Secretary Kennedy’s announcement of a shake-up at the Department of Health and Human Services spotlights the need for major reform at the bloated agency.

S ecretary Robert F. Kennedy Jr. has announced a sweeping restructuring of the Department of Health and Human Services (HHS) — eliminating an estimated 10,000 positions equal to a $1.8 billion annual reduction. For too long, HHS has been bloated, redundant, and misaligned with the real needs of the American people. HHS has ceased to be a responsive, effective steward of public health. Instead, it has grown into a slow-moving leviathan, riddled with redundancy and soaked in taxpayer dollars. A course correction — one that consolidates overlapping agencies with the intent of a more streamlined, mission-focused department, puts mission before empire, and outcomes before bureaucracy — is long overdue.

The disparate agencies at HHS often have duplicative functions leading to siloed approaches to addressing the department’s mission, the building of individual fiefdoms, and needless administrative spending that would not be tolerated anywhere except the federal government. A reorganization of the department has long been necessary to eliminate redundancy, deliver on HHS’s mission, and reduce wasteful spending.

Paragon has tackled problems at the Centers for Disease Control and Prevention in a 2023 report, Unauthorized & Unprepared: Refocusing the CDC after COVID-19. We found that unchecked mission creep at the CDC — enabled by a lack of clear congressional authorization — has stretched it far beyond its core purpose of controlling infectious disease. This drift not only created an overlap with other federal agencies, but also diverted resources and attention from the CDC’s primary responsibilities. CDC’s profound failures during the Covid-19 pandemic — from botched testing to politicized messaging — laid bare the consequences of that failure.

To restore trust and prepare for future threats, the CDC must be refocused, depoliticized, and properly authorized by Congress. The Biden administration stated its intention to reorganize the CDC, but this reorganization was moving around deck chairs with changes like press office reporting. They were cosmetic efforts to provide the appearance of change and improvement to allow the calcified agency structures and the fiefdom of the CDC commissioner to run unabated. This sham reorganization did not actually address the myriad problems at the CDC identified during the pandemic.

CDC and other public health agencies have an overgrown bureaucracy with multiple layers of often uncoordinated spending, which has advantaged specific interest groups that know how to manipulate the system.

Many HHS agencies, for example, operate with their own IT systems, human resource departments, and contracting offices — a fragmented setup that defies logic. In the private sector, efficiency and productivity are constant imperatives. In the federal government, the opposite is true: Costs rise relentlessly, and new programs are routinely layered on top of old ones without any serious evaluation of overlap or redundancy. Duplication isn’t the exception, it’s the norm. Efforts to assess and improve operational efficiency are rare, and when they do occur, they’re too often ignored. For another example, despite the National Institute for Health’s (NIH) significant resources, the institution lacks systematic approaches to data sharing — with more than 147 siloed and independent data repositories that cannot communicate.

The reorganization plan calls for a reduction of 6 percent of the NIH workforce. A large percentage of the current NIH roles are administrative, not research positions. The reorganization at NIH can help reduce the diversion of research dollars that are funding bureaucratic positions at the expense of money flowing into research. This and other reforms, such as tackling NIH indirect costs, are essential to improving American biomedical research and health.

We live in the 21st century information age economy, but the HHS bureaucracy moves with the speed of a 19th century steamboat. The private sector and the American people understand that we must be constantly improving and becoming more efficient. They constantly are looking for ways to do more with less, while our federal bureaucracy seems to be focused on doing less with more. As we approach Tax Day, taxpayers should have more confidence that federal agencies and departments are spending their money wisely and that their focus is on the American people and the mission they have been delegated, not protecting old, antiquated systems and an ever-increasing bureaucracy. While the details have not been released and are important, it is undeniably true that HHS’s public health agencies need major reform and a shake-up was past due.