> From an MMT perspective, the government (any one using it's own fiat currency) creates and destroys money rather than spending and receiving it, even if it pretends otherwise in an outdated effort to ape a commodity-/representational-money system.

Even under that view, you can still see a difference. Spending $1 trillion in healthcare requires the government to create $1 trillion permanently. Spending it to purchase mortgage backed securities that are eventually sold or mature requires creating that $1 trillion only temporarily (while the asset is held).