Secretary Robert F. Kennedy, Jr., has announced and begun implementing the elimination of 10,000 positions at the Department of Health and Human Services. He is also reorganizing the department. He estimates savings of $1.8 billion per year. A further 10,000 HHS employees have taken buyout offers or retired early since President Trump resumed office. Altogether, these moves will reduce HHS staffing levels by some 24 percent.
To the extent Congress authorizes the secretary to do so, reducing HHS staffing levels is the right thing to do. Congress should go further by eliminating the regulations and spending programs those HHS employees implemented. Doing so would prevent the risk that cutting some HHS jobs could paradoxically increase the size of government.
Many HHS Employees Deserve to Lose Their Jobs
Let’s be honest. Many HHS employees deserve to lose their jobs. To take just one example, when COVID-19 came to the United States, HHS employees crippled the public health response.
While other nations were removing regulatory barriers to COVID-19 diagnostic tests, Food and Drug Administration officials increased regulatory barriers to those tests. Scientists called the FDA’s actions “insane.” Private companies and government labs developed dozens of effective tests. FDA officials blocked them all. They did not loosen their grip until President Trump ordered them to stop blocking tests and to let states approve tests themselves.
It gets worse. For many months, the only test the FDA approved was the one that the Centers for Disease Control developed. Yet the CDC (also part of HHS) contaminated its tests with the COVID-19 virus, rendering them “useless.” An FDA inspector warned CDC employees that if the CDC were a private company, he would “shut you down.” Spoiler alert: the FDA did not shut the lab down.
A federal court has just ruled that Congress never even gave the FDA authority to regulate the laboratory-developed tests it banned during COVID-19.
HHS employees exceeded their authority. They admitted that they treat their fellow bureaucrats better than lowly private citizens. Their mistakes likely cost lives. But when those abuses came to light, did any of them lose their jobs?
Institutional Incompetence
Such institutional incompetence is pervasive at HHS. The department implements countless regulations and spending programs that do more harm than good.
HHS enforces regulations that deny patients the right to make their own health decisions. It denies patients with life-threatening illnesses the right to choose their treatments, including treatments available in other countries. It forces women seeking birth control and diabetics seeking insulin to get permission from government-appointed gatekeepers. It prevents many beneficial treatments from ever reaching patients. All evidence indicates these regulations have a net negative impact on health. They’re just not worth having.
Kennedy fired the entire FDA office whose job is to restrict access to safer alternatives to cigarettes. The only people who should mourn their departure is Big Tobacco.
HHS implements regulations that increase health insurance premiums, create unnecessary gaps in coverage, and force insurance companies to compete to avoid and mistreat the sickest patients. The purpose of those regulations, naturally, is to protect the sick. Yet one of President Biden’s economic advisors found those regulations produce “backdoor discrimination” against the sick that is both “beyond any insurance carrier’s ability to control” and so pervasive that even “currently healthy consumers cannot be adequately insured.”
HHS implements spending programs that increase the burden of government, health care prices, and health insurance premiums. It reduces health care quality and encourages medical errors. It pays low-quality providers more than high-quality providers. It gives quality bonuses to low-quality hospitals and mediocre health insurance plans. An arm of Congress—the Medicare Payment Advisory Commission—has complained for decades that HHS doesn’t even bother to measure the quality of medical care on which HHS spends trillions of taxpayer dollars.
Those spending programs are the main force driving the federal government toward a debt crisis. Enrollees and taxpayers would be better off if Congress fired upward of 90 percent of Medicare and Medicaid bureaucrats, cut Medicare spending by a third, gave what remains to enrollees as cash, and converted Medicaid into a system of zero-growth block grants.
“Authoritatively stating that these drastic changes will improve the health of Americans without any explanation insults the American public and defies logic,” three members of Congress wrote to Kennedy. One could say the same of Congress’ creation of HHS’s authorities in the first place.
Surging HHS Staffing
Nonetheless, HHS staffing levels have grown along with both the overall federal workforce and the harmful regulations and spending the department implements. Over the past two decades, the federal workforce added 452,000 net jobs, including 132,000 in the past five years. Federal jobs are surging even as trust in the federal government is falling.
From 1996 to 2023, full-time equivalent positions at HHS grew from 57,200 to 81,300, a 42 percent increase. Most of that increase came under Presidents Obama, Trump, and Biden. President Clinton initially cut 8,900 full-time equivalent positions (13 percent of HHS’s workforce) but then added back 3,300, for a net reduction of 5,600 (8 percent). President George W. Bush eliminated a net 700 full-time equivalent positions (a 1 percent decrease). HHS’s workforce grew by 12,800 full-time equivalent positions (a 21 percent increase) under Obama, 2,500 (3 percent) under Trump, and 6,200 (8 percent) in Biden’s first three years.
In context, Kennedy’s cuts are substantial but reasonable. The layoffs he announced (10,000; 12 percent of workforce) are comparable to Clinton’s reductions at HHS (8,900; 13 percent) from 1993 to 1996. They are comparable to recent private-sector layoffs at Intel (15,000; 15 percent), Tesla (14,000; 10 percent), Dell (12,500; 10 percent), Boeing (17,000; 10 percent), and Cisco (9,600; 11 percent). Other companies recently announcing substantial layoffs include Meta (3,600; 5 percent), UKG (2,200; 14 percent), Intuit (1,800; 10 percent), Expedia (1,500; 8 percent), and Indeed (1,000; 8 percent).
After Kennedy’s layoffs, HHS would still employ more people than it did when George W. Bush left office.
To read about private-sector job losses is to watch a wondrous market process of constant correction and adjustment, one that constantly moves resources from low- to high-value uses.
That process does not touch government jobs. Even if HHS’s activities were net beneficial, its staffing levels would be long overdue for correction and adjustment following a 15-year surge.
Cutting Some HHS Jobs Would Expand Government
Paradoxically, absent further action, terminating some HHS employees would expand government. HHS implements regulations that bar market entry for foods, drugs, and medical devices. Until food inspectors and drug/device reviewers set those barriers aside for specific items, HHS continues to deprive consumers and producers of their rights to buy and sell those items. Firing those employees (or employees who support them) effectively raises those barriers higher. (Firing FDA drug reviewers’ communications team, which numbered “about 50 people,” is a different matter.) Inspectors general and other administrative staff identify and stop improper payments in Medicare and Medicaid. All else equal, eliminating those positions would increase government spending.
Kennedy claims his plans to cut 3,500 FDA jobs will not “affect drug, medical device, or food reviewers, nor will it impact inspectors.” As the Zen master says, we’ll see. Media reports claim device reviews have slowed despite HHS rehiring some reviewers.
To the extent any of these cuts would expand government, the solution is to eliminate the underlying regulations and spending. Kennedy and Trump should immediately call on Congress to do so.
What’s the Endgame?
If these cuts are happening because Kennedy is the rare government official who voluntarily limits his own power, he deserves tremendous praise. His behavior suggests he isn’t.
Other than firing people, he has given scant indication that he wants to shrink government or restore people’s right to make their own health decisions. He has not called on Congress to eliminate harmful regulations and spending programs. Past rounds of firings at HHS, which occurred while Kennedy was secretary, did terminate FDA device reviewers.
Indeed, these cuts may be a prelude to expanding government and further curtailing freedom. Kennedy’s actions and rhetoric suggest he wants to use HHS’s powers to erect even greater barriers to entry for food additives, infant formula, vaccines, and other medicines. He has launched new studies on vaccines and autism. He has demanded that FDA employees hand over data on device safety. He promises to deliver absolute safety—something that does not exist but is typically code for more regulation. He uses rhetoric like “gold standard” science to hide the reality that the safety standards HHS enforces—that he now imposes on consumers and producers—are inherently unscientific value judgments.
These factors suggest that Kennedy is not looking to lay down HHS’s powers so much as prepare the ground to use them more vigorously than his predecessors. Let the patient beware.