It is the Health one that always amuses me - its more per capita than we spend on the NHS, even in its current wasteful state. In return for this generosity the good folk of the United States get two beans in exchange.
It must be one of the biggest scams in human history.
A significant fraction of the waste in Medicare and Medicaid results from the fact that they are both required, under the law that established them, to pay for any FDA-approved medication used on-label. In other words, Medicare can't do what insurers (and other countries) do, and refuse to pay for more expensive alternative treatments until the cheaper ones have been tried. It also results in Medicare/Medicaid lacking the bargaining power other countries' health systems have on price.
What happens is Big Pharma gets their shiny new drug approved, then deploys its army of pharmaceutical reps to convince doctors to prescribe the expensive new alternative with limited additional benefits. They spend ungodly sums on legal inducements, which less scrupulous doctors accept in return for a tacit
quid pro quo to prescribe, and pocket the profits.
This is all well documented in the media. It's a long-running game of Whac-A-Mole where every time Congress shuts the major inducements down, Big Pharma and its army of consultants just find a new line of attack.
The problem is that clause in the original legislation, but addressing it would play in the media as an attack on Medicare, which is every bit the third rail of American politics that Social Security is. Touch it and die.
