To Succeed at Cutting Government, Musk and Ramaswamy Must Take on Entitlements
Possibly the biggest pile of waste in the federal government is the amount of “improper payments” made every year by the Medicare and Medicaid programs. In 2023, for example, those mistakes cost taxpayers more than $100 billion.
This is worth noting for two reasons in the wake of the news that President-elect Donald Trump has asked Elon Musk and Vivek Ramaswamy to head up a new Department of Government Efficiency (DOGE). Despite the name, the DOGE looks to be more of an unofficial advisory board that will work with the White House’s Office of Budget and Management (OMB), and Trump says it will help “drive out the massive waste and fraud which exists throughout” the government’s $6 trillion budget.
First, it’s not as if there is some secret knowledge to be uncovered by the DOGE when it comes to fixing the rampant inefficiencies of the federal government. Those Medicare and Medicaid overpayments are documented annually, for example. The Government Accountability Office and various inspectors general file regular reports. The Congressional Budget Office maintains a list of things that could be cut to reduce the deficit. Various members of Congress—most prominently, Sen. Rand Paul (R–Ky.)—periodically publish lists of silly, wasteful, or dubious government spending.
What’s lacking, in short, is not ideas but the political will to act on them.
The amount of political will is going to matter, because that is very relevant to the second point:Â Unless Trump is willing to set aside his promise not to touch America’s entitlement programs, the DOGE will be unable to follow through on its mandate.
Again, look at those improper payments made by Medicare and Medicaid. The $101.4 billion of improper payments the two entitlements made in 2023 accounted for 40 percent of all improper payments across the entire government that year, according to the GAO. That same GAO report suggested a simple change in how Medicaid bills some of its services that, if implemented, could save $141 billion over 10 years.
That should be the lowest of low-hanging fruit for any serious
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