This is a small data point I’ve been following but one with potentially vast implications. Since mid-February I’ve noticed a consistent pattern based on speaking to many sources across the federal government. In contrast to almost every other part of government, the Centers for Medicare & Medicaid Services has emerged relatively unscathed. Obviously, this is not at all a bad thing. CMS oversees Medicare, Medicaid and other federal health care provision services.
This is in great contrast to the situation at the Social Security Administration which has been submitted to a full DOGE onslaught. SSA has been the focus of a propaganda wave from Elon Musk himself, major cuts and a host of disruptions. Wired reported on Friday that DOGE plans to rewrite SSA’s computer system from scratch over a period of a few months. It’s difficult to describe how crazy a plan this is. Such an effort is one that under any realistic timeline would take years not months.
It’s also in great contrast to the rest of HHS. I have been meaning to dig back into the situation at NIH because it is very clear that the general public and even the scientific/biomedical community outside of NIH doesn’t grasp the sheer level of destruction. More on that very soon.
So what’s the deal with CMS?
A possible answer comes in this Monday article from Politico. The “DOGE lead” at HHS is Brad Smith. He led one of the constituent parts of CMS during the first Trump administration. That’s the Center for Medicare & Medicaid Innovation. This has led to controversy and conflict within DOGE/HHS because people think Smith is protecting his former agency. This apparently lead to a weekend delay in the latest round of HHS cuts. Because people wanted to review the situation at CMS to see whether Smith had prevented enough cuts. As one sympathetic observer put it to me, someone’s been looking out for CMS.
The whole situation is more than a little perverse and weird: One DOGEr catching flack for not allowing enough destruction of a bureaucracy he presumably has some familiarity with. But that’s where we are.
I don’t have too much more information here than that. I simply wanted to connect these dots. I will return to the matter of the extreme and dire situation at the Social Security Administration. We seem to be in a liminal period of a few weeks in which the future of the program will be decided. Not good vs bad but bad vs catastrophic. Needless to say, one is much easier to recover from than the other.
