On April 2, the Senate unveiled a new budget blueprint, a crucial step in using reconciliation to enact President Donald Trump’s agenda. This budget isn’t just a missed opportunity; it actively worsens our nation’s debt trajectory. The resolution abandons the House’s concrete spending reductions desperately needed in today’s high-debt environment, sets a dangerous precedent by adopting a so-called current policy baseline that hides the very real deficit impact of extending tax cuts, and adds hundreds of billions in new deficit spending. The Senate should go back to the drawing board.

Under the amended budget framework, the Senate allows for $1.5 trillion in new tax cuts plus $500 billion in new spending, primarily for immigration and defense. That’s on top of the $3.8 trillion in tax cuts that will be magically waived away by using a current policy baseline—roughly the equivalent of pretending it doesn’t cost anything to extend a streaming subscription because you’ve been paying for it for a few months already. The graph below shows the change to the deficit over ten years under the amended resolution.

Together, the Senate’s amended resolution would add $5.8 trillion in new deficits over ten years. Per the Committee for a Responsible Federal Budget, that would double the growth of the debt-to-GDP ratio, with public debt reaching an astonishing 211 percent of GDP by 2055. To offset new tax cuts and spending, the Senate proposes a paltry $4 billion in spending cuts. Shameful.

For comparison, the current House budget resolution, while allowing $2.8 trillion in new borrowing, provides concrete instructions for $1.5 trillion in spending reductions and contains a binding measure to encourage $2 trillion in savings. That’s hardly a full offset tax package, but at least the House attempts to bend the arc on rampant federal spending. The Senate doesn’t even try.

Fiscal Hawks Should Hold the Line

As the House Appropriations Chair Tom Cole (R‑OK) has said, “[I]t’s time to put up or shut up if you’re serious about spending.” House Budget Committee Chair Jodey Arrington (R‑TX) concurred, noting, “When you’ve got the appropriations chair and the budget chair singing off the same song sheet, people need to pay attention in terms of what is needed in this fateful hour.” Other House deficit hawks, including Reps. Schweikert (R‑AZ), Smucker (R‑PA), and Roy (R‑TX), have rightly warned that the Senate isn’t being ambitious enough with their spending reductions, and it may not pass muster in the House.

Federal spending in fiscal year 2025 is projected to be $7 trillion, or nearly $90 trillion over ten years. Americans cannot afford for Congress to not only kick the fiscal can down the road but, worse, strap it to a rocket and blast it directly into a fiscal black hole.

Cato Scholars Offer Their Perspectives

As with the House and prior Senate budget resolutions, we reached out to our fellow Cato scholars to assess the Senate’s fiscal framework. Here’s what Cato Institute experts had to say in reaction to the Senate’s latest proposal.

The Senate dodges needed spending cuts and accelerates fiscal decline. As Adam Michel, Director of Tax Policy Studies, explains:

The Senate budget avoids making any of the hard decisions that are necessary to ensure permanent tax cuts. This framework doesn’t even bother to cut spending to match the new tax cuts, let alone begin to rationalize the growing gulf between revenues and outlays. The Senate’s framework sets the stage for capitulating to the business-as-usual Washington pastime of cutting taxes and increasing spending—kicking the fiscal can down the road. Without meaningful spending reforms, tax cuts will necessarily be temporary as the pressure of mounting deficits builds.

Permanent, pro-growth tax reform is more necessary now than ever. However, a more than $5 trillion reduction in revenue without any offsetting spending cuts is a recipe for fiscal collapse, not the foundation for an economic revival.

The Senate baseline rescues Biden’s health care spending spree, forcing taxpayers to overpay for low-quality health care. As Michael Cannon, Director of Health Policy Studies, explains:

As the United States government barrels toward a debt crisis, both House and Senate Republicans seem content to keep forcing taxpayers to overpay for low-quality health care. Senate Republicans especially are blindfolding the passengers while slamming on the gas. The Senate GOP budget would rescue Joe Biden‘s spending spree. Obamacare premium subsidies for households earning up to $600,000 per year would stay. Biden‘s 14 percent increase in Medicare spending and 20 percent increase in Medicaid spending over the pre-Biden baseline—that is, new spending above and beyond the typical year-to-year increases—would stay. The House Republicans’ budget could at least reduce annual growth in Medicaid spending from 6 percent to 3 percent; by the 10th year of the budget window, it could just barely eliminate that one portion of the Biden Bump. Meanwhile, Senate Republicans’ phony “baseline” would preserve all of Biden’s unnecessary spending. It is perhaps the largest, most dishonest, and most shameful budget gimmick in U.S. history.

When a debt crisis arrives, it will bring drastic cuts to federal health programs. Not reductions in the rate of growth. Actual, deep cuts. Mostly to Medicaid. Democrats who continually expand government health programs and Republicans who continually expand federal debt are putting the health care of low-income patients in a precarious situation.

The Senate uses budget gimmicks to avoid tough decisions while enabling Trump’s destructive tariff policy. As Policy Analyst Tad DeHaven explains:

The Senate Budget Resolution is the latest evidence that Republicans’ talk about downsizing government and cutting spending to head off a debt crisis is all just talk. Instead, the Republican majority Senate is proposing no serious spending cuts and trillions more in debt, and it intentionally obfuscates the cost by gaming the budgetary score. At the same time, all but a few Senate Republicans are enabling President Trump to usurp Congress’s constitutional responsibility to set tariff policy. As a result, so-called pro-growth tax cuts are set to be undermined by the president’s unilateral imposition of a massive tax hike on American consumers and businesses.

The Current Policy Disaster

The Senate plans to rely on an unprecedented scoring framework under which the extension of expiring tax cuts would score as costing $0 (the deficit will still go up). Extend this framework to a future Democratic Congress. On a party-line vote, the Senate could pass a one-year, temporary Medicare-for-All package and then extend it in the subsequent year, claiming it costs nothing. Are Senate Republicans so short-sighted that they think this won’t come back to haunt them?

The Senate should not be playing budget games with America’s fiscal future. The current policy gambit enables new deficit spending and reduces the pressure to repeal costly laws, such as the Inflation Reduction Act’s energy subsidies. Legislators should reject the current policy baseline gamble.

Go Back to the Drawing Board

The Senate should be stepping up to the present fiscal challenge and embracing spending cuts that are bolder than the House plan as part of a truly pro-growth tax cut strategy. Instead, Senate leadership is dropping the ball, abandoning any semblance of fiscal responsibility. Americans continue to suffer from inflation, high interest rates, and economic uncertainty. Further fueling the rising debt will boost inflation, eroding Americans’ purchasing power and pushing interest rates higher—making mortgages, car loans, and everyday expenses more difficult to afford. To bring about economic stability and unleash opportunity, Congress must rein in spending and pair tax relief extensions with real fiscal discipline. Otherwise, today’s deficits will become tomorrow’s tax hikes and inflationary pain for American families.

As the United States government barrels toward a debt crisis, both House and Senate Republicans seem content to keep forcing taxpayers to overpay for low-quality health care. Senate Republicans especially are blindfolding the passengers while slamming on the gas. 

Former President Biden went on a health care spending spree. He created Obamacare premium subsidies for households earning up to $600,000 per year. He opened the floodgates to improper enrollment in Obamacare. He increased Medicare spending by 14 percent and Medicaid spending by 20 percent over the pre-Biden baseline—that is, new spending above and beyond the typical year-to-year increases. The House Republicans’ budget might at least reduce annual growth in Medicaid spending from 6 percent to 3 percent; by the 10th year of the budget window, it might just barely eliminate the Medicaid portion of the Biden Bump. 

The Senate GOP budget is an effort to rescue Biden’s spending spree. Obamacare subsidies for those earning up to $600,000 would stay. Biden‘s Medicaid and Medicare spending increases would stay. And Senate Republicans would accomplish all this through what is perhaps the largest, most dishonest, and most shameful budget gimmick in US history.

Decades ago, Congress enacted budget rules to prevent runaway deficits. But no Congress can bind future Congresses. Profligate legislators have rewritten those rules, including by subterfuge. The result is a record federal debt equal in size to the entire US economy, which Congress increases by another 6 percent of GDP each year. 

The Senate GOP budget would rescue Joe Biden’s spending spree. But Senate Republicans don’t want to face accountability for that decision. So they devised a novel and massive subterfuge that would enable them to pass their irresponsible budget with fewer votes and would effectively throw all congressional budget rules out the window.

Their subterfuge is literally to pretend that tax and spending laws that Congress has already passed aren’t real. Senate Republicans want to pretend that Congress has already renewed Biden’s spending spree, that Congress has already cut taxes, and that the federal debt is already heading as high as Senate Republicans want to raise it. None of those things are true, of course. But if the Senate passes a resolution that pretends they are, Republicans can enact those policies without facing accountability from voters. After all, if those things have already happened, there’s no need to cast unpleasant votes for the tax increases and spending cuts necessary to pay for them. Senate Republicans’ phony “policy baseline” is perhaps the largest, most dishonest, and most shameful budget gimmick in US history.

The United States government is heading toward a debt crisis. The House Republican budget would keep barreling down that road. Senate Republicans are blindfolding the passengers while slamming on the gas.

When a debt crisis arrives, it will bring drastic cuts to federal health programs. Not reductions in the rate of growth. Actual, deep cuts. Mostly to Medicaid. Democrats who continually expand government health programs and Republicans who continually expand federal debt are putting the health care of low-income patients in a precarious situation.

A new book, The Triumph of Fear: Domestic Surveillance and Political Repression from McKinley to Eisenhower, by Cato’s Patrick G. Eddington, a senior fellow in homeland security and civil liberties, was released on April 1. The book, excerpted below, examines the rise and expansion of surveillance-enabled political repression in America from the late 1890s to early 1961 and shows how this domestic spying has helped fuel federal assaults on free speech and association that continue to this day. To purchase the book, click here, here, or here. 

Conclusion

At the dawn of the twentieth century, the only two executive branch agencies routinely involved in domestic surveillance and related political repression were the Secret Service and the Postal Service, and the former—despite the relatively limited number of Secret Service agents—was far more active than the latter, which acted as a partner with the Treasury Department’s investigative arm when needed. Three related events changed that and put the United States on the path to creating a domestic surveillance and political repression apparatus that in time would rival those of its European neighbors.

The first event was the growth of the popularity of anarchist, socialist, and communist ideals among major segments of American labor and left-leaning political elites.

As noted in Chapter 1, at least as early as 1898, the Secret Service was monitoring anarchist political activists and labor organizers in places like Patterson, New Jersey, at the time a major hub of both immigrant labor and textile mills with generally deplorable working conditions. In the period between the Spanish-American War and President McKinley’s assassination, federal authorities had generally been content to keep an eye on key anarchist groups and leaders while leaving it to state and local authorities to deal with anarchist-inspired or led strikes and labor–business disputes, even when violent incidents occurred.

The second key event was McKinley’s assassination by the (likely mentally disturbed) recent anarchist convert Leon Czolgosz, which transformed the political and domestic security landscape.

Officials at the federal, state, and local levels went after known or suspected anarchists in communities across the country. During Roosevelt’s first abbreviated term as McKinley’s successor, the Secret Service intensified its surveillance of those deemed political radicals, and Congress passed the Anarchist Exclusion Act, which barred legal entry into the United States of anyone professing a belief in anarchism. Those measures failed to stamp out the appeal of anarchism, and its rival political philosophy, socialism, gained even more adherents during Roosevelt’s two terms in office. 

Roosevelt’s subsequent efforts to employ the Secret Service and Postal Service against Socialist Party presidential candidate Eugene V. Debs and the socialist newspaper Appeal to Reason set additional, dangerous precedents that threatened the Bill of Rights. But it was the Roosevelt administration’s more widespread misuse of the Secret Service to engage in politically related investigations, and even prying into the marital affairs of a junior US Navy officer, that would trigger a confrontation with Congress that sparked Roosevelt’s unilateral expansion of federal domestic surveillance and the potential for widespread political repression in the decades that followed through the creation of the Bureau of Investigation.

The Navy Department’s use of a Secret Service agent to uncover Ensign Earl Pritchard’s extramarital affair in late 1907 generated a national uproar and a legislative backlash from Congress, which in April 1908 barred Secret Service agents from being used for anything other than presidential protection and capturing counterfeiters. When Roosevelt responded by instructing Attorney General Charles Bonaparte to create a cadre of investigators within the Justice Department itself, he did so despite the lack of any authorizing legislation allowing it. A precedent of presidential circumvention of a congressional ban on a surveillance activity or authority had been set, and it would be repeated by Roosevelt’s successors or their subordinates over the balance of the twentieth century.

The episode also marked one of the last times Congress would take decisive action to rein in presidential overreach on surveillance activities during the twentieth century. The decline of true, probing congressional oversight actions targeting the executive branch was the third key development that accelerated the rise and growth of the American surveillance state.

With the outbreak of World War I and America’s subsequent entry into the war in April 1917, Congress largely jettisoned its role as an overseer of executive branch actions in the areas of security policy and surveillance, instead becoming a full partner in expanding the legal framework that enabled widescale, pervasive domestic surveillance and political repression, particularly in connection with the First Amendment, free speech, and the press.

The enactment during the war of the Espionage Act, the Trading with the Enemy Act, the Food and Fuel Control Act, and the Sedition Act represented a radical expansion of federal surveillance and prosecutorial powers that harmed thousands of innocent Americans and the press while doing little, if anything, to help defeat the Central Powers. The subsequent Harding administration engaged in a limited rollback of those wartime authorities, persuading Congress to repeal the Sedition Act and Food and Fuel Control Act. But the Espionage Act and Trading with the Enemy Act were left in place, and the broad language of the former would be used decades after the Great War to prosecute intelligence community whistleblowers like Edward Snowden. While it is true that the Army and Navy intelligence bureaucracies and the FBI shrank substantially after the war, the FBI’s profile did not, largely supplanting the Secret Service as the premier domestic surveillance agency in the federal government, with the number of its field offices spreading to every state and territory well before the outbreak of World War II in Europe.

In his landmark work Crisis and Leviathan, historian Robert Higgs noted this “ratchet effect” on government power in the aftermath of a major crisis. “Without the powerful ideological and constitutional restraints that operated for over a century after the birth of the United States—restraints destroyed during the national emergencies of 1916–1945—modern governmental authorities may,” Higgs wrote, “drink deeply and often from the heady wellsprings of political power and social control.”¹ In the context of domestic surveillance and political repression, this proved true time and again between 1919 and 1961.

The victory of Soviet forces in the Russian civil war had a further galvanizing effect on American political elites and the emerging national security establishment. A political and economic philosophy totally at odds with the American and western European model had captured the largest (in geographic terms) country on the planet, and the leadership of the new Union of Soviet Socialist Republics was intent on exporting their philosophy and governing model around the world. In the United States, this triggered the first Red Scare and a related push by both the Congress and executive branch law enforcement and intelligence elements to identify, expose, and where possible prosecute or deport those openly sympathetic to the Soviet cause.

In the congressional context, it would lead first to the House creating the infamous Fish Committee, then the McCormack–Dickstein Committee, and later the Select Committee on Un-American Activities—with the latter conducting unconstitutional raids on civil society organizations and even engaging in wiretapping during FDR’s presidency. Well before the end of World War II, the renamed House Committee on Un-American Activities would effectively be made permanent, going on to become among the most feared and loathed institutions in American history. During Truman’s tenure, HUAC got a Senate counterpart—the Senate Internal Security Subcommittee.

Over the course of several decades, HUAC’s and SISS’s public show trial–style hearings would destroy the professional and personal lives of thousands of Americans who had no connection to Soviet espionage efforts. Even those who would confess to having been CP USA members or had otherwise dabbled in radical politics would never be proven to be active Soviet espionage agents. Their “crime” was that they had explored, then in most cases abandoned, a political and economic philosophy that was vehemently opposed by their own government and the overwhelming majority of their fellow citizens but that never posed a realistic threat to the survival of the Republic.

The interwar period also saw the executive branch engage in vastly expanded domestic surveillance targeting of known or suspected communists, with the FBI, MID, and ONI all heavily involved in the effort. Wiretapping controversies also grabbed the spotlight, especially after the Supreme Court effectively sanctioned it via its 1928 Olmstead decision. The congressional backlash against the decision led to the 1934 passage of the Communications Act, which banned the practice outright. In the six years that followed, FDR and his senior law enforcement and intelligence officials periodically debated whether or not to seek to change the law to allow wiretapping in specific circumstances. By the late spring of 1940, FDR decided to go it alone, ignoring the most recent Supreme Court decision affirming the Communications Act’s ban on wiretapping (the Nardone case) and telling his then-Attorney General Robert Jackson in May 1940 to proceed with wiretapping in national security cases, particularly espionage. Like his late cousin and predecessor Theodore Roosevelt, FDR was comfortable circumventing Congress and the federal courts in matters involving domestic surveillance activities. It was yet another anti–Bill of Rights precedent, one that every one of his successors would follow for nearly thirty years.

Less than three months after the Japanese Navy’s surprise attack on Pearl Harbor, FDR ordered the long-laid plans for the round-up and incarceration of Japanese Americans to be put in motion, via his now-infamous Executive Order 9066. Roosevelt took the action despite multiple reports from ONI and his taxpayer-funded private spymaster, John Franklin Carter, that the overwhelming majority of Japanese Americans were clearly loyal to the United States. Intense political pressure from West Coast House and Senate members, not the facts concerning Japanese American loyalty, is what ultimately moved FDR to order the Army to forcibly evacuate those American citizens from their homes to places in the interior of the United States. Subsequent Supreme Court rulings against Japanese Americans who challenged their evacuation and internment gave FDR’s order a veneer of legality. Cabinet members like Interior Secretary Harold Ickes and even Attorney General Francis Biddle recognized the fundamentally discriminatory, unconstitutional nature of the act, yet they elected to stay in office rather than resign in protest over the policy. Fear-driven racism, not legitimate national security concerns, would keep more than 100,000 Japanese Americans in concentration camps for nearly the entire war. Not until more than seven decades after the last Japanese American was released from War Relocation Authority custody would a different Supreme Court rule that, “The forcible relocation of U.S. citizens to concentration camps, solely and explicitly on the basis of race, is objectively unlawful and outside the scope of Presidential authority.”²

Other domestic surveillance structures and practices created during World War II—the systematic monitoring of federal employee loyalty, the FBI’s creation of a massive informant network in the defense industry and elsewhere among civil society organizations, and the increased use of wiretapping and the collection of telegram traffic—became permanent fixtures during the Cold War. And while Army and Navy intelligence components continued to play a major role in all these areas, the FBI under J. Edgar Hoover’s leadership solidified its position as the dominant player.

Hoover’s long and close relationship with FDR stood in marked contrast with his relatively cool and distant one with Truman. Even so, as noted in Chapter 5, neither Truman nor his senior White House advisors hesitated to employ Hoover and his agents to surveil political rivals like Tommy Corcoran and Ed Pritchard, despite the absence of any evidence either man had committed a federal crime at the time. Hoover himself utilized his agents to surveil those who dared to criticize him or the FBI. Interior Department official Jebby Davidson, who publicly criticized Hoover for the Bureau’s tactics in federal employee and other investigations, would suspect as much at the time but was only able to confirm it decades later via a Freedom of Information Act request, as noted in Chapter 5.

The change of administrations from Eisenhower to John F. Kennedy coincided with an emerging social and political revolution in American society—changes that would drive the FBI, NSA, and military intelligence organizations to new extremes in their search for subversives and others challenging long-standing political, economic, and social paradigms.

By the time of Kennedy’s assassination in November 1963, Students for a Democratic Society (SDS) was becoming a major force for social change and drawing Hoover’s attention. As the decade of the 1960s progressed, opposition to the Vietnam War by multiple segments of American society paralleled the splintering of the civil rights movement into nonviolent (read King and SCLC) and militant (the new Black Panther Party) factions. The FBI, Army Intelligence, and ONI would all be involved in surveilling and trying to disrupt the groups seeking to stop the war in Southeast Asia, end racial discrimination, advance the rights of women, and address long-standing grievances of the Native American community.

Yet the usual veil of secrecy over federal surveillance practices was occasionally, and tellingly, pierced in the years after Kennedy’s death. A key player in the drama would be the late Missouri Senator Thomas Henning, Jr.’s replacement, Edward V. Long.

Between 1964 and 1967 Long would use his position as chairman of the Senate Subcommittee on Administrative Practice and Procedure to conduct a number of oversight actions and hearings designed to ferret out details of domestic surveillance operations by the IRS, Post Office, and other federal agencies.³ Long’s activities coincided with the emergence of the modern right-to-privacy movement, popularized by the publication of Alan Westin’s Privacy and Freedom in 1967.⁴ But neither Long nor Westin would surface the most damaging federal surveillance and political repression activities, and Long’s efforts to get federal privacy legislation enacted fizzled when two key Supreme Court cases had the effect of limiting federal agencies’ use of wiretaps as well as creating “an expectation of privacy” in certain settings.⁵ The passage in 1968 of the Omnibus Crime Control and Safe Streets Act, with its explicit probable cause–based warrant requirement for any federal criminal wiretap operation, also had the effect of blunting momentum toward more sweeping privacy-centric legislation.

Instead, a new phenomenon—the emergence of the government whistleblower—would, starting in early 1971, spell the beginning of the end of many secret federal surveillance and political repression programs described in this book.

A series of hearings in the House and Senate spanning 1971–1975, building off of those whistleblower revelations, would expose multiple COINTELPRO activities, along with other Army, Navy, CIA, and NSA domestic spying operations. Those hearings, televised to the nation, permanently altered how Americans viewed their government. The most famous of those congressional bodies, led by Senator Frank Church (D‑ID), produced a series of recommendations that led to the passage of the Foreign Intelligence Surveillance Act (FISA), the Inspector General Act, and the creation of permanent House and Senate committees to oversee federal surveillance activities and monitor the intelligence operations of the FBI, CIA, NSA, and America’s other intelligence components.

Yet over forty years after the enactment of these measures, it is clear that despite the best intentions of Church and his colleagues, their efforts to prevent a repeat of the surveillance and political repression abuses of the first half of the twentieth century failed. In the decades since the Church Committee completed its work, multiple additional incidents of NSA, CIA, FBI, and other federal agency and department domestic surveillance scandals have surfaced with considerable regularity.⁶

Within a year of Ronald Reagan taking office, the FBI was back in the business of spying on domestic civil society organizations in the absence of a valid criminal predicate, in this case, groups opposed to Reagan’s Central America foreign policy.⁷ In the waning days of George H.W. Bush’s administration, then-Attorney General William Barr authorized the Drug Enforcement Agency to engage in a vast, warrantless telephone metadata collection program that did not allegedly end until 2013 and did not come to light until 2015.⁸ And during at least the last term of the Clinton administration, the CIA ran an electronic mass surveillance program against the global telecommunications network backbone, according to a 2002 CIA Inspector General report only uncovered in 2023 via Freedom of Information Act litigation against the Privacy and Civil Liberties Oversight Board by the Cato Institute.⁹ Indeed, the number of such episodes is lengthy enough to fill another entire book on the subject.

The pace and scope of those revelations have not been similarly matched by renewed congressional reform efforts, and absent such a new, in-depth reckoning, America’s descent into a permanent domestic surveillance state will continue apace.

Excerpted from The Triumph of Fear: Domestic Surveillance and Political Repression from McKinley to Eisenhower by Cato Institute senior fellow Patrick G. Eddington, Georgetown University Press © 2025

NOTES

1. Robert Higgs, Crisis and Leviathan: Critical Episodes in the Growth of American Government

(Oakland: The Independent Institute, 2012), 257.

2. Trump v. Hawaii, 585 U.S. ___ (2018), at 38.

3. A brief but highly informative account of Long’s activities can be found in Brian Hochman’s,

The Listeners: A History of Wiretapping in the United States (Cambridge: Harvard

University Press, 2022), 179–192.

4. Alan Westin, Privacy and Freedom (New York: Simon and Schuster, 1967).

5. Hochman, The Listeners, 188–194.

6. The reader can get a sense of the scope and duration of these programs and episodes by

visiting Cato’s “American Big Brother” surveillance timeline at https://​www​.cato​.org/​a​m​e​r​i​c​a​n​-​b​i​g​-​b​r​other.

7. See The FBI and CISPES: Report of the Select Committee on Intelligence, United States

Senate together with Additional Views, July 1989, S. Rpt 101–46, 101st Congress

(1st Session).

8. Brad Heath, “U.S. Secretly Tracked Billions of Calls for Decades,” USA Today, April 8,

2015 (digital edition).

9. Patrick Eddington, “Is the CIA Still Secretly Capturing Americans’ Communications?”

Orange County Register, November 26, 2023 (digital edition).

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.

According to the Substance Abuse and Mental Health Services Administration (SAMHSA), over 6.1 million people over age 12 have opioid use disorder (OUD). Increasing access to OUD treatment would reduce the number of people who seek drugs in the dangerous black market and, in turn, reduce the risk and incidence of overdose deaths. 

In the United States before 1972, primary care physicians would prescribe methadone to people with OUD. Since 1972, however, only government-approved opioid treatment programs (OTPs) have been allowed to dispense methadone to treat OUD. SAMHSA places regulations and restrictions on organizations that seek to operate OTPs. OTPs must obtain certification from the Drug Enforcement Administration (DEA) to operate a narcotics treatment program. States must also license OTPs, imposing additional regulations, costs, and restrictions. 

The various layers of regulations hinder the proliferation of OTPs. These and other government obstacles explain why only about 400,000 individuals with OUD received methadone in 2019, while 1.6 million US residents reported developing OUD that year. Recognizing these barriers, Congress has attempted incremental reforms. For the past few sessions of Congress, the bipartisan Modernizing Opioid Treatment Access Act (MOTAA) has failed to pass. If enacted, MOTAA would expand access to methadone treatment by allowing board-certified addiction medicine physicians to prescribe methadone in their offices and clinics. 

However, President Donald Trump’s February 19 executive order implementing his “Department of Government Efficiency” Deregulatory Initiative provides an opportunity to expand access to methadone treatment for people with opioid use disorder (OUD). Seizing on this deregulatory momentum, the American Society of Addiction Medicine (ASAM) has spearheaded a letter to Attorney General Pam Bondi and Acting DEA Administrator Derek Maltz, calling for a review of methadone treatment regulations. The letter argues that these regulations are “not based on the best reading” of the underlying law and “constitute a significant regulatory action that materially harms competition in health care delivery.” The American Society of Health-System Pharmacists, the National Commission on Correctional Health Care, the National Community Pharmacists Association, and the R Street Institute endorsed the letter. 

Many policymakers have long believed that the current methadone treatment regime is mandated by federal statute. In reality, much of it was created by federal regulatory agencies— specifically the Drug Enforcement Administration (DEA) and the Department of Health and Human Services (HHS)—pursuant to authority delegated by Congress. 

The direct legislative sources are the Narcotic Addict Treatment Act (NATA) of 1974 and 21 U.S.C. § 823(h). NATA authorized the use of narcotic drugs like methadone to treat addiction but required practitioners dispensing such drugs to be registered with the DEA and that SAMHSA and the DEA approve treatment programs. 21 U.S.C. § 823(h) states that the attorney general, through the DEA, “shall register an applicant to dispense narcotic drugs to individuals for maintenance treatment or detoxification treatment” in compliance with standards set and certified by the Secretary of HHS.

Congress didn’t specifically require the DEA to set up OTPs. It authorized the DEA to set up some sort of registration and regulatory system. The DEA decided to implement 21 USC Sec 823 (h) by requiring OTPs. 

In its letter to Bondi and Maltz, ASAM argues that because 21 U.S.C. § 823(h) does not explicitly mandate the use of OTPs — but instead grants the Attorney General (through the DEA) the authority to register practitioners “in accordance with” HHS standards — the requirement that methadone be dispensed only through OTPs is a regulatory choice, not a statutory mandate.

Before discussing how the regulatory change can help, it’s worth clarifying a key distinction: addiction and dependency are not the same. Opioid addiction and opioid dependency are two distinct subsets of OUD. Dependency refers to the physiological adaptation to the drug such that abrupt cessation can cause a physical withdrawal reaction. Addiction is a behavioral disorder characterized by compulsive use despite negative consequences. People with addiction still feel compelled to use opioids even when they are no longer physically dependent. 

Methadone and buprenorphine are time-tested, evidence-based medications used to treat OUD. Clinicians have been using methadone to treat OUD since the 1960s. They’ve been using buprenorphine since the 1990s. Some patients respond better to methadone; others do well with buprenorphine. 

If the ASAM-inspired initiative is successful, the Trump administration will implement regulatory reforms that could remove obstacles preventing people with OUD from accessing methadone treatment. These reforms can go even further than MOTAA’s modest, incremental reform. The administration can permit all licensed clinicians who are interested in treating OUD to register with the DEA to provide methadone treatment. The administration could remove regulatory barriers to patients with OUD accessing methadone through primary care clinicians, including nurse practitioners, in their community offices and clinics. The DEA and SAMHSA have already implemented this policy for buprenorphine prescribing. 

Critics of treating methadone prescribing like buprenorphine prescribing worry that patients might “divert” the methadone to the black market. But the evidence suggests otherwise. 

In March 2020, the Substance Abuse and Mental Health Services Administration (SAMHSA) temporarily loosened methadone take-home restrictions for opioid treatment programs (OTPs), permitting “stable” patients to receive up to a 28-day supply. The policy proved so effective that SAMHSA made it permanent. Researchers from the Centers for Disease Control and Prevention and the National Institute on Drug Abuse analyzed the effects of this change and reported in JAMA Psychiatry in July 2022 that “monthly methadone-involved overdose deaths remained stable after March 2020.” The National Institutes of Health reported that same month that “the percentage of overdose deaths involving methadone declined between January 2019 and August 2021.” 

It often surprises people that the DEA allows any clinician with a standard narcotics license to prescribe methadone for pain yet prohibits them from prescribing it for addiction treatment. According to the National Institute on Drug Abuse, “Methadone diversion is primarily associated with methadone prescribed for the treatment of pain and not for the treatment of opioid use disorders. In one survey, giving methadone away was identified as the most common form of methadone diversion, which aligns with other findings that 80 percent of people who report diverting methadone did so to help others who misused substances.” 

Of course, no reform is secure unless Congress codifies it. One drawback of relying on executive actions and regulatory reassessments is that they can change in subsequent administrations. While the Trump Administration can move quickly to improve access to methadone treatment, a subsequent administration could revert to the old approach. Ideally, Congress should codify any regulatory reforms in statute.

In a Cato Policy Brief, Sofia Hamilton and I point out that clinicians in Australia, Canada, and the UK have been prescribing methadone to patients with OUD in their offices and clinics for nearly 60 years. They coordinate with community pharmacists who are part of the treatment team. Regulators in those countries defer to clinicians to exercise their medical judgment in deciding the timing and amount of take-home methadone. We argue that clinicians and patients in the United States deserve the same freedom.

We call on lawmakers to enable patients with OUD to receive methadone treatment from sources other than government-approved OTPs. Providers should include office-based addiction specialists, primary care physicians, nurse practitioners, and physician assistants. These treatment options can coexist with more traditional inpatient or outpatient treatment programs.

Ideally, lawmakers should end drug prohibition. As a result of the failed war on drugs, federal bureaucrats, police, SAMHSA, and the DEA regulate how clinicians practice medicine. Prohibition lets lawmakers, policymakers, and law enforcement agents intrude into clinical decision-making and the patient-doctor relationship.

As President Donald Trump threatens so-called “reciprocal tariffs” on US trading partners, some countries are offering lower duties to avoid the US leader’s wrath. Vietnam recently announced that it is cutting tariffs on a range of US exports, including energy and agricultural products, as well as approving the Starlink satellite internet system owned by Trump ally Elon Musk. Similarly, India appears willing to cut its tariffs on approximately half of all US imports, and Israel is removing all remaining tariffs on US goods (although the move’s practical import is less dramatic, as the vast majority of US exports were already duty-free thanks to a 1985 trade deal). 

More countries may follow. 

At least on the surface, such developments seem to vindicate Trump’s aggressive approach. Merely the risk of higher tariffs has prompted countries to offer lower duties, with attendant benefits for US exporters. It’s not difficult to see why some might claim this as an example of the president’s much-ballyhooed dealmaking prowess in action.

But let’s not put this in the win column just yet. 

Although tariff cuts on US exports are always welcome, they must be balanced against the totality of Trump’s record. That looks set to include not only tariff reductions by the likes of India (which received $41.8 billion in US exports in 2024) and Vietnam ($13.1 billion), but also retaliatory tariff increases by key trading partners such as Canada (a $349.4 billion export market in 2024) and the European Union ($370.2 billion).

That the benefits of lowered tariffs from some countries will outweigh the burden of looming retaliatory tariffs on US exporters is not clear.

Additionally, whatever tariff cuts US trading partners announce in response to Trump’s pressure could prove fleeting. The unilateral reductions announced by India and Vietnam, for example, are not secured by binding agreements. Absent such a deal, there is nothing to prevent these countries from raising their tariffs in the future.

Lastly, whatever tariffs Trump imposes as part of his reciprocal tariff policy will harm the US economy as businesses and consumers contend with higher prices. Just as trade is mutually beneficial, barriers to trade, such as tariffs, create losses on both sides of the exchange.

Between retaliation and the burden of higher tariffs, the pain caused by Trump’s approach will almost surely outweigh any (potentially short-lived) gains.

Furthermore, there’s also a significant opportunity cost here. If Trump is interested in securing a reciprocal lowering of tariffs, there’s a far better way of doing it. 

Rather than rattling his tariff saber, Trump should pursue new free trade agreements (FTAs). Through such deals, the US and its trading partners can lower (ideally, eliminate) tariffs, remove non-tariff barriers (e.g., “Buy America” rules and the Jones Act), and agree upon a common set of rules for conducting trade and more deeply integrating their economies. Such agreements—which the United States has negotiated with 20 countries—offer far greater tariff reductions than whatever the likes of India, Vietnam, or anyone else are likely to offer.

This isn’t theoretical. Under the Trans-Pacific Partnership FTA signed by the United States in 2016, Vietnam was slated to permanently reduce or eliminate the vast majority of its tariffs on US exports. Trump, however, withdrew from the deal shortly after taking office in 2017, and now the US must content itself with Vietnam cutting tariffs on a more modest range of products.

All of this assumes, of course, that President Trump is truly interested in a mutual lowering of tariffs and not merely searching for new justifications to raise US duties. Unfortunately, that seems an increasingly dubious proposition.