Health Scare-Trump Cabinet Nominations Round II

The Trump Administration has fired all diplomats and staff associated with the Obama Administration, many of them career employees of the government, without securing replacements. Among other things, this means the nation’s nuclear arsenal, which comes under the Department of Energy and is currently overseen by a nuclear physicist, who has also been given his walking papers, will be administered by former Texas governor and Dancing with the Stars contestant, Rick Perry, who has not yet been confirmed. As promised, here is Round II of the Trump nominations to run important government agencies, their views, and what it might entail for you.

What’s at Stake	Nominee	Perspectives	Analysis
The Food and Drug Administration (FDA) oversees food and drug safety for the nation. This is one of the most powerful non-cabinet level positions. This agency conducts surveillance on food safety and oversees the standards by which new drugs, including biologicals are approved for sale in the U.S. It also reviews over the counter medications, cosmetics, and natural food products like vitamins. The agency enforces strict labeling, as well as contamination prevention standards. It also determines which food can be imported into the U.S.	James O’Neill is under consideration for Commissioner of the FDA. The other individual under consideration is a venture capitalist who own a genetic testing company, Balaji S. Srinivasan. The third person under consideration is an actual MD, Scott Gottlieb, and he served as deputy commissioner for the FDA from 2005-2007.	Here is a direct quote from Mr. James O’Neill, “We should reform FDA so there is approving drugs after their sponsors have demonstrated safety-and let people start using them, at their own risk, but not much risk of safety,” unquote.[1] Regarding Balaji, just the fact he is a venture capitalist in the healthcare industry should be scary enough, because excessive profiteering in U.S. healthcare is a bigger problem than the insurance question. Dr. Gottlieb is a member of the conservative American Enterprise Institute and is at least, experienced and qualified for the job.	O’Neill will kill people if he allows the pharmaceutical industry, which uses unethical direct to consumer advertising, coercion throughout the medical system, and heavy lobbying to get what it wants, police itself. Case in point, during the Bush Administration Pharma was successful in preventing Medicare from being able to negotiate the price of drugs for their programs when Part D was added. How has that worked out for you? Dr. David Kessler, who served as FDA Commissioner under Bush and Clinton has this to say, “This will set back the competitiveness of the American pharmaceutical industry, which has been the envy of the world, by 50 years.”[2]
The Department of Commerce is the federal government agency which oversees the collection of economic, financial, and trade data across the land, which is used for policy making. Additionally, the U.S. Census Bureau is also part of this agency and a new national census is due shortly, since the last full census was in 2010.	The nominee for Secretary of Commerce is Wilbur Ross, a former banker who is now a billionaire through acquiring businesses and restructuring them.	Mr. Ross is a former Democrat, with an Ivy league education, at Harvard and Yale. He is 79 years old, which makes the number two appointee for this role very critical. Ross will want to influence trade deals, but there may be conflicts of interest given his far-flung business interests. His current wife, Betsy McCaughey has also been named an economic advisor.	He is certainly competent to run the Commerce Agency, because of his banking and business experience. Ross was a latecomer to the Trump camp, as he was a supporter of Senator Marco Rubio in the primary election. Ross replaces another billionaire, who was appointed by Obama.
The U.S. Trade Representative negotiates international trade agreements, which are crucial to the economy.	Robert Lighthizer is the nominee for U.S. Trade Representative. If he pursues Trump’s agenda, his job would include renegotiating NAFTA and the Trans Pacific Trade Agreements.	Lighthizer is an attorney, which is a requirement for this job, He has a history of representing steel workers in trade litigation disputes. A big concern was the Chinese “price dumping” of steel to drive American producers out of business.	Several unions are interested in renegotiating trade agreements if it means saving American jobs, which could coincide with Trump’s agenda.
The Small Business Administration (SBA) works to promote business and provide financial assistance for small business development. The SBA has a 124 billion loan portfolio.	Linda McMahon, wife of the impresario of World Wrestling Entertainment and a billionaire, is the nominee to run the SBA. She had an unsuccessful run for the senate in Connecticut. She was the CEO of WWE, which made a mint in pay-for-TV.	McMahon had been a supporter of Governor Chris Christie’s presidential run. She knows how to run a business and grow it.	It is difficult to see how a billionaire from the entertainment industry will give much of a boost for small businesses, but heh, this is a political appointment. Thanks for your checks Linda.
The Office of Management and Budget (OMB) oversees the financial reporting for the federal government.	Mike Mulvaney is the nominee to head the OMB. He is a founding member of the ultra-conservative, House Freedom Caucus and is responsible for getting rid of Speaker of the House, John Boehner.	Mulvaney will be looking for ways to cut taxes and reform the tax code.  He came to office in 2010 with the Tea Party Movement. He demanded a dollar-for-dollar spending cut proposal to authorize the Hurricane Sandy Disaster Relief funding.	Mulvaney once favored shutting down the government versus voting for a spending bill. He will be the one putting the brakes on infrastructure spending and torpedoing the Affordable Care Act.
The Department of Homeland Security (DHS) was started after 9/11 and secures the nation’s borders, airport security, and cyber security infrastructure. The agency is also responsible for enforcement of immigration laws.	Thomas P. Bossert has been appointed as head of the Department of Homeland Security. He comes from the private sector and was formerly a security advisor under George Bush.	Bossert is a beltway insider, with previous national security experience. He is a senior fellow at the Atlantic Counsel, working on the Cyber Statecraft Initiative. (Donald Trump's Cabinet Is Taking Shape: Here's The Latest List, 2017)	Since one of Trump’s platforms was to build a wall between Mexico and the U.S. this will come under the purview of the DHS and you can expect huge cost overruns. Trump also wants to vet immigrants based on religion and has threatened to send back millions of residents.
Special Adviser to the President-which can mean just about anything you can imagine.	Jared Kushner, Donald Trump’s son-in-law and himself a real estate magnate also with daddy’s money has already been appointed to this newly created role.	Kushner was responsible for jettisoning Chris Christy from the cabinet and holds sway with Trump. U.S.policy on Israel and the West Bank will be influenced by him.	The appointment of any family member is considered in violation of the anti-nepotism laws, which have prevented Congressman even from having their children work as interns. But why should this be any different, Trump didn’t disclose his income tax return, hasn’t set up a blind trust, and has gleefully exclaimed he is exempt from prosecution as president. (Nixon thought so too.)
The Director of Trade and Industrial Policy is a new office under president elect Trump.	Peter Navarro has been appointed to this role. He is a professor of economics and public policy at the University of California, Irvine.	He has been highly critical of China’s trade policies and we can expect some action here. Navarro is the author of  "Death by China".	I think we can expect the Trans Pacific Trade Agreement to go away. The problem is, China will absorb the vacuum left by the U.S. extraction. It remains to be seen how a professor will fare with the sharks and oligarchs in Trump’s cabinet.
The Department of Veterans Affairs oversees the administration of veteran’s healthcare and other veteran’s benefits.	David Shulkin is the nominee for Secretary of Veterans Affairs. He is a physician and was an Obama appointee to Veterans Health in 2015. He has experience running large healthcare entities, like the University of Pennsylvania and Beth Israel Medical Center in New York.	He was responsible for cutting the time veterans had to wait for treatment and restoring credibility to the agency.	He rejects privatization of the Veterans Administration as it would add billions to the cost of providing care. Good call and good health care, both provided at the capable hands of Dr. Shulkin.
The Department of Labor is responsible for enforcing the nation’s labor laws, including collective bargaining, and enforcement of ERISA, PPACA, COBRA, FMLA, and other health & welfare laws. The agency oversees workplace safety and administration of unemployment benefits. This agency also makes legislative recommendations.	Andrew Puzder is the nominee for Secretary of Labor and he is the Chief Executive of the Hardee’s and Carl’s Junior chains. He obtained his JD from Washington University School of Law in St. Louis.	It is rumored that Puzder is most like Trump in personality. I wonder if that includes crotch-grabbing. He is also anti-union. Unlike Trump, he has only been married twice. As Secretary of Labor he could determine which businesses are inspected, audited, or fined.	He is adamantly opposed to minimum wage laws, overtime requirements, and of course, the mandate to provide medical insurance to his workers. His goal is to deliver the least expensive, but profitable unhealthy food to the public, so that we as taxpayers can foot the bill for the diabetic epidemic. Don’t expect Puzder to look out for your job security.

Though not a government agency, this week, Trump created a presidential task force to evaluate the safety of vaccinations, with only one caveat, there were no scientists or doctors included to lead the review. The effectiveness of vaccinations has been proven through many Cochrane published gold-standard studies, by actual scientists. I guess this is the loose style that Trump will deploy in administering our government resources, which has scary implications for national health.

If anyone wishes to harm the U.S.A., the transition chaos created by the Trump Administration certainly makes the nation vulnerable on many fronts. Though America loves to criticize the educated, one would think that even the less enlightened would still be concerned about the safety of their energy supply, their medications, and their food supply.

And this is the healthpolicymaven signing off, wishing you fully informed consent in all our decisions.

The healthpolicymaven is a trademark of Roberta E. Winter and Praevalere Inc. Feel free to share this article with anyone whom you feel may benefit. She is the author of a guidebook to the U.S. healthcare system, which was published in 2013.

https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

References

Donald Trump's Cabinet Is Taking Shape: Here's The Latest List. (2017, January 14). The New York Times. Retrieved from http://www.nytimes.com/interactive/2016/us/politics/donald-trump-administration.html

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[1] Trump Weighs Nontraditional Pick for FDA, Thomas M. Burton, Wall Street Journal, Saturday January 14, 2017

[2] Trump Weighs Nontraditional Pick for FDA, Thomas M. Burton, Wall Street Journal, Saturday January 14, 2017

Barbarians at The Gate-What Consumers Can Expect from The Trump Administration

Now that President-Elect Trump’s opinions and omissions can create harmful consequences, this is your Jumping-Off-the-Cliff guide to staying informed, develop an action plan and mitigate damages from his reign. First, the cliff notes on his cabinet and chief staff members:

What’s at Stake	Nominee	Perspectives	Analysis
Your Health The Secretary of Health and Human Services controls the following agencies: Centers for Medicare and Medicaid, Food and Drug Administration, administers the Affordable Care Act, and grants more money for medical research than any other agency in the world.	Tom Price, Republican from Georgia, He is an orthopedic surgeon, and represents one of the healthcare sectors with expensive medical devices and lucrative profit margins for health systems. Resentful of the 3% medical device tax his industry pays to fund the Affordable Care Act for low-income Americans.	Wants to get rid of Obama Care and replace it with another insurance based payment system. Questions the value of the Centers for Medicare and Medicaid innovation through Demonstration Projects. He wants to reduce the footprint of government policy making in healthcare. Though he wants consumers to shoulder more responsibility for their health care, he questions the value of performance assessment as a component of government funding and oversight by government agencies. CMS’s Accountable Care Organization program has been successful and 31% of 2015 participants received bonuses. There are 400 healthcare systems participating in this program. Would he impinge on medical research by eliminating stem cell research as his predecessor George Bush did?	By defunding CMS, the nation would have no national bully pulpit to pressure healthcare suppliers, drug companies, and insurance companies on cost and accountability. Medicare is the most effective tool we have for making changes in U.S. healthcare with an integrated national platform. Medicare Shared Savings programs saved the CMS 1.6 million in 2015. (David Muhlestein, 2016) Would he repeal the Sunshine Act which requires federal reporting of pharmaceutical industry influence on universities and medical training to avoid conflicts of interest? (American Medical Association, 2016) Would he abolish the successful Accountable Care Organization Program which rewards health-driven clinical outcomes? He will also eliminate birth control under Medicaid plans.
Your Air and Water The Environmental Protection Agency sets standards for air & water quality, extracts fines from offenders, and litigates as required for compliance with federal and state laws.	Scott Pruitt, Republican Attorney General from Oklahoma and former senator, is decidedly not part of the beltway. He will drain the swamp and poison your well.	The EPA was created by the Nixon Administration and is responsible for improvements in air and water quality throughout the nation. Pruitt wants to gut the Clean Water and Clean Air Acts signed by the Obama Administration. Has pledged to dismantle the EPA and is in the back pocket of the oil and gas industry. He has been vociferous in his lawsuits against government regulations. Doesn’t think global warming is an issue. Wants to get out of the Paris Climate Change Accords, which were signed by 95 countries.	Carbon emissions are the greatest contributor to greenhouse gases causing global warming and the melting of the polar ice caps. Obama Administration clean air rules force power plants, especially coal powered ones, to reduce particulate emissions. The act established standards for emissions but allows flexibility for states to administer. States have already submitted plans for reaching targets.
Your Children’s Education  The Department of Education sets national standards for education (No Left Behind and Common Core), provides funding, and enforcement of standards.	Betsy DeVos, former chairwoman of the Michigan Republican Party, is from the Amway family of billionaires and has never attended a public school, nor have her children. She attended Calvin College, a private liberal arts college.   She is the sister of infamous military defense contractor, Eric Prince, founder of private mercenary group, Blackwater.	Wants to deconstruct the agency and give more responsibilities to states, counties, and individual districts to set curriculum. She is a huge supporter of charter schools, which are funded with public funds but operate like private schools. She advocates a school voucher system where the government would essentially provide support for private schools. In Michigan, 80% of the schools are run by private companies. She is does not believe in recognizing homosexuality.	Current Secretary of Education, John King, Jr, says there are a lot of charter schools which are doing poorly and are not taking the steps needed to improve performance. For a vision of what could happen to primary education in the country, look to the healthcare sector where competing private interests often increase costs and work against effective public health improvements.
Your Money The Department of the Treasury, oversees revenue collection through the IRS, and sets standards for currency and financial management for the nation.	Steve Mnunchin, former Goldman Saks executive and Hollywood film financier, is a Wall Street banker insider, who graduated from Yale.	No information is available for his position on the landmark Dodd-Frank Act which created liquidity standards for banks to prevent the financial collapse of the nation and the world. If the U.S. government hadn’t bailed out AIG Insurance, General Motors, Fannie Mae, Freddie Mac, and a host of banks the depression would have been much more severe. (ProPublica.org, 2016)	He is well-educated and more liberal than Trump’s Cabinet picks, but hews from the hedge fund world, which contributed to the 2007 economic collapse of the mortgage banking industry. The question is, will that experience inform better safeguards or is this a fox-in-the-hen-house scenario? Investment banks are chaffing to go back to the Wild West of deal making.
Your Liberty The Attorney General of the United States, oversees the administration of federal laws, court system, and enforcement for anti-trust and civil rights laws.	Jeff Sessions, Attorney General, Republican Senator from Alabama, and former Attorney General of Alabama. He was rejected by the Reagan Administration for a federal judicial appointment because of racist views.	Has a reputation of being anti-immigrant, anti-Muslim, and anti-gay (LBGTQ). One of the most conservative members of Congress often at odds with his own party. Is a supporter of the stop and frisk ethos.  Widely considered to have anti-minority views.	Concerns are; the gerrymandering of redistricting, potential repeal of the voting rights act, enforcement of election laws, and actions against those using their first amendment rights for protest and free assembly.
Your National Parks The Secretary of the Interior oversees the vaunted National Parks system, national forests, and all public lands, including the Bureau of Indian Affairs.	Ryan Zinke is a Republican freshman senator from Whitefish, Montana who is a former navy SEAL commander.	One of his most alarming views is he considers climate change to be unsettled. We don’t know anything about his governance perspectives. However, at least he is not a beltway insider. Montana has many tribal lands, including the Flathead Indian Reservation.	Maybe we could swap Zinke for Perry, because I would rather trust a military officer with protecting our nuclear plants. Concerns are he will use public lands as private sector resources for industry versus preservation.
Your World The Secretary of State is 4th in line to the presidency and is chief negotiator of foreign policy on behalf of the nation, also responsible for coordination and security of diplomatic posts. This person is a foil for the president.	Rex Tillerson, current chief executive of Exxon, is retiring this month. He has lucrative financial interests in countries which are considered enemies, including Russia.	Tillerson has a fifteen-year relationship with Putin, czar of Russia and advocates loosening of economic sanctions. Unlike other Trump nominees, he favors climate change action, including the carbon cap taxes on emissions. He also favors supporting the 2015 Paris Accords for Climate Change Action. He probably would favor the Keystone Pipeline completion.	The far-flung oil and gas interests of Exxon  and his personal wealth would be impacted by actions of the federal government. No one has the potential for more conflicts of interest except Trump. He would have the ability to push back against the dogma from uninformed views of other cabinet nominees, especially on energy and climate issues.
Transportation The Secretary of Transportation oversees highway safety and road construction projects.	Elaine Chao is former head of the Department of Labor and married to Senate Majority leader, Mitch McConnell.	One of Trump’s centerpiece platforms is the rebuilding of America, so Chao will be responsible for contract letting, management, and other infrastructure requirements.	Chao is perhaps the most experienced member of the cabinet, as she ran a large government agency under the Bush Administration.
Keeping the Lights On The Secretary of Energy has oversight of the nation’s nuclear arsenal, also sets policy on utilization of resources to develop and maintain the nation’s energy grid.	Rick Perry, is the former Texas Governor, failed presidential candidate, and middling Dancing with the Stars Contestant.	The only qualification Mr. Perry has for energy expertise, is his support of wind power in his home state. He has no scientific background and has suggested the Department of Energy could be eliminated. The current Secretary of Energy, Ernest Moniz is a nuclear physicist.	Perry wasn’t a strong advocate for Trump so perhaps the president elect is an advocate of recreational pot as there is no other explanation for this appointment.

Next Steps

Now is the time to study the issues for which you are most passionate and draft whitepapers and reach out to your elected officials. I have already reached out to my elected representatives on several points since November 8^th and have also published several opinions in the New York Times. This article is my third posting since the election and my 99^th since I started this column. The election of caustic Trump to one of the most influential positions in the world has not dulled my sense of liberty, but inspired more insights and energy to inform readers about critical resourcing issues. And this is the healthpolicymaven signing off and encouraging you to share this article with all who value their democracy.

Roberta Winter is a freelance journalist who publishes under the trademark healthpolicymaven, which has been in continuous use since 2007. She is a public policy and healthcare book reviewer for the New York Journal of Books, a technical writer, and author. Her consumer guidebook to the U.S. healthcare system was published by Rowman & Littlefield in 2013. https://www.amazon.com/Unraveling-U-S-Health-Care-Personal/dp/1442222972

Other Articles On the Republican Agenda To Jettison the Affordable Care Act
http://healthpolicymaven.blogspot.com/2016/06/republican-plan-to-replace-obamacare.html

http://healthpolicymaven.blogspot.com/2016/01/top-10-things-from-affordable-care-act.html

http://healthpolicymaven.blogspot.com/2015/10/affordable-care-act-program-shows.html

 References:

American Medical Association. (2016, December 16). Physician Financial Transparency Reports (Sunshine Act). Retrieved from American Medical Association : https://www.ama-assn.org/practice-management/physician-financial-transparency-reports-sunshine-act

David Muhlestein, R. S. (2016). Medicare Accountable Care Organization Results for 2015: The Journey Toward Better Quality and Lower Costs Continues. Health Affairs. Retrieved December 16, 2016, from http://healthaffairs.org/blog/2016/09/09/medicare-accountable-care-organization-results-for-2015-the-journey-to-better-quality-and-lower-costs-continues/

ProPublica.org. (2016). Bailout Recipients December 12, 2016. ProPublica.org. Retrieved December 15, 2016, from https://projects.propublica.org/bailout/list