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April 16, 2025 - Epoch Times
24:52
RFK Jr. is 'laying the groundwork for true, transformational change' - David Mansdoerfer
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We have seen a complete reset of a federal agency within 60 days of Secretary Kennedy getting there.
To me, that is unprecedented, and it is going to be one of the most impactful approaches to public health and the health economy in the United States.
David Mansdorfer served as HHS Deputy Assistant Secretary during the first Trump administration.
Now, he's chief strategist at the Independent Medical Alliance and describes himself as the MAGA-Maha connector.
We have not won this fight.
We've begun the fight.
And we have industry forces that are going to try to do everything to limit good policy ideas of a Secretary Kennedy and a President Trump.
What reforms are already underway since Secretary Kennedy took over the Department of Health and Human Services?
What pushback has he faced?
And will the administration be able to reconcile or even merge the disparate agendas of the MAGA and MAHA movements?
Even in the terms of the unknown, it is better to have leadership that's willing to take these bold actions than it is to continually lead Americans down a poor health outcome path.
This is American Thought Leaders, and I'm Jan Jekielek.
David Manstorfer, such a pleasure to have you on American Thought Leaders.
Thank you.
At HHS, what's being described as a historic opportunity, perhaps a once-in-a-lifetime opportunity, is in play.
Bobby Kennedy Jr. has been made HHS secretary, and there's a number of other what you would call disruptors in the system, in the sub-agencies now.
Give me a sense of what you see as the opportunity here.
Why it's rare?
Well, Secretary Kennedy came in on a movement that was combined with President Trump's agenda, which gives us a disruptor in chief and then also a disruptor of health at the same time.
As we've seen, even with the combination of all the doge work that's happening, we have seen a complete reset.
Of a federal agency within 60 days of Secretary Kennedy getting there.
To me, that is unprecedented, and it is going to be one of the most impactful approaches to public health and the health economy in the United States.
Give me a sense of the scale of this agency.
A complete reset.
That's kind of hard to imagine what that looks like.
Yeah, so when I was there in Trump 1.0, the agency was about 80,000 folks, full-time equivalents, and 150,000 contractors that supported the mission of the agency.
At HHS, it is the entire gambit of health.
So we all know the big agencies, but I'll go through some of them.
We have NIH, which really focuses on research and has a lot of interactions with Congress about specific disease pathways.
You have CDC, which is focused on surveillance and, to a certain extent, global health.
Then you have FDA, which is really centered around Bringing your drugs to market or bringing your products to market within the health space.
And then you have the payer system, which is your Medicare and your Medicaid systems, which, as we know, anyone over the age of 65 or typically the poor through the Medicaid system.
So it is the largest.
I'm a cost driver of the federal government.
I don't know what the exact number is, but when I was there, it was about $1.3 trillion worth of expenditures, which has again ballooned during the Biden administration, which we're really now seeing a reset back to 2019 levels through this administrative reorg action.
Explain to me what a reset actually means here.
There were really two big components of the reset.
There was a public health reset, and then there was a business operations reset within the agency.
And so they took divisions that were part of the larger HHS infrastructure, so SAMHSA, which is your mental health division.
essentially. HRSA which is your federally qualified health center or you know your local community health center that the government runs and then my old office in OASH and they combine that to be this new department the AHA and so that department is going to have a much greater Visibility and impact on public health because it brings together disparate resources that weren't talking to each other and
putting them all into the same direction.
And so I am extremely excited about it.
And then on the other side, you had an operational reorganization where we all hear about Medicare fraud.
We all hear about the different things that HHS enforces through either civil rights and HIPAA.
Or through Medicare or through payment systems and whether we're overpaying or underpaying folks.
They created a new division on enforcement that's going to greater operationalize the ability to protect taxpayer resources by making sure that one person is governing and leading over those specific agencies as opposed to three where it was before.
Let's use that $1.3 trillion.
Can you give me a broad sense of where money goes in that $1.3 trillion?
Yeah, so the biggest is going to be CMS, so the Center for Medicaid and Medicare.
That is your payment system, essentially, for either the Medicaid system, which typically goes out to states, or the Medicare system, which is your elderly care.
Essentially. And so that's the biggest chunk of it.
Another large chunk is NIH and the grants that it pushes out to local organizations and to Higher education institutions to study different disease research.
Within NIH, you've seen significant restructures on the types of grants that they're focusing on to better align them to the secretaries and the president's agenda.
And so you've already started to see some reforms there.
Other big pockets of money are, you know, I mentioned HRSA, which is your federally qualified health centers or your local community health center.
That's really Direct patient care for the poor in certain communities.
And then you have a whole slew of other grants like at CDC, as we learned during COVID, where they do surveillance on disease pathways, infectious disease, and other things like that.
And so it's a pretty broad agency in terms of the types of things that it funds.
But at the end of the day, this reorganization action is going to be Better for the taxpayer because it's going to take parts of that agency that have historically not talked to each other but dealt with similar topics and actually get them all on the same page and push them forward.
Does this also somehow make it easier for the secretary to implement his vision?
It does.
HHS has a secretary.
It has...
Division directors or assistant secretaries.
So we've seen Dr. Bhattacharya over at NIH.
We've seen Dr. Oz at CMS.
And then underneath that, you have roughly 180 to 200 political appointees that support the principals in many different ways.
And what this organization does...
Of the political appointees is it basically puts folks over specific divisions underneath SAMHSA, OASH, HRSA, all of these acronym words that don't make sense maybe to the general public,
but have integral parts to the health economy system in the United States.
And so the Secretary, by reorganizing this, has basically level set to the career bureaucracy in And what I mean by career bureaucracy are the folks that last beyond an administration.
Political appointees are attached to the president.
The career bureaucracy, or the 80,000, now 62,000, are folks that typically last no matter who is in charge in the executive office.
By resetting the agency, you get to now pick the leadership.
For all of these new divisions that you're creating.
And unlike the status quo, where we saw very little turnover in the agency, you basically get to put an entirely new fresh face of career leaders that are aligned to the president's agenda and the secretary's agenda in positions of authority that could be and will be longer lasting than just this administration.
So broadly speaking, How is this agenda different from the past agenda?
So, if folks remember, when President Trump first took office in 2017, repeal and replace was on the agenda.
It was a very high priority.
Obviously, we weren't successful in that occasion.
But we really had to deal with the political dynamics of the Affordable Care Act.
Well, the Affordable Care Act, again, is mostly focused on health economy, right?
It's health insurance.
It's getting folks to health outcomes.
But this time, we are infusing a new era of public health, which Republicans and conservatives have typically not talked a lot about.
Republicans and conservatives stay very strong.
On the health economy.
We love to talk about payments.
We love to talk about hospital, rural health, and how the economy is impacted by health.
Right now we have a secretary who cares deeply about public health, which is everything from the mRNA vaccine to food dye in your foods and chemicals within your food to environmental factors.
These have traditionally not been topics that your normal historical Republican agenda would focus on.
And so to me, having a disruptor in chief in the president and then a...
Public health disruptor sets this time for changing the course of American history from more expenditures, worse health outcomes, to more efficient expenditures,
better health outcomes.
David, we're going to take a quick break right now and folks will be right back.
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And we're back with David Mansdorfer.
Chief Strategist at the Independent Medical Alliance I want to find out a little more about you.
How is it that you came into this role of assistant secretary in the first place?
What does that actually mean?
What are the qualifications of such a person?
Because you're not a doctor.
I was lucky to be called upon very early in the first administration as a generalist.
My first job at the department was actually the director of boards and commissions.
That sounds very innocuous until I tell you that there are over 280 advisory boards at the agency.
180 advisory boards are everything that your listeners might have heard of from the Presidential Physical Fitness Council, you know, the old Arnold Schwarzenegger Council, to the, it's called PACHA, or the President's Council on HIV and AIDS.
But each one of these advisory councils feeds policy.
Into the agency.
So if the members on that council aren't aligned to the secretary's or the president's agenda, then there's some conflict and friction there.
And so I had the opportunity to really get a crash course on the agency, looking at all these policy advisory councils on behalf of the secretary and, to a certain extent, the president when I was there.
That translated to, okay, so David had an opportunity to view the agency, and I'm a more operations-focused person.
So a lot of folks in health policy or political appointees, they're great at certain topics.
They're really good MDs that know specific disease pathways.
They have great clinical backgrounds.
I can tell you how to get a contract done and go from A to B. And so having that relationship with high-level, highly intelligent political appointees was great because I got to operationalize some of the things that they wanted to accomplish.
Those topics ranged from ending HIV, fentanyl and opioids, to reorganizing the department the first time, which I had a hand in.
And when you're a political appointee, you kind of just get tasked with duties as assigned.
So given that I was more operational, I had the opportunity to negotiate the labor contracts for HHS.
I had the opportunity to reorganize the district offices and some of the public health functions the first time.
And I had the opportunity to really work with high-level leadership on driving home presidential agendas from Things like veteran suicide, which is very important in the first administration and is going to be important in the second administration as well.
And just having the opportunity to be a Swiss Army knife on a number of programs within HHS.
How is it that you came to be this operations guy?
Well, I've luckily worked for almost every type of government at this point.
I started off working for the County of Orange out in California, Orange County.
I don't know why they have that differentiation, but I worked for a county supervisor out there, Senator Moorlach, where I learned a lot from.
He was then promoted to the California State Senate, so I had the opportunity to see local government in action and then state government in action.
Due to some connections that we had within Senator Moorlach's office, half of our office got called to D.C. to work for the Trump administration.
And so I had the opportunity to work at the state and local and then go realize about all the things that we complained about at the state and local at the federal level.
And so having that knowledge really gave me an inside scoop on how to address operational.
What are the issues within some of the theoretical issues that we have in policy?
Broadly speaking, an organization like HHS, it's mostly these obviously vast, vast, vast, vast majority as we've discussed is these career people.
And is the issue that they have just a particular vision of what it needs to accomplish and that is sometimes at odds with the vision of the executive?
Yes. So I actually, before Elon took over Twitter, there was a...
Hard way to define what a presidential administration turnover looks like.
But given the visibility of what Elon did at Twitter, think about the same actions where he came in with the kitchen sink, right?
You know, to the front doors.
But an organization that doesn't know you, doesn't particularly align with you, and yet you're now in charge.
So think about if they fired the 180 top leaders at any Fortune 500 company on one day.
And then 180 new leaders showed up on the next day and says,"Hey, we don't like what the last group was doing, and we're here to give you new direction." Okay, so you have that as a dynamic to start.
And then you have the normal cultural dynamic where I think if you did political polling with inside of the agency, you'd probably see 80 to 90 percent would be more Democrat-oriented and much fewer would be Republican-oriented.
And that plays out where we see things like the District of Columbia, right, going 85-15 Democrat to Republican.
Those are the folks that are working in these agencies.
So you're walking into an ideological culture battle the moment you come in to these agencies.
Now, there are some wonderful career appointees at HHS.
They were actually some of the folks that gave me the best idea, but they weren't ever allowed to be empowered to be impactful because they were a minority in their thought processes of what needed to be done.
I don't want to paint a broad brush that the entire agency is inefficient and ineffective because there are many parts of the organization that are great and many people within, but they are silenced when Republicans are not in charge.
Something a little more theoretical, and I recently realized that the spoils system, which is basically what you've been describing here, I always thought it was sort of...
Just a side effect of the realities of politics.
But I only recently discovered that it's actually intentional, right?
And I wonder if you could speak on that since you probably have thought about this before.
Elections have consequences.
If you look at the ideological pendulum, you know, over the last 20 to 25 years, you had presidents that were closer to ideologically aligned, even if they were in different parties.
Bush. I would say their policy differences back then weren't nearly as stark as we are seeing between Obama, Trump, Biden, Trump.
The pendulum is swinging much more significantly with...
The policy agendas of each of these different administrations.
And so with that, it is much more stark when it comes to the outcomes for when a president wins.
And so for agencies like HHS, you have wild changes in policy on areas like the pro-life agenda, on areas for interpretation around gender, which is a big part of what HHS does, to even how you view the health care market.
And so I don't think it's necessarily what the four founders didn't expect.
I think it's just more extreme as we get further and further away from political leadership that kind of ideologically agrees on 60 to 70 percent and then has their own platforms.
But when you have a 80 to 90 percent difference in ideology.
The differences for a presidential agenda are very, very stark.
I'm a big believer in diversity of thought and diversity of opinion.
And having the ability to have different vantage points come in and structure government is so crucial at a time where government's just been living on its laurels.
It's, you know, before Obama, it was, you know, plus 3%.
Doesn't matter which administration you're in.
Every year, it's, you know, the agency would get the same amount of money, plus 3%.
We're excited about it.
We can continue on.
When Obama got here, we had obviously the Affordable Care Act, which represented a significant increase in expenditures to the health economy.
And then we had President Trump come in, create some efficiency around that.
And then you had President Biden come in and then just blow it out of the water again.
And so right now, you have a reset that would be normal in any normal corporate business.
We all don't like to talk about that, because we hold the public employee different than your corporate employee, because that's how we've been trained here in the United States, is that public service is a great calling, and it is a great calling, but it doesn't mean that our governmental entities shouldn't be treated in similar ways.
Every now and then to reset them to make sure that they align with both the president's agenda but to better health outcomes.
How can you argue that this arcane system where we have 80,000 plus employees and 150,000 contractors and are spending trillions of dollars yet receiving some of the worst health outcomes is what's best for the American public?
I can't make that argument.
I'm really interested to see how the Democrats are going to try and make that argument over the next coming months.
There is no one better than Secretary Kennedy to push this agenda forward, and we need to show a little bit of grace when things don't happen as soon as we possibly want them.
I say that because having been on the inside, you are up against so many forces to try and accomplish what is going to be precedent-setting.
And never been done before type policy actions.
And so I understand that you have an American public that is very action-reaction oriented.
We won, so why have we not won entirely?
But at the end of the day, Secretary Kennedy and his team are laying the groundwork for true transformational change within the United States and globally.
Any final thoughts as we finish today?
I very much applaud President Trump and Secretary Kennedy for doing the right thing and disrupting an organization and an apparatus that has continually led to bad health outcomes.
No matter what the outcome is, I am excited to see what we learned during this process that will improve the lives of everyday American citizens.
I personally think it's going to be a resounding success.
But even in the terms of the unknown...
It is better to have leadership that's willing to take these bold actions than it is to continually lead Americans down a poor health outcome path.
Well, David Mansdorfer, it's such a pleasure to have had you on.
Thank you.
Thank you all for joining David Mansdorfer and me on this episode of American Thought Leaders.
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