Description
John Lister’s book delivers a searing examination of what happens to health care when power falls into the hands of a narcissistic, authoritarian leader intent on enriching a small elite of business allies across finance, technology, real estate, and fossil fuels. Using Donald Trump’s second presidential term as its main case study, the book exposes how self-interested governance and reactionary ideology can devastate public health systems, entrench inequality, and imperil millions of lives—not only in the United States but around the world.
At the heart of Trump’s agenda lies a systematic effort to dismantle public welfare in favor of the ultra-rich, guided by the Heritage Foundation’s “Project 2025,” an ultra-conservative blueprint designed to reshape U.S. federal institutions and centralize power in the executive branch. Every aspect of publicly funded care is targeted for cuts to justify massive tax breaks for the wealthy. Medicaid reductions alone are projected to strip health coverage from 15 million Americans and endanger hundreds of rural hospitals and nursing homes. Meanwhile, 22 million families stand to lose benefits from the Supplemental Nutrition Assistance Programme (SNAP), deepening hunger and poverty.
The book also underscores the reckless appointments and anti-science attitudes that define this administration’s health policies. The nomination of Robert F. Kennedy Jr.—an anti-vaccine activist known for bizarre personal behaviors—as Health Secretary epitomizes the fusion of conspiracy thinking and political extremism (“woo-woo meets MAGA”). In parallel, billionaire Elon Musk’s influence over U.S. aid funding is portrayed as emblematic of plutocratic indifference—“the world’s richest man killing the world’s poorest children.”
The broader human toll is staggering. The book estimates that Trump’s policies could contribute to 15.2 million deaths from AIDS, 2.2 million from tuberculosis, and nearly 8 million preventable child deaths worldwide. Cuts to the Centers for Disease Control and Prevention and to vital medical research—including cancer studies—further erode the global capacity to respond to disease and health emergencies. Environmental and climate policies are equally catastrophic: NASA’s climate satellites face destruction for revealing data inconvenient to climate-change deniers, while environmental protections are rolled back, asbestos bans reconsidered, and dangerous pesticides deregulated. Even basic public-health measures like water fluoridation are questioned, illustrating the ideological hostility to evidence-based policy.
Lister’s analysis links these developments to global trends, particularly in Britain, where Reform UK—supported by Trump and the far right—echoes similar themes: climate-change denial, increased health privatization, defunding the NHS, and hostility toward migrant workers whose labor underpins the healthcare system. Such parallels make the book acutely relevant beyond the American context, serving as a warning to democracies everywhere.
Ultimately, the book is both a lament and a rallying cry. Quoting former U.S. official Eric Schwartz, Lister concludes that words can barely capture “the horrors that this administration has visited on the world.” Yet amid the devastation, the author calls for resistance: community solidarity, public protest, advocacy, and legal challenges. The hope is that widespread outrage will one day consign Trump’s legacy to history’s museum of hubris—his reign remembered, in Shelleyan irony, as a monument to arrogance and ruin: “My name is Trump, king of kings; look on my works, ye mighty, and despair.”
