The federal government workforce has largely been static for the past 80 years. They serve a larger population than in 1945, so they do more with less. And yet federal employees seem to be the target of the proposed budget cuts. Remote work also gets tossed around like a dirty word. And yet it is part of the solution and not the problem. Here are several areas that should be looked at before we start looking at the workforce. I’m leaving out defense because that hinges on a procurement problem that will take years to fix. Let’s start with something obvious like stop paying dead people.
Bring Out Your Dead
Monty Python and the Holy Grail gave us a humorous look at who is dead and who is “feeling much better.” The reality in government is much more challenging. In 2015 Sixty Minutes did an episode on problems in the social security system. It covered people who the system thought were dead, and people that the system didn’t think were dead. The first is just a paperwork mess. The latter is a line item. Then Social Security Inspector General Patrick O’Carroll indicated that there were 6.5 million people in their system over the age of 111. (The number of people over the age of 100 is closer to 89,000) If you consider that there are only a handful of people alive over 111, and if all of the names were receiving the average Social Security payment, we are talking about $134,000,000,000 annually going to dead people. While I’m hoping the number has improved in the past 10 years, I doubt it’s gotten significantly better.
Social Security isn’t the only problem when paying dead people. They receive farm subsidies from the Department of Agriculture, pensions from the Office of Personnel Management, and even tax refunds from the IRS. It’s a combination of carelessness, bad data, and fraud. Fixing the data saves a significant amount of money and helps in other areas related to census and fraud in various government programs. It’s much easier to commit fraud with dead people than live people. If you take dead people out of the equation, it should reduce fraud and the federal budget. And if you take live people out of the Federal workforce, who is going to clean up this mess?
Rethink Medicine
Next to defense, our biggest national expense is health care. Spending has grown substantially, rising from 31% of total federal spending in 1974 to approximately 63% in 2024. The model focuses on a fee-based treatment model when we should be focused on value-based preventative care. This would reduce unnecessary treatments and improve patient outcomes. By focusing on early detection and management of chronic diseases it reduces hospitalizations and long-term treatment costs for conditions like diabetes and heart disease. It also reduces fraudulent billing by making it harder to add items to bills.
Additionally, we should take a remote-first approach to all non-emergency medical care. This allows a distributed approach to triage and many health visits. It will help eliminate boarding in larger hospitals and closing of smaller hospitals by distributing workload. A patient in Boston might be seen virtually by a doctor in Wisconsin before being scheduled for a visit with a provider closer to home, rather than waiting for 6 hours in the ER.
Taking a holistic approach to patient care also helps address social determinants of health which improve overall community health and reduce emergency visits. This requires better systems, standard taxonomies for services, and shared directory structures. It also requires standards for data sharing consent that are manageable for the providers, and manageable by the participants.
This is a much larger problem than can be adequately covered in a couple of paragraphs. Even the Reader’s Digest version would be longer if done correctly. This is just a snapshot of where we need to focus our attention. And in the short term, it requires more federally funded workers and not less.
Invest, Don’t Cut
Sometimes you have to spend money to save money. In the last 50 years, our non-defense infrastructure spending has gone from about 50% down to 27% in 2024, Translation, our bridges, roads, and piers are in bad shape. Approximately 230,000 bridges need significant repair or preservation. The cost to repair all the bridges is estimated to be around $125 billion, and it would take until 2071 to complete all the repairs at the current spending level. Remote work helps extend the life of some of these resources by having them used less. It’s probably not significant, but it does help.
Better bridges and roads mean more jobs, better commute times, and safer driving. Again, not something that is going to get better, with fewer federal workers.
Another area that needs investment is the infrastructure for sharing Social Determinants of Health (SDOH) and health data in general. New York is the first state to go down this road with roughly $750M in Medicaid 1115 demonstration waiver funds to build the required infrastructure. Wouldn’t it be nice if you didn’t have to fill out the same forms over and over for health services, or services through the state? Roughly $ 25 billion over 3 years would build out what is needed nationwide. (That’s less than the government pays dead people each year.) Ultimately it will save billions, improve health equity, and improve health outcomes. And again, it needs Federal workers to make it happen.
About Those Workers
News flash – remote workers don’t need permanent desks. As of March of this year, the U.S. government was leasing 176 million square feet of commercial real estate. The General Services Administration pays 5.7 Billion dollars annually for this privilege. If we just assume a 50% reduction in rental need, that’s almost a 3 billion dollar savings (not even including the 363 million square feet of commercial real estate in 8,397 buildings that the government owns.) Does anyone want to buy a government building?
I think everyone can find an example of something that could be improved with the policies and practices within the government. There are probably more than a few examples of outdated, top-heavy structures that the general public could benefit from changing. But realistically it is a drop in the bucket. We shouldn’t be worried about a senior official’s $180,000 salary when there are real problems with a lot more zeros in the price tag.reduction in rental need, that’s almost a $3Billion dollar savings (not even including the 363 million square fee of commercial real estate in 8,397 buildings that the government owns.) Anyone want to by a government building?
I think everyone can find an example of something that could be improved with the policies and practices within the government. There are probably more than a few examples of outdated, top heavy structures that the general public could benefit from changing. But realistically it is a drop in the bucket. We shouldn’t be worried about a senior official’s $180,000 salary when there are real problems with a lot more zeros in the price tag.
