Title: A Surgeon’s Insights on Health Care Reforms and Waste During the Trump Administration
By Christine Ward, Trauma and Critical Care Fellow
In his inaugural address to Congress, former President Donald Trump promised extensive economic reform. Through aggressive deregulation, diminished federal oversight, and a commitment to “eliminate inefficiencies,” his administration took significant steps across various industries, including health care. While the call for “efficiency” is appealing, the realities experienced by those on the ground—especially medical professionals—indicate a more intricate and troubling scenario.
Where Trump’s cost-reduction goals collide with the vast bureaucratic structure of American health care exists a system that is not only exorbitantly costly but, paradoxically, increasingly unclear. The fallout from this discord usually affects patients and providers navigating a landscape where costs and care appear to function in disparate realms.
The Hidden Costs of Administrative Efficiency
One of the many cost-reduction strategies of the Trump administration involved the aggressive elimination of federal workforce programs and agencies, particularly in the Department of Veterans Affairs. Reports have surfaced of veterans losing their positions at the VA, along with longstanding federal staff being laid off—a decision defended by a commitment to governmental efficiency. While this may serve some political interests, it has led to disruptions in health services, especially for vulnerable populations.
However, this bureaucratic restructuring has not necessarily yielded a healthier or more economical health care system. The United States remains the globe’s leader in health care expenditures—exceeding $4.5 trillion per year—yet routinely fails to achieve superior health outcomes relative to its international peers. Despite significant investments, the U.S. trails behind in accessibility, results, and systemic equity, prompting serious inquiries about the allocation of these funds.
An Expensive Puzzle: The Price of Surgery
As an active surgeon at a county hospital, I confront the daily paradox of being unable to provide a straightforward answer to one of the most fundamental patient inquiries: “What will this cost?”
The truth is, I am completely in the dark. And in all honesty, so is everyone else at that moment.
Surgical costs hinge on factors that are multifaceted, variable, and generally beyond the reach of both the patient and the provider during an emergency. Is the surgeon part of the insurance network? Is anesthesia billed separately? What does the patient’s insurance really cover? What might they refuse? These answers fluctuate moment by moment and span regulatory and corporate divisions that are inaccessible in real time.
This convoluted system leaves patients exposed to unexpected bills and physicians unable to provide care influenced by any understanding of financial implications. Although this cost-blind method allows essential treatment to continue free from financial concerns—particularly crucial in urgent situations—it also results in uncertainty for both parties until the bill is presented.
The Perils of Ignorance in a Profit-Driven System
In many respects, physicians operate in a financial vacuum as a result of design. Training centers on medical expertise, not financial knowledge. We learn to stop bleeding before tackling paperwork and to prioritize physiology over copays. This focus is vital during emergencies, where time is of the essence and financial considerations should not interfere.
Yet, this lack of awareness carries risks. In a profit-centered system, where decision-makers are often distanced from patient care, sheer financial ignorance allows other parts of the system—particularly those motivated by profit—to set the rules unchecked.
The Abyss of Administrative Expansion
This reality is starkly visible in the growth of administrative roles within health care over recent decades. Studies indicate that the hiring of health care administrators has surged far beyond that of physicians. Administrative expenditures can encompass up to 30% of U.S. health spending, inflating costs for patients while not delivering commensurate value.
Throughout the COVID-19 emergency, we witnessed a widening of the gap between care and administration. As physicians and nurses struggled in ICUs and trauma areas, managing limited supplies and reconfiguring hospital spaces, administrators adapted from the comfort of their homes. This imbalance provokes the question: does this hierarchical structure benefit patients—or the system itself?
Administrative roles are crucial, but to what extent? Is it necessary to employ ten administrators for every single physician to manage PPE orders, approve claims, or ensure compliance? Or has the proliferation of bureaucracy resulted in added layers of inefficiency, confusion, and expense without enhancing outcomes?
Is Bureaucracy the Next Target for Cuts?
If the Trump administration’s efforts toward cost savings resurface with fresh intensity—potentially under the influence of technocrats like Elon Musk—it may be time for them to direct their focus to the upper echelons of hospitals, where executive offices are located. These well-appointed, climate-controlled spaces stand in stark contrast to the sterile, blood-smeared rooms where lives are preserved during the late hours.
What if Medicare beneficiaries demanded from hospital executives the same accountability for productivity that federal employees are required to provide? What if hospitals funded by taxpayer money made a greater effort to justify their administrative expenditures rather than focusing primarily on mergers and marketing budgets?
The Disquieting Reality
The disquieting reality is this: providers working on the front lines like