THE SET-UP: Disruption and efficiency. That’s the cocktail Elon’s been swilling since Election Day and he’s kinda drunk with power … from his widely-reported influence over Trump’s Cabinet picks to, of course, his ethically fraught plan to lay waste to the Federal government under the guise of flaying waste from the body politic.
Is it possible that his Dept. Of Gov’t Efficiency will actually do some good by peeling away layers of redundancy and stripping some of the budgetary fat that bloats federal agencies like the Defense Department?
Perhaps.
Or perhaps this will be like other private sector efforts to impose “efficiency” on departments and programs many Americans depend upon. To wit, I offer you a case-in-point before moving on to the make-up and motivations of the Tech Bros currently salivating at the opportunity to manifest their inner Ayn Rand by moving fast and breaking things that get in the way of their utopian vision of unimpeded power.
As such, disruption and efficiency could end up being a recipe for disaster, but only for the people least able to afford it. - jp
TITLE: Florida’s Deloitte-Run Computer System Cut Off New Moms Entitled to Medicaid
https://kffhealthnews.org/news/article/florida-deloitte-medicaid-computer-system-women-pregnancy-disenroll/
EXCERPTS: An unknown number of mothers in Florida have abruptly lost Medicaid coverage after giving birth, despite being eligible, according to an ongoing federal lawsuit filed against the state in August 2023. The issue is linked to the state’s computer eligibility system, run by Deloitte Consulting, according to trial testimony from state and Deloitte employees. It is yet one more example of problems states and beneficiaries have encountered with Medicaid management systems operated by Deloitte, a giant consulting firm.
As of July, Florida had awarded the global firm contracts valued at more than $100 million to modernize, operate, and maintain the state’s integrated eligibility system for Medicaid and other benefits.
Deloitte did not respond to requests for comment about its work in Florida.
In total, 25 states have awarded Deloitte eligibility system contracts, making the company the dominant player in this crucial slice of government business. These agreements, in which Deloitte commits to design, develop, or operate state-owned systems, are worth at least $6 billion, according to a KFF Health News analysis of state contracts.
The KFF investigation found that errors in Deloitte-run eligibility systems can cost millions and take years to fix while denying benefits like health insurance to eligible people.
In response to the investigation, Deloitte spokesperson Karen Walsh said the firm’s clients — state governments — “understand large system implementations are challenging due to the complexity of the programs they support and that all IT systems require ongoing maintenance, periodic enhancements and upgrades to software and hardware, and database management.”
Senate Democrat John Fetterman of Pennsylvania, which is one of Deloitte’s state clients, sees it much differently. “Let’s call this what it is: a racket,” he said. “This isn’t an occasional glitch. It’s a pattern of systemic failure. And the worst part? We’re paying them billions to do it.”
In July, Kimber Taylor of Jacksonville and Lily Mezquita of Orlando testified in a federal courtroom in Florida that state officials removed them from Medicaid even though their pregnancies made them eligible. The class-action lawsuit alleges that Florida did not adequately explain to people with Medicaid the reason for cutting their health insurance, or explain to them that they could appeal the decision before losing coverage.
Florida has denied the allegations in court filings. But the trial revealed problems with the computer system the state uses to determine Medicaid eligibility and inform people that they are no longer eligible. Deloitte did not respond to questions about the trial, in which a judge’s decision is pending.
Although Deloitte is not a named defendant in the lawsuit, an employee was called to testify about the firm’s role in operating Florida’s eligibility system. Harikumar Kallumkal, a Deloitte managing director who is responsible for Florida’s system, said that a “defect” may have led to coverage losses for new mothers.
William Roberts, a state worker who reviews Medicaid eligibility decisions, also testified that the agency learned about a “glitch” that cut postpartum coverage for eligible new mothers in April 2023 — the same month Florida launched a Medicaid eligibility review process known as “unwinding,” which all states undertook after pandemic-era coverage protections ended in March of that year. Kallumkal testified that Deloitte fixed the problem by April or May 2024.
During the unwinding, Florida disenrolled nearly 2 million people, including kids, from Medicaid, according to the Centers for Medicare & Medicaid Services.
Patient advocates say flaws in Florida’s Deloitte-operated computer system prevented some of the state’s most vulnerable residents from getting care they were entitled to receive.
“Florida’s Medicaid officials knew from the start of the unwinding period that their system was not handling pregnancy and postpartum Medicaid correctly, and proceeded full steam ahead anyway,” said Lynn Hearn, an attorney with the Florida Health Justice Project, a nonprofit legal aid and advocacy group that together with the National Health Law Program represents the class-action plaintiffs. “To this day, we don’t know that the problems have been fully corrected. The mothers of this state deserve better from their government.”
Medicaid is the largest insurance payer for childbirths in Florida, covering nearly 98,000, or 44%, of all deliveries in 2022, according to the state health department. But it’s unclear how many mothers have been cut from the Medicaid coverage they were entitled to receive. Florida’s Department of Children and Families on Sept. 9 cashed a check from KFF Health News to cover the processing fee for records it requested about eligible mothers who were disenrolled. As of Nov. 22, the state had not released the records.
While the class-action lawsuit awaits a judgment, the problems revealed at trial echo those encountered in other states with Deloitte-run Medicaid eligibility systems, such as Arkansas, Colorado, Florida, Georgia, Kentucky, Michigan, Pennsylvania, Rhode Island, Tennessee, and Texas.
In Texas, according to a July report by the U.S. Government Accountability Office, “about 100,000 eligible individuals had been disenrolled due to eligibility system errors,” including denial of postpartum coverage for some eligible women.
The error-plagued systems and widespread denials of Medicaid for eligible people have caught the attention of lawmakers on congressional committees that oversee social programs. They blame state leaders who they say aren’t holding vendors like Deloitte accountable.
“As the errors compound, contractors are rewarded with more billing hours and higher payouts,” said Rep. Lloyd Doggett (D-Texas). “This is an alarming and unacceptable waste of taxpayer dollars.”
Sen. Ron Wyden (D-Ore.), chairman of the Senate Finance Committee, which oversees Medicaid, said that too many people “can’t even get in through the front door due to outdated and inaccurate eligibility systems.”
And Rep. Kathy Castor (D-Fla.) said that “there’s such a pattern of trying to discourage and inappropriately cutting families off of Medicaid in Florida.”
“It appears to be intentional,” she said, “and I think it clearly is.”
TITLE: ‘Patriotism, Ego, Access’: Why Elon Musk’s DOGE Is Attracting Young Coders And Tech CEOs Alike
https://www.forbes.com/sites/alexkonrad/2024/11/27/elon-musk-doge-attracts-young-coders-and-tech-ceos/
EXCERPTS: DOGE will expect staffers to relocate to Washington, D.C. for the next 12 to 18 months, working on the job full-time, the sources said. Musk and Ramaswamy already have access to influential billionaires like a16z cofounder and investor Marc Andreessen and former Uber CEO Travis Kalanick to serve as informal advisers, noted one; what DOGE needs are rank-and-file staffers to execute on its goals, working as much as 100 hours per week in a sprint reminiscent of Musk’s product deadlines at his businesses SpaceX, Tesla and X.
Those who have applied cited a range of motivations, both professional and civic. “This is a chance to work on the reverse ‘New Deal,’” said one college-aged DOGE applicant. “It’s not the Manhattan Project: these aren’t physicists, but 22-year-old engineers.”
A college student studying computer science in the Bay Area who applied to DOGE through X said they were motivated by the opportunity to bring a “technologist’s perspective" to government. “This is the type of thing you don’t really get to do too often,” they said. “If you’re not working on a startup, you could take a Big Tech engineering job, really coasting, or you can do this and really work hard on something meaningful. Obviously, it will not be the most glamorous thing.”
At the University of Arizona, computer science and philosophy student Shawki Sukkar said he hoped to apply to assist in dismantling the “administrative state” that has “had a very terrible influence on culture in the U.S.” A Syrian immigrant, Sukkar said he was concerned by the government’s “undermining of the Angle-Saxon tradition of classical virtues,” and hoped that Musk could embody a new era of “natural aristocracy,” an early 19th century political theory developed by Thomas Jefferson in which the most talented and virtuous citizens form a new leadership class.
Sukkar hopes to build a model of spending excesses in Democrat-voting blue states using software from Palantir, the Peter Thiel cofounded analytics company, over his college winter break, then apply to DOGE with the results.
Others hope DOGE takes a more moderate approach. Several applicants said they empathized with government officials who might lose their jobs because of DOGE’s activities and called for reinvestment of resources that DOGE could identify as misused.
Justin Intal, a former cofounder at payments startup Forage, said his experience working there to bring food stamp credits online made him hopeful that DOGE could improve how startups work with government bodies like the Department of Agriculture. Intal is currently participating in a group chat of YC founders, he said, thinking of other possibilities for government-facing innovation.
“Elon has touched on how there will be short-term pain, and a lot of people unemployed in the short-term,” said venture capitalist Brandon Brooks, a former partner at Overlooked Ventures in Pittsburgh. Brooks hopes to work with DOGE on improving the efficiency of the State Small Business Credit Initiative, a program intended to spur nearly $10 billion in financing for such efforts, and which has achieved just under one-third of that target to date. “The answer will be to invigorate the private sector with more small businesses and more startups.”
Several DOGE applicants said they had no illusions about the organization’s long odds for achieving its goals. They noted that a previous attempt at eliminating government waste, a survey under the Reagan Administration known as the Grace Commission, proved largely ineffective in the 1980s. Such long odds were worth it for the chance at success, they argued. “A chance to see change is better than not doing anything,” said Dean, the crypto applicant.
[Two-time startup founder and CEO Chinmay Singh Singh] said he hoped that DOGE would tap veteran tech leaders like himself to tackle “the deeper problems.” One of the college-aged DOGE applicants noted that many of their peers remained interested in DOGE as more of a summer or part-time role. “A friend said it would be fun if it was a three-month civil service program,” they said. “People in tech don’t always have a high sense of civic duty.”
But for others, one allure of DOGE is the potential career boost — a forged-in-fire experience similar to working under Kalanick at Uber, or after Musk’s takeover of X. One DOGE applicant pointed to a comment made by Figma CEO Dylan Field on X on Monday as “very good, pro-DOGE propaganda”: “I’d wager that in 10-20 years the group that works on DOGE will be the next PayPal Mafia,” Field posted.
TITLE: Musk’s DOGE Plans Rely on White House Budget Office. Conflicts Await.
https://www.wsj.com/politics/policy/elon-musk-doge-conflict-of-interest-b1202437
EXCERPTS: Musk and Ramaswamy encouraged Trump to reappoint as OMB director Russell Vought, who led the office during Trump’s first term, a person with knowledge of their discussions said. Trump picked Vought for the role on Nov. 22.
Vought contributed to the conservative Heritage Foundation’s Project 2025, a more-than- 800-page blueprint for the incoming Republican administration. Vought wrote a chapter titled “Executive Office of the President of the United States,” explaining how he believes the director and political appointees of the OMB, and not career officials, should guide it.
Vought met over the summer with Robert F. Kennedy Jr., Trump’s pick to lead the Department of Health and Human Services, people familiar with the meeting said. The OMB oversees regulations affecting the Food and Drug Administration, the HHS division overseeing the safety of the clinical trials for Musk’s brain-computer interface company, Neuralink.
The OMB influences regulations and budgetary matters across federal departments that oversee Tesla and SpaceX, including the Transportation and Defense departments and the National Aeronautics and Space Administration. Tesla and SpaceX have lobbied OMB for years, according to lobbying disclosures. SpaceX recently won government contracts of more than $700 million.
“They are the central portal through which all regulatory efforts must go,” said Danielle Brian, president of Project On Government Oversight, an independent watchdog group.
Musk’s influence over the budget agency could give his companies an easier path to federal approvals and contracts in part because it is responsible for developing policies and regulations for federal contractors, Brian said. “It is literally giving him the keys to the kingdom to help his business interests get a leg up compared to their competitors,” she said.
SpaceX Chief Operating Officer Gwynne Shotwell said at a conference organized by Baron Capital in New York on Nov. 15 that regulators have slowed innovation.
Palmer Luckey, a founder of Anduril Industries, a military-technology company, addressed a Trump-allied donor network known as the Rockbridge Network in Las Vegas at the Four Seasons hotel on Nov. 11 about easing restrictions on government contracting with companies, according to a person at the meeting.
Anduril has business with the federal government. The company announced in October that it won a more than $240 million government contract to help enhance U.S. air defense.
Musk wrote to Luckey on X the day after the election that Anduril should have more opportunities to work for defense and intelligence agencies.
“Very important to open DoD/Intel to entrepreneurial companies like yours. Pay for outcomes, not requirements documents,” Musk wrote.
SEE ALSO:
Trump's gift to Musk: a conflict of interest for billions
https://fakti.bg/en/mnenia/930273-trump-s-gift-to-musk-a-conflict-of-interest-for-billions
Trump White House Picks, Including Elon Musk And Scott Bessent, Spark Conflict Of Interest Concerns: 'Potentially The Greatest Ethics Cataclysm In The History Of Our Government'
https://www.benzinga.com/media/24/11/42239913/trump-white-house-picks-including-elon-musk-and-scott-bessent-spark-conflict-of-interest-concerns-potentially-the-greatest-ethics-cataclysm-in-the-history-of-our-government
Trump tariffs risk turning American businesses into corporate welfare recipients, warns Citadel’s Ken Griffin
https://fortune.com/2024/11/22/trade-tariffs-donald-trump-economy-growth-competitiveness-ken-griffin-citadel/
Georgia’s Disastrous Medicaid Work Requirements
https://www.thenation.com/article/society/medicaid-work-requirements-georgia/