Tag: Elon Musk

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

Feb 27, 2025

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.

DEI Is Now a Four Letter Word

Feb 4, 2025

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.

And you thought Mastadons were extinct…

Nov 8, 2022

by KIM BELLARD

Until last week, for me, “mastodon” only meant the giant animal that went extinct several thousand years ago (I was, it appears, unaware of the heavy metal band Mastodon). Now, as the result of Elon Musk’s purchase of Twitter, many Twitter users are being forced to take a look at alternatives, such as the social networking site Mastodon.

It’s possible that we are about the witness the Myspace-ization of Twitter, brought down by competition, bad management, and bad product decisions. In my usual “there must be a pony in here somewhere” fashion, there may be some lessons in the Twitter saga that healthcare might want to pay attention to.

As most know by now, Mr. Musk has been a Twitter power user for many years, and a frequent critic. In March of this year he started discussions about purchasing it. In short order, he threw out a bold bid, was rejected then accepted by Twitter’s board, tried to get out of the deal, was sued by Twitter, and closed the deal late last month.

Then things got really rocky.

Mr. Musk tried to reassure squeamish advertisers, only to make them and others even more nervous when he retweeted some disinformation. After a spike in hate speech on the site, he promised that, as much as he was buying Twitter out of his love for free speech, Twitter “cannot become a free-for-all hellscape, where anything can be said with no consequences!” Then he shocked observers (and Twitter employees) by suddenly laying off half the workforce, including much of the content moderation staff. Some are now being asked back, being told they were laid off “by mistake.”

He then floated a balloon about charging $20 a month for Twitter’s blue verification, had a tweet argument with Stephen King about it, then went forward with a $7.99 plan, only to be punked by users illustrating the flaws. At this writing, the plan now appears to be on hold, at least until Tuesday’s mid-term elections.

Advertisers appear to be fleeing, or at least curtailing spending.

As The Wall Street Journal put it: “In Elon Musk’s first week at Twitter Inc., he flouted much of the advice management gurus have dished out for decades.” It’s no wonder many Twitter users are looking at Mastodon.