I knew some people that were initially very optimistic, and I tried to keep an open mind when DOGE got started despite the outlandish claims that they would be able to cut $2 trillion dollars from the budget, but it's apparent at this point that the project has been an extreme failure. It'll probably take a few years to really sort out their damage and overall impact though.
It's also imperative to mention in every DOGE-related discussion and conversation that the funding freeze to USAID is directly responsible for killing thousands of people [0]. Most of the damage done by DOGE can probably be reversed, but the thousands of death as a direct result of actions taken by the richest man in the world should not be forgotten. (Although I'm told there is a bit of uncertainty with any specific figures because the funding disruption also impacted the mechanisms for tracking and reporting deaths.)
I work @ the nih, formerly at the cdc... can I politely ask why they were optimistic? When I first started seeing rumblings about this a year ago, my first thought was "the deficit is entitlement spending; this is a political problem, not a bureaucratic one".
Anyways, like you, I genuinely wish the DOGEsters would have asked us what we thought was inefficient about gov work. I have been in many meetings where 90% of it was spent complaining about compliance. I personally hate the USAJOBS system. Like any big company, there's a lot that can be improved.
Instead, they went scorched-Earth and assumed we were all deep state leeches. Elon acted like he had just done a leveraged buyout of the US government. For me, he remains the most embarrassing man on Earth.
Agreed, anyone who just glanced at federal budget would know, it's Social Security/Medicare/Medicaid/Defense. Touching anything else is just tinkering at edges.
Social Security comes from its own budget paid by a separate tax. When its savings (accrued by that same dedicated tax) runs dry it has to cut spending. It will not, under current law, deficit spend. The only problem to solve there is whether we want to adjust its funding so benefit levels don’t drop in the nearish future.
People bringing it up in discussions of the general budget usually either don’t understand how it’s funded, or are presenting it inaccurately because they want to end it.
This is part of what I meant by "political problem". People see the mainline deficit number without thinking about the underlying stocks/flows of the system. There are feedback loops embedded in this that are unavoidably political (nobody wants to take grandma's retirement money). There's no "founder's mentality" that can avoid this basic fact.
I “blame” it only in the sense that it’s part of the negative cash flow, even if it has its own dedicated pool of cash. I don’t use the term “entitlement” pejoratively.
But I am not a “panic about the deficit” guy. There’s a lot of trivial things we could do: rethink fee for service, negotiate more w/ providers, raise taxes, etc
> Agreed, anyone who just glanced at federal budget would know, it's Social Security/Medicare/Medicaid/Defense.
It's almost a trope/meme to label the US government as "an insurance company with an army":
> Think of the federal government as a gigantic insurance company (with a sideline business in national defense and homeland security), which does its accounting on a cash basis, only counting premiums and payouts as they go in and out the door. An insurance company with cash accounting . . . is an accident waiting to happen.
The U.S. federal budget is now 50 percent consumed by spending for Social Security, a social insurance program; Medicare and Medicaid, two of the largest health insurance programs in the country; and various other social safety net programs which act as insurance plans as well.
Except for one thing. None of these federal insurance programs operate as licensed sanctioned insurance plans as we see in the private sector where money is collected from the individual and invested or managed in a fiduciary manner to build assets to pay for claims in the future.
Voters think they've saved: "I paid my taxes all my life".
But what would it mean for a government to save money over decades?
How else can a government run except on a cash basis?
Aside: I belong to a non-profit health insurance co-op and a non-profit car insurance - they run by matching payouts to premiums and limiting what they cover (e.g. Southern Cross Healthcare is extra healthcare on top of what the NZ government provides). Edit: ooops, I've just noticed my car insurer AMI Insurance which was a mutual insurance company before the Canterbury earthquakes went bust and the government sold it (now part of IAG).
The SSA had actually been collecting 'extra' money (from Baby Boomers) for awhile now and putting off to the side, but that extra income stopped a while ago, and the trust fund where it was stored was being tapped to keep benefits up.
The "shortage" in Social Security that is sometimes in the US news is the estimated time when the 'extra' funds run out, and benefits will only be covered in cashflows.
And this is not sudden thing: many government pension systems in the world are facing similar situations. The politicians in the US have not done anything about (for decades), whereas Canada did decide to change their system:
> when the 'extra' funds run out, and benefits will only be covered in cashflows
The issue is that the necessary delivered services is a kinda fixed amount that the economy should deliver. The economy can't really "save" money. A government can choose to change taxes, change benefits, sell assets (to who?), or burden the next generation with debts (e.g. via mortgages).
Talking about money between generations is often just fictional accounting.
The US has done something about it, they raised the retirement age to 67. But that was more of a band aid.
The real solution is to raise the maximum SSA payment or eliminate it all together.
That said, even if the government does nothing, it's not as if SSA goes away. Instead, the payments are reduced (Last I saw, it was around 75% of current payments). That'd suck, for sure, but it's not the all or nothing framing.
American soldiers I've met overseas seemed to think the defense department is mainly a social healthcare/education/jobs program. Perhaps these need to be split from the defense budget, and applied to the entire population.
> "the deficit is entitlement spending; this is a political problem, not a bureaucratic one".
Sort of? Medicare is about a trillion dollars, but what percentage of that is actually helping people and how much is going to unnecessary tests or fraud or overpaying for things? If e.g. HHS issues some bad rules that increase healthcare costs, that increases the cost of Medicare and Medicaid and the VA, but if you're doing it properly you're not ignoring that part of HHS just because its regulatory budget is comparatively smaller when it's doing things that incur billions in indirect costs.
Moreover, you can't find a trillion dollars in a program that costs a million dollars, but if it costs a million dollars and isn't worth a million dollars then that's not a reason to keep it.
And nobody can claim with a straight face that the military budget contains no inefficiencies, but that's not entitlement spending.
> Instead, they went scorched-Earth and assumed we were all deep state leeches.
The general problem is that nobody wants their thing to be the thing that gets cut even when it's the thing that ought to be, and then how do you tell if something is actually important when somebody will claim that everything is? It's legitimately a hard problem and DOGE did not succeed in solving it, but that means we need a solution that actually works or people are going to keep coming at you with knives drawn because the status quo is untenable.
Any serious attempt at reducing the deficit would mean confronting one of the largest sectors of the American economy. All of the stuff you mentioned - pointless tests, upcoding fraud, etc - is part of that.
It is not irrational to cut millions in wasteful spending. It is irrational for a department of government efficiency to spend all of its energy cutting random million dollar contracts instead of figuring out how to plan the attack for the confrontation above.
DOGE did not fail because its a hard problem. They failed because they thought it was easy. Taking over a company with a thousand employees is categorically different than revamping the spending of the United States.
DOGE "failed" because cutting the budget wasn't their real goal.
Here are a few outcomes they were able to achieve:
(1) Cutting funding for agencies and organizations that were investigating companies run by Elon Musk.
(2) Cutting funding for organizations, like NOAA, that have high economic returns for every dollar the government spent on them.
(3) Copying information from multiple government databases.
(1) had immediate benefits to Musk. (2) leaves openings for someone with enough capital to fill in the gaps left behind and make a profit charging for what used to be a government service. (3) provides numerous long term benefits to Musk and anyone else with access to that data.
> Cutting funding for agencies and organizations that were investigating companies run by Elon Musk.
Which doesn't make any sense because you don't need to cut their funding when it's your buddies in office. They just don't investigate you anymore regardless of their funding level.
> Cutting funding for organizations, like NOAA, that have high economic returns for every dollar the government spent on them.
It's obvious why fossil fuel companies (and therefore Trump) would want to do this, but Musk is the guy who does electric cars and grid storage batteries. His financial incentive would be to play up the dangers of climate change.
And this is the same as the first one. If your guy is in office then you don't need to cut the funding of some agency under your own control, you just have them stop doing whatever it is you don't want them to do anymore.
> Copying information from multiple government databases.
The only reason DOGE could copy them to begin with is that they were already in control of the government and therefore already had access to the databases. If you want to complain about something, how about why does the government keep all of this sensitive information instead of encouraging systems that use decentralized identity or don't imply or require mass surveillance in order to operate? Every administration has access to that when they get elected, including the ones you don't like, so let's not have it to begin with.
> (2) leaves openings for someone with enough capital to fill in the gaps left behind and make a profit charging for what used to be a government service.
If this was actually a profitable market then there would be no reason for it to be a government service to begin with. But it isn't, because collecting the data is expensive and there aren't a lot of buyers. If anything getting rid of NOAA would cost SpaceX money because NOAA pays SpaceX to launch satellites, and nobody else is going to do it.
Republicans want to cut NOAA because they publish climate data and the fossil fuel industry is a Republican constituency. But you don't need DOGE for that when the Republicans control Congress.
They were completely feckless at finding the right things to cut but this stuff is conspiracy theories.
> Any serious attempt at reducing the deficit would mean confronting one of the largest sectors of the American economy. All of the stuff you mentioned - pointless tests, upcoding fraud, etc - is part of that.
Which is exactly what they should have been doing. It's blatantly obvious that they failed -- federal spending went up year over year.
But that means the problem remains and someone's going to have to take another go at it.
The budget is determined by what's written on a piece of paper that Congress eventually passes. You don't have to be a member of Congress to be the one drafting it or making recommendations.
I believe their argument was that the Impoundment Act is unconstitutional because Congress can appropriate money for something, and the executive branch can't take that and use it for something else, but Congress doesn't have the power to make them do something with it instead of just not spending it at all. It's basically a checks and balances argument; to get the government to do something you need Congress to appropriate money for it and the President to implement it and if either of them says no then it's not happening.
The executive can't unilaterally declare something is unconstitutional. The impoundment act was passed to prevent exactly this because that's exactly what Nixon did. The executive doesn't make the laws and congress literally already litigated this. If you want it to be unconstitutional then take it up with the supreme court, otherwise you're just indulging in lawlessness. This is a ridiculous argument.
> The executive can't unilaterally declare something is unconstitutional.
Any of the branches can do that. The courts don't need the permission of Congress or the President to strike down a law. Congress doesn't need anyone's permission to refuse to pass something because they think it's unconstitutional.
Consider what prosecutorial discretion is.
> The impoundment act was passed to prevent exactly this because that's exactly what Nixon did.
Congress passed it, but Congress frequently does unconstitutional things and then one of the other branches has to put a stop to it because that's how checks and balances work.
What do you suppose would happen if Congress passed a First Amendment-violating censorship law, the courts struck it down and then Congress passed a second law saying the courts have to uphold the first one?
I've followed DOGE closely and haven't heard anything that would indicate they were even trying to reduce unnecessary medicare spending. Where I have heard that they've tried to touch healthcare spending, they've made a huge mess. For instance, they cancelled a lot of support contracts at the VA, but many of those contracts did necessary things, like maintaining complex machinery. If you read ProPublica's article on DOGE at the VA, it's pretty clear that this was done incredibly quickly by a guy with zero healthcare knowledge using a minimal prompt and wasn't even directing the AI to read the most important parts of the contract. https://www.propublica.org/article/trump-doge-veterans-affai...
There seems to be some indication that they hired some incompetent people and/or were prohibited from cutting some of the things that ought to be cut. And I don't think there is any question that the deadline they set for themselves was unrealistically aggressive.
Which means we need someone to go back and do it properly, not that it doesn't need to be done.
Sure it can, by the atorneys general. A core part of their job is identifying, stopping, and prosecuting fraud and waste spending in the government.
Doge was never legal, but there were agencies that had the statutory power to do what doge wanted. However, they also could investigate things like emoluments violations which is precisely why they were some of the first to be fired.
They could just go after Medicare fraud (committed largely by extremely wealthy corporations in extremely detectable ways), get an easy $100B or so under their belt, then reconvene on next steps.
That'd require them to be willing to go after their grifter buddies, and to understand anything about our institutions other than what they read on Twitter.
> The general problem is that nobody wants their thing to be the thing that gets cut even when it's the thing that ought to be, and then how do you tell if something is actually important when somebody will claim that everything is?
We have a process for this. It's called appropriations. It happens in Congress.
> They could just go after Medicare fraud (committed largely by extremely wealthy corporations in extremely detectable ways), get an easy $100B or so under their belt
My impression of the 2025 feud between Musk and Trump is that Musk actually wanted to do stuff like that and Trump wouldn't do it.
And they should do it, but this year's deficit is ~$1.8T despite federal receipts pushing the record high in real dollars per capita (as usual) and consistent with historical norms as a percent of GDP.
So what about the other $1.7T?
> We have a process for this. It's called appropriations. It happens in Congress.
We also have some strong empirical evidence that the outcome of that process is huge deficits, so something has to change if it's not to stay the same.
But we were set to pay off the nation debt by 2013 before Bush tax cuts. Bush’s tarp, Trump tax cuts plus Covid were the other nails in the coffin of debt reduction.
Starve the beast has been an official Republican strategy for 40 years.
It went way, way up during WWII and hasn't changed much since. And that's relative to GDP over a period that real GDP per capita increased significantly, i.e. government revenue in real dollars per capita is through the roof.
The US tax system has an evolved defect where the tax brackets are set in nominal dollars and then as inflation pushes everyone into the next highest bracket Congress periodically gets to claim credit for passing a "tax cut" without actually reducing the level of real government revenue -- indeed it has been going up enough to keep up with real GDP growth. And if you confuse that with an actual tax cut then you can write articles where "without the tax cut" there would be more revenue, but only because there is an implicit continuous tax increase baked into the tax code to allow Congress to repeatedly tell everyone that up is down.
It's not a revenue problem. Revenue is up. It's a spending problem.
> We also have some strong empirical evidence that the outcome of that process is huge deficits, so something has to change if it's not to stay the same.
Get on the barricades and start the revolution then.
> He said "Entitlements like Medicare and Medicaid need to be eliminated."
The only thing on the internet that search engines turn up for that exact quote is your post. Here's the actual quote:
> “Most of the federal spending is entitlements. So that’s the big one to eliminate. That’s the sort of half trillion, maybe six, 700 billion,” Musk said on Monday in an interview with Fox Business’ Larry Kudlow. Musk’s comments came in response to a question from Kudlow about whether there would be a report on targeting waste, fraud and abuse in federal spending.
Medicare is around a trillion dollars by itself, so those numbers don't make any sense as the removal of entire programs, but total entitlement spending is several trillion in total and a reduction in those amounts would make sense in the context of targeting waste, fraud and abuse in entitlement spending, which is the thing he was being asked about.
> unnecessary tests or fraud or overpaying for things?
Glad you ask. That was the job of the Attorneys general to figure out. A core part of their task was finding and eliminating waste, fraud, and abuse.
They were fired almost day one of the Trump admin. DOGE's notion that the actual gov spending was in the employees was laughable. If we actually wanted to eliminate waste then we should have put more employees in the AG and IRS, not done mass firings from those agencies.
The other part to mention is that Medicare Part C, putting public dollars into private insurers, has lead to a huge amount of the fraud. Those useless tests have often been done by these private insurance agencies because they can easily bill the government for them.
Eliminating that public/private partnership is exactly what will save money. Our inefficiencies are largely due to our reliance on the private sector to backfill what the government isn't doing.
> They were fired almost day one of the Trump admin.
And then they hired different ones. Which in and of itself has nothing to do with it.
> The other part to mention is that Medicare Part C, putting public dollars into private insurers, has lead to a huge amount of the fraud. Those useless tests have often been done by these private insurance agencies because they can easily bill the government for them.
That's not the half of it though. The entire US healthcare industry is full of corruption and inefficiency. In general it's the providers who want the unnecessary tests, not the insurance companies.
> Our inefficiencies are largely due to our reliance on the private sector to backfill what the government isn't doing.
I feel like this is why we never solve it. The Democrats insist that the only solution is for the government take the whole thing over, the Republicans point to people in France waiting a year for an appointment and then nothing changes because they're both taking money from the industry so neither of them are trying to fix the real problem.
Because what you need is to set up non-emergency care to have actual competition. If you need an X-ray some time in the next month, a computer gives you a list of every office with an open appointment, their price and their distance from you. The providers charge between $50 and $200 but some are closer to you or have sooner appointments, the insurance pays $50 no matter where you go and then you get to pick but you pay the difference.
You need the patient to have the ability to say "you know what, the one that's 10 minutes closer isn't worth $120 extra" and pick the less expensive one, because then they actually have the incentive to get prices under control, instead of the current insanity where just getting them to tell you how much something is going to cost is like pulling teeth and the government subsidizes getting your health insurance through your employer in the tax code to keep it that way.
Because I think everyone agrees there is extreme amounts of waste in government spending and budgets. I was hopeful when they announced DOGE but imo they went about it entirely wrong.
Any “we’re going to fix waste in the government and reduce the deficit” project that doesn’t lead with “… so first we’re going to review the last twenty years of recommendations from the CBO and GAO and start implementing what they say or imply we should do to meet those goals” is almost certainly bullshit.
Being optimistic about this one was one of those “having a mind so open your brain falls out” sorts of things.
Yep. There’s an entire catalog already built of deeply researched inefficiencies in the government.
What a shame that DOGE burned a huge portion of this generation’s willingness to take a bold approach to said inefficiencies. Similar efforts will be tainted for years.
It is not remotely a failure. As a vessel for achieving project 2025 goals, the clear purpose of DOGE, it was successful. It's just that the successes it achieved are reprehensible.
They want to to shut down large portions of the government. For example, they want to completely eliminate all public education, not make it more efficient.
That was not the clear purpose of DOGE. The Trump campaign deliberately distanced itself from Project 2025. If they had been honest about their intent to enact Project 2025 to voters, they would have lost.
Agreed. Anyone with a modicum of common sense knew this was the plan all along. It's not like it was hard to find people saying this before the election.
I'm not excusing elected officials. I would go further and blame Vivek Ramaswamy for playing a huge part in pitching the failed DOGE. I'm just pointing out that the Trump admin deliberately lied about its connection to Project 2025, which made DOGE's connection unclear to people who consume Fox News etc.
People are downing my comment for suggesting that many people who don't take the internet straight into their veins every day might have had a hard time connecting the dots between DOGE and Project 2025.
I think at some point people need to take some accountability for their own information ecosystem.
It really is a Catch-22 though, since the imperative and ability to do that is itself derivative of the information ecosystem.
Which is why I blame, more than anyone else, the actual smart people (largely cynical, craven, and greedy) who didn’t through their weight against this stuff when it could’ve mattered.
All they had to do was skim any decent daily, weekly, or monthly newspaper or news magazine in 2024. Folks whose only news sources are Facebook shares and Fox News are simply stupid. The reason they don’t know WTF is going on may be due to their news sources, but they chose those. That’s a really stupid thing to do.
Well, sure. There’s most of a century of science behind the finding that votes aren’t really made or motivated by the things a democratic idealist might hope they are, nor do most voters have half a clue what’s going on or how anything works.
All modern campaigns assume large segments of the electorate are very dumb. Because they in-fact are. You’ll get your ass handed to you by a less-idealistic campaign every time if you pretend things are otherwise.
The trouble now is the huge private media empire capitalizing on that fact was deliberately built over a period of 40+ years and is now entrenched. Countering that is gonna be hard and take generations. Everyone alive now is going to have to suffer for decades before it maybe gets better.
> would go further and blame Vivek Ramaswamy for playing a huge part in pitching the failed DOGE
Ramaswamy is a useless idiot. He wasn’t useful in getting DOGE to exist. (He rallied voters in states Trump couldn’t or otherwise would have won. It’s why he was easily cast aside–he didn’t bring anything to the table.)
I know people who didn’t know the government had shut down until more than two weeks into it (and on discovering it were like “oh shit this might affect us!” because their whole lifestyle depends on money from the government).
The same people didn’t know the east wing had been torn down until a couple weeks after it happened.
In both cases they only found out when my wife told them.
They pay attention to lots of “news” but it’s AI videos of mass crimes and viral “look how bad democrats are” garbage.
That people are dense motherfuckers (can we stop sugar coating how stupid these people are if they’re surprised about any of these things? I mean dumb as a bag of hammers kinds of dumb, dimmest bulb in a box of broken bulbs, that level of dumb) doesn’t mean this wasn’t clear.
It is 100% these morons’ own fault they’re surprised.
I think you're being too harsh. "Dense motherfuckers"?
My own sense is that these people are willfully ignorant. That is, they seek to find confirmation of what they already believe. Kind of human nature, really. It's sad that there is a complete infrastructure that spouts what these people want to hear, make lots of money doing so.
I’m done with treating willful morons nicely. The last year has turned me from a Vonnegut to a Twain, if you will. A good chunk of My Fellow Americans are just awful, and after 25ish years of serious political awareness & attention and watching what’s happened over that time my benefit-of-the-doubt tanks are dry, having been siphoned at high rates continuously that entire time. Probably I was myself stupid ever to have thought better of these dangerous dipshits. It’s not like I wasn’t pretty familiar with history, but somehow, it took watching people be extremely dumb and never learn over a long period to break through what I suppose was some kind of savior-complex ego thing that made me want to be the kind of person who believed people were mostly pretty good. How embarrassing.
They’re dense motherfuckers, and that’s the generous take. They’re a black hole of stupid. That’s the level of density we’re dealing with. And that’s just the America I’ll be living with until I die. One that’s been trashed so thoroughly by the idiot brigade that hope for actual improvement is gone for, best case, several more decades, which will amount to the rest of my life.
They’ve wrecked shit out beyond the horizon of my plausible lifespan, in all likelihood. They’ve been continuously working toward doing this my whole life. No, I’m absolutely not being too harsh.
Maybe cutting some slack would be more appropriate if the voting public didn't make decisions that end up killing a large number of people and turning the U.S. into a fascist state.
>No, it wasn't clear. I know several Trump voters who either didn't know Project 2025 existed or believed the lies that it was a liberal hoax.
>To anyone paying an ounce of attention, yeah it might have been clear.
Many, many folks were out there long before the election saying (both as promises -- from the Trumpers and warnings -- from pretty much everyone else) that Project 2025 would be the blueprint for a new Trump administration.
That some folks either ignored or disbelieved it doesn't make it "unclear." Rather, it means that a lot of people believed the lies. Which says more about those who believed such lies than it does about everyone else.
And to put a fine point on it, what more could others have done to disabuse those folks of the lies told them by the Trump campaign? Seriously.
I think this article is correct in spirit but a little disingenuous in parts. Would it not be more fair to blame Russia as the primary cause for the deaths in Ukraine due to the collapsing health care system rather than USAID subsequently intervening to stop easily preventable deaths.
I say this not to defend DOGE but rather to emphasize that we should always make abundantly clear the humanitarian disaster in Ukraine lies solely with Putin
> Brooke Nichols, the Boston University epidemiologist and mathematical modeller, has maintained a respected tracker of current impact. The model is conservative, assuming, for example, that the State Department will fully sustain the programs that remain. As of November 5th, it estimated that U.S.A.I.D.’s dismantling has already caused the deaths of six hundred thousand people, two-thirds of them children.
Which links to Impact Counter [0], if you want to read more on how they reached those figures.
I think it's fair to say with absolute certainty that thousands of people have died as a direct result of dismantling USAID, but that we aren't certain of the exact magnitude. One model estimated it's around 600 thousand, but we don't have exact figures because of the disruptions.
Do you think there's a way this could be communicated more clearly? I'm not trying to be deceptive in how I present this information, and I could be persuaded to re-evaluate the exact figure if presented with a better analysis.
For one thing maybe they could try being honest. Looking at the methodology it seems like the calculation here is a completely unrealistic absolute upper bound of how many lives could have been saved:
> Based on the budget for the 2024 financial year, USAID's nutrition program was allocated $168 million dollars [3]:. It is estimated that the cost of treating a child for severe malnutrition, while varied by context, is between $100-$200 [4]:. Assuming: a similar budget of $160 million dollars in 2025, that this budget is utilized for treatment of severe acute malnutrition in children and that on average treatment per child costs $150 (midpoint of range), approximately 1.12 million children with severe malnutrition would remain untreated as a result of USAID funding freeze and discontinuation in 2025.
> This would result in approximately 168,000 (112,000 – 224,000) annual deaths in children under 5. Additionally, children who survive but do not receive treatment will love with long-term morbidity. One element of this is compromised immune systems, leaving them vulnerable to other infections like diarrheal disease and pneumonia. These estimates do not capture that morbidity.
It assumes that 100% of the funding went to treating children with malnutrition. First of all its doubtful that even the intent of the program was to spend 100% of the money on that in particular. And even if it was, this is clearly false because even a super efficiently run program to help starving children is going to have massive overhead, so not even close to 100% of the funding would be spent that way. It's not like starving children of the world are located around major logistics hubs, so I would be absolutely shocked if they could even get close to 50% here. It also assumes that you only have to treat each child once. So ok, you treat a child for malnutrition and then what? You send him back out into the same place where he couldn't get food in the first place? There's just so much wrong with this number that I have a hard time believing you are even asking in good faith.
If you look at the sources for the $100-200 figure, she's looking at a particular form of humanitarian aid - community-based therapeutic care for children with severe acute malnutrition. There are other models like inpatient programs that are more expensive, but also reach fewer children, and then if you're supporting people who don't have severe acute malnutrition it's presumably much less expensive because you don't have to include the healthcare costs.
If you look at the papers that are being cited, these programs are incredibly effective:
> A total of 328 patient cards/records of children treated in the programs were reviewed; out of which 306 (157 CTC and 149 TFC) were traced back to their households to interview their caretakers. The cure rate in TFC was 95.36% compared to 94.30% in CTC. The death rate in TFC was 0% and in CTC 1.2%. The mean cost per child treated was $284.56 in TFC and $134.88 in CTC.
If you look at what they mean by CTC program, it's ongoing support in addition to the treatment for acute malnutrition, so it's not just throwing a child back into the same environment:
> CTC programs use decentralized networks of outpatient treatment sites (usually located at existing primary health-care facilities), small inpatient units (usually located in existing local hospital facilities), and large numbers of community-based volunteers to provide case detection and some follow-up of patients in their home environments. Patients with severe malnutrition, with good appetite, and without medical complications are treated in an outpatient therapeutic program (OTP) that provides ready-to-use therapeutic food (RUTF) and medicines to treat simple medical conditions. The food and medicines are taken at home, and the patient attends an OTP site weekly or fortnightly for monitoring and resupply.
In terms of overhead, the overhead for the organization providing care is already accounted for in the $100-200 figure, including the costs of managing the program from the capital. Presumably Save The Children takes a chunk of the grant for its own overhead but I believe these costs are typically capped by the US government at something like 10%. Similarly, USAID has its own costs but I'm not sure if those are accounted for in the $168m line item or if they're accounted for elsewhere.
So, sure, Nichols' paper is using a cost estimate that's based on specific types of programs and generalizing that. Given the number of countries and organizations involved, I'm not sure how much more accurate you could get.
But your cynicism is also pretty unfounded. The sources take into account the organization's overhead, the logistics of reaching remote areas (the Ethiopia paper points out that much of the overhead goes to vehicle rental and gives a distribution of patients by how far they have to walk to get to the treatment center). It accounts for ongoing vs acute care.
So I wouldn't take 168,000 number especially seriously - and I would note that the author adds some very large error bars - but I also wouldn't dismiss it as a complete fiction.
I’m not totally sure what point you’re making, but I don’t see an inconsistency between the two portions of comment that you quoted here.
“Thousands of people” covers at least 3 orders of magnitude, depending how loose you get with the language… I don’t see the contradiction in “the error bands are wider without the high-fidelity surveillance, but even from fuzzier sources, the absolute minimum is definitely in the thousands.”
The implication is that the death toll is under-reported due to the disruption of the means by which those deaths would be reported and logged. In other words, those thousands of deaths are just the ones we know about.
We should also not ignore the fact that USAID was responsible for many hundreds of millions (if not more) in fraudulently directed contracts and spending [1].
And that makes those deaths fine and dandy, or what do you mean now? When I go to the hospital I don't expect to be killed to fix my cancer, even though it would indeed make me cancer free.
It's also imperative to mention in every DOGE-related discussion and conversation that the funding freeze to USAID is directly responsible for killing thousands of people [0]. Most of the damage done by DOGE can probably be reversed, but the thousands of death as a direct result of actions taken by the richest man in the world should not be forgotten. (Although I'm told there is a bit of uncertainty with any specific figures because the funding disruption also impacted the mechanisms for tracking and reporting deaths.)
[0] https://www.newyorker.com/culture/the-new-yorker-documentary...