Vivek Ramaswamy

So a couple of things there, Ben, and it's worth I mean, I'm not going to just give you the standard talking points you can read about anywhere.

OK, I want to give you some specifics from where I sit.

I think there's an incentive failure in the way that states deal with the federal government as it relates to Medicaid.

And this is important to understand.

OK, as you said, it's well-intentioned people producing outcomes that are not well and that are not effective.

really doing well by the people who are supposed to serve, why is the question.

So this incentive failure is important, where if a given state today

Cracks down on this waste, fraud, and abuse.

Okay, cracks down on Medicaid overexpenditures.

And you could talk about uppercase F fraud, and there's also lowercase F fraud, which is to say maybe technically legal, but it doesn't comport with anyone's sense of who should be getting these dollars.

The problem is the state that does that heavy lifting, okay, the equivalent of a doge at a state, say, if you did that.

You as a state don't really get to keep most of those dollars.

What instead happens is you get fewer pass-through payments from the federal government.

So that is a broken incentive system.

So for people who aren't familiar how this works, it's like you get reimbursed for your expenses, almost all of them from the federal government.

So if you cut those expenses, but you're losing the reimbursement, then you as a state, let's say you're a governor of a state, say, okay, well,

I got other competing priorities because I would rather look after some other priority in my state.

This is gonna make me less popular, giving free government money away to people who could be voting for me.

But in return, the federal government is still the backstop anyway, why bother?

So I think that incentive failure needs to change.