Robert S. Kiefner, MD, retired family physician, lives in Concord.

Project 2025 is a compilation of greatest hits of the Heritage Foundation, and a guidebook for those intent upon “taking our country back” — to the Middle Ages, that is. Although former President Trump has often distanced himself from Project 2025 when in his best interest, Heritage President Kevin Roberts has described the effort as “institutionalizing Trumpism.”

As one focuses on the healthcare policies, one can legitimately deduce that Project 2025 is a right-wing playbook designed to harm as many Americans as possible by gutting programs that work and promoting those of no value. Though the healthcare section is only 54 pages of the 900+ page diatribe, it painstakingly details the plans to degrade our basic rights, health, and dignity. Let’s summarize the treachery of the Project 2025 healthcare agenda.

Goal one is entitled “protecting life, conscience, and bodily integrity.” The authors state that “a robust respect for the sacred rights of conscience, both at HHS and among governments and institutions funded by it, increase choices for patients and program beneficiaries and furthers pluralism and tolerance.” And, for them, abortion is not health care. Any discussion of gender identity and basic human rights for members of the LGBTQ community “threatens American’s fundamental liberties as well as the health and well -being of children and adults alike.” Rather than supporting freedom and constitutional rights, the compassionless positions of Project 2025 would do the opposite, while promoting hate and distrust of the healthcare system.

Goal two states that, “Health care reform should be patient-centered and market-based and should empower individuals to control their health care-related dollars and decisions.” Of course, we need patient-centered care, but yielding one’s health to the profiteers of private insurance companies has never been demonstrated to do this. The Project 2025 proposal to shove people into junk insurance and privatized Medicare Advantage programs, with less choice and worse outcomes than traditional Medicare, is a fine way to add $80+ billion per year to our monstrous national debt.

For those on Medicaid, the imposition of block grants upon states, and work requirements upon beneficiaries, would most certainly result in millions of poor folks being cut loose from the safety net. The Heritage people go on to say that “of course, providers who deliver health care also need the freedom to address the unique needs of their patients.” The enactment of Project 2025 would effectively hogtie and demoralize providers, who would be rendered powerless to properly care for women’s reproductive health. A reliance upon private insurers assures that delay and denial of care will reign supreme. The ranks of healthcare providers, already critically short in many areas of the country, would be further depleted by the moral injury imposed upon providers.

Goal three is ostensibly concerned with “promoting stable and flourishing families.” The authors clearly state that single parents, LGBTQ parents, and other nontraditional parenting represent an anathema to proper and moral child-rearing. Further, they believe that health policy and financial assistance should be directed away from non-nuclear families. For a movement supposedly advocating for less government and for more personal freedom, they sure want to spend a lot of time collecting data on us and snooping around in our bedrooms and physicians’ exam rooms.

Goal four is nothing less than a proposal to demolish public health in the United States. Oblivious to the reality that COVID-19 was a novel, evolving, and highly lethal virus, the authors broadly and brazenly condemn the scientists who eventually gained the upper hand through public health measures and rapid vaccine development. Hindsight does, indeed, provide perspective as to how the pandemic could have been better managed. But most of the objections to public health measures were based upon misinformation wrapped in politics.

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While Donald Trump ranted on about conspiracy theories, dangerous and ineffective treatments, and the miracle of introducing disinfecting light into the lower intestine, true public servants and scientists like Drs. Deborah Birx and Anthony Fauci could only stand in silence and wince, lest the pandemic response be fully hijacked by lunatics. The missions of the CDC and the NIH should be fully defined by scientists, not ideologues.

The goals of Project 2025 relative to healthcare go on to fit the narrative of a radical Christian Nationalist agenda. There is much emphasis on denial of women’s healthcare, from defunding of Planned Parenthood to the banning of mifepristone and misoprostol, and the criminalization of all abortions, medical necessity notwithstanding.

Vaccines, the greatest public health accomplishments of modern times, would also come under fire. Project 2025 would ban vaccines with even remote ties to fetal tissue, while Trump has stated that he would withhold federal funds from any school that mandates vaccines for children. And Project 2025 would further stir the cauldron of infectious disease by eliminating Medicare coverage of vaccines for seniors.

So, in summary, Project 2025 has something for everyone who yearns for the bloodletting of the Middle Ages. If you are a pregnant woman with life-threatening complications, you’ll have few options to survive. If you are a school-aged child whose parents have gone down anti-vax rabbit holes on the internet, you may well die of a disease readily prevented by vaccines. If you are a young adult with a new or preexisting medical condition, you’ll have a tough time getting medical attention if your Medicaid coverage unravels or your ACA guarantees are torched by Project 2025 initiatives. If you are LGBTQ you will simply cease to exist as an individual with human rights. And, as a Medicare beneficiary, you will be denied coverage for life-saving vaccines. Welcome to the medieval healthcare of Project 2025, complementary leeches for everyone.