Brad Smith has been a leading figure within the Trump administration's U.S. DOGE Service, directing its cost-cutting efforts at the Department of Health and Human Services, a vast agency whose charges include ensuring drugs are safe, preventing diseases from spreading, and administering health care for older, disabled, and low-income Americans.
Given the pain DOGE's cuts have inflicted, it appears Smith brought the same success-at-any-cost mantra to the government. He helped carry out $67 billion in cuts to HHS, by DOGE's count, which includes the National Institutes of Health, the Food and Drug Administration, the Centers for Disease Control and Prevention, and other key health agencies. That sounds like a big number, but it amounts to just 4% of the department's spending, which totaled about $1.7 trillion in 2024.
Smith's role as a senior adviser at HHS was always meant to be temporary, and he stepped down before Memorial Day
He defended cuts to indirect research costs at The National Institutes of Health that sent shockwaves through the scientific community. He criticized the fact that NIH had 27 different centers, 27 different chief information officers, and 700 different information technology systems that can't speak to one another, according to the administration.
"When you think about making great medical discoveries, you have to connect the data," Smith said.
Smith said he was looking at both cost and quality, but the former happens to be easier to measure.
Value-based care has been around for decades and researchers have, by and large, not been able to prove that its various iterations save money, said Lawton Robert Burns, a professor of health care management at the University of Pennsylvania's Wharton School of Business.
"They all seem like good ideas, but then when you dig into it, you say, 'Geez, that didn't work out the way it was supposed to,'" Burns said.
Even as Smith's own conclusion was that value-based care, by and large, doesn't save money, the companies he founded all hinge on that very concept: making money from saving insurers money by taking better care of their members.
Given the pain DOGE's cuts have inflicted, it appears Smith brought the same success-at-any-cost mantra to the government. He helped carry out $67 billion in cuts to HHS, by DOGE's count, which includes the National Institutes of Health, the Food and Drug Administration, the Centers for Disease Control and Prevention, and other key health agencies. That sounds like a big number, but it amounts to just 4% of the department's spending, which totaled about $1.7 trillion in 2024.
Smith's role as a senior adviser at HHS was always meant to be temporary, and he stepped down before Memorial Day
He defended cuts to indirect research costs at The National Institutes of Health that sent shockwaves through the scientific community. He criticized the fact that NIH had 27 different centers, 27 different chief information officers, and 700 different information technology systems that can't speak to one another, according to the administration.
"When you think about making great medical discoveries, you have to connect the data," Smith said.
Smith said he was looking at both cost and quality, but the former happens to be easier to measure.
Value-based care has been around for decades and researchers have, by and large, not been able to prove that its various iterations save money, said Lawton Robert Burns, a professor of health care management at the University of Pennsylvania's Wharton School of Business.
"They all seem like good ideas, but then when you dig into it, you say, 'Geez, that didn't work out the way it was supposed to,'" Burns said.
Even as Smith's own conclusion was that value-based care, by and large, doesn't save money, the companies he founded all hinge on that very concept: making money from saving insurers money by taking better care of their members.
The shrewd startup founder who led DOGE’s cost-cutting at HHS
The relentless drumbeat of cuts to U.S. government research and disease prevention have devastated tens of thousands of affected workers and academics. To
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