role of a constitutional republic-based federal government, the constitutional role of individual States (which are responsible for regulating the practice of medicine), and both the sovereign rights of the individual and the global right to truly informed consent to medical interventions.

This article appeared in Brownstone Institute on March 29, 2025, and is republished by kind permission.

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