The Health Secretary, the War Budget, and the Louisiana Doctor Who Kept Fact-Checking
By Dianne Marie Normand Hartley
Over seven congressional budget hearings in the past two weeks, Health and Human Services Secretary Robert F. Kennedy Jr. was on Capitol Hill defending a proposed $111.1 billion discretionary budget for HHS — a $15.8 billion cut, 12.5% below the 2026 enacted level. At the same time, President Donald Trump’s budget proposes $1.5 trillion for national defense/offense — a 44% increase for the newly rebranded Department of War. Reuters described the proposal as the largest year-over-year increase in U.S. defense spending since World War II.
The already embattled HHS secretary was left explaining why the nation’s health department should shrink to politicians whose constituents are stung with exploding healthcare costs, which left his right flank open to the few doctors on the committee who believe Kennedy’s version of science is, shall we say, unorthodox, if not wrong. That contrast framed everything that followed.
Kennedy came to Congress arguing that chronic disease is hollowing out the country. He spoke of diabetes, obesity, ultra-processed food, poor nutrition, chemical exposure, medical schools that barely teach nutrition, and a healthcare system that spends trillions treating disease after it has already taken hold. But he was not there merely as an advocate for healthier food. He was there as a cabinet secretary defending a budget that cuts the department responsible for health, public health, medical research, disability programs, disease surveillance, rural health, and emergency preparedness. He also came to defend his version of science and the firing of those who do not agree with his version. At moments, he sounded like the public-health reformer America desperately needs, and at other times … well, let’s just say his version of “gold standard science” does not match many experts’.
One of the most revealing exchanges came not from a Democrat, but from Louisiana’s own Sen. Bill Cassidy, a physician and the Republican chairman of the Senate Health, Education, Labor, and Pensions Committee.
Cassidy has a unique role in this drama. He is not only the chairman overseeing Kennedy’s testimony, which gives him the right to continue asking questions as he hands the ball off to another senator — he is a doctor who helped clear the path for Kennedy’s confirmation after receiving assurances about vaccines. In the hearing, Cassidy sounded like a man who felt burned.
He began by pressing Kennedy on vaccine confidence, measles, and the independence of the next CDC director. Cassidy said he had personally seen people die from vaccine-preventable diseases. He asked whether the new CDC director would have authority to make decisions independently of political appointees Kennedy had placed at the agency. Kennedy said the director would have that power.
Cassidy then turned to a practical question: with the World Cup and America’s 250th birthday expected to bring tourists from around the world, what was HHS doing to prepare for imported vaccine-preventable diseases like measles?
Kennedy did not answer directly. Instead, he defended his record, saying the measles outbreak started before he came into office, that other countries had worse outbreaks, and that the U.S. had done better than any country in the world at controlling it. Cassidy brought him back to the question: what steps was HHS taking to track diseases that might come in through international events? Kennedy eventually said the administration was “laser-focused” and would have testing booths and institutions around the games.
But the most striking Cassidy moment came later, after Sen. Bernie Sanders challenged Kennedy on a passage from Kennedy’s book, The Real Anthony Fauci. Sanders quoted Kennedy’s claim that the idea vaccines caused the dramatic decline in infectious-disease mortality in North America and Europe during the 20th century was “simply untrue.” This was a shock to Sanders.
Kennedy responded by citing a study he called “Guyer,” eventually spelling it for the committee. He said the CDC had done a “real study” showing that the decline in disease mortality was not attributable to vaccination, but to hygiene, sewer systems, clean water, and engineering. He also noted a McKinlay/McKinlay paper stating the same.
The exchange went like this:
Senator Bernie Sanders: Thank you. Secretary Kennedy, thanks for being with us. In your book The Real Anthony Fauci, you wrote, and I quote, “A doctrinal canon of the germ theory credits vaccines for the dramatic declines of infectious disease mortalities in North America and Europe during the 20th century. Most Americans accept this claim as dogma. It will therefore come as a surprise to learn that it is simply untrue.” But despite your assertion in your book, according to a peer-reviewed study in The Lancet led by the World Health Organization, vaccines have saved the lives of more than 150 million people and reduced infant deaths by 40% over the past 50 years. So, my question is a simple one. Do you still believe that one of the central tenets of the germ theory, that vaccines sharply reduce infant mortality, is, quote, “simply untrue”?
Kennedy: What I was saying in that book … First of all, the study you cited is a modeling study.
Sanders: It’s a what?
Kennedy: It’s a modeling study. CDC has actually done a real study that answers that question. It’s called Gyer, G-u-y-e-r, 20 or 2000. And it says that the 80% mortality in chronic disease that took place — in mortalities from chronic disease that took place in the 20th century, that almost none of it was attributable to vaccination. It was attributable to hygiene, to sewer plants, to better water supplies, to engineering that got …
Sanders: I have to interrupt you because I have other questions. You’re entitled to your view.
Kennedy: As I said, that’s my view. That’s CDC’s view.
Sanders: Well, you’re entitled to CDC’s view, but according to the World Health Organization and scientists all over the world, vaccines have played an enormous role in saving lives.
Kennedy: I don’t contest that. I’m just saying that if you want to talk about why disease mortalities disappeared in the 20th century, it was not vaccines.
Sanders: Well, you are in a minority. All right. Well, I have other questions …
Then Cassidy did something unusual in real time: he fact-checked the citation during the hearing. Before moving to another senator, Cassidy stopped and asked Kennedy for the paper again.
Cassidy: Mr. Secretary, before I go to Senator Hassan, what was the CDC paper you said attributed improvements in longevity to sewer treatment, for example, not vaccines? I’m looking for that on ChatGPT, and it says it doesn’t exist.
Kennedy: So, what is that called? Guyer. The lead author is Guyer, G-u-y-e-r. There’s another one that came out in 1977 that was required reading in virtually every medical school that says the same thing, and I actually —
Cassidy: Who’s the author of that one?
Kennedy: That one is called McKinley and McKinley.
Cassidy: McKinley and McKinley. That one is not CDC, according to ChatGPT …
Kennedy: Well, that’s not. The Guyer is CDC and Johns Hopkins.
Kennedy was referring to “Annual Summary of Vital Statistics: Trends in the Health of Americans During the 20th Century,” by Bernard Guyer and colleagues, published in Pediatrics in 2000. The paper did argue that much of the decline in infectious-disease mortality among children occurred before many antibiotics and vaccines were widely available, and that public-health measures such as sanitation, clean water, food safety, hygiene, housing, and socioeconomic improvements played a major role.
He also pointed to an older 1977 paper by John B. McKinlay and Sonja M. McKinlay, “The Questionable Contribution of Medical Measures to the Decline of Mortality in the United States in the Twentieth Century,” which is not a CDC paper, and argued that many medical interventions arrived after major infectious-disease mortality declines were already underway.
Later in the hearing, Cassidy returned with the fuller context.
Cassidy: Yes, and just speaking as a doctor, just to close the conversation, thank you for giving Guyer’s name. I’ve looked up the article. The quote is, “Thus, vaccination does not account for the impressive declines in mortality seen in the first half of last century. The reductions in vaccine-preventable diseases, however, are impressive.” I’ll condense. In the early 1920s, there were about a half a million annual cases before the introduction of the measles vaccine in the ’60s. Because of vaccines, these deaths have been virtually eliminated. So, that’s the complete context.
Kennedy: I was talking about mortalities, Senator.
Cassidy: That’s what they’re saying. The deaths have been virtually eliminated.
He then sent him to Senator Baldwin. Cassidy later came back to follow up:
Cassidy: Again, speaking as a physician, I will say we looked up the McKinley articles. There were 3.5 million cases of measles per year before the vaccine came along and about 550 deaths. And then the vaccine took those to less than 100 and like zero deaths. So, the efficacy of the paper was written before — for events before 1950, which is before the vaccine came out. But then the vaccine came out, and that’s when cases went from 3.5 million down to near zero, and deaths went to zero from 550 a year. So, a tremendous impact of the vaccination.
That exchange is the heart of the dance. Kennedy was answering one question: What caused the dramatic decline in infectious-disease mortality in the first half of the 20th century?
Cassidy was asking another: What happens when vaccination rates fall now, after vaccines helped drive measles and other vaccine-preventable diseases toward elimination?
Both questions matter. But they are not the same question.
Kennedy is right that vaccines do not deserve sole credit for the great 20th-century decline in infectious-disease mortality. Clean water, sanitation, nutrition, housing, refrigeration, sewer systems, and public-health infrastructure may be among the greatest lifesaving technologies in American history.
But Cassidy is right that this historical truth can become misleading if used to minimize the disease-specific impact of vaccines after they were introduced. This is where the hearing became more than a partisan fight. It became a lesson in how public-health truths can be bent into political half-truths.
Kennedy’s strongest argument is about chronic disease. He repeatedly pointed to the staggering burden of diabetes, obesity, metabolic disease, poor nutrition, and chronic illness. He said America cannot continue spending trillions on disease management while ignoring the upstream causes of sickness. He is right about that.
The most bipartisan moments in the hearing came when senators talked about food.
Sanders pushed Kennedy on warning labels for unhealthy foods and junk-food advertising to children. Kennedy said he would support banning junk-food ads from television, noting that similar arguments had once been made about tobacco advertising. Sen. Rand Paul pushed the idea of removing soda, candy, chips, and other unhealthy foods from SNAP purchases. Kennedy said many states had applied for waivers to remove candy from SNAP, and that once ultra-processed foods were formally defined, states could begin seeking broader restrictions.
Republicans praised Kennedy for emphasizing nutrition, food dyes, medical-school nutrition education, and changes to dietary guidelines. Democrats challenged him on cuts, vaccines, and public-health capacity. But across party lines, there was a rare area of agreement: the American food system is helping make Americans sick.
That may be Kennedy’s most important contribution. He has made nutrition politically unavoidable. But even there, the budget problem remains. If nutrition, sanitation, public-health infrastructure, and prevention are the foundation of health, why cut health?
Sen. Lisa Murkowski raised one of the clearest examples. She praised some Indian Health Service funding protections, but warned about an 87% cut to the sanitation facilities construction account. She reminded Kennedy that he had seen Alaska communities without running water, clean drinking water, or sanitation facilities.
Kennedy had just invoked sewer systems, clean water, and sanitation as the real drivers of public-health progress. Yet here was a senator from Alaska warning that the budget would cut sanitation construction for communities that still lack those basics.
The same contradiction appeared around rural healthcare. Sen. Tim Kaine cited Virginia clinic closures and loss of OB-GYN services that health systems attributed to the reconciliation bill and federal funding reductions. Kennedy acknowledged that rural hospital closures are tragic, not only because they reduce access to care but because hospitals are often the largest employers and economic anchors in rural communities. He pointed to the Rural Health Transformation Fund and argued that rural hospitals need new models, telehealth, and infrastructure.
Sen. Andy Kim pressed Kennedy on proposed cuts affecting people with disabilities, including the Limb Loss Resource Center and Paralysis Resource Center. Kennedy said he was not familiar with some of the programs and offered to discuss them further. Sen. Patty Murray challenged Kennedy on canceled grants for maternal health, vaccine research, Alzheimer’s, and cancer. Sen. Tammy Baldwin pressed him on Affordable Care Act marketplace coverage losses and proposed rules that could increase costs or reduce coverage. Sen. John Hickenlooper raised the local burden of measles outbreaks, noting that even small outbreaks can require enormous contact-tracing resources from local public-health departments. Sen. Hassan and Sen. Markey both pressed Kennedy on Trump’s actions related to glyphosate and Monsanto/Bayer. Kennedy previously sued Monsanto and won a major verdict, and he has said glyphosate is dangerous. But senators accused him of standing down as the administration supports domestic production and legal protections tied to glyphosate. Kennedy said he opposed the administration’s position internally and framed the issue as a “national-security concern” because U.S. agriculture, especially corn farmers, is dependent on glyphosate.
Throughout the hearing, Kennedy kept saying that he was not responsible for the current measles outbreak — that the children who died were denied the vaccine by their parents before he was in office. He was not responsible. The hearing became a collision between Kennedy’s message, Make America Healthy Again, and his anti-science stance and budget cuts to fund billionaires’ tax cuts and now load the Department of War, making that impossible.
Cassidy was acting like a physician who understood the difference between a historical mortality argument and present-day disease control. He did not deny that sanitation and clean water saved lives. He did not deny that public health is broader than vaccines. But he refused to let Kennedy use that truth to blur another one: measles vaccination dramatically reduced measles cases and deaths.
In a hearing full of speeches, Cassidy kept returning to the record.
What study?
Who wrote it?
What does the next sentence say?
What is the complete context?
That is what public health needs right now: not slogans, not tribal warfare, not blind trust in institutions, not reflexive distrust of them either. It needs complete context.
Kennedy is right that America’s chronic-disease crisis is real. He is right that nutrition matters. He is right that sanitation, food, water, housing, and environment deserve far more credit than medicine usually gives them.
But he is wrong when that argument becomes a shield against vaccine accountability, outbreak preparedness, or the basic responsibilities of the health department he leads. And he does not seem to have the power to stop what he knows will harm Americans: pesticides and war.
It was not that Kennedy is always wrong or that his critics are always right. It was more uncomfortable than that.
America is sick. Kennedy knows it.
America is overmedicalized. Kennedy knows it.
America’s food system is dangerous. Kennedy knows it.
America’s healthcare costs are unsustainable. Everyone in that room knows it.
But knowing it is not enough. A nation does not become healthy by cutting health and funding war.