‘Health’ Without Health Workers
Terry H. Schwadron
April 22, 2025
The Trump administration seems fixated on ruining what we have known as health systems.
Lured variously by the size of the spending on health services, the idea of federal overreach, the nature of science to speak too loudly against opinion based on faith or individualism, or the simple need for control, Team Trump continues to target medical research, vaccines, Medicare and Medicaid, the Centers for Disease Control, abortion-adjacent programs and more for cuts.
Through worker dismissals by the tens of thousands, the ending of research and humanitarian aid programs, wacky unproved scientific assertions by Health Seretary Robert F. Kennedy Jr., and the looming federal budget showdowns that require giant cuts into social service programs, we face getting sicker and less resilient in a hurry.
Almost daily now, we are seeing articles, opinions, statements and programmatic shutdowns that all point to the same conclusion: Our aspirations for a constantly growing health system that looks to be preventive, seeking out disease for elimination, taking science and medicine seriously, is in jeopardy. Instead, we’re starting to see the documentation of spreading contagions like measles, which before this year last proved fatal 25 years ago, along with vaccine hesitancy, and unfounded assertions about autism. Kennedy devoted his first formal press conference to rising reports of autism, dismissing better reporting about the subject or broadening definitions of the condition since 2013 to insist that we need studies to show that environmental factors from obesity to mold to vaccines are responsible.
Kennedy is following up with promises to rid the nation’s cereals of food dye and to recommend halting fluoride treatments to reservoirs. Are these the health crises facing the country?
Kennedy’s focus on autism rates that have increased slightly since 2020 come amid threats against university medical research programs and the broad attack in Medicare and Medicaid that will require $880 billion in cuts just to help balance the cost of tax cuts for the wealthiest, an amount way beyond any estimates of fraud and waste that officials say are possible to find. It comes as thousands of health workers, including those who work on public contagions and those who track and measure health outcomes, are dismissed.
It’s interesting to see what “health” means to the guy in charge, someone with a skewed idea of medical research and clinical trials or the priority of providing access to doctors and treatments for those not on corporate health plans.
Money and Health
Last week, a preliminary, 64-page budget document outlined slashing budgets for federal health programs by a roughly one-third by the Department of Health and Human Services, according to reporting by The Washington Post, which obtained it. As part of preparations for a 2026 federal budget, the document from the Office of Management and Budget also proposes a major shuffling and restructuring of health and human service agencies.
As it stands, some of its provisions even buck changes already outlines by Kennedy, who recently dismissed 20,000 workers, ordered a reorganization, and cut the heart from medical research staff at the National Institutes of Health. It will go to the budget committees in Congress, which already have committed to whopping cuts to Medicare and Medicaid even as Trump continues to defy reason by arguing that only waste and fraud will be eliminated.
Journalists have joined with medical experts to try to sort out what is being tossed, a difficult task despite Trump’s claims of transparency for Elon Musk’s DOGE efforts and agency reviews. Generally, Trump sloughs off any federal cuts, saying the functions eliminated would be better managed by states, before then cutting payments to those very state health agencies.
HHS had a discretionary budget of about $121 billion in fiscal 2024, but under the Trump administration’s preliminary outline, it would see a decrease to $80 billion.
The Centers for Disease Control and Prevention, which has lost staff and programs to prevent drowning, gun violence, improved worker safety, and testing of sexually transmitted illnesses and hepatitis, will lose chronic disease programs for heart disease and obesity and domestic HIV work. National Institutes of Health staff have been told to end research contracts on vaccine hesitancy, transgender health and Covid, will fuse programs under a new organization, and lose 40 percent of its funds for the National Institute on Minority Health and Health Disparities and the National Institute of Nursing Research.
A new Administration for a Healthy America would be created out of pieces of other groups to “Make America Healthy Again” through focus on chronic childhood diseases like autism but not lead poisoning preventions or advancing rural health initiatives or tracking patients with amyotrophic lateral sclerosis, or ALS. Also seemingly eliminated are programs for rural areas that include hospitals and remote health sites. Money for the Head Start program, which provides early childcare and education for low-income families and is funded by HHS’s Administration for Children and Families, would be eliminated. “The federal government should not be in the business of mandating curriculum, locations and performance standards for any form of education,” the document says.
Health Effects
Overall, the slashing effort is so broad and so legally contentious that it becomes difficult to try to track some of the specifics. One reason for the plethora of articles about health risks ahead is because they get mixes in with political coverage about what can get through Congress or what is stuck in the courts. Was this an article about Musk’s overreach, or about Kennedy’s insistence that some unlabeled and untested medical recommendation, like cod liver oil for potential measles contagion victims, just might prove effectual if only we study that the way we once studied cancers.
The result is that as citizens, we cannot help but think that we are having the health rug pulled out from beneath us.
One example: HIV and AIDS. The administration’s cuts to HIV prevention will lead to new infections, medical costs and death, say doctors and public health advocates who were once able to imagine the end of the HIV epidemic in our lifetime. New infections have dropped since the mid-1980s from 130,000 a year to 37,000 and are controllable by drugs. But those efforts are recommended for elimination.
Instead, the MAHA effort is embracing new research aimed at linking autism cases numbers that appear to have risen as the result of more awareness and testing to vaccines and environmental factors — a key personal campaign from Kennedy. And he asked a discredited vaccine denier to lead the study. Research from science says autism is genetic, though Kennedy insists that it is preventable.
In another era, it would be possible both to study autism and, say, HIV or cancer, but when the government eliminates a third of discretionary money, that no longer can happen.
Trump’s attack on Harvard University, which he says is about antisemitism and diversity issues, will dry up research going on hospitals working with Harvard researchers, creating a direct impact on personal health.
None of this touches Medicare and Medicaid, which Republicans in Congress and Trump insist can lose vast sums through eliminating undocumented recipients — non-citizens already are not eligible — or through waste and abuse. That alternative to Obamacare that Trump always says is just around the corner has yet to show its face.
Something like 18 percent of the entire Gross Domestic Product of the United States is spent on health care. You would think that would be worth a bit more focus than entertaining slogans and renaming health programs to align with Making America Healthy.
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