Intended Consequences
By
Leonard Zwelling
There is a lot of hand wringing on the part of the left-wing, liberal media about the unintended consequences of the Trump-Musk-DOGE layoffs in the federal civil service. Fires may not be fought. Bathrooms may not be cleaned. Tax refunds may not be received. The list goes on. My personal call to the IRS, which had instructed me to call in a letter, cannot be answered because there is such a back-up of in-coming calls and there are not enough people to answer the phones.
Calling all of this unintended is absolutely wrong. This is the chaos in which Mr. Trump thrives. He has no concern that the law suits against the government surrounding the lay-offs might come to fruition for the plaintiffs. The Supreme Court will side with Trump on all matters. How they are going to sanction Trump’s proposal to ignore the Fourteenth Amendment is going to be interesting to watch, but undoubtedly they will vote 6 to 3 to support whatever Trump proposes to do. Furthermore, Congress has elected to do nothing with regard to the large number of federal lay-offs and the eradication of some agencies that Congress created and funded. No matter. There will be no attempts to curb the power of this President on Capitol HIll.
Another intended consequence has arisen here in the Texas Medical Center. In the week of February 17, a merger between the oncology services at Texas Children’s Hospital and MD Anderson was announced. This alone is of interest, but the timing of the merger even more so.
For a long time, lay leaders in Houston have wondered why the Texas Medical Center needed two children’s cancer services steps from one another. For years TCH wanted total control of any proposed merger, so one never took place. But there is new leadership at TCH and the hospital lost the lucrative CHIP contract recently. Funds were tight there and also across the street at Anderson, at least that’s the rumor.
What does each side get out of this deal?
TCH will secure the ability to see every single child with cancer coming to either institution. The children’s cancer service at MD Anderson will be no more after 2026. Most current MD Anderson faculty will eventually be TCH faculty with the exception of the Pediatrics Research faculty and those clinicians who care for adolescents and young adults. These AYA patients will stay at MD Anderson, probably absorbed into clinical services in Cancer Medicine.
Thus, TCH gains all of that revenue to make up for the loss of the CHIP contract. What does MD Anderson get?
Anderson will off load the cost of this service. The pediatric intensive care unit and its cost will be gone. Green 9 will be empty and undoubtedly repopulated with adult in-patients who are far more lucrative. This can serve as an important spill-over floor as the new MD Anderson Hospital is constructed.
In other words, everybody wins except the MD Anderson Pediatric faculty members who have to make some hard, personal decisions about their futures, their finances (will they still get the SAP when they become TCH faculty?), and most importantly about their careers. This is not what they planned for. But it is what the leaders of both institutions planned for and probably the UT Board of Regents as well.
This is a good decision for both institutions and will probably benefit patients, but here the intended consequences were boosting the TCH and MD Anderson revenues and decreasing the MD Anderson costs. There is nothing unintended about it.
The Trump Administration, Elon Musk, Texas Children’s, and MD Anderson have all made big changes and are planning more. Like all changes, these have big consequences. But in these cases, none is unintended.
