How Can I Help Elon Musk Reduce U.S. Federal Spending, Especially the $2.14 Trillion on Medicare and Medicaid, Value-Based Healthcare Reform?

https://x.com/cb_doge/status/1839757582233416004

Donald Trump on Elon Musk today: “I’m going to get Elon Musk, he’s going to be our cost cutter. I think he can save trillions. I don’t think I can get him full time because he’s a little bit busy sending rockets up and all the things he does”

Regarding the value of Elon Musk to government efficiency, here's my commentary:

According to the financial data I found for the U.S. federal government in the 2023 fiscal year:

- The federal government’s net expenditure was $6.13 trillion.

- The net revenue was $4.44 trillion.

- This resulted in a fiscal deficit of $1.69 trillion.

Spending on Medicare and Medicaid exceeded $2.14 trillion, making it the largest part of the Department of Health and Human Services' expenditure. Pension spending was over $1.2 trillion.

Expenses for Medicare, Social Security, and interest on national debt are considered mandatory for the federal government. These three categories totaled more than $4.4 trillion in the 2023 fiscal year, surpassing the government’s net revenue. These mandatory expenses are inflexible and nearly impossible to significantly reduce.

Elon Musk's business achievements are notable in boosting corporate efficiency and promoting technological innovation. However, running government operations is fundamentally different, particularly in dealing with legally mandated spending and social welfare issues.

Potential impacts of improving government efficiency include:

1. Administrative Efficiency: More efficient management processes, technological innovations, and talent management can reduce administrative costs, but these savings may be marginal compared to the total mandatory spending.

2. Technological Application: Using technology to enhance service delivery efficiency—such as digitization and data analysis—can improve public service quality to some extent.

3. Policy Promotion: Innovations from the private sector could help drive policy innovation and reform, but statutory expenditures are difficult to cut directly through efficiency improvements.

Spending on large welfare programs like pensions and healthcare relies more on legislative adjustments, as these involve complex social and political processes. Thus, even with a strong vision for efficiency improvement, achieving substantial changes in spending is still very challenging. Musk's influence on government efficiency may be more apparent in administrative and technological reforms rather than in directly reducing large mandatory expenditures.

If, according to Trump, Elon Musk's task is to save $1 trillion in spending, effectively reducing the $6.13 trillion to $5.13 trillion, then cutting back on Medicare and Medicaid spending would be essential to achieving this goal.

I have a well-developed idea for compressing government-provided health insurance spending: a value-based payment model. This concept arose from my collaboration with ICCA Global on my therapy.

In our partnership, we developed a unified pricing model: for patients with advanced cancer, our 4-week (21-day) treatment costs a total of $50,000 at the clinic. We guarantee that tumors will shrink by more than 80% (in total volume terms), or we will refund 50% of the cost ($25,000).

Unlike standard hospital billing models, which charge based on services regardless of patient outcomes, our model considers the value provided to the patient. The biggest benefit of a value-based payment model is significantly reducing patient costs and preventing overtreatment. In cancer treatment, overtreatment is common, benefiting only doctors and pharmaceutical companies without actual patient benefits. Given the general low effectiveness of cancer treatments, no doctor or hospital wants to provide any treatment, as the perceived value is minimal.

For example, using new cancer treatments, such as PD-1, U.S. cancer patients incur an average annual cost of approximately $150,000. However, if PD-1 manufacturers guaranteed an 80% tumor reduction, like our model, they might not earn any money since PD-1 often doesn't achieve such reductions. In terms of value, the annual cost for PD-1 shouldn't exceed $10,000, because one study found an objective response rate of 83% (tumor shrinkage of 30% or more), making an 80% reduction an unachievable goal for them.

Thus, even for new drugs like PD-1, the value provided is far less than their price. With our technology (chlorine dioxide tumor injection) and a value-based payment approach, we could reduce PD-1's cost from $150,000 to $10,000. This approach could potentially cut patient payments in half for cancer treatment and, if applied across the U.S. healthcare system, reduce patients' total spending by over 30%. Consequently, U.S. government spending on Medicare and Medicaid could decrease from $2.14 trillion by 30% ($642 billion) to $1.498 trillion.

Clearly, this would help Trump and Elon Musk achieve their budget goals.