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Tag: DOGE

Are the MA(HT)GA crowd going to be proud of themselves?

By MATTHEW HOLT

I have been trying hard to suppress this line of thought but when I woke up in the middle of the night with this piece basically fully formed in my head I couldn’t not write it. Yes I might lose some friends, but someone in health tech has to say this.

Last week a bunch of health tech companies, providers, plans and others went to the White House to an event remarkably called “Make American Health Technology Great Again”. The main organizer Amy Gleason is someone I consider an industry friend. No one can doubt her credentials in wanting to help patients, especially given her daughter Morgan’s medical condition and her awful experience in the health system. The initiatives spelled out–while they are voluntary and based on actions and regulations that are already on the books–will be net net good for American health care, and good for patients. 

Now, almost everything proposed is happening anyway. Anyone in health tech knows that it’s much easier to get health data and to run AI on it than it was in 2020, and it was way easier to get health data in 2020 than it was in 2016. Yes, of course it should be better and easier than it currently is. Yes, it should have happened quicker. Yes, the big provider systems and their main EMR Epic have not exactly bent over backwards to make data access more convenient for patients and innovators. Yes, of course there are too many demands to “send us a fax”. I personally had great fun with a UCSF-affiliated hospital last week, speaking to 5 different people and ending up both emailing and faxing them a referral to get an appointment. I’m pretty sure I’ll be doing the same thing in 2028. 

You can read tons more about the plans, the event and the voluntary agreement from luminaries like Lisa Bari and new dad Brendan Keeler.

But none of that is what is troubling me. What is deeply disturbing is the normalization of the people allegedly in charge of the nation’s health and health tech and the nonchalance and even knee-bending of those who went to the event last week.

Now I wasn’t there, even if several industry friends and clients were. I was at several similar events back in the Obama administration, but what we have seen from this Trump administration is a radical and toxic departure from America’s leadership in health and democracy, and it is not acceptable.

This is encapsulated by the people on the dias, and the actions they have taken.

Trump and his administration have committed so many egregious authoritarian acts that there’s no way to list them all. Just because people voted for him and the Congress and Judiciary is neutered does not obviate the fact that he was – deep breath – convicted of rape and separately found to be lying about mortgages in a civil court; convicted of 34 felonies for essentially tampering with the 2016 election; and impeached twice–once for politicizing America’s foreign policy and once for starting a violent coup. Don’t forget that at the time of the 2024 election he was being–another deep breath–prosecuted for stealing (and presumably selling) state secrets; being prosecuted for vote tampering in Georgia; and being prosecuted for planning the coup on Jan 6. It’s worth pointing out that two countries that have recent experience of dictatorships (Korea and Brazil) have both prosecuted and banned from office the leaders who attempted similar crimes there. (Incidentally I highly recommend you watch I’m Still Here, the Oscar-winning story of one family whose father was “disappeared” under Brazil’s military dictatorship in the 1970s).

Since his return to office, Trump has overseen the greatest direct political corruption ever in this country – you can bribe him directly via his memecoin. He has also overseen the transformation of ICE into an American-style Gestapo. Masked unidentified ICE agents are now snatching people, including both citizens and legal immigrants, off the streets and burying them in concentration camps here and abroad. Don’t forget that many immigrants or first generation immigrants are heading up those health tech companies at the meeting last week, not to mention how many poor, and perhaps undocumented, immigrants are working in our health care system. 

I haven’t even mentioned the impending cuts to Medicaid, the program for the poorest Americans, which will be the result of Trump’s “One Big Beautiful Bill Act”. That is sure to have a terrible effect on patients and on much of the health system, including many health tech companies trying to support Medicaid patients.

I didn’t even mention Epstein! And this is the guy America’s health care community wants to go and politely applaud just because he reads a speech about interoperability?

And it doesn’t stop there.

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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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Musk Moves US to Socialized Medicine

By THCB STAFF

After a few weeks analyzing government spending and putting all of his calculations into Grok, the head of DOGE, Elon Musk, has made another decisive move in the attempt to save the government money. Speaking on the Joe Rogan show, Musk declared that his team had given Big Balls and Little Balls instructions to stop screwing around with the minor stuff like cutting off foreign aid saving the lives of children or getting all worked up about storing paper records in a mine, and to “go after the real money”. It turns out that means putting all US health care into a national health service and eliminating all private, non state-run health care.

He told Rogan, in between injections of what he claimed were vitamin supplements, that “the DOGE team realized that the British government spends about $7,500 per capita on health care, and the US government spends about $8,000”. After observers noticed a few puffs of smoke coming from Musk’s side of the room he went on to say, “that means our government can use the example of the Brits and cut spending by $500 a head and as an added bonus, private employers can stop wasting money on health care premiums”. When asked by Rogan if this new move was influenced by his desire to cut costs at his companies, Musk appeared to be unaware that he ran any companies.

Musk went on to say, “it’s incredible that we’ve been giving all these hospitals and health insurers government money and they’ve been sticking it in their hedge funds. Little Balls told me that he read a post from some blogger claiming that there’s over $500 billion sitting on the balance sheets of big hospitals and non-profit health plans. Now we have nationalized them all, that money can be put to better use.”

Rogan asked him how this would work and Musk said that all doctors, nurses and hospitals now worked for the Federal government and could just deliver care for free. “They’ll be paid British wages, and they’ll be happy–British people are still rich enough to be buying Teslas, no one else is! And if the line is too long, then people can fly to Scotland where they’ve got this socialized health care thing down pat. I understand President Trump has a special going at his hotel on that golf course, if you don’t mind looking at the windmills.”

When asked whether he supported Musk’s move, President Trump told the White House press corps that he wasn’t on the group call but that Don Jr had mentioned that Adderall was free in the UK, so it seemed like a good idea to both of them.

In unrelated news, Tesla also announced a stock buy-back in the amount of $500 billion.

At Little-Known Health Agency, DOGE Ends Dream ‘To Make A Difference’

By MICHAEL MILLENSON

Four days after emergency surgery and barely able to walk, Heather Sherman flew from Chicago to Washington for first-day-of-work onboarding at the Agency for Healthcare Research and Quality. Fourteen months later, Sherman suddenly became one of the thousands of federal employees summarily dismissed by a weekend email telling them they were “not fit for future employment.”

The trauma of that abrupt ending in mid-February — giving her just a few hours before all access was shut off — still lingers. “This was my dream job,” Sherman told me.

If Sherman were an air traffic controller or nuclear materials expert, her work keeping the public safe would be obvious. But as a mid-level employee with a technical role at a little-known agency in the mammoth Department of Health and Human Services, her curt dismissal and that of an undisclosed number of AHRQ colleagues prompted not even a ripple of news coverage.

Yet what a New York Times editorial decried as a “haphazard demolition campaign” by the Elon Musk-led Department of Government Efficiency, one that is undermining “the safety and welfare of the American people,” applies to agencies like AHRQ and low-profile jobs like Sherman’s just as much as to more high-profile positions.

In complex systems, of which healthcare is surely one, carelessness has consequences.

(Disclosure: I’ve known Sherman for years, and while I serve on AHRQ’s National Advisory Council, I have no inside information. All opinions are my own.)

For Sherman, with two master’s degrees and a Ph.D., the anodyne title of health scientist administrator masks a beyond-the-data devotion to patient safety. A 2023 report by the President’s Council of Advisors on Science and Technology declared patient safety “an urgent national public health issue.” In truth, the urgency is embraced mostly by a small number of individuals determined to drastically reduce the estimated 160,000 Americans perishing each year from preventable medical errors in hospitals.

That death toll is a conservative estimate by the Leapfrog Group. Food and Drug Administration administrator-designate Martin Makary has called medical error “the third-leading cause of death” and estimated a death toll of more than 250,000 Americans.

Saving Lives and Money

Even if the focus is only fiscal — leaving aside the human impact — medical care that causes unintended harm is inefficient and costs money. The potential savings are large: an in-depth examination of medical records by the HHS Office of the Inspector General found that a shocking one-quarter of Medicare patients suffer some level of harm during a hospital stay.

It’s that “inefficiency,” human as well as financial, that Sherman wanted to attack at AHRQ. She proposed an initiative enabling hospitals nationwide to collaborate within a legal framework that promotes candor by protecting their interactions from being discoverable in a malpractice lawsuit. That structure is known as a “patient safety organization,” established by Congress through bipartisan legislation in 2005. The process of ongoing collaboration is known as a “learning health system.”

Sherman recalls reaching out to everyone she knew whose organization was affiliated with a PSO and asking what they needed to meet today’s challenges. “The almost unanimous answer was, ‘We want a place to find solutions, a place to share solutions,’” Sherman said. “‘We want to know what to do.’”

“Any kind of systemic prevention of problems saves money,” she added.

To be effective, however, collaborative problem-solving on a large scale requires more than just setting up Zoom calls and sharing documents. It quickly gets technical; e.g., ensuring that all participants classify and report an adverse event in the same way.

“Classification is the key,” Sherman said. “It’s like a box of different-colored Lego pieces in different sizes. Each Lego is a data element. Everybody has to understand what it means in order to use it.”

Along with her technical expertise, Sherman also brought a determination to expand what information was collected and how it was used; for instance, by bringing in patient and family input. “The law was not meant to exclude reporting of problems by anyone who wasn’t a clinician,” Sherman said. She also planned to utilize qualitative data “to tell a story. You learn a lot more about the nuances of error in the qualitative data.”

To accomplish those ambitious goals, Sherman began seeking buy-in from AHRQ leadership while also planning a national kick-off conference for May. Then, awakening on Saturday morning, Feb. 15, and turning on the TV news, she heard a White House correspondent report that government departments were firing “probationary employees.” Soon afterwards, the dreaded email popped up in her inbox from the HHS personnel office.

“We all knew it was coming,” Sherman said. “We just didn’t know when.”

A Legal Loophole

“Probationary employee” has a different meaning for federal employees than for private-sector ones. In the private sector a probationary period might last a few months, but an employee can typically still be fired “at will” any time afterwards, barring protections related to union membership or illegal discrimination. In federal employment, in contrast, the probationary period before civil service job protections kick in can last one, two or even three years, depending on various factors, and the probationary period can start over even for long-time employees if they’re promoted or switch agencies. Sherman was hired on a two-year probationary period.

Even probationary employees, however, can be fired only for certain reasons. Hence the careful language of the DOGE-driven form letter signed by HHS Chief Human Capital Officer (Acting) Jeffery Anoka that informed Sherman she’d not met “the burden to demonstrate why it is in the public interest” for the government to finalize her appointment. It continued, “your ability, knowledge and skills do not fit the Agency’s current needs, and your performance has not been adequate.”

Excerpt from letter firing federal workers
Excerpt from letter sent to probationary federal employees

“I was very calm that day,” remembered Sherman. “The next day I was a mess.” Questions of what would happen to her work, as well as compensation for unused sick leave and time off, remain unresolved; senior AHRQ managers are also in the dark. “Nobody knows anything, and there’s no guidance,” she said. “I am disheartened and disappointed.”

At the Centers for Medicare & Medicaid Services, a senior manager named Jeff Grant pushed back hard in a letter to Anoka posted on LinkedIn after 82 employees in his group were told they were “not fit for continued employment.” Grant began by announcing he was immediately retiring after 41 years of federal service, emphasizing later that he had served with equal dedication both Republican and Democratic administrations. Grant went on to refute accusations of incompetence by saying the fired workers had not only passed a series of formal reviews with high marks, but the interview process, one in which he was personally involved, allowed CMS to select “truly the best of the best” out of hundreds of resumes.

Moreover, Grant pointedly noted, many of those fired at his Center for Consumer Information and Insurance Oversight were set to work on writing and implementing a new rule announced as a Trump administration priority. That rule, “is projected to save billions in program dollars,” he wrote, “which is the ultimate in government efficiency.”

A Plea For Public Service

On an even more personal note, an “open letter to America from career federal civil servants,” written anonymously to avoid retaliation, poignantly reminded the public, “We are your neighbors, friends and family. … Most of us heeded a call to serve because we love this country and what it represents as much as you and wanted to give back. The hard work we do, we do on your behalf.”

That declaration resonates with Sherman, who said she’s long yearned to work for AHRQ, a small-budget agency with the big-mission task of helping make U.S. medical care better and safer.

“I never wanted to leave AHRQ,” Sherman said. “I wanted to be in this department, in this job, for the rest of my life. I didn’t go into this profession to be rich. I went into this profession to make a difference in people’s lives.”

The “chainsaw” approach favored by Musk continues: the administration has ordered every federal agency to turn in a plan for even more drastic cuts by March 13. The impact of two federal juges’ orders reversing some probationary employee layoffs remains to be seen, particularly since they are being appealed. For Sherman, meanwhile, there are two poignant codas to her career situation. DOGE, the force behind her firing, has been criticized for acting with both joyful cruelty and dubious legal authority. As it happens, Sherman’s undergraduate major was in judicial morality and constitutional democracy.

Meanwhile, although Sherman almost immediately lost all job-related access, her last official day on the AHRQ payroll was March 14. This year, that’s the next-to-last day of Patient Safety Awareness Week.

Michael L. Millenson is president of Health Quality Advisors & a regular THCB ContributorThis piece was previously in Forbes

What would a rational DOG(gi)E do(o)?

By MATTHEW HOLT

DOGE, or Doggie as Kara Swisher has been calling it, has gone from being a meme about Shiba Inus to a crypto scam to a group tearing the Federal government apart.So I thought I would use the title of this piece to make a joke. Like Musk’s humor it’s puerile and not funny. What’s also not funny is what Musk’s team has done to small government agencies, like USAID & CFPB that really help people, not to mention the irrational firing of thousands of government employees that appear to be screwing up the NIH, the National Parks, the FAA and much more. But it’s all got me thinking, what in health care should an effort to quickly rationalize government spending do?

Now I’m not proposing that there’s anything OK with the way Musk and his team have been blundering around the Federal government, telling lies about what it does and indiscriminately firing the people who have the most important responsibilities and then desperately trying to get them to come back. This has been pure ignorance theater, and it would be hilarious if it wasn’t so damaging. Equally importantly the places DOG(gi)E has started are stupid because they don’t spend much money. But the government spends a lot on health care –between two and three trillion dollars, depending on how you count it.

So if you wanted to save some money and potentially change the system, what would you do? First you’d take a deep breath and get some real data, and improve your understanding about what is actually happening. There are some areas in health care where the issues are well understood and the data is clear and there are others where it’s less obvious.

Let’s start with a relatively small one–spending on Federal Employees health benefits. Chris Deacon’s Linkedin posts are a constant source of fun and games, and she has been highlighting screwups in the FEHBP administration for a long time. Essentially the government via the OPM pays lots of different insurance companies to manage Federal employees’ health care. There is very poor oversight of what happens in those programs and when the OPM’s OIG points that out, not much happens. The plans (including Horizon Blues in NJ and BCBSNC and many others) have been caught being sloppy or fraudulent but not much has happened. All DOG(gi)E needs to do is read the report on the audits, or look at what GOA said about $1bn being spent on ineligible members in 2022 and apply their recommendations.

Next let’s get into something that requires a little more investigation. In America we buy (and sell) drugs in a mind-bogglingly complex way.

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Disruption For the Sake of Disruption Is Not Innovation

By MIKE MAGEE

The technological leaps of the 1900s — microelectronics, antibiotics, chemotherapy, liquid-fueled rockets, Earth-observing satellites, lasers, LED lights, disease-resistant seeds and so forth — derived from science. But these technologies also spent years being improved, tweaked, recombined and modified to make them achieve the scale and impact necessary for innovations.”    Jon Gertner, author of “The Idea Factory.”

The Idea Factory is a history of Bell Labs, spanning six decades from 1920 to 1980. Published a decade ago, the author deliberately focused on the story inside the story. As he laid out his intent, Jon Gertner wrote “…when the drive to invent has become a mantra, Bell Labs offered us a way to enrich our understanding of the challenges and solutions to technological innovation. Here, after all, was where the foundational ideas on the management of innovation were born.”

One of the scholars Gertner likes to reference is Clayton Christensen. As a professor at Harvard Business School, he coined the term disruptive innovation. The Economist magazine loved him, labeling him in 2020 “the most influential management thinker of his time.”

A process thinker, Christensen deconstructed innovation, exploring “how waves of technological change can follow predictable patterns.” Others have come along and followed in his steps.

  1. Identify a technologic advance with a potential functional market niche.
  2. Promote its appeal as a “must have” to users.
  3. Drop the cost.
  4. Surreptitiously push aside or disadvantage competitors.
  5. Manage surprises.

Medical innovations often illustrate all five steps, albeit not necessarily in that order. Consider the X-ray. Its discovery is attributed to Friedrich Rontgen (Roentgen), a mechanical engineering chair of Physics at the University of Wurzburg. It was in a lab at his university that he was exploring the properties of electrically generated cathode rays in 1896.

He created a glass tube with an aluminum window at one end. He attached electrodes to a spark coil inside the vacuum tube and generated an electrostatic charge. On the outside of the window opening he placed a barium painted piece of cardboard to detect what he believed to be “invisible rays.” With the charge, he noted a “faint shimmering” on the cardboard. In the next run, he put a lead sheet behind the window and noted that it had blocked the ray-induced shimmering.

Not knowing what to call the rays, he designated them with an “X” – and thus the term “X-ray.” Two weeks later, he convinced his wife to place her hand in the line of fire, and the cardboard behind. The resultant first X-ray image (of her hand) led her to exclaim dramatically, “I have seen my death.” A week later, the image was published under the title “Ueber eine neue Art von Strahlen” (On A New Kind of Rays).

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DEI Is Now a Four Letter Word

By KIM BELLARD

I’d love to be writing about something fun. Something that makes us think about things in a new way, or something exciting that will take us into the future. There are lots of such things happening, but there’s too many Orwellian actions happening that I can’t be silent about.

Diversity, we’re told, is actually a pretext for racism – against white people. Equity is foolhardy at best and pernicious at worst. Inclusion only matters if you are the “right” kind of person. “Meritocracy” is the new buzzword; we want only the “best and brightest,” with none of the lowering of standards that we’re being told comes with trying to ensure that everyone has a fair chance to prove their merits.

The Trump Administration has declared war on DEI. It has fired scores of workers whose jobs involve DEI, has asked other workers to inform on people they think may be involved in DEI, and is searching out even workers who attended diversity training (mandated or not). All that would be horrifying enough but it isn’t ending there.

Federal websites are being cleansed of any references to anything that might be construed as DEI. Pages are being edited, or taken down entirely. The NIH has ground to a halt until the appropriate authorities can ensure that no grants are being even to anything that might possibly be related to DEI. The CDC has been forced to pull papers from its researchers that are up for publication for similar review.

The Atlantic reports: “the government was, as of yesterday evening, intending to target and replace, at a minimum, several “suggested keywords”—including “pregnant people, transgender, binary, non-binary, gender, assigned at birth, binary [sic], non-binary [sic], cisgender, queer, gender identity, gender minority, anything with pronouns”—in CDC content.”

Thousands of pages of data from the CDC and Census Bureau have “disappeared,” and the same from other agencies. Health data is prominent among the missing. Angela Rasmussen, a virologist at the University of Saskatchewan, told Science: ““I knew it was going to be bad, but I didn’t know it was going to be this bad. It’s like a data apocalypse.”

Elon Musk, who has no official power yet seems to have control over government IT and the data it contains, is shutting down U.S.A.I.D., who provides almost $40b annually in health services, disaster relief, anti-poverty, and other social mission programs. Previously the Administration had shutdown, then reinstated, PEPFAR, a vital international HIV program that has been credited with saving millions of lives.

The President and his team even tried to blame last week’s Washington D.C. plane-helicopter collision on DEI.  That’s just “common sense, ok,” according to President Trump.

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