Much attention, mainly in the digital world, has been dedicated to the potential cabinet appointments by Donald Trump, the President-elect, after his election win. These selections have sparked a spectrum of responses—some have incited substantial anger, like the nomination of Pete Hegseth for Defense, largely due to ethical or criminal issues. Others, like the possibility of Marco Rubio assuming the role of the Secretary of State, have been met with either anticipation or indifference. However, the proposed appointment of Robert Kennedy Jr. as the head of Health and Human Services (HHS) has stirred commotion across political lines.
For the sake of argument, let’s posit that Kennedy’s beliefs hold a dangerous potential, not only for him but also for others. Interestingly, the danger might not be as severe as we imagine, particularly considering his role as an administrator. However, this presumption may obscure a more critical problem: HHS, as an enormous administrative entity with extensive responsibilities, requires a competent leader. The anti-science stance Kennedy holds regarding vaccines has been a topic of heated debate. If he is appointed, he’d find himself heading not only the FDA but various other departments as well.
Kennedy, if confirmed, would also oversee the Administration for Children and Families, Administration for Community Living (a housing unit authority), the Agency for Healthcare Research and Quality, Advanced Research Projects Agency for Health, Administration for Strategic Preparedness and Response, Agency for Toxic Substances and Disease Registry, Centers for Disease Control and Prevention, Centers for Medicaid and Medicare Services, the Food and Drug Administration, Health Resources and Services Administration, Indian Health Services, National Institutes of Health, and Substance Abuse and Mental Health Services Administration.
In total, these agencies and departments fall under the jurisdiction of 14 primary administrative, communicative, coordination, and cooperative agencies and offices of the HHS. As per my research, HHS employs a full-time workforce of 59,905 individuals. To that, add 6,370 medical officers and 5,635 nurses spread across 10 regional offices that work in conjunction with state, local, and tribal partners.
It’s important to note these figures don’t account for non-permanent employees—individuals on scientific grants or private contractors that function as lab workers, insurance auditors, accountants, among many others. Consistently, all of these operate under complex regulations and rules created over seven decades of legislative actions, court rulings, and regulatory decisions. These have followed long-established administrative practices ever since the HHS was merged into existence in 1953.
The noteworthy bit about all of this is that there is little policy-making that happens internally. These departments primarily administer current programs or the new ones passed down from the legislature. The rest of the work involves micromanaging minor regulatory areas, which have been significantly narrowed down following a Supreme Court ruling in the Loper Bright Enterprises v. Raimondo case. This ruling overturned the ‘Chevron doctrine,’ which granted departments wide latitude in interpreting congressional intent.
The traditional test for potential cabinet secretaries involves an assessment of their administrative capabilities and competency, followed by their policy expertise. Kennedy can make alarming public statements, put together high-profile committees, and push for unusual policies like installing raw milk dispensers, but his powers to implement broad departmental policy are extremely limited.
I am skeptical that a single individual, particularly with no prior experience in administration or medical training, like Kennedy, could effectively steer this behemoth agency. Regardless, Kennedy’s preferences may not be substantial enough to sway policy decisions beyond minor operational aspects. The primary directive for all policy comes from the Congress, not the Secretary, who is mainly responsible for overseeing day-to-day paperwork and administration of the agencies and centers.
Kennedy’s fitness for this role isn’t an issue for the rumors that circulate around Washington D.C. Rather, it’s because of his significant lack of experience in managing anything of greater scale or importance than a fast-food outlet. This administration responsibility, with its vast administrative machinery and enormous employee workforce, is simply too great for someone without the required experience.
In conclusion, the point here is not to underestimate the significance of the Secretary’s role. It is more about understanding the limitations of the position’s power when it comes to decision-making and policy. While the head of the HHS theoretically presides over a significant number of agencies and services, their control and influence primarily extend to the execution of pre-existing policies and mandates.
Committing to administrative reforms or pushing for new ideas from scratch, as Kennedy might do, is generally not within the Secretary’s jurisdiction. In essence, they can’t single-handedly sketch or extrapolate departmental policy. They can make public statements, form committees, and even advocate for unique initiatives, but their directive always finds its root in Congress’s decisions.
The gravity of leading the HHS requires more than just political leverage or public influencer status. It requires a grasp of administrative procedures, experience with large-scale operations, and nuanced understanding of the medical and human services sectors. Most importantly, a humbling realization is required—that all policies and the direction of the department ultimately hinge on decisions made in Congress, not in the Secretary’s office.
Looking at the massive administrative machinery of the HHS, its numerous subsidiary bodies, and the diverse workforce, it’s clear that an effective head for this department would need skills and insights far beyond what Kennedy seems to offer. Concerns surrounding his appointment need not stem from his unproven ideas or public image, but from the simple fact that he lacks the necessary experience to steer such a crucial ship in the national healthcare landscape.