Reflections from a retired hospital CEO on the intentional chaos coming from Washington

I am going to step back from my usual focus on addressing the causes and consequences of clinician burnout -- and the role and responsibility of hospital and health system senior leaders to change the workplace conditions and management culture that give rise to burnout -- to address the dumpster fire in our nation's capital. Â
At first blush, it's hard to grasp the logic of the Trump administration's decision to suspend disbursing -- and then after a judge's temporary restraining order took effect -- to almost immediately rescind the prior suspension of all federal grants. To add insult to injury, the portal through which all 50 states access Medicaid payments was also closed before being subsequently re-opened after a hailstorm of protests from across the country and a threatened coordinated action by some 22 state attorneys general.  Also in the mix: a peremptory announcement designed to hollow out the federal workforce by proffering roughly eight months of pay to any and all 2.25 million federal employees who accepted the payout offer by February 6.  Â
Taken together, we're talking trillions of dollars, millions of people, and thousands of organizations here.
Beyond the financial cudgels, Trump has also nominated a rogues gallery of manifestly unqualified misfits for Cabinet positions. For those of us in the healthcare field, none is more appalling than the conspiracy theorist, anti-vaxxer, and overall junk science crank than RFK, Jr. to head Health and Human Services (HHS) into which the CDC, Centers for Medicare and Medicaid Services (CMS), National Institutes of Health, and FDA all roll up. Â
Apologists for Trump are defending these actions by saying he was elected to "shake up the status quo" and that he has a "mandate" to do so. No, and no.
Trump only won a plurality of the popular vote with 77,302,580 votes (49.8%) to Kamala Harris' 75,017,613 votes (48.3%). Close to 90 million eligible voters did not vote. In other words, over 165 million American voters did not choose Donald Trump. His narrow election is not the stuff of mandates.Â
The appellation of "disrupter" is also misplaced because it implies someone who wants to rapidly innovate, to shake things up to make the system perform better, not to break it. That's not why Trump has nominated the likes of Matt Gaetz, Kash Patel, Pete Hegseth, Tulsi Gabbard, Linda McMahon, and RFK, Jr. The best description I've seen as to the "why" these grossly unqualified people are being put forward comes from Timothy Snyder, a Yale history professor, and specialist in the origins and manifestations of fascism, authoritarianism, and oligarchies. He refers to what's underway with the new administration as a "decapitation strike"; ie, the placement of loyalists into key government roles who are being put there to weaken key democratic institutions, advance the agenda of the framers of Project 2025, and potentiate the advent of an authoritarian or at least semi-authoritarian state. The flooding of the news cycle with a rapid succession of unprecedented, mind-boggling announcements is part of the same playbook. The chaos is not an accident; it's intentional: to keep people and institutions off balance.
If you want to learn more about Professor Snyder and his socio-political analysis, consider purchasing his seminal book, On Tyranny: Twenty Lessons from the Twentieth Century, and/or subscribe to his blog, "Decapitation Strike", on Substack. Another good resource to track -- and deconstruct -- current events and what's behind them is "The Contrarian", co-founded by Norm Eisen and Jennifer Rubin. It, too, is on Substack.
In the meantime, keep calm and carry on.
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