Dismantling by Design: A Mid-2026 Reckoning on U.S. Population and Public Health - A PopHealth Week Special
By Fred Goldstein, MS and Gregg Anthony Masters, MPH | PopHealth Week, Healthcare NOW Radio
What is happening to American public health right now is categorically different from anything we have discussed on PopHealth Week before. It is not policy drift. It is not the familiar friction between evidence and politics. It is intentional dismantling, and at mid-2026, the cumulative damage is measurable, accelerating, and consequential in ways that will take a generation to repair.
That is the unambiguous conclusion of our mid-year special edition, recorded this summer as three story lines converged: RFK Jr.'s ideological remake of HHS, a CDC leaderless during a record measles outbreak, and an FDA commissioner pushed out after refusing to approve fruit-flavored vapes on a presidential timeline. The through line, as Gregg Anthony Masters framed it at the top of the episode, is the subordination of science to political will.
The Legitimate Grievance and the Dangerous Prescription
Let us be precise about what MAHA gets right, because intellectual honesty requires it. The chronic disease burden in the United States is not a debatable proposition. Cardiovascular disease, diabetes, obesity, and metabolic disorders have replaced infectious disease as the dominant drivers of morbidity and premature mortality, a transition that reflects decades of food system choices, physical inactivity, and a healthcare financing model that rewards procedures over prevention. Food quality, poly pharmacy, and the slow-motion failure of primary care are all legitimate targets for reform.
But as Fred Goldstein put it on this episode:
"When you place MAHA into a realm where science and research and what we know best are no longer the relevant measure, you then come out with things that are fundamentally wrong."
The administration has correctly named the disease while reaching for prescriptions that contradict the very evidence base it claims to champion.
The most visible contradictions: vaccine messaging that creates confusion around one of the most effective public health tools in human history; the promotion of raw milk despite documented safety risks; and a growing wave of fluoride removals from municipal water systems, including multiple Florida cities as Goldstein noted, driven by misreadings of studies whose own conclusions undercut the anti-fluoride argument. Goldstein observed that one widely circulated social media post cited a scientific study that found no detectable harm below a certain fluoride threshold, a threshold that was itself twice the level of fluoride actually present in municipal water systems. The evidence, correctly read, supported fluoridation. The conclusion being circulated opposed it.
The science on community water fluoridation is not genuinely contested in the peer-reviewed literature. CDC data from 2023 show that 99.99% of community water systems that add fluoride operate below the EPA safety threshold of 2.0 mg/L, and the U.S. Public Health Service recommends 0.7 mg/L as the optimal level for cavity prevention, roughly half the safety ceiling. KFF analysis notes that community water fluoridation reduces tooth decay by about 25% in children and adults, and programs nationwide generate approximately $6.5 billion per year in net savings by averting direct dental treatment costs and related productivity losses. The cities removing fluoride are not responding to new science. They are responding to political pressure dressed in scientific language.
Three Agencies, Three Crises
HHS under RFK Jr. has undergone restructuring that is difficult to characterize as anything other than a purge. PBS News reported that the department downsized to 62,000 positions, losing nearly a quarter of its staff, with 10,000 jobs cut through layoffs and another 10,000 workers taking early retirement and voluntary separation. The proposed FY2027 budget requests a further $15.8 billion cut, a 12.5 percent reduction from 2026 funding levels, alongside the elimination of the National Institute on Minority Health and Health Disparities, the Fogarty International Center, and the National Center for Complementary and Integrative Health. As the Network for Public Health Law documented, 23 state governments sued HHS and Secretary Kennedy, alleging the cuts left states at greater risk of pandemic spread and unable to maintain essential public health services.
The CDC, meanwhile, is operating without confirmed permanent leadership during the worst measles crisis in a generation. As of July 2, 2026, the CDC confirmed 2,170 measles cases in the United States, with 93% of them outbreak-associated. That total stands just 119 cases below the entire 2025 annual count, with more than five months of transmission season remaining. The U.S. is on a near-certain path to surpassing the 33-year case record. The driver is not a new pathogen. MMR vaccination coverage among kindergartners has declined from 95.2% during the 2019-20 school year to 92.5% during 2024-25, a drop that, according to the Common Health Coalition, could translate to 17,000 additional measles cases, 4,000 hospitalizations, and 36 preventable deaths annually. Johns Hopkins epidemiologist Dr. William Moss has warned that if the trend continues, 2026 will easily surpass 2025.
The FDA situation is perhaps the most instructive. Dr. Marty Makary resigned on May 12, 2026, after 13 months as FDA Commissioner. Multiple reports tied his departure directly to the flavored vape decision, with accounts suggesting he had not supported authorizing fruit-flavored variants and that political pressure to do so was a significant factor in his exit. Reports indicated that Makary told several confidants his conscience would not allow the approval given the products' documented appeal to young people. Trump had, as Gregg Anthony Masters noted, campaigned in 2024 on saving vaping. The FDA ultimately authorized two fruit-flavored vape products, and the episode crystallizes what has become the defining pattern: the subordination of regulatory independence to political and commercial interests.
University of Michigan researchers writing in The Conversation note that while vaping carries lower relative risk than combustible cigarettes for existing smokers, it represents an increased risk for non-smokers, and that fruit remains the flavor category most strongly associated with underage vaping initiation. The regulatory question is not whether vapes are useful harm-reduction tools for adult smokers. It is whether fruit flavors designed to attract new users belong on the market. That question should be answered by science, not by a campaign promise.
When the Evidence Itself Is Fabricated
One of the most alarming threads in our conversation concerns what happens when the federal government stops merely misinterpreting evidence and starts manufacturing it. As Masters flagged on the episode, the MAHA report contained citations to studies that did not exist, almost certainly the product of AI-generated text submitted without verification. Fred Goldstein's framing deserves attention: "Was it because they were lazy, or did they know? Either way, it's problematic."
This matters beyond the specific report. When HHS, i.e., the parent agency of the CDC, FDA, and CMS, releases documents built on phantom citations, it corrupts the epistemological foundation on which federal health policy rests. Every subsequent guidance, every recommendation, every emergency order now carries an asterisk. The people who trusted the institutions are uncertain. The people who never trusted them feel vindicated. Both outcomes serve those who benefit from a paralyzed public.
Goldstein articulated the trust spiral clearly: when you create doubt about vaccines through messaging ambiguity, and then suppress a vaccine safety report because it does not support your ideological position, you do not just lose the people who were already skeptical. You lose the people who were with you. The net result is a society in which no institution's seal of approval carries the weight it once did.
The Rebuild Problem and the Financing Reckoning
We asked the hardest question: if a future administration wanted to restore what has been damaged, what does that rebuild look like?
Goldstein's answer was sobering. The workforce problem is not merely about numbers. Federal public health agencies have lost experienced career scientists and administrators who have found stability elsewhere. Who returns to an agency that fired them, knowing the cycle could repeat? The culture problem may be deeper still: how do you rebuild institutional trust in a society that has been systematically taught to distrust government? "There are some things that have been broken so badly they can't be fixed," Goldstein said. He is not a pessimist by nature. That assessment reflects serious analysis, not despair.
On the financing side, the conversation moved into territory PopHealth Week has long occupied. Masters characterized the current system as "the Healthcare Borg," a structure so hierarchical, siloed, and incentive-misaligned that no rational designer would create it. Fee-for-service medicine, he argued, is the wrong incentive architecture on top of a for-profit orientation. The interest of the insurer is to deny or delay care; the interest of the hospital is to maximize billable procedures; the interest of the patient is to stay healthy. These are not the same interest.
The path to single-payer, however, is more complicated than advocates often acknowledge. Goldstein noted that more than half of Medicare beneficiaries are already enrolled in Medicare Advantage, i.e., private insurance plans operating under a Medicare umbrella. A transition to "Medicare for all" that preserves the current Medicare Advantage structure would not eliminate commercial plans from the equation. It would simply route public money through them under a different label. The problem is not the label. It is, as Goldstein frames it, a lack of ethics by the players, and as Masters retorted, you cannot CRISPR out a greed gene.
What Is Required Now
Both Goldstein and Masters closed with a call that is neither partisan nor comfortable: the public health community, clinical medicine, researchers, and ordinary citizens must speak up. The mechanisms of democratic accountability have not been suspended. But they require participation.
The parallel Goldstein draws is to environmental restoration, specifically the Indian River Lagoon, an ecosystem he has worked to protect. You do not restore a degraded ecosystem by waiting for someone else to care. You do it person to person, community by community, starting conversations with neighbors who did not know the problem existed. Population health is a degraded ecosystem right now. The silence of experts, including researchers who do not speak publicly, clinicians who do not engage their communities, and public health professionals who stay behind institutional walls, is not neutrality. It is a form of consent to what is happening.
Enough is enough. It is way past time.
Sources and Further Reading CDC Measles Data and Research, Updated July 2, 2026 Johns Hopkins IVAC U.S. Measles Tracker U.S. News and World Report: Tracking 2026 U.S. Measles Outbreaks The Hill: U.S. Measles Cases Exceed 2,000 in 2026 NBC News: FDA Commissioner Makary Pushed to Resign Over Flavored Vapes The Conversation: Flavored Vapes and the FDA Shake-Up PBS NewsHour: HHS to Cut 20,000 Positions Healthcare Dive: White House Seeks 12% Cut to HHS in FY2027 Network for Public Health Law: HHS Restructuring and Funding Cuts CDC MMWR: Community Water Fluoridation Levels, United States, 2016-2021 CDC: Community Water Fluoridation Recommendations KFF: Water Fluoridation in the U.S.