Former President Barack Obama once said, “elections have consequences.” 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 U.S. Constitution, explicitly establishes checks and balances designed to shield us from the domination of extremists of any political stripe.
And for well over 200 years, those principles have held. But since the second inauguration of President Donald Trump, the country is facing an existential crisis of Constitutional fragility across every aspect of government and governing in America.
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. as HHS secretary. Proposed disruptions or elimination of vital healthcare access for vulnerable populations, massive cuts in critical medical research, and withdrawal from long-standing commitments to global health 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 impact 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, 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” 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 U.S., 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, or removing protections for patients with preexisting medical conditions.
- Reductions in Medicaid benefits, like nursing home care and the Early Periodic Diagnostic Screening and Treatment (EPSDT) benefit for children living in low-income families.
- Cutting billions of dollars of funding from NIH-funded studies, including cancer, heart disease, and infectious disease research.
- Potentially drastic reductions in the Children’s Health Insurance Program (CHIP) that has provided otherwise unattainable coverage for millions of children.
- A potentially dangerous overhaul of FDA, as well as non-evidence-based messaging on vaccines, from known anti-vaccine advocate — and now HHS secretary — Kennedy.
- 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.
- Eliminating USAID, 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, 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 doctors and 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 sledge hammer. 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 our profession to actively resist drastic, damaging changes heading our way.
Here are two specific ideas:
First, doctors 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 House 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 MIA.”
Take the issue of vaccines for example: 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, MD, was quoted in Roll Call saying, “We are pediatricians, not politicians” 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 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.
Doctors 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, doctors 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 & Public Affairs at Columbia University in New York City. He is also a senior advisor to the Clinton Global Initiative’s Ukraine Action Network, co-founder of the Ukraine Children’s Action Project, and an adjunct professor of pediatrics at Albert Einstein College of Medicine in New York City.
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