In a wild presidential election featuring dozens of criminal felony charges, fallacious claims about election fraud, and sexist invective, it's easy to forget a fundamental truth: The real impact of the election will be expressed through changes to federal law and policy. 

After Trump won in 2016, he nominated several right-wing judges to the Supreme Court, and now there are no federal protections for abortion rights. As a result, women are dying. Those federal protections would still exist if there had been a different outcome in 2016. 

So, how would a 2024 victory for Trump impact policy? 

Trump is not eager to say. Trump claims his policy agenda is available on his campaign website, Agenda47. But Agenda47 is just a series of disjointed talking points presented by Trump in video monologues. For example, one Agenda47 video claims that Trump will "eradicate the drug addiction crisis in America" by strengthening "the pillars of work, faith, and family which give life meaning," and taking other vague steps. 

There is one policy area where Trump has been much clearer. At his Madison Square Garden rally on October 27, Trump said he would put RFK Jr. in charge of the nation's health policy. "I’m going to let him go wild on health, I’m going to let him go wild on the food, I’m going to let him go wild on medicines," Trump told the crowd. At an online event the following day, RFK Jr. said that Trump had promised him "control" of all federal public health agencies.

What are RFK Jr.'s plans once he controls federal public health policy?

On Saturday, RFK Jr. posted on X that he would "advise all U.S. water systems to remove fluoride from public water" on the first day of Trump's presidency. 

According to the CDC, fluoridated drinking water in the United States is "one of the ten greatest public health achievements in the United States."  Specifically, "[d]rinking fluoridated water keeps the teeth strong and reduces tooth decay by approximately 25% in children and adults." Fluoridation of community water supplies is "recommended by nearly all public health, medical, and dental organizations including the American Dental Association, American Academy of Pediatrics, US Public Health Service, and World Health Organization." According to the American Dental Association, "every $1 invested in water fluoridation saves $38 in dental treatment costs." While the federal government is not directly involved in fluoridating water, there are many ways for the federal government to influence state and local policy.

Community water fluoridation has been criticized by cranks and conspiracy theorists since the 1950s when some claimed it was part of a plot by Communists to brainwash the American public. Others falsely claim that the practice was started by the Nazis as a method to poison and pacify Jews. In his post, RFK Jr. incorrectly describes fluoride, a naturally occurring mineral, as "industrial waste." Fluoride can be a byproduct of the production of aluminum and certain fertilizers, and conspiracy theorists have claimed that water fluoridation was pushed by corporations looking to offload their excess fluoride. 

Like many substances, fluoride can be harmful at very high concentrations, according to the EPA. A recent study found fluoride may be linked to lower IQ in children in concentrations "at or above 1.5 milligrams per liter (mg/L)." But that is more than twice the recommended community fluoridation level of 0.7 mg/L in the United States. In September, a federal judge directed the EPA to review its guidelines to ensure a sufficient margin between the current recommended levels of water fluoridation and levels that are safe for children. The ruling has been seized on by RFK Jr. and other fluoridation critics, but it stops well short of removing all fluoridation from water. 

The Trump campaign, notably, chose not to contradict RFK Jr.'s claims about the Trump administration's plans for fluoridation. “While President Trump has received a variety of policy ideas, he is focused on Tuesday’s election,” Trump adviser Danielle Alvarez told the Associated Press. 

Fluoride is not the only issue where RFK Jr.'s views deviate from public health experts. RFK Jr. has also falsely linked childhood vaccines — which have saved millions of lives — to autism and chronic diseases, claimed that COVID-19 was engineered to spare Ashkenazi Jewish and Chinese people, and claimed that 5G technology "damages human DNA [and] causes cancer." 

The potential adverse impacts of putting someone like RFK Jr. in charge of federal public health policy are unknown. Should he win the presidency again, Trump appears determined to install loyalists in key positions regardless of their qualifications — or the consequences. 

Musk's $2 trillion cut

Trump has also promised to appoint Elon Musk, who has spent over $120 million backing Trump, to a new position to reduce government spending. Musk promised to cut $2 trillion in government spending, a massive reduction that would make significant cuts to "Social Security, health care, defense, and veterans’ benefits" unavoidable. Musk, the world's richest man, acknowledged that his proposals would "necessarily involve some temporary hardship" for Americans. 

The truth about Project 2025

Dozens of people appointed or nominated to positions in the first Trump administration and transition created a policy blueprint called Project 2025 under the auspices of the Heritage Foundation. Project 2025, which spans 922 pages, calls for withdrawing approval for the abortion pill, banning pornography, slashing corporate taxes, abolishing the Department of Education, replacing thousands of experienced federal workers with political appointees, imposing a "biblically based… definition of marriage and families," and placing the Justice Department and other independent agencies under the direct control of the president.

Trump has sought to distance himself from the document, saying he "has no idea who is behind it." Heritage Foundation President Kevin Roberts, however, told the Financial Times that he is "personally close" with Trump and talks to him "often." Roberts says that "based on conversations with President Trump and his associates… some large percentage of these recommendations will be in the mix for implementation."