Goods and Services
Government impact of personnel reduction on infectious disease prevention and treatments
I’m not a trained economist. However, unless one is a hermit living completely off grid—we, all of us, are the economy. (Like that joke about how one isn’t stuck in traffic—they are traffic.) “Economics is a social science that focuses on the production, distribution, and consumption of goods and services,” per Investopedia. We can see the economic impact of decisions made on personal, family, business, and government levels—and sooner or later, we will feel them.
Waste, fraud and abuse is everywhere—in personal life (did I really need to throw away that food?), in our businesses and, of course, in our government. While we can and should address it and reduce it, chances are good that it will never go to zero.
A repurposed US Digital Services has become DOGE—Department of Government Efficiency. Using a hatchet (or chainsaw) rather than a scalpel, it has been slicing through our Federal government, affecting grants, staffing, and even whole agencies, such as the US Agency for International Development.
How does this affect the goods and services around our health? Does the government actually do anything?
There are very few goods that most of us use that are from our government. I do use government-issued ID when I travel. I rarely carry change (goodbye, pennies) and often don’t have more than a few bills. Most of the economic transactions I make involve digital payments in one way or another—direct payments from my bank to the mortgage company, credit card payments, or NFC payments with my phone.
Some government agencies may be making prototype equipment, easier now with 3D printers, but for the most part, other than sending payments from programs such as Medicare, Social Security or IRS tax refunds, most of what government does is services—lots and lots of services. Some of these agencies even have “Service” in their names—the National Weather Service, the National Park Service, the Secret Service, and my favorite, the Epidemic Intelligence Service. We call those who serve in our military service members.
While it is right and proper to debate what limits should be attached to the goals of our government as stated in the Preamble of the United States Constitution (“in Order to form a more perfect Union, establish Justice, insure domestic Tranquility, provide for the common defence, promote the general Welfare, and secure the Blessings of Liberty to ourselves and our Posterity”), from an Infectious Disease and public health standpoint, serious injury has happened to these government services.
I previously wrote about the interruption of cooperation with the World Health Organization—Anywhere is Everywhere—which happened in the early days of the current administration, and how infectious diseases care not about international borders.
Defunding of personnel and grants to the USAID that funds health services, including malaria, tuberculosis and HIV/AIDS care in underdeveloped nations. While there is no immediate direct impact on health in the US, multidrug resistant infections, that occur with inadequate treatment, have a history of making their way to our shores. Draw your own conclusion about the geopolitical impact of withdrawing these services.
These are the services that I most worry about now:
Staffing at the Centers for Disease Control and Prevention. Firing, and not hiring, new workers means no trainees as we move forward. The pipeline and training period is long. The disease surveillance at CDC affects infectious diseases and more.
Staffing at the FDA that evaluates new medical devices, medications and new biological agents, primarily vaccines. New influenza vaccines need to be formulated every year to combat this rapidly changing virus. All of these goods require government services to get approval and into use for us, the American people to have benefit, and for manufacturers to earn income on their years of investment. Slowing down the approval process means prolonging suffering and more deaths while waiting for the approval process.
Can these necessary services be provided by many fewer employees with much less resources? That is the experiment that DOGE is inflicting on the American people. A bad outcome will mean more death and disability.
The “Move Fast and Break Things” mantra has worked well in Silicon Valley and the technology world, although it is not without limits. However, the mission of tech is to create tools that are used by society. Translating that approach to the government mission of sustaining life and providing services will cost lives if services are significantly disrupted. It is time to improve, not break, things.