Senate Minority Leader Chuck Schumer predicted Americans will “rise up” if President Donald Trump defies courts that challenge his policies, saying he doesn’t trust Trump’s pledges to abide by judicial rulings.

Schumer was responding to a question on NBC’s Meet the Press about a previous comment that any such effort by Trump would require “extraordinary action” by Democrats. 

If “the public is so, so angry and takes action — and certainly we Democrats will — it will trigger a mass movement from one end of the country to the other, something that we haven’t seen in a very long time,” Schumer said.

Trump’s push to test the limits of executive power has played out in a clash with a US district judge over the deportation flights of alleged Venezuelan gang members who ended up in a prison in El Salvador. 

The judge, James Boasberg, admonished the administration for disregarding his order on March 15 to halt the deportation flights. Trump has dubbed Boasberg a “radical left” judge and called for his impeachment, prompting a rebuke by Supreme Court Chief Justice John Roberts.

Schumer struck a defiant tone toward his own party when asked about his decision to end a blockade by Senate Democrats against a Republican spending plan to avert a government shutdown.

“Look, I’m not stepping down,” said Schumer, whose stance prompted a backlash among some Democrats. Those questioning his decision include former House Speaker Nancy Pelosi.

Read more: Schumer Leads a Party in Conflict After Retreat on Shutdown

A shutdown “would be 15 or 20 times worse” by handing the Trump administration an opportunity to “eviscerate” the government, he said.

Schumer argued that Democrats shouldn’t allow themselves to be split over disagreements about how to deal with the short-term spending bill, known as a continuing resolution.

“Our goal, our plan, which we’re united on, is to make Donald Trump the quickest lame duck in modern history by showing how bad his policies are,” Schumer said.

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Three European allies provided millions of dollars that the United States was supposed to spend for low-income countries. Then the Trump administrationand Elon Musk’s government-cutters arrived.

Government officials from Sweden, Norway and the Netherlands told The Associated Press that a combined $15 million they contributed for joint development work overseas has been parked at the U.S. Agency for International Development for months.

After the Republican administration and Musk’s Department of Government Efficiency cut USAID’s funding and the bulk of its programs, the Europeans asked whether their money would be funneled to projects as expected or refunded.

They have gotten no response.

“It’s a concern for us, especially as we want our partner organizations to be compensated for the work they have put into the programs,” said Julia Lindholm, a spokeswoman for the Swedish government’s international development agency.

The true total may be larger. Other foreign governments also had money entrusted with USAID for distribution in a range of joint development projects at the time President Donald Trump ordered the funding freeze on Jan. 20, according to an official directly familiar with the matter who was not authorized to comment publicly and spoke on condition of anonymity.

The worries point to the extent to which the new administration’s abrupt cutoff of foreign assistance and canceling of contracts for humanitarian and development work are raising questions about Washington’s financial reliability. They also show further strain between allies as Trump revamps American foreign policy.

The State Department and USAID did not immediately respond to questions asking how many foreign governments had money for joint development programs going unspent and unrefunded in the USAID funding freeze, how much money that was in total, and whether the administration was doing anything about it.

Concerns from American allies

Sweden, Norway and the Netherlands had been partnering with USAID on a project called Water and Energy for Food, or WE4F. It helps farmers and others in poorer countries develop innovative ways to grow more food without straining water supplies or depending on climate-damaging forms of energy.

“Most importantly,” Lindholm said by email, the U.S. failure so far to disburse or refund allies’ donations is harming ”6 million of the poorest and most vulnerable farmers in the world who are dependent on the technologies for their food production and food security.”

Other administration actions already have alarmed traditional partners. Trump has said he would not necessarily follow the mutual-defense pact underlying the NATO security agreement, he has advanced some of Russia’s talking points and demands in its invasion of Ukraine and has imposed tariffs on Canada, the European Union and others.

America as a reliable financial partner

Now, doubts about the U.S. as a reliable business partner have emerged in lawsuits over the administration’s abrupt cancellation of what Secretary of State Marco Rubio said were 83% of USAID contracts, forcing partner organizations to lay off workers and driving some out of business.

In a brief supporting a lawsuit from federal workers, former Defense Secretaries Chuck Hagel and William Perry, former CIA Director Michael Hayden and more than a dozen other former senior U.S. officials said the administration’s mass canceling of thousands of USAID contracts was flouting U.S. financial regulations and “destroying the United States’ credibility as a reliable partner.”

Canceling the contracts “sends a message that this administration does not feel bound by those regulations — regulations on which every business that works with the United States relies,” the former officials said.

In another case, lawyers for nonprofits and businesses seeking payment from USAID told a judge that because of the financial chaos surrounding the agency’s dismantling, banks have stopped what used to be routine financing for USAID partners based on their contracts with the U.S. agency.

Since the Cold War, the national security argument for development programs has been that making poorer countries more prosperous and stable lessens refugee flows and conflicts.

Trump and Musk call foreign assistance through USAID in particular a fraud and scam. Administration officials are looking at focusing U.S. development efforts much more narrowly on combating China’s influence abroad and boosting U.S. trade and business opportunities.

Seeking money back from the Trump administration

Growing steadily more alarmed by the administration’s foreign aid moves, Sweden, Norway and the Netherlands initially sent USAID emails inquiring about the money they had parked in USAID accounts.

Frustrated at getting no response, two of them warned in the government-to-government emails that they were looking at talking to local media about their missing money, according to the official directly familiar with the matter.

Under court order, the administration has started making good on some $2 billion USAID already owed when Trump ordered the freeze in USAID and State Department foreign assistance on Inauguration Day.

But forced leaves and firings have yanked most officials and workers at USAID’s headquarters off the job. That includes many who oversaw development programs and would be involved in tracking down numbers and calculating any refunds for the foreign governments.

Sweden’s development agency told the AP that it estimates it has $12 million total, including $5.1 million for WE4F, sitting in USAID accounts — money going unspent for people in Africa, Asia and the Middle East and unrefunded by the administration.

Lindholm, the spokesperson for Sweden’s development agency, called the WE4F program “extraordinarily impactful,” with measurable benefits for farmers and others many times greater than the program’s initial targets.

The Norwegian Agency for Development Cooperation told the AP that it has received no information about the fate of a $1.4 million funding tranche for WE4F since Trump began dissolving USAID.

The Dutch Foreign Ministry said it reached out to the U.S. aid agency on how much of the $1.6 million it had given most recently for WE4F had yet to be disbursed by USAID and should be refunded, but that it had not yet gotten any response.

“Donor partners are now exploring other opportunities to continue to run the WE4F programme to ensure a responsible completion,” Lindholm said by email.

This story was originally featured on Fortune.com

Is there anything GLP-1s can’t do? Diabetes and obesity are increasingly looking like the tip of the semaglutide iceberg. The Food and Drug Administration (FDA) has approved Wegovy for cardiovascular disease, and researchers are now exploring the potential of GLP-1s for a host of conditions, including asthma, arthritis and psoriasis, certain liver diseases, depression, eye disorders, Alzheimer’s, and substance use disorders. A recent study even found GLP-1s may reduce the risk of 10 different cancers.

The growing list of potential GLP-1 indications suggests the drugs may target the root cause (inflammation, probably) of the most prevalent and costly conditions in the U.S. If even a fraction of the trials now underway pan out, GLP-1s have the potential to reshape health care as we know it.

But they can’t solve everything. In fact, the GLP-1 phenomenon is making the fragmentation and dysfunction of our health care system even more apparent. Just as GLP-1s may help us discover the common denominator in seemingly disparate diseases, they are shining a bright light on the root causes of the health care system’s ills.

Drugs are too expensive

The price tag of GLP-1s in the U.S.—up to $15,000 per year, far higher than in other affluent countries—has become one of the single biggest drivers of rising health care costs. Private employers, already facing an unsustainable cost trend, are feeling the pressure from their workforce to cover the drugs, yet they quite literally may not be able to afford it. Some studies suggest widespread GLP-1 adoption, absent cost controls, could bankrupt Medicare and the health care system as a whole.

GLP-1s are also shining a harsh light on the inefficiency and inequity in health care. Those who can afford to pay out of pocket are gobbling up the supply of GLP-1s (in some cases for vanity use), while access remains limited for people on Medicare or Medicaid who are disproportionately burdened by obesity and diabetes. For example, Eli Lilly’s recent move to slash the price of Zepbound only applies to patients paying out of pocket; and at several hundred dollars per month, even the markdown price is out of reach for many.

GLP-1s shows how quickly health care can turn into a gold rush

Pharmaceutical companies, telehealth providers, and even supplement sellers are marketing GLP-1s directly to consumers to meet the runaway demand. Exploiting a loophole resulting from the GLP-1 shortage, some providers are prescribing compounded generic versions of the drugs that the FDA has warned may be unsafe.

This is a prime example of the limitations of the transactional Telehealth 1.0 model and the dangers of consumerism running amok. Patients can easily get compounded GLP-1s, even when lifestyle changes or other approaches are more clinically appropriate. But who is looking after their health once the transaction is complete? Who is helping them manage side effects, as well as their overall physical and mental health?

If patients get sick from compounded GLP-1s, they could end up in the ER—and their employer and insurer foot the bill. In this scenario, no one wins.

Fragmented care delivery

The type of clinicians prescribing GLP-1s has expanded rapidly. In their first act as a diabetes drug, GLP-1s were prescribed almost exclusively by endocrinologists. Now cardiologists, orthopedists, internal medicine physicians, and even psychiatrists are prescribing them—presumably with a different lens than an endocrinologist would, and sometimes without full visibility into the patient’s overall health. Different specialties are starting to establish their own clinical guidelines for GLP-1s.

Given how siloed specialty care is, it’s increasingly likely that a primary care physician (PCP) might prescribe GLP-1s for weight management without the patient’s cardiologist knowing about it—and vice versa. Who’s looking out for the whole person? Who’s looking at clinical outcomes and costs in a holistic way—for that patient, and for the system as a whole?

The prescription we really need

I’m rooting for GLP-1s to be a miracle drug. But the jury is still out, and in the meantime, the GLP-1 frenzy is exposing healthcare stakeholders across the system—patients, employers, insurers, providers—to unsustainable clinical and financial risks.

On the plus side, these mounting risks—and the unprecedented attention from consumers and the industry alike—may finally be what it takes to fix broken health care models. And the solutions to the problems surrounding GLP-1s are the same ones we’ve needed all along:

• Prevention. The U.S. invests far less in preventive and primary care than other affluent nations. Increasing access to primary care and mental health services—including through virtual care—is essential to sustainably address the upstream causes of the conditions we’re now treating with GLP-1s.
• Integrated care. This includes longitudinal care coordination between PCPs and specialists, as well as navigators and patient advocates. The wrap-around financial and administrative support these care team members provide is especially important given the high cost of the drugs and the challenges of managing chronic conditions like diabetes.
• Outcomes-based payment. The recent push to include GLP-1s in Medicare negotiations is a good start, but it’s not a silver bullet for the healthcare cost trend. Despite the consumer demand for GLP-1s, studies have shown that as many as two-thirds of patients don’t stick with the drugs long enough to achieve or sustain the clinical benefits, which means substantial upfront costs with little to no payoff for patients and healthcare purchasers. Business and payment models tied to clinical and financial outcomes that matter—and that incentivize judicious prescribing and the integrated care needed to boost adherence and long-term results—are a critical step toward minimizing waste and realizing the full value of GLP-1s.

GLP-1s have the potential to transform medicine. But if we continue shoehorning them into our siloed and fragmented health care system, their potential will be stunted. It’s yet another indication that we need to reimagine the health care system from the ground up.

Read more:

• Misaligned incentives plague our health-care system. Here’s how to make America healthy again
• My son’s rare disease diagnosis spurred me to ditch Big Pharma for a biotech startup
• I cared for my dad under ‘hospital at home’ in his final weeks. The program is missing one big piece
• Cancer made me a patient. Health care’s blind spots made me a CEO
• Americans finally got a rule protecting their credit scores from unexpected medical debt. Now Trump is attacking the agency behind it

The opinions expressed in Fortune.com commentary pieces are solely the views of their authors and do not necessarily reflect the opinions and beliefs of Fortune.

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