There can be no mistake: Donald Trump has just been elected with a mandate for change. In announcing that Robert F. Kennedy Jr. can go wild on health, has targeted healthcare in America as a prime candidate for major change. That mandate may be a force that revitalizes and restructures the US healthcare system, or it could be Camelot on a curve. Here are five areas that can show how RFK Jr. decides between the two:

The Vaccine Question

First, Kennedy, a noted vaccine skeptic, would do a much-needed service by determining and elucidating the risks and efficacies of all vaccines, especially those for Covid-19 and influenza. In a recent post, he stated, “Bottom line: I’m not going to take anyone’s vaccines away from them. I just want to be sure every American knows the safety profile, the risk profile, and the efficacy of each vaccine. That’s it.”

There is no question that vaccines have saved more lives than all other medical treatments combined. However, we are now in a new era of mRNA vaccines, yet most Americans, including many healthcare practitioners, have no comprehensive knowledge of their risks and efficacy. It is well known that these vaccines don’t prevent Covid-19 infection, but they may reduce disease severity in people with healthy immune systems. However, for people without functional immune systems, their benefits are, at best, minimal. A blue-ribbon Government inquiry would be a robust start in answering this question.

Bringing Drug Manufacturing Back To The US

Second, the US must start to onshore its healthcare infrastructure. A prime example is the US need to produce more of its active pharmaceutical ingredients (APIs), the essential components of drugs. Currently, the US produces only 10% of these vital chemicals and relies on imports for the rest. The major suppliers are India (48%) and China (13%), with Italy, Switzerland, the United Kingdom, Belgium, and Germany accounting for the rest. Any geopolitical or environmental disruption in the supply chains would wreak devastation throughout the US healthcare system. Encouraging and facilitating domestic production of APIs would increase public health safety, create jobs, and reduce reliance on outside manufacturers.

Disruptions are not theoretical. The recent devastating floods in North Carolina highlight another weakness in the US healthcare infrastructure that Kennedy must address: the over-reliance on a single, or very few, providers of essential healthcare materials. Hurricane Helene’s floods closed the Baxter International factory, which produces 60% of the nation’s IV solutions. That closure crippled healthcare delivery for a large portion of the country. Fortunately, Canada, China, the United Kingdom, and Ireland provided emergency materials, but hospitals were forced to initially forced to ration supplies.

Reforming HHS

Third, the federal healthcare bureaucracy is an unwieldy, inefficient, wasteful, and often redundant web of agencies. Within these agencies, there is already a Game of Thrones atmosphere in which each is jockeying to protect their independence and funding, but to what end? Even before the election, the pressing demand for a reasonable restructuring of the bureaucratic behemoth was recognized, and one initiative for restructuring the National Institutes of Health (NIH) merits consideration. Restructuring, to eliminate duplication of effort, continuation of failed or failing projects, and cost-inefficient projects while bolstering areas with more significant potential, makes sense. This is the time for increased investment in the all too often neglected areas of diagnostics and therapeutics. There is, however, one proviso: a slash-and-burn approach does not make sense, as exemplified by the heavy-handed recent CDC budget cuts and layoffs, does not make sense.

Patient Information

Fourth, patient participation in their healthcare remains of paramount importance. The single most significant cause of poor health in America is obesity, and it leads to more than just diabetes. GLP-1 drugs have been touted as effective in reducing obesity but at a cost that is yet to be determined. GLP-1 drug’s sole action is to slow digestion. All the other benefits derive from the loss of weight. However, it is not widely known that in some people, GLP-1 usage has led to serious adverse events, and the cost in real dollars is staggering.

With almost daily advances in self-monitoring, individuals can follow their sleep patterns, exercise activities, and vital signs. This lends itself to modification of behavior. In keeping with that benefit, what would happen if every person in the U.S. had access, in addition to the benefits just listed, to an inexpensive Continuous Blood Glucose Monitor system that would deliver a real-time readout of calorie consumption and exercise benefits? Of course, maximizing the benefits of deploying and using monitoring devices will require provider and consumer education. However, such monitoring leads to measurable healthy changes in lifestyle. 74% of US adults are overweight, which is it is one of the most significant factors affecting health. Self-monitoring is a way of raising patient awareness and is a stimulus for behavior modification. Proactive patient involvement in their health is much more effective than the costlier reactive need for disease treatment.

Healthcare Is A Business

Fifth, Kennedy would have his most significant effect on healthcare if he could refocus the money-making business of medicine to its original goal of maintaining and improving health. For-profit takeovers of healthcare facilities may yield impressive returns for investors, but, in some cases, returns significantly accrue only at the cost of poorer patient care and outcomes. The latter is due to cutbacks instituted at some facilities in the name of efficiency and cost containment. Primary Care Physicians and other specialists must see as many as 40 patients daily to meet their performance metrics. The most significant cost for any healthcare facility is staff. While cutting staff does cut costs, it also leads to over-taxation of the remaining staff, burnout, and poorer patient care. A 10% increase in nurses’ intention to quit is linked to a 14% increase in patient mortality. Doctors register similar complaints, and dissatisfaction is one reason for the shortage of primary care physicians. The fact that healthcare is a business does not and should never put profit over health.

On November 5th, the American voters delivered a mandate for change. The new administration is, so far, long on promises and short on details. On the healthcare prescription, RFK Jr. may be just what the doctor ordered to change that.