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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.

DOGE "failed" because cutting the budget wasn't their real goal.

Here are a few outcomes they were able to achieve: (1) Cutting funding for agencies and organizations that were investigating companies run by Elon Musk. (2) Cutting funding for organizations, like NOAA, that have high economic returns for every dollar the government spent on them. (3) Copying information from multiple government databases.

(1) had immediate benefits to Musk. (2) leaves openings for someone with enough capital to fill in the gaps left behind and make a profit charging for what used to be a government service. (3) provides numerous long term benefits to Musk and anyone else with access to that data.

> Cutting funding for agencies and organizations that were investigating companies run by Elon Musk.

Which doesn't make any sense because you don't need to cut their funding when it's your buddies in office. They just don't investigate you anymore regardless of their funding level.

> Cutting funding for organizations, like NOAA, that have high economic returns for every dollar the government spent on them.

It's obvious why fossil fuel companies (and therefore Trump) would want to do this, but Musk is the guy who does electric cars and grid storage batteries. His financial incentive would be to play up the dangers of climate change.

And this is the same as the first one. If your guy is in office then you don't need to cut the funding of some agency under your own control, you just have them stop doing whatever it is you don't want them to do anymore.

> Copying information from multiple government databases.

The only reason DOGE could copy them to begin with is that they were already in control of the government and therefore already had access to the databases. If you want to complain about something, how about why does the government keep all of this sensitive information instead of encouraging systems that use decentralized identity or don't imply or require mass surveillance in order to operate? Every administration has access to that when they get elected, including the ones you don't like, so let's not have it to begin with.

> (2) leaves openings for someone with enough capital to fill in the gaps left behind and make a profit charging for what used to be a government service.

If this was actually a profitable market then there would be no reason for it to be a government service to begin with. But it isn't, because collecting the data is expensive and there aren't a lot of buyers. If anything getting rid of NOAA would cost SpaceX money because NOAA pays SpaceX to launch satellites, and nobody else is going to do it.

Republicans want to cut NOAA because they publish climate data and the fossil fuel industry is a Republican constituency. But you don't need DOGE for that when the Republicans control Congress.

They were completely feckless at finding the right things to cut but this stuff is conspiracy theories.

> 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.

Doge never had any power to even change government spending. The budget is determined by congress.

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.

Why were congressionally appropriated funds impounded by Doge?

I believe their argument was that the Impoundment Act is unconstitutional because Congress can appropriate money for something, and the executive branch can't take that and use it for something else, but Congress doesn't have the power to make them do something with it instead of just not spending it at all. It's basically a checks and balances argument; to get the government to do something you need Congress to appropriate money for it and the President to implement it and if either of them says no then it's not happening.

The executive can't unilaterally declare something is unconstitutional. The impoundment act was passed to prevent exactly this because that's exactly what Nixon did. The executive doesn't make the laws and congress literally already litigated this. If you want it to be unconstitutional then take it up with the supreme court, otherwise you're just indulging in lawlessness. This is a ridiculous argument.

> The executive can't unilaterally declare something is unconstitutional.

Any of the branches can do that. The courts don't need the permission of Congress or the President to strike down a law. Congress doesn't need anyone's permission to refuse to pass something because they think it's unconstitutional.

Consider what prosecutorial discretion is.

> The impoundment act was passed to prevent exactly this because that's exactly what Nixon did.

Congress passed it, but Congress frequently does unconstitutional things and then one of the other branches has to put a stop to it because that's how checks and balances work.

What do you suppose would happen if Congress passed a First Amendment-violating censorship law, the courts struck it down and then Congress passed a second law saying the courts have to uphold the first one?

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-affai...

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.

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.

What Doge was trying to do cannot be done legally.

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.

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.

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.

> 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.

This is a biased source but is the first I could find- https://www.americanprogress.org/article/tax-cuts-are-primar...

But we were set to pay off the nation debt by 2013 before Bush tax cuts. Bush’s tarp, Trump tax cuts plus Covid were the other nails in the coffin of debt reduction.

Starve the beast has been an official Republican strategy for 40 years.

Federal receipts as a percent of GDP:

https://fred.stlouisfed.org/series/FYFRGDA188S

It went way, way up during WWII and hasn't changed much since. And that's relative to GDP over a period that real GDP per capita increased significantly, i.e. government revenue in real dollars per capita is through the roof.

The US tax system has an evolved defect where the tax brackets are set in nominal dollars and then as inflation pushes everyone into the next highest bracket Congress periodically gets to claim credit for passing a "tax cut" without actually reducing the level of real government revenue -- indeed it has been going up enough to keep up with real GDP growth. And if you confuse that with an actual tax cut then you can write articles where "without the tax cut" there would be more revenue, but only because there is an implicit continuous tax increase baked into the tax code to allow Congress to repeatedly tell everyone that up is down.

It's not a revenue problem. Revenue is up. It's a spending problem.

> 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.

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.

> 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.

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.

CMS itself could also do a lot of work, especially the OIGs

Unfortunately: also fired day (week?) one.

> 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.

> 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.