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Health Care, Welfare & Entitlements Archive



March 2015



Rule of Law on Trial in King v. Burwell

Written by , Posted in Health Care, Welfare & Entitlements, Liberty & Limited Government, Taxes, The Courts, Criminal Justice & Tort

You might think King v. Burwell is just about Obamacare. To be sure, the ruling could profoundly impact the law if nothing else is done. Though depending on how legislators react, even a finding in favor of the challengers could be made to have no real impact at all.

But what will certainly have an impact is a finding in favor of the government. Endorsing their position would be a huge blow against a most basic tenet of our representative system. I wrote about this in my latest column for EveryJoe.

…If the court rules in favor of the government, it will mean that the executive branch is free to rewrite legislation despite the clear meaning of a law if they can plausibly argue that the consequences for not doing so would be negative. It is, at its core, a case about who gets to write the law.

It’s true that Congress typically gives the Treasury department more latitude than typical because of the complexity of the tax code. But where Congress has not said to fill in the blanks, Treasury must follow the law, as must any other agency within the executive branch. To allow otherwise would undermine a fundamental principle of our government: that we are a nation of laws, which are created by elected representatives.

As an example of what to expect if the court allows for erosion of the separation of powers, consider the current call by Sen. Bernie Sanders – self-described socialist – for the White House to rewrite the tax code without Congress.

He wants Obama to declare by fiat the elimination of certain “loopholes.” But what are commonly referred to as “loopholes” are really just particular policy choices made by elected leaders. They can be either good, such as those which alleviate double taxation, or bad, such as those which provide special handouts for politically favored businesses. Regardless, they are part of the tax code which Congress has created, as is their legal prerogative. If they don’t like it they should legislate a new tax code, and if we don’t like it we can vote them out of office.

…This White House has been open about its desire and willingness to rewrite the law as Obama sees fit in order to advance his agenda. And his spokesman responded favorably to Sen. Sanders suggestion, saying that Obama is “very interested” in unilaterally hiking taxes. If the court rejects the latest challenge to Obamacare and finds in favor of the government, it will only serve to embolden his efforts to unconstitutionally transform the nation.

The whole piece is available here.



January 2014



If Government Healthcare is So Wonderful, Why Are Many Seeking Private Alternatives?

Written by , Posted in Free Markets, Health Care, Welfare & Entitlements

I’ve written before about Canadians having to turn to the private sector in order to receive timely and quality healthcare, despite supposedly having “universal” coverage. Similarly, most Medicare recipients in the U.S. have supplemental plans, despite the almost $600 billion spent on the program in 2013.

Now it turns out that Sweden, much celebrated for its generous welfare, is seeing growth in private plans due to the long lines – including year-long waits for cancer patients – and inadequate care provided by government:

Sweden, a country famous for a welfare state that has actually been trimmed back substantially in recent years, is experiencing a phenomenon unlikely to bring cheer to those Americans who think the answer to Obamacare’s problems is more government involvement in medicine. Tired of long waits and inadequate care, Swedes increasingly purchase private health insurance policies to gain access to the care the state can’t provide.

Proponents of government-run healthcare routinely point to other nations as proof that central planning can work. But merely pointing to a system that has not yet collapsed is not the same as proving that it can sustain itself. What we are increasingly seeing is that so-called universal healthcare is self-defeating, but its inherent faults sometimes take time to fully metastasize.



October 2013



End Times for the Welfare State

Written by , Posted in Big Government, Health Care, Welfare & Entitlements, Liberty & Limited Government, The Nanny State & A Regulated Society

A recent letter to the The New York Times:

To the Editor:

Stephen D. King correctly observes that the United States and many other so-called advanced economies are looking forward to a dismal future (“When Wealth Disappears,” October 6). Unfortunately, he dances around and at best merely alludes to the root cause of the problem.

While recent years have seen rather dismal economic growth, the fact remains that people today are, by and large, wealthier than ever before. Levels of comfort and convenience – from air conditioning to machine washers to access to multiple vehicles per family – once reserved for the wealthiest few are now common even for the least among us. In asserting that “we are reaching the end times for Western affluence,” King thus fails to be sufficiently precise in his analysis. It is the Western welfare state whose affluence has reached its limits.

While the last century has witnessed tremendous strides economically, with incredible new technologies revolutionizing how we live, work and play, it has also seen an ever increasing share of those gains diverted to the public sector. It is for this reason that King’s prescriptions are just a step in the right direction. For our nation to avoid becoming another Greece, politicians henceforth must refrain from promising the fruit of another’s labor as a means for enhancing their own political power.

Brian Garst
Director of Government Affairs
Center for Freedom and Prosperity



September 2013



Serious Liberal Thinkers™ Compare Accepting 2,000 Page Legislative Monstrosity to Moral of Children’s Story

Written by , Posted in Health Care, Welfare & Entitlements

In one of the more bizarre public policy debates in recent memory (and that’s saying something), Serious Liberal Thinkers™ responded to Senator Ted Cruz’s 21+ hours of floor speech against Obamacare not with facts or substantive arguments, but by analyzing a children’s book. Seriously.

As is often the case for filibusters (or filibuster-like speeches, as this was), Sen. Cruz had a lot of time to fill. Those in similar situations have sometimes opted to read the phone book, for instance, but he chose instead to at one time recount some of the best quotes from TV ratings juggernaut Duck Dynasty, as well as read his little girls a bedtime story through the TV since he wasn’t going to be home to do it in person. While most Americans might find the latter to be endearing, liberals instead seized upon the parental act as an excuse to sidestep the many substantive arguments Sen. Cruz made against Obamacare, or the letters he read from anguished citizens (and Obama supporting unions!) already feeling its ill effects.

Serious Liberal Thinker™ Matt Yglesias got right to the heart of our healthcare debate at Slate by explaining to us “what Ted Cruz doesn’t understand about Green Eggs and Ham.” His brilliant observation? It’s about trying things!

The Democrats’ bet on the Affordable Care Act is that it’s like green eggs and ham—they’re convinced the public will like it when they try it.

Conservatives like Cruz claim that this is wrong. That Americans will taste the green eggs and ham and they’re going to hate it. But their actions speak otherwise. They’re desperate to repeal the law before it’s implemented. …Because deep down they fear that Dr. Seuss was right.

Or maybe they just think it’s a bad idea and are doing their jobs by seeking to undo it before it does any more harm? You know, exercising their legislative judgment as they were elected to do.

Matt Yglesias has a point of view and it would be awfully convenient for him if his opponents adopted silly governing philosophies like “try it and you might like it” that enable him to get what he wants without opposition. I get it. But that’s a silly way to run a country – which I suppose explains its appeal to the left where those who say they “would not, should not” try the latest fad are just anti-progress fuddy-duddies. Back in the land of reality, lawmakers would not, should not pass laws just to see what happens.

Yglesias was hardly the only offender advocating government by children’s book. Serious Liberal Thinker™ Rachel Maddow also admonished Cruz because “he apparently didn’t understand the story.” Serious, Elected Liberal Thinker™ Senator Chuck Schumer even threw some faux-outrage into the mix by declaring he was “appalled” by Ted Cruz’s refusal to exercise his Constitutional duties without first checking that his actions pass the Dr. Seuss test.

In making his case, Yglesias referenced favorably Nancy Pelosi’s declaration that they had to pass Obamacare so the rest of us could find out what was in it. But I’m reminded of another of her quotes – specifically her remark in 2006 before assuming the speakership that “The gavel of the speaker of the House … will be in the hands of America’s children.”

It’s hardly hidden knowledge that laws put into place are harder to undo, for a myriad of reasons, than laws not yet fully implemented. Matt Yglesias sees recognition of this fact as deep seated fear among Obamacare opponents. I, on the other hand, see his and other liberals’ widespread decision to sidestep via childish antics any form of serious debate over an unpopular law already proving to be deeply destructive to the economy, as well as to the quality of the service it was purporting to benefit, as evidence that they would not, could not win that debate on the merits.



November 2012



Canadians Turn to Private Care as Government Fails

Written by , Posted in Big Government, Economics & the Economy, Free Markets, Health Care, Welfare & Entitlements

Private markets can be their own worst enemy. Rather than force people to deal with the consequences of bad policy choices, they provide a relief valve for ill-considered socialist schemes. Such is the case in Canada right now, as patients are increasingly forced to seek refuge from their “universal” health care debacle.

Surgery wait times for deadly ovarian, cervical and breast cancers in Quebec are three times longer than government benchmarks, leading some desperate patients to shop around for an operating room.
But that’s a waste of time, doctors say, since the problem is spread across Quebec hospitals. And doctors are refusing to accept new patients quickly because they can’t treat them, health advocates say.

…The worst cases are gynecological cancers, experts say, because usually such a cancer has already spread by the time it is detected. Instead of four weeks from diagnosis to surgery, patients are waiting as long as three months to have cancerous growths removed.

“It’s a crisis for Quebec women,” said Lucy Gilbert, director of gynecological oncology and the gynecologic cancer multi-disciplinary team at the McGill University Health Centre. Her team has had access to operating rooms only two days a week for the past year, with dozens of patients having surgeries postponed week after week.

…One worried patient, a mother of five children who waited three months for surgery for invasive breast cancer, said she is worried about the effects of such a long wait. After surgery, she paid $800 for a bone scan in a private clinic rather than wait five months for a scan at the Jewish General Hospital.

There are always costs. You cannot legislate them away. Trying to do so through price controls just forces them to manifest elsewhere. In this case, the cost is increased wait times, which when it comes to health equates to increased mortality rates. The reason is simple: when you remove the market signals generated by free floating prices, you lose the most effective means known to man for allocating resources. A bunch of government bureaucrats cannot anticipate demand and allocate the appropriate resources to meet it as well as the invisible hand.



July 2012



Overgovernment: Nanny Knows Breast Edition

Written by , Posted in Big Government, Health Care, Welfare & Entitlements, The Nanny State & A Regulated Society

I could probably populate this blog entirely with the stupid things Nanny Bloomberg does if I so wanted. His latest outrageous policy is to hide baby formula from new mothers in an effort to force them to breast feed:

New York’s Mayor Michael Bloomberg is locking up the baby formula, because he wants newborns to drink breast milk instead.

He’s using his mayoral power to direct maternity-ward nurses to hide baby-milk formula after Sept. 2 so that new moms feel pressured to provide breast milk to their newborns.

Bloomberg’s mammary-mandate is supported by white-coated public-health officials, who say the scientific data shows that mothers’ milk aids infants’ digestive systems and shields them from some diseases.

His wishes are law because he controls much of the city’s health network in a city-wide version of Obamacare.

Thus illustrates a central problem with granting government control over health care, which is that it gives government the power to throw its weight around when it comes to the most intimate and personal of decisions.

As with most things, there are both pros and cons to breast-feeding, and no one but the individual mother should have any say in the matter. But as usual Nanny Bloomberg thinks he knows breast… er, best.



July 2012



Medicaid and Federalism

Written by , Posted in Big Government, Health Care, Welfare & Entitlements, Liberty & Limited Government, The Courts, Criminal Justice & Tort

The less talked about, though hardly ignored, aspect of the Supreme Court’s recent Obamacare decision is the fact that the court struck down the requirement that state’s expand Medicaid coverage up to 133 percent above the federal poverty line (some states do so already), or lose their federal Medicaid funding.  The court ruled that while the federal government can provide strings for accepting new federal dollars, it cannot threaten to revoke already granted dollars if new strings are not adhered to.  The latter is deemed coercive on the part of the federal government, and thus an unconstitutional violation of state sovereignty. The ruling essentially cuts in half the number of uninsured which the law was supposedly going to give coverage.

While the court was right to strike the provision, the scope of the decision was insufficient and the distinction offered is strained and unworkable. Congress must retain the power to revisit the law creating Medicaid, as one Congress cannot legally bind a future Congress, which means there is no real mechanism to prevent them from changing the requirements on states to receive Medicaid dollars. The error of the court is in not acknowledging that all federal dollars to states are coercive, whether they come with only carrots or include an explicit stick. All federal carrots eventually turn to sticks.

Transferring federal dollars to states erodes state sovereignty, undermines one of the primary benefits of federalism (competition and innovation in policy approaches) and reduces democratic accountability. No such grants should be allowed, period.

As I previously wrote on the subject:

A fifty-five mph speed limit, promptly ignored by most motorists, was dictated to the states by passage of the 1974 Emergency Highway Energy Conservation Act.  Although the national speed limit was later repealed in 1995, numerous federal standards remain, such as the minimum ages for drinking and smoking. The federal government has largely accomplished this power grab by opening the spigot of federal dollars, then threatening to cut off any state that doesn’t kowtow to Washington’s demands.

So when a number of governors of both parties balked at taking federal money for unemployment insurance, knowing that they would be stuck with the bill of an expanded government welfare mandate when the federal funds expired, it should come as no surprise that the beltway response was to attempt to denigrate and browbeat the rogue states into compliance. Democratic Senator Charles Schumer responded to their rejection of federal funds by admonishing governors for playing “political games,” then boldly declared, “whether the governors want to or not, they can be forced to take the whole thing.” This astonishing declaration strikes at the heart of our federalist system.

…Aside from the eventual subjugation of state authority, funneling federal dollars into the states also leads to significant waste. No longer dependent on their constituents for financial support, the states become rent-seekers looking to game the federal system. This is why 250,000 Washington State residents recently received a $1 check in the mail.  As a reward for this wasteful spending, the federal government will pump into the state millions in new welfare funds. This seemingly irrational and grossly wasteful spending is encouraged by the present system, where states have financial incentives to meet federal bureaucratic rules that allow them to qualify for more funding.  The impact on the taxpayer is simply not important to the state in this calculus.

When states are offered federal dollars, it’s a lose-lose situation. Their citizens are already paying the taxes, and if one state refuses while another accepts, it means tax money is being redistributed from the more fiscally prudent state to big spending states. States, moreover, are only ever offered bribes to increase spending and regulation, but never to reduce either. In other words, it is a taxpayer funded incentive for bigger government. States that accept federal money, meanwhile, are then placed at the mercy of a federal government which can cut off funds at any time, leaving local politicians to either pick up the slack (by reducing other spending or racing taxes) or face the consequences at the polls.

Which leads to my next point. Collecting funds through federal mechanisms to be spent by states reduces politically accountability. Who do voters blame for poor results, the federal taxers or the state administrators? And what keeps either focused on the interests of voters? The goal of state lawmakers is to please the federal lawmakers that keep the money flowing, while the federal lawmakers just point to state government’s as the source of any mismanagement.

This is completely backwards from the concept of America at its founding. Taxes should be collected as locally as possible and sent up, rather than down, the political ladder. If state and local governments collected the bulk of taxes, for instance, and then had to “buy in” to the federal government, federal lawmakers would be held accountable by state governments that are closer to – and thus more easily held accountable by – the people.

States cannot be counted on to refuse the offer of federal dollars, and the mere fact that other states might and will accept penalizes them for refusing if they do. Nor is there hope that the federal government might decide on its own to stop engaging in the practice. Politicians will always seek to expand their power, which for the federal government means encroaching upon the sovereignty of the states. The cash spigot is simply too useful a tool in the pursuit of federal power to ever be turned off, and explains why the prevalence of such programs has exploded in recent decades.

The fact that the federal government can offer it at all is the problem, and the ideal solution is thus to prohibit all federal grants to states. But unless the Court can be convinced that any federal dollars are necessarily and inherently coercive to states, its Obamacare ruling will have minimal impact on the practice. A Constitutional amendment is the only real solution I see available.

For more on this issue, see this great summary by Cato’s Downsizing the Federal  Government, and related blog posts here and here.



June 2012



Uninformed Government

Written by , Posted in Health Care, Welfare & Entitlements, Waste & Government Reform

How people imagine government works and how it actually works are often two very different pictures. Many people like to believe, for instance, that government is run by deliberative lawmakers and interested technocrats who careful consider policies before implementing them, and then later consider the data to evaluate their progress.

Little could be further from the truth.

Government is better thought of as children. Politicians jump from issue to issue seemingly at random, showing at first the kind of intense interest similar to a youngster discovering a new hobby only then to see it abandoned a week later when something newer and shinier comes along.

Laws already on the books are yesterday’s news, of no more interest than the half-finished, abandoned tree fort in the backyard. Government, it turns out, doesn’t care enough to know any details about how its policies are doing:

Americans spend $80 billion each year financing food stamps for the poor, but the country has no idea where or how the money is spent.

…Coinciding with lobbying by convenience stores, the U.S. Department of Agriculture, which administers the program in conjunction with states, contends that disclosing how much each store authorized to accept benefits, known as the Supplemental Nutritional Assistance Program (SNAP), receives in taxpayer funds would amount to revealing trade secrets.

As a result, fraud is hard to track and the efficacy of the massive program is impossible to evaluate.

This is no way to govern. And it’s not just lawmakers lacking information. As Gene Healy explains, this administration has taken keeping the public in the dark to a whole new level.

Government as it turns out is not a thoughtful, deliberative process, or a place where smart people get together to solve all our problems. It’s more like a dark, dank back-alley full of drunks stumbling around to find their footing.



May 2012



Overgovernment: Cookie Police Edition

Written by , Posted in Big Government, Health Care, Welfare & Entitlements, The Nanny State & A Regulated Society

The nannies in Massachusetts are on a sugar-hating kick, picking on that most popular of targets in recent years – so-called junk food:

Bake sales, the calorie-laden standby cash-strapped classrooms, PTAs and booster clubs rely on, will be outlawed from public schools as of Aug. 1 as part of new no-nonsense nutrition standards, forcing fundraisers back to the blackboard to cook up alternative ways to raise money for kids.

At a minimum, the nosh clampdown targets so-called “competitive” foods — those sold or served during the school day in hallways, cafeterias, stores and vending machines outside the regular lunch program, including bake sales, holiday parties and treats dished out to reward academic achievement. But state officials are pushing schools to expand the ban 24/7 to include evening, weekend and community events such as banquets, door-to-door candy sales and football games.

The heavy-handed, paternalistic rules are bad enough, but what really irks me is this mentality:

State Sen. Susan Fargo (D-Lincoln), chairwoman of the Joint Committee on Public Health, said the problem of overweight children has reached “crisis” proportions.

“If we didn’t have so many kids that were obese, we could have let things go,” Fargo said.

“But,” she added, “this is a major public health problem and these kids deserve a chance at a good, long healthy life.”

No, obesity is not a “public health problem,” it is an individual health problem. Public health problems exist when one persons sickness can make me sick or unhealthy. But one person being fat has no impact whatsoever on whether or not I am fat.

There is a related problem where I am expected to bear the cost of another’s health choices, but that doesn’t make it a public health issue, that just makes inherently unfair regulations requiring some to subsidize the healthcare of others, even when the cause of the need for care is based on choice.

What State Sen. Susan Fargo (D-Lincoln), chairwoman of the Joint Committee on Public Health, is doing is using one set of boneheaded policies put in place by people like State Sen. Susan Fargo (D-Lincoln), chairwoman of the Joint Committee on Public Health, in order to justify a further collectivized society, and more power in the hands of people like State Sen. Susan Fargo (D-Lincoln), chairwoman of the Joint Committee on Public Health. Funny how that works.



April 2012



Obama Desperately Lashes Out at SCOTUS

Written by , Posted in Health Care, Welfare & Entitlements, The Courts, Criminal Justice & Tort

Indicating just how serious the White House is taking the Supreme Court’s review of Obamacare after the government’s dismal performance during oral argument, President Obama has lashed out with a populist and ignorant scolding of the court for daring to consider the Constitutionality of his signature legislation.

“I am confident the Supreme Court will not take what would be an unprecedented, extraordinary step of overturning a law that was passed by a strong majority of a democratically-elected congress,” President Obama said at a White House event in the Rose Garden today.

“I just remind conservative commentators that for years we have heard the biggest problem on the bench was judicial activism or a lack of judicial restraint. That an unelected group of people would somehow overturn a duly constituted and passed law. Well, this is a good example and I am pretty confident that this Court will recognize that and not take that step,” Obama said to the White House press.

Is the President really so ignorant of both the facts regarding his legislation (it was not passed with a strong majority, for instance, but instead by an extremely narrow, party-line vote), and the Court’s history? There is nothing unprecedented about overturning unconstitutional legislation. Overturning unconstitutional acts is precisely the job of the court. Or is our law professor President not familiar with Marbury v. Madison?

And as I’ve previously written, judicial activism is a red herring. The job of the court is to actively defend the Constitution.

The President later urged the court to look at the “human element,” as if liberal feel-good intentions trump the Constitution. This is typical of the left, where the ends are frequently used to justify any means. If a law is good and necessary to advance some liberal goal then it must be Constititional by virtue of the fact that the left has deemed it good and necessary. But of course that’s not how it works, and a President supposedly schooled in Constitutional law should know better.