The Al Franken Podcast: Atul Gawande on Musk’s Destruction of USAID

Release Date: April 13, 2025
Guest: Mr. Ballin (Former Assistant Administrator of USAID's Bureau of Global Health)
Host: Al Franken
Duration: Approximately 46 minutes

Introduction

In this compelling episode of The Al Franken Podcast, host Al Franken engages in a deep and insightful conversation with Mr. Ballin, a seasoned professional who served as the Assistant Administrator for USAID's Bureau of Global Health for three years. The discussion centers around the critical dismantling of USAID under the administration of Donald Trump and Elon Musk, exploring the profound implications this has had on global health initiatives and the broader U.S. healthcare system.

Healthcare Reform and Overuse in the U.S.

The conversation kicks off with reflections on the state of healthcare in the United States, particularly focusing on the excessive use of medical procedures in regions like McAllen, Texas. Mr. Ballin recounts his investigative work comparing McAllen to El Paso, highlighting profound disparities in healthcare costs and outcomes.

• Mr. Ballin [06:11]: "Healthcare, most expensive community for healthcare for Medicare per person in the United States."

• Atul Gawande [10:55]: "Well, it's still amazing that we're the only developed country without universal healthcare."

Mr. Ballin emphasizes the systemic issues driving up healthcare costs, such as the corporate healthcare model that prioritizes business incentives over patient well-being, leading to unnecessary procedures and inflated expenses. The discussion underscores the dire need for primary care accessibility, noting that approximately half of Americans lack regular access to a primary healthcare specialist.

• Mr. Ballin [13:32]: "It's estimated around half of Americans do not have regular access to a primary healthcare specialist and are obtaining care in very fragmented ways."

The Role and Achievements of USAID

Delving into USAID's pivotal role, Mr. Ballin elaborates on the agency's contributions to global health, agriculture, and humanitarian assistance. He highlights the transformative impact USAID has had in countries like India and Costa Rica, where assistance led to significant economic and health improvements.

• Mr. Ballin [27:40]: "The core of the work is reducing premature deaths, which I measured by tracking that. The measure of that was reducing deaths before 50."

He shares success stories such as Costa Rica’s leap in life expectancy and Thailand’s near parity with U.S. life expectancy through effective primary care systems, all achieved with minimal per capita expenditure compared to the U.S.

• Mr. Ballin [15:01]: "Costa Rica progressed to having not only independence of needing foreign assistance but ended up with the longest life expectancy among the Americas."

Dismantling of USAID by Trump and Musk

The conversation takes a critical turn as Mr. Ballin details the swift and destructive actions taken by Donald Trump and Elon Musk to dismantle USAID. He describes the abrupt executive orders that halted funding and operations, leading to immediate and severe disruptions in ongoing health programs worldwide.

• Mr. Ballin [29:53]: "It took about four days. The initial move there was an executive order that pulled the United States out of WHO."

• Mr. Ballin [32:26]: "Doge Elon Musk has been the driver of taking the chainsaw to entire agencies. And this is in line with that."

Mr. Ballin recounts the chaos that ensued, including the termination of thousands of staff members and the suspension of vital health initiatives. This unilateral action by Trump and Musk not only crippled USAID but also jeopardized global health security.

Consequences of Shutting Down USAID

The ramifications of USAID's shutdown are both immediate and far-reaching. Mr. Ballin provides harrowing examples of how halted programs have led to increased mortality rates and the resurgence of preventable diseases.

• Mr. Ballin [32:39]: "In addition, there was a vaccine campaign and set of work underway that was in the midst of expanding, reducing measles and addressing HPV. For every 70 girls in low-income countries who are vaccinated against cervical cancer from HPV, one life is saved."

He underscores the impact on ongoing crises, such as the Ebola and MPOX outbreaks, which were left unattended due to the cessation of foreign assistance. The lack of coordination and abrupt policy changes have led to millions of lives being at risk, showcasing the critical importance of USAID.

• Mr. Ballin [33:05]: "We actually quantified that during my time there, the countries where we worked had at least 1.2 million lives saved from work associated with work that we were doing."

Broader Implications on Health and Science Infrastructure

Beyond USAID, the episode touches upon the broader assault on American scientific and health institutions. Mr. Ballin draws parallels between the dismantling of USAID and the targeted attacks on universities and research agencies like the NIH, CDC, and FDA.

• Mr. Ballin [43:56]: "The funding is predominantly research funding. It's cancer awards, it's Alzheimer's disease, it's maternal mortality work. It's across the board."

He laments the erosion of the infrastructure that has been instrumental in advancing public health and scientific research, highlighting the long-term consequences such as the loss of a generation of scientists and the abandonment of critical health and science engines that have bolstered American prosperity since World War II.

Conclusion

The episode concludes on a somber note as Mr. Ballin reflects on the staggering loss of life and the catastrophic setbacks in global health initiatives resulting from the dismantling of USAID. He stresses the urgent need to restore and rebuild the agency to prevent further decline in both global and domestic health outcomes.

• Mr. Ballin [43:06]: "It's putting into place political controls over what were otherwise independent agencies."

Al Franken and Atul Gawande facilitate a conversation that not only highlights the invaluable contributions of USAID but also serves as a poignant critique of the political maneuvers that have severely undermined essential health and scientific institutions. The discussion calls for a renewed commitment to global health and the preservation of the systems that save millions of lives worldwide.

Notable Quotes:

• Mr. Ballin [06:11]: "Healthcare, most expensive community for healthcare for Medicare per person in the United States."

• Atul Gawande [10:55]: "Well, it's still amazing that we're the only developed country without universal healthcare."

• Mr. Ballin [27:40]: "The core of the work is reducing premature deaths, which I measured by tracking that."

• Mr. Ballin [29:53]: "It took about four days. The initial move there was an executive order that pulled the United States out of WHO."

• Mr. Ballin [32:26]: "Doge Elon Musk has been the driver of taking the chainsaw to entire agencies. And this is in line with that."

• Mr. Ballin [43:06]: "It's putting into place political controls over what were otherwise independent agencies."

This episode serves as a crucial reminder of the fragile balance between political agendas and the vital operations of public health institutions. It underscores the need for vigilance and advocacy to protect and sustain the frameworks that ensure global health security and domestic well-being.