In Donald Trump’s second administration, the US’s health agenda has taken a new shape in the form of a populist movement known as Make America Healthy Again, or Maha. So far, its central figurehead, US health secretary Robert F Kennedy Jr (RFK Jr) has cancelled $500m of vaccine research, fired thousands of health agency workers and promoted an unsubstantiated link between Tylenol and autism.

But what underlying vision ties the Maha project together?

Its fundamental claims are simple: Americans suffer from a chronic disease epidemic fuelled by corrupt incentives in the medical, food and pharmaceutical industries. But what starts as a reasonable, even compelling, complaint about corruption quickly devolves into a mistrust of vaccines, health institutions and mainstream medical treatments.

What further separates Maha from other health movements is its larger cultural and social critique: a belief that the “ills” of modernity – its vaccines, artificial foods and environmental toxins – are symptoms of a social and spiritual decay that must be countered with a health-conscious conservative lifestyle. Maha’s clean anti-establishment message has gone on to attract a diverse coalition of concerned mothers, wellness influencers, conspiratorial hippies, culture warriors, health food CEOs, conservative social critics and alternative medicine practitioners.

One of the movement’s central architects is Calley Means, current special government employee at the Department of Health and Human Services (HHS) and direct advisor to RFK Jr. A close friend of Kennedy’s, he was the visionary who first connected RFK Jr to Trump after recognising a politically powerful overlap in their populist messages. Calley’s own political debut came in 2024, when he and his sister, Casey Means, co-authored the bestselling health and wellness book Good Energy and promoted it to right-leaning audiences on The Tucker Carlson Show and The Joe Rogan Experience. Together, the Means siblings built and spread the Maha message to millions of rightwing listeners.

The siblings pair their work with a carefully calibrated backstory: Calley tells stories of corruption from his time as a former lobbyist for the food and pharmaceutical industry. Casey, a Stanford-trained physician, retired from the medical profession feeling disillusioned with its profit-driven and overspecialised approach to health. They tout their “former insider” status as proof of their populist credentials, a strategy so effective that it landed them insider positions in the Trump administration: as previously mentioned, Calley as an adviser at the US health department and Casey as Trump’s nominee for surgeon general. The siblings are set to become some of the most powerful figures in American health.

But if you, as Maha evangelists say, “do your own research”, you’ll find that Vanity Fair reported that Calley Means has never registered as a lobbyist in the US and that former employers dispute him ever having worked for food and pharmaceutical clients. In response, Calley Means said: “I stand by everything I’ve said.” Meanwhile, in the LA Times and Vanity Fair, Casey’s former colleagues have suggested that her departure from medicine was motivated more by stress than disillusionment. But perhaps misrepresenting parts of your backstory is simply a part of the growing pains of building a new political movement. So, what do these public health newcomers offer in terms of concrete policy?

In interviews, Calley often repeats a rhetorical question: why should we work to increase healthcare access if we know that the system is broken? Instead, he argues, Americans should focus on holistic “root causes” of ill health, which is why he co-founded Truemed, a platform connecting tax-free health savings account (HSA) owners with a marketplace of wellness products. Visit Truemed’s website and his intended audience becomes clear: Americans who shop for $1,000 cold plunge baths, five-figure personal saunas and flashy Peloton bikes.

As Calley candidly explained on a podcast, Truemed’s ultimate goal is to redirect every cent of the $4.5tn the US spends on programmes subsidising the healthcare of poor and elderly people into accounts like HSAs for people to spend at their discretion on mainstream and wellness medicine. The latter marketplace is hardly a fringe cottage industry – it represents a $6.3tn global wellness sector, a loosely defined and largely unregulated industry of brands and influencers promoting a “state of holistic health. Calley is deeply invested in the wellness industry’s flourishing. His sister, Casey, similarly has roots in the wellness industry, where she started with a popular newsletter and podcast that grew into a multi-million-dollar health wearables startup, Levels.

As agents of the Maha cause, Calley and Casey aren’t just using their new national platform to promote their own businesses. They’re turning Maha into the wellness industry’s new business plan. So far, the Trump administration is putting pieces of that plan into place. The recently passed “big, beautiful bill” includes provisions to expand HSA use, directly benefitting Calley, Truemed and the wellness sector at the taxpayers’ expense. More consequential are the bill’s $1tn in Medicaid and Medicare cuts, which not only slashes coverage for poor and elderly people, but also strips funding from rural hospitals, community health centres and nursing homes.

Maha likes to frame itself as the David to big pharma’s Goliath. But the pharmaceutical industry’s $1.6tn global valuation pales in comparison to the wellness industry’s $6.3tn. When we begin to understand Maha as simply another Goliath, its most nonsensical positions suddenly seem very sensical. RFK Jr’s sudden embrace of digital health wearables, despite once calling them tools for “surveillance”, makes sense knowing that Maha superstar Casey co-founded a health wearables company. It makes sense that none of Maha’s figureheads opposed Trump’s cuts to healthy school lunch programmes or his subsidies for the commodity crops that fuel the ultra-processed food industry. It makes sense that Calley and his wellness entrepreneur friends can launch an organisation called End Chronic Disease to push HSA expansion even as Trump cuts billions of dollars for chronic disease research.

When Calley attempts to rhetorically justify cuts to Medicaid and Medicare by asking, “Why provide more access to a broken system?”, he touches on Maha’s central contradiction. For those of a certain socioeconomic class, American healthcare is not broken. After all, there’s a reason why Saudi royals frequently seek medical care in the US or why the US attracts a nearly $8bn medical tourism market. What is broken is the American healthcare system – the inherent injustice of subjecting human rights to the logic of private markets.

Americans need more access to a broken system when lack of access is the essence of its brokenness. But if Maha were to address this problem in any meaningful way, it would cease to exist. By instead making the problem worse, by funnelling public money into the private hands of the wellness industry and exacerbating the healthcare disparities that produce systemic rage, Maha will always have something to complain about, a message for those who are suffering and customers to sell it to.

But the problem with a grift that deals in life and death is that, actually, you may not always have customers. If Maha successfully decimates public health spending at a time when Americans face, in Calley’s words, “almost genocidal levels” of chronic disease among children, who will survive to buy what Maha sells next? When the Maha president’s health spending cuts close the last rural hospitals and clinics in the very counties that voted for him, the future of American public health may depend on whether these communities reach the ballot box before the grave.

• Alexander Avila is a video essayist, writer and researcher. A version of this article first appeared as a video essay on his YouTube channel