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To Beat Parkinson’s, You Must Stand on Your Head

By WOJCIECH WASILEWSKI

Dear Reader, if you’re looking for something soft and easy, please buy a different book. This one isn’t here to comfort you — it’s here to shake your lazy world, to shock you, to drag you out of the same lethargy I was trapped in for years after being diagnosed. If you feel anger, rebellion, or even a surge of motivation while reading, then it was worth writing this book, each and every hour. Parkinson’s isn’t polite — and I won’t be either. This is my war manifesto against Parkinson’s.

Throughout this book, I use the word “Parkinson” as shorthand for Parkinson’s disease, not as a reference to James Parkinson, the doctor who first described it. If that feels like an oversimplification — I apologize. But trust me, it’s the least important thing here.

People today are searching for real stories — not textbook definitions, sterile medical jargon, or sugar-coated tales of suffering. You won’t find any of that here. What you’ll find instead is something far more valuable: the truth. Raw, unfiltered, sometimes brutal, sometimes even vulgar. Why? Because that’s what this disease really is. That’s the kind of relentless fight you’ll need if you don’t want Parkinson’s to steal your life, piece by piece. I’m not afraid of that fight — and this is exactly what this book is about. I want you to stop being afraid and to believe you can get into this fight too.

This is not a scientific book. I’m not a doctor. I don’t have a PhD. I’m not an “expert” who appears on morning TV. I’m just a patient — like you. Someone who heard the diagnosis and, instead of quietly accepting it and waiting for the end, chose to fight back. And the most important part? After years of struggle, I’m living proof that it can be done. This isn’t theory — it’s my sweat, my pain, my setbacks, and my comebacks. If you want to read the story of someone who curses Parkinson’s out loud every day and refuses to let it win — you’re in the right place.

If you want to hear the voice of someone who tests every possible method to claw back one more day of normal life from this disease, someone who isn’t afraid to speak the truth and take risks — this book is for you. This is my declaration of war on Parkinson’s. And if you’re ready to join me in this fight — come on board. Because to live well with Parkinson’s, you have to completely change your lifestyle. That’s exactly what this book is about.

PARKINSON’S AFFECTS THE YOUNG

I’m talking to you — the person who typed into Google: “Parkinson’s and physical activity,” “diet and Parkinson’s,” “how to stop Parkinson’s,” “can you recover from Parkinson’s,” or “can young people get Parkinson’s.” If you’ve landed here, you’re searching for answers. I’m no miracle worker. I don’t have magic pills or secret formulas. I do have something better though — real strategies that work for me. Not just for me.

This isn’t an academic thesis. This is a battle guide. A survival manual. It’s about resisting this disease, outsmarting it, slowing it down, exhausting it. It’s about clawing back one more day of normal life — and doing it all over again tomorrow.

You know what annoys me the most? That the majority of people still think Parkinson’s is a disease of old men sitting on benches outside their apartment buildings. That’s just not true. More and more young people — people who should have their whole lives ahead of them — are being diagnosed. And then what? Fear. Panic. The crushing feeling that everything is over. Doctors rarely have time to explain what’s really going on. And the internet? It hits you with nightmare scenarios — videos of people shaking so violently they can’t even lift a spoon. Nevertheless, that’s not the full truth about Parkinson’s.

For younger people, Parkinson’s is a completely different fight — a different tempo, a different pressure, a different kind of war. They are the ones who this book is for. For people in their 30s, 40s, and 50s, with families, careers, dreams, and plans — all of which Parkinson’s is trying to rip away. We don’t have to let it happen. We can fight back.

WORDS OF CRITICISM FOR THE CRITICS

I can already hear the noise — the mocking, the scoffing, the eye-rolling. Critics saying there’s no scientific proof, that maybe something did work for me but won’t work for anyone else, that it’s all clichés and empty words. Maybe my Parkinson’s is ‘defective,’ they’ll say. Or maybe I don’t even have it. Or I just got lucky and ended up with the soft version — you know, Parkinson’s Lite.

To all the critics who will claim that nothing in this book works, I have only one thing to say: Keep on clucking.

When I first decided to fight Parkinson’s, my condition was declining fast. I had muscle rigidity. I could barely walk. My left arm didn’t swing. I felt that heavy-leg fatigue, and my tremors were intense. I passed out twice — both times collapsing in the bathroom. Then I underwent the FUS procedure, and it significantly reduced the tremor in my left hand. That was the moment I realized I had to change my life. And so began a slow but powerful transformation.

I HAVEN’T WON THE WAR

Let’s be clear, dear Reader: I haven’t won the war against Parkinson’s — not even close. Writing this book, after working full-time as an analyst for eight hours a day, takes a toll on me. Sitting at the computer for hours temporarily worsens my symptoms. Just this morning, I woke up in pain — arms, legs, back, everything.

And what did I do? First I went for a light three-kilometer run. Next I took a freezing cold shower. Then I had a healthy breakfast. These simple steps and just like that — my body came back to life.

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Bloom is Off the Rose at UnitedHealth Group

By JEFF GOLDSMITH

A Forty Year Growth Saga is Coming to an End

After market close Wednesday April 16, UnitedHealth Group reported its First Quarter 2025 earnings. UNH missed their expected 1Q earnings by 9 cents a share, but the firm also lowered its full year 2025 earnings estimate by 12%. On Thursday opening, investors reacted with an unbridled fury, and stripped UNH of more than a hundred billion in market capitalization in a matter of hours. In the glare of hindsight, UNH was priced for perfection at a pre-crash trailing Price Earnings ratio of 38, six points higher than Amazon and eight points higher than Microsoft, which might account for the savagery of the correction.

Definitive answers to the question–what is happening to United’s sprawling mass of businesses–are impossible because the company is an $400 billion black box. The main United businesses–health insurance, care delivery, pharmacy benefits management and business intelligence/services–are so intertwined with one another that only United CFO John Rex and a few other senior managers actually know from whence United’s earnings actually flow. What follows is some speculation on the root causes of United’s earnings problem.

First, a major driver of the last two decades of United’s earnings growth has been using a big chunk of its astonishing monthly cash flow (which was approaching $3 billion a month) buying other companies. This party might be over. United has historically spent about half their accumulated wealth on dividends and share buybacks, that is, paying off shareholders to remain shareholders.

However, a big and undisclosed contributor to UNH earnings growth has been acquisitions, which have occurred in a nearly unbroken string for forty years. From 2019 to 2023, United spent an astonishing $118 billion buying other companies, nearly all of which ended up in Optum. Thanks to great discipline by UNH Executive Chair Stephen Hemsley and CFO-now-President John Rex, United almost invariably bought profitable firms in transactions that were accretive to earnings.

United appears to be running out of accretive transactions. With the dearth of major new transactions, United’s $81+ billion horde of cash and short term investments (larger than Exxon Mobil) is likely to plump up yet more. This will cause folks to wonder why United is raising their rates to employers or shaking down providers for deeper discounts when they are sitting on a growing mountain of cash.

United cannot buy more health insurers (both CIGNA and Humana been for sale for years) because federal antitrust enforcers will stop them. There are no more accretive risk-bearing physician group deals. Hospitals presently employ more than a third of practicing physicians in the US (a very unhappy state affairs for both parties). But these hospital acquisitions have limited the universe of available physician transactions for United.

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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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Roon – the Demo and Interview

I was a little surprised that in the days of limitless content, AI, and all types of medical information being online a company could raise $15m to create a platform where actual doctors could answer specific questions that patients might have. Vikram Bhaskaran, the CEO is ex Pinterest and knows the consumer world well. Rohan Ramakrishna is  a neurosurgeon who is worried about the level of misinformation that he saw showing up in his clinic daily. So Roon is trying to build what might be the impossible, a free personalized (mostly video) guide for health powered by the world’s best experts. They gave me a tour of what they have built so far, and it’s both impressive, ambitious and has a way to go. It’s an interesting demo and it raises some interesting questions about how that knowledge will be shared in the very near future–Matthew Holt

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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We Need to Nationalize to Prevent Fraud

By MATTHEW HOLT

Two weeks ago I wrote an April Fool’s piece that claimed that Elon Musk and DOGE were going to nationalize American health care to save some money. That piece was half-joking but full-serious. 

If you look at what Musk is complaining about there are two major areas of “waste, fraud and abuse” in government spending. 

One is people directly employed by government agencies. Most of the people I’ve ever met in government work damn hard and for much less money than they’d get in the private sector. But you can of course find stories about useless government bureaucrats, who don’t do any work and pad their expense accounts. Those stories are probably about as true as Reagan’s pink Cadillac driving welfare queen in that there is some basis in reality for there being a tiny minority of bad actors, but the politics has far outrun the truth. (BTW that Welfare Queen article by Josh Levin in Slate is remarkable and very long!)

The other major area where Musk claims to be finding fraud is in work contracted out. There are of course lots of types of government work contracted out. If, like me, you’re old enough to remember the Iraq war, you probably are thinking of beltway bandits like Halliburton supplying any number of services to the military. (Remember when the Cheneys were baddies?). Another is the Blue Cross & Blue Shield plans who were the original contractors processing Medicare & Medicaid claims. Funnily enough they couldn’t actually deliver on that so in turn they outsourced it to Ross Perot at EDS and others like ACS, later Conduent. But there’s a ton more across every agency.

Musk & DOGE have been running around in the most ham-fisted way imaginable, axing both actual employees–including 20,000 of the 80,000 working at HHS– and allegedly slashing $150 billion in contracts. Of course on closer examination, many of the “contracts” were already over, or were made up. DOGE has been a pathetic piece of performance art that would be funny if it hadn’t ruined so many careers of people doing great work, or killed so many desperately poor children in poor countries.

The clever people at Brookings, (Elaine Kamarck and Paul Light) in a detailed piece on the topic, came up with an estimate of the ratio between direct employees and contractors.

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