Though it sounds as if ophthalmology dodged a bullet in terms of reimbursement cuts for 2023—the cut was around 2 percent vs. a possible 8-percent bite—it turns out that a cut may not have been necessary at all if the government had trimmed just a fraction of its wasteful spending in the last year.

Based on the number of Medicare-reimbursed cataract surgeries each year and what Medicare spends on each, the 2-percent cut saves roughly $132,386,000. When you peruse the most recent report on wasteful spending compiled by Sen. Rand Paul (R-Ky), “The Festivus Report 2022,” it turns out you don’t have to look far to find enough wasteful spending to avoid the cut entirely:

• The Office of the Inspector General found that, of the 117,135 emergency Economic Injury Disaster Loan grants (part of the COVID-19 relief program) that had a high likelihood of an improper payment, 44,920 grants (38.3 percent) were previously deemed “potential fraud risks.” So if they just would have followed protocol and not paid fraudulent grant applicants, the country would’ve saved $1.7 billion of our tax dollars.1

• But you didn’t need to save a billion to avoid the Medicare fee cut: Broward County, Florida used $140 million in COVID-19 relief funds to construct a luxury hotel, complete with 30,000 square feet of pool decking, a rooftop bar, and an 11,000-square-foot spa and fitness center.1 Though the Treasury Department prohibits the use of COVID-relief funds for large capital projects such as this, according to news articles covering the construction and notes from county board meetings, the local government used some creative accounting to make it possible.2,3 

• In a bizarre move, the United States Agency for International Development spent $50 million on a campaign to get people to visit Tunisia. The waste report points out, though that Tunisia made $1 billion from tourism in 2019.1 USAID argued it was to “expand the market for Tunisian handicrafts,” so I guess it’s OK.

• Since 1996, the NIH has given Northeastern University more than $3 million dollars each year to inject hamsters with steroids and then have them fight each other. (You can be sure the gambling pigeons from last year’s waste report have money riding on these fights.) The waste report says researchers say it was done to “study whether current drugs for aggressive youth suppress steroid-induced aggression.”1 However it also points out it's cheaper to have them just stop abusing steroids in the first place.

Though you have to laugh to keep from crying with some of these, here’s hoping that just a fraction of this waste can be trimmed in the coming year. Until then, we’ll always have Tunisia.


— Walter Bethke
Editor in Chief


1. Senator Rand Paul. Senator Rand Paul’s 2022 Festivus Report.

2 Slodysko B. Pandemic relief money spent on hotel, ballpark, ski slopes. The Associated Press, March 24, 2022.

3. Broward County County Commission. County Commission Regular Meeting Agenda. Broward County, Florida, February 22, 2022.