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. 

As momentum for closing the US Department of Education gains steam, questions about the transition are starting to surface, with the biggest ones concerning student loans. While we have argued for the privatization of student loans (full report or blog summary), which would eliminate the need for a new home for student loans, most of the current discussion revolves around keeping the existing loan programs but moving them to another department or agency, with the Department of the Treasury and the Small Business Administration (SBA) being the most discussed new homes. Treasury is the better choice for three reasons.

First, just under 40 percent of students are repaying through an income-driven repayment (IDR) plan, which requires information on income, information that the Treasury already has but SBA does not. Under IDR plans, payments are a set percentage of income (typically 10 percent) each month. With monthly payments varying, the length of the loan varies too, with high earners repaying their loans more quickly. Since the Treasury already collects income information (through the Internal Revenue Service) needed for IDR, it is better positioned to manage IDR plans than the SBA.

Second, the Treasury already has systems set up and running to deal with troublesome loans. For example, the Treasury Offset Program is used to collect unpaid taxes and student loans from borrowers who default by garnishing their tax refunds and other government payments. The SBA would have to set up its own system or outsource the task to Treasury.

Third, SBA’s experience facilitating loans is irrelevant for student loans. One of the main things the SBA does is provide loan guarantees to private lenders, which means it has considerable experience evaluating the quality of loans (often called underwriting). But student loans do not go through underwriting as eligibility and loan terms are all set by Congress, which renders SBA’s greater experience in underwriting irrelevant. Relatedly, SBA’s experience with loan guarantees is likewise irrelevant, because student loans should not have loan guarantees.

Overall, if student loans are moved, the Department of the Treasury would be a better choice than the Small Business Administration. 

Number eight in our series of occasional roundups on election law and policy:

• I had a few things to say last week about President Donald Trump’s executive order purporting to overhaul election law by decree, something an American president doesn’t have the power to do. Our friend Stephen Richer supports some substantive elements of the scheme, including a firm Election Day cutoff on ballot receipt, but gives the order a failing grade on governance: “The president pretends as if we don’t have a Congress, and he rides roughshod over the states.” Trump’s demand that states turn voter files over to his agencies replays a similar data demand in his first administration with which 44 states refused to comply. [Rick Hasen] The funding cudgel won’t be very menacing if limited to election funding since the federal government doesn’t dispense much of that to the states [VoteBeat] Expect to see backflips on federalism as some Democrats who promoted H.R. 1’s trampling of state election authority now find merit in state autonomy after all, even as some Republicans accomplish the reverse [Dan Balz, Washington Post]
• For those who want to get into the finer details, I recommend this resource from the Institute for Responsive Government, which discusses transformation of the independent, bipartisan Election Assistance Commission into an instrument of the president’s will, big new unfunded mandates for some states, hassles on proof of citizenship for military/​overseas voters, loss of jobs by noncitizens who’ve long worked uneventfully at election vendors, and hyped-up fraud claims once DOGE and DHS publicize data entry errors or simple misunderstandings of the voter file. Also: “Why Trump wants to ban barcodes on ballots, and what it means for voters and election officials.” [VoteBeat]
• Having pulled a similar stunt in Pennsylvania last year, which I wrote about at the time, Elon Musk is now promising money to registered voters in Wisconsin. Will the law catch up with him at some point? [Associated Press, Rick Hasen, Alexander Shur/​VoteBeat]
• You can watch my recent appearance before the Montgomery County, Maryland Board of Elections on a panel discussing ranked choice voting, especially implementation. The conversation starts at about the 0:37 minute mark and—be warned!—goes on for well over two hours. And I discussed proposals to use RCV presidential primaries in Maryland presidential primaries on WBAL’s Torrey Snow show; 
• I agree with the authors’ take here: even though there are now roughly balanced amounts of pro‑R and pro‑D gerrymandering in races for the US House of Representatives, that’s no reason to stop working for redistricting reform. Each of the individual biased maps undermines political fairness and voter choice in its state. [Nicholas Stephanopoulos, Eric McGhee and Christopher Warshaw, Washington Post]
• New York high court rules that under the state constitution, New York City can’t authorize noncitizens to vote in its municipal elections (they’re already barred by law from voting in elections at the state and federal level) [Derek Muller]
• A bad enforcement action, withdrawal was the proper course: feds will withdraw Biden administration suit over Georgia election enactments [AP; earlier here, here, etc.]

President Trump is moving to shut down the federal Department of Education. Congress will need to make any cuts permanent, but downsizing the federal education bureaucracy is a long-overdue reform. The department, however, is not the only way that the federal government intervenes in the nation’s schools.

The government also spends $35 billion a year on school food programs through the Department of Agriculture. The school lunch program was enacted in 1946 and has morphed into an array of breakfast, lunch, after-school, and summer food programs that now cover 30 million children.

My new op-ed at National Review discusses four reasons to axe federal school food programs and allow the states to adopt their own policies.

My full study on the issue is here.