By Gregg Anthony Masters, MPH**
As producer or executive producer of six shows, both live and on demand, for Healthcare NOW Radio, including our most recent launch ‘Inside the Revival‘
we (the hosts and producers) were asked for our ‘Open Mic’ predictions for 2026 as follows:
What major event, transformation, or innovation in 2025 had a lasting impact on healthcare, whether positive or negative, and is likely to shape its future trajectory?
Pasted below is my one paragraph version, followed by a ‘long form‘:
The singular “impact event” of 2025 has been the politicization and destabilization of U.S. public health leadership at the very moment competence and continuity are most needed, against a backdrop of a structurally mispriced “sickcare” economy: in 2023 the U.S. spent about $4.9T on health care (≈ $14,570 per person; 17.6% of GDP) while federal public health spending fell sharply as pandemic-era funds expired (down 58.3% from $90.2B in 2022 to $37.6B in 2023), and CDC’s FY2025 budget request was $9.683B – a rounding error compared with the trillions spent treating disease after it matures. That underfunded prevention and surveillance backbone has now been hit by operational and governance shocks: USAID was dismantled following the 2025 foreign-aid review (with courts finding DOGE-linked actions likely unlawful), impairing a core global health delivery and surveillance apparatus whose disruption is associated with catastrophic projected mortality (including Lancet-linked estimates warning of >14 million additional deaths by 2030 under severe cut scenarios – think the ‘BBB’ Medicaid and Medicare cuts and ACA premium credit defunding), while immunization governance was destabilized when HHS removed all 17 ACIP members on June 9, 2025 – an action with real-world implications because ACIP recommendations are tightly linked to vaccine coverage and access across payers. Bottom line: the nation’s public health infrastructure = already treated as a political punching bag and fiscal afterthought relative to the acute care “non-system”- is perilously compromised and may take a generation to rebuild; for the full long-form, sourced analysis and timeline, see my post on ACOwatch.com. – Gregg Anthony Masters, MPH, Managing Director, Health Innovation Media
Long Form
The singular “impact event” of 2025 has been the politicization of U.S. public health leadership at precisely the moment when competence and continuity matter most – because public health is not a branding exercise; it is operational infrastructure.
Start with the structural imbalance. In 2023, the U.S. spent $4.9 trillion on health care- about $14,570 per person – and health spending consumed 17.6% of GDP.
That is the financial footprint of an acute, downstream “sick-care” model. Meanwhile, federal public health spending fell sharply as COVID-era funds expired dropping 58.3% from $90.2B (2022) to $37.6B (2023).
Even the CDC’s FY2025 budget request was $9.683B – a ’rounding error’ relative to the trillions spent treating late-stage disease.
Against that backdrop, public health has been dealt a potentially lethal blow – not only through chronic underinvestment, but through destabilizing governance and dismantling core capabilities.
First: USAID
On January 20, 2025, the White House issued Executive Order 14169, initiating a foreign aid review and pause. In the wake of that process, USAID was dismantled, according to the Congressional Research Service’s overview of the 2025 restructuring.
Separately, a federal judge ruled that DOGE’s reckless dismantling of USAID likely violated the Constitution and blocked further cuts.
Whatever one’s politics, this is not “efficiency” – it is the impairment of a core global health delivery and surveillance apparatus, executed at speed by clueless DOGE actors with limited operational insight into what USAID does, how programs are implemented, and how health security risk is managed.
The downstream human cost is not hypothetical – in my book it’s borderline criminal. A Lancet-reported analysis warned that severe USAID funding cuts could contribute to more than 14 million additional deaths globally by 2030, including millions of children under five.
When you break global disease surveillance, reporting control practices (HIV, TB, malaria, maternal-child health, outbreak readiness), you don’t just harm “over there.” You increase the odds of delayed detection, disrupted containment, and cross-border spread – problems that always return. Think the iconic Fram oil filter commercial: where a mechanic holds up a new oil filter opining ‘you can pay me now (preventively) or pay me later‘ (in the shop).
Second: immunization governance and trust
On June 9, 2025, HHS announced it removed all 17 sitting members of ACIP. CDC later stated the 17 were replaced with eight new, shall we say more aligned with the Secretary of Health and Human Services anti-vax ideology, members.
This matters because ACIP is not symbolic: ACIP recommendations are tightly linked to vaccine access and coverage. Federal law generally requires most private plans to cover ACIP-recommended adult immunizations without cost-sharing, and KFF documents how ACIP recommendations function as a key trigger for coverage requirements.
Destabilizing that system invites confusion, coverage churn, and reduced uptake – fuel for outbreaks in an era when vaccination rates and trust are already strained. As a lead monitoring and declaring outbreaks in K-12 school districts for San Diego County, the trust of the public was a key driver of both trust and in the efficacy of the pandemic response (both NPI, non-pharmaceutical interventions and mass immunization efforts).
Bottom line: the management of our aggregate public health infrastructure is perilously compromised by ‘leaders’ at HHS, CMS, CDC, FDA and NIH who value the ideology over science mantra of the ‘charlatan in chief” RFK. Jr. We have a nation that can mobilize trillions to treat disease after it ‘matures’, yet repeatedly treats prevention, surveillance, and preparedness as foolishly expendable line items – until the next emergency arrives.
The consequences of dismantling USAID capabilities and destabilizing evidence-based advisory systems will not be measured in headlines; they will be measured in avoidable morbidity and mortality, domestically and globally.
It will likely years – possibly a decade or more – to rebuild durable surveillance, preparedness capacity, and the credibility required for effective public communication for potentially “unpopular” but necessary interventions.
==##==
acowatch.me 