RFK Jr. is 'laying the groundwork for true, transformational change' - David Mansdoerfer

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 Mansorfer 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've 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 push back has he faced and will the administration be able to reconcile or even merge the disperate agendas of the MAGA and MA 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 Ya Kellik David Mansorfer 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 uh 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 and 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 um 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 one of 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 You know a complete reset That's kind of hard to imagine what that looks like Yeah So um when I was there in Trump 1.0 um the agency was about 80,000 folks uh full-time equivalents and 150,000 contractors that supported the mission of the agency Um 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 um 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 uh the poor through the Medicaid system So uh it is the largest um cost driver of the federal government Um I don't know what the exact number is but when I was there 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 um they took divisions that were part of the larger HHS infrastructure So SAMA which is your uh mental health division essentially HERSA which is your um 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 uh 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 disperate resources that weren't talking to each other and putting them 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 um we all hear about Medicare fraud We all hear about the the different uh things that HHS enforces through either civil rights and HIPPA or through Medicare or through you know payment systems and you know 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 those diff specific agencies as opposed to three where it was before Let's use that 1.3 trillion annual budget Can you give me a broad sense of where money goes in that 1.3 trillion yes So the biggest is going to be CMS So the center for Medicaid and Medicare Um that is your payment system essentially for either the Medicaid system which typically goes out to states or the Medicare system which is your um elderly care essentially And so um that's the biggest chunk of it the uh another large chunk is NIH and the grants that it pushes out uh to local organizations and to higher education institutions to study different disease research uh 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 HERSA which is your federally qualified health centers or your local community health center Um that's really um uh 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 um it's a pretty broad agency in terms of the types of things that it funds Um 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 Bodacharia over at NIH We've seen um Dr Oz at CMS And then underneath that you have roughly 180 to 200 political appointees that support the principles in many different ways And what this organization does um of the political appointees is it basically puts folks over specific divisions underneath um SAMA OASH HERSA all of these acronym words that you know don't make sense maybe to the general public but um have integral parts to the health economy system in the United States And so the secretary by reorganizing this has basically level set the career bureaucracy in the agency 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 um 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 longerlasting than just this administration So I mean broadly speaking how is this agenda different from the past agenda so if um folks remember when President Trump first took office in 2017 um 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 Um 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 you know payments We love to talk about hospital rural health and how the economy is impacted by health And right now we have a secretary who cares deeply about public health which is everything from the mRNA vaccine to um 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 we'll be right back You may have noticed it's Shen Yun season again but I wanted to tell you a little bit personally about why I love this show and go see it every year Aside from being beautiful it's actually a homegrown American dream success story All things from traditional China were under attack during the cultural revolution and have kind of really remained that way since and traditional Chinese dance was almost destroyed but parts of it actually survived So what the Shenyun people did is in upstate New York they brought together the people that actually remembered what it was all about and kind of rekindled it put it back together rebirthed it in upstate New York They started with one company in 2006 Today there's eight of them touring the world A million people see it every year I mean just think about that in under 20 years pulling your boots up no government funding and they brought back traditional Chinese dance to the world So the tagline is China before communism which something speaks very deeply to me personally The Chinese Communist Party has been trying to destroy this group you know prevent them from performing all these years And over the last year the New York Times has even been going after Shen Yun using a lot of the same talking points that the Chinese Communist Party has been using And with these increased attacks I particularly feel motivated personally to invite you to see Shen Yun and actually see for yourself what it's all about how amazing it is how inspiring it is So to find out where ShenYun is performing near you check out Showtimes at shenyun.com sen.com You can use the code jan25 to get theater ticketing fees waved Again that's jan25 I can't stress how highly I appreciate this show and how much I think you will love it And we're back with David Mansorfer chief strategist at the Independent Medical Alliance I want to find out a little more about you Like how is it that you came into this role of assistant secretary in the first place what is what does that actually mean what what are the qualifications of such a person because you're not a doctor I was lucky to um be called upon very early in the first administration um 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 Those 280 advisory boards are everything that your listeners might have heard of from the presidential fitness physical fitness council you know the old Arnold Schwarzenegger council to um the it's called Pasha 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 secretaries 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 highlevel 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 uh fentanyl and opioids um to reorganiz reorganizing the department the first time which I had a hand in Um 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 um reorganize the district offices and some of the public health functions the first time and I had the opportunity to really work with highlevel leadership on driving home presidential agendas from things like veteran suicide which was very important in the first administration and I 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 product uh programs within HHS Yes How how is it that you came to be this operations guy uh well I' I've luckily worked for almost every type of government at this point Um I started off uh working for um 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 Morlock where I learned a lot from Um he was then uh promoted to the California State Senate So I had the opportunity to see local government in action and then state government in action And then due to some connections that we had within Senator Morlock's office we all got half of our office got called to DC 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 um how to address operational 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 Um 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 um I actually before Elon took over Twitter um 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 the front doors but a 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 um I think if you did political polling with inside of the agency you'd probably see 80 to 90% 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 8515 uh Democrat to a 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 uh appointees at HHS They um 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 and their thought processes of what needed to be done And so um I don't want to paint a broad brush that the entire agency is um inefficient and ineffective because there are many or 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 theoretically and I recently realized that this the spoils system which is basically what you've been describing here You know I always thought it was sort of just an a side effect of the realities of politics but I only recently discovered that it's actually intentional right i wonder if you could speak on that since you 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 Clinton 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 uh 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 Um to even how you view the healthcare marketplace And so I don't think it's necessarily what the forefounders 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% and then has their own platforms But when you have a 80 to 90% difference in ideology the uh the differences for a presidential agenda are very very stark I'm a big believer in diversity of thought and diversity of opinion and um having the ability uh 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 um Obama it was you know plus 3% Doesn't matter which administration you were 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 Um 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 efficiencies 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 public you know the public employee different than your corporate employee you know 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 reactionoriented We won So why have we not won entirely but at the end of the day Secretary Kennedy is laying and his team are laying the groundwork for true transform 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 h 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 Mansorf it's such a pleasure to have had you on Thank you Thank you all for joining David Mansorfer and me on this episode of American Thought Leaders I'm your host Yana Kell [Music]