To cut back on Washington's inflationary deficit spending, you've got to start at the top. That means @DOGE should start its work with the Department of Health and Human Services.

How big is HHS? In 2023 it spent more than:
-Department of Defense (plus "defense-civil programs" and the Army Corps)
-Veterans Affairs
-Transportation
-Homeland Security
-Justice and the Judiciary
-Interior
-Commerce
-Energy and the EPA
-Labor
-State Department and foreign aid
-Congress and White House operations
-NASA and the National Science Foundation
-Small Business Administration

...combined.

Federal health spending and subsidies grow relentlessly. The HHS budget is now on par with the GDP of Florida or the country of Spain. Put another way, HHS consumes the work output of tens of millions of people every year.

HHS covers a lot of important things - poorly. It provides far less benefit to the health of the American people than it ought to given its gigantic budget.

Because HHS is so sprawling and has so many problems, I'm going to split it into multiple threads. The National Institutes of Health and the Centers for Disease Control (both part of HHS) will get extra scrutiny. Even then, there's plenty of potential policy fixes I'm leaving out.

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The largest program in HHS, and the second-largest in the federal government, is Medicare. @DOGE can lead the way on overdue reforms.

Because millions of seniors rely on Medicare, it's a sensitive subject. Americans who have paid a dedicated Medicare payroll tax for their entire working lives expect that promises repeatedly made by both political parties will be kept.

Yet because Medicare is a program operated by teams of government and medical bureaucrats, there's an enormous amount of waste. We can save hundreds of billions on Medicare without pulling the rug out from under retirees.

-The lowest-hanging fruit from a policy standpoint is to stop being needlessly generous to medical providers. For example, Medicare pays more for treatments based on where it takes place, even when there's no added benefit for the patient. "Site neutrality" reforms would save hundreds of billions of dollars.

-Another way to save money would be to change how Medicare reimburses medical providers for "bad debt", which occurs when a Medicare patient doesn't cover their part of a bill. Private health plans don't bend over backwards in these situations, but Medicare does. Tens of billions in savings here.

-Medicare is subject to tens of billions of dollars in fraudulent and excessive payments every year. Scamming Medicare is now a cottage industry. Congress has passed bills to go after improper payments a few times already, but there's still work to be done.

-The first Trump administration called for improving how we pay for medical equipment to ensure proper competition. This simple change was estimated to save $8 billion per decade as of 2020, so probably $10 billion now.

-Medicare has evolved into a multi-part program. Parts A and B have their own separate rules and paperwork, costing people time and money. Simplifying them into a single program would not only reduce federal costs by billions, but also costs for medical practices.

Make no mistake: pushing for reforms like these would lead to immediate backlash from groups that benefit from excessive Medicare spending. They will try to equate spending less with breaking promises to seniors. That's complete nonsense, but those tactics scare politicians to death.

It will take courageous leadership to fight for reforms to improve the Medicare system for seniors and taxpayers alike.

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Burdened by What Has Been, Part 4

The Biden-Harris administration has used the federal government to push leftist ideology, misusing taxpayer dollars while corrupting programs and institutions on a massive scale.

Few Americans are aware of what I discuss in this thread. (1/7) "Whole of Government" Schemes

Traditionally, the federal government addresses problems and goals through targeted agencies and programs.

The Biden-Harris administration has rolled out a series of cross-cutting Executive Orders and actions that rope multiple federal agencies into its ideological crusades at once.

These include:
-Executive Order 13985 on "racial equity"
-Executive Order 14008 on climate
-The Justice40 initiative, which draws from the two EOs
-A memorandum on science agencies needing to use "Indigenous Knowledge"

The result is that agency resources (money and workers) are diverted away from core functions and towards appeasing activists. Since bureaucrats lean left themselves, many are happy to go along with this, and the few who disagree mostly bite their tongue. (2/7)

Burdened by What Has Been, Part 3

The Biden-Harris administration has made choices that are driving the country towards bankruptcy, both for families and the government.

This isn't just a long-term problem for America. It's a now problem, as I'll explain in this thread. (1/7) Making a Bad Situation Worse

The federal budget was in rough shape in January 2021. Both parties deserve blame. However, just doing nothing would have led to dramatic deficit reduction as COVID-related programs from 2020 expired.

The Biden-Harris administration wasn't interested in deficit reduction. They wanted to ram through as many handouts as they could get away with.

I covered the 2021 stimulus package previously. This was the worst mistake by far. (2/7)

https://x.com/DavidADitch/status/1831716613810483591

Burdened by What Has Been, Part 2

In 2022, Democrats passed a package focused on subsidies to "green" energy and electric vehicles, among other things.

Vice President Harris cast multiple tiebreaking votes to enable it.

This thread covers the unfolding failure. (1/7) "Build Back Better" Goes Bust

Starting in spring 2021, Democrats (led by Biden and Harris) began pushing a $3.5 trillion boondoggle labeled "Build Back Better." It was going to include handouts to every left-wing interest group under the sun.

However, a few less-radical members recognized that tossing several trillion dollars into the economy during the worst inflation crisis since the 1970s was a bad idea.

By mid-2022. Democrats started to shrink the package so it could pass both chambers. (2/7)

Burdened by What Has Been, Part 1

In 2021, Democrats passed $1.9 trillion of "COVID" spending. It turned simmering inflation into a roaring fire.

Vice President Harris cast the tiebreaking vote on the bill's passage. This thread covers the enduring damage it caused. (1/7) Stimulus Problem 1: Inflation. The package was pure deficit spending, and frontloaded at that. With the Federal Reserve actively enabling the spending spree, that meant a big injection of cash into the economy, increasing demand without helping supply. (If anything it hurt supply; more on that below)

More demand for the same supply leads to higher prices. While inflation wasn't evenly distributed, the spike that began in early 2021 hit so many different goods and sectors that everyone felt it. (2/7)

Congress is back with a spending package to fund the rest of the federal government. This one is 1,012 pages long, plus another 932 pages of "explanatory statements" that contain a lot of the gory details.

MEGATHREAD with gimmicks, earmarks, and a few wins. (1) A way for Congress to get around spending caps is "rescissions," or cuts to previously enacted spending. Every dollar "cut" makes room for more spending.

For instance, this "rescission" is an annual fake cut; the money wouldn't have been spent.(2)

The House and Senate have released a 1,050 page spending package. Yet because there are long lists of pork projects and niche special interest carve-outs, there's another 1,281 pages of "explanatory statements".

Ongoing MEGATHREAD of highlights and lowlights (1): The name of the game for congressional spenders is "what can we get away with" rather than "how can we use the public's money most responsibly." For example: they use "emergency" designations as a budget gimmick to cram more $$$ inside spending caps. (2)

The amount of confusion about what the debt limit deal means for debt and spending, even though we've had the text for almost 2 days, says a lot about how it's drafted. There's gamesmanship to try and provide plausible deniability to both D and R leadership. Examples:
(1/7) The PACT Act, dealing with toxic exposure coverage for veterans, passed last year. The last omnibus included $5 billion for a related fund. Debt limit deal increases the fund dramatically. How is this counted?
(2/7)

Last year's obscenely bloated omnibus spending bill is a big source of discontent among House conservatives. Since the spending debate is only just beginning, I'm going to highlight 23 of the worst FY 2023 earmarks over the next several weeks. MEGATHREAD: (1/x)

https://twitter.com/DavidADitch/status/1605102741617086464

Today's earmark is $500,000 for upgrading a skate park in Burrillville, Rhode Island, which was requested by Rep Langevin with support from Sen Whitehouse.

Burrillville, population 16k, is located about 20 miles northwest of Providence and seems like a perfectly nice town. (2/x)

In the wee hours of the morning, Senate leadership delivered 4155 pages of unfiltered swamp called an Omnibus, concluding with authorization of a Continuous Plankton Recorder.
appropriations.senate.gov/imo/media/doc/…

Ongoing omnibus thread on the 2023 Omnibus:
(1/x) Opposition to this sort of backroom, no-ability-to-read-or-amend, debt-hiking governance will be portrayed as radical. That is exactly backwards. The American people’s representatives deserve an opportunity to properly consider important legislation. (2/x)

A year ago, Sen. Manchin started pushing back against the left's attempt to railroad through a huge tax-and-spend bill. His reasoning, focused on inflation and the national debt, was sound. And he has completely abandoned it over the last two weeks.🧵 (1/6) INFLATION 1: Manchin correctly cited deficit spending as inflationary. Yet he has just voted for two bills with heavy deficit spending (CHIPS and PACT), and the new package's claimed deficit reduction mostly happens years from now. Net result makes things worse. (2/6)