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PaperclipPerfector  1d ago (text post)   9657 thread views

Culture War Roundup for the week of February 10, 2025

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@2rafa? Your response?

DOGE sets its sights on Medicare and Medicaid:

Elon Musk's Department of Government Efficiency is quickly expanding its reach through the federal government. It recently accessed systems at the Centers for Medicare and Medicaid Services. Musk and his team are now looking at key payment and contracting systems for Medicare and Medicaid - that was first reported by The Wall Street Journal. On X, Musk posted, he believes that, quote, "big money fraud is happening."

Mostly just talk and speculation at this point, but there are clear indications that medicare/medicaid have not escaped the notice of the DOGE.

In spite of the perceived celerity with which DOGE is eviscerating government programs, I'm still mostly in the "nothing ever happens" camp. "Cutting government spending" at this point is akin to rearranging deck chairs on the sinking Titanic that is Western civilization. The slow Brazilification of America is irreversible either way. Nonetheless, I am enjoying the apoplectic response that Musk's antics have occasioned.

EDIT: Oh, and social security was named as a potential target alongside medicare/medicaid as well.

What I’d like to see (like significantly cutting medicare coverage for treatments that prolong the lives of the very elderly / sick for minimal benefit) happen still seems very unlikely to happen, so I’m not updating any beliefs now.

Here in the UK every government comes to power promising to cut “waste” in the welfare and/or healthcare bill. And sure, there is some waste here and there. But in the end, they all find that real savings require real cuts to coverage, quality and funding, and they lack the guts to do that.

Perhaps Trump will be different, but I think Trump’s instincts run against that. As with calling for a federal abortion ban, he knows that’s unpopular.

It is probably possible to make an at least noticeable difference in the medicare/medicaid bill by cracking down on fraud, without reducing coverage, just because outright billing fraud is so common. Remember, these are single payer healthcare, not single provider, and the payer is well known for always paying. For for profit healthcare providers, that's tempting.

A bunch of the somalis convicted of that $250,000,000 COVID child food aid fraud had also been conning Medicaid for "adult daycare services." Some of them were still being paid for running non-existent daycares even after their fraud convictions!
It hasn't made the news much, but there's billions of dollars of theft out there.

Medicare fraud is extremely common. There are entire companies that just ship wildly expensive, random "medical equipment" (which is usually some kind of actual equipment, like a back brace or something) to old people and charge it to Medicare on their behalf, and then just see if the octogenarians can figure out how to file a return through their Byzantine phone trees or website.

The slow Brazilification of America is irreversible either way.

What does this mean?

To expand on what @Primaprimaprima wrote, it means you will have walled communities with armed guards that will provide first world living standards, but will have little to no political power, because huge numbers of black and brown bodies voters will live in the slums outside and demand more and more handouts with each election. At most, left-wing populists will be replaced with right-wing populists for a term.

It means becoming like a Latin American country in terms of racial demographics, standard of living, general texture of the social fabric, etc.

The actions of Trump on immigration and Doge on the budget will set the Brazilification project back by at least a decade, or indefinitely as long as the Republicans can keep winning elections.

Consider that immigration under Biden 2 would have been something like +15 million and under Trump it will probably be negative.

Similarly, there is hope on the budget. A return to 2019 spending would mean a $500 billion budget surplus. While that's not possible due to inflation, the era of mega deficits only started in 2020. We can and will go back to a more reasonable 3% deficit/GDP. When we do, interest rates will fall, reducing our borrowing costs and further reducing the deficit.

Similarly, there is hope on the budget. A return to 2019 spending would mean a $500 billion budget surplus. While that's not possible due to inflation, the era of mega deficits only started in 2020. We can and will go back to a more reasonable 3% deficit/GDP. When we do, interest rates will fall, reducing our borrowing costs and further reducing the deficit.

Actual question- where's the extra spending? Totally understandable that the deficit exploded in 2020 and 2021 due to stimulus packages but those aren't going on anymore. Is it just social security increases due to population aging?

A decent chunk is also interest expense

Yes. And this is what makes the problem more tractable than it may seem at first. If we can get the budget under control, interest rates will come down, which creates a virtuous cycle.

Check out the IRA budget. I haven't even started to wrap my head around the scale of it. It's literally all the crazy "green new deal" stuff they ever asked for. I see articles from WA green groups about how they can't spend all the money.

Consider that immigration under Biden 2 would have been something like +15 million and under Trump it will probably be negative.

It's unclear that Trump can even deport all of the people Biden let in.

Oh, he can't. There's no question about that. The Biden Wave was unprecedented and terrible.

But I think net immigration will be negative for the next 4 years. If Biden had got a second term, that would have resulted in a second Biden Wave and put us firmly on the path towards a Third World future.

I was hoping you were referring to the dystopian movie Brazil, written by written by Terry Gilliam, Charles McKeown, and Tom Stoppard.

I assume this is exaggerating for effect? The US has way too much going for it in comparison to Brazil, from geography to demographics to the structure of their economy, for something like this to happen in the forseeable future.

geography

Sure, the continental US is a valuable piece of land. But as the saying goes, there’s no magic dirt.

demographics

For now. But you have to look at the trend line.

the structure of their economy

Ultimately dependent on and a product of demographics. A high quality population produces high quality conditions, and vice versa.

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