To Achieve Government Cuts, Musk and Ramaswamy Need to Address Entitlements

The issue of “improper payments” through Medicare and Medicaid has emerged as a significant concern in the realm of federal government spending, costing taxpayers over $100 billion in 2023 alone. This colossal waste has garnered attention particularly in the context of President-elect Donald Trump’s plans to establish the Department of Government Efficiency (DOGE), which will include figures like Elon Musk and Vivek Ramaswamy. Charged with driving out “massive waste and fraud” from the federal budget, the DOGE is expected to interact with the Office of Management and Budget (OMB). However, while the concept of the DOGE appears promising, it raises questions about its actual effectiveness given the existing documented inefficiencies and the political willingness to address them.

Despite the plethora of reports from the Government Accountability Office (GAO) and various Congressional committees pointing to areas of waste, what remains elusive is the political will to implement necessary changes. For any serious reform initiative, understanding that the root of improper payments is well-documented—but not acted upon—is crucial. The GAO’s assessment identifies that a staggering 40% of all improper payments originate from Medicare and Medicaid. These figures hint at an opportunity for significant savings, such as the potential $141 billion savings over a decade by reforming Medicaid billing practices. However, any realistic discussion of reform may be hampered by Trump’s stated intention to keep entitlement programs intact, limiting the DOGE’s options.

The challenge of raising political will within the context of reform represents another hurdle. The Congressional Budget Office (CBO) routinely identifies various options for deficit reduction; notably, most of these proposals involve alterations to entitlement programs. Suggestions like capping Medicaid spending or adjusting Medicare premiums could result in substantial savings, but the DOGE’s ability to drive these changes relies heavily on whether Trump can be convinced to reconsider his stance on entitlement reform. The fiscal landscape indicates that entitlements are not only a growing expenditure category but also a major part of the federal budget, amounting to nearly $4 trillion this year. This raises an important question: how can meaningful cuts be implemented to discretionary spending without addressing the much larger issue of mandatory spending?

Moreover, while Musk has made bold claims of being able to cut $2 trillion from government spending, achieving this without touching mandatory spending, including entitlement programs, may prove to be unrealistic. Even if all discretionary spending were eliminated—a monumental challenge—it would still fall short of Musk’s objective. The assertion that there can be significant fiscal reform without delving into entitlement programs suggests an underlying misunderstanding of the fiscal realities faced by the government. Thus, any plans from the DOGE that ignore this fundamental truth will likely falter in effectiveness.

The historical reluctance of Congress to cut funding for programs that serve as vital support for constituents and contractors further complicates this issue. While it may be relatively straightforward to highlight instances of waste, convincing Congress to enact meaningful cuts requires much more substantial political maneuvering. Given that entitlement reform is one of the most politically fraught issues, its consideration is essential if the DOGE is to pursue real efficiencies. Political infighting and resistance to change have long impeded progress toward reducing wasteful spending, highlighting the pressing need for a change in mindset if the DOGE hopes to achieve its objectives.

In conclusion, while the establishment of the DOGE has the potential to bring some much-needed focus on federal spending inefficiencies, its capacity to effect real change remains highly uncertain. Until the political environment shifts, and particularly unless Trump is willing to modify his unwavering support for existing entitlement programs, the initiative risks becoming little more than a symbolic gesture rather than a meaningful mechanism for reducing government waste. Progress in these areas may be slow, but continued dialogue about reform is necessary. Ultimately, the effectiveness of the DOGE will depend on the development of actionable ideas and a willingness to confront the political challenges that have historically stymied significant fiscal reform. For now, the potential for substantive change remains largely untested.