This discussion of healthcare was prepared prior to last night’s news about US action against Iran’s nuclear weapons program.
Seismic shifts may be underway in healthcare
In January, McKinsey said this about the US healthcare sector:
We estimate that healthcare EBITDA will increase at a 7 percent CAGR to $987 billion in 2028 from a baseline of $676 billion in 2023 (Exhibit 2). In many segments, improvement could come from recovery from post-pandemic lows (for example, in most payer and provider segments); in other areas, growth will accelerate (for example, HST and specialty pharmacy).
(“What to expect in US healthcare in 2025 and beyond,”
https://www.mckinsey.com/industries/healthcare/our-insights/what-to-expect-in-us-healthcare-in-2025-and-beyond)
At the beginning of this year, the entire American healthcare sector was nearly $5 trillion annually in size. That’s about 18% of the nation’s GDP. Healthcare employment was about 18 million people (“All Employees, Health Care,” https://fred.stlouisfed.org/series/CES6562000101).
The process of research for new treatments, distribution of government funding, role of providers, regulation, staffing, and approval is now undergoing extraordinary change. We have a reading list at the bottom. It reports on changes driven by the DOGE/Congress budget, changes in regulation and supervision initiated by HHS secretary RKF, Jr. Readers are invited to spend some time perusing the elements in the reading list. We compiled a master list and tried to edit it down to reduce redundancy.
Vaccine policy shifts
Please note the list of the 17 people who were summarily “fired” from a key advisory committee. The link to that list is among the references at the bottom. Also note the 8 people who replaced them. (You might even take a few minutes to compare their resumes.) Also note that there was a change in process so that the usual overlapping transition in this important advisory committee was ignored. Readers can decide for themselves if they think that type of upheaval is beneficial for healthcare outcomes. As far as I’m concerned, it isn’t.
While the vaccine review committee (Advisory Committee for Immunization Practices) made the lead headline, other committees, such as the one on infections and the prevention of them, have also been dismissed. Here’s an NBC report: “Trump administration has shut down CDC’s infection control committee,” https://www.nbcnews.com/health/health-news/trump-administration-shut-cdcs-infection-control-committee-rcna205209. Note that the “new” ACIP is scheduled to meet on June 25–27 in Atlanta at the CDC offices.
The list at the bottom has more.
(Photo posted on Facebook by Physicians for a Healthy Democracy on 6/18/2025)
Citizens push back
Not all healthcare-related news is alarming. Sometimes citizen activism can cause a positive change. Below is a Florida story about a reversal in what was a devastatingly opaque policy originating in Tallahassee. To reverse it took negative healthcare outcomes and then pressure placed on state legislators by medical professionals, families and friends of sick people, and other concerned citizens. But the citizen activism worked. In my opinion, when enough people get sick or die and the citizens at large begin to see the impacts of the disruptive healthcare changes, they will slowly coalesce into a political force strong enough to demand and obtain changes. I expect it will take some pain to get to the “breaking point.” But look what happened in Florida after the state took down a public information website.
Here’s the story: “Florida disease-tracking chart returns: Measles, mpox, hepatitis surveillance now available” | Sun Sentinel, https://www.yahoo.com/news/florida-disease-tracking-chart-returns-175900687.html.
Here are some key tracking points the reopened Florida website reveals about vaccine-preventable diseases:
1. A child in Broward County less than 4 years old contracted measles in April, marking the second case in South Florida in two months. The child acquired the disease outside of the US.
2. Broward leads the state in new cases of mpox (formerly known as monkeypox). Thirteen cases of mpox have been reported in Florida so far this year, three in Broward County. In 2022, Florida was part of a nationwide outbreak of monkeypox.
3. Fourteen cases of leprosy (Hansen’s disease) have been reported in Florida in 2025. In August 2023, the Centers for Disease Control and Prevention warned travelers that leprosy cases in Florida were surging. At the time, Florida was among the top reporting states with nearly 30 cases. The BCG vaccine, while primarily for TB, can offer some protection against leprosy, particularly if someone in the household has leprosy.
4. The state has been grappling with a massive rise in pertussis (whooping cough). There have been 614 cases reported in Florida since January. To date in 2025, the CDC has reported over 8,000 cases of whooping cough, a more than two-fold increase from the same time last year. The CDC recommends whooping cough vaccine for people of all ages.
5. Already in 2025, 63 cases of Hepatitis A have been reported in the state. Florida has grappled with a spread of Hepatitis A for several years, predating the pandemic. In 2019, Florida experienced a statewide outbreak with more than 2,000 cases reported.
6. Tracking disease spread has become more critical as vaccination rates have dropped. According to the US Centers for Disease Control, only 88.1% of kindergartners in Florida were vaccinated against measles in the 2023–2024 school year. Herd immunity for measles requires a 95% vaccination rate. Florida’s rate is one of the lowest in the nation.
7. Florida’s pediatricians say that real-time surveillance helps them guide parents in making informed decisions about vaccination. “We end up playing catch-up after a child contracts a vaccine-preventable illness, and then we start looking at who else is vulnerable and start offering vaccines,” said Jennifer Takagishi, professor of pediatrics and division chief of General Academic Pediatrics at the University of South Florida.
8. Florida’s surveillance chart tracks close to 100 diseases, indicating the age range, county, diagnosis status, and whether the person acquired the disease inside Florida, inside the US or outside the US.
Sun Sentinel health reporter Cindy Goodman can be reached at cgoodman@sunsentinel.com. Originally published May 27, 2025.
Medical professionals organize
I know of medical professionals forming groups and committees at a grassroots level throughout the United States. The organizers and members are nurses and doctors and researchers and hospital staff and many other categories of professionals and support staff. They are Democrats, Republicans, and independents. They are putting the nation’s health ahead of their political affiliations. They are fed up with what they are seeing. They are watching the shortages of healthcare staff grow as the national policy of deportation threatens a nurse or hospital staff person or researcher who was in the US legally on a temporary status but is then arrested, detained, and sometimes deported. Case after case is reaching the public awareness.
Note that I’m all for deportation of a criminal and all for the prosecution of a murderer, but there are 500,000 people who were all legally given temporary status, which has now been revoked. I have met some of them. I met some that were working in the healthcare industry. They were studying to advance themselves. Now they have left. Or they are scared. And their replacements are not coming to America now because of fear. So, the shortage of healthcare workers seems to be intensifying everywhere. It has even reached the premier military medical center of the United States, Walter Reed. See: “Nursing Staff Shortages Disrupt Infusion Clinic Operations at Walter Reed,” https://www.military.com/daily-news/2025/06/13/nursing-staff-shortages-disrupt-infusion-clinic-operations-walter-reed.html.
Dear readers, it is up to us now. The system that we knew has changed.
For everyone, the choices are now requiring more research and effort. When we cannot rely on the transparency of our government, then we are on our own for good or bad decisions. That is where things stand, whether we like it or not. Healthcare is going to function in some form, whether well or poorly. The issue is how, where, and with what decision-making system. Welcome to the RFK, Jr. era.
Philanthropy steps in
The role of philanthropy has become more important than ever. It is stepping in where government is stepping back. That model carries a risk, since the donors influence the direction and application of their money, and since private money cannot reach every need. In my case, I have been donating and funding nursing advancement and training. I do that locally in education programs and with Sarasota Memorial Hospital. I also apply philanthropy to assistance for veterans who need rehab and then treatment for PTSD. The direction of that money is to help those who served in the armed forces and are amputees. And I support research on a specific type of cancer — mine. Those are my choices. Others are free to make theirs.
My point is that philanthropy is replacing government. There are pros and cons to the change.
Pharma tariffs and reshoring raise costs
Lastly, in the arena of pharmaceuticals, we are witnessing reshoring among the major companies. That process has been underway for years, and the tariff policy may accelerate it. My own situation is a case study. I have two types of leukemia (CLL and CMML). The treatments for each are powerful pharmaceuticals. One is made in Switzerland; the other is made in South Korea. Trump’s tariff policy applies to the importation of both drugs. The companies are now manufacturing these drugs in the US as well as in the foreign country, though at a higher cost. The tariff’s effect is to raise the prices of the drugs. Why? If the drug is imported, the tariff is collected when the customs agent clears the shipment. Someone in the supply chain must pay the tariff to the US Treasury. So, a sales tax is levied on a drug that is used to treat about 30,000 cancer patients who have a bleeding risk from their disease. I’m one of them. Additionally, reshoring has entailed extra costs that drive increased higher drug prices.
So the tariff has caused a price increase. Who pays that increase and at what level is obscure and variable because of the patchwork nature of our healthcare system. The restructuring of national healthcare has imposed situations like this across the 50 different jurisdictions of the 50 states. We will observe how that works in due time.
I want to remind readers that until 1996, 33 American pharmaceutical companies manufactured drugs in American territory under direct American supervision. The location was Puerto Rico. In 1996, a change in federal law with a 10-year sunset provision started the transition of pharma companies to locations outside the US. After the 10 years elapsed, pharma had moved, and Puerto Rico went bankrupt. Now the situation is partially reversing and has been for some time. Will tariffs change the policy direction? That is a debate. Will they raise drug costs? Absolutely, since they are a sales tax on healthcare treatments.
The reading list is below. Citizens’ committees are forming nationwide. The rest is up to us.
Reading List
Seismic shifts underway in healthcare
(Chart source: CDC Data Project, link below)
“In the proposed FY26 budget, programs that help Americans live safer, healthier, longer lives are on the chopping block” | CDC Data Project,
https://www.cdcdataproject.org/“The toll of NIH funding cuts: 6 key takeaways” | Becker’s Hospital Review,
https://www.beckershospitalreview.com/finance/the-toll-of-nih-funding-cuts-6-key-takeaways/“NIH grant funding losses, by state” | Becker’s Hospital Review,
https://www.beckershospitalreview.com/finance/nih-grant-funding-losses-by-state/“2025 healthcare policies timeline” | HFMA,
https://www.hfma.org/legislative-updates/2025-healthcare-policies-timeline/“Katie Couric and Eric Topol: On the State of US Life Science and Extending Healthspan” | Ground Truths,
https://open.substack.com/pub/erictopol/p/katie-couric-and-eric-topol-on-the
Vaccine policy shifts
“4 ways to anticipate next week’s ACIP” | Your Local Epidemiologist,
https://open.substack.com/pub/yourlocalepidemiologist/p/4-ways-to-anticipate-next-weeks-acip
“RFK Jr.: HHS Moves to Restore Public Trust in Vaccines” | WSJ,
https://www.wsj.com/opinion/rfk-jr-hhs-moves-to-restore-public-trust-in-vaccines-45495112
“Kennedy removes all ACIP members, eyes replacements” | CIDRAP,
https://www.cidrap.umn.edu/adult-non-flu-vaccines/kennedy-removes-all-acip-members-eyes-replacements
“RFK Jr. guts the U.S. vaccine policy committee” | Your Local Epidemiologist,
https://yourlocalepidemiologist.substack.com/p/rfk-jr-guts-the-us-vaccine-policy
“ACIP Membership Roster” | CDC, archived at the Wayback Machine, June 9, 2025,
https://web.archive.org/web/20250609214210/https://www.cdc.gov/acip/membership/roster.html
“RFK Jr. Names Replacements for CDC Vaccine Panel” | MedPage Today,
https://www.medpagetoday.com/infectiousdisease/vaccines/116026
“Removed ACIP Members Say ‘U.S. Vaccine Program Critically Weakened’” | MedPage Today,
https://www.medpagetoday.com/infectiousdisease/vaccines/116101
“HHS justifies decision to stop recommending Covid shots during pregnancy with studies supporting the shots’ safety” | POLITICO,
https://www.politico.com/news/2025/06/10/hhs-justifies-decision-to-stop-recommending-covid-shots-during-pregnancy-with-studies-supporting-the-shots-safety-00396523
“Health groups urge insurers to cover COVID-19 shots for pregnant women” | West Virginia Watch,
https://www.yahoo.com/news/health-groups-urge-insurers-cover-100044729.html
“State health officials urge kids, pregnant women to get COVID-19 vaccine despite federal pullback” | Milwaukee Journal Sentinel,
https://www.jsonline.com/story/news/2025/06/05/wisconsin-health-department-still-recommends-covid-19-vaccine/84035875007/
“FDA to Mandate Placebo-Controlled Trials for New Vaccines” | Bloomberg,
https://www.bloomberg.com/news/articles/2025-05-01/fda-to-require-placebo-controlled-trials-for-vaccine-approvals
“An Uncertain Vaccines Market Keeps Getting Dicier” | MedPage Today,
https://www.medpagetoday.com/opinion/second-opinions/115888
Citizens push back
“Florida disease-tracking chart returns: Measles, mpox, hepatitis surveillance now available” | Sun Sentinel
https://www.yahoo.com/news/florida-disease-tracking-chart-returns-175900687.html“FLHealthCharts Reportable Diseases Frequency Report,”
https://www.flhealthcharts.gov/ChartsReports/rdPage.aspx
Medical professionals organize
CIDRAP News: One of the claims Secretary Kennedy has made, and he said this on May 14th when he was testifying before Congress and in a recent Fox News interview, was that the only vaccine that has been tested in placebo-controlled trials is the COVID vaccine. And he’s made variations on that claim in other venues. Based on your review of the RCTs that you’ve compiled, is that true?
Jake Scott: It’s unequivocally, demonstrably, measurably false.
“Vaccine RCT spreadsheet aims to show the data, dispel myths about vaccines,”https://www.cidrap.umn.edu/adult-non-flu-vaccines/vaccine-rct-spreadsheet-aims-show-data-dispel-myths-about-vaccines
“Viewpoint: RFK’s reckless firing of CDC vaccine advisors not supported by evidence” | CIDRAP,
https://www.cidrap.umn.edu/covid-19/viewpoint-rfks-reckless-firing-cdc-vaccine-advisors-not-supported-evidence
Philanthropy steps in
“Philanthropy Must Accelerate Spending and Broaden Collaboration” | Stanford Social Innovation Review,
https://ssir.org/articles/entry/philanthropy-government-cuts-spending-collaboration
“2025 Federal Budget Crisis: The Role of Philanthropy in Filling the Gap” | FundsforNGOs,
https://us.fundsforngos.org/articles/2025-federal-budget-crisis-the-role-of-philanthropy-in-filling-the-gap/
Pharma tariffs and reshoring raise costs
“How U.S. Tariffs Stand to Impact Prescription Drugs” | Harvard Business Review,
https://hbr.org/2025/05/how-u-s-tariffs-stand-to-impact-prescription-drugs
“What Pharmaceutical Tariffs Would Mean for Americans” | Johns Hopkins Bloomberg School of Public Health,https://publichealth.jhu.edu/2025/tariffs-and-us-drug-prices
“Pharma’s US manufacturing moment: Where companies are making the biggest moves” | Pharma Voice,
https://www.pharmavoice.com/news/pharma-manufacturing-tariff-trump-lilly-novartis-novo-amgen-jnj/745092/
