There is a photo that exemplifies the paradox of Robert F. Kennedy Jr.’s nomination as secretary of the Health and Human Services Department: Kennedy is sitting at a table in Trump One with President-elect Donald Trump, Don Trump Jr., and Elon Musk, with a table of McDonald’s spread out between them. Kennedy grimaces over an open Big Mac box, looking sick to his stomach. “Make America Healthy Again starts TOMORROW,” Trump Jr. posted. With a beginning like that, it’s easy to doubt whether the new administration will seriously support Kennedy’s crusade to fix America’s “chronic disease” epidemic.
Health was Kennedy’s cornerstone on the campaign trail, both before and after he threw in his lot with Trump. There, it was easy to point out problems. If he is confirmed as HHS secretary, Kennedy’s work will become much more difficult. His success depends not just on the president’s support but also on his ability to navigate the intersection between Big Junk Food, Big Pharma, and HHS — a “revolving door” Kennedy promises to “slam shut.”
That’s easier said than done. HHS oversees 13 subagencies and has the largest budget of any government department. Kennedy has compared the department’s relationship with private businesses to a “cartel,” similar to Dwight Eisenhower’s military-industrial complex, with the ringleader being the “mercantile interests of the pharmaceutical industry.”
But those interests have a powerful hold on how health policy is dictated in the United States. This appears most clearly in one of the biggest players inside the revolving door of Big Pharma right now: Ozempic and its sister class of drugs recently approved for weight loss, including Wegovy, Zepbound, and Mounjaro. Created primarily by the Danish company Novo Nordisk and the American Eli Lilly, the drugs have been hailed as a “magic pill” for fighting America’s rising obesity rates, at least in the short term, but their sticker price — at times over $1,000 per month out of pocket, with spotty insurance coverage — has given rise to a discussion about drug price negotiation and insurance backing for a condition that is increasingly considered to be as a chronic disease that may require lifetime treatment.
The Biden administration has pushed for funding weight loss drugs as a matter of justice. In November, it released a proposed rule that would expand coverage to drugs such as Ozempic in Medicare and Medicaid, including coverage in all state Medicaid programs, with 10-year cost estimates between $7.1 billion and $25 billion. The rule would take months to implement, leaving the final choice, and possible costs, financial and political, to the Trump administration. The argument in favor of this spending is that healthcare costs from diseases commonly attributed to obesity — heart disease, diabetes, and so on — cost the U.S. far more.
The argument against such action, Kennedy’s argument, is that Big Pharma is profiting off of obesity and stands to profit more off of a medical response to it. He believes he has an even cheaper way to solve America’s insoluble problem: food. “If we just gave good food, three meals a day, to every man, woman, and child in our country, we could solve the obesity and diabetes epidemic overnight,” Kennedy said on Fox News in October.
Kennedy has long advocated nonpharmaceutical responses to America’s health problems. His Make America Healthy Again, or MAHA, campaign, as laid out in a September Wall Street Journal op-ed, proposes to use HHS to ban certain food additives that have been linked to diseases, cut subsidies to Big Ag corporations that encourage production of products such as high-fructose and seed oils, and get soda and processed foods out of SNAP programs. It also seems to present a self-contradiction: It argues that Ozempic is too expensive in the U.S. and that drug price caps should be implemented to give more people access to it despite saying in October that its maker is “counting on selling it to Americans because we’re so stupid and so addicted to drugs.”
But not everyone in the incoming administration, or connected to it, seems to agree. Dr. Mehmet Oz, Trump’s pick for the Centers for Medicare and Medicaid Services, appears to be more Ozempic-friendly. And Elon Musk, famously, is an Ozempic user himself. The co-leader of Trump’s new Department of Government Efficiency posted recently that the federal government should subsidize the drug: “Nothing would do more to improve the health, lifespan, and quality of life for Americans than making GLP inhibitors super low cost to the public,” he said. “Nothing else is even close.”
All of this means that Kennedy is a controversial pick, not just for those concerned about his statements on vaccines and autism or fluoride in the water supply. He’s a controversial pick both inside the administration and out: for anyone who is caught in the current battle between Big Pharma and Big Food to redefine what health, and food and weight especially, mean in America.
Why Kennedy at Trump’s HHS, then? And what could he actually accomplish there?
Kennedy has one of the strongest anti-corruption brands on health matters in the country. His oft-cited “revolving door” between Big Food and Big Pharma is no conspiracy: A recent study found that 95% of the members of a government committee for setting U.S. dietary guidelines had connections to one of the three Bigs: Food, Ag, or Pharma. Nine out of 10 previous commissioners of the Food and Drug Administration have gone on to work in pharma companies. And then there’s the fact that government health campaigns have a history of being co-opted by Coca-Cola, PepsiCo, or Nestle, Michelle Obama’s “Let’s Move!” campaign, with board members and funders from most of the large food corporations in America, being a prime example. It has become a well-worn tactic by now: When Big Food or Big Junk feel threatened, they start a new “Healthy Eating” marketing campaign and sign up a celebrity.
Big Pharma is no different. It funds about three-quarters of the FDA’s budget through its “user fee” program — essentially lobbying for the approval of new products. When Trump says he wants to “let Bobby go wild” at HHS, these seem like the most likely targets.
Kennedy seems to understand that many people are unhappy with their health and their healthcare. (The reactions to the shooting of UnitedHealthcare CEO Brian Thompson revealed the frustration in a violent fashion.) The percentage of people who say they’re paying too much for healthcare is a nearly unanimous 94%, according to a recent study from Gallup and West Health. The U.S. government spends twice as much on health as on defense — and without the justification of good results, especially on obesity and diseases commonly attributed to it. The Centers for Disease Control and Prevention estimates that around 74% of adults are overweight, around 40% are obese, and related healthcare costs amount to $173 billion per year.
It’s unsurprising then that so many healthy food advocates across the political spectrum have rallied behind aspects of MAHA, from the “crunchy mom” Instagram influencers on the Left to the “healthy cons” on the Right. They share concerns about the fact that nearly 75% of Americans’ calories come from ultraprocessed foods, which they, with Kennedy, consider a deeper cause of the diseases linked with obesity, and that government and advertising are pushing Ozempic instead of addressing the root causes of the country’s problems with weight.
But what about the average, non-crunchy American? Gallup estimated that the number of people on injectible weight loss drugs was 15.5 million as of last spring, and that number is likely higher when the use of compounded and black-market versions is factored in. In the next five years, 13% of the U.S. population is projected to be on a weight loss drug. The FDA has approved them for use in children as young as 12, as lifetime medications.
Behind these statistics are millions of people whom Kennedy would see as victims of Big Food and Big Pharma and who tend to see themselves as desperate for results and up against a wall of insurance and pharma bureaucracy that, even for those who are pro-Ozempic, don’t have their best interests at heart. One California woman who asked to remain anonymous described to me a lifetime of trying and failing to lose weight or regaining weight with numerous diets and previous generations of weight-loss drugs. She lost 30 pounds on Wegovy and then lost access because of insurance complications: Amid a shortage of the drug, her employer implemented a requirement for an online lifestyle training program that turned into a technical nightmare. She has been unable to find alternatives and has gained weight back.
“It’s just a disaster. It’s the biggest failure” on the part of the healthcare industry, she told me. “You’re just put through the wringer, and it’s so impersonal you feel like nobody cares. You’re just another number.” As she sees it, insurance companies are concerned about rising demand and demands for coverage, and drug companies are profiting off of high prices, which leaves no one on the side of the patient, who has been told by everyone from the government to the ads on the nightly news that it’s of vital importance for her health that she lose weight.
In fact, she was lucky to have a period in which the drug was covered at all. Fewer than 1 in 5 private employers currently cover weight loss drugs, Medicare covers Zepbound and Wegovy for heart problems only, and only a small number of state Medicaid programs cover them.
The debate over whether a Kennedy-led HHS would approve the Biden rule change on Medicare and Medicaid coverage raises two major questions about how obesity is treated in America. The more obvious question is that of access: “Even my richest patients can’t afford it” without insurance coverage, said a doctor in West Virginia, which has the highest percentage of obese people of any state. “We’ve separated between the haves and the have-nots.”
And the deeper question is about what the proper treatment even is. The medical establishment, Big Pharma, and Big Food are on the same team in seeing obesity as a disease, not just a lifestyle choice, and a “chronic, complex disease” with numerous genetic, biological, and social factors. Many doctors, life coaches, and users of the drugs who I have spoken to say that Ozempic and its sister drugs can be useful, at least to kick-start weight loss. While their exact prescriptions change, and they suggest lifestyle changes in addition to the drug, they’re far from agreeing with Kennedy that by simply eating better, Americans “could solve the obesity and diabetes epidemic overnight.”
Kennedy is not going to kibosh Ozempic. But will he be able to push organic food over Ozempic, or will his and the Trump campaign’s libertarian-lite approach to related drugs, such as abortion pills, win out? As early as 2023, Kennedy’s “civil libertarianism” was already leading him into conundrums on assisted suicide and gender surgeries. His own precedent on these matters, that personal choice and bodily autonomy trump all, seems to favor Ozempic.
A cynical reading of Trump’s choice of Kennedy is that he offers an alternative to paying for coverage of this and other popular drugs through pushing personal responsibility and eating habits — buy organic. But Kennedy actually has at least two close advisers pushing for systemwide changes from a right-wing perspective: Dr. Calley Means and Casey Means, a sibling team, the first of whom wrote a book on natural ways to solve metabolic disease, and the second of whom is an anti-Big Food lobbyist who aims to fight chronic disease by using government funding to fix America’s food supply. So MAHA is not just rhetoric, or doesn’t plan to be.
A more realistic reading asks whether, as HHS secretary, Kennedy would be in the right place to pull off MAHA. He seems to be most interested in problems with the food supply. The agency with the most direct impact on school lunch and welfare programs such as SNAP, crop subsidies, and pesticide regulation is not the HHS but the U.S. Department of Agriculture. While HHS does oversee the FDA, which oversees dietary guidelines and issues approvals of new food products, bans on food additives and the like are both challenging to pass and wouldn’t have as broad of an effect on Americans’ lifestyles as something like a USDA overhaul of SNAP. And while he could theoretically purge “entire departments” of the FDA, and has veto power as well, to streamline approvals and expand experimental treatments, the reality is change is slow and many of the changes he wants to see (a de-emphasis on drugs such as Ozempic being a prime example) are embattled in his own camp and outside of it.
A more likely effect of a Kennedy HHS would be another injection of enthusiasm into the privatized wellness industry. Already estimated at a global $1.8 trillion, about double that of the pharma industry, the social media-driven health market backed MAHA in the election and will continue to do so as Americans pick up on the narrative that their weight is a social problem and that the solution in a populist era is one of personal choice to improve and personal resentment against the forces arrayed against one’s chances at improvement. That’s not a new story when it comes to weight loss, which has often been about social pressure at least as much as science, but MAHA could reinforce it, and influencers, and perhaps innovators, with the latest and most accessible magic pill could profit.
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This confluence of populist, anti-establishment sentiment with a broadly felt acknowledgment of a need for systemic change is what makes Kennedy’s Big Mac photo op both fascinating and ironic: He hasn’t allied with Sen. Bernie Sanders (I-VT) and his campaign for affordable weight loss drugs in the name of justice. He has allied with the side that he believes will free the food market from its cronies and its corruption. But that’s also the side that uses McDonald’s as a symbol for its freedom from elites’ moral reprobation of fast-food chains and disdain for GMOs. To pull off MAHA, Kennedy would need to sell a healthier food supply, not a shot sold by a Danish drug giant, as on the side of the little guy.
For the vast majority of Americans, Chris Arnade recently wrote in the Free Press, each McDonald’s is “a community.” It’s a symbol of the Trump administration’s populism, its affirmation of the compromises, comforts, and discomforts of the average American, from choices in the voting booth to the drive-thru window. Now, if only they’d throw out the seed oils and bring back the beef tallow, Kennedy’s legacy could be making McDonald’s great again.
Hannah Rowan is managing editor of Modern Age and a fellow in the Robert Novak Journalism Program through the Fund for American Studies.