The Trump-Musk Doctrine: F-ck Around and Find Out

173 snips

Feb 18, 2025

Guest

Michael Geruso

Guest

Tim Layton

In this discussion, Michael Geruso, an economics professor specializing in healthcare policy, and Tim Layton, a healthcare economics expert from UVA, delve into the chaos of recent federal government changes, highlighting Musk's controversial tactics. They unpack the inefficiencies in healthcare spending, particularly within Medicare Advantage, and the staggering amounts lost to waste and fraud. The guests emphasize the dire need for a reconstruction of federal aid programs, particularly in health care, while critically assessing the ethical implications of current practices.

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ANECDOTE

DOGE's Ineptitude

DOGE's reckless cuts affected essential staff at the National Nuclear Security Administration and the Pantex plant.
Buyouts offered to Veterans Affairs staff, including doctors and nurses, were rescinded days later.

ANECDOTE

Data Collection and Public Health Cuts

DOGE's cuts at the Department of Education harmed the Institute for Education Science, impacting crucial data collection programs.
Similar cuts at the FDA, CDC, and NIH threaten food and medical device testing, epidemic prevention, and biotech funding.

ANECDOTE

USAID Decimation

DOGE severely impacted USAID, placing most employees on leave and reducing staff from 10,000 to 600.
These cuts jeopardize life-saving programs like PEPFAR, impacting global health initiatives.

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For the past month, chaos and confusion have gripped Washington and the federal government. Elon Musk and his Department of Government Efficiency, or DOGE, have served as an iron fist of the Trump administration—ransacking government agencies, lighting fires in various departments, and generally firing as many people as they can get away with. Much of this work is plainly illegal. Every 12 hours, it seems, another federal judge rules that the Trump administration has exceeded its executive authority.

Efficiency is a worthy goal, and some of the programs that Musk and his team cut may turn out to be wasteful. Still, the way Musk has gone about his work—destroying life-saving programs at USAID, mistakenly offering buyouts to nuclear assembly engineers and essential doctors with Veterans Affairs, slashing funds for important studies and data collection programs across government—suggests that his bureaucratic blitzkrieg isn't just illegal; it's careless and harmful. The U.S. deserves a theory of government more sophisticated than "F-ck around and find out."

So, what would an effective DOGE look like? Today’s guests are Michael Geruso, an associate professor of economics at the University of Texas at Austin, and Tim Layton, a professor of health care policy at UVA. We explain why any sensible waste and fraud search-and-destroy effort should start with health care spending. Then we get very nerdy about waste and fraud in health care. Most importantly, we talk about trade-offs. It’s a myth that there is some pot of $10 billion just lying around, doing nothing, gathering dust. Every dollar of federal government spending goes to a person in a place doing a thing. And that means that every dollar we cut will have a recipient on the other end who is losing a dollar. Taking government efficiency seriously requires thinking about both sides of this equation: What do we get when we spend this dollar, and what do we lose when we take that dollar away?

If you have questions, observations, or ideas for future episodes, email us at PlainEnglish@Spotify.com.

Host: Derek Thompson

Guests: Michael Geruso and Tim Layton

Producer: Devon Baroldi

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