برچسب: DOGE

  • John Thompson: Oklahoma Has Its Own DOGE, Just as Destructive as Elon’s

    John Thompson: Oklahoma Has Its Own DOGE, Just as Destructive as Elon’s


    After Trump introduced Elon Musk and his so-called “Department of Government Efficiency,” several Republican-controlled states created their own DOGE operations. Like the one Musk launched, these were non-governmental, unelected, unaccountable cost-cutters, set loose to apply a chainsaw to state government.

    John Thompson reports on what happened in Oklahoma.

    CBS’s Sixty Minutes recently reported on the danger of H5N1 bird flu spinning out of control. It cited Dr. Kamran Khan who explained why “We are really at risk of this virus evolving into one that has pandemic potential.” Another expert agreed that “this flu could make Covid look like a walk in the park.”

    This frightening reporting comes as the DOGE–OK seeks to cut nearly $150 million for programs that provide immunization services, pathogens surveillance, and emerging infectious diseases prevention, and provide Epidemiology and Laboratory Capacity for Prevention of Control of Emerging Infectious Diseases.

    And this is only one reason for looking into the DOGE–OK process.

    Anyone paying attention to Elon Musk’s leadership of the Trump administration’s DOGE campaign to cut federal programs has reason the fear the DOGE campaigns launched in 26 states. After all, as the Economic Policy Institute (EPI) explains, when Governor Kevin Stitt opened Oklahoma’s DOGE-OK, he called for a reduction in our personal income and corporate tax rates, thus making the state’s tax code even more regressive.

    The EPI further explained that Stitt selected Marc Nuttle, “who was the ‘chief strategist’ behind Oklahoma’s 2001 so-called right-to-work referendum—a policy designed to disempower workers and lower wages (and contrary to proponents’ claims, it did not bolster job growth in the state).” The executive order empowered Nuttle to lead efforts of a newly formed agency to study the state budget.

    Moreover, the EPI explains:

    DOGE-OK is itself duplicative since the Office of the State Auditor and Inspector is constitutionally mandated to “examine the state and all county treasurers’ books, accounts, and cash on hand, stipulating that [the office] shall perform other duties as may be prescribed by law.” Similar to DOGE-OK, the auditor reviews staffing levels, assesses state spending, and issues public reports to promote transparency.

    The DOGE-OK report now explains:

    Once DOGE-OK ideas are received, they are analyzed and vetted with the appropriate group. If validated, ideas are added to the DOGE-OK website. 

    But, when I studied the report, I found no sign of hard evidence to back its claims. For instance, they didn’t explain their methodology, and offered no cost/benefit analyses. DOGE didn’t explain what “groups” it considered to be “appropriate,” and what data was used to analyze and vet, and validate their ideas.  

    Since the first DOGE headlines focused on $157 million in supposedly “wasteful health grants” by the federal government, I focused on Medicaid and Department of Health cuts.

    These proposed cuts are especially disturbing because, as Shiloh Kantz, the executive director of the nonpartisan Oklahoma Policy Institute, explained, “Oklahoma already ranks among the worst in health outcomes.”

    First, DOGE-OK claimed that $60 million per year would be saved if the state, not the federal government, performed eligibility checks on children. And, they cited two drugs that received accelerated approval without working, costing $42 million. But, they did not mention the number and the benefits of the other drugs, like the Covid vaccine, that received accelerated approval.

    Also, DOGE-OK inexplicably said that easing the prescription drug cost cap would improve prices. And they recommended repeal of staffing requirements for Long-Term Care facilities in order to save $76 million annually, without mentioning harm to elderly patients due to under-staffing.

    DOGE-OK also said that three Oklahoma State Department of Health programs should be cut by almost $150 million because their funding exceeded the amount necessary.  As already mentioned, in the wake of Covid pandemic, and as measles and bird flu spread, these programs provide immunization services, pathogens surveillance, and emerging infectious diseases prevention, etc. So, how did DOGE reach the conclusion that the full funding of those programs is no longer necessary?  

    Then, DOGE-OK said that 7 programs should have cuts because of “duplication,” with partners doing the same or similar work. They said $2.2 million would be saved by getting rid of the team efforts necessary to improve health.

    And Sex Education should be cut by $236,000 because of its low Return on Investment.

    Again, I saw no evidence behind their recommendations for $157,606,300 in overall health care reductions. Neither did they address financial costs of implementing their ideas. And, there is no evidence that DOGE seriously considered the costs in terms of the lives that would be damaged or lost.

    Given the history of the Trump/Musk DOGE, none of the DOGE–OK should be a surprise. When Gov. Stitt selected Nuttle, a true-believer in Milton Friedman, to run the project, Stitt said, “With his help, we’ll leave state government leaner than we found it.”

    Is that the proper way to launch a supposedly balanced and evidence-driven investigation of such complex and crucial policy approaches?

    Stitt’s news release previewed Nuttle’s methodology: “use his knowledge of the inner workings of government to comb through agency budgets, legislative appropriations, and contracts.”

    So, to paraphrase the DOGE-OK report’s description of its methodology, its proposals would be “analyzed and vetted” by what they see as the “appropriate group.”

    In other words, Oklahomans were never promised an open, balanced, evidence-based DOGE process for making our state better. But the same is also true for Musk’s federal DOGE chainsaw.



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  • Did Musk and DOGE Save Any Money at All?

    Did Musk and DOGE Save Any Money at All?


    In an investigative report, The New York Times demonstrated that Elon Musk failed to deliver on his claim that he could cut $2 trillion from the federal budget. Not only did he fall short, but his efforts were so reckless that they might cost money instead of saving it.

    Having launched his so-called “Department of Government Efficiency” (which is not a department at all and was never authorized by Congress), Musk and his then-partner Vivek Ramaswamy promised to cut $2 trillion. Their goal dropped to $1 trillion, and Vivek left the team to run for Governor in Ohio.

    Some of DOGE’s claims turned out be be inflated (one alleged saving of $8 billion turned out to be a saving of only $8 million.

    Musk eventually reduced his saving claim to only $150 billion.

    Since DOGE began, thousands of federal employees have been fired. Some have been rehired after courts decided their firing was illegal. Some have been fired, rehired, and fired again. Some career employees have taken buyout offers. Tens of thousands of federal employees have been laid off, without regard to their experience. There was no time for DOGE workers to evaluate each person they ousted, nor did DOGE have the competence to judge its victims.

    The New York Times concluded that DOGE’s activities may actually save nothing at all. Firing workers is expensive when you do it the wrong way, the DOGE way.

    Elizabeth Williamson of The New York Times wrote:

    President Trump and Elon Musk promised taxpayers big savings, maybe even a “DOGE dividend” check in their mailboxes, when the Department of Government Efficiency was let loose on the federal government. Now, as he prepares to step back from his presidential assignment to cut bureaucratic fat, Mr. Musk has said without providing details that DOGE is likely to save taxpayers only $150 billion.

    That is about 15 percent of the $1 trillion he pledged to save, less than 8 percent of the $2 trillion in savings he had originally promised and a fraction of the nearly $7 trillion the federal government spent in the 2024 fiscal year.

    The Partnership for Public Service, a nonprofit organization that studies the federal work force, has used budget figures to produce a rough estimate that firings, re-hirings, lost productivity and paid leave of thousands of workers will cost upward of $135 billion this fiscal year. At the Internal Revenue Service, a DOGE-driven exodus of 22,000 employees would cost about $8.5 billion in revenue in 2026 alone, according to figures from the Budget Lab at Yale University. The total number of departures is expected to be as many as 32,000.

    Neither of these estimates includes the cost to taxpayers of defending DOGE’s moves in court. Of about 200 lawsuits and appeals related to Mr. Trump’s agenda, at least 30 implicate the department.

    The errors and obfuscations underlying DOGE’s claims of savings are well documented. Less known are the costs Mr. Musk incurred by taking what Mr. Trump called a “hatchet” to government and the resulting firings, agency lockouts and building seizures that mostly wound up in court.

    “Not only is Musk vastly overinflating the money he has saved, he is not accounting for the exponentially larger waste that he is creating,” said Max Stier, the chief executive of the Partnership for Public Service. “He’s inflicted these costs on the American people, who will pay them for many years to come.”

    Mr. Stier and other experts on the federal work force said it did not have to be this way. Federal law and previous government shutdowns offered Mr. Musk a legal playbook for reducing the federal work force, a goal that most Americans support. But Mr. Musk chose similar lightning-speed, blunt-force methods he used to drastically cut Twitter’s work force after he acquired the company in 2022.

    “The law is clear,” said Jeri Buchholz, who over three decades in public service handled hiring and firing at seven federal agencies, including NASA and the Defense Intelligence Agency. “They can do all the things they are currently doing, but they can’t do them the way they’re doing them. They can either start over and do it right, or they can be in court for forever.”



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  • Musk’s DOGE Protects One (1) Person: Elon Musk

    Musk’s DOGE Protects One (1) Person: Elon Musk


    Before Trump was elected, Elon Musk was being investigated by multiple federal agencies. After Trump’s election, Musk persuaded Trump to put him in charge of a cost-cutting operation called “Department of Government Efficiency,” which was tasked with cutting the budgets or shuttering multiple federal agencies.

    Musk and his team of hackers were ruthless in closing agencies that did not like. They shut down USAID, which provided food and medicine to the world’s neediest families and children.They terminated scientific research on a large number of university campuses and in the NIH, which sponsors critical research into cures for deadly diseases. They defunded large and small.

    But there is one kind of project they not defund: anything that pays federal funds to Elon Musk.

    More than that, Musk had a very lucky break. His good friend Trump, to whom he gave nearly $300 million for the 2024 election, is unlikely to prosecute his pal Elon.

    Lawrence Darmiento of the Los Angeles Times had the story:

    Elon Musk and his companies faced at least $2.37 billion in potential federal fines and penalties the day President Trump took office, according to a congressional report released Monday that highlights the possible conflicts of interest posed by the billionaire’s cost-cutting work in government.

    The 43-page memo by the minority staff of the Senate’s Permanent Subcommittee on Investigations, led by Sen. Richard Blumenthal (D-Conn.), is the most exhaustive attempt yet to detail Musk’s alleged conflicts as an advisor to Trump and chief promoter of his team called the Department of Government Efficiency, or DOGE.
    Based on publicly available documents, media reports and the committee’s own calculations, the memo found that as of Jan. 20, Musk and his companies were “subject to at least 65 actual or potential actions by 11 different federal agencies” and that 40 of those created $2.37 billion in potential liabilities.

    “Mr. Musk has taken a chainsaw to the federal government with no apparent regard for the law or for the people who depend on the programs and agencies he so blithely destroys,” the memo stated. “The through line connecting many of Mr. Musk’s decisions appears to be self-enrichment and avoiding what he perceives as obstacles to advancing his interests.”

    The memo notes that Musk’s companies have received more than $38 billion in government contracts, loans, subsidies and tax credits going back more than 20 years. And it notes that SpaceX, as of Friday, had $10.1 billion in federal contracts.

    “President Trump could not have chosen a person more prone to conflicts of interest,” states the memo, which calls on the president, executive departments and regulatory agencies to “take coordinated action to address Elon Musk’s threat to the integrity of federal governance.”

    To no one’s surprise, the white Hohse press office indignantly insisted that Musk had no conflicts of interest.

    The committee found that Tesla created most of the potential penalties for Musk — a cumulative $1.89 billion — due to investigations, lawsuits and other issues involving eight agencies.

    The largest single liability was a potential $1.19-billion fine due to a reported criminal investigation opened by the Department of Justice into allegedly false or misleading statements made by Musk and the company about its Autopilot and Full-Self Driving Features since as early as 2016.

    The Times previously reported the National Highway Traffic Safety Administration is probing the Full-Self Driving technology after reports of four collisions in low-visibility conditions, including one in which a pedestrian was killed.

    However, doubts have been raised about the Justice Department’s commitment to any prosecution. The memo notes that in February the department dismissed a lawsuit it filed against SpaceX for allegedly discouraging asylum seekers and refugees from applying for jobs or hiring them because of their citizenship status. It calculated the lawsuit could have exposed SpaceX to $46.1 million in liabilities.

    The second single largest liability of $462 million facing Musk also involved Tesla. It arose out of a 2023 lawsuit filed by the Equal Employment Opportunity Commission for the company’s alleged toleration of widespread racial harassment of Black employees at its Fremont, Calif., factory. Tesla has denied the allegations. In January, Trump fired two Democratic commissioners and the agency’s general counsel.

    How likely is it that any of these charges will go to trial?



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  • DOGE Kids Are Slashing Government Agencies, While Holding Multiple Jobs

    DOGE Kids Are Slashing Government Agencies, While Holding Multiple Jobs


    Imagine that you are a career civil servant , having worked at the same agency for 30 years. Then one day a 25-year-old youngster arrives with instructions to make rapid, sweeping change. He fires you and everyone else who knows how the agency works. This is called reform. Who are these people? It turns out that they hold jobs in multiple federal agencies. Do they receive multiple salaries?

    Ethics experts have questioned the practice but Trump has never listened to ethics experts.

    Faiz Siddiqui and Jacob Bosage wrote in The Washington Post:

    Gavin Kliger, a U.S. DOGE Service software engineer in his mid-20s, arrived at Internal Revenue Service headquarters in February, telling senior agency officials he was there to root out waste, fraud and abuse.

    Then, according to three people with direct knowledge of the events, he placed five government-issued laptops on a conference table and requested a sixth computer that would give him access at the IRS.

    At the time, court records show, Kliger held two job titles at the Office of Personnel Management, as well as positions at the U.S. Department of Agriculture and the Consumer Financial Protection Bureau. He was also working on dismantling the U.S. Agency for International Development.

    Earlier this month, according to a person with knowledge of the matter, Kliger showed up at the Federal Trade Commission, too.

    Kliger is not alone. His expanding portfolio — which now includes jobs in as many as seven federal offices — is typical of at least a handful of DOGE staffers. The unorthodox practice affords trusted acolytes of billionaire Elon Musk authority across broad swaths of government, as well as access to an array of confidential information, including tax documents, federal workforce records and consumer data.

    Because their jobs are embedded within agencies, the DOGE staffers have far more influence than those who might have worked collaboratively across government before — and their positions raise the possibility that even if Musk leaves government service at the end of May, as he has suggested, his allies will still have power, potentially for years to come.

    “Your people are fantastic,” Trump told Musk in a Cabinet meeting on Thursday. “In fact, hopefully they’ll stay around for the long haul. We’d like to keep as many as we can. They’re great — smart, sharp, right? Finding things that nobody would have thought of.”

    Government policy and ethics experts say the arrangement is unusual — and unprecedented — for the sweeping amount of access it grants to relatively low-level bureaucrats. Government officials have argued that DOGE and Musk do not have formal authority over decisions but rather advise officials at Cabinet departments on actions to take. But that makes the appointments DOGE liaisons are taking at multiple agencies even more influential.

    In addition to Kliger, who worked for Twitter before Musk bought the platform in 2022 and later joined an AI-focused data software firm, numerous DOGE associates have been given extraordinary power to shape government policy at multiple agencies. Among them:

    • Software engineer Christopher Stanley, who worked on the White House WiFi system and was serving at the Office of Personnel Management, was appointed as a director on the board of the mortgage financing giant Fannie Mae. The appointment came with an annual salary ranging from at least $160,000, but Stanley quickly resigned. Stanley, who has worked for X and SpaceX, did not respond to a request for comment.
    • Former Tesla engineer Thomas Shedd, 28, is running the digital arm of the General Services Administration, known as the Technology Transformation Services division but also has served in the office of the chief information officer at the Department of Labor, according to records reviewed by The Washington Post.
    • Luke Farritor, a former SpaceX internin his 20s who won a prestigious prize for decoding a Roman scroll, is detailed to at least five agencies, according to a lawsuit challenging DOGE’s authority.
    • And in perhaps the most high-profile case of cross-posting, Edward Coristine, the 19-year-old software engineer who used the online moniker “Big Balls,” was appointed to the State Department and the Department of Homeland Security, in addition to his position at DOGE.

    Even Amy Gleason, the official administrator of DOGE, is also an “expert/consultant” at the Department of Health and Human Services, a court filing shows. Gleason’s appointment to HHS was reported earlier by Politico.

    White House spokesman Harrison Fields did not directly address multiple positions held by DOGE staffers, but he touted DOGE’s work in a statement to The Post.

    “President Trump is committed to ending waste, fraud, and abuse, and his entire Cabinet, in coordination with DOGE, is working seamlessly to execute this mission efficiently and effectively,” he said.

    In his business empire, Musk has frequently moved staffers and resources across companies, sometimes inviting scrutiny. But such arrangements are unusual in the federal government, where employees traditionally are assigned to one job and one agency at a time.

    Staffers in DOGE’s predecessor agency — the U.S. Digital Service — worked collaboratively across government to improve technology, according to a former employee of the office, who spoke on the condition of anonymity for fear of retribution. Though they might sometimes receive an additional government-issued laptop from an agency they were assigned to work with, they did not typically work with more than one organization at a time, the person said.

    Earlier this month, after Politico reported that Trump had told his inner circle Musk would soon depart government service, Trump told reporters that Musk would leave after “a few months.” Before that, Musk said most of DOGE’s work to find $1 trillion in annual spending cuts would be complete by about the end of May, when his status as a special government employee requires him to leave his White House post.

    Max Stier, president and CEO of the nonprofit Partnership for Public Service, which advocates for better government, said that cross-postings might fly at a tech company but that they pose a “huge problem when it’s a governmental entity keeping people safe and providing critical support to millions of Americans.”

    “You’ve got people who have been deputized who have no business doing what they’re doing,” Stier said.

    State Democracy Defenders Fund, a group that aims to safeguard elections and perceived threats to democracy, has filed a lawsuit on behalf of more than two dozen USAID workers challenging DOGE’s constitutional authority, claiming Musk exercised authority that would typically be unavailable to a person who lacked a presidential nomination and Senate confirmation.

    The lawsuit argues that multiple simultaneous postings provide Musk and his allies with extraordinary authority over government functions, as well as backdoor access to agencies that DOGE aims to target for spending reductions.

    The suit cites the case of Farritor, a software engineer who, according to court records, was detailed to five agencies at the same time.

    “You have to ask yourself: When you have people who are appointed to as many as five agencies at times — a single person — and you have others who are obviously not qualified, are those legally valid appointments or are they sham appointments done with intent to evade the law?” Norm Eisen, executive chair of State Democracy Defenders Fund, said in an interview.

    He added: “I have been working for or around the federal government for almost 35 years and I never heard of a detailee with that many different jobs.”



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  • Easter: Reflecting on the Deaths Caused by DOGE Dismantling USAID

    Easter: Reflecting on the Deaths Caused by DOGE Dismantling USAID


    Today is a good day to reflect on hypocrisy. The Trump administration is deeply entwined with two groups: evangelical Christians and Elon Musk’s DOGE team. The White House has frequent prayer meetings, issues proclamations written by evangelical leaders, and even has offices in the Weat Wing for Trump’s spiritual advisors.

    Meanwhile, Trump empowered DOGE to ransack every federal agency, fire staff by the tens of thousands, and shutter agencies that were established by Congress. Many fear that Medicaid, Medicare, and Social Security will suffer deep cuts.

    The result will be not “efficiency,” but inefficiency. Worse, people will die if they cannot afford to pay for health care and do not get their Social Security because their local or regional office has been closed and they do not have a cell phone or computer.

    The prime example of DOGE slaughter of an agency that has saved millions of lives is USAID. Foreign aid has had bipartisan support for decades. It brings food, medicine, and medical clinics to desperately poor people around the globe. American farmers supply the grains that are exported and lose billions of dollars.

    But most important, millions of people will die because of the cutoff of drugs and food.

    This is rank cruelty. This is obscene. This is a crime.

    What do the evangelicals who surround Trump say about this? Clearly they influence his words but not his deeds. Jesus spoke about love, compassion, healing the sick, feeding the hungry, welcoming the stranger. What do they say about withdrawing drugs and food from millions of the needy and poor?

    Today is a good day to ask, What would Jesus do?

    David Remnick, editor of The New Yorker, interviewed Dr. Atul Gawande about his work at USAID. He was especially interested in learning Dr. Gawande’s views about the likely consequences of the evisceration of USAID.

    Remnick writes:

    It is hard to calculate all the good that Atul Gawande has done in the world. After training as a surgeon at Harvard, he taught medicine inside the hospital and in the classroom. A contributor to The New Yorker since 1998, he has published widely on issues of public health. His 2007 article in the magazine and the book that emerged from it, “The Checklist Manifesto: How to Get Things Right,” have been sources of clarity and truth in the debate over health-care costs. In 2014, he published “Being Mortal: Medicine and What Matters in the End,” a vivid, poetic, compassionate narrative that presents unforgettable descriptions of the ways the body ages and our end-of-life choices.

    Gawande’s work on public health was influential in the Clinton and Obama Administrations, and, starting in November, 2020, he served on President Joe Biden’s covid-19 Advisory Board. In July, 2021, Biden nominated him as the assistant administrator for the Bureau of Global Health at the U.S. Agency for International Development, where he worked to limit disease outbreaks overseas. Gawande, who is fifty-nine, resigned the position on the day of Donald Trump’s return to the Presidency.

    When we spoke recently for The New Yorker Radio Hour, Gawande, usually a wry, high-spirited presence, was in a grave mood. There were flashes of anger and despair in his voice. He was, after all, watching Trump and Elon Musk dismantle, gleefully, a global health agency that had only lately been for him a source of devotion and inspiration. As a surgeon, Gawande had long been in a position to save one life at a time. More recently, and all too briefly, he was part of a vast collective responsible for untold good around the world. And now, as he made plain, that collective has been deliberately cast into chaos, even ruins. The cost in human lives is sure to be immense. Our conversation has been edited for clarity and length.

    President Biden appointed you as the assistant administrator for global health at U.S.A.I.D., a job that you’ve described as the greatest job in medicine. You stepped down on Trump’s Inauguration Day, and he immediately began targeting U.S.A.I.D. with an executive order that halted all foreign aid. Did you know, or did you intuit, that Trump would act the way he has?

    I had no idea. In the previous Trump Administration, they had embraced what they themselves called the “normals.” They had a head of U.S.A.I.D. who was devoted to the idea of development and soft power in the world. They had their own wrinkle on it, which I didn’t disagree with. They called it “the journey to self-reliance,” and they wanted to invest in Africa, in Asia, in Latin America, to enable stronger economies, more capacity—and we weren’t doing enough of that. I actually continued much of the work that had occurred during that time.

    Tell me a little bit about what you were in charge of and what good was being done in the world.

    I had twenty-five thousand people, between D.C. and sixty-five countries around the world, working on advancing health and protecting Americans from diseases and outbreaks abroad. The aim was to work with countries to build their systems so that we protected global health security and improved global outcomes—from reducing H.I.V./aids and other infectious diseases like malaria and T.B., to strengthening primary health-care systems, so that those countries would move on from depending on aid from donors. In three years, we documented saving more than 1.2 million lives after covid alone.

    Let’s pause on that. Your part of U.S.A.I.D. was responsible, demonstrably, for saving 1.2 million lives—from what?

    So, covid was the first global reduction in life expectancy in seventy years, and it disrupted the ability across the world to deliver basic health services, which includes H.I.V./aids [medications], but also included childhood immunizations, and managing diarrhea and pneumonia. Part of my target was to reduce the percentage of deaths in any given country that occur before the age of fifty. The teams would focus on the top three to five killers. In some places, that would be H.I.V.; in some places that would be T.B. Safe childbirth was a huge part of the work. And immunizations: forty per cent of the gains in survival for children under five in the past fifty years in the world came from vaccines alone. So vaccines were a big part of the work as well.

    What was the case against this kind of work? It just seems like an absolute good.

    One case is that it could have been more efficient, right? Americans imagine that huge sums of money go to this work. Polls show that they think that a quarter of our spending goes to foreign aid. In fact, on a budget for our global health work that is less than half the budget of the hospital where I did surgery here in Boston, we reached hundreds of millions of people, with programs that saved lives by the millions. That’s why I describe it as the best job in medicine that people have never heard of. It is at a level of scale I could never imagine experiencing. So the case against it—I woke up one day to find Elon Musk tweeting that this was a criminal enterprise, that this was money laundering, that this was corruption.

    Where would he get this idea? Where does this mythology come from?

    Well, what’s hard to parse is: What is just willful ignorance? Not just ignorance—it’s lying, right? For example, there’s a statistic that they push that only ten per cent of U.S.A.I.D.’s dollars actually got to recipients in the world. Now, this is a willful distortion of a statistic that says that only ten per cent of U.S.A.I.D.’s funding went to local organizations as opposed to multinational organizations and others. There’s a legitimate criticism to be made that that percentage should be higher, that more local organizations should get the funds. I did a lot of work that raised those numbers considerably, got it to thirty per cent, but that was not the debate they were having. They’re claiming that the money’s not actually reaching people and that corruption is taking it away, when, in fact, the reach—the ability to get to enormous numbers of people—has been a best buy in health and in humanitarian assistance for a long time.

    Now the over-all agency, as I understand it, had about ten thousand people working for it. How many are working at U.S.A.I.D. now?

    Actually, the number was about thirteen thousand. And the over-all number now—it’s hard to estimate because people are being turned on and off like a light switch—

    Turned on and off, meaning their computers are shut down?

    Yeah, and they’re being terminated and then getting unterminated—like, “Oops, sorry, we let the Ebola team go.” You heard Elon Musk say something to that effect in the Oval Office. “But we’ve brought them back, don’t worry.” It’s a moving target, but this is what I’d say: more than eighty per cent of the contracts have been terminated, representing the work that is done by U.S.A.I.D. and the for-profit and not-for-profit organizations they work with, like Catholic Relief Services and the like. And more than eighty per cent of the staff has been put on administrative leave, terminated, or dismissed in one way or the other.

    So it’s been obliterated.

    It has been dismantled. It is dying. I mean, at this point, it’s six weeks in. Twenty million people with H.I.V., for example—including five hundred thousand children—who had received medicines that keep them alive have now been cut off for six weeks.

    A lot of people are going to die as a result of this. Am I wrong?

    The internal estimates are that more than a hundred and sixty thousand people will die from malaria per year, from the abandonment of these programs, if they’re not restored. We’re talking about twenty million people dependent on H.I.V. medicines—and you have to calculate how many you think will get back on, and how many will die in a year. But you’re talking hundreds of thousands in Year One at a minimum. But then on immunization side, you’re talking about more than a million estimated deaths.

    I’m sorry, Atul. I have to stop my cool journalistic questioning and say: This is nothing short of outrageous. How is it possible that this is happening? Obviously, these facts are filtering up to Elon Musk, to Donald Trump, and to the Administration at large. And they don’t care?

    The logic is to deny the reality, either because they simply don’t want to believe it—that they’re so steeped in the idea that government officials are corrupt and lazy and unable to deliver anything, and that a group of young twentysomething engineers will fix it all—or they are indifferent. And when Musk waves around the chainsaw—we are seeing what surgery on the U.S. government with a chainsaw looks like at U.S.A.I.D. And it’s just the beginning of the playbook. This was the soft target. This is affecting people abroad—it’s tens of thousands of jobs at home, so there’s harm here; there’s disease that will get here, etc. But this was the easy target. Now it’s being brought to the N.I.H., to the C.D.C., to critical parts of not only the health enterprise but other important functions of government.

    So the National Institutes of Health, the Centers for Disease Control and Prevention, and other such bureaucracies that do equal medical good will also get slammed?

    Are being slammed. So here’s the playbook: you take the Treasury’s payment system—doge and Musk took over the information system for the Treasury and the payments in the government; you take over the H.R. software, so you can turn people’s badges and computer access on and off at will; you take over the buildings—they cancelled the leases, so you don’t have buildings. U.S.A.I.D.—the headquarters was given to the Customs and Border Protection folks. And then you’ve got it all, right? And then he’s got X, which feeds right into Fox News, and you’ve got control of the media as well. It’s a brilliant playbook.

    But from the outside, at least, Atul, and maybe from your vantage point as well: this looks like absolute chaos. I’ve been reading this week that staff posted overseas are stranded, fired without a plane ticket home. From the inside, what does it look like?

    One example: U.S.A.I.D. staff in the Congo had to flee for their lives and watch on television as their own home was destroyed and their kids’ belongings attacked. And then when they called for help and backup, they could not get it. I spoke to staff involved in one woman’s case, a pregnant woman in her third trimester, in a conflict zone. They have maternity leave just like everybody else there. But because the contracts had been turned off, they couldn’t get a flight out, and were not guaranteed safe passage, and couldn’t get care for her complications, and ended up having to get cared for locally without the setup to address her needs. One person said to me, as she’s enduring these things, “My government is attacking me. We ought to be ashamed. Our entire system of checks and balances has failed us.”

    What’s been the reaction in these countries, in the governments, and among the people? The sense of abandonment must be intense on all sides.

    There are broadly three areas. The biggest part of U.S.A.I.D. is the fema for disasters abroad. It’s called the Bureau for Humanitarian Assistance, and they bring earthquake response; wildfire response; response in conflicts, in famines. These are the people who suit up, and get assistance, and stabilize places where things are going wrong.

    The Global Health Bureau, which I led, is the second-largest part of the agency, and that does work around diseases and health threats, as well as advancing health systems in low- and middle-income countries around the world. There’s coöperation on solving global problems, like stopping pandemics, and addressing measles outbreaks, and so on.

    The third is advancing countries’ economies, freedom, and democracy. John F. Kennedy, when he formed U.S.A.I.D. in 1961, said that it was to counter the adversaries of freedom and to provide compassionate support for the development of the world. U.S.A.I.D. has kept Ukraine’s health system going and gave vital support to keep their energy infrastructure going, as Russia attacked it. In Haiti, this is the response team that has sought to stabilize what’s become a gang-controlled part of the country. Our health teams kept almost half of the primary health-care system for the population going. So around the world: stopping fentanyl flow, bringing in independent media. All of that has been wiped out completely. And in many cases, the people behind that work—most of the people we’re working with, local partners to keep these things going—are now being attacked. Those partners are now being attacked, in country after country.

    What you’re describing is both human compassion and, a phrase you used earlier in our conversation, “soft power.” Describe what that is. Why is it so important to the United States and to the world? What will squandering it—what will destroying it—mean?

    The tools of foreign policy, as I’ve learned, are defense, diplomacy, and development. And the development part is the soft power. We’re not sending troops into Asia and Africa and Latin America. We’re sending hundreds of thousands of civilians without uniforms, who are there to represent the United States, and to pursue common goals together—whether it’s stemming the tide of fentanyl coming across the border, addressing climate disasters, protecting the world from disease. And that soft power is a reflection of our values, what we stand for—our strong belief in freedom, self-determination, and advancement of people’s economies; bringing more stability and peace to the world. That is the fundamental nature of soft power: that we are not—what Trump is currently trying to create—a world of simply “Might makes right, and you do what we tell you,” because that does not create stability. It creates chaos and destruction.

    An immoral universe in which everybody’s on their own.

    That’s right. An amoral universe.

    Who is standing up, if anyone, in the Administration? What about Secretary of State Marco Rubio, whom you mentioned. What’s his role in all of this? Back in January, he issued a waiver to allow for lifesaving services to continue. That doesn’t seem to have been at all effective.

    It hasn’t happened. He has issued a waiver that said that the subset of work that is directly lifesaving—through humanitarian assistance, disaster relief, and so on, and the health work that I used to lead—will continue; we don’t want these lives to be lost. And yet it hasn’t been implemented. It’s clear that he’s not in control of the mechanisms that make these things happen. doge does not approve the payments going out, and has not approved the payments going out, to sustain that work.

    The federal courts have ruled that the freeze was likely illegal and unconstitutional, and imposed a temporary restraining order saying that it should not be implemented, that it had to be lifted—the payment freeze. Instead, they doubled down. And Marco Rubio signed on to this, tweeted about it earlier this week—that over eighty per cent of all contracts have now been terminated. And the remaining ones—they have not even made a significant dent in making back payments that are owed for work done even before Trump was inaugurated.

    There’s always been skepticism, particularly on the right, about foreign aid. I remember Jesse Helms, of North Carolina, would always rail about the cost of foreign aid and how it was useless, in his view, in many senses. I am sure that in your time in office, you must have dealt with officials who were skeptical of the mission. What kind of complaints were you getting from senators and congressmen and the like, even before the Trump Administration took over in January?

    It was a minority. I’ll just start by saying: the support for foreign-aid work has been recognized and supported by Republicans and Democrats for decades. But there’s been a consistent—it was a minority—that had felt that the U.S. shouldn’t be involved abroad. That’s part of an isolationist view, that extending this work is just charity; it’s not in U.S. interests and it’s not necessary for the protection of Americans. The argument is that we should be spending it at home.

    They’re partly playing into the populist view that huge portions of the budget are going abroad, when that’s not been the case. But it’s also understandable that when people are suffering at home, when there are significant needs here, it can be hard to make connections to why we need to fight to stop problems abroad before they get here.

    And yet we only recently endured the covid epidemic, which by all accounts did not begin at home, and spread all over the world. Why was covid not convincing as a manifestation of how a greater international role could help?

    Certainly that didn’t convince anybody that that was able to be controlled abroad—

    Because it wasn’t.

    Because it wasn’t, right. And covid did drive a significant distrust in the public-health apparatus itself because of the suffering that people endured through that entire emergency. But I would say the larger picture is—every part of government spending has its critics. One of the fascinating things about the foreign-aid budget, which has been the least popular part of the budget, is that U.S.A.I.D. was mostly never heard of. Now it has high name recognition, and has majority support for continuing its programs, whether it’s keeping energy infrastructure alive in Ukraine, stabilizing conflicts—whether it’s Haiti or other parts of the world—to keep refugees from swarming more borders, or the work of purely compassionate humanitarian assistance and health aid that reduces the over-all death rates from diseases that may yet harm us. So it’s been a significant jump in support for this work, out of awareness now of what it is, and how much less it turns out to cost.

    So it took this disaster to raise awareness.

    That’s human nature, right? Loss aversion. When you lose it is when you realize its value.

    Atul, there’s been a measles outbreak in West Texas and New Mexico, and R.F.K., Jr.—who’s now leading the Department of Health and Human Services—has advised some people, at least, to use cod-liver oil. We have this multilayered catastrophe that you’ve been describing. Where could the United States be, in a couple of years, from a health perspective? What worries you the most?

    Measles is a good example. There’s actually now been a second death. We hadn’t had a child death from measles in the United States in years. We are now back up, globally, to more than a hundred thousand child deaths. I was on the phone with officials at the World Health Organization—the U.S. had chosen measles as a major area that it wanted to support. It provided eighty per cent of the support in that area, and let other countries take other components of W.H.O.’s work. So now, that money has been pulled from measles programs around the world. And having a Secretary of Health who has done more to undermine confidence in measles vaccines than anybody in the world means that that’s a singular disease that can be breaking out, and we’ll see many more child deaths that result from that.

    The over-all picture, the deeper concern I have, is that as a country we’re abandoning the idea that we can come together collectively with other nations to do good in the world. People describe Trump as transactional, but this is a predatory view of the world. It is one in which you not only don’t want to participate in coöperation; you want to destroy the coöperation. There is a deep desire to make the W.H.O. ineffective in working with other nations; to make other U.N. organizations ineffective in doing their work. They already struggled with efficiency and being effective in certain domains, and yet they continue to have been very important in global health emergencies, responding and tracking outbreaks. . . .

    We have a flu vaccine because there are parts of the world where flu breaks out, like China, that don’t share data with us. But they share it with the W.H.O., and the result is that we have a flu vaccine that’s tuned to the diseases coming our way by the fall. I don’t know how we’ll get a flu vaccine this fall. Either we’ll get it because people are, under the table, communicating with the W.H.O. to get the information, and the W.H.O is going to share it, even though the U.S. is no longer paying, or we’re going to work with other countries and be dependent on them for our flu vaccine. This is not a good answer.

    I must ask you this, more generally: You’re watching a President of the United States begin to side with Russia over Ukraine. You’re watching the dismantlement of our foreign-aid budget, and both its compassion and its effectiveness. Just the other day, we saw a Columbia University graduate—you may agree with him, disagree with him on his politics, but who has a green card—and ice officers went to his apartment and arrested him, and presumably will deport him. It’s an assault on the First Amendment. You’re seeing universities being defunded—starting with Columbia, but it’ll hardly be the last, etc. What in your view motivates Donald Trump to behave in this way? What’s the vision that pulls this all together?

    What I see happening on the health side is reflective of everything you just said. There is a fundamental desire to remove and destroy independent sources of knowledge, of power, of decision-making. So not only is U.S.A.I.D. dismantled but there’s thousands of people fired—from the National Institutes of Health, the C.D.C., the Food and Drug Administration—and a fundamental restructuring of decision-making so that political judgment drives decision-making over N.I.H. grants, which have been centralized and pulled away from the individual institutes. So the discoveries that lead to innovations in the world—that work has a political layer now. F.D.A. approvals—now wanting a political review. C.D.C. guidance—now wanting a political review. These organizations were all created by Congress to be shielded from that, so that we could have a professional, science-driven set of decisions, and not the political flavor of the moment.

    Donald Trump’s preference, which he’s expressed in those actions and many others, is that his whims, just like King Henry VIII’s, should count. King Henry VIII remade an entire religion around who he wanted to marry. And this is the kind of world that Trump is wanting to create—one of loyalty trumping any other considerations. So the inspectors general who do audits over the corruption that they seem to be so upset about—they’ve been removed. Any independent judgment in society that would trump the political whims of the leader. . . . The challenge is—and I think is the source of hope for me—that a desire for chaos, for acceding to destruction, for accepting subjugation, is not a stable equilibrium. It’s not successful in delivering the goods for people, under any line of thinking.

    In the end, professionally organized bureaucracies—that need to have political oversight, need to have some controls in place, but a balance that allows decision-making to happen—those have been a key engine of the prosperity of the country. Their destruction will have repercussions that I think will make the Administration very unpopular, and likely cause a backlash that balances things out. I hope we get beyond getting to the status quo ante of a stalemate between these two lines of thinking—one that advances the world through incremental collective action that’s driven around checks and balances as we advance the world ever forward, and one in which a strongman can have his way and simply look for who he can dominate.

    Right now, Robert F. Kennedy, Jr., is the head of H.H.S. His targets include not only vaccine manufacturers but the pharma industry writ large. But he’s talked a lot, too, about unhealthy food in the American diet—to some extent, he’s not wrong. Do you see any upside in his role in pushing this so-called Make America Healthy Again idea?

    Of course there is good. I mean, we as a country have chronic illness that is importantly tied to our nutritional habits, our exercise, and so on. But for all our unhealthiness, we’ve also had an engine of health that has enabled the top one per cent in America to have a ninety-year life expectancy today. Our job is to enable that capacity for public health and health-care delivery to get to everybody alive, I would argue, and certainly to get it to all Americans.

    What’s ignored is that half the country can’t afford having a primary-care doctor and don’t have adequate public health in their communities. If R.F.K., Jr., were taking that on, more power to him. Every indication from his history is that this is an effort to highlight some important things. But how much of it’s going to actually be evidence-driven? He’s had some crazy theories about what’s going to advance chronic illness and address health.

    I’d say the second thing is the utter incompetence in running things and making things work. They’ve utterly destabilized the National Institutes of Health, the Centers for Disease Control, the F.D.A.

    Explain that destabilization—what it looks like from inside and what effects it’ll have.

    One small example: doge has declared that all kinds of buildings are not necessary anymore. That includes the headquarters of the Department of Health and Human Services. They’re saying, “Oh, everybody has to show up for work now, but you won’t have a building to work in anymore.”

    No. 2 on the list is F.D.A. specialized centers around the country. There’s a laboratory in St. Louis where they have specialized equipment for testing food and drugs for safety. And so that whole capability—to insure that your foods and your medications are able to be tested for whether they have contaminants, whether they are counterfeit—that’s a basic part of good nutrition, good medicine, that could be pulled away.

    Whether it’s maintaining the building infrastructure, maintaining the staff who are being purged sort of randomly left and right, or treating them not like they’re slaves but actually bringing good work out of everybody, by good management—that is what’s not happening.

    I have the feeling that you, even in a short time, loved being in the federal government. What I hear in our conversation is a sense of tragedy that is not only public but that is felt very intimately by you.

    I did not expect that going into government would be as meaningful to me as it was. I went into government because it was the covid crisis and I was offered an opportunity to lead the international component of the response. We got seven hundred million vaccines out to the world. But what I found was a group of people who could achieve scale like I’d never seen. It is mission-driven. None of these people went into it for the money; it’s not like they’ve had any power—

    I assume all of them could have made more money elsewhere.

    Absolutely. And many of them spent their lives as Foreign Service officers living in difficult places in the world. I remember that Kyiv was under attack about eight weeks after I was sworn in. I thought I was going to be working on covid, but this thing was erupting. First of all, our health team, along with the rest of the mission and Embassy in Kyiv, had to flee for safety. But within a week they were already saying, “We have T.B. breaking out, we have potential polio cases. How are we going to respond?” And my critical role was to say, “What’s going to kill people the most? Right now, Russia has shut down the medical supply chain, and so nearly a hundred per cent of the pharmacies just closed. Two hundred and fifty thousand H.I.V. patients can’t get their meds. A million heart patients can’t get their meds. Let’s get the pharmacies open.” And, by the way, they’ve attacked the oxygen factories and put the hospitals under cyberattack and their electronic systems aren’t functioning.

    And this team, in four weeks, moved the entire hospital record system to the cloud, allowing protection against cyberattacks; got oxygen systems back online; and was able to get fifty per cent of the pharmacies open in about a month, and ultimately got eighty per cent of the pharmacies open. That is just incredible.

    Yes, are there some people that I had to deal with who were overly bureaucratic? Did I have to address some people who were not performing? Absolutely. Did I have to drive efficiency?

    As in any work . . .

    In every place you have to do that. But this was America at its best, and I was so proud to be part of that. And what frustrated me, in that job, was that I had to speak for the U.S. government. I couldn’t write for you during that time.

    Believe me, I know!

    I couldn’t tell the story. I’ve got a book I’m working on now in which I hope to be able to unpack all of this. It is, I think, a sad part of my leadership, that I didn’t also get to communicate what we do—partly because U.S.A.I.D. is restricted, in certain ways, from telling its story within the U.S. borders.

    If you had the opportunity to tell Elon Musk and Donald Trump what you’ve been telling me for the past hour, or if they read a long report from you about lives saved, good works done, the benefits of soft power to the United States and to the world and so on—do you think it would have any effect at all?

    Zero. There’s a different world view at play here. It is that power is what matters, not impact; not the over-all maximum good that you can do. And having power—wielding it in ways that can dominate the weak and partner with your friends—is the mode of existence. (When I say “partner with friends,” I mean partner with people like Putin who think the same way that you do.) It’s two entirely different world views.

    But this is not just an event. This is not just something that happened. This is a process, and its absence will make things worse and worse and have repercussions, including the loss of many, many, maybe countless, lives. Is it irreparable? Is this damage done and done forever?

    This damage has created effects that will be forever. Let’s say they turned everything back on again, and said, “Whoops, I’m sorry.” I had a discussion with a minister of health just today, and he said, “I’ve never been treated so much like a second-class human being.” He was so grateful for what America did. “And for decades, America was there. I never imagined America could be indifferent, could simply abandon people in the midst of treatments, in the midst of clinical trials, in the midst of partnership—and not even talk to me, not even have a discussion so that we could plan together: O.K., you are going to have big cuts to make. We will work together and figure out how to solve it.”

    That’s not what happened. He will never trust the U.S. again. We are entering a different state of relations. We are seeing lots of other countries stand up around the world—our friends, Canada, Mexico. But African countries, too, Europe. Everybody’s taking on the lesson that America cannot be trusted. That has enormous costs.

    It’s tragic and outrageous, no?

    That is beautifully put. What I say is—I’m a little stronger. It’s shameful and evil. ♦︎



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