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Lisa Baudot, Associate Professor of Accounting and Management Control, HEC Paris Business School

‘Fraud, waste and abuse’: US healthcare caught in the crossfire of a political narrative

During his spell as a US special government employee earlier this year, billionaire Elon Musk said the following: “The waste and fraud in entitlement spending […] Most of the federal spending, is entitlements, so that’s the big one to eliminate.” In doing so, entitlement programs, such as Social Security and government-sponsored healthcare, became swept up in the latest chapter for a phrase hailed as common sense and derided as propaganda.

“Fraud, waste and abuse” (FWA) has become a loaded term in US political discourse, invoked to justify sweeping changes in government programs. At first glance, targeting FWA seems like a reasonable goal: who would oppose eliminating inefficiency, unlawful behavior, or unethical misuse of public funds? Invoking FWA suggests that massive savings can be realized simply by ending inefficiencies and rooting out bad actors; the rhetoric around the phrase suggests these savings can result without cutting services or harming beneficiaries.

Most US government programs deliver something that is already scarce, something from which funding cannot be slashed without making difficult choices. But instead of debating the actual merits or consequences of policy proposals and choices, lawmakers use the narrative of FWA to claim they are concentrating on cleaning up dysfunction. This rhetorical convenience, however, obscures reality. It not only overstates the scale of actual fraud or inefficiency, often without evidence, but enables damaging policy shifts that undermine public trust and justify cuts to essential services that many people depend on.

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