Destruction of health and disease prevention infrastructure, education, and pretty much everything good

This will be one of the most disastrous effects of Trumpism, and among the hardest to restore.  In fact, there will be an entire body of research missing.  Hopefully, some other countries will be picking up the slack until (and if) the United States comes back on line.

As for layoffs in the government during shutdown specifically...

Right out loud.

This will be exhibit A in all the lawsuits for wrongful termination.

Rural hospitals shutting down is starting to break through.  So what to do?  They lie.  ALL THE TIME.  There has been some instance of rural hospital closings for several decades, but nothing to compare to what's happening after the Big Beautiful Billionaire Bonus.  It wasn't Joe Biden's policies that shut them down.

And that $50 billion?

SNAFU...