The proposed Department of Government Efficiency (DOGE), to be run by Elon Musk and Vivek Ramaswamy, has been tasked by President-Elect Trump to “dismantle Government Bureaucracy, slash excess regulations, cut wasteful expenditures, and restructure Federal Agencies.” But the DOGE is also a once-in-a-century opportunity to improve the health and wealth of the American people.

Although reducing the discretionary budget by $2 trillion would be a huge success, we should strive for an even more long-lasting result. That means dealing with the politically “untouchable” mandatory entitlements spending on Social Security and Medicare to make them more efficient and solvent. According to the Committee for a Responsible Federal Budget, “The drivers of the growth in primary spending are Social Security and federal health care programs -- namely Medicare.”

In FY2023, the federal government spent $1.35 trillion on Social Security (22% of the budget) and $1.56 trillion (25% of the budget) on major health care programs, most of which was for Medicare and Medicaid. The objective of DOGE should not be to cut these, but to restructure them to be more effective and efficient in generating investment returns (for Social Security) while reducing fraud and “sick care” costs (for Medicare).

Social Security accounted for 22% of the total federal budget. In 2023, the trust funds that support Social Security ran a deficit, depleting the funds by $41 billion. This deficit is only expected to get worse, but can be reduced by either increasing contributions, reducing benefits, or increasing the yield on trust fund investments. Politicians have tried the first two methods, which are both difficult and unpopular, but never the third, which is truly the best way to ensure solvency and secure this critical safety net. With proper restructuring, Social Security can grow its way out of its deficit. Instead, the trust fund has been used as a piggy bank to fund federal deficits at an extremely low rate of interest. As we downsize government and move towards a balanced budget, we should also change how we invest the trust fund.

American citizens own the Social Security system and it is only right that they be allowed to benefit from the financial success of America just like wealthy investors who are able to invest in stocks, bonds, real estate, and other higher-yield investments. But instead of privatizing it, we should establish a new public fiduciary to manage investments to obtain superior investment returns while carefully managing risk. The managers of such a fiduciary would be accountable for its investment returns and would effectively compete with giant investment companies such as Vanguard and Black Rock. But it would act only as a fiduciary for the American people, with no authority to pursue Environmental, Social and Governance (ESG) or other politically-motivated goals.

In fact, we can use such a fiduciary to also eliminate the financial conflicts of interest of elected officials and senior federal bureaucrats. Instead of just trying to ban all federal legislators from engaging in insider stock trading, and monitoring to ensure they don’t cheat, they should be required to deposit their investment funds, as well as congressional pension funds, into a pool to be managed by the Social Security fiduciary during their term of office. This would align the financial incentives and investment returns of Congress and senior administration officials with that of the American people.

The second part of this restructuring of mandatory spending would focus on making Americans healthier so we can spend less on sick care while improving health and life expectancy. This brings us to Medicare and the entire public health sector, soon to be run by nominated HHS Director Robert F. Kennedy, Jr. under a mandate to Make America Healthy Again. If we promote and invest in healthy lifestyles and food, instead of just the sick care system, we can stop the out-of-control growth of health care spending. We spend about twice as much as other large, wealthy countries, yet have a more obese and sick population. Our current health care spending focuses on getting Americans hooked on medications instead of helping them to stay healthy. And, of course, we need new systems, processes, and data analytics to cut down on the massive amount of Medicare fraud.

Had our public health system promoted regular exercise, healthy food, Vitamin D, and other supplements, for instance, fewer Americans would have died or suffered from the COVID-19 virus. Government efficiency isn’t just about deciding what to cut, but what to spend money on in order to promote the life, liberty and happiness of the American people.

What would such a restructuring look like? We can start by tackling the epidemic of childhood obesity in public elementary schools by funding daily physical fitness and sports, healthy breakfast and lunch foods, classes on nutrition and cooking, and preventive health care, including vitamins or other supplements, as needed. Obesity kills more people each day than COVID ever did. It also means a reassessment of the entire childhood vaccination schedule, which is likely causing harm in the form of asthma, allergies, delayed development, autoimmune disorders, autism, and other health-destroying maladies.

The food stamp program also needs to be entirely revamped to focus on healthy food, supplements and preventive health care. Private schools should also be assessed and provided incentives to deliver healthy food and physical fitness activities. This might include denying federal student aid, or even state funding, to private schools that fail to promote fitness and healthy food. Or, it might include funding for certified classes on nutrition and cooking.

Finally, the big pharma and big food industries need to be held accountable and brought to heel to start getting Americans healthy instead of making and keeping people sick for profit. This should be directly translated into Medicare policies and funding as well as a federated system of investigating and regulating unhealthy foods and medicines. For instance, state health officials should be given the funding and authority they need to enact their own health programs and override or ignore corrupt federal health officials if they have been captured by their regulated industries and fail to do their jobs. Section 1801 of the original 1965 Medicaid law specifically denies the federal government the authority to “control over the practice of medicine or the manner in which medical services are provided.”

In 2023, $150.9 billion (11%) of Social Security spending went to disability benefits and $50.9 billion (4%) covered other, including survivor, benefits. If Americans were healthier, as a result of improvements to our food and health care, we could probably reduce the amount spent on disabilities and survivors, which could then be shifted to help cover the cost of longer life expectancy. Incentives to promote healthier lifestyles could include health insurance rebates or a Social Security bonus for people who stay in good health and do not run up large health care expenses.

In summary, the DOGE should not limit itself to finding ways to cut the discretionary budget -- it should also work to refocus how the federal government promotes the “general welfare,” as well stated by our Founders.

David Thalheimer is a graduate of (pre-radicalized) George Washington University and Harvard University, the Air War College, and the National Intelligence University. He retired from the US Air Force as a colonel and now works as an engineer in the field of cybersecurity.

Image: Vivek Ramaswamy