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> "the deficit is entitlement spending; this is a political problem, not a bureaucratic one". Sort of? Medicare is about a trillion dollars, but what percentag

> "the deficit is entitlement spending; this is a political problem, not a bureaucratic one". Sort of? Medicare is about a trillion dollars, but what percentage of that is actually helping people and how much is going to unnecessary tests or fraud or overpaying for things? If e.g. HHS issues some bad rules that increase healthcare costs, that increases the cost of Medicare and Medicaid and the VA, but if you're doing it properly you're not ignoring that part of HHS just because its regulatory budget is comparatively smaller when it's doing things that incur billions in indirect costs. Moreover, you can't find a trillion dollars in a program that costs a million dollars, but if it costs a million dollars and isn't worth a million dollars then that's not a reason to keep it. And nobody can claim with a straight face that the military budget contains no inefficiencies, but that's not entitlement spending. > Instead, they went scorched-Earth and assumed we were all deep state leeches. The general problem is that nobody wants their thing to be the thing that gets cut even when it's the thing that ought to be, and then how do you tell if something is actually important when somebody will claim that everything is? It's legitimately a hard problem and DOGE did not succeed in solving it, but that means we need a solution that actually works or people are going to keep coming at you with knives drawn because the status quo is untenable.

estearum 1y ago
They could just go after Medicare fraud (committed largely by extremely wealthy corporations in extremely detectable ways), get an easy $100B or so under their belt, then reconvene on next steps. That'd require them to be willing to go after their grifter buddies, and to understand anything about our institutions other than what they read on Twitter. > The general problem is that nobody wants their thing to be the thing that gets cut even when it's the thing that ought to be, and then how do you tell if something is actually important when somebody will claim that everything is? We have a process for this. It's called appropriations. It happens in Congress.
- AnthonyMouse 1y ago
  > They could just go after Medicare fraud (committed largely by extremely wealthy corporations in extremely detectable ways), get an easy $100B or so under their belt My impression of the 2025 feud between Musk and Trump is that Musk actually wanted to do stuff like that and Trump wouldn't do it. And they should do it, but this year's deficit is ~$1.8T despite federal receipts pushing the record high in real dollars per capita (as usual) and consistent with historical norms as a percent of GDP. So what about the other $1.7T? > We have a process for this. It's called appropriations. It happens in Congress. We also have some strong empirical evidence that the outcome of that process is huge deficits, so something has to change if it's not to stay the same.
  - __loam 1y ago
    > We also have some strong empirical evidence that the outcome of that process is huge deficits, so something has to change if it's not to stay the same. Get on the barricades and start the revolution then.
  - estearum 1y ago
    Not true. Musk wanted to go after Medicare benefits. He said "Entitlements like Medicare and Medicaid need to be eliminated." Don't sanewash here. Musk has no clue what he's doing.
    - cogman10 1y ago
      Exactly. It's the job of the atorneys general to investigate and prosecute fraud. Trump fired them almost day 1. If they wanted to actually address that, then they should have put all of the doge employees to work for the AG.
      - estearum 1y ago
        CMS itself could also do a lot of work, especially the OIGs Unfortunately: also fired day (week?) one.
    - AnthonyMouse 1y ago
      > He said "Entitlements like Medicare and Medicaid need to be eliminated." The only thing on the internet that search engines turn up for that exact quote is your post. Here's the actual quote: > “Most of the federal spending is entitlements. So that’s the big one to eliminate. That’s the sort of half trillion, maybe six, 700 billion,” Musk said on Monday in an interview with Fox Business’ Larry Kudlow. Musk’s comments came in response to a question from Kudlow about whether there would be a report on targeting waste, fraud and abuse in federal spending. Medicare is around a trillion dollars by itself, so those numbers don't make any sense as the removal of entire programs, but total entitlement spending is several trillion in total and a reduction in those amounts would make sense in the context of targeting waste, fraud and abuse in entitlement spending, which is the thing he was being asked about.
apical_dendrite 1y ago
I've followed DOGE closely and haven't heard anything that would indicate they were even trying to reduce unnecessary medicare spending. Where I have heard that they've tried to touch healthcare spending, they've made a huge mess. For instance, they cancelled a lot of support contracts at the VA, but many of those contracts did necessary things, like maintaining complex machinery. If you read ProPublica's article on DOGE at the VA, it's pretty clear that this was done incredibly quickly by a guy with zero healthcare knowledge using a minimal prompt and wasn't even directing the AI to read the most important parts of the contract. https://www.propublica.org/article/trump-doge-veterans-affairs-ai-contracts-health-care https://www.propublica.org/article/trump-doge-veterans-affai...
- AnthonyMouse 1y ago
  There seems to be some indication that they hired some incompetent people and/or were prohibited from cutting some of the things that ought to be cut. And I don't think there is any question that the deadline they set for themselves was unrealistically aggressive. Which means we need someone to go back and do it properly, not that it doesn't need to be done.
  - apical_dendrite 1y ago
    I think everyone would agree that we should reduce fraud and waste in healthcare spending. I don't think DOGE was making a serious attempt to do that.
  - __loam 1y ago
    What Doge was trying to do cannot be done legally.
    - cogman10 1y ago
      Sure it can, by the atorneys general. A core part of their job is identifying, stopping, and prosecuting fraud and waste spending in the government. Doge was never legal, but there were agencies that had the statutory power to do what doge wanted. However, they also could investigate things like emoluments violations which is precisely why they were some of the first to be fired.
biophysboy 1y ago
Any serious attempt at reducing the deficit would mean confronting one of the largest sectors of the American economy. All of the stuff you mentioned - pointless tests, upcoding fraud, etc - is part of that. It is not irrational to cut millions in wasteful spending. It is irrational for a department of government efficiency to spend all of its energy cutting random million dollar contracts instead of figuring out how to plan the attack for the confrontation above. DOGE did not fail because its a hard problem. They failed because they thought it was easy. Taking over a company with a thousand employees is categorically different than revamping the spending of the United States.
- AnthonyMouse 1y ago
  > Any serious attempt at reducing the deficit would mean confronting one of the largest sectors of the American economy. All of the stuff you mentioned - pointless tests, upcoding fraud, etc - is part of that. Which is exactly what they should have been doing. It's blatantly obvious that they failed -- federal spending went up year over year. But that means the problem remains and someone's going to have to take another go at it.
  - __loam 1y ago
    Doge never had any power to even change government spending. The budget is determined by congress.
    - AnthonyMouse 1y ago
      The budget is determined by what's written on a piece of paper that Congress eventually passes. You don't have to be a member of Congress to be the one drafting it or making recommendations.
      - __loam 1y ago
        Why were congressionally appropriated funds impounded by Doge?
jmye 1y ago
Are you under the impression that CMS doesn’t address fraud and overpayments with extremely harsh penalties, every single time they’re found? Do you think CMS just shrugs and oks every single test? I don’t understand the basis for your complaints, here. There are two big issues with CMS costs, and you’ve identified 10% of one of them.
cogman10 1y ago
> unnecessary tests or fraud or overpaying for things? Glad you ask. That was the job of the Attorneys general to figure out. A core part of their task was finding and eliminating waste, fraud, and abuse. They were fired almost day one of the Trump admin. DOGE's notion that the actual gov spending was in the employees was laughable. If we actually wanted to eliminate waste then we should have put more employees in the AG and IRS, not done mass firings from those agencies. The other part to mention is that Medicare Part C, putting public dollars into private insurers, has lead to a huge amount of the fraud. Those useless tests have often been done by these private insurance agencies because they can easily bill the government for them. Eliminating that public/private partnership is exactly what will save money. Our inefficiencies are largely due to our reliance on the private sector to backfill what the government isn't doing.
- AnthonyMouse 1y ago
  > They were fired almost day one of the Trump admin. And then they hired different ones. Which in and of itself has nothing to do with it. > The other part to mention is that Medicare Part C, putting public dollars into private insurers, has lead to a huge amount of the fraud. Those useless tests have often been done by these private insurance agencies because they can easily bill the government for them. That's not the half of it though. The entire US healthcare industry is full of corruption and inefficiency. In general it's the providers who want the unnecessary tests, not the insurance companies. > Our inefficiencies are largely due to our reliance on the private sector to backfill what the government isn't doing. I feel like this is why we never solve it. The Democrats insist that the only solution is for the government take the whole thing over, the Republicans point to people in France waiting a year for an appointment and then nothing changes because they're both taking money from the industry so neither of them are trying to fix the real problem. Because what you need is to set up non-emergency care to have actual competition. If you need an X-ray some time in the next month, a computer gives you a list of every office with an open appointment, their price and their distance from you. The providers charge between $50 and $200 but some are closer to you or have sooner appointments, the insurance pays $50 no matter where you go and then you get to pick but you pay the difference. You need the patient to have the ability to say "you know what, the one that's 10 minutes closer isn't worth $120 extra" and pick the less expensive one, because then they actually have the incentive to get prices under control, instead of the current insanity where just getting them to tell you how much something is going to cost is like pulling teeth and the government subsidizes getting your health insurance through your employer in the tax code to keep it that way.

estearum 1y ago

They could just go after Medicare fraud (committed largely by extremely wealthy corporations in extremely detectable ways), get an easy $100B or so under their belt, then reconvene on next steps. That'd require them to be willing to go after their grifter buddies, and to understand anything about our institutions other than what they read on Twitter. > The general problem is that nobody wants their thing to be the thing that gets cut even when it's the thing that ought to be, and then how do you tell if something is actually important when somebody will claim that everything is? We have a process for this. It's called appropriations. It happens in Congress.

AnthonyMouse 1y ago
> They could just go after Medicare fraud (committed largely by extremely wealthy corporations in extremely detectable ways), get an easy $100B or so under their belt My impression of the 2025 feud between Musk and Trump is that Musk actually wanted to do stuff like that and Trump wouldn't do it. And they should do it, but this year's deficit is ~$1.8T despite federal receipts pushing the record high in real dollars per capita (as usual) and consistent with historical norms as a percent of GDP. So what about the other $1.7T? > We have a process for this. It's called appropriations. It happens in Congress. We also have some strong empirical evidence that the outcome of that process is huge deficits, so something has to change if it's not to stay the same.
- __loam 1y ago
  > We also have some strong empirical evidence that the outcome of that process is huge deficits, so something has to change if it's not to stay the same. Get on the barricades and start the revolution then.
- estearum 1y ago
  Not true. Musk wanted to go after Medicare benefits. He said "Entitlements like Medicare and Medicaid need to be eliminated." Don't sanewash here. Musk has no clue what he's doing.
  - cogman10 1y ago
    Exactly. It's the job of the atorneys general to investigate and prosecute fraud. Trump fired them almost day 1. If they wanted to actually address that, then they should have put all of the doge employees to work for the AG.
    - estearum 1y ago
      CMS itself could also do a lot of work, especially the OIGs Unfortunately: also fired day (week?) one.
  - AnthonyMouse 1y ago
    > He said "Entitlements like Medicare and Medicaid need to be eliminated." The only thing on the internet that search engines turn up for that exact quote is your post. Here's the actual quote: > “Most of the federal spending is entitlements. So that’s the big one to eliminate. That’s the sort of half trillion, maybe six, 700 billion,” Musk said on Monday in an interview with Fox Business’ Larry Kudlow. Musk’s comments came in response to a question from Kudlow about whether there would be a report on targeting waste, fraud and abuse in federal spending. Medicare is around a trillion dollars by itself, so those numbers don't make any sense as the removal of entire programs, but total entitlement spending is several trillion in total and a reduction in those amounts would make sense in the context of targeting waste, fraud and abuse in entitlement spending, which is the thing he was being asked about.

apical_dendrite 1y ago

I've followed DOGE closely and haven't heard anything that would indicate they were even trying to reduce unnecessary medicare spending. Where I have heard that they've tried to touch healthcare spending, they've made a huge mess. For instance, they cancelled a lot of support contracts at the VA, but many of those contracts did necessary things, like maintaining complex machinery. If you read ProPublica's article on DOGE at the VA, it's pretty clear that this was done incredibly quickly by a guy with zero healthcare knowledge using a minimal prompt and wasn't even directing the AI to read the most important parts of the contract. https://www.propublica.org/article/trump-doge-veterans-affairs-ai-contracts-health-care https://www.propublica.org/article/trump-doge-veterans-affai...

AnthonyMouse 1y ago
There seems to be some indication that they hired some incompetent people and/or were prohibited from cutting some of the things that ought to be cut. And I don't think there is any question that the deadline they set for themselves was unrealistically aggressive. Which means we need someone to go back and do it properly, not that it doesn't need to be done.
- apical_dendrite 1y ago
  I think everyone would agree that we should reduce fraud and waste in healthcare spending. I don't think DOGE was making a serious attempt to do that.
- __loam 1y ago
  What Doge was trying to do cannot be done legally.
  - cogman10 1y ago
    Sure it can, by the atorneys general. A core part of their job is identifying, stopping, and prosecuting fraud and waste spending in the government. Doge was never legal, but there were agencies that had the statutory power to do what doge wanted. However, they also could investigate things like emoluments violations which is precisely why they were some of the first to be fired.

biophysboy 1y ago

Any serious attempt at reducing the deficit would mean confronting one of the largest sectors of the American economy. All of the stuff you mentioned - pointless tests, upcoding fraud, etc - is part of that. It is not irrational to cut millions in wasteful spending. It is irrational for a department of government efficiency to spend all of its energy cutting random million dollar contracts instead of figuring out how to plan the attack for the confrontation above. DOGE did not fail because its a hard problem. They failed because they thought it was easy. Taking over a company with a thousand employees is categorically different than revamping the spending of the United States.

AnthonyMouse 1y ago
> Any serious attempt at reducing the deficit would mean confronting one of the largest sectors of the American economy. All of the stuff you mentioned - pointless tests, upcoding fraud, etc - is part of that. Which is exactly what they should have been doing. It's blatantly obvious that they failed -- federal spending went up year over year. But that means the problem remains and someone's going to have to take another go at it.
- __loam 1y ago
  Doge never had any power to even change government spending. The budget is determined by congress.
  - AnthonyMouse 1y ago
    The budget is determined by what's written on a piece of paper that Congress eventually passes. You don't have to be a member of Congress to be the one drafting it or making recommendations.
    - __loam 1y ago
      Why were congressionally appropriated funds impounded by Doge?

jmye 1y ago

Are you under the impression that CMS doesn’t address fraud and overpayments with extremely harsh penalties, every single time they’re found? Do you think CMS just shrugs and oks every single test? I don’t understand the basis for your complaints, here. There are two big issues with CMS costs, and you’ve identified 10% of one of them.

cogman10 1y ago

> unnecessary tests or fraud or overpaying for things? Glad you ask. That was the job of the Attorneys general to figure out. A core part of their task was finding and eliminating waste, fraud, and abuse. They were fired almost day one of the Trump admin. DOGE's notion that the actual gov spending was in the employees was laughable. If we actually wanted to eliminate waste then we should have put more employees in the AG and IRS, not done mass firings from those agencies. The other part to mention is that Medicare Part C, putting public dollars into private insurers, has lead to a huge amount of the fraud. Those useless tests have often been done by these private insurance agencies because they can easily bill the government for them. Eliminating that public/private partnership is exactly what will save money. Our inefficiencies are largely due to our reliance on the private sector to backfill what the government isn't doing.

AnthonyMouse 1y ago
> They were fired almost day one of the Trump admin. And then they hired different ones. Which in and of itself has nothing to do with it. > The other part to mention is that Medicare Part C, putting public dollars into private insurers, has lead to a huge amount of the fraud. Those useless tests have often been done by these private insurance agencies because they can easily bill the government for them. That's not the half of it though. The entire US healthcare industry is full of corruption and inefficiency. In general it's the providers who want the unnecessary tests, not the insurance companies. > Our inefficiencies are largely due to our reliance on the private sector to backfill what the government isn't doing. I feel like this is why we never solve it. The Democrats insist that the only solution is for the government take the whole thing over, the Republicans point to people in France waiting a year for an appointment and then nothing changes because they're both taking money from the industry so neither of them are trying to fix the real problem. Because what you need is to set up non-emergency care to have actual competition. If you need an X-ray some time in the next month, a computer gives you a list of every office with an open appointment, their price and their distance from you. The providers charge between $50 and $200 but some are closer to you or have sooner appointments, the insurance pays $50 no matter where you go and then you get to pick but you pay the difference. You need the patient to have the ability to say "you know what, the one that's 10 minutes closer isn't worth $120 extra" and pick the less expensive one, because then they actually have the incentive to get prices under control, instead of the current insanity where just getting them to tell you how much something is going to cost is like pulling teeth and the government subsidizes getting your health insurance through your employer in the tax code to keep it that way.