MAHAahahahahahaaaa....

ONE OF THE BIGGEST ADVANCES in public health from the last few years is one that you’ve probably never heard about—and one that now may be in jeopardy thanks to the Trump administration.

I’m talking about a dramatic turnaround in America’s opioid crisis, the epidemic that began in the late 1990s with an explosion in the use of addictive prescription painkillers, and then got even worse with a surge in the use of heroin and its synthetic alternative, fentanyl. The effects have left families, communities, and in some cases whole regions of the country reeling, and more than 700,000 Americans dead from overdoses.

BY JONATHAN COHN

When ‘Make America Healthy Again’ Actually Means the Opposite
As part of a ‘painful period’ of cuts, Trump and RFK Jr. plan on dismantling the agency that focuses on substance abuse.

But recently the death rate from overdoses has started to fall. In the latest twelve-month period that the official data captures, the decline has been particularly steep: 24 percent.

In raw numbers, that’s 27,000 fewer deaths over the course of a year—a figure that, as Johns Hopkins University professor Brendan Saloner told me in an interview, is “astonishing.”

Pinpointing the cause of the drop is, as always, difficult. Researchers like Saloner think it’s most likely a combination of factors—like changes in the purity of fentanyl available from dealers and more effective interdictions of foreign smuggling chains. There’s also the grim possibility of a “burning out” effect, as the people most likely to overdose die off.

But another likely factor, in the view of most experts, has been a surge in federal support for substance abuse programs.

That includes the programs offering prevention, treatment, and recovery services, as well as those focusing on “harm reduction” strategies like the distribution of Naloxone, the fast-acting drug that can keep overdose victims alive long enough to get them emergency medical care.

The surge started with legislation that Barack Obama signed in the final year of his presidency, but in the years that followed the effort was relatively bipartisan. That included support from Donald Trump, who talked frequently about the opioid crisis during the 2016 campaign and then, as president, returned to the subject in a memorable October 2017 speech.

“As Americans, we cannot allow this to continue,” Trump said, citing his late brother’s difficulties with alcoholism as a personal connection to the issue. “It is time to liberate our communities from this scourge of drug addiction.” And although his record didn’t really live up to his rhetoric, his administration did launch several anti-opioid initiatives.

Now Trump is back in the White House and, in theory, he remains committed to the opioid effort. In fact, a little less than two weeks ago, Secretary of Health and Human Services Robert F. Kennedy Jr. renewed the epidemic’s status as a “public health emergency,” stating in an official release that “addressing the opioid overdose crisis . . . is one of many critical steps we will take to Make America Healthy Again.”

But just nine days later, Kennedy announced sweeping layoffs designed to slash HHS staff by 25 percent, as part of a broader reorganization that will partly dismantle several of the department’s smaller agencies. One of them is an agency that’s been at the center of the federal opioid effort.

IT’S CALLED the Substance Abuse and Mental Health Services Agency, or SAMHSA. And if you’ve never heard of it, don’t feel bad. Most people haven’t.

But SAMHSA is the agency that awards and manages the big grant program that states use to finance their substance abuse efforts. It’s also the agency that runs the National Survey on Drug Use and Health, the gold-standard assessment that policymakers and researchers rely on to understand trends and shifts in how people are using drugs.

Other SAMHSA duties include establishing best practices for different types of substance abuse initiatives, offering training programs for substance abuse workers, and operating the new 988 hotline for suicide and mental health crises.1In order to keep close tabs on what’s actually happening in the country—and maintain an ongoing dialogue with local officials—SAMHSA had staff in the ten HHS regional offices.

Now all of that is going to change. The plan Kennedy announced will eliminate SAMHSA as a separate entity, folding it and several other smaller agencies into a new division called the “Administration for a Healthy America.” It will also cut the number of HHS regional offices in half, leaving just five.

And while HHS officials have not specified publicly how many SAMHSA staff will lose their jobs, the New York Times has reported (and a source familiar with discussions has since confirmed to me) that Kennedy and his lieutenants have talked about reducing the agency’s headcount by half, with occasional mention of even bigger cuts.

The official rationale for the cuts and consolidation is that they will make SAMHSA work better: “Transferring SAMHSA to AHA will increase operational efficiency and assure programs are carried out because it will break down artificial divisions between similar programs,” an HHS press release said.

It’s the same way Kennedy justified the broader HHS overhaul, which he explained in a six-minute video posted to social media. “HHS is a sprawling bureaucracy that encompasses literally hundreds of departments, committees, and other offices,” Kennedy said. “You know how bureaucracies work. Every time a new issue arises, they tack on another committee.”

“This will be a painful period for HHS,” Kennedy acknowledged, although he vowed that the public won’t feel much of a pinch: “We’re going to do more with less. No American is going to be left behind.”

There’s absolutely nothing controversial about trying to reorganize the sprawling, frequently byzantine structure of HHS, or hacking away at the internal processes and rules that can impede rather than enable progress. Just three years ago, a blue-ribbon commission convened by the Commonwealth Fund—a well-respected, left-leaning think-tank—issued its own call for substantial changes at the department.

But that document was the result of lengthy, careful discussion of priorities and tradeoffs. There are few visible signs that the Trump administration engaged in such deliberations, and plenty of signs that it didn’t—especially at SAMHSA.

SAMHSA GOT ITS FIRST TASTE of cuts back in February, when the Trump administration ordered government-wide firings of “probationary” workers (which meant anybody, whether newly hired or newly promoted, who’d been in their position for less than a year).

Among those hit hardest were the ten regional offices, according to Scott Gagnon, who ran the New England division. SAMHSA’s staffing at several of them fell from four or three workers to one or none, he told me, undermining capabilities and responsiveness in a way that will only get worse with the new cuts HHS just announced.

“Imagine what that means—they’re still going to cover the whole country, but now every office is going to cover up to twelve states, instead of just five or six,” said Gagnon, who is now on administrative leave because the courts ordered the Trump administration to reinstate the probationary workers but HHS hasn’t put them on the job. “In my state of Maine, they would see me several times a year. Now they might be lucky to get one or two visits. It’s just really going to dilute that responsiveness and that connection,”

The damage to SAMHSA’s data collection work could be even more pernicious, several experts told me, because the data is so essential to public and private-sector leaders trying to craft substance abuse policy—and because projects like the big national survey require so much expertise and institutional knowledge to operate.

“That is the only national survey we have on drug use, and if the staff who does that work is cut, then we’re flying blind,” Regina LaBelle, a Georgetown University professor who served in the Obama and Biden administrations, told me.

“Good data actually takes a lot of manpower,” added Kathryn Poe, a health care researcher at the think tank Policy Matters Ohio. “You have to clean it, you have to evaluate it, you have to organize it. You have to make sure that you’re getting accurate reporting. You have to actually analyze it. And all of that is stuff that’s done by humans.”

THE BEST HOPE for the government’s opioid efforts is that all of the talk about making HHS more effective is genuine, that they will cut smartly and not arbitrarily, and that somewhere in the Trump administration there are officials mindful of recent progress and eager to—as Saloner put it to me—“be heroic and do something big and important to sustain what was already underway.”

But it’s awfully hard to imagine such thoughtful, deliberate reforms coming from leaders who wave around chainsaws while discussing their designs on government, or who say their ultimate goal is turning career civil servants into “villains.” And it’s hard to understand how HHS is going to get more efficient when it is shuttering so many offices—and firing so many people—whose very jobs are to watch over agency programs and make sure they are working properly.

“They have the know-how, in-house, to make decisions about how to steer resources, that institutional judgment . . . that’s intangible but super important,” Saloner said, adding that they are also the ones who handle the tedious, unglamorous and essential work “of making sure that there’s compliance with federal standards, that things are being correctly reported, that there’s no misuse or waste of funds.”

As for Trump, his interest in the opioid project also seems suspect at best. The rhetoric from his first campaign and term, whatever its authenticity, featured a discernible empathy for people with substance abuse problems—and a clear commitment to the proposition that an effective strategy included the kinds of investments SAMHSA has managed.

Now, whenever Trump talks about opioids, it’s to raise the specter of fentanyl as a foreign menace, justifying his border policies and posture towards other countries.

Trump is also behind congressional efforts to enact sweeping spending cuts, in order to offset the cost of his multitrillion-dollar tax cut. And although the Republicans in Congress are still arguing over how to do that, it’s easy to imagine them agreeing to cuts in substance abuse funds given that one element of the current strategy—harm reduction—already has loud critics among conservatives, who think it implicitly condones drug use.

And that’s to say nothing of the possibility, which Republicans in Congress have discussed explicitly, of cuts to Medicaid, the federal-state program that pays medical bills for more than 70 million mostly low-income Americans. It is the nation’s single biggest financier of mental health and substance abuse treatment.

If Medicaid shrinks and fewer people have coverage, either states will have to make up for the lost substance abuse funding by pulling funds from elsewhere, or they’ll just let the shortfalls stand. Either way, the result will likely be fewer people getting the help they need and, ultimately, more people dying from overdoses.

It doesn’t have to be that way, as the last two years have shown. But it’s not at all clear the Trump administration knows this—or that it cares.

https://www.thebulwark.com/p/when-make-america-healthy-again-actually-means-opposite-rfk-trump-opioid-overdose-hhs-samhsa-painful

YOURDEMOCRACY.NET RECORDS HISTORY AS IT SHOULD BE — NOT AS THE WESTERN MEDIA WRONGLY REPORTS IT.

Gus Leonisky

POLITICAL CARTOONIST SINCE 1951.

By Gus Leonisky at 21 Jul 2025 - 5:55am
Gus Leonisky's blog
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APBS safe....

Pharma tariffs would be 'deeply concerning': O'Brien

By Courtney Gould

Shadow Treasurer Ted O'Brien says suggestion the US could slap a 200 per cent tariff on pharmaceutical exports is "deeply concerning".

"It should come as no surprise to the government, which is why I'm just so angry that the prime minister has not prioritised a relationship with the United States," he told Sky News.

"People have been talking about the threat to our pharmaceutical sector through tariffs for months now. But the government has not taken adequate action."
Donald Trump flagged the possibility of tariffs on pharmaceuticals and copper prior to a meeting of his cabinet on Tuesday, local time — but said pharmaceutical producers would get a grace period to move production to the US.

Earlier, Treasurer Jim Chalmers reiterated the government had no plans to trade away or do deals on Australia's Pharmaceutical Benefits Scheme.

https://www.abc.net.au/news/2025-07-09/federal-politics-live-blog-july-9/105509964

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YOURDEMOCRACY.NET RECORDS HISTORY AS IT SHOULD BE — NOT AS THE WESTERN MEDIA WRONGLY REPORTS IT.

Gus Leonisky

POLITICAL CARTOONIST SINCE 1951.

By Gus Leonisky at 21 Jul 2025 - 8:30am
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medicare....

John Menadue

Fifty years since that little green card came into being

Gough Whitlam had to do plenty of hard yakka to introduce an universal healthcare system. Today, it is central part of Australia life, and one of our great policy achievements.

Medibank started on schedule on 1 July 1975 when health insurance cards were issued to the Australian population. But the story of Medicare really goes back almost 60 years.

Down a different path in Melbourne: how Medibank was conceived

On a bleak midwinter night, the germ of an idea crystallised into a grand plan.

It was hard going developing policies in Opposition, particularly for a reform party out of power during the long Menzies ascendancy. The task was made harder in Australia, with our written Constitution interpreted for many years by a conservative High Court.

A historic meeting

Health policy was no exception, but a turning point came on the night of 6 June 1967, at the home of Dr Moss Cass in Melbourne. Cass was among the most farsighted and perceptive thinkers on health policy that I have met. He was then in charge of a trade union health clinic in Melbourne and later became a minister, but not health minister, in the Whitlam Governments.

As Gough Whitlam’s “Chief of Staff “in an office of only three people in the mid-1960s, I had been building up groups of people who could advise him on a range of issues, such as education, science, housing, transport and health. These groups were the building blocks that Whitlam used to rewrite almost the whole of the ALP platform.

He called the ALP Platform the “Old Testament’ He was intent on writing the “New Testament”.

That work came to fruition in the ALP’s election victory of 1972.

The advisory groups were made up of professionals, academics and other reform-minded people who freely gave of their skill and time. Few were members of the ALP.

Professor Sol Encel was my chief collaborator in building these groups. He was reader in Political Science at the Australian National University at the time and later became Professor of Sociology at the University of New South Wales. Encel suggested Cass as an adviser on health policy. Cass had written an influential Fabian Society pamphlet on health policy and advocated a national health system founded on public hospitals and health centres staffed by salaried doctors.

In 1967, the ALP’s election prospects seemed as bleak as the midwinter night when Whitlam and I rang Cass’s front doorbell. Many years later, Whitlam asked me what time of the year the meeting was held. I recalled it was midwinter because Cass had lit a log fire to try to cheer us up. The evening turned out to be a historic turning point, although no-one recognised it at the time. If we had realised how important it was, we would at least have had a photographer present!

Cass had also invited Dr Rod Andrew, Foundation Dean, Faculty of Medicine at Monash University, who had been a public advocate of more salaried staff in hospitals. Also present was Dr Jim Lawson, Superintendent of the Footscray Hospital, who was described by Cass as having a view that there were too many hospital beds, and that they should be used more efficiently and with greater emphasis on care in the community. Dr Harry Jenkins, the ALP spokesman on health in the Victorian State Parliament, was also present. However, the key attendees. were two young researchers from the Institute of Applied Economic Research at Melbourne University, John Deeble and Dick Scotton. Deeble had previously been deputy general nanager of the Peter MacCallum Clinic in Melbourne. Scotton had been economist at the Commercial Banking Company in Sydney and was doing ground-breaking research at Melbourne University on the pharmaceutical industry, hospital costs and compulsory and voluntary health insurance.

A scheme of universal health insurance

From that 6 June 1967 meeting, Deeble and Scotton developed a universal and compulsory health insurance scheme to be funded by a tax levy. It was clear that the Liberal-Country Party Coalition Government’s voluntary health insurance scheme, supported by taxpayers’ funds, was wasteful and inequitable and that an alternative was needed.

In May 1968, Deeble and Scotton distributed their paper, A scheme of universal insurance (unpublished paper, Institute of Applied Economic Research, May 1968). Whitlam used this academic treatise as a major input in his own policy development. In July that year, 13 months after the meeting at Cass’s house and almost five years before he became prime minister, Whitlam outlined the alternative national health program (called Medibank, and later Medicare), which was to become so much part of Australian national life. The Deeble and Scotton ideas became a practical and political program. Once again, rigorous policy development and a compelling Whitlam speech became party policy.

In retrospect, the June 1967 meeting took health down a path that neither Whitlam nor I expected. We were looking in another direction. Medibank was about financing access to “the health system”, not about how the health system could better deliver services to the community. It is noteworthy that 50 years after the obvious success of Medibank, with increased demands on the health system in a consumer society, we are being forced to again consider how we can better deliver health services. Access to “the health system” is no longer sufficient; the system itself needs attention.

In most of the seven years I spent with Whitlam, we were not working on a compulsory health insurance scheme but focusing on how to develop and strengthen a public hospital system with regional clinics and services providing GP-like services. Because of the constitutional and political barriers to nationalisation of the medical profession, the only feasible route seemed to be via increased federal government funding for expanded state public hospital and community services that could compete with private hospitals and private doctors.

The overseas experience

At the time, many of us in the ALP were attracted to the National Health Service which the British Labour Party had introduced in the 1940s. But such a scheme in Australia was constitutionally impossible. It was also politically hazardous, with doctors in many countries suspicious of and rigorously opposed to the British NHS at the time, although it has stood the test of time much better than its many critics.

With Cass’s assistance, we read the literature on different healthcare schemes around the world. What caught our attention were the many surveys and analyses which showed that fee-driven, private medicine resulted in excessive treatment, high costs and orientation away from preventive care. These health schemes were overwhelmingly producer- rather than consumer-driven and were inherently unstable, with suppliers of the services substantially managing the demand. I recall particularly articles in the New England Journal of Medicine about the development of health maintenance organisations in the US in response to escalating private health costs.

A national hospital system

In 1961, long before Deeble and Scotton came along and Medibank was conceived, Whitlam had described his path for health reform in his Curtin Lecture: “…the best way to achieve a proper national health service is to establish a national hospital system.” He added: “…the proper approach is for the Commonwealth to make additional grants to the states on condition that they regionalise their hospital services and establish salaried and sessional medical and ancillary staff in hospitals.”

These ideas were further developed and articulated in a speech which he gave to the citizens of Rochester, Victoria, in 1964. They were clearly nonplussed when, at their rural hospital, he told them that “it is more important to nationalise hospitals than to nationalise the medical profession”. What was he talking about? This was Whitlam’s way of circumventing the constitutional obstacles, although it seemed very remote from the problems facing Rochester. While federal Parliament could “make laws with respect to … pharmaceuticals, sickness and hospital benefits”, it could not “authorise any form of civil conscription”. Nationalisation of the medical profession, as in the United Kingdom, was out, but a national health service based on “Section 96” federal grants to the states for hospitals with regional health services and employing salaried staff was seen as a way forward. There would be choice for doctors and patients. (Under Section 96 of the Australian Constitution, “the [Commonwealth] Parliament may grant financial assistance to any state on such terms and conditions as the Parliament thinks fit”.)

Elected in 1972, the Whitlam Government introduced a five-year program of capital assistance for hospitals. Under Section 96 of the Constitution, these were “special purpose grants”. The Fraser* Coalition Government did not renew the program, nor did the Labor governments of Hawke or Keating.

However, after June 1967, major health reform was to go down the Medibank compulsory insurance route rather than the funding of hospitals and related services. Medibank would prove simpler to explain and implement. It was also a more likely political winner.

Voluntary versus compulsory health insurance

While developing reforms based on hospitals, Whitlam had been persistently criticising the shortcomings of voluntary health insurance. He had asked many questions on notice in federal Parliament since the early 1960s about the high cost, high reserves and limited coverage of private health funds. We were of the view that, on a per capita basis, the total cost of the Australian health system exceeded by a large margin the cost of the NHS in the United Kingdom, but we were finding it hard to prove. We could identify the government’s health costs, but the additional costs to individuals, either directly or through their health funds, were hard to pin down. We suspected that the higher costs in Australia were due to the inefficiencies of the health funds and the perverse financial incentives inherent in fee-for-service, which encouraged over servicing and overprescribing.

So, when Whitlam met Deeble and Scotton to discuss their new approach to health insurance, he was very receptive, although I recall that the 6 June meeting was slow to begin, with Whitlam’s eyelids drooping a few times. But his interest sparked up dramatically when Deeble and Scotton explained that in their view a compulsory and universal scheme would be cheaper than existing arrangements. There was thus the exciting prospect ahead of a health scheme that was both universal and politically defensible as to its cost.

Whitlam’s critique of voluntary health insurance, supported by the work of Deeble and Scotton, was confirmed by Justice Nimmo in his 1969 report. (The Coalition Government had established the Nimmo inquiry into health insurance to try to pre-empt the findings of a Senate committee which was reviewing health insurance.)

The campaign against Medibank

The long drawn-out battle for the Medibank reforms was unrelenting in both the 1969 and the 1972 elections. John Cade, general manager of the Medical Benefits Funds of Australia, said in August 1968, one month after Whitlam outlined his “Alternative National Health Program”, that “Karl Marx’s theories have never been wanted by Australians in the past and they are needed even less today …If you want to pervert the truth and have it believed, tell a whopper and tell it often!”

It wasn’t a particularly well-argued or dispassionate analysis of Whitlam’s proposals, but Cade’s comments give some idea of the hype and passion of the anti-Medibank campaign. Health funds spent contributors’ money, including mine, to fight Medibank.

The Australian Medical Association and the more militant General Practitioners’ Society in Australia conducted a shrill and long campaign against Medibank. An AMA “freedom fund” was established. Television, radio and newspaper advertising, supported by a public relations campaign, was waged relentlessly, year after year. The AMA sent letters and publicity kits to all doctors. They were designed to keep up the “noise level”. Even a former Miss Australia was called to the battlefront following petitions in federal Parliament and “calls to action” by doctors. Without any apparent sense of irony, the campaign against Medibank was described by the AMA as protecting the “doctor and patient relationship”.

The two Medibank Bills were thrice rejected by the Senate after the 1972 election and were only finally passed after a double dissolution of federal Parliament and the joint sitting of Parliament in July 1974. The Medibank Bills were two of the six bills on which a double dissolution had been secured in April 1974. But, even then, the Coalition Opposition, supported by doctors, would not concede. The implementation of Medibank was delayed further by the Senate in late 1974 when it rejected three bills to impose a 1.35% levy on taxable incomes. As a result, it was decided to finance the scheme initially from general revenue, and the funding was provided in Bill Hayden’s first budget in August 1975. At that time, I was secretary of the Department of Prime Minister and Cabinet.

The future

It had been a long and bitter campaign from that midwinter night in Melbourne in 1967 to spring in Canberra in July 1975. No government will now seriously tamper with the compulsory and universal health insurance scheme. The area of concern and debate for the future will not be so much about funding of Medicare, but rather about how we improve the delivery of health services.

https://johnmenadue.com/post/2025/07/fifty-years-since-that-little-green-card-came-into-being/

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YOURDEMOCRACY.NET RECORDS HISTORY AS IT SHOULD BE — NOT AS THE WESTERN MEDIA WRONGLY REPORTS IT.

Gus Leonisky

POLITICAL CARTOONIST SINCE 1951.

REMEMBER, THE COALITION WANTED TO SKUTTLE MEDICARE: