December 2024

Welcome to Cato Audio for December 2024. I'm Caleb Brown. In this edition, I speak with various Cato scholars on what advocates for liberty should expect from the now-secured second Trump administration. On the inextricably linked areas of trade and immigration, David Beer and Clark Packard will evaluate Donald Trump's plans for both mass deportations and new trade restrictions. Cato's Tom Fiery and Walter Olsen discuss the harsher realities of attempts to engage in broad, substantial deregulation by executive fiat. Michael Cannon and Jeff Singer discuss their preferred avenues for reducing the role of the feds in American healthcare.

and Brendan Buck and Justin Logan break down foreign policy in a new Trump administration. Before we get to all of that, a brief programming note. This will be our final monthly edition of Cato Audio. We'll still continue to bring you the best thinking emanating from the Cato Institute, but our next edition will come in February 2025. We'll continue keeping you up to date with Unintended Consequences, the podcast of Regulation Magazine, our events podcast feed, and my personal favorite, the Cato Daily Podcast.

President-elect Donald Trump has promised two big policies with respect to trade and immigration, and neither of them respect Americans' freedoms. Another large reduction in legal migration amid a massive deportation of illegal immigrants that may involve the U.S. military forces and massive new trade restrictions in the form of tariffs. Cato's David Beer and Clark Packard discuss why these policy ideas will pay negative dividends for Americans' freedom and their wallets. A lot of changes are likely for the federal government with the second Trump administration taking office. And so, Clark, I want to start with you. What has been thrown around by the president-elect on the campaign trail and has presented as a solution to all manner of problems that we might have fiscally, and that is tariffs. And depending on what the product is or what time of day Donald Trump is speaking, it is either a 10 percent across the board tariff, sometimes a 20 percent across the board tariff with special.

three-digit tariffs on certain products, either from people we don't like or from countries we don't like. So can you give me a sense of what you expect going forward? Yeah, that's a good question. I think they've got to do something. My sense is it's going to be in that 10% to 20% sort of across the board initially with a 60% tariff on imports, all imports from China. Whether that's sort of an opening salvo in negotiations is up in the air. But again, my sense is he campaigned.

very seriously on it. And the appointments he's made so far sort of indicate that they are pretty serious about trying to do something, whether it's Stephen Miller at the White House or the strong likelihood that Robert Lighthizer is going to come back as the USTR. All right. So when trying to sell this, the president-elect has argued, this is something that we need. It will generate...

lots of revenue, and so much so that he's promised that it would pay for some sort of large-scale federal child care program, that it would allow for either radical reductions in income taxes, possibly the elimination of the income tax. How realistic is that? It's not realistic at all. On one hand, you can't... tariffs can't serve a purpose of protecting a domestic industry and raising revenue for the federal government, right? The purpose of a tariff is to raise the price of a foreign product so that Americans switch to a domestically made product. So in an ideal world for protectionists, you don't pay the tariff at all. But he seems obsessed with the concept of tariffs and has said it's the most beautiful expression in the English language. So it's a clean trade-off, really, right? Either you switch to domestic production and you pay more.

or you pay the tax on the good from a foreign country and you pay more. But the revenue, the new revenue, comes from one of those decisions. Yeah, that's exactly right. And again, they seem to be wanting to have it both ways. Dave, immigration is important. It is extremely valuable. These people are contributors. What do you expect to see based on the president-elect's promises about immigration in the early days of his term?

Well, look, the handcuffs have really come off when it comes to immigration policy. In the last eight years, the Supreme Court and appeals courts have basically just deferred to the executive branch on so many issues when it comes to what they want to do with people who cross the border, who they want to prioritize, whether they want to do the work of the federal government when it comes to processing visas. Essentially, the only limits on his ability to act in the immigration space are logistical and practical and maybe... to a small extent, political, as opposed to some kind of legal construct that we have the Immigration and Nationality Act, and that tells us who should come and who should go. That's really out the window. And so I expect, look, he's going to crack down on legal immigration first. I think that's going to be one of the first things he does is enact a wide ranging travel ban. He's talked about a travel ban that's much bigger than what he had done in the past. So you're looking at certainly many majority Muslim countries and areas, as well as.

a number of other countries that he's just deemed security threats or, you know, unwelcome for whatever reason. And so that's one of the top priorities, the easiest thing really to implement. It's a lot easier to make something illegal that was legal as opposed to... try to stop illegal activity that is happening at the border in the United States. And so, yes, he once talks about mass deportation. He says that's the priority. It's not really the priority. The priority will be cracking down on legal immigration, eliminating pathways for people to come legally. We have these parole sponsorship programs, the refugee program, these programs he's talked about suspending or eliminating entirely. So it's going to be a large scale, immediate reduction in legal immigration, a slow ramp up.

in enforcement and deportations in the interior. He said, I'm going to prioritize criminals and get rid of gangs and all that stuff. They're already prioritizing criminals and trying to get rid of gang members. It's the people who haven't committed crimes and violent offenses and other serious crimes that are not priorities for deportation under this administration, who will on day one become priorities for this next administration. And so it's going to be chaotic. It's going to be a major change in policy. And I don't really see as much optimism.

coming in in terms of people who are going to push back within the administration against some of these more extreme policy ideas. So the logistics of a mass deportation, what does that look like? And what does that, I have to imagine that this will show enormous disrespect to Americans' rights in the process. Absolutely. If they're ever going to achieve what they're talking about, millions of deportations per year, you're going to have to disrespect American civil liberties in very serious ways. I mean, the main logistical obstacles to mass deportation are the fact that you have to identify someone as being removable from the United States. And that requires someone to go out, identify a specific individual, say you're.

allege that you're removable, arrest you, detain you, put you in some kind of facility while they prove it to an immigration judge that, yes, indeed, this person is removable from the United States. That's a burdensome process, as it should be. It shouldn't be just the government can grab people off the street and put them on a plane to some foreign country. That's not how it should work in the United States of America. And of course, even when you have identified a specific individual as removable, you have to then go get them. And that requires, OK, well, you know.

going into people's homes or searching businesses. And again, that's where Americans' rights, as business owners, as homeowners, as property owners who are renting to people, are all impacted by this quest for mass deportation. And look, I expect there are going to be significant obstacles to him carrying out millions of deportations. It's not as if he went in last term saying, yeah, I don't really care about mass deportation. No, he did all the same executive orders the last time around, and he was stymied by...

the logistics, by the practicalities, by the legalities. I think there are less obstacles, legally speaking, but I do think the Constitution provides some backstop for due process that will prevent it from ever getting to millions of people over four years. The cost. What does that look like? I got to assume hundreds of billions of dollars to achieve what they say they want to achieve. Yeah, absolutely. So, you know, there was a recent study from the American Immigration Council. It's the most detailed that I've seen looking at every component of the process and what it would take. And you're talking about over $100,000 per individual that they're trying to deport. So, you know, you just multiply that times 10 million, hundreds of billions of dollars in costs.

And then, of course, this is all debt, right? So you really triple it over the next century in terms of the cost to our debt and deficit because we're going to be paying interest on all this new spending that they want to do. And he says there's no price tag for mass deportation. I will spend whatever is necessary. But even if they have an unlimited checkbook, it's going to be less effective than they think it will be. And maybe that's partially my hope it will be less effective than they hope it will be. But I think past experience does tell us something here.

I hope we don't end up in a situation where we spend a half a trillion dollars to deport 10 million people. That would be a tragedy for our country. And of course, with those 10 million are many U.S. citizen kids and spouses and family members who are going to be caught up in this whole thing and be forced out of their country as well. And all of that is to say nothing of the impact of losing productive people.

millions of productive people in the U.S. economy who, whether here legally or not, are contributing for the most part. That's right. Yeah, just today, actually, we published an analysis, a fiscal cost analysis of this recent cohort that has entered. Congressional Budget Office says it'll end up being around 8 million people who've come in under the Biden administration. And that group of individuals are producing a lot of not just goods and services for us as Americans, which is obviously why they're here, the open jobs.

At one point in 2022, we had 12 million open jobs. We still have 8 million open jobs. And that's why they're coming in to contribute, to make our lives better. And at the same time, as a result of that productive activity, they're producing a lot in tax revenue for the federal government. And the analysis that we published today suggests that it'll be about $5 trillion in net present value over the course of their lifetime. And this is similar in magnitude to what the Congressional Budget Office says over the next decade, it'll be a trillion dollars in deficit reduction from this cohort.

Of course, ours is a much longer time span than the CBO, but in both cases, we're finding significant fiscal benefit to the immigrant population. And of course, because of, you know, that's just a byproduct, the taxes are kind of secondary to the economic benefit that they're providing to us as consumers and business owners and the rest. Clark, trade and immigration are two sides of the same coin. In many ways, when people are prohibited or they find it too costly to come to the U.S. legally to contribute, they're going to do those things in other countries.

or if they have those opportunities. A lot of the things that we would like to be produced in the United States will end up being produced elsewhere. And then guess what? We pay a tariff. In terms of services, is there any indication about what that might look like? That is cross-border services? I think just in general, services trade continues to expand pretty rapidly, in part because the U.S. economy has over time shifted its composition away from sort of manufacturing towards services. But yeah, I mean...

I think the internet and sort of our digital connectivity helps facilitate a lot of services trade. And so I think, yeah, that's an area certainly where I see a ton of growth potential over the coming decades. And we've seen a lot just in the past maybe 10 or 15 years. And again, I anticipate that that would continue. It seems pretty grim, guys.

What hope do you have going forward on your issue areas? My sense is, I guess, that there have to be some political costs to doing this in the short term that might be visible. So maybe speed of undertaking some sort of mass deportation plan would produce those political costs down the road. We saw overreach last time with the Trump administration's family separation policy. Once Americans see what mass deportation is going to look like, how it's going to affect American citizens, hopefully that will...

produce a similar reaction like, hey, this doesn't make sense. What are we doing here? This is a waste of our taxpayer dollars to be pursuing this. And yeah, I mean, I think Americans, they want a legal orderly process for people to come to the United States. That's what they want. Certainly, I think that's what they expect they'll get under the Trump administration. Unfortunately, I don't see them pursuing that as a strategy. They want to restrict legal entry. And ultimately, that will lead to more disorder rather than less.

From my standpoint, yeah, I think there will be a political price to pay when his promises don't come to fruition and when his policies reveal themselves to be in practice much different than how he's selling them. It's not going to be a bunch of gang members being deported. It's going to be a lot of people who are friends and family of Americans being rounded up and removed. Clark, on trade. Higher prices seem like the logical conclusion to across-the-board tariffs. And not just higher prices, but higher prices for inputs, which raise prices for things that the U.S. would like to export. Yeah, that's exactly right. And I think one of the things that the election last week revealed was that people and voters are not happy with the status quo in terms of price increases over the last couple years. And I think that this has the potential to sort of supercharge that. And so, as David was just saying, I do anticipate some sort of political backlash.

somewhat of a serious market reaction if he were to go out and announce pretty heavy tariffs. And maybe that gets him to sort of back off a little bit. But overall, yes, it's pretty grim. My outlook in terms of, you know, for those of us who believe in the free exchange of people, ideas and goods and services across borders. David Beer directs immigration studies at Cato, where Clark Packard is a research fellow.

Under the banner of the so-called Department of Government Efficiency, Donald Trump claims he wants to engage in substantial reductions in spending, the federal workforce, and particularly federal regulation. So far, at least, the evidence that these efforts will pay big dividends is pretty weak. It was Tom Fiery and Walter Olson discuss what should define those efforts over the next few years. President-elect Donald Trump will take office in a different regulatory environment, at least with respect to how courts will treat various attempts at federal regulating. Courts will not be bound to defer to agencies making certain interpretations of their statutory authority. So to talk about this, I've got Tom Fiery and Walter Olson. Walter, as far as the legal...

environment goes, what does this tell us about the likelihood of federal agencies to engage in the kind of broad sweeping regulation or deregulation that we, at least Donald Trump, has talked a lot about? Everyone knew that if the Chevron Doctrine got overturned, as it did, that this was going to... bring courts back in to closer scrutiny of whether the executive branch wasn't interpreting the law correctly or whether it was stretching. And of course, this overturn was much more popular with Republicans than with Democrats, who now get to find, like the dog who have caught the car, that it's their administration that is going to come under more exacting judicial scrutiny. Now, for a variety of reasons, I don't think it will necessarily make that much difference. One of the things the courts have been pretty willing to do for many years and under both types of administration is, chevron or no chevron, they were going to take a...

close look at whether through the major questions doctrine, so-called, or if you remember the various things that were done in response to COVID, they got, I think, quite properly strict with the Biden administration's attempts to use it to do things like moratoriums on evictions and the like. So where will it make a difference? Well, most likely on things where there isn't that much of a valence of right and wrong and more of a matter of technical regulation. There may be less inclination to let the agency have it if it's pipeline rates or something. The wider question which is interesting is, is the Trump 2 administration going to behave in the same ways as the Trump 1 administration on regulation? I think no one knows yet because there are numerous indications that we're not going to get the mixture as before.

And some of that is going to involve using regulatory agencies in new ways. Some of it may involve trying to pare back the scope of regulation. And as we all remember from previous instances, deregulation can count as regulation when it comes to judicial review. Judges can strike down deregulation under the same sorts of rules as they strike down regulation. Tom Fiery, with respect to technical regulation, what can we say with confidence about the first Trump administration with regard to sort of the rough metrics that people apply to regulation?

Well, my position on this is pretty well stated, which is the Trump administration really didn't do a whole lot. Trump came in claiming that he was going to cut two regulations for every one regulation that was implemented. And yet somehow mysteriously, the number of regulations went up. You can work around with the mathematics and try to figure out how that happens. The basic answer is there wasn't a lot of attention given to it. In the very first 90, 100 days, there was mainly because of Congress, because Congress had the Congressional Review Act, which is legislation that allows it to toss out regulations of the outgoing administration. The Congress in 2017 tossed out several Biden administrations.

or I'm sorry, several Obama administration regulations that they passed late in their term. But after that, things kind of went quiet. And the part of the reason for that is deregulation is very hard. It takes a lot of commitment and political capital by the chief executive and his administration. And quite frankly, Donald Trump just wasn't very good at that. So do you have any particular expectations with respect to the regulatory state? I know that you've written about this.

Schedule F, and this has to do with a certain class of employee that can be hired or fired at will. And at least early in the campaign for President Donald Trump talked up this idea of replacing a good deal of the federal workforce with the kinds of employees that could be easily fired. That is, with the assumption being that these employees will be more responsive to the demands of the administration. I've made a prediction about what's going to happen, and I'm curious to see if my prediction is right. Definitely, Donald Trump and his top people in his first administration believed they were blocked in achieving parts of their agenda by the federal bureaucracy. The reason they were blocked is simply that the bureaucracy churns slowly. It has to dot a lot of I's, cross a lot of T's, check a lot of boxes. This is a good thing in general, because whether you're a pro-regulation or a pro-deregulation administration, it basically slows you down and makes you work very hard to get done what you want to do. But Trump believes that, well, if I can get rid of these people, or at least some people.

around Trump, believe that they can get rid of these bureaucrats that slowed things down, that would allow them to get a lot more done through the bureaucracy. The problem is, the bureaucracy is a lot like a Jenga. board in which you have all these little bars crisscrossing, creating this tower. And if you just go through and just pull a bunch of them out, you're not going to somehow prove that the tower is going to fall down. Whether we like regulation or not, to have reform, it needs to be done with a lot of thought, a lot of precision. Again, a lot of dotting I's, crossing T's, and checking boxes. And again, the Trump administration, at least the first Trump administration, wasn't very good at that.

Continuing on the theme of looking at what he campaigned on this time, which is a somewhat different set of issues than what he campaigned on eight years ago, he campaigned a lot on energy issues. I would expect there to be more vigor applied to the energy and environmental side, partly, of course, to reverse things that Biden did. But once he gets much beyond that, he faces the fact that Congress's cooperation is really important. I'm one who reads the appointment of former Congressman Zeldin to the EPA as not quite as mystifying, in part because the EPA is seen as in the middle of a political thicket in which you are trying to reach out not only to Congress, which Zeldin has experience on, but also to the states, which are very important co-players. And the Northeastern states are actually an important block, whether it be on fracking or on pipelines or whatever. California is too.

but there's not much he can do about California, whereas he may feel there's something he can do about the Northeast. So one of the issues that may be in much more play the second administration than first is permitting reform, in that a head of steam is built up among some moderate Democrats, in part because they've discovered that our incredibly sclerotic approach to permitting means that clean energy projects, you know, solar and wind and so forth, get caught up in the same endless delays of other types of big projects. And so it will be interesting to see whether there is an attempt at putting together legislation that can pick up support from perhaps some Democrats or whether they treat it as just a Republican priority. Tom Walter said something which is... something I hadn't really thought seriously about, though I should have, which is the idea that deregulating for the purposes of courts can be the same as regulating.

Yeah, it all requires writing regulations. There is no such thing as simply yanking them out and throwing them in the trash. You take one chunk of regulations and you say, I'm rewriting this now in a completely different way to accomplish completely different things. And of course, Walter, remember you were in the Reagan administration. You got to see this firsthand that there were lots of pages written in the Reagan administration of regulation. They were just more market friendly, more relaxing than than what Reagan walked into office or even before that Carter had walked into the office and what the federal register looked like.

deregulation has to jump over the same sorts of hoops as regulation. Now, that still leaves the question of whether the Trump administration is all that interested in deregulation when push comes to shove. As you mentioned, Tom, he didn't do that much of it in the first term. And one of the things that has also changed between Trump one term and Trump two term is the national conservatives have come along, represented in some ways by J.D. Vance, who's going to be vice president. And their theme across many areas is we need to stop with these ideals of reducing the government and making it neutral. We need to invoke the government in order to smash wokeness and in order to win the wars that, by their view, the left has been fighting for all these times. So that immediately...

leads to several different regulatory areas, ranging from telecommunications and whether or not things like television are treated with a light hand, obviously to social media as a possible target for regulation. Also, right into areas like antitrust, where Trump has been known to want to use antitrust as a lever against what he views as hostile, opposed to corporations. I'm going to be watching with interest to see what his appointments are in some of those areas. There definitely are some people who would go into the FTC, the FCC, the antitrust division, and say, yeah, you ordered it, sir. We're coming up with making life much harder for some of these liberals.

corporations. And then there can be other people coming from other traditions, like, you know, the fondly remembered Ajit Pai of the FCC commissioner who just told Trump to take a hike, basically, when he said to yank licenses of these various broadcasters, sorry, Mr. President, that's not the way it works. So I'll be watching those with great interest. Yeah, to piggyback on what Walter said, you know, one thing that kind of sort of chilled down my spine about a month ago, J.D. Vance commented that one of the people that he really liked in the Biden administration, I can't remember whether he said they should try to hold him over to the new Trump administration, but he said he really liked was Lena Kahn, who is head of the Federal Trade Commission. Yeah, so I've spoken.

with Jennifer Huddleston on exactly that point. But more broadly to the point is that, you know, the national conservatives, people who believe that government should be a powerful tool used for good for specific ends that they like. I'm a little reminded of when Ronald Reagan first came into office in 1981. John Samples talks about this conversation that either a conversation he had or the writing of David Stockman on this, which was he hired people he thought were going to help him keep a handle on the scope and size and scope of government. you come into that first cabinet meeting and everybody wants something for the department that they are in charge of. Trump's appointments as announced so far are often people who don't have that much institutional stake in the areas he's pointing them out. And that's a separate discussion, but it signals that he may be looking for not simply someone who will appear at a cabinet meeting in order to represent the considered professional judgment of all of those civil service people under him. I'm going to throw in if I could pursue...

the question of what would national conservatives be urging him to do. And there are a couple of areas where I know there have been urgings that he turned the government into an instrument against wokeness. One of them is regulation of education and higher education in particular. And another one is the whole national HR department represented by employment and discrimination law. It has been encouraging companies to do DEI trainings. And there are a bunch of people in the, not just national conservatives, but others who say, look, we've got anti-discrimination laws on the books that that should be interpreted to forbid and make illegal some kinds of DEI trainings that wind up being divisive or that attack.

majority groups, put out regulations and make sure you go hard on companies that are trying to get away with that kind of work training. I know they're going to get that advice. Whether they take it or not, I don't know. Tom, your prediction for this next term then is what exactly, as succinctly as you can put it, so that I can easily throw it in your face if it turns out to be wrong. The first time around, we had a lot of smoke, a lot of mirrors and not a whole lot of activity. I think this time there may be more attempts to get some things done. I think a number of people who have hitched their wagon to Trump star this time around are doing so with specific notions of things they want to get done. I just don't know. So far, I've seen the appointments. I've kind of looked at the people that he seems to like. I don't know if they're particularly good at getting things done. And my phrasing it that way means I don't think they are. So we'll find out.

Walter Olson and Tom Fiery are senior fellows at the Cato Institute. Tom Fiery is managing editor of Regulation Magazine. There are perhaps no areas more ripe for federal reform than health care. Donald Trump's pick to direct the massive bureaucracy at HHS is Robert F. Kennedy Jr., someone whose ideas range from outside the box to utterly unsupported by science. Cato's Michael Cannon and Jeff Singer detail what we can expect in the next presidential term with respect to prescription drugs, health insurance, and health care regulation. First, a history lesson.

From Michael F. Cannon. Michael, when Donald Trump was elected to the presidency in 2016, there were plans to repeal and replace Obamacare. But much like the Kraken that was to have been unleashed in early 2021, revealing all manner of election malfeasance, nothing ever came of it. There were concepts of plans to repeal Obamacare. Republicans had made a lot of noise about that. They ran on that for several election cycles at that point. And when President Trump became president or when he won the election, it sort of took everyone by surprise. And they were a little bit like the dog that caught the car. They didn't really know what to do. And so when they went to put together to try to say that they delivered on this years long promise of repealing Obamacare, they put together two bills in the House and the Senate that didn't.

repeal Obamacare. They weren't repeal bills. They left the central provisions of Obamacare intact, but they called it repeal. And you got this bipartisan collusion around this deception that it was an actual repeal bill where each party said the same untrue thing, but for different reasons. And then when it failed, everyone said, well, Republicans failed to repeal and replace Obamacare. But in fact, they never even tried. And I think it's instructive to go back in time and look at what happened because it was the same cast of characters are coming into office in 2025. We're going to have a President Trump again.

We're going to have a Republican House and a Republican Senate. And you had the Speaker of the House saying that Obamacare needs repeal or at least drastic reform. And there will be legislation on health care, even though Republicans are really inept when it comes to health care. No matter what, there will be change when it comes to health care. And so it'll be interesting to see what happens. And maybe what happened in 2017 is just pre-staging what's going to happen this time around, where Republicans, hopefully, there's lots for them to do. There's lots of ideas that free market advocates have put out there that we've been...

begging Republicans to pursue for a long time. Hopefully, they'll have more of an appetite for actual change than they did in 2017. But maybe not. We'll have to see. Jeff, one of the people, and you and I have discussed this at length on the Cater Daily podcast, who may play an outsized role as of this recording in the middle of November, may play an outsized role in healthcare in the United States or health agencies in the United States, is RFK Jr., somebody who is, I believe, as you said in our previous conversation, at times off the wall. Some of his ideas are

Well, dangerous. And others, he seems to understand some of the endemic problems of federal policymakers. Yeah, I think there will be opportunities, I think, for significant FDA reforms. He's been, of course, calling for that. And a lot of people are very frustrated with the behavior of the FDA. He's expressed frustration, for example, at the FDA's foot dragging when it comes to approving psychedelics such as MDMA for psychedelic assisted psychotherapy. So there's an opportunity there for.

a push where Congress could actually push the FDA to move on that. This is actually has bipartisan appeal. Psychedelic assisted psychotherapy has been shown to be very effective in treating veterans with PTSD. A lot of Republicans like this idea. Also, there's, there's been a reform proposal that's been proposed in the Senate at least two times. And that's called international drug reciprocity, which reciprocity is really, I wouldn't have chosen that word because that implies I do something for you. You do something for me. But basically the idea is that in addition to.

doctors and patients being able to access drugs approved by the FDA, they can also access drugs approved by the equivalent agencies of a list of so-called trusted countries. I'll bring that in quotes. For example, drugs approved by the Canadian regulatory agency or the UK or the European Union or Israel or Japan or Switzerland. As an example, on two occasions, a bill has been introduced last time by Senator Mike Lee and Senator Ted Cruz called the RESULT Act. And that stands for Reciprocity Ensures Streamlined Use of Life-Saving Treatments.

But now with people being very frustrated with the slow response of the FDA to approving drugs and the general dissatisfaction with what appears to be regulatory capture and politicization of many of the FDA's decisions, that may breathe new life into that effort. Now, that's not an ideal solution, but at least it's a movement of things in the right direction. So with respect to health insurance, for example, and access to care, Michael, is there anything that Republicans or Donald Trump has said that you view to be moving in a positive direction? So sure, when the Speaker of the House says we need to repeal or drastically overhaul Obamacare, that would certainly be a move in the right direction. When Donald Trump says we should not cut Medicare at all, we shouldn't touch Medicare at all, that is incredibly detrimental to the cause of, first of all, fiscal rectitude in Washington, D.C., because the main problem with the federal budget, the main force driving federal deficits and debt higher is the Medicare program. But it's also a problem for health reform because we're not going to get.

more universal, lower cost, higher quality health care until we reform the Medicare program. Donald Trump said he doesn't want to do that. Michael, you had a thought on related to RFK Jr. being having outsized influence in the federal bureaucracy related to health. And I jumped on it before you could say it. His health advocacy is something of a mixed bag. He wants more restrictions when it comes to FDA regulation of vaccines, but fewer restrictions when it comes to, as Jeff mentioned, psychedelics. So the problem is we're with him on the psychedelics.

but not so much on the vaccines. His advocacy does not center around letting people make their own health decisions, letting people make these decisions for themselves. He's perfectly happy with the government standing in between people and the medicines that they want to take as long as those restrictions reflect his values. He just wants to substitute the values of the people who are currently running the FDA with his own values and then impose those on American patients. Jeff, what are the odds of substantially reducing the authority of federal health agencies to tell us what we can and cannot do?

Probably not great because what usually happens is the various special interests, including the pharmaceutical companies themselves, kind of like the current regime. They're comfortable with it. But at least along the edges, there are certain things we can do. For example, hormonal contraceptives. I think there's a real opportunity for Congress to basically tell the FDA that they should.

reclassify hormonal contraceptives as over-the-counter. Women can get hormonal contraceptives over-the-counter in 100 countries. And for decades now, the American College of OB-GYN, the American Academy of Family Physicians, the American Medical Association, have all said, you don't need to come to see us and get a prescription for hormonal contraceptives. You could do this yourself. Yet the FDA still will not allow women to obtain this over-the-counter. And there have been efforts both in the House and Senate on both sides of the aisle to try to address this so that we can see something there we might be able to see.

some legislation on telehealth where if Congress would say that the locus of care is the state in which the practitioner is licensed rather than the state in which the recipient of the care happens to be dwelling at the time using the Commerce Clause of Article I, Section 8, then that could make it more easy for people across the country to obtain health care using telehealth from health care practitioners all around the country, which, again, improves their choice and their control over their health care decisions. So these are things that... appear doable, but they're not giant steps. They're basically nibbling around the edges, in my opinion. Yeah, a whole lot of what I've seen so far in the early days is that people are getting confused, I think, about this distinction between having a government that is efficient and a government that is smaller.

And I certainly have my clear preference for one over the other. And I think Republicans broadly have had this confusion for a long time. I don't want a more efficient government telling me what to do. I would like less of it, please. And in health, it seems that that is a possibility, that that confusion continues. That confusion continues because President-elect Trump just created a thing that he's calling the Department of Government Efficiency. And the job of this...

private organization is going to be to recommend cuts in government programs. I think that would make the economy more efficient. It may or may not make government more efficient, but my favorite part is that he nominated or he named two people to head the Department of Government Deficiency. And that's right. You can see this distinction between the size of government and the efficiency of government in the Medicare program. People, especially Medicare for all advocates, love to boast that the Medicare programs are incredibly efficient because its administrative costs are less than 3% of outlays, less than 3% of...

claims payments. But that happens because the Medicare program does not review the claims that people submit. And so people submit fraudulent and abusive claims and upcode for all sorts of wasteful services all the time. And to the point where health spending among the elderly in the United States is even more out of line with international norms than health spending broadly. So if what you mean by government efficiency is having government send checks out the door to people faster with less oversight, you can definitely improve government efficiency.

But that's not what we need. What we need is to reduce the amount of money that the government is taking out of the economy and then wasting on low-value things that don't improve people's lives. Michael Cannon directs health policy studies at Cato Institute, where Jeff Singer is a senior fellow. What will be the drivers of a second Trump administration in terms of foreign policy? The first term was famously all over the place. Cato's Justin Logan and Brandon Buck evaluate what they expect in the next term.

As is sometimes the case with Donald Trump, the president-elect entering the White House for a second term, some of his impulses seem to be correct and his strategy and tactics seem to be troublesome. So, Justin, to the extent that you can lay out what the impulse might be in any given area of foreign policy, what do you expect generally to be the drivers of a Trump foreign policy come January? I'd like first to push back against the term strategy and the term tactics, because I think that we may be over attributing those in this case. Go ahead. That's your terminology. No, I think the president hasn't taken office yet. President-elect has not taken office yet. So he's assembling a cabinet. And I think, you know, I was always taught, you know, there are two kinds of analysts, simplifiers and complexifiers, and you want to be a simplifier. So to simplify, I think what we're seeing is...

abnormal premium being placed on personal loyalty to the president-elect. And so what that turns out to be, I think, is very much underdetermined, right? Trump, we remember from the first Trump administration, would turn on a dime sometimes with a policy that was zero yesterday and one today. So I think him not even having taken office yet, we're all sort of trying to determine what is happening based on these appointments. But being that the appointments appear to be driven primarily by personal loyalty to the man himself, they don't provide a lot of independent...

content, sort of ideological or policy content that we can suss out. Brandon, to the extent that we can point to the previous Trump term with respect to international engagement and specifically war. It strikes me that a lot of whatever his impulses were, it seems like they were pointed in a direction that I find agreeable. Yeah. Well, I mean, vis-a-vis Iran, it kind of depends when, right? Because he did obviously drone strikes Soleimani, but he also had an opportunity to escalate even further, right? There was that drone incident in which a drone was shot down and Trump quite famously thought that any kind of proportionality, you know, where the strike wasn't there. And so he didn't, so he didn't, right? So it's sort of a which Trump and which action. But, you know, vis-a-vis the overall commitment in the Middle East.

And there certainly was his attempt to pull troops out of Syria. He did end Operation Timber Sycamore, which was the effort to topple the Assad regime, which really, I mean, that was pretty big. And that was a sizable change in policy in the region. And so with some of these personnel changes, will he be able to plot a center course where he maintains, and let's be honest, he probably will likely maintain status quo with the Israeli government, but will he be able to make some changes at the margins, particularly vis-a-vis Syria and Iraq and his policy changes? I mean, his personnel so far leave that up in the air with the exception of possibly Tulsi Gabbard at DNI. And just one more point on this is the further that we get away from the global war on terror, the Cold War paradigm, it's going to be more difficult to classify what...

you know, a post-GWAT conservative policy is, right? Because it's been formulated as negatives, right? Things that we don't want to do. And there's largely absent of a positive vision. So it's going to be difficult to even talk in terms of non-intervention or intervention or war or anti-war, because at least as far as the American conservative movement is, we're entering into uncharted ideological waters. Is there a sense, Justin, in the first Trump term, it seemed that with respect to a planned withdrawal from Afghanistan,

To me, that's the example where you can point to and say, it seemed like President Trump was getting the runaround from the Pentagon and was extremely frustrated by it and did the best he could, it seems, to put a plan in place to cajole, compel the next administration to complete that task. Yeah, so I'll see you in raise, right? I got back into this business in November of 2018, and I think it was December 23rd of 2018. Trump gave this very short, very succinct, very linear, logical argument for why we were going to withdraw from Syria. And he said, the caliphate has been destroyed. That's what we went in to do. ISIS holds no territory. The troops are coming home.

And I thought to myself, my goodness, have I been missing this, you know, while I was, you know, off doing other things? And so USA Today does this thing where they write their own editorial and then they have the so-called opposing view. So they were vehemently against withdrawing from Syria. And they said, well, you and a former colleague of mine write the opposing view saying it's good to get out of Syria. We said, absolutely, we'd love to. And that was a case where, you know, Trump literally had the rug pulled out, not literally had the rug pulled out from under him, but had the rug pulled out from under him by people who were hiding the number of troops we had in Syria from the president of the United States and admitted this.

In a popular publication said it was we were always playing a shell game with the number of troops that we had there so that they could essentially make Trump believe that we had, in fact, withdrawn. And I think to go back to my previous point about personal loyalty, had you had people in government at that time who were personally loyal to the president. We might have withdrawn from Syria. It just happens to be the case that the people who were there were working assiduously against the president's policies in a place where, in my view, they were good to squash them effectively. And so we still have troops in Syria to this day. So I think this goes back to this point about personal loyalty, where it really depends on Trump's impulse on any given policy. But in the first term, where he had good impulses, he had disloyal people in his administration who squashed the policies. And I think, you know, if he has some good impulses this go around, we should have a little bit more hope that they might actually be followed through on.

Yeah. And those impulses will... I mean, certainly, I think if Gabbard is confirmed, that might be a uphill battle, but she might serve as ballast in a cabinet by certainly Secretary of State Rubio, who's a little bit more of a plumb line hawk in a neocon tradition. So I don't know. In addition to loyalty, is he trying for some kind of cabinet arrivals thing here? I mean, I don't know that he's... He went there. You really went there. Well, I am a historian, so I do have to occasionally...

Let that be known. Is that his effort or is it just all loyalty? We don't know. But if you do have a few folks like Gabbard, maybe some other big names that folks like us are hoping for, maybe there'll be some sort of ideological ballast in the cabinet. Is there anything that we should take away from the nomination of Pete Hegseth to head the Defense Department? I mean, it seems like a sort of off the wall pick. But Justin, if what you say is true about Donald Trump having the rug pulled out from under him.

And like many presidents, having facts obscured when it comes to so-called progress in the war in Afghanistan, as I think you and others have said, we turned 20 to 30 corners in Afghanistan in our quote unquote progress in that war. Yeah, I mean, I think, you know, I'll go back to the well here and point to not just the personal loyalty thing, but, you know, we've forgotten a little bit or I forgot a little bit what the sort of I've used this term with mild amusement, the sort of Trump show, like what it was like. And the answer is it was a lot like this. So Donald Trump famously watches a lot of TV. And Pete Hegseth is a guy who's on TV a lot. So he has the personal loyalty there.

And he has on TV a lot there. We famously remember the stories of Trump seeing John Bolton on TV. And I think the thing was Trump didn't like mustaches, but then he got over that in Bolton's case because Bolton was, in his terms, a madman. And he thought that this would be, I mean, we're all laughing here, but it's true, right? And so Hegseth is a guy who's always on TV and is very loyal to the president. And so I think you can, look, if you want to make the argument on the other side, right, secretaries of defense are not the comptroller of the defense department, which is like a really wonky in the weeds job where you have hundreds of billions of dollars sloshing around. You know, my wife is an accountant.

Accounting terrifies me, but you know that you can't, whereas the secretary of defense, yes, you might have any secretary of defense might have one or two or three things that he or she wants to accomplish. And there's a whole ton, hundreds and hundreds of other big consequential developments that are happening beneath that level that are done by deputies, et cetera, et cetera. So, you know, if you want to make the case, it's that, you know, Hegseth has said he's going to go after wokeness, right? There's talk about having a group of retired generals that will defenestrate generals that don't have the attributes the president wants. I think.

You can make cases for and against this. It's not the case that the officer corps has really been putting up a lot of wins over the past several decades. So some accountability might be in order here. However, do you want to have any president just hiring and firing generals on a whim based on vibes, right? And so I think that you can look at both sides of it. But, you know, if Hegseth comes in and he wants to do get rid of wokeness and DEI and this stuff and one or two other things, there will be a lot of consequential developments that happen beneath that that won't necessarily be designed at a detailed level from the top and then pushed down into the bureaucracy. I can.

Remember, I think it was 2019 when Congress really, in a sense, stood up to Donald Trump because of his preferred policies in Syria and Afghanistan, led by Mitch McConnell. And there's no love lost there. Is it more likely perhaps that Congress would go along with the less hawkish impulses to the extent that they exist for this White House than last time around? That is an interesting question. I mean, I looked at the midterms this past time, and even though the Republicans underperformed, those that took a non-interventionist or dovish stance, if you will, vis-a-vis Russia and Ukraine actually did quite well. So especially if...

a future president Trump could present himself as having a mandate and having a level of popular support in the base. He does have some people to work with on the Hill and perhaps then politicians, being who politicians are, wanting to get reelected perhaps will sense where the wind is blowing and get further in line than they did perhaps with a first Trump term in which he won by the skin of his teeth. It's different this go around. So perhaps Congress will see that the... basis change and it's moving in that direction and is more amenable to restraint. I think also, if you want to go back to the first Trump term, one of the areas where you really saw an uncommon congressional resurgence was on Yemen, where there was a real right-left convergence on war powers issues with the U.S. project, if you want to call it that, in Yemen. And of course, President Trump famously vetoed the restrictions on his authority to continue the policy. I think that is not likely to resurface. I think you're going to see a lot of reticence to rein in the president's ability, not to say right.

to do various things overseas without congressional authorization. Again, you have to think of it from the very most cynical frame of reference, right? What Congress wants to do is to take credit when things go well and avoid blame when they go poorly. So it's rational for Congress to enable an administration to do things and then blame them if they go casters up without having their fingerprints on it one way or the other. They can take credit without authorizing things, but they will have to take blame if they choose to authorize them and they go poorly. So I do worry about...

That admittedly failed. I mean, they passed legislation and then the president vetoed it. But it was a sort of glimmer of the kind of congressional coalition that would reassert Congress's role, rightful constitutional role in matters of war and peace. And so I do worry that we're less likely to see, should there be more conflicts of that nature, we're less likely to see serious pushback. It is sort of shocking to think that the U.S. is still a presence in Iraq.

or at least I suppose it should be. What is the game theory of the U.S. ending its involvement there? I don't think it requires game theory. I mean, these troops are sitting ducks in a country that is cheek to jowl with some of the sketchiest characters in the Iranian government. We keep telling ourselves that we're there to help train and equip the Iraqi forces, who are, again, cheek to jowl with these folks. A lot of these guys, to a lesser extent than in Syria and Jordan, but to a pretty significant extent.

are sitting ducks for regional militias who are, again, in the middle of this trifecta between the Iraqi government and paramilitaries in Iraq that are tightly linked to the Iraqi government, rogue sort of groups inside Iraq and the Iranian government. So I don't think you need game theory here to, you know, I ain't no game theorist, but to make the case that we ought to get out. There's been these halting efforts to try to negotiate a withdrawal. All the people who you would imagine from the Saudis to the CENTCOM commander don't want to get out. And so how that would go if, you know, as Brandon was pointing out earlier.

Were there a Biden initiative to get troops out? The question is, if that were thrown into Trump's lap, what he would do with it? I don't know, Brandon. I mean, it would give him the opportunity to disperse responsibility for this decision, right? Much like Afghanistan, but in reverse, right? He could take it, go with it. If it goes well, he could take credit for it. If it goes poorly, then the Democrats could blame him for it. But in any event, it would give a window to spread this decision over two administrations. And it could give him an opportunity to give a...

a bone to his base who obviously wants this and there is a desire to do it. So maybe by spreading that decision out over two administrations, it would give him a bigger window to act on it. Yeah. And I think just maybe as a coda to this, J.D. Vance in particular represented the ticket as an anti-war ticket.

I mean, it was made expressly clear during the campaign. And there was a good piece in Foreign Affairs in the middle of November by Dan Caldwell and Reed Smith, former friends, well, current friends and former colleagues of ours, that basically said, you can't go back on this, right? You ran as a peace candidate. And, you know, FDR ran as a peace candidate. Brandon could go down the list of American presidents that ran as peace candidates and then reneged. And I really do think it's important to hold the administration accountable to what they sold to the American voter. And that was peace, right? No new wars. Trump says this over and over again. There were no new wars under my administration. And, you know, the problem here is that.

There's an awful lot of, you know, we Catholics talk about the near occasion of sin. There's the near occasion of war in pretty much every theater across the globe. So they're going to have to have some dedicated commitment to getting away from that near occasion of war if they really want to deliver what they promised to the American people, which was being anti-war. Justin Logan directs defense and foreign policy studies at the Cato Institute. Brandon Buck is a research fellow at the Cato Institute.

As I mentioned at the top of this program, this will be our final monthly edition of Cato Audio. We'll still continue bringing you the best thinking emanating from the Cato Institute, but our next edition will come in February 2025. We'll continue keeping you up to date with Unintended Consequences, the podcast of Regulation Magazine, our events podcast feed, and of course my personal favorite, the Cato Daily Podcast. That will do it for this edition of Cato Audio. I'm Caleb Brown. Talk to you again next year.