A good first post, but yes, it did underestimate the damage, the strangeness, the fraud. How could it not? I’m tired of everything always turning out to be worse than we think it is. But that’s the new normal, I guess. I hate it.
I hate what he is doing blatantly to our Country ...and breaking all the guardrails daily !!!!! Authoritarianism is here NOW and marshal law is next...but ya know..you can't keep good people DOWN .... not for long = how long will American people put up with the lies so he can nail down every single guardrail, lawyers, judiciary???? And won't it be so so INTERESTING, when we find out WHY the GOP enabled this and are therefore also 100% culpable as trump
I do not believe it is accurate to say that "most government spending happens because it delivers something people want, and you can’t make significant cuts without hard choices." It occurs because a federal employees -- the executive -- are directed and obliged by law that specifies that a dollar be spent, a protection be enacted, an initiative be pursued. So-called bureaucrats do not concoct these programs by themselves, but rely on processes of evaluation and review in settling how to spend tax dollars on mandated programs (if they have been given that authority by law), and *always* overseen and approved by elected officials (ultimately, member of the President's cabinet). We do not have senior civil servants that have ultimate authority over programs; all programs are ultimately the responsibility to elected officials.
If we are fortunate, the elected representatives in congress who empower the executive to create and run programs do, in fact, want to deliver some "good" to we citizens. But since the Reagan years I've been less sure of this.
The whole "unelected bureaucrats spending the people's money" as a total canard, a lie of such grand proportions that no one bothers to challenge it.
You've exposed how the con game is played. Now for the why. They promulgate this lie because their end goal is to eliminate the programs people want, but they can't just come right out and say it. Imagine the backlash against a politician openly stating "We should eliminate Social Security so my wealthiest donors/patrons can pay lower taxes".
So they use tropes, buzzwords, dog whistles and a generous helping of Kool-Aid to convince the low information/low education masses against the very programs that help them. They use a long established reichwing media mechanism to promote and spread the fabrications as far and wide as possible. The end result is a steaming pile of Orange Fecal Matter landing in the Oval Office.
A country NEEDS a stable and functioning government for its people - broken. It NEEDS economics so we can buy food and shelter - broken and breaking the private sector now. It NEEDS Values so the people TRUST the government and its companies and its policing / courts....all broken by trump/putin. Who in their right mind does not see the big picture ?
Absolutely. The ways laws are written determine how our tax dollars are spent, not the personal preferences of bureaucrats. Most laws give some discretion in how they are enacted, but some are poorly thought out and some are just plain self-destructive when Congress wants to pretend they are giving us something popular but that the party in power does not actually like.
A few comments are necessary: Of all insurance carriers, Medicare actually has the lowest "overhead", meaning the percentage of budget that does not pay for medical care. In the insurance business, this is the opposite of the "loss ratio". The percentage of concern is the amount that goes for administration, to pay debt, and, in the case of for-profit companies, to the stockholder. As a (retired) doctor, I can note that Medicare actually pays "clean" claims with the least hassle and fastest.
Medicare is also required by law to set standards for care and to analyze items and procedures as to whether they actually work. That has been very effective, and all the private insurance companies use the Medicare product as the basis for their such systems, as does Hayes Reports, which is the sort of Consumer's Reports for the Healthcare sector.
Medicare is required to set physician and hospital payments yearly, so some of its administrative system is workload is an extensive reanalysis yearly of all payments. All private payment systems use the Medicare assessments as a model.
Medicare has the most effective fraud and abuse detection system of any carrier. No for-profit system matches it. Even then, it is a troubled issue, and one can only hope that with some AI embedded in the analysis, better detection will occur. For example, this weekend in the Times, there was an expose regarding biologics used for wound care. A more astute payment system would pick up on that abuse easily.
DOGE can certainly criticize HHS/Medicare, but in doing so, they are ignoring the reality that it is a very refined and efficient system in its own way. Even if the country were to shift to a single payer system tomorrow, most of the core functions at the governmental level would remain, although those currently in the private sector (meaning for profit and actually less efficient) would be eliminated. Where a key savings would occur would be in medical offices, where single-payer would result in some staffing reductions.
Ah don’t feel bad. We were all so young and naive three months ago. I’m sure someone imagined it would get this bad but if they did they kept it to themselves. And I doubt that even trump and musk imagined it would be so easily to destroy the federal government
Naw. With project 2025, it was telegraphed ahead of time, planned out meticulously, entirely obvious and many were shouting from the rooftops — not that you couldn’t have predicted an assault on law and reason from his first administration, ending in Jan 6, yourself. Having gone through this experience and having found himself charged with dozens of felonies on a diversity of different crimes, what would the serial repeat offender do differently so it didn’t happen again the next time? Surely, not follow the law… That would be unthinkable (read: unprofitable), so better to break the rule of law. Problem solved™!
It is incorrect to say those that imagined what would happen kept it to themselves. No patriot does that. What really happened was nobody listened, because it was “one more liberal looney” shouting at the wind.
Some day, progressives might get to actually make policy, like doubling the minimum wage, Medicare for all, or even democracy over despotism in the workplace. Then you will listen. For now, while we unnecessarily and to our own detriment continue to sideline the left, we have to imagine “nobody could have known” because the truth of our complicit and willful ignorance in the ongoing debacle would be damaging to self-esteem.
I don't know how, if not by presenting and interpreting the data, to make the case against this administration. Thank goodness a (the?) master at presenting and explaining the data is on Substack. Thank you.
I'm sure, unfortunately, a great deal more debunking of MAGA "truths" are on the way.
The main issue of the extreme cost difference in US health care administration costs compared to all the other countries is: ALL the other countries have government run universal health care for their people. The US system is flawed with private health care. Why are we fighting universal health care. Thank you MUSK for pointing out the need for universal health care!
At the risk of sounding like a fanboy, Dr. Krugman nailed it! I love his commentary about American health care costs. No wonder the US is so much less efficient and cost-effective!
I totally love this article! The painting is a wonderful find!
Here is another important observation from Italy in the same time period:
“There is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than the creation of a new system. For the initiator has the enmity of all who would profit by the preservation of the old institutions and merely lukewarm defenders in those who would gain by the new ones. The hesitation of the latter arises in part…from the general skepticism of mankind, which does not really believe in an innovation until experience proves its value.”
– Niccolo Machiavelli, 1513 in “The Prince”, Chapter 6
Even then it wasn't a new idea, but it was beautifully expressed.
Trump often makes accusations about others that tell us what he is about to do. Looking for "waste, fraud, and abuse" means that is what he is looking to institute. The most obvious way to do it is to privatize any government service:
budget - overhead = service
becomes
budget - overhead - profit = less service
In value stream analysis the new entry "profit" is "waste" by definition because that is cash flow that doesn't go to the intended outcome.
As for abuse, just look at what Muck is doing to the Social Security computer system. He is adding real, living people to the book of the dead. If that isn't abuse, I don't know what is. That is much worse than putting Edward Kennedy's name on the TSA "no fly" list right before a critical Senate vote. There was no way to challenge the action. He was able to purchase an Amtrak ticket and get there in time anyway. These individuals will not have that option unless they have large cash reserves. How will they "self deport" if they can't use their bank accounts or credit cards? This is just a test of their new system to eliminate birthright citizenship.
More abuse:
Political criticism is protected by the First Amendment, but only if you have deep pockets and can hire world class attorneys to fight the hundreds of millions of dollars of pro bono effort from the best corporate law firms in the country. Even billionaires hesitate to criticize Trump now.
As for fraud, we only have to observe that we elected the fraudster in chief. We will get what we asked for. It's what he does best. Check out the stock manipulation and bit coin scam. They are hot off the presses.
Every time I hear someone say that government ought to be run like a business, my reaction is to think that makes as much sense as saying you ought to ride a horse like you ride a bicycle.
Thank you for a review of a prescient start!! There was, I think, one committee for government efficiency that was effective , and that was the government efficiency committee called National Partnership for Reinventing Government (NPR) during Bill Clinton's presidency, led by Al Gore. From Wikipedia, "During its five years, it catalyzed significant changes in the way the federal government operates, including the elimination of over 100 programs, elimination of over 250,000 federal jobs, and consolidation of over 800 agencies . .and "introduced the use of performance measurements and customer satisfaction surveys, and encouraged the use of technology including the internet. NPR is recognized as a success and had a lasting impact according to government officials who worked on or were influenced by it under the" Clinton and Bush administrations. Sounds too constructive a model for the Trump White House to have followed!!
Sick at heart and mad in my mind. Recently, my cousin, who was the widow of the last person killed by a deranged person, died at age 81. To her credit, she always looked and acted forward.
There is basically no waste fraud or abuse in the government. What is there was engineered in by congress (medicare scams mostly, plus military contracting).
A good first post, but yes, it did underestimate the damage, the strangeness, the fraud. How could it not? I’m tired of everything always turning out to be worse than we think it is. But that’s the new normal, I guess. I hate it.
I hate what he is doing blatantly to our Country ...and breaking all the guardrails daily !!!!! Authoritarianism is here NOW and marshal law is next...but ya know..you can't keep good people DOWN .... not for long = how long will American people put up with the lies so he can nail down every single guardrail, lawyers, judiciary???? And won't it be so so INTERESTING, when we find out WHY the GOP enabled this and are therefore also 100% culpable as trump
I’m sure it isn’t anything so interesting as a conspiracy or clever trick. They just want power and with power comes grift.
I do not believe it is accurate to say that "most government spending happens because it delivers something people want, and you can’t make significant cuts without hard choices." It occurs because a federal employees -- the executive -- are directed and obliged by law that specifies that a dollar be spent, a protection be enacted, an initiative be pursued. So-called bureaucrats do not concoct these programs by themselves, but rely on processes of evaluation and review in settling how to spend tax dollars on mandated programs (if they have been given that authority by law), and *always* overseen and approved by elected officials (ultimately, member of the President's cabinet). We do not have senior civil servants that have ultimate authority over programs; all programs are ultimately the responsibility to elected officials.
If we are fortunate, the elected representatives in congress who empower the executive to create and run programs do, in fact, want to deliver some "good" to we citizens. But since the Reagan years I've been less sure of this.
The whole "unelected bureaucrats spending the people's money" as a total canard, a lie of such grand proportions that no one bothers to challenge it.
🎯
You've exposed how the con game is played. Now for the why. They promulgate this lie because their end goal is to eliminate the programs people want, but they can't just come right out and say it. Imagine the backlash against a politician openly stating "We should eliminate Social Security so my wealthiest donors/patrons can pay lower taxes".
So they use tropes, buzzwords, dog whistles and a generous helping of Kool-Aid to convince the low information/low education masses against the very programs that help them. They use a long established reichwing media mechanism to promote and spread the fabrications as far and wide as possible. The end result is a steaming pile of Orange Fecal Matter landing in the Oval Office.
👆👆🎯
A country NEEDS a stable and functioning government for its people - broken. It NEEDS economics so we can buy food and shelter - broken and breaking the private sector now. It NEEDS Values so the people TRUST the government and its companies and its policing / courts....all broken by trump/putin. Who in their right mind does not see the big picture ?
Absolutely. The ways laws are written determine how our tax dollars are spent, not the personal preferences of bureaucrats. Most laws give some discretion in how they are enacted, but some are poorly thought out and some are just plain self-destructive when Congress wants to pretend they are giving us something popular but that the party in power does not actually like.
A few comments are necessary: Of all insurance carriers, Medicare actually has the lowest "overhead", meaning the percentage of budget that does not pay for medical care. In the insurance business, this is the opposite of the "loss ratio". The percentage of concern is the amount that goes for administration, to pay debt, and, in the case of for-profit companies, to the stockholder. As a (retired) doctor, I can note that Medicare actually pays "clean" claims with the least hassle and fastest.
Medicare is also required by law to set standards for care and to analyze items and procedures as to whether they actually work. That has been very effective, and all the private insurance companies use the Medicare product as the basis for their such systems, as does Hayes Reports, which is the sort of Consumer's Reports for the Healthcare sector.
Medicare is required to set physician and hospital payments yearly, so some of its administrative system is workload is an extensive reanalysis yearly of all payments. All private payment systems use the Medicare assessments as a model.
Medicare has the most effective fraud and abuse detection system of any carrier. No for-profit system matches it. Even then, it is a troubled issue, and one can only hope that with some AI embedded in the analysis, better detection will occur. For example, this weekend in the Times, there was an expose regarding biologics used for wound care. A more astute payment system would pick up on that abuse easily.
DOGE can certainly criticize HHS/Medicare, but in doing so, they are ignoring the reality that it is a very refined and efficient system in its own way. Even if the country were to shift to a single payer system tomorrow, most of the core functions at the governmental level would remain, although those currently in the private sector (meaning for profit and actually less efficient) would be eliminated. Where a key savings would occur would be in medical offices, where single-payer would result in some staffing reductions.
This is an amazingly helpful article
I saved it an md relook at it and sent it to friends and family
Ah don’t feel bad. We were all so young and naive three months ago. I’m sure someone imagined it would get this bad but if they did they kept it to themselves. And I doubt that even trump and musk imagined it would be so easily to destroy the federal government
Naw. With project 2025, it was telegraphed ahead of time, planned out meticulously, entirely obvious and many were shouting from the rooftops — not that you couldn’t have predicted an assault on law and reason from his first administration, ending in Jan 6, yourself. Having gone through this experience and having found himself charged with dozens of felonies on a diversity of different crimes, what would the serial repeat offender do differently so it didn’t happen again the next time? Surely, not follow the law… That would be unthinkable (read: unprofitable), so better to break the rule of law. Problem solved™!
It is incorrect to say those that imagined what would happen kept it to themselves. No patriot does that. What really happened was nobody listened, because it was “one more liberal looney” shouting at the wind.
Some day, progressives might get to actually make policy, like doubling the minimum wage, Medicare for all, or even democracy over despotism in the workplace. Then you will listen. For now, while we unnecessarily and to our own detriment continue to sideline the left, we have to imagine “nobody could have known” because the truth of our complicit and willful ignorance in the ongoing debacle would be damaging to self-esteem.
I don't know how, if not by presenting and interpreting the data, to make the case against this administration. Thank goodness a (the?) master at presenting and explaining the data is on Substack. Thank you.
I'm sure, unfortunately, a great deal more debunking of MAGA "truths" are on the way.
The main issue of the extreme cost difference in US health care administration costs compared to all the other countries is: ALL the other countries have government run universal health care for their people. The US system is flawed with private health care. Why are we fighting universal health care. Thank you MUSK for pointing out the need for universal health care!
This article predicted Exactly what musk would find and shows he only caused damage
At the risk of sounding like a fanboy, Dr. Krugman nailed it! I love his commentary about American health care costs. No wonder the US is so much less efficient and cost-effective!
I totally love this article! The painting is a wonderful find!
Here is another important observation from Italy in the same time period:
“There is nothing more difficult to plan, more doubtful of success, nor more dangerous to manage than the creation of a new system. For the initiator has the enmity of all who would profit by the preservation of the old institutions and merely lukewarm defenders in those who would gain by the new ones. The hesitation of the latter arises in part…from the general skepticism of mankind, which does not really believe in an innovation until experience proves its value.”
– Niccolo Machiavelli, 1513 in “The Prince”, Chapter 6
Even then it wasn't a new idea, but it was beautifully expressed.
Trump often makes accusations about others that tell us what he is about to do. Looking for "waste, fraud, and abuse" means that is what he is looking to institute. The most obvious way to do it is to privatize any government service:
budget - overhead = service
becomes
budget - overhead - profit = less service
In value stream analysis the new entry "profit" is "waste" by definition because that is cash flow that doesn't go to the intended outcome.
As for abuse, just look at what Muck is doing to the Social Security computer system. He is adding real, living people to the book of the dead. If that isn't abuse, I don't know what is. That is much worse than putting Edward Kennedy's name on the TSA "no fly" list right before a critical Senate vote. There was no way to challenge the action. He was able to purchase an Amtrak ticket and get there in time anyway. These individuals will not have that option unless they have large cash reserves. How will they "self deport" if they can't use their bank accounts or credit cards? This is just a test of their new system to eliminate birthright citizenship.
More abuse:
Political criticism is protected by the First Amendment, but only if you have deep pockets and can hire world class attorneys to fight the hundreds of millions of dollars of pro bono effort from the best corporate law firms in the country. Even billionaires hesitate to criticize Trump now.
As for fraud, we only have to observe that we elected the fraudster in chief. We will get what we asked for. It's what he does best. Check out the stock manipulation and bit coin scam. They are hot off the presses.
You can't say that a painting is "by Bellini".
Giovanni, Jacopo, and Gentile Bellini, from the same family, were all bright lights of School of Venice.
ps: Otherwise, great post!
Definitely shoulda stuck with "Krugman wonks out"
Every time I hear someone say that government ought to be run like a business, my reaction is to think that makes as much sense as saying you ought to ride a horse like you ride a bicycle.
Thank you for a review of a prescient start!! There was, I think, one committee for government efficiency that was effective , and that was the government efficiency committee called National Partnership for Reinventing Government (NPR) during Bill Clinton's presidency, led by Al Gore. From Wikipedia, "During its five years, it catalyzed significant changes in the way the federal government operates, including the elimination of over 100 programs, elimination of over 250,000 federal jobs, and consolidation of over 800 agencies . .and "introduced the use of performance measurements and customer satisfaction surveys, and encouraged the use of technology including the internet. NPR is recognized as a success and had a lasting impact according to government officials who worked on or were influenced by it under the" Clinton and Bush administrations. Sounds too constructive a model for the Trump White House to have followed!!
Sick at heart and mad in my mind. Recently, my cousin, who was the widow of the last person killed by a deranged person, died at age 81. To her credit, she always looked and acted forward.
Thanks for this.
There is basically no waste fraud or abuse in the government. What is there was engineered in by congress (medicare scams mostly, plus military contracting).