medicare

Americans could be forgiven if they’re unaware that President Trump recently performed one of his most essential tasks and sent his annual budget request to Congress, though months late and stunningly incomplete.

After all, so much else has been dominating the news lately: the Mideast war that Trump promised not to start. Price rises he’d vowed to end. His repeated insults of Pope Leo XIV. His portraying himself as Jesus Christ, then lying about having done so. An incompetent attorney general to fire. And the president’s actual priorities — plans for a $400-million White House ballroom and a massive “Triumphal Arch” nearby!

It’s a lot.

Once again, as in Trump’s first term, the public and press are inattentive to the nation’s fiscal health relative to past years. But that reflects the president’s own disengagement with reconciling spending and revenue — this from a president many Americans voted for based on his purported prowess as a businessman. For decades back to Ronald Reagan’s time, so-called deficit wars in Washington were a big story. Now, even Republicans in Congress complain of Trump’s absence from the fiscal fray as they struggle to belatedly finish this year’s budget work that was due last fall, and to end a weeks-old partial government shutdown, before turning to the budget for the fiscal year starting Oct. 1.

Yet it’s worth paying attention to U.S. budgets even if Trump won’t, for the sake of our children and grandchildren who’ll inherit the bills. In one document, a federal budget reflects the nation’s priorities. And these days, in the perennial guns-versus-butter debate, Trump has made his feelings all too plain.

“We’re fighting wars,” he told a group at the White House on April Fools’ Day. “We can’t take care of day care … Medicaid, Medicare, all these individual things.”

Forget that Trump swore to end wars. Or that last year, long before he went to war against Iran, he cut $1 trillion over 10 years from Medicaid and other healthcare programs in his misnamed “One Big Beautiful Bill.”

Yes, budgets can be boring, especially to a president with a famously short attention span. Trump and many of us Americans are distracted constantly by all the shiny objects he throws at the national consciousness by his words, acts and social media postings at all hours.

Yet the budgetary trend is clear to anyone bothering to look: As president, Trump is once again exacerbating the nation’s unsustainable course of piling up debt. According to the nonpartisan Congressional Budget Office, among other credible sources, debt is now approaching the highest level in U.S. history, which was reached during World War II. It already surpasses the size of the entire economy and threatens higher borrowing costs and reduced investments.

For all the achievements Trump likes to claim — ending eight wars in a year! — here’s one that’s real: He is on a path to break his own record for the most debt in a single presidential term, $8.4 trillion in Trump 1.0, which was nearly double the increase under President Biden.

Need further proof of Trump’s brazen mendacity? Of course you don’t, but here it is: In the face of the well-documented budget record, Trump declared both this year and last year to a joint session of Congress, on national television, that he would balance the federal budget —“overnight,” he said in February.

The inequitable tax cuts and big spending increases for the military and immigration crackdowns that Trump and the Republican-controlled Congress enacted last year are significantly greater than in his first term, and are driving up the debt despite Republicans’ deep healthcare cuts. Just months after Trump took office, the ratings firm Moody’s downgraded the nation’s sterling credit rating for the first time in more than a century.

And now, in his new budget request, Trump seeks to inflate military spending from under $1 trillion when he regained office to $1.5 trillion, for the biggest year-to-year increase in military budgets since World War II.

This fiscal irresponsibility is happening at the worst possible time. For the last quarter of the 20th century, presidents and Congresses of both parties annually debated how to reduce deficits and several times reached consequential multi-year deals, culminating during the second Clinton term in four straight years of surpluses. (Those surpluses ended — wait for it — with Republicans’ tax cuts and war spending during the George W. Bush administration.)

Politicians back then were moved not just by the deficits of their time — deficits that, as a share of the economy, were less than half what they are now. They also were responding to experts’ warnings of a demographic tsunami by the 2020s: With the aging of the huge baby-boomer population, spending for Social Security, Medicare and Medicaid would greatly increase even as the workforce whose payroll taxes support those programs shrank. Today the number of people 65 or older is almost three times what it was 50 years ago, and rising.

This reckoning is upon us, though you wouldn’t know it as Trump keeps calling for cutting revenue and spending more for lawless wars, immigration raids and monuments to himself. Barring bipartisan action, in 2033 Social Security’s retirement fund and Medicare’s hospital fund will no longer be able to cover beneficiaries’ full claims, according to their trustees’ annual report, necessitating reduced benefits or shifts of money from other worthy programs.

Trump did put Vice President JD Vance in charge of a “war on fraud.” But that holds about as much promise as Elon Musk’s fiscal fiasco — remember DOGE? — that cost money instead of cutting $2 trillion as promised.

Like other problems, Trump likely will leave the fiscal follies to his successor, who, should he or she win two terms, would preside as Social Security and Medicare become insolvent. I’ve yet to hear any of the early 2028 presidential aspirants — or Trump — address or be asked about that.

Let the debate, belatedly, begin.

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WASHINGTON — Reviews to detect Medicare overpayments were done on fewer than 1% of the doctors who bill the federal health insurance program, a congressional investigator said Wednesday.

The reviews by Medicare’s private contractors are an important way to identify physicians who have been paid too much to treat the elderly and disabled, auditor William Scanlon said at a House Budget Committee hearing.

In the 2000 budget year, those private contractors reviewed the medical claims of 1,891 physicians out of more than 600,000 who billed Medicare that year, said Scanlon, who covers health issues for the General Accounting Office, the investigative arm of Congress.

Most Medicare payments are proper, Scanlon said. But the program “faces a difficult task in finding an appropriate balance between ensuring that Medicare only pays for services allowed by law and making it as simple as possible for providers to treat Medicare beneficiaries and bill the program.”

In 1999, payments made in error amounted to $11.9 billion, the government has reported.

At the hearing, government and academic experts said Congress should pay more attention to the financial health of the 36-year-old program. Government projections earlier this year predicted Medicare, a $240-billion program, would start running short of cash in about 15 years.

An official at the agency that runs Medicare promised a turnaround on all counts.

“In no way will we diminish our interest in fighting waste, fraud and error in the Medicare program,” said Ruben J. King-Shaw Jr., the chief operating officer for the Centers for Medicare and Medicaid Services.

“For the small percentage of people who take advantage of the system, we will continue our aggressive efforts to protect the funds that taxpayers have entrusted to us.”

Financial experts also told Congress that the goals of overhauling Medicare and adding a popular prescription drug benefit could be too much all at once.

“Medicare’s future will likely be written numerous times as health care changes and baby boomers move through the system,” said Marilyn Moon, a health economist at the nonpartisan Urban Institute.

There were also warnings about encouraging private health plans to compete with the federal program. President Bush promoted the idea this month.

Bush said he wants more health maintenance organizations and private health plans to compete for seniors’ business within the underlying Medicare program; 15% of the 40 million enrollees use private plans. Bush said such competition could bring better service, lower premiums and extra benefits, such as complete drug coverage.

But the government would have to make sure it helps all seniors, regardless of which plan they are in, said Comptroller General David Walker, head of the GAO.

“Separating winners from losers is a basic function of competition,” Walker said in a report to Congress.