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Category: Health Policy

A Proud Republican Who Faced Off A Party Leader. . .and Won!

By MIKE MAGEE

This past week, Trump’s posting of himself as The Pope surfaced once again David French’s classic Christmas, 2024, New York Times column titled “Why Are So Many Christians So Cruel?”

As I wrote at the time, “French and his wife and three children have experienced the cruelty first hand since he openly expressed his opposition to Donald Trump during the 2016 Presidential campaign. That resulted in threats to his entire family by white supremacists who especially targeted his adopted Ethiopian daughter. Ultimately, he was “cancelled” by his own denomination, the small (approximately 400,000 members), Calvinist “Presbyterian Church of America”.

Over the past week, American politicians of every stripe have debated what exactly was Trump’s motive in debasing the Papacy as Pope Francis was being laid to rest. Three main theories have emerged. 

1.      As a malignant narcissist, Trump could not bear the fact that Pope Francis was stealing his limelight.

2.      Trump was appealing to conservative Christian Evangelicals who are strongly opposed to the Papacy on theological grounds.

3.      Trump was appealing to conservative Catholics like New York Post columnist Charles Gasparino who says, “… we respect Trump more than the socialist Pope.” 

Of course, there likely are elements of truth in each of these. But I prefer to fall back on my New York City high school training and believe that this is the product of a dull witted school yard bully who thought this was funny. 

This is not to say he has the courage to claim ownership. (Obviously this doesn’t get posted without his approval.) No. He lies to your face, saying:

“I had nothing to do with it, Somebody made up a picture of me dressed like the pope, and they put it out on the internet. That’s not me that did it, I have no idea where it came from — maybe it was A.I. But I have no idea where it came from.” 

With his blessing, the image was posted at 10:29 PM on May 02, 2025 on his Truth Social account.

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Medicaid Should be Abolished. But Not Like This!

By MATTHEW HOLT

A long time ago in a different country, there was a landslide election from a population looking for change. And change they got. Americans had been campaigning for national health care since 1917. There had been failures in 1933 and 1946 and 1961. But in 1965 they got it. Sort of.

But a weird thing happened in the Congress. Out of the political sausage making came a plan that “Cared” for those over 65. While another plan came out that “Aid”ed the poor. (Stole that from the wonderful Adimika Arthur). Weirder still, the Medicare program was and is a Federally-funded program. The Medicaid program was a state-administered program, even though it was at least half funded by the Feds. 

That meant that Medicaid was always vulnerable to the whims of states. Of course many states already had demonstrated dismal records in how they treated their poorer and minority populations in the past (think slavery, Jim Crow, KKK, separate schools, drinking fountains, buses…you get the idea).

So while Medicare became the savior program for anyone who made it to 65, and later for those who were disabled or had kidney disease, Medicaid was a program for poor people that then got treated poorly. (Stole that from Jonathan Cohn). And right now in 2025 it is under severe threat yet again.

Before we get to that threat, it’s worth looking at the program. Medicaid has evolved and now covers most nursing home care (for “poor” seniors), care for the disabled, and even pays Medicare Part B premiums for people too poor to pay their own.  It also covers health insurance for poor people under 65 and in those states that accepted ACA Medicaid expansion, that’s a considerable number. Of course these are people under an imaginary line that makes them too poor to buy on the exchanges set up by the ACA. And usually Medicaid includes the CHIP program, an insurance program that covers poor children set up under Clinton in 1997.

This chart from the venerable KFF shows that while 75% of people on Medicaid are, poor, under 65, and not classified as disabled, 50% of the money goes to those who are not.

This all results in a bizarro world in which there is one Federal government program for people over 65 and the disabled, and then an entirely different state-based one, which spends 1/2 of its money on people who are over 65 and disabled and who are also in the Federal program. This is plain stupid and always has been.

Of course there is more to it than that.

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Welcome to the (U.S. Science) Apocalypse

By KIM BELLARD

I’m starting to feel like I’m beating a dead horse, having already written a couple times recently about the Trump Administration’s attacks on science, but the hits just keep on coming. Last Friday, for example, not only did the Administration’s proposed 2026 budget slash National Science Foundation (NSF) funding by over 50%, but Nature reported that the NSF was ceasing not only making new grants but also paying out on existing grants.

Then this week, at an event called “Choose Europe for Science,” European leaders announced a 500 million euro ($566 million) program to attract scientists. It wasn’t specifically targeted at U.S. scientists, but the context was pretty clear.

Sudip Parikh, chief executive officer of the American Association for the Advancement of Science, called the proposed budget cuts “a crisis, just a catastrophe for U.S. science.” Even if Congress doesn’t go along with such draconian cuts and grant approval resumes, Dr. Parikh warns: “That’s created this paralysis that I think is hurting us already.” 

One NSF staffer fears: “This country’s status as the global leader in science and innovation is seemingly hanging by a thread at this point.”

Nature obtained an internal NSF April 30 email that told staff members “stop awarding all funding actions until further notice.” Researchers can continue to spend money they’ve already received but new money for those existing or for new grants are frozen “until further notice.” Staff members had already been told to screen grant proposals for “topics or activities that may not be in alignment with agency priorities.”

NPR reports that some 344 previously approved grants were terminated as a result, as they “were not aligned with agency priorities.” One staffer told Nature that the policy had the potential for “Orwellian overreach,” and another warned: “They are butchering the gold standard merit review process that was established at NSF over decades.” Yet another staffer told Samantha Michaels of Mother Jones that the freeze is “a slow-moving apocalypse…In effect, every NSF grant right now is canceled.”

No wonder that NSF’s director, Sethuraman Panchanathan, resigned last week, simply saying: “I believe I have done all I can.” 

If you think, oh, who cares? We still have plenty of innovative private companies investing in research, so who needs the government to fund research, then you might want to consider this: new research from American University estimates that even a 25% drop in federal support for R&D would reduce the U.S. GDP by 3.8% in the long term. And these aren’t one-time hits. “It is going to be a decline forever,” said Ignacio González, one of the study’s authors. “The U.S. economy is going to be smaller.”  

If you don’t believe AU, then maybe you’ll believe the Federal Reserve Bank of Dallas, which estimates that government investments in research and development accounted for at least a fifth of U.S. productivity growth since World War II. “If you look at a long period of time, a lot of our increase in living standards seems to be coming from public investment in scientific research,” Andrew Fieldhouse, a Texas A&M economist and an author of the Dallas Fed study, told The New York Times. “The rates of return are just really high.”

It’s no wonder, then, that European leaders see an opportunity.

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Tom Knight, HealthcareDiversion.org

Tom Knight is the Chairman of HealthcareDiversion.org, a nonprofit that is trying to educate about the topic of drug theft from facilities. This happens both because medical professionals are addicts (and victims themselves) and also because of organized crime and resale. The consequences are awful, with patients receiving water instead of analgesic drugs, getting infections and often dying. And of course there’s a lot of liability and problems for those facilities when these issues are found out. What’s worse is that this problem is rampant. Tom has built a database to show just the tip of the iceberg of the problem. So come on a journey to a terrible health care problem you’ve never thought of that almost certainly affects you–Matthew Holt

Pope Francis Links to Scalia on Due Process: The Case Made by a Skadden Litigator

By MIKE MAGEE 

The Pope’s passing interrupted an epic battle between Trump and the rest of the civilized world over whether America remains a society “under the law.” Critical to the rule of law is the principle of “Due Process,” as described in not one, but two Amendments to our Constitution. 

The Fifth Amendment states that no inhabitant shall be “deprived of life, liberty or property without due process of law.” 

The Fourteenth Amendment, ratified after the Civil War and Emancipation, uses the same eleven words, called the “Due Process Clause,” to describe a legal obligation of all states. 

In arrogantly ignoring any pretense of “Due Process” last week by deporting accused (but not proven) alleged gang member Kilmar Abrego Garcia to an El Salvador top security prison along with 220 others, and ignoring a court order to return the planes while still in flight, Trump basically thumbed his nose at America’s legal system. This was a bridge too far, even for some of his political supporters in Congress. 

With that case still in litigation, the Administration tried to repeat the publicity stunt with another group of accused aliens this past weekend and was slapped down by the Supreme Court in an unanimous decision. 

What Trump is learning the hard way is that without “Due Process” the law profession might as well hang up its shingle. Trump thought he had Chief Justice Roberts in his pocket when he purposefully allowed himself to be caught on a hot mic as he passed the Chief Justice on his way to deliver the 2025 State of the Union Address. His words for the camera, “Thank you again. Thank you again. Won’t forget it.”  were intended to signal to the world, He owes me big time, and I own him. 

A common “Due Process” thread connecting these two current events (the Pope’s death and the illegal deportation of Kilmar Albrego Garcia)  includes another Supreme Court Justice – Antonio Scalia. Catholic and trained by Jesuits, he shared a common lineage with Pope Francis, the first Jesuit ever to lead the Catholic Church. Other Justices also share this Jesuit educational parentage including Clarence Thomas, Brett Kavanaugh, and Neil Gorsuch. 

But Francis and Antonin have a second historical connection. Pope Francis, the day before the 2025 State of the Union address, publicly labeled the immigration policies of the incoming President and Vice President, “a disgrace.” More recently, the Vatican spoke out in opposition to last weeks El Salvador imprisonments. Part of criticism tracks back to the lack of “Due Process.” 

Glaringly obvious today, this was just one arm of an aggressive Project 2025 campaign against America’s Legal Profession. By late March, multiple DC based law firms pledged allegiance to the Trump Administration to avoid being barred from entering Federal buildings to represent their clients. Some members of the targeted firms resisted. For example, Skadden associate, Rachel Cohen, resigned from her firm in protest, stating, “It does just all come around to, is this industry going to be silent when the president operates outside the balance of the law, or is it not?” 

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Fair Warning: There Won’t Be Fair Warnings

By KIM BELLARD

Perhaps you are the kind of person who acts as though that the food in the grocery store somehow magically appears, with no supply chain vulnerabilities along the way. You trust that the water that you drink and the air you breathe are just fine, with no worries about what might have gotten into them before getting to you. You figure that the odds of a tornado or a hurricane hitting your location are low, so there’s no need for any early warning systems. You believe that you are healthy and don’t have to worry about any pesky outbreaks or outright epidemics.

Well, I worry about all those, and more. Say what you will about the federal government – and there’s plenty of things it doesn’t do well – it has, historically, served as the monitoring and warning system for these and other potential calamities. Now, under DOGE and the Trump Administration, many of those have been gutted or at least are at risk.

But, at the end of the day, the thing at risk is us.

Here is a not exhaustive list of examples:

FDA: Although HHS Secretary Kennedy has vowed he will keep the thousands of inspectors who oversee food and drug safety, it has already suspended a quality control program for its food testing laboratories, and has cut support staff that, among other things, make arrangements for those inspectors to, you know, go inspect.  Even before recent cuts, a 2024 GAO report warned that the FDA was already critically short on inspectors.

The FDA has already laid off key personnel responsible for tracking bird flu, including virtually all of the leadership team in the Center for Veterinary Medicine’s office of the director. Plus: “The food compliance officers and animal drug reviewers survived, but they have no one at the comms office to put out a safety alert, no admin staff to pay external labs to test products,” one FDA official, who was not authorized to speak publicly, told CBS News.

Even worse, drafts of the Trump budget proposal would further slash FDA budget, in part by moving “routine” food inspections to states.  

CDC: Oh, gosh, where to start? Cuts have shut down the labs that help track things like outbreaks of hepatis and antibiotic-resistant gonorrhea. We’re having a hard time tracking the current measles outbreak that started in Texas and has now spread to over half the states.

The White House wants to encourage more people to have babies, but has cut back on a national surveillance program that collects detailed information about maternal behaviors and experiences to help states improve outcomes for mothers and babies. It helped, among other things, compare IVF clinics. “We’ve been tracking this information for 38 years, and it’s improved mothers’ health and understanding of mothers’ experiences,” one of the statisticians let go told The Washington Post.

The Office on Smoking and Health was effectively shuttered, in what one expert called “the greatest gift to the tobacco industry in the last half century.”  CDC cuts will force the Consumer Product Safety Commission (CPSC) to stop collecting data on injuries that result from motor vehicle crashes, alcohol, adverse drug effects, aircraft incidents and work-related injuries.

And if you’re thinking of taking a cruise, you should know that the CDC’s cruise ship inspections have all been laid off – even though those positions are paid for by the cruise ship companies, not the federal government.

EPA: Even though EPA head Lee Zeldin “absolutely” guarantees Trump cuts won’t hurt either people or the environment, the EPA has already announced it will stop collecting data on greenhouse gas emissions, is shutting down all environmental justice offices and is ending related initiatives, “a move that will impact how waste and recycling industries measure and track their environmental impact on neighboring communities.”

The EPA has proposed rolling back 31 key regulations, including ones that limit limiting harmful air pollution from cars and power plants; restrictions on the emission of mercury, a neurotoxin; and clean water protections for rivers and streams. Mr. Zeldin called it the “greatest day of deregulation our nation has seen” and declared it a “dagger straight into the heart of the climate change religion.”  But, sure, it won’t hurt anything.

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Residency and Parenting Are Incompatible

By EMILY JOHNSON 

Being a parent during residency requires one or more of the following:

●     Family and/or friends nearby who are willing and able to provide free childcare

●     A stay-at-home spouse/co-parent

●     A spouse/co-parent who is willing to let their own career to be a distant second priority beneath family responsibilities and the resident’s career

●     Significant amounts of generational wealth that allow you to outsource household and childcare obligations with money you didn’t personally earn

●     High levels of financial risk tolerance and willingness to incur extraordinary levels of debt above and beyond average medical school debt ($234k!). 

Because medical residency in the United States is incompatible with being a parent.

It is a Sunday evening, and I am writing this as I wait for my husband to get back from the hospital. He was “on call” today, which, in lay terms means his work hours were “all day.” He was out the door before I woke up, and it is now 9:30pm and Find My shows that he is still at the hospital. So that means he’s on hour 15 or 16 of his workday, and he could be leaving in a few minutes, or he could be there for another few hours (and I have no idea which).

I do know he got at least a 15-minute break today, because our toddler and I went to the hospital today to have lunch with him. Why interrupt his workday, drag a toddler across town right before nap time (thereby risking the loss of my cherished mid-day downtime because of the dreaded car nap), and pay for parking and mediocre cafeteria food on a Sunday? Because if I hadn’t, I truly don’t know when my son would have seen his dad next.

This pattern – out before the family wakes up, back after bedtime- is the rule, not the exception. An “early” day might mean he gets out before 7pm – but that doesn’t guarantee that he’ll see our toddler, who goes to bed between 7 and 7:30pm.  

As a medical spouse with a young child, of the most infuriating comments I ever hear is among the lines of “but don’t they cap work hours now?” Or even worse – the occasional insinuation that perhaps today’s residents have it “too easy” because of work hour restrictions. Because the answer is yes – work hours are technically capped at 80 hours/week – but let’s talk about that: 

First, here’s what an 80 hour/week schedule looks like, in case you haven’t worked one lately:

 MonTuesWedsThursFridaySatSun
Start6:45am6:45am6:45am6:45amOFF(but studying for upcoming board exam)6:45am6:45am
End8pm6pm5:30pm8pm8pm10pm
Total Hours13+111113+13+16 (and counting)
Total: 77 + study time (Bingo! No problems here! Under 80 hours/week)

Second, from a caregiving perspective, an 80/hour week cap is laughable, because you can still miss 100% of a toddler’s waking hours most days of the week on an 80 hour/week schedule.

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How Using Opioids for Acute Pain is Like Burning Coal for Energy

By MATT McCORD

Using opioids to treat acute pain is a lot like burning coal to power our homes. Both are legacy solutions from an earlier era. Both were once celebrated as breakthroughs. And both have since proven to be dirty, dangerous, and incredibly costly to clean up. Despite this, we continue to rely on them, even as safer, smarter alternatives sit right in front of us.

Coal fueled the Industrial Revolution—but it did so at a steep price: polluted air, poisoned water, caused respiratory illness, and climate instability. It was never a clean solution, just a convenient one. Similarly, opioids became the go-to solution for pain not because they were ideal, but because they were easy. They blunt pain quickly, require no special skill to administer, and were aggressively marketed to physicians as safe and effective. We now know the truth: opioids for acute pain can ignite a chain reaction that leads to dependence, chronic pain, disability, and even death.

Short-Term Relief, Long-Term Consequences

The similarities run deep. Coal gives you power today but saddles society with pollution and disease tomorrow. Opioids offer pain relief in the moment but often leave patients worse off in the long run. In both cases, what’s convenient in the short term creates massive long-term externalities—not for the industries that profit, but for the workers, families, and communities left to clean up the mess.

Systemic Pollution

Coal pollution clogs lungs and chokes rivers. Opioids pollute something more intimate—the brain’s natural ability to regulate pain.

Acute use of opioids disrupts normal pain modulation, leading to a phenomenon called opioid-induced hyperalgesia—a worsening sensitivity to pain. It’s like installing a furnace that makes your house colder over time, requiring more fuel just to maintain baseline comfort. That’s the trap many patients fall into after routine surgery or injury.

Hidden Costs and Broken Systems

Coal seems cheap—until you calculate the health consequences, environmental damage, and regulatory burden. The same is true for opioids. The prescription may be covered by insurance, but the downstream effects—addiction treatment, emergency room visits, lost productivity, broken families, foster care placements, criminal justice costs, and overdose deaths—are paid for by the rest of us. And the price is staggering. Like coal, opioids externalize their costs, masking the true price we all pay.

Entrenched Interests and Resistance to Change

Just as coal was propped up by powerful lobbies and outdated infrastructure, opioids have persisted because of habit, inertia, and industry influence. For decades, pharmaceutical companies promoted opioids with junk science and aggressive marketing. Today, the pharmaceutical industry continues to shape public perception—not just through lobbying, but through the media itself. Pharmaceutical companies are among the largest advertisers on television, particularly during news programming. This significant advertising presence may influence media narratives, potentially downplaying the role of prescription opioids in the opioid crisis.

As a result, the public is often fed a new narrative: that fentanyl is the problem, not prescription opioids.

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How Health Systems are Losing Contact with their Clinicians

By JEFF GOLDSMITH

Jeff wrote this article for Hospitals & Health Networks in the July 5, 1998 edition. He republished it this week on his substack calling it a “27th anniversary edition”. It’s an enlightening piece, but as you read it please ask yourself. What, if anything, has changed, and did anything get better?–Matthew Holt

It is hard not to be impressed by the sweep of change, both in the capabilities of the American health system and in health care organizations, over the last 20 years. In the space of a single generation, health services have evolved from a cottage industry into a substantial corporate enterprise. A breathtaking array of new technologies has been added to the hospital’s diagnostic and therapeutic capability. Hospitals have also managed-though not always gracefully-the transition to a more ambulatory and community-based model of care.

Through all these changes, the hospital has remained a central actor in the health system — and despite periodic political challenges, its economic position has significantly strengthened. But this success has come at a terrible price: the increasing alienation of professionals who are the lifeblood of health care and who bear most of the moral risk of the health care transaction.

As organizations have integrated structurally, they have disintegrated culturally. Not merely physicians, but also nurses, technicians, and social workers have seen themselves transformed into commodities and marginalized by the corporate ethos of health services. Professional discontent has intensified as physician practice has become increasingly incorporated into the hospital and as health systems have begun rationing care through captive health plans.

The gulf between managers and professionals — and even between senior and middle management — has widened into a chasm. At its peak financial strength and amid a record economic expansion, the health field has grown ripe for unionization. In fact, the labor climate among health professionals has become so hostile toward management that organizing health services could single-handedly revive the dying union movement in the United States.

Some of this tension is a by-product of the pressure to reduce the excess hospital capacity that health systems have inherited. To move from the present concentration of ownership to consolidation of excess capacity will inevitably mean workforce reductions or redeployment. The fact that little actual reduction in hospital workforce capacity has taken place so far doesn’t mean that the pressure to cut jobs and improve productivity isn’t real and tangible — or that it won’t increase in the future.

But the origin of workforce problems in hospitals and health systems runs deeper than the pressure to consolidate. In little more than a generation, management of hospitals has moved from a passive, custodial, and largely benign “administrative” tradition to an aggressive, growth-oriented entrepreneurial management framework.

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Saving U.S. Manufacturing: Think Biotech, Not Cars

By KIM BELLARD

Amidst all the drama last week with tariffs, trade wars, and market upheavals, you may have missed that the National Security Commission on Emerging Biotechnology (NSCEB) issued its report: Charting the Future of Biotechnology. Indeed, you may have missed when the Commission was created by Congress in 2022; I know I did.

Biotechnology is a big deal and it is going to get much bigger. John Cumbers, founder and CEO of SynBiobeta, writes that the U.S. bioeconomy is now already worth $950Bn, and quotes McKinsey Global Institute as predicting that by 2040, biology could generate up to 60% of the world’s physical inputs, representing a $30 trillion global opportunity. Not an opportunity the U.S. can afford to miss out on – yet that is exactly what may be happening.

The NSCEB report sets the stakes:

We stand at the edge of a new industrial revolution, one that depends on our ability to engineer biology. Emerging biotechnology, coupled with artificial intelligence, will transform everything from the way we defend and build our nation to how we nourish and provide care for Americans.

Unfortunately, the report continues: “We now believe the United States is falling behind in key areas of emerging biotechnology as China surges ahead.”

Their core conclusion: “China is quickly ascending to biotechnology dominance, having made biotechnology a strategic priority for 20 years.1 To remain competitive, the United States must take swift action in the next three years. Otherwise, we risk falling behind, a setback from which we may never recover.”

NSCEB Chair Senator Todd Young elaborated:

The United States is locked in a competition with China that will define the coming century. Biotechnology is the next phase in that competition. It is no longer constrained to the realm of scientific achievement. It is now an imperative for national security, economic power, and global influence. Biotechnology can ensure our warfighters continue to be the strongest fighting force on tomorrow’s battlefields, and reshore supply chains while revitalizing our manufacturing sector, creating jobs here at home.

“We are about to see decades of breakthrough happen, seemingly, overnight…touching nearly every aspect of our lives—agriculture, industry, energy, defense, and national security,” Michelle Rozo, PhD, molecular biologist and vice chair of NSCEB, said while testifying before the April 8 House Armed Services Committee Subcommittee on Cyber, Information Technologies, and Innovation. Yet, she continued, “America’s biotechnology strengths are atrophying—dangerously.”

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