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HEALTHCARE IN FLUX!

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OLD and QUIRKY

Health Care Administration: The 2025 Crisis of Leadership and Its Consequences

The year 2025 has been one of the most disruptive in recent memory for health care administration in the United States. Alongside sweeping regulatory changes, rapid adoption of artificial intelligence, and continued struggles with workforce shortages, a wave of firings and forced resignations at the highest levels of public health agencies has shaken the system. Senior officials at the Centers for Disease Control and Prevention (CDC), the Food and Drug Administration (FDA), and the Department of Health and Human Services (HHS) have been dismissed, sometimes with little explanation, and thousands of staff have been laid off in broader restructuring efforts. While leadership changes are not uncommon in government, the scale and speed of these removals in 2025 stand out—and they raise pressing questions about institutional stability, scientific independence, and leadership at the top level.

High-Profile Firings and Political Tensions

The most visible episode was the firing of Susan Monarez, the newly appointed CDC Director, who was dismissed less than a month into her tenure. Reports suggest that her removal followed disagreements with HHS leadership over vaccine policy, an issue that has become politically charged. Her abrupt departure was followed by additional resignations and firings of senior CDC officials, creating leadership vacuums in areas critical to public health, such as infectious disease surveillance and vaccine advisory committees.

This turmoil was not confined to the CDC. Across the broader HHS system, mass layoffs and reductions in force affected thousands of employees, including scientists, policy analysts, and career administrators. The FDA and CMS also saw leadership turnover, with concerns that ideological shifts rather than performance metrics were driving personnel decisions. For critics, these moves represent an erosion of scientific independence; for supporters, they are an effort to realign agencies with new political priorities. Secretary Kennedy is at the center of all this chaos. This sort of chaos, particularly with vaccines, has led to an increase in reported cases of measles and will most likely result in an increase of infectious diseases.

Risks of Leadership Instability

The consequences of these firings are multifaceted. First is the loss of institutional knowledge. Senior officials often carry decades of expertise, and their departure leaves behind gaps that cannot easily be filled by newcomers. For programs like disease outbreak monitoring, vaccine development, or regulatory review of new therapies, institutional memory is not just helpful—it is essential for effective decision-making.

Second, leadership turnover creates operational disruption. Programs that depend on consistent oversight can stall or lose direction when key personnel are removed. Policy implementation may be delayed, messaging to the public can become inconsistent, and ongoing projects may be abandoned before completion. In the case of vaccine guidance, even small lapses in clarity can undermine public compliance at critical moments.

Third, these actions have a direct impact on staff morale and retention. When firings appear abrupt, politically motivated, or poorly communicated, the remaining workforce experiences heightened insecurity and stress. This climate can accelerate turnover among mid-level staff, further eroding the talent pool and deepening the workforce crisis already facing public health.

Finally, perhaps the most damaging consequence is the erosion of public trust. Health agencies depend on credibility to persuade the public to follow guidance, especially in times of crisis. If firings suggest that science takes a back seat to politics, or that expert voices are silenced, the public should become skeptical of future recommendations. The result is reduced compliance with public health measures, widening inequities, and greater vulnerability to health threats.

Legal and Governance Implications

The wave of firings has also triggered legal and regulatory challenges. Some dismissals, such as Monarez’s, have been questioned on procedural grounds, with legal scholars debating whether statutory protections for certain positions were respected. Congressional committees have begun inquiries into whether the removals undermine the independence of federally mandated programs. Beyond individual cases, these disputes highlight a deeper governance issue: how to balance political leadership with the stability required for scientific and administrative effectiveness.

Conclusion

The firings of 2025 have underscored how fragile health care administration can be when leadership instability collides with political conflict, in this case Secretary Kennedy. Clearly the information used by Secretary Kennedy has little to no scientific validity and when testifying before Congress he resorts to anger when it becomes apparent that he lacks the knowledge to provide correct answers. Removing key personnel may realign agencies with new priorities driven by politics, but it also risks undermining expertise, disrupting operations, and eroding public confidence.

Ultimately, health care administration depends on more than policies and technologies; it depends on the stability of the people who lead and the trust they command. The turbulence of 2025 offers a stark reminder that protecting these human and institutional foundations is as important as any regulatory reform or technological breakthrough.

T.  Michael Smith

wwwtmichaelsmith

HUMAN RIGHTS RECKONING

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 OLD AND QUIRKY                                                            September 7, 2025

The United States, long viewed as a beacon of hope for immigrants seeking safety and opportunity, faces a moral and legal crisis in its treatment of immigrant children. From detention centers to courtroom battles, the experiences of these vulnerable minors reveal deep flaws in the nation’s immigration system and raise urgent questions about justice, compassion, and accountability.

What Is the Administration Doing too Immigrant Children? 

In the early hours of Sunday August 31, in the middle of a three-day holiday weekend, the Trump administration attempted to take vulnerable children out of government custody and ship them alone to their country of origin, Guatemala.

The administration was planning to move up to 600 children from the custody of the Office of Refugee Resettlement (ORR), where they are held according to law until they can be released to a relative or a guardian living in the U.S. who can take care of them while their case for asylum in the U.S. is being processed.
Unaccompanied migrant children are considered a vulnerable population and are covered by the 2008 Trafficking Victims Protection Reauthorization Act. That law gives them enhanced protection and care, making sure they are screened to see if they have been trafficked or are afraid of persecution in the country they come from. Congress has specified that such children can be removed from the country only under special circumstances. Nonetheless, the administration appears to have removed about 76 of those transferred out of the custody of ORR—the only agency with legal authority to hold them—where they were waiting to be released to a relative or guardian.  

Early on Sunday, August 31, advocates for the children filed a suit to prevent the administration from removing them. Shortly after 2:30 in the morning, Judge Sparkle Sooknanan got a phone call about the case, and by 4:00 she had issued an emergency order blocking the removal and scheduled a hearing for 3:00 pm that afternoon. She moved it up to 12:30 pm when she learned that the administration was already moving some children out of the country. By noon Monday, according to the government’s lawyers, all the children were back in ORR custody.

Immigrant children have always been part of America’s story. But the modern era, especially post-9/11, has seen a shift toward securitization and deterrence. Policies like family separation under the Trump administration and overcrowded detention facilities have drawn international condemnation.

Legal Protections vs. Reality

The Flores Agreement of 1997 was a landmark settlement that established minimum standards for the treatment of immigrant children in federal custody. It mandates that children be held in “safe and sanitary” conditions and released “without unnecessary delay” to appropriate sponsors. However, enforcement has been inconsistent. In 2025, a federal judge ordered continued monitoring of U.S. Customs and Border Protection (CBP) after failures to meet these standards.

Moreover, access to legal representation remains a critical issue. Children with lawyers are far more likely to appear in court and succeed in asylum claims—95% versus just 33% for those without attorneys. Yet, in March 2025, the federal government terminated a contract that provided legal counsel for over 26,000 unaccompanied minors, leaving thousands without support in navigating complex legal systems.

Detention and Its Consequences

Detention facilities, especially those housing families, have come under scrutiny for poor conditions and inadequate medical care. A reopened center in Texas revealed issues like malnutrition, tuberculosis, and insufficient mental health screening. While the Biden administration initially halted family detention in favor of alternatives like electronic monitoring, recent policy shifts have revived large-scale detention efforts.

Children in detention, whether alone or with family, face trauma that can have lifelong consequences. The psychological toll of confinement, uncertainty, and separation from loved ones undermines their development and violates international norms of child welfare.

Humanitarian and Ethical Concerns

Beyond legality, the treatment of immigrant children is a humanitarian issue. These minors often flee violence, poverty, and instability in Central America, arriving at the U.S. border in search of safety. Instead, they encounter bureaucratic hurdles, hostile environments, and prolonged uncertainty.

Critics argue that the U.S. response exacerbates the very crises these children are escaping. Policies that prioritize deterrence over protection risk violate both domestic law and international human rights standards.

Toward Reform: What Needs to Change

To uphold its values and obligations, the United States must:

  • Restore and expand legal representation for all immigrant children.
  • Fully implement and enforce the Flores Agreement, with independent oversight.
  • Invest in community-based alternatives to detention, which are more humane and cost-effective.
  • Ensure trauma-informed care and education for children in custody.
  • Reform asylum procedures to prioritize child welfare and family unity.

Conclusion

As I look back over our history with indigenous people and black people, I shouldn’t be surprised by all of this. I don’t want to think of my country as evil. But I am surprised by the treatment of immigrant children in the United States.  This is not just a policy issue, it is a reflection of national character. As the country grapples with its identity in a globalized world, how it treats its most vulnerable newcomers will speak volumes. Justice demands more than compliance; it calls for compassion, dignity, and the courage to do better.  We can and must do better.

T. Michael Smith

wwwtmichaelsmith.com

CIVIC ALARM BELLS

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OLD AND QUIRKY

A CIVIC ALARM BELL

Washington, D.C., now hosts 2,000 National Guard troops—armed, visible, and federally controlled. Their presence is framed as a response to crime. Yet violent crime in the city has declined sharply, reaching a 30-year low. The contradiction invites a deeper question: What purpose does this deployment truly serve?

There is no crisis in DC. The troops are not responding to riots or unrest. They are not assisting overwhelmed police. They are simply… present. Armed. Watching. This raises constitutional alarms—not because of what has happened, but because of what could.

The troops are doing a bit of gardening. They are assisting the park service in spreading mulch around the cherry trees.

SYMBOLISM AND POWER

Deploying National Guard Troops from distant states to perform menial tasks—mulching and picking up trash—does not address any genuine security need in the district.  Instead, these actions serve to normalize a visible military presence in everyday civic life, subtly permitting federal control even in the absence of crisis. This strategy aligns with tactics often seen in authoritarian regimes where symbols of force are introduced to assert dominance and discourage dissent.  The insistence that these troops were necessary to “crack down on crime” stands in stark contrast to the city’s record-low crime rate and the absence of unrest. These troops are being used as instruments of power and symbolism to reinforce the notion that Trump is the sole protector.

A CIVIC PROTECTOR

Deploying troops in a peaceful city sends a message—not of safety, but for control.  It normalizes the presence of armed forces in civic life. It blurs the line between policing and militarization. And it risks turning the capital into a stage for political theater, rather than democratic governance.

With Trump underwater on all his key issues and his job approval rating dismal, the administration is trying to create support for him by insisting that the U.S. is mired in criminal activity and he alone can solve the problem. The administration’s solution is not to fund violence prevention programs and local law enforcement—two methods proven to work—but instead use the power of the government to terrorize communities,

There is a frantic feel to the effort, as if the feel they must convince Americans to fear crime more than they fear of rising grocery prices or having to take their children past police checkpoints on their way to school.

Now, with Illinois governor J.B. Pritzker taking a stand against the deployment of troops in Chicago, Trump is nervous about sending troops on his own hook and instead is trying to pressure Pritzker to ask for them.  He has complained about Pritzker not asking for troops and on social media he has referred to Pritzker as  “an incompetent Governor who should call me for HELP.”

A CALL FOR VIGILENCE

This is not just about D.C.  It is about precedents.  If federal troops can be deployed without legal justification, what stops future administrations from doing the same—anywhere, anytime?

Democracy depends not just on elections, but on norms. On restraint.  On the quiet, often invisible boundaries between civilian life and military power.  When those boundaries erode, history warns us that freedom will follow.

Each moment carries its own context. But all share a common thread: the tension between federal force and civil liberty.

T. Michael Smith

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The QUIET EROSION of CIVILIAN RULE

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OLD and QUIRKY

A New Normal?

In the summer of 2025, armored vehicles rolled through downtown Los Angeles—not in response to foreign attack, but to guard federal buildings during a wave of domestic protest. The troops weren’t requested by California’s governor. They were sent by presidential order. For many Americans, it was a jarring sight: the military, long a symbol of defense abroad, now stationed in the heart of a U.S. city.

This wasn’t a one-off. It was part of a broader trend—one that threatens to blur the line between civilian governance and military power. And now troops are in Washington DC to stem crime in our nation’s capital.  What a symbol for an emerging authoritarian movement.

At the moment we seem to be practicing a system of state capitalism- –a hybrid between socialism and capitalism in which the state guides the decisions of nominally private enterprises. There is a clear change from the free-market economy the U.S. once embraced. In Trump’s first term, CEOs routinely spoke out when they disagreed with his policies on immigration and trade. Now, they shower him with donations and praise or are mostly silent. Trump is deploying financial power and regulatory power to intimidate media companies, banks, law firms, and government agencies he thinks are not sufficiently supportive.

The Legal Guardrails—and Their Cracks

For nearly 150 years, the Posse Comitatus Act has stood as a bulwark against military involvement in domestic law enforcement. Its message is simple: the armed forces are not a police force. But the Insurrection Act, a much older law, offers the president a way around this restriction—allowing troop deployment during times of rebellion or when laws cannot be enforced.

Historically, this power has been used sparingly: to enforce civil rights in the 1960s, to quell riots when local authorities were overwhelmed. But recent deployments—without state consent and absent clear legal justification—suggest a shift. The question isn’t just whether the law allows it. It’s whether our democracy can withstand it

The Risk of Military Governance

The use of US troops domestically tends to escalate tensions, not defuse them. More importantly, it signals a dangerous normalization: federal force as an acceptable substitute for local governance.

This undermines the principle of federalism, the idea that states have autonomy over their internal affairs. It also erodes civilian control, a cornerstone of democratic society. When the executive branch can deploy troops without oversight or consent, the balance of power tilts dangerously later toward authoritarianism.

A Culture Clash in Uniform

Even within the military, there’s discomfort. Pentagon regulations emphasize that domestic deployment must be legal, necessary, and appropriate. Many commanders worry that repeated use of troops on U.S. soil risks politicizing the armed forces and damaging public trust.

The military’s ethos is built on defending the Constitution—not enforcing political will. When soldiers are asked to patrol neighborhoods or guard against protestors, that line begins to blur.

What Comes Next?

California’s lawsuit against the federal government may set a legal precedent. But the deeper question is cultural: Will Americans accept troops in their cities as a new normal? Or will they push back against the quiet erosion of civilian rule?

Democracy depends not just on laws, but on norms—on shared understandings of what power should and shouldn’t do. The use of troops on U.S. soil tests those norms. And the outcome will shape the character of American governance for years to come.

The Vice President

Another interesting development is that Vice President J.D. Vance appears to have been distancing himself from Trump and the administration by taking repeated vacations.  Vance also appears to be undercutting Trump over the Epstein files, twisting the knife while also seeming to make overtures to Trump’s MAGA voters, who have never warmed to Vance.  Vance set up a meeting at his residence to discuss Epstein, a meeting that just happened to leak to the press. Then a few days later, Vance brought up the issue again in an interview with Maria Bartiromo on the Fox News Channel, parroting MAGA beliefs that the files name prominent Democrats.

“Lot of Americans want answers. I certainly want answers,” Vance said

Those people cheering on Trump’s drive for autocratic power because they still somehow think he will use that power to make their lives better might want to consider how their lives may change if that power is in the hands of J.D. Vance.

T. Michael Smith

wwwtmichaelsmith.com