Relentless wreckage
DO NOT RESUSCITATE #437
10 APR 2026
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The Federal Government’s healthcare function is being set up to fail through a familiar playbook: defund, demoralize, dismantle; point to induced incompetence; privatize. Or simply delete.
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(Intentional) chaos in the bureaucracy 1
Rebecca Pifer Parduhn, “One year after HHS layoffs, a department in disarray,” Healthcare Dive, Apr 1, 2026
Federal workers in the huge Medicare/Medicaid/HHS administration voice their despair to an industry publication (anonymously): “We’re working like crazy because there’s not enough people and there’s no incentive.” “I’m reaching my breaking point.” “I really struggle with how I can work for people that just lack any humanity and morality.” Those remaining after the purges face heavy workloads, new bureaucratic hurdles, and the loss of colleagues with deep institutional knowledge. Some challenged their firings with lawsuits, which are working their tedious way through the courts. Now, “the smoke has settled on a smaller, unfriendlier, and more chaotic workplace.” Some of the eliminated agencies were to be folded into Kennedy’s promised Administration for a Healthy America, but that doesn’t yet and may never exist. New political controls slow down procurement, meetings, and contracting. Hot mess designed and delivered.
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Chaos in the bureaucracy 2 - CMS
Emily Olsen, “CMS tackles big policy changes with diminished workforce,” Healthcare Dive, Apr 1, 2026
DOGE cut a huge swath through the federal workforce, then assigned remaining staff ambitious reorganization plans. Things are not going well at the Center for Medicare and Medicaid Services (CMS). It has 1,000 fewer employees with extensive new duties: work requirements for Medicaid/SNAP eligibility; more stringent fraud oversight; health technology initiatives. Fewer people have to do “easily double the amount of work.” Many of those who left or were fired had specialized knowledge of contracting, systems management, and other key skills. “With the new leadership, you never know if your job is secure anymore. Morale is in the toilet.” The authors of Project 2025 announced that this was exactly their goal; they achieved it.
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Chaos in the bureaucracy 3 – 9/11 responders
Liz Neporent, “Bipartisan concern grows as 9/11 health program delays stretch past a year,” ABC News, Mar 31, 2026
Even the sainted 9/11 firefighters are getting the shaft. The World Trade Center Health Program, which serves 140,000 responders and survivors with cancers, respiratory illness, and other conditions linked to 9/11 exposure, is short-staffed and waiting for answers that never come. Decisions on whether to add autoimmune, cardiac, and cognitive conditions are 2 years overdue, and meanwhile patients whose illnesses aren’t officially tied to 9/11 exposure aren’t covered. Said one sick clean-up veteran, “Whatever happened to ‘Never Forget’?” Even Republicans are writing strongly worded letters about it.
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Chaos in the bureaucracy 4 – HIV/AIDS in Africa
Gabrielle Emanuel, Jonathan Lambert & Fatma Tanis, “Congress gave money for global HIV work. The Trump administration isn’t spending it,” NPR, Apr 4, 2026
Here’s another area where the Trump minions simply don’t carry out congressional directives. HIV/AIDS programs in 12 African countries are stymied because the approved funding simply doesn’t arrive. Congress budgeted $6 billion for it, but the State Department is “deliberately withholding” funds. The AIDS support known as PEPFAR originated during the Bush II years to make up for the disastrous hit to U.S. credibility after the Iraq conquest debacle. But the current team doesn’t give a hoot about public opinion or what dark-skinned people think. Instead, it’s conditioning ongoing aid with concessions through country-by-country extortion schemes dubbed “negotiations.” Programs are teetering on the edge as funds run out: “That’s not a funding cliff—that’s a controlled demolition.”
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Chaos in the bureaucracy 5 - Native tribes punished
Nora Mabie, “Tribes in Montana lose millions after USDA kills farm grants,” Montana Free Press/Associated Press, Apr 3, 2026
A health-promotion nonprofit on the Blackfeet Reservation had its federal grant cut off because it favored tribal members over white people. Aside from the historical irony of that stance, it’s not even true: the project to aid local farmers didn’t exclude non-Natives. Trump canceled 49 of 50 grants designed to support farmers and ranchers under a 2021 (Biden-era) law. “We were so happy that we were finally going to be able to recover some lands for the benefit of our young people. And now it’s gone.” The initiative was designed to facilitate younger Montanas to stay in or enter farming and ranching where the average age is now around 60.
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Chaos in the bureaucracy 6 - Long Covid march
Betsy Ladyzhets, “‘Not a whole lot of substance’: HHS posts Long COVID website, six months after making big promises,” Sick Times, Mar 31, 2026
To counter criticism over its shuttering of the former Office of Long COVID Research and Practice and other Biden-era initiatives, RFK Jr made promises last year that the Feds would tackle long Covid and support people suffering from it. HHS finally put up a new website on the topic, which was immediately trashed as “a shiny bauble” that added bupkis to what’s already known. It promises a “tech sprint” to develop new technologies and resources, but so far it’s talk. “Progress has not been speedy or transparent. There is no evidence of the promised Long Covid consortium, accelerated clinical trials, or new action from Pharma.” A federal advisory committee on Long COVID was eliminated before members had ever met. Long COVID impacts an estimated 5–7% of U.S. adults, about 18 million people. However, that data is no longer being gathered, another Trump team decision.
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Medicare Advantage jumps ship
Christopher Rowland, “Why millions of seniors have suddenly lost health care coverage,” Washington Post, Mar 28, 2026
Medicare Advantage insurers are bailing on low-profit geographic zones, and enrollees tempted into MA plans with neat extras and low fees are SOL. “Thousands of elderly people in New Hampshire lost their insurance and were forced to scramble for alternatives” as MA companies decamped for greener pastures. Rural states were the big losers. The shift highlights a risk that MA boosters don’t like to mention: plans are under no obligation to provide continuous coverage. If the business isn’t lucrative, they can leave town. “This year the churn reached a peak. Almost 3 million people were forced off Medicare Advantage plans this year because their carriers pulled out.” That’s 10% of all MA customers. Their customers have to fall back on traditional Medicare and shoulder the 20% of Part B costs not covered. The original idea behind MA was that encouraging “robust competition” among insurance companies would lead to lower costs, but unsurprisingly the opposite has happened. The Feds will pay MA insurers an estimated $76 billion in excess of what the same coverage would cost under traditional Medicare.” Even that’s not enough. UnitedHealth, the biggest MA peddler, has dropped 600,000 beneficiaries “to reinvigorate profit.” A local pol who represents the NH county featured in this article says, “Every single day in my email in box I get 20 or 30 people, saying ‘Tell me what to do. What can I do?’” Answer: nada. Those annual fitness allowances that enrollees could use for lift tickets at the state’s destination ski areas? Gone.
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The anti-fraud fraud
Phil Galewitz, “Trump’s hunt for undocumented Medicaid enrollees yields few violators,” KFF Health News, Apr 1, 2026
Repeat after me: “Waste, fraud, and abuse!” That’s the distraction mantra to cover up Trump’s massive shift of national treasure from human wellbeing to bomb-making. But after the shouting dies down, there’s often no there there. “The Trump Administration sent states the names of hundreds of thousands of Medicaid enrollees with orders to determine whether they were ineligible based on immigration status.” Here are the results:
Texas: 77 ineligible names out of 28,000 reviewed
Ohio: 260 out of 65,000
Utah: 42 out of 8,000
Pennsylvania and Michigan: 0 out of 79,000
Since people’s immigration/citizenship status is checked upon enrollment, it’s not surprising that the burdensome and costly reviews turned up diddly squat.
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Fraud/not fraud
Ken B. Morales & David Armstrong, “The DOJ declined over 900 cases of federal program or procurement fraud,” ProPublica, Mar 31, 2026
Roses are red/Violets are blue; We’re not defrauding/That’s all on you. “While Elon Musk’s DOGE operatives said they were rooting out federal waste, fraud, and abuse, the DoJ declined over 900 cases of federal program or procurement fraud.” Bondi, the unlamented ex-Attorney General, swept into office and immediately started shutting down corruption, narcotics, and terrorism cases “at a record pace” to focus legal attention on immigrants. Included in the investigations tossed aside were 900 cases of “federal program or procurement fraud,” including 100 in the healthcare sector, which is supposedly so important now.
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Killing science 1
“Research advocates prepare for next NIH budget fight,” Axios, Apr 2, 2026
Congress keeps trying to save the NIH from the politicized wreckage Trump is visiting upon it. But that’s a rearguard action. Congress rejected a 40% cut the administration proposed for NIH last year and even increased it, but Trump’s cronies have other ways of furthering the assault: a relentless program of canceled grants, layoffs, and bureaucratic maneuvers to slow the pace of getting money out the door. One of them is “forward funding,” that is, pushing a full grant out in one lump sum instead of yearly installments. That uses up the budget quickly so that many fewer grants are awarded. That’s on top of the nearly $1 billion in grants that were summarily canceled because they had naughty words in them like “equity.”
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Killing science 2
Rachana Pradhan & Katheryn Houghton, “Six federal scientists run out by Trump talk about the work left undone,” KFF Health News/CNN, Mar 6, 2026
The NIH under Trump 2.0 has lost about 4,400 people, one fifth of its total workforce, through firings and harassment and others escaping from a hostile environment requiring displays of fealty and acceptance of incompetent overlords. This article details the research expertise lost and the variety of long-term impacts such as the research shift “toward private-industry research” and its profit-seeking priorities.
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Killing science 3
Elizabeth Ginexi, “Inside the NIH forecast graveyard,” Substack, Mar 31, 2026
A Notice of Funding Opportunities (NOFO) is the way the NIH used to alert scientists about what they might seek funding to do. Under Trump, many are being quietly buried. “The picture that emerges is not haphazard. It is a story about two different strategies for eliminating research the current administration does not want to fund,” despite supposed legal obligations to Congress. The strategy is a way to avoid outright cancellations of grants that can be challenged later. The ignored NOFOs have certain common elements: either DEI language or topics the Trump people don’t like, such as substance use or HIV/AIDS research. “These cancellations read like the output of a keyword search, because they almost certainly were.” Congress could push back and insist the Feds obey its mandates. Yeah, right.
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Class-tiered healthcare
Rhonda Winegar, Tara Martin & Zhaoli Liu, “Cancer’s grim calculus for the young: their insurance status can determine how long they survive,” Fortune/The Conversation, Apr 1, 2026
Young people are being hit with cancer diagnoses at rising rates. How they do in treatment depends on their insurance status in our class-based medical system. If they have commercial insurance, they live longer than those on Medicaid or uninsured. “This survival advantage ranged from a modest 8% lower risk of death for lymphoma to a drastic 2 to 2.5 times lower risk of death for melanoma and multiple other cancer types.” The most vulnerable were young adults dealing with cancer who had just aged out of their parents’ plans. The reasons for the starkly different outcomes go beyond bills. “Health insurance determines whether a patient can access a specialist, how quickly treatment begins, and whether they are eligible to enroll in a clinical trial.” Only the expensive kind opens the door to quality care.
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Legal immigrants impoverished
Vanessa G. Sánchez, “Immigrant seniors lose Medicare coverage despite paying for it,” KFF Health News/El Tímpano/NPR, Apr 6, 2026
People who worked legally in the U.S. and paid into Medicare and Social Security are getting stiffed under the Trump austerity budget. After contributing tens of thousands of dollars for decades, they now get nothing because they weren’t born in the U.S. After seeing their savings stolen, they can also get kicked out.
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Democrats draft next sternly worded letter
Jonathan Cohn, “Dems quietly start their next big health care effort,” The Bulwark, Mar 29, 2026
Radical demands from Democrats sighted! The fightback has begun! “The debate about health care in America is about to get out of the rut it’s been in for about 15 years.” That sounds promising—what are the militant actions being prepared by the nation’s leading opposition figures? “A dozen of the party’s senators released an open letter announcing their intention to develop policies” on rising healthcare costs. English translation: We are beginning to get ready to start to commence to prepare a plan to get really tough—at some future date. And here’s our vigorous rhetoric in print! The Healthy Americans Act will be “a detailed legislative proposal complete with a financing scheme and independent analysis of its likely cost and impact,” which sounds like another wonk-tastic round of policy minutiae aimed at saving for-profit health insurance from oblivion. The Trump-induced wreckage of Obamacare’s incremental reforms will be the new set point.
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Dr AI will see you now 1
Marty Stempniak, “CEO of America’s largest public hospital system says he’s ready to replace radiologists with AI,” Radiology Business, Mar 31, 2026
New York City’s safety net hospitals are welcoming AI radiology to save money. What could go wrong? AI is increasingly being used to interpret mammograms and X-rays, and it’s cheaper than actual doctors. The 11-hospital safety net system will let robots do “first reads” with radiologists “double-checking any abnormal screenings.” They argue that AI will report a false negative “only” 3 times out of 10,000 low-risk women. One dissident radiologist warned, “Any attempt to implement AI-only reads would immediately result in patient harm and death.” Cost-cutting administrators deny they’ll hand the function over entirely to the machines, but the economic pressure to do so won’t go away.
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Dr AI will see you now 2
Giles Bruce, “Kill switches, guardrails: The raging debate over healthcare AI agents,” Becker’s Health IT, Apr 3, 2026
“AI is arriving in health systems before anyone has agreed on how to contain it.” More and more, it looks like the definition of human monitoring and oversight is that a clinician must click “accept.” What happens when a doctor-monitor starts hitting “reject” too often? A health admin quoted here says, “The limit is driven by regulation, liability, and culture, not by what the models can already do.” Or should do? Talk about the strong guardrails in place do not persuade your humble skeptic, despite all the talk of “full audit logs, real-time performance dashboards, strict permissions, no access to ordering, and an immediate kill switch.” The real kill switch is the one hovering over any mid-level MD-operator who refuses to go along with corporate speed-up and costs them money. A Connecticut hospital exec says, “We require extensive human-in-the-loop validation, but if the models perform as expected and exceed benchmark thresholds, then we will allow them to execute autonomously with periodic audits.” Would that be the patient outcome audit or the CFO/Wall Street analyst audit? The eventual goal is clearly to let the bots straight-up deliver healthcare. “Immature liability frameworks and risk of patient harm are major barriers.” But it’s clearly coming “if and when agentic [AI] capabilities mature and regulatory clarity catches up.” Imagine the savings!
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Dr AI will see you now 3
Matt Stoller, “Yes, therapy sessions are being used to train AI,” BIG, Apr 4, 2026
Mental health clinicians told Stoller that corporate middlemen are elbowing their way into the therapy space, using recorded sessions to train AI models for an eventual takeover. Platforms like Therabot and Talkspace are LLMs with millions of “anonymized patient-provider messages.” Another one called Blueprint “creates a summary of sessions, which can be used for electronic health records and billing purposes” while offering “prompts” to therapists. Would those be voluntary or mandated? The psychologists suspect that AI is coming dressed as a tool but in fact is a surveillance mechanism. For example, one “value-based care” outfit proposes to have their therapists input a bunch of client data on quality of life, relationships, work life, and overall functioning. It then whips out a “therapy report card” for tracking purposes to which clinicians will have to use to meet certain measurable outcomes. Last month, hundreds of clinicians at the Kaiser system in northern California went on a 24-hour strike to denounce a new triage system in which high school grads took helpline calls and checked off items on a prepared script to determine suicide risk. The AI/PE overlords are on the march to convert the therapeutic experience into a numbers-driven hellscape.
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AI knows best
Kyle Orland, “‘Cognitive surrender’ leads AI users to abandon logical thinking,” Ars Technica, Apr 3, 2026
Experimenters tested subjects on their independence of mind when using AI assistants. Wild guess as to what happened. They programmed some of the robots to give wrong answers to see how much people would go along. The result: all too often. In nearly 10,000 trials, subjects were willing to accept faulty AI reasoning a whopping 73.2% of the time while only overruling it in one of our five cases. “On one side are those who treat AI as a powerful but sometimes faulty service that needs careful human oversight. On the other side are those who routinely outsource their critical thinking to what they see as an all-knowing machine.” They conclude: An “uncritical abdication of reasoning itself” is more likely when an LLM’s output is “delivered fluently, confidently, or with minimal friction.”
The study: Calignano et al., “Thinking—fast, slow, and artificial: How AI is reshaping human reasoning and the rise of cognitive surrender,” Society for the Improvement of Psychological Science. The study is dated 2021—we can speculate on why the Ars Technica writer decided to report it now.
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Rural health band-aid 1
Natalie Krebs, “Iowa hopes to get up to $1 billion to improve rural health infrastructure. Some say it will do little to offset looming Medicaid cuts,” Iowa Public Radio, Apr 1, 2026
When Trump and the GOP blew up Medicaid with their punishment budget in 2025, uneasiness in the bright-red countryside led them to toss in a sweetener of $50 billion ostensibly to protect rural health. After a rushed application period, the shape of this last-minute program is starting to become clear. Iowa will lose nearly $4 billion for its rural health structure over a decade ($400m a year), and this year got $200m back. Despite the obvious arithmetic problem and the fact that they can’t use more than 15% of the new money to plug the holes created by the cuts, people commenting in this article are mostly eager to get the short-term cash.
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Rural health band-aid 2
Lisa Jarvis, “The rural health transformation program isn’t so transformational,” Bloomberg, Apr 5, 2026
“The shortcomings of the hastily devised plan are becoming increasingly clear. The [fund] emphasizes building the rural health-care system of tomorrow rather than address the structural challenges of today.” They have to promote goals like RFK Jr’s MAHA agenda and buy AI technology for remote medicine. Meanwhile, 300 rural hospitals are at risk of closure, and individual rural residents have to shoulder new co-pays and higher premiums if they haven’t lost their coverage entirely. “The fund is like a tow truck showing up when you have a flat and offering you a new airbag instead of a tire.”
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Rural health band-aid 3
Lauren Weber, “RFK Jr. and Dr. Oz have a plan to save rural health care. Here’s the catch,” Washington Post, Mar 24, 2026
The new money going into rural hospitals isn’t for their money-losing operations. North Dakota will buy drones for delivering lab samples; Massachusetts is expanding telehealth for isolated communities; Texas will “speed up fax processing by increasing AI-based automation.” Private consultants are lining up to help rural hospitals spend the money, especially start-ups peddling the AI miracle. The Trump/Oz special fund is temporary; the Medicaid support cuts are permanent.
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Big Ag is killing Iowans
Natalie Krebs, “Report examines potential link between environmental factors and Iowa’s high cancer rate,” Iowa Public Radio, Mar 25, 2026
Iowa depends on agriculture; agriculture depends on poisonous chemicals; Iowans get cancer a lot. Powerful people want to keep things that way because money. Nonetheless, some uncomfortable truths are leaching out, kind of like the pesticides, PFAS, and nitrates in Iowa’s soil. So far, the state seems to be stuck in “listening sessions” where officials hear people express their worries about dying but don’t act on them. The Iowa Farmers Union and Iowa Environmental Council “learned from people that they felt like there was some risk [from chemicals], but they didn’t know enough about it.” Industry always says yes to “learning more” as long as there’s never a conclusion that we know enough to actually do something.
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Long-suffering white people
Michael C. Bender & Alan Blinder, “Trump Administration begins investigations into three medical schools,” New York Times, Mar 26, 2026
The Justice Department demanded admissions-related data from Stanford, Ohio State, and UC-San Diego with which it will try to prove how mean those schools are to white applicants. The “or else” part is threats to their substantial federal research and other funding. The DoJ officials making the demand/threat is one Harmeet K. Dhillon who “posted a picture on social media of her signing one of the letters with her fountain pen, a Pelikan Souverän with an 18-karat gold, extra-fine nib.” It’s important to bring fine jewelry to the fight against racial discrimination.