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 [email protected].

Host: Derek Thompson

Guests: Michael Geruso and Tim Layton

Producer: Devon Baroldi

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