Member Essays & Opinions

& Talking Points

Buyer's Remorse?

(Opinion from Rick Skeen 1/26/25)

Are you upset about Donald Trump's radical (and often unconstitutional and unlawful) executive orders?  Perhaps you didn't think he was serious during his insane campaign rally rants.  Perhaps you didn't think that your civil service job was in jeopardy simply because of a President's whim.  Perhaps you didn't think essential services that you rely on would be eliminated to pay for tax cuts for the wealthy.  Perhaps you didn't expect that unqualified nominees would be appointed as executive branch agency heads that oversee thousands of personnel and have budgets in the billions.  And he's just getting started.

Well, you're welcome to join us in an effort to try to stop (or at least slow down) his agenda and save our country.  We  can't guarantee miracles, but we can guarantee that if you do nothing, most of you will not like the results.  We realize that some of you  don't fully appreciate the gravity of the situation, yet.  However, we'll be here when you do.  

Trump Cabinet Nominees & Confirmation Process

Rick Skeen (12/20/24) - Updated 1/18/25

I recommend that citizens review the qualifications (competency and character) of the proposed Trump Administration nominees, and if they find them as appalling as I do, please contact Senators Britt and Tuberville.  If you decide to write them, there are two approaches.  One is to write a short and polite letter.  This is the traditional method which is more likely to be read.

However, these are not normal times.  I personally believe that we are dealing with a bully (Donald Trump) and a group of GOP politicians who are more concerned about being "primaried" by a MAGA opponent than they are about the American people.  I believe a more assertive posture is necessary.  I have suggested that if Senators back these unqualified candidates, their complicity will make them responsible for any disasters caused by these terrible nominees.  If these nominees pose a risk to our well being, I want the politicians to share that risk, in terms of their political career.

My approach consists of several essays posted below, under my name.  The essays do not necessarily reflect the opinion of the Dale Democratic Party, but the factual information presented is based on reliable news sources.  Where opinions are expressed they are my own.

I have provided detailed descriptions of just a few of the nominees.  Start with these examples - If I see your interest in this information, I may discuss other cabinet nominees.  In the meantime, you can look at Rachael Maddows "Public Servant Announcements" which are video discussions of some of the Trump nominees presented in an entertaining manner.  They can be seen at https://www.youtube.com/playlist?list=PLDIVi-vBsOExll56zG8y58SuDJFLRjHb- This link provides videos for 6 nominees.  I believe she will be adding more in the futures, but I'm not sure that they will be at this specific link.  You may need to search for Maddow and Public Servant Announcements.

For additional background on the nominees, you can also read the article links on our Dale Democratic Party website.  Most of the source material for the essays below came from these articles: https://www.dalecodemocrats.com/home/news-articles-for-voters/trump-admin-appointments

If one wishes to write a letter with a more assertive tone, feel free to use any information in the essays.  However, be more brief and focused than I have been, otherwise your letter will not likely be read.  If you call, you may have more latitude to express your feelings.  You can be assertive, but try not to be aggressive.  Obviously, don't use profane language or threats of physical violence.

Essay on Trump Nominees and the Senate Confirmation Process - 12/20/24

(Rick Skeen)

We call on Senators Tommy Tuberville and Katie Britt to honor their Constitutional responsibility and seriously review the qualifications of Donald Trump's nominees for his cabinet, cabinet-level officials, ambassadors, and any other executive branch positions requiring Senate confirmation. This review should include an evaluation of a nominee's competence and experience relative to the position put forward by the future President. It should also include an evaluation of the nominee's honesty and character along with an evaluation of any potential conflicts of interest that might detract the nominee from his responsibility to primarily serve the American people.

We reject any efforts to circumvent this review and confirmation process by invoking extraordinary measures (such as Congressional recess appointments). We call on nominees to be vetted by the FBI, especially those requiring security clearances, prior to confirmation hearings. This is the standard process that has been used in prior executive branch transitions. We reject any attempts by the Trump transition team to initially substitute its own background checks for those from the FBI, and then require rigorous FBI background checks only after confirmation of the nominee and his/her installment in office.

Why are we making these demands? It is our opinion that many of the nominees put forth by the future Trump Administration lack the qualifications necessary to perform their duties. For many, it's a lack of relevant experience or competence. For some, it's a lack of character or a conflict of interest. For some, it's both a competence and character issue. In fact, some of the proposed administration nominees are so bad, we wonder if they were selected to sabotage the agencies they are slated to head, in an attempt to ultimately destroy them or make them ineffective in performing the job they were established to do. Could this be part of Steve Bannon's goal of “Deconstruction of the Administrative State?”

Many citizens take for granted the roles that executive branch agencies play in their lives by insuring our national security; enforcing federal law; promoting economic activity and opportunity; protecting our natural resources and environment; helping to manage and maintain our national infrastructure; administering federal insurance and public assistance programs; helping to protect our health and safety through science and regulation; and assisting states in providing quality education to all citizens which is fair and equitable. In addition, the State Department conducts diplomacy and foreign relations with other countries, which may not impact most of us directly, but does affect us indirectly through its impact to all other agencies and their responsibilities. Many citizens tend to underestimate the benefits that they receive from these agencies and focus only on the costs associated with them.

When politicians claim that Donald Trump has the “right” to select his own cabinet to advise him, we point out that most of these cabinet nominees will also head agencies that employ thousands and have budgets in the billions (for the Department of Defense – millions of personnel and hundreds of billions in expenditures). For this reason, we feel that the American people have the “right” to expect that nominees have demonstrative executive and administrative qualifications to properly deal with the public resources placed at their disposal. If Donald Trump fails to submit nominees with these requisite skills, it is up to the Senate, as the People's representatives, to reject them and demand better nominees.

If certain politicians claim that Trump has an election “mandate” to do as he wishes, we point out that although he won the popular vote (first Republican popular vote win in 20 years and only second since George H. Bush won in 1988), Trump still received less than half the votes cast in the 2024 election. His win can hardly be considered a mandate from the people for his policies and nominees.

The following attached essays discuss specific qualification problems and shortcomings for certain select nominees. We encourage you to read them closely. The essays are organized by nominee name and the position they are expected to hold. The list is by no means comprehensive. It reflects the focus of the news media, from which we draw our information. Assuming that public Senate confirmations will be held, we will continually monitor and reevaluate nominees as to their qualifications.

In addition to addressing specific nominees, we would also like to make some general observations about the nominees selected. First, an unusual number of nominees have a background in television media, not only on Fox news (Pete Hegseth - Secretary of Defense; Sean Duffy - Secretary of Transportation; Mike Huckabee - Ambassador to Israel; Kimberly Guilfoyle - Ambassador to Greece; Tulsi Gabbard - Director of National Intelligence; Sebastian Gorka - counter-terrorism chief; Tom Homan - “border czar”; Dr. Janette Nesheiwat - Surgeon General), but also Mehmet Oz – Administrator for Medicare and Medicaid Services (Dr. Oz Show) and Linda McMahon (World Wrestling Entertainment - WWE). Sean Duffy, in addition to his Fox TV show, appeared on several MTV programs (Real World) and ESPN in the 1990s/2000s. While some of these nominees may have the relevant experience and competence to perform their proposed role, we fear that some may have been chosen primarily for their media image, appearance, and popularity. Government is not “reality TV.” As you review these nominees, please keep this fact in mind.

Secondly, we notice the large number of billionaires on the list of nominees. Billionaire nominees requiring Senate confirmation include Wall Street CEO Howard Lutnick - Secretary of Commerce; hedge fund manager Scott Bessent - Treasury Secretary; former Small Business Administration head and wrestling entertainment entrepreneur Linda McMahon - Secretary of Education; North Dakota governor and software & venture capital entrepreneur Doug Burgum - Interior Secretary; payment processing and aviation entrepreneur Jared Isaacman - NASA Administrator; real estate tycoon Steven Witkoff - special Middle East envoy; investment banker Warren Stephens – Ambassador to the United Kingdom.

In addition to the billionaires requiring Senate confirmation, we also note that billionaire Vivek Ramaswamy and billionaire Elon Musk, the richest man in the world, have had a special Department of Government Efficiency (DOGE – an acronym corresponding to Musk's favorite cryptocurrency) created especially for them. According to Donald Trump, the two “will pave the way for my Administration to dismantle Government Bureaucracy, slash excess regulations, cut wasteful expenditures, and restructure Federal Agencies." Musk added “This will send shockwaves through the system.” Despite the threatened shockwaves, Trump has apparently said the new department will not be officially part of the government and, therefore, the necessity of any Congressional approval process is unclear. We wonder if this unofficial super lobby will have to follow the same rules and laws imposed on other lobbyists.

We see that proposed billionaire Treasury Secretary Scott Bessent and proposed billionaire Commerce Secretary Howard Lutnick are both strong tariff proponents, despite the fact that the vast majority of economists argue against tariffs, saying that they cause higher prices and inflation, reduce competition and domestic innovation, and potentially result in retaliatory tariffs impacting our exports. However, from a billionaire's perspective, one might see that a tariff (acting like a sales tax) is a regressive form of taxation that primary impacts poorer and middle class consumers. The revenue generated by tariffs could help offset cuts to more progressive forms of taxation such as the income tax and the capital gains tax, a situation which would definitely benefit the wealthy. Since tariffs can be targeted against certain countries or industries, they allow Donald Trump to reward his benefactors, penalize any opposition, and help consolidate his personal power. Although we are no fan of Communist China, we note that Elon Musk's Tesla would benefit greatly from heavy tariffs on less expensive Chinese manufactured electric vehicles. We also observe Musk's plans to cut government expenditures by reducing regulations, many of which protect average citizens against any indifferent, callous, or cruel actions taken by the wealthy and their corporations. In some ways, cutting necessary regulations can be thought of as “defunding the police” in terms of any white collar or corporate corruption.

For many of these nominees, loyalty and subservience to Donald Trump and his MAGA philosophy appear to be their only qualifications. Several nominees appear focused on exacting the retribution promised during Trump's campaign, even at the expense of ethical, legal and constitutional considerations. During Trump's first administration, especially at its beginning, there were more experienced and traditional administration officials that could counsel the President against his more radical and dangerous impulses. Donald Trump and his transition team have worked hard to eliminate this type of counsel in his second term.

By now, we realize that the content and tone of this essay will probably have upset many readers, especially in Republican dominated Alabama. At this time, it may be easily to dismiss our comments as simply fear mongering and partisan. We believe that many Trump voters when they entered the polls thought that his more outrageous rally statements and promises were merely campaign rhetoric. With Trump's choice of his Administration nominees, however, it is now becoming clear that he was deadly serious. This fact is starting to give some of his voters pause. If Trump's proposed nominees take over government agencies and implement Trump's radical agenda, we are confident that citizens will soon feel the adverse consequences of that agenda and, with our help, will eventually focus their righteous indignation on those executing that agenda and on those who were complicit in its implementation.

We realize the intense political pressure placed on Republican Senators to see that these Trump Administration nominees are put in place. We are aware of the threats from the Trump transition team and various right-wing groups to fund party primary election challenges against any Republican Senators who dare to disapprove any Trump nominee. We sincerely hope that Senators will ignore these attempted extortion attempts, evaluate the obvious shortcomings of some of these nominees, and then do their duty and reject them.

However, for those who are planning to base their confirmation votes upon short term political calculations and considerations (or even worse, attempt to circumvent the confirmation process), please consider this. We will continually monitor the actions of the new Trump Administration, the role of the Republican controlled Congress in supporting these actions, and the resulting adverse impacts to citizens. We will be speaking to our neighbors and coworkers and placing blame where it is due. We will be documenting the facts and writing editorials and opinion pieces. We will be reminding those in agriculture, a critical component of Alabama's economy, about the impact of tariffs to global exports of farm products and about potential labor shortages to farms and poultry processing plants if immigrants are deported. We will be speaking to our local and state representatives (mostly GOP in Alabama) and asking them pointed questions about their plans to fund the additional government responsibilities passed down to the states, as the federal government downsizes, especially without the numerous federal grants Alabama currently relies on to provide needed services and infrastructure. (Please note that Alabama currently receives much more in federal benefits than it pays in federal taxes.)

We sincerely hope that we are wrong about the damage to our country that will occur if Donald Trump and these proposed administration officials take over the executive branch. If we are wrong, there probably will be little political repercussions to Alabama elected federal officials. But please take a close look at some of these nominees, and determine if their confirmation poses a risk to our institutions, to our citizens' personal and economic well-being, to Republican political careers, and to the future of the Republican Party. There will be accountability for your choices and actions.

Peter Hegseth (Secretary of Defense) – 12/28/24

(Rick Skeen)

The Department of Defense (DoD) consists of 16 different departments, agencies, services, etc. with diverse responsibilities. In addition to the Army, Navy, Marines, Air Force and Space Force, it includes 3 intelligence agencies (Defense Intelligence Agency - DIA, National Security Agency/Central Security Service - NSA/CSS and National Geospatial-Intelligence Agency). Other agency responsibilities include defense logistics, defense acquisition and contract auditing, communication and information processing, the management of weapons of mass destruction, the corps of engineers, etc. It is responsible for 1.3 million active duty personnel, 825,000 reserve and national guard personnel, and 600,000 civilian personnel. It has an annual budget in excess of $800 billion.

Does any reasonable person believe that a former national guard infantry major, with little executive and administrative experience other than the alleged mismanagement of a couple of small non-profit political advocacy organizations, can effectively run the sprawling institution that is the Department of Defense?

Some may argue that billionaire Stephen Feinberg, Trump's nominee for deputy defense secretary, has the necessary executive background and management skills to compensate for Hegseth shortcomings. But if Hegseth is inadequate as an executive, is Feinberg meant to be the “shadow” DoD Secretary?

In addition to the managerial requirements, the Secretary of Defense also has a diplomatic role, interfacing with defense ministers, foreign ministers, and sometimes prime ministers of allied nations to coordinate military strategy, coordinate military cooperation, help negotiate mutual security agreements, help negotiate foreign basing of US forces, etc. The Defense Secretary must also deal credibly and diplomatically with the U.S. President, the National Security Council, the Joint Chiefs of Staff, and other senior military leaders. As will be shown, Pete Hegseth has serious shortcomings in these areas also.

Pete Hegseth has little or no foreign policy or national security experience. In several books and in public statements, he has disparaged the United Nations, our NATO allies (Turkey in particular because he labels it “Islamic”), the UN peacekeeping force sent to Afghanistan, etc. He has advocated that the Department of Defense be renamed as the “War Department”, suggesting a very aggressive posture that undermines previous U.S. policy of “peace through strength.” He has closely aligned his military objectives to the priorities of Israel, calling for the U.S. to conduct a “crusade” against Israel's enemies. Hegseth has spoken out against U.S. compliance with the Geneva Convention and other international laws concerning the conduct of warfare. He has advocated pardoning military personnel convicted of war crimes. He is quoted as saying, “Who cares what other countries think.” It is alleged that while drunk at a public bar, Hegseth yelled out several times, “Kill all Muslims.” One might wonder how these statements might impact his ability to negotiate cooperation with Arab allies in the Middle East.

With regard to credibility, Hegseth has claimed that the January 6th attack on the capitol was carried out by Antifa members disguised as Trump supporters. He claimed that Trump supporters at the capitol were peaceful and were unaware of the illegal entry into the capitol building. He has also publicly supported Trump's 2020 claims of voter fraud, despite there being no evidence to support that claim. That being said, Hegseth has suggested that domestic use of military troops to quell riots would be alright. One wonders if troop use would be dependent upon the political perspective of those in the streets.

Hegseth has stated that senior military leadership must be purged of “woke” generals and admirals that support diversity, equity and inclusion (DEI), including General Charles Q. Brown Jr., the chairman of the Joint Chiefs of Staff and an Afro-American. In response to a question about Hegseth, Republican Chuck Hagel, a former Secretary of Defense, cautioned against politicizing the military, suggesting that unjustified firing of senior leadership will damage unit cohesiveness, causing other officers and senior enlisted personnel to resign. Hagel warns that firings and resignations would seriously weaken the military and damage our national security.

Hegseth has very recently called women “some of our greatest warriors” and claimed that earlier statements regarding women in the military were “misconstrued.” However, on November 7th 2024 he stated, “I’m straight up saying we should not have women in combat roles.” While some (not all) women might not have the physical strength to fulfill certain infantry combat roles, Hegseth's limited perspective keeps him from considering the fact that women currently pilot combat planes & helicopters, operate radar & sonar consoles in shipboard combat information centers, are deployed on forward operating bases in hostile environments, and successfully perform many other non-infantry combat roles.

In addition to competence, character is an important aspect of military leadership. Hegseth has a lengthy history of excessive drinking and womanizing. Hegseth has admitted that during his first marriage he had five affairs, and this marriage coincided with the period of his National Guard service. Fortunately for Pete Hegseth, his adulteries were either unnoticed by the military or were considered insufficient to meet the criteria of adversely impacting discipline, good order, or the military's reputation. Otherwise, he could have possibly been court-martialed, with a maximum punishment of dishonorable discharge and one year of confinement.

In 2017, Hegseth was accused of sexual assault by an attendee of a convention of Republican women in Monterey California, where he spoke. Hegseth claimed the sex was consensual. The Monterey County District Attorney declined to prosecute because there was insufficient evidence to support “proof beyond a reasonable doubt.” However, despite what he claims, Hegseth was not completely exonerated. Hegseth and the alleged victim signed a confidentiality settlement, and Hegseth paid the woman an undisclosed amount, which his lawyer characterized as “civil extortion”. Hegseth's lawyer said the payment was made to prevent a lawsuit that might have hurt Hegseth's Fox News career. The public will probably never know for sure what happened in that Monterey hotel room. However, even if Pete Hegseth did not sexually assault that woman, he, at the very least, put himself in a position to be “extorted.” If he was willing to make a payment to save his career, can we trust him to protect America's secrets and its interests if he is blackmailed after another unsavory and embarrassing situation? For most military and DoD personnel, questionable judgment involving personal conduct is a major reason for security clearance denial.

The Secretary of Defense is on call 24 hours a day, seven days a week, so as to be available to respond immediately to attacks on (or threats to) American armed forces, American citizens, American allies, American assets, or other American vital interests. Crises are often international in nature, but could also include attacks to the Homeland, such as a 9-11 type terrorist attack. The Secretary of Defense must remain clear headed at all times and cannot be drunk or hungover when a crisis occurs. If history is any indication, this fact may pose a problem for Pete Hegseth.

Hegseth's coworkers at Fox News and two nonprofit advocacy organizations he worked for say that he had a serious drinking problem. A so-called “whistleblower report,” created years before Hegseth's nomination, states that Hegseth was repeatedly drunk at the nonprofit organization's events and sometimes had to be carried out of them. The same report states that Hegseth became so drunk at a Louisiana strip club he had to be restrained by his coworkers from jumping on stage with the strippers. Although Hegseth says that the “whistleblower report” was simply an email from a disgruntled former employee of the nonprofit, multiple staffers at Fox News were also concerned about his drinking. These staffers claimed that they often smelled alcohol on Hegseth as he prepared for his Saturday early morning “Fox and Friends Weekend” show. On several occasions Hegseth complained of being hung over prior to airtime, and staffers felt they had to “babysit” him to make sure he made it to the show Saturday morning. “We’d have to call him to make sure he didn’t oversleep because we knew he’d be out partying the night before,” one stated. Two Fox News coworkers recall Hegseth drinking all the beers used in a St. Patrick's Day television display at approximately 10 AM, after his Fox & Friends show ended. By that time, the beers were warm and flat, but Hegseth drank them anyway. In the opinion of one former Fox employee, “He should not be secretary of defense. His drinking should be disqualifying.”

Hegseth is now proclaiming that he is a changed man, and he is promising that he will not drink during his tenure as Secretary of Defense. However, a Fox colleague said that they smelled alcohol on him recently and stated that he was complaining about being hung over before a show this autumn. While not commenting on recent drinking allegations, Hegseth's lawyer attributes earlier drinking problems to the stress resulting from his combat experience in Afghanistan, with that stress being reduced over time. While one can be sympathetic, one can also imagine that the stress of managing the DoD and dealing with major international crises would be even greater. One might doubt Hegseth's ability to stay sober.

Tulsi Gabbard (Director of National Intelligence) – 01/01/25

(Rick Skeen)

The Office of the Director of National Intelligence (ODNI) oversees the United States intelligence community (IC) and its 18 different agencies dispersed throughout the executive branch, directing and coordinating the collection and analysis of intelligence; briefing the President, the National Security Council, and the Homeland Security Council; and establishing the policies for sharing intelligence with foreign intelligence agencies. The Director of National Intelligence (DNI) is a senior cabinet-level position and the DNI attends all cabinet meetings, interfacing with other cabinet members as required. ODNI assembles the President's Daily Brief which integrates, prioritizes, and summarizes intelligence from the entire intelligence community and trusted foreign sources into a format that can be easily digested by the President each morning. Whereas other IC agencies can compartmentalize sensitive information on a need-to-know basis, most, if not all, important intelligence product passes through the DNI on its way to the President. For this reason, the DNI usually has a prior background with an intelligence agency or has experience with intelligence community oversight. The DNI has historically been subjected to the most rigorous background investigation, even that surpassing investigation associated with normal Top Secret clearances.

ODNI has five critical mission centers, which gather and analyze intelligence associated with the following threats:

• National Counterproliferation & Biosecurity Center (spread & use of weapons of mass destruction);
  

• National Counterterrorism Center (terrorism);
  

• National Counterintelligence and Security Center (foreign intelligence efforts against the U.S.);
  

• Cyber Threat Intelligence Integration Center (malware, software and network vulnerabilities, other cyber vulnerabilities, and the actors attacking our cyber infrastructure and exploiting any vulnerabilities);
  

• Foreign Malign Influence Center (foreign sponsored propaganda and media influence designed to falsely malign and damage the United States, its leaders, and its democratic processes - including fair elections)
  
  

Tulsi Gabbard has no formal intelligence experience and has shown a tendency to accept and repeat disinformation and positions advanced by our adversaries, especially Russia. This is ironic, since ODNI's Foreign Malign Influence Center is specifically tasked to combat foreign disinformation targeting our citizens. Gabbard has little or no administrative experience or foreign policy experience. There are serious questions about whether Ms. Gabbard can delivery accurate, honest, and unbiased intelligence to the President and other national policy makers. Some members of Congress (of both parties) and former national security officials have even questioned her loyalty or suggested that she may be “compromised.” These concerns could extend to allied foreign intelligence agencies, which may be unwilling to share intelligence with us in the future for fear that their “sources and methods” of intelligence gathering may be jeopardized.

Gabbard has publicly defended Russia's invasion of Ukraine and blamed NATO, citing what she calls Russia's “legitimate security concerns” about Ukraine possibly joining NATO. She has harshly and publicly criticized Western economic sanctions imposed against Russia after its Ukrainian invasion, claiming that the Biden Administration was trying to starve the Russian people. She has publicly repeated false Russian claims that the United States is financially supporting a biological weapons lab in Ukraine and that the U.S. worked with Ukraine to sabotage an important gas pipeline between Russia and Germany. Her comments were often repeated on Russian and Chinese television for propaganda purposes. In various Russian news media, Gabbard has been referred to as “our girlfriend,” “comrade,” and “an agent of the Russian state.” Russian media has applauded her nomination for Director of National Intelligence.

Russia is not the only American adversary that Tulsi Gabbard has supported. As a member of Congress, Gabbard often expressed pro-Syrian sentiment that was in conflict with our stated Middle East foreign policy. She claimed that Bashar al-Assad, the brutal Syrian dictator and Putin ally who had a history of murdering and decimating his own people, was not our enemy. (Assad was recently overthrown in late 2024.) Despite ample evidence, Gabbard expressed doubt that Assad had used internationally outlawed chemical weapons in attacks against Syrian rebels. In 2017, Gabbard traveled to Lebanon and Syria on a trip funded by an Arab American organization and met with Assad twice. Prior to her trip, Gabbard's itinerary reported to the House Ethics Committee made no mention of any plans to meet Assad, and she notified Congress only later, after her return.

Tulsi Gabbard has also disagreed with economic sanctions against Iran and with the U.S policy of classifying certain Iranian military and Revolutionary Guard members as terrorists. She claimed that a Trump Administration drone attack against an Iranian Revolutionary Guard leader was unconstitutional. Earlier, she spoke out against Obama Administration airstrikes targeting ISIS (Islamic State) positions in Syria.

While in Congress, Gabbard advocated for the repeal of Section 702 of the Foreign Intelligence Surveillance Act which, although controversial, is estimated by some experts to be the source of 60% of the President's daily intelligence briefing. (She now says she has changed her mind on Section 702 of FISA.)  Also, Gabbard introduced several bills, including “The Protect Whistleblowers Act,” that would have legally protected those who leak classified material to the media, including former NSA employee Edward Snowden and WikiLeaks publisher Julian Assange. These two individuals were deemed to have seriously damaged U.S. national security by leaking and publishing highly classified information. Snowden currently resides in Russia, having evaded U.S. authorities.

Two national security advisors from Trump's first administration have spoken out against Tulsi Gabbard's nomination. John Bolton called her the “worst cabinet-level appointment in history”, and in another interview reportedly said, “The worst and most dangerous nominee at this point is Tulsi Gabbard for DNI, and I think that her views are not simply extreme; they’re really very dangerous and would have significant negative effect on confident [sic] other countries have in us to share intelligence with us and work cooperatively on a range of things.” Trump national security advisor General H.R. McMaster also expressed serious reservations. Former U.N. ambassador and Republican presidential candidate Nikki Haley has stated, “DNI, Department of National Intelligence. This is not a place for a Russian, Iranian, Syrian, Chinese sympathizer.” Almost 100 former national security officials jointly signed a letter that criticized Gabbard's nomination and also requested a closed-door Senate hearing to evaluate any information the government has about her.

Some have tried to explain Tulsi Gabbard's attitudes, actions, and statements. Some believe that she is a Russian asset and is colluding with our enemies. Some believe that she is simply naive about the intentions of our foreign adversaries, and, as a result, really believes that the U.S. is too aggressive in our defensive and intelligence posture. Some believe that she is an opportunist, imitating Donald Trump's contempt and distrust for the intelligence community to gain favor with him. Some even believe that she may have been inappropriately influenced by a Hare Krishna inspired guru and cult that she and her family were exposed to during her youth in Hawaii.

Several of Gabbard's former Congressional aides believe that the answer lies in the unreliable media that she consumed. She often relied on internet blogs for her news and she was an avid follower of Russia Today (RT), the Russian owned media outlet that is known for being a distributor of propaganda and disinformation. Like CNN and other media, Russia Today has a website in addition to its television network. According to Gabbard's aides, she frequently read and shared RT articles despite being warned that it was unreliable as a source of information. In fact, the U.S. State Department claims that, “We now know that RT moved beyond being simply a media outlet and has been an entity with cyber capabilities. It is also engaged in information operations, covert influence, and military procurement.” Just recently, two RT employees were indicted for allegedly paying $10 million to U.S. right-wing social media influencers to “disseminate content deemed favorable to the Russian government.”

The public may never know exactly what motivates Tulsi Gabbard's bizarre behavior. However, before she is ever confirmed for the DNI role, someone in our government needs to understand it and, somehow, justify it. That responsibility falls on the U.S. Senate, via its confirmation process. The public is generally unaware of any security clearances that Gabbard may have held during her prior National Guard service or Congressional tenure and whether any clearances have ever been updated. However, given her lack of intelligence community experience, it is doubtful that any prior background checks meet the extensive background investigation criteria necessary for the DNI position. Unfortunately, Donald Trump and his presidential transition team have not mandated any FBI background checks for his cabinet nominees. It is unclear whether the Senate (or possibly the intelligence community) will require a rigorous FBI background check of Gabbard before the Senate confirmation hearings.

One final note: Alabama Senator Tommy Tuberville has advocated that Congress adjourn so that Trump can bypass the normal Senate hearing and confirmation process and install his cabinet nominees via a recess appointment.

Robert F. Kennedy Jr. (Secretary - Department of Health and Human Services) - 01/07/25

(Rick Skeen)

According to its website, “The mission of the U.S. Department of Health and Human Services (HHS) is to enhance the health and well-being of all Americans, by providing for effective health and human services and by fostering sound, sustained advances in the sciences underlying medicine, public health, and social services.”

Under HHS, Public Health Service agencies include the Centers for Disease Control and Prevention (CDC); National Institutes of Health (NIH); Food and Drug Administration (FDA); Indian Health Service (IHS); Substance Abuse and Mental Health Services Administration (SAMHSA); Health Resources and Services Administration (HRSA); Agency for Healthcare Research and Quality (AHRQ); Advanced Research Projects Agency for Health (ARPA-H); and Administration for Strategic Preparedness and Response (ASPR). In addition, Human Service agencies include the Administration for Children and Families (ACF); the Administration for Community Living (ACL); and the Centers for Medicare and Medicaid Services (CMS). In fiscal 2024 HHS spent approximately $1.7 trillion, with CMS accounting for nearly $1.5 trillion and the remaining $200+ billion allocated to the various other HHS agencies and HHS administration. HHS has more than 80,000 employees.

Although a thorough description of HHS authority is beyond the scope of this paper, a quick review of the subordinate agency names illustrates the immense breadth of its responsibilities. When one includes expenditures by CMS, spending by HHS is the largest of any federal department, dwarfing even that of the Defense Department.

The ideal nominee to head HHS would have a background in public administration, science, medicine, social sciences, economics, and education. The ideal candidate would be able to understand all aspects of health care and social service policy; would be able to collect applicable data and information; would be able to objectively and impartially evaluate the available evidence; and would then be able to render and communicate policy judgment that was credible and understandable by the American people. While the perfect nominee probably doesn't exist, RFK Jr. has none of the requisite experience. His background as a civil plaintiff attorney makes him an advocate rather than an objective judge. Advocacy for a client or a cause may be appropriate for a lawyer in a courtroom. However, advocates tend to exaggerate evidence supporting their cause, while ignoring or disparaging evidence that supports other perspectives. When scientific or logical arguments are unavailable to support their case, legal advocates may rely on irrational or emotional appeals to sway a jury or a judge. The nominee to head the HHS must objectively seek the truth, rather than seeking a favorable verdict for his cause or client.

To illustrate the danger of Kennedy's advocacy and lack of scientific experience, please consider his erroneous declarations about vaccines. He has repeatedly claimed that vaccines are associated with autism, despite many scientific medical studies that have disproved and discredited this theory. Kennedy tends to ignore the historic role of vaccines in nearly eradicating many infectious diseases, including polio, small pox, diphtheria, mumps, measles, and rubella. With regard to the Covid-19 vaccine (which researchers estimate saved over 3 million people in the U.S.), Kennedy called the shots “a crime against humanity.” RFK Jr. also has founded an anti-vaccination (anti-vaxx) non-profit organization, Children’s Health Defense, which makes emotional appeals to parents of autistic children to support litigation against vaccine manufacturers and against state and local governments that mandate vaccinations of school aged children. Certain social media sites, such as Facebook and Instagram, have banned anti-vaxx posts from this organization for posting false medical information. When speaking at anti-vaxx conferences, such as AutismOne, RFK Jr. has made wild accusations of unscrupulous conspiracies and other extreme and unsubstantiated allegations, referring to the CDC as a “cesspool of corruption” and likening vaccine mandates to the fascism of Nazi Germany. He has made unsubstantiated claims that the CDC was covering-up the hurting of children, and his exaggerated rhetoric has included comparisons to “Nazi Death camps.” In one AutismOne speech, Kennedy made the following statement about vaccine scientists: “Is it hyperbole when I say these people should be in jail? They should be in jail and the key should be thrown away.”

In addition to conspiracy theories about the CDC and vaccine misinformation, RFK Jr. has theorized, without foundation, that pesticides may lead to gender confusion and sexual identification problems in children. He has stated that AIDS is not caused by HIV. He has stated that antidepressants lead to school shootings. He has claimed that electromagnetic radiation from cell phones can cause cancer. (The FDA states there is no evidence of that claim given the signal levels allowed by the FCC.) He has spoken out against tap water fluoridation, which, for over 75 years, has been proven to be safe (at the levels allowed by the FDA) and proven to be an effective method for reducing tooth decay. Kennedy has promoted the drinking of raw, unpasteurized, milk, despite the risk of food poisoning and the risk of contracting bird flue. (The H5N1 bird flue has infected many cattle herds, has begun to spread to people, and is feared by some to be the next pandemic. The virus was recently detected in unpasteurized milk from a California dairy.) While not promoting heroin use, RFK Jr. has claimed that his prior use of heroin helped with an attention deficit disorder and helped him improve his grades. At the same time, he disparaged the use of more traditional ADHD drugs like Aderall.

The scientific and medical community worries about the dangers of this type of misinformation propagating through our country. If RFK Jr. takes over HHS, his new position will give additional credibility to his more wild, unsubstantiated, and dangerous theories. At the expense of public health, state legislators are bowing to political pressure from misinformed parents who cite parental rights, and they are already introducing bills to reduce or eliminate school vaccination requirements. RFK Jr.'s anti-vaxx rhetoric will only make this trend worse. Vaccination rates of school age children have been dropping in recent years, leading to more than four times the number of U.S. measles cases in 2024 than in the same period in 2023. Whooping cough is also on the rise. Measles is highly contagious, with one sick person able to infect more than a dozen others. Using historical data, the CDC estimates that approximately 20-25% of measles cases will require hospitalization, and it estimates that one death will occur with every 1000 cases. In recent years, the large Somali community in Minnesota has seen several measles outbreaks, after anti-vaxx activists targeted it to successfully discourage vaccinations.

In July 2018, two nurses in Samoa incorrectly prepared MMR (measles, mumps, rubella) vaccine doses and accidentally killed two one-year-old Samoan children. Local anti-vaxx activists blamed the vaccine itself, rather than it's incorrect mixing, and Samoans lost faith in the MMR shot. The Samoan government halted their vaccination program for 10 months, and vaccination rates for newly born children reportedly fell to 31%. As measles cases began increasing, in the summer of 2019 RFK Jr. traveled to Samoa, spoke to the Samoan prime minister, and encouraged local anti-vaxx activists as they continued to blame the MMR vaccine and other factors for the resulting measles induced deaths. On social media, Kennedy spoke out against vaccinations and, thereby, exacerbated the problem. By October 2019, the small island nation had a large scale measles outbreak that lasted four months until vaccination renewal and herd immunity ended it. The outbreak was so severe that the Samoan government had to declare a state of emergency in mid-November 2019, closing schools and requiring MMR vaccinations.

The scientific and medical community is not only concerned about RFK Jr. It's also concerned about other Trump and Kennedy selections for HHS. Trump's nominee to head the CDC (under HHS) is former GOP congressman Dave Weldon, who, like Kennedy, has accused the CDC of cover-ups of the supposed vaccination-autism connection. After his Congressional tenure, Weldon appeared in a couple of anti-vaxx films, including the infamous “Vaxxed,” produced and directed by disgraced research fraudster and former British doctor Andrew Wakefield. Mehmet Oz, Trump's nominee to head CMS (Medicare/Medicaid) is another worrisome candidate under Kennedy's HHS, but Dr. Oz and CMS will be discussed in a separate report. A close Kennedy ally, fellow lawyer Aaron Siri, has reportedly been helping RFK Jr. assess candidates for health positions at HHS. In 2022, Siri petitioned the FDA to rescind its approval of the polio vaccine, a vaccine against an infectious disease that once killed and paralyzed thousands during outbreaks in America. As a lawyer acting on behalf of others, Siri has also submitted numerous other petitions asking that certain vaccine distributions be stopped, including distribution of the hepatitis B vaccine.

Siri's involvement illustrates other concerns. Without ever meeting the existing National Institutes of Health (NIH) staff, Kennedy has pledged to replace 600 of them on his first day as HHS head. Is lawyer Siri selecting the replacements? As HHS head, Kennedy could perhaps intervene in resolution of Siri's petitions to the FDA regarding vaccine approval and distribution. Through appointments to committees and panels that make recommendations on immunization practice, RFK Jr. could stifle the development of new vaccines, stop government payment for many free vaccinations to children, and reduce the number of vaccines that insurance companies are currently required to provide as part of coverage. He could curtail Department of Justice legal support to protect current vaccine laws and regulations when anti-vaxx groups, like the one Kennedy founded, sue to overturn them.

RFK Jr. has recently stated “we're not going to take vaccines away from anybody." In public, he claims that he only wants to gather and review vaccine safety data and then present the results to citizens so they can decide themselves whether or not to be vaccinated. However, in a more private conversation with Howard Lutnick (the Trump transition co-chair) Kennedy supposedly had preconceived notions about what the safety data would show and what his subsequent actions would be. According to Luddick, “He says, if you give me the data, all I want is the data and I’ll take on the data and show that it’s not safe. And then if you pull the product liability, the companies will yank these vaccines right off of the market. So that’s his point.” Since Kennedy has yet to see any vaccine safety data, this hardly sounds like an unbiased safety review and an opportunity for Americans to make their own decision.

Although not referring to Kennedy directly, Republican Senator Mitch McConnell, whose left leg was partially paralyzed by polio when he was aged 2, stated, “Efforts to undermine public confidence in proven cures are not just uninformed – they're dangerous.” Senator Chris Murphy, who sits on a health related Senate committee, has said he doesn't want HHS to be headed by a “denier of science.” Former NYC mayor Michael Bloomberg, at the Bloomberg American Health Summit, claimed that placing Kennedy in charge of HHS would constitute “medical malpractice on a mass scale” and be “beyond dangerous.” Even Caroline Kennedy, RFK Jr.'s cousin, has labeled his views “dangerous.” Scott Gottlieb, an FDA commissioner in Trump's first administration, is quoted as saying, “If RFK follows through on his intentions - and I believe he will, and I believe he can - it will cost lives in this country.”

The current American health system is far from perfect. It is expensive and generally tends to focus on treating symptoms rather than preventing and curing diseases, many of them chronic. RFK Jr. has stated that he wants to refocus HHS away from vaccines and concentrate on preventing and curing chronic diseases. Ironically, vaccines have been a huge success in preventing infectious diseases. However, Kennedy may be correct in the need to address the prevention and cure of chronic diseases, such as heart disease, cancer, diabetes, obesity, hypertension, stroke, arthritis, depression, etc. The causes of these diseases are varied, but most can be generally attributed to one or more of the following: environment, diet, lifestyle choices (exercise, smoking, substance abuse, etc.) and hereditary factors. Kennedy is correct in complaining about the amount of processed food and food additives that Americans consume. He is correct in encouraging Americans to eat healthier, exercise, lose weight, and live a healthier lifestyle. He has questioned the use of agricultural pesticides and genetically modified food, although adverse health impacts resulting from proper pesticide use and genetically modified food are unproven.

With regard to these issues, RFK Jr. has lofty goals, but can he achieve them? There are powerful interests (pharmaceutical, agricultural, food processing, medical – AMA, insurance, chemical, etc.) that prefer the status quo. Recent political trends compound these problems. Kennedy may question pesticide and chemical use, but Republicans have called for relaxed environmental regulations. He may argue against food additives and processed foods, but they tend to increase shelf life, ease food distribution, and lower consumer costs. Food prices are expected to rise if Trump enacts tariffs on imported fruits and vegetables and if he deports immigrants who pick those grown domestically. Fresh fruits and vegetables may be more nutritional, but not if the average American can't afford them.

To somehow convince the American public to eat better and live a healthier lifestyle is a monumental task that would require a massive public relations effort, with appeals not only to the public's intellect (brain) but also emotional appeals which can be more effective. The necessary effort would be long term, so as to counter decades of advertising and imagery designed to encourage us to consume sugary cereals, fatty fast food, salty snacks, and sodas or cold beers to wash them down. Americans may have to be reconditioned, not just encouraged, to get off the couch and be sports participants rather than just sports spectators and wagerers. The public may need to rethink how it values common physical labor saving devices, like riding lawn mowers, leaf blowers, and robotic vacuums.

While Kennedy's proposals are noble, are they practical? To a limited degree, HHS already promotes a healthy diet, encourages exercise, discourages substance abuse, and suggests medical screening to identify hereditary risks. Efforts in states to go further, through regulation and taxation of unhealthy food or sodas, have been ridiculed by right-wing media as “woke.” Anyone suggesting a complete redirection of public health policy and emphasis would have to justify the economic costs, both transitional and recurring. Given Trump's (and Musk's) emphasis on reducing government expenditures, Kennedy would have to quantitatively illustrate how his health policy refocus would pay for itself in the long run. Kennedy lacks the macro-economic background to do so.

RFK Jr. would also need exceptional executive, political, and leadership skills to defeat the corporate lobbyists, and he would require exceptional credibility, communication, and educational skills to convince the American public to live healthier. RFK Jr. lacks many of these skills, especially credibility. While some of those responsibilities might normally be delegated to subordinates, Kennedy is not known for his managerial and executive skills. In his past roles with non-profits, he was primarily the public persona or spokesman rather than the managing executive. Jeff Hutt, a close Kennedy associate who was National Field Director for RFK Jr.'s recent presidential campaign, describes Kennedy as follows, “He’s an inspirational leader who’s able to communicate. But he’s not a manager.” Other campaign staffers agree, with one stating anonymously, “I have no idea how he’s going to run a full department, if that’s how he ran the campaign.”

Kennedy may have passion and certain communication skills, but credibility is a real problem for him, especially in the scientific / medical community. His highly publicized anti-vaxx positions and other unsubstantiated health theories contribute greatly to this problem. However, his past history of drug abuse, a story about a brain eating worm, and bizarre anecdotes about transporting bear and whale carcasses don't help either.

Despite his obvious shortcomings, it is difficult to say whether or not Kennedy will be confirmed by the Senate. Certain GOP Senators, like Josh Hawley, seem more concerned about the health of unborn children than the health of living children. After interviews with RFK Jr., Hawley claims that Kennedy agreed to help restrict the abortion pill mifepristone, if that was Trump's desire. Hawley claimed that Kennedy also committed to reactivating the Mexico City policy, which cuts off U.S. family planning funding to any foreign non-governmental organizations (NGOs) that don't certify that they won't perform or promote abortion as a method of family planning in that country using money from any source (regardless of whether or not the funding comes from the U.S.). One might wonder if family planning restrictions like this might exacerbate future migration crises.

Alabama Senators Tuberville and Britt have typically stated support for Trump's cabinet nominees, prior to Senate hearings. However, there is a slight hope that the hearings, reporting such as this, and calls from concerned citizens might change their initial positions. Tommy Tuberville has claimed that RFK Jr. has “got a lot of great ideas” and is “outside the box.” One might suggest that Kennedy is so far “outside the box,” that he is out of this world.

Mehmet Oz (Head of Centers for Medicare and Medicaid Services (CMS)) - 1/12/25

(Rick Skeen)

The Centers for Medicare and Medicaid Services (CMS) is the federal agency that provides health coverage to more than 160 million through Medicare, Medicaid, the Children's Health Insurance Program, and the Health Insurance Marketplace (associated with the Affordable Care Act). CMS is one component of the Department of Health and Human Services (HHS), and it works in partnership with the entire health care community to improve quality, equity and outcomes in the health care system. CMS sets operating standards for health care providers. By setting Medicare payment rates, CMS helps establish a basis for the payment levels used by private insurers. CMS directly employs approximately 6,700 people but also utilizes many third party personnel and businesses to fulfill its responsibilities. A rough estimate of expenditures from CMS is $1.5 trillion, including payments to beneficiaries and insurance providers.

Donald Trump's nominee for CMS Administer is Mehmet Oz, a heart surgeon best known as a daytime television personality sharing nutritional and lifestyle guidance. As a surgeon, Oz was highly regarded, but, in later years, his questionable advice while on television has damaged his credibility in the medical community. While a successful investor and media star (television, radio, books, social media), Oz has no administrative experience dealing with the bureaucracy of a large government organization like CMS.

On his popular “Dr. Oz Show” television program (lasting 14 years), he represented himself to be a trusted physician that was able to communicate with viewers in an easygoing, matter-of-fact manner. However, Mehmet Oz has many times touted very questionable medical remedies and weight-loss solutions to nationally televised audiences. In 2014, he was called before a U.S. Senate committee after accusations of false advertising of weight loss supplements, advocated by him on his show. A group of doctors, in a joint 2015 letter to Columbia University medical school, recommended that he be fired. They claimed that advice dispensed on his television program was, at best, lacking scientific evidence and, at worst, contradicted by scientific evidence.

In response to the 2014 Senate hearing, Oz denied having ever been paid to promote a particular product or supplement. However, he has used “passionate language” (his words) to promote, in a general manner, suspect techniques and approaches for weight loss. Some he has called “miracle cures.” While admitting that many of the supplements he pushed lack scientific evidence of their medical efficacy, Oz testified, “I actually do personally believe in the items I talk about on the show. I passionately study them. I recognize they don’t have the scientific muster to present as fact but nevertheless I would give my audience the advice I give my family all the time, and I have given my family these products.” A consumer advocacy organization has asked the FTC to investigate Oz for his alleged undisclosed association with a herbal health company he endorsed on social media platforms.

On one “Dr. Oz Show,” Oz promoted green coffee beans as a weight-loss supplement, citing a questionable study that was later retracted. Oz gushed, “You may think magic is make-believe, but this little bean has scientists saying they found a magic weight loss cure for every body type.” Shortly thereafter, a Florida based company began selling a weight loss supplement labeled “Pure Green Coffee,” and it marketed its product using video from Oz's show. The Federal Trade Commission (FTC) later sued the Florida firm for deceiving customers and making phony claims. Oz had no relationship with the company, did not authorize use of the video, and received no money from the firm. However, he did promote the false weight-loss narrative which eventually lead to the development of the bogus product.

Guests on the Dr. Oz Show have included RFK Jr. (possibly his new boss) pushing his anti-vaccination message. Another guest pushed a weight loss plan employing a pregnancy hormone and a massive reduction in calorie intake. Although participants using the plan did lose weight, it was due to the reduced intake of calories, not the pregnancy hormone. During the Covid-19 pandemic, Oz advocated for hydroxychloroquine treatments, although more mainstream medical professionals questioned their effectiveness. Despite the hype (including that from then President Trump), hydroxychloroquine was later shown to be ineffective, and the FDA withdrew its emergency authorization as a Covid treatment.

While not profiting directly from sales of deceptive supplements or questionable treatment plans, Oz did profit from his television show, made popular by viewers looking for the “miracle cure” to their particular ailment or medical/physical condition. According to 2022 financial disclosure statements required by his failed Pennsylvania Senate campaign, Oz also had substantial investments in pharmaceutical, food, and insurance companies that might pose a conflict of interest if he heads CMS. It is difficult to quantify the investments because the required financial statements did not require exact figures, only ranges. (Oz's total 2022 net worth was reported to be in the range of $100M - $315M.) In addition, we don't currently know which investments Oz still has. Oz will be required to complete a new financial disclosure form for his nominated CMS administrator position, and hopefully any potential conflicts of interest will be exposed. Most of his previously disclosed investments were diversified and were with well known companies, not small herbal or supplement firms.

In 2022, Dr. Oz held stock worth between $280,000 and $600,000 in UnitedHealth Group (some reports are $550,000) and stock worth between $50,000 and $100,000 in CVS Health. This is significant because both companies offer Medicare Advantage insurance plans, which Oz has promoted heavily. In fact, Oz has suggested in the past that Medicare be privatized with all seniors being placed in Medicare Advantage plans from private insurers. (In 2020, Oz suggested that all Americans, not just seniors, be offered Medicare Advantage, a position he has since backed away from.) Currently, Medicare Advantage is an option for seniors in lieu of traditional Medicare, with many healthier seniors opting for these plans. While Medicare Advantage plans can often offer lower monthly premiums, extra coverage benefits, and certain perks, disadvantages may include a more limited selection of doctors, less coverage outside of a given geographic area, and a requirement of insurance authorization prior to certain treatments. Critics believe that insurers often disapprove valid requests for treatment, blocking or postponing necessary care.

When Medicare Advantage plans were first established, it was thought that private insurance companies would be able to treat seniors and the disabled more efficiently and cheaply than traditional Medicare. However, the Medicare Payment Advisory Commission performed an analysis and found that Medicare Advantage, when compared to traditional Medicare, would overcharge the government $83 billion more, just in 2024. In a letter sent to Oz after his CMS nomination, Democratic Senators included the following statements, "In your financial disclosures from your 2022 Senate run, you reported owning over $550,000 of stock in UnitedHealth, the largest private insurer in Medicare Advantage and largest employer of physicians in the nation......The company is currently under a sprawling antitrust investigation by the Department of Justice — including for its role in aggressively upcoding Medicare Advantage enrollees to secure higher payments from CMS — and has been sued on multiple occasions for Medicare fraud." Upcoding refers to the practice of diagnosing patients with diseases they may not have, because Medicare will pay the insurers more, based on a diagnosis, for sicker patients at higher risk. Since the higher payments are based on diagnoses rather than any actual treatment, insurance companies can pocket the difference between what they are paid (based on sickness scores) and what they have to pay out for actual treatments. The Wall Street Journal reported recently that, on average, sickness scores went up 55% in the first year after traditional Medicare patients moved into UnitedHealth Medicare Advantage plans. UnitedHealth argues that more thorough diagnostic procedures (like a software diagnostic checklist that their doctors must follow; and home visit health risk assessments- HRAs) lead to healthier patient outcomes. However, it is reported that some of these same diagnostic approaches are used only on their Medicare Advantage customers, not on their regular insured customers, presumably because of financial incentives. For insurers like UnitedHealth, risk adjusted payments from Medicare run into the billions.

Medicare Advantage providers, like UnitedHealth, strongly encourage periodic home visits to their insured so as to conduct health risk assessments (HRAs). Rather than the patient's own doctor, Medicare Advantage insurers or their third party contractors conduct these assessments to diagnose serious health problems. Insurers also conduct chart reviews of data derived from previous doctor visits to diagnose issues that may have previously been missed. A recent government report pointed out that approximately 1.7 million Medicare Advantage plan enrollees received home visits for HRAs, but then received no follow-up care for their supposed serious health problems. The report stated, “OIG’s findings raised concerns about the appropriateness of risk-adjusted payments generated by HRAs, the quality of care coordination for enrollees, and the completeness of encounter data.” As CMS administrator, Mehmet OZ will help determine how much Medicare Advantage insurers are paid for each patient they enroll.

If confirmed, Mehmet Oz may face other potential conflict of interest issues. On his TV show, Oz has heavily promoted the weight-loss drugs Ozempic and Wegovy, and in 2019 he called their manufacturer, Novo Nordisk, a “trusted partner.” In the past, CMS would not pay for these popular (and expensive) drugs because they were considered treatment for obesity only. However, recently, these drugs were approved under limited circumstances to treat diabetes and certain cardiovascular disease when obesity was a factor also. The drugs will be covered under Medicare Part D, and will require cost sharing by the patient. Even with cost sharing and limited approval, the expense of these drugs to prescription drug plans and Medicare Advantage plans will be enormous. Oz's impact to Novo Nordisk and other pharmaceutical business could be significant. It remains to be seen how Oz will address the Ozempic/Wegovy cost issue, especially in light of Trump's effort to cut costs and RFK Jr.'s dislike of the pharmaceutical industry.

Currently, CMS establishes rules for health insurance advertisements related to the government programs it administers. CMS can disapprove advertisements that it views as being misleading or deceptive, and during the Biden Administration, approximately one third of the proposed advertisements were vetoed. Given his background as a television spokesman and promoter, Oz might not be as restrictive.

In summary, Mehmet Oz will placed in a political firestorm, caught between two opposing camps. Extremists on one side want to privatize Medicare; impose severe restrictions on Medicaid; and replace the Affordable Care Act and the Health Insurance Marketplace with some, as yet, undefined alternative. Extremists on the other side want unlimited, high quality, unrestricted, no cost, health care for everyone, paid for by corporations and rich billionaires. Neither side is realistic. The most likely solution will be a tweaking of the existing system that will probably completely satisfy nobody. It will take an experienced and knowledgeable administrator, not a controversial celebrity, to objectively evaluate the current CMS situation, formulate a realistic plan, and implement the best compromise. Mehmet Oz has yet to demonstrate those administrative and management skills.