The Government Shutdown • Safety Net Reality Check

This week marks not only the start of a new fiscal year but also the beginning of another government shutdown. At Open the Books, we wanted to offer a reality check on government spending and highlight one particular area.

We recently highlighted wasteful Pentagon spending and will continue to do so because defense spending is such a large part of our budget. We also noted we need a war on waste, not just a war on waists, per Secretary of War Pete Hegseth’s comments about overweight generals.

But we want to look beyond defense spending and consider all federal spending.

As this chart illustrates, the amount of money that flows through programs like Medicare and Social Security is mind-bogglingly large and dwarves the savings claimed by this year’s recissions actions and DOGE cuts.

As a point of clarity, the supposed “cuts” to Medicaid that are part of the shutdown debate are not cuts at all but a slowdown in the rate of the growth in spending.

Of the $6.9 trillion in spending from 2024, $912 billion went to Medicare and $1.5 trillion went to Social Security. Defense accounted for $872 billion while interest payments on the national debt exceeded our defense budget for the first time and topped $892 billion.

By contrast, the recissions package passed by Congress, which largely focused on USAID cuts, saved $9 billion. DOGE’s cuts saved $150 billion according to Elon Musk but probably much less according to our estimates and others who checked DOGE’s records.

At the same time, additional funds for the Department of Homeland Security for immigration enforcement topped $75 billion, resulting in a significant increase in the size and scope of the administrative state if no further downsizing occurs. A strong case can be made that this increase at DHS will more than pay for itself, but time will tell, and we’ll help provide an honest look at outcomes and receipts.

Regardless, the amounts of disputed savings in 2025 pale in comparison to our spending on safety net programs. If the flow of money in the federal government could be viewed from a jet cruising at 30,000 feet, Medicare would the Mississippi River and Social Security would be the Columbia River while USAID and “woke” spending programs would be barely visible, tiny streams. This doesn’t mean these areas of the budget are not important. They are important and Open the Books has exhaustively documented the scope of “woke” spending.

But this chart below also tells an important part of the story in one of those key flows. Our investigators looked at just one aspect of safety net spending – the Medicare Part D prescription drug benefit linked to providers – to illustrate the massive flow of taxpayer dollars through the safety net.

Our investigators found that the top 1,000 providers in the system are associated with more spending ($10.9 billion in 2023) than was saved by the recissions package. The top ten providers that year are associated with $829 million in payments, nearly the amount of savings generated by the $1.1 billion in cuts to PBS and NPR.

To be clear, these names are publicly available on The Centers for Medicare & Medicaid Services website, and we are not implying any of these providers are engaging in anything other than lawful conduct on behalf of Medicare beneficiaries.

Yet, it is also true that health care spending in the United States is grossly inefficient and fraudulent at a large scale. In June the Department of Justice charged 324 defendants for defrauding Medicare of $14.6 billion. Meanwhile, last year, the Wall Street Journal reported that insurers “pocketed $50 billion from Medicare for diseases no doctor treated.”

Open the Books has consistently exposed improper payments in federal health care programs. CMS estimates it made $140 billion in improper payments in 2024 alone. Health care inefficiencies go beyond government programs. The Peter Peterson Foundation estimates that 25 percent of all health care spending in the United States, nearly $935 billion, is wasteful.

A truism in life is that if you want to understand costs, benefits, vulnerabilities and potential savings, you should “follow the money.” Spending transparency is so crucial because when taxpayers see where their money is flowing, especially in times of heated debates and shutdowns, they can hold policymakers accountable to better direct its flow.

**The full dataset on the costs associated with Medicare Part D prescriptions is available here for download.