Taxpayers and lawmakers have ensured that the federal Health and Human Services agency operates with roughly $2 trillion in discretionary and mandatory funding. This means the agency can employ about 80,000 staffers, many of them top experts in medical science, health care policy, and public health.

This concentration of expertise and experience, however, may mean less than ever.

That’s because just one man, and his hand-picked few, insist that they hold the absolute power to make life and death decisions for more than 330 million Americans, especially when it comes to health care and government spending on it.