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Presidents have great leeway in picking their cabinet. If a president’s nominees pass the Senate’s constitutionally mandated “advice and consent” test, they can build a team that shares their ideology and goals.
Still, overseeing a federal government agency is a job that requires some skills, not just a philosophy in common with the president.
That is one reason that so many of President-elect Donald Trump’s nominees are so worrisome. Sure, Trump wants to shink, perhaps even dismantle, parts of the federal government, a goal that appeals to many Americans.
But what does it mean to remake or hobble entire agencies?
Take for example, the U.S. Department of Health and Human Services (HHS). Trump has nominated Robert F. Kennedy Jr. to head the agency. Kennedy, who has been highly critical of vaccines, touted debunked medical treatments and supported removing fluoride (which has been shown to reduce cavities) from public water, has raised alarm bells among many health care professionals, researchers and others.
Beyond his unconventional views on science and some health care treatments, Kennedy should be raising alarm bells for another reason, Bloomberg columnist Tyler Cowen writes.
The economy.
The Department of Health and Human Services is a sprawling agency that includes the Centers for Medicare and Medicaid Services, which sets reimbursement rates for Medicare, the country’s health insurance program for seniors. Medicare accounts for 14 percent of federal spending.
Medicare is also an important source of money for health care institutions, ranging from hospitals to doctors’ offices to hospice care centers in communities across the country. A reduction in the Medicare reimbursement rate could mean these health care providers have to cut costs or raise rates for people with private insurance.
Cutting costs typically means reducing staff, which could worsen the care and treatment of patients, which often leads to higher costs in the long run, not to mention the impacts of subpar care and treatment on patients.
Higher costs for medical care can lead people to put off needed care, which also costs and their care is likely to be more expensive when a condition worsens.
“The danger is that, with RFK Jr. at HHS, the U.S. would restrain health-care spending in exactly the wrong areas,” Cowen wrote in a recent column. “The human costs of such a mistake are obvious, but from a more narrow fiscal perspective, a sicker America would lead to even more serious budgetary problems.”
In addition, reductions in health care staffing driven by lowered federal reimbursements could hurt communities, especially in rural areas where health care providers are often the largest employer.
This illustrates the complexities of the seemingly simple idea of shrinking the federal government. It is not just a bunch of bureaucrats in Washington, although there are a lot of those. The federal government funds and regulates programs and activities in every community. It employs scores of people in every state. Certainly, there are government programs and spending that should be re-examined and some likely can be cut or even eliminated. But we need to understand that the impacts of such changes will likely affect people and communities far from our nation’s capital.
That was a message shared this week by Cara Pelletier, who was recently chosen by the Bangor City Council to again be its chair.
The council’s priorities for the upcoming year, such increasing housing availability in the city, could be affected if Trump and Congress follow through with pledges of cuts to federal spending. For example, programs that receive federal funding, such as Bangor’s public health department and public transportation, could see reductions in support. As a result, the city may have to devote more money to those resources in order to keep them healthy and functioning, Pelletier said.
“I’m going to do my very best to work with my peers in other levels of government to protect and sustain the city of Bangor while I’m in office,” she added.
This is an important reminder that pledges to cut government spending or to fill a cabinet with loyal ideologues may sound good on the campaign trail, but the effects of such decisions will likely affect our communities in far-reaching ways.
