Government Failure Compounds Denial in Abortion Policy

Denial and govt failureFurther to last week’s post on denial as a basis for abortion policy, such denial in large part is no doubt a function of most Americans’ perception of how government works.

According to high school civics classes, government functions to protect us from bad meat, bad medicine, bad buildings, and bad guys in general.

In the real world, we find that this is mostly not true. Yes, there are lots of regulations and agencies whose purported function is to protect us from such dangers, but in practice we find that the various agencies get captured by the big players in the industries they are supposed to be regulating, and thus function primarily as protection rackets, keeping new entrants from competing with established special interests.

As has been eminently clear in the aftermath of the grisly Gosnell case, and the now-unfolding exposé of Planned Parenthood’s mining fetal body parts, the regulation and oversight of abortion clinics has functioned even more perversely—that is to say, there is virtually none.

In Pennsylvania, where Gosnell performed his barbaric spinal-chord snipping operations under indescribably filthy conditions, there had been no inspections of abortion clinics for 17 years. And this has been seen to be the rule, not the exception: in state upon state, abortion clinics are subject to less inspection than a common barber shop, nail salon, or pizzeria.

That this is the case ought not be surprising. Politicians have learned that the subject of abortion is so dangerous to their careers that it is safer, politically, to simply stay out of clinics altogether. In the aftermath of Gosnell, several states passed or attempted to pass regulations to ensure that abortion clinics meet a minimum level of cleanliness and safety, which attempts were mostly blasted by self-proclaimed “women’s rights advocates” as attempts to “end abortion.”

The upshot has been that dirty, dangerous, and unethical clinics continue to operate with little to no oversight, with women seeking abortion subject to a crapshoot of conditions.

In a normally competitive market for services, government failure isn’t a problem: bad providers are filtered out through various information channels—private rating agencies such as Yelp or Angie’s List, or certification by an independent ratings agency such as Consumer Reports for hospitals. In less competitive markets such as college campuses, there are even ratings for professors.

One candidate for providing such a service for abortion clinics, the National Abortion Federation, denied membership to Gosnell’s clinics for failing to meet acceptable standards. But when criticized for not blowing the whistle on the conditions later uncovered that included flea-infested cats wandering the halls, urine-and blood-splattered walls, and corroded suction tubing, the head of the Federation said, “What we saw didn’t meet our standards, but they’d cleaned the place up and hired an RN for our visit. We only saw first-trimester procedures”—thus not following standard procedures for rating agencies that usually include unannounced and multiple visits.

The upshot is that in the name of protecting a woman’s right to choose, abortion advocates have in practice delivered a network of abortion providers that in too many cases do not protect a woman or her unborn child—with politicians and bureaucrats providing cover for abusive practices.

Government failure in abortion is now fully evident, with the White House demonstrably captured by the biggest abortion special interest of them all: Planned Parenthood. At last Thursday’s White House press conference, press secretary John Earnest, when asked about the videos, parroted Planned Parenthood’s stance:

there’s ample reason to think that this is merely the tried-and-true tactic that we’ve seen from extremists on the right to edit this video and selectively release an edited version of the video that grossly distorts the position of the person who’s actually speaking on the video.

And Planned Parenthood has indicated that’s exactly what’s occurred here.

When asked if there was any consideration of investigating Planned Parenthood, Mr. Earnest further defended the organization, claiming the videos misrepresented the “organization’s policies and ... the high ethical standard that they live up to.”

Those wishing to undertake a thoughtful consideration of how to best care for women unintentionally pregnant and unwanted children should therefore not rely on government to inform or decide.

Further, we can discuss and debate policy and practice on the termination of more than a million pregnancies each year, but we ought no longer pretend the issue is simply a matter of denying high quality and ethical care of women, and removing unwanted, amorphous “fetal tissue.”

Though not for the faint of heart, the videos, regardless of editing, document extended discussions of positioning the body to be aborted in order to ensure that specific, desired body parts can be recovered intact.

The second part of the fourth video—definitely not for the faint of heart—clearly shows tiny bodies in the lab with their easily identifiable parts (leg, eye, brain, heart) being separated out and discussed.

Removing all question of precisely what is being examined, at 9:03 of this video, the Planned Parenthood doctor, looking at the aborted remains in the lab, says:

“It’s a baby.”

Do we care so little about women in our culture that we want them subjected to dirty and dangerous conditions; that we want them lied to about what abortion entails; that we want them to sign uninformed permissions when already under distress for their babies’ bodies to be used as lab specimens?

And do we value children so little that we accord them no rights or status—subject solely to choices made on any basis?

How “Progressive”.

FreedomFest Recap: Why Obamacare Stifles Healthcare Innovation

26925793_MI had the pleasure of speaking recently on a healthcare panel at FreedomFest in Las Vegas. Here’s a recap of my remarks on innovation and entrepreneurship in healthcare.

In the 2012 book Priceless: Curing the Healthcare Crisis by Dr. John C. Goodman, my colleague at the Independent Institute, John wrote: “The ACA [Obamacare] approach will stifle innovation and entrepreneurship” (p. 263).

Why was John so certain that Obamacare would slow healthcare innovation?

The approach to innovation in Obamacare is to spend money on pilot programs and other experiments, find out what “works,” and then copy it on a grand scale.

This is not entrepreneurship! Rather, this is top-down cookie-cutter replication, where government bureaucrats decide what “works,” not healthcare consumers and their doctors.

True entrepreneurship consists of thousands, often millions, of people trying NEW things, not copying current approaches. Successful innovations come from challenging conventional thinking, not by replicating it. True innovation is the antithesis of replication. It is about trying new approaches, discovering what works—as judged by decentralized consumers—and going against accepted ways of doing things when needed.

This is why Obamacare stifles true innovation – the rewards go to copycats who pursue known ways of doing things, not to radical disruptors. And no sector of the economy needs entrepreneurial disruption more than healthcare.

As a result of the Obamacare approach to “innovation,” Dr. Goodman describes the resulting healthcare sector as “a sea of mediocrity punctuated by islands of excellence” (p. 43).

Despite severe impediments to true innovation in healthcare today, there are green shoots of innovations that would put consumers in the driver’s seat, if only governments would get out of the way. For example, Heal allows patients to open an app and request a doctor to be dispatched to their home. Payment ($99 per visit) is done through the app, and doctors can do things from standard checkups to blood tests onsite. Ultrasounds and vaccines are in the pipeline.

GiveForward is an online fundraising platform that helps patients handle out-of-pocket medical expenses through crowd funding.

Castlight Health allows patients to enter their zip code and the service or procedure they need, and it gives them a list of area doctors, as well as a breakdown of what they charge for their services.

iTriage connects symptoms to potential conditions and offers real-time features like wait times at nearby emergency rooms and urgent-care clinics.

Emmi Solutions is a company that uses teams of visual and graphic artists, voice artists, scriptwriters, and patient focus groups to simplify complex medical information to provide people with information they can easily understand. Think of it as healthcare infographics for the general public.

ZocDoc lets users view a map of doctors in their insurance network and read patient reviews to help choose the right doctor. Brighter lets consumers compare dentists by price and reputation.

This is what true entrepreneurship and innovation looks like. It’s messy, scattered, and about disrupting conventional approaches. These innovations give new meaning to “consumer-driven healthcare.”

In contrast, Obamacare pilot projects are about conformity—a centralized cookbook approach that promises failure on a grand scale.

Healthcare needs entrepreneurial disruption focused on consumer satisfaction and consumer empowerment, not bureaucratic conformity focused on aiding political cronies.

Ai Weiwei Goes to London

AeiWeiWeiBritain’s Home Office has rectified the decision to grant Ai Weiwei—China’s most famous artist and somewhat of a “cause célèbre” among victims, critics and dissidents in China—a 21-day visa in connection with the exhibition that will open soon at the Royal Academy of Arts. Home Secretary Theresa May has backtracked and granted him the six-month visa he had originally requested.

It is obvious that the offensively restrictive permit was aimed at preventing Mr. Weiwei from being in London at the same time that Chinese president Xi Jinping will be visiting Britain to discuss investments and trade with his hosts in October. The desperate attempt to clear the way for Mr. Jinping originally led the British government to prove once again the close connection between the absurdity of political bureaucracy and absurdist art that goes back to Dadaism and surrealism in postwar Europe, and which Weiwei’s own art exemplifies, in part reflecting the lack of communication in a world devoid of meaning.

London had alleged that the Chinese artist concealed a criminal conviction in his application. Actually, he concealed nothing because the Chinese government thugs who kidnapped him and placed him in arbitrary detention for three months in 2011, and who subsequently kept him under house arrest for four years, never charged him or sentenced him.

What Weiwei did get was a “tax fine” of $2.4 million that he was able to pay only with the help of some 30,000 sympathizers who sent him money—and to whom he gave in return beautifully designed and drawn IOUs that are probably worth much more than their face value.

This kind of attitude by Western liberal democracies towards dictatorial regimes always begs the question: Is it a case of servile obedience to the express wishes of the government they are trying to please, or simply an anticipatory gesture based on an interpretation of what those wishes might be?

Prime Minister David Cameron was not always as ready to please the Chinese authorities. In 2012, for instance, he caused a stir in Beijing by meeting with the Dalai Lama. A few months later, however, he seemed to atone for that act of diplomatic impudence by publicly rebuking the same Dalai Lama before taking a major trade delegation to China on an official visit.

He had further occasion to show remorse when, last year, he resisted every request to express sympathy for the valiant pro-democracy activists who were denouncing China’s move to change the voting system in Hong Kong. He has exercised no such restraint when invited by the Beijing authorities to embrace China’s efforts to gain influence over its neighbors and beyond—for instance by having Britain join the Asian Infrastructure Investment Bank.

By all means, let the Brits and the Chinese engage each other commercially and even politically. But why should the price of political and business engagement be to limit or bar other types of engagement, including the civic, moral and spiritual kind that Weiwei embodies by taking his conscience and his tongue wherever he is able to go? Only if one has a narrow-minded and perverse notion of what free exchanges mean can one find any sort of reason in restricting a visit from Weiwei in order to facilitate a visit from Jinpin.

Restricting Weiwei also amounts to restricting the Brits from deciding by themselves whether they want to see, talk to, listen to, or debate with this man who has a message he wants to share with them.

New Evidence that Obamacare Is Working?

in-line-for-obamacareObamacare supporters are excited by a research article suggesting Obamacare is working to increase access to care. In an article published in JAMA: The Journal of the American Medical Association, researchers followed up respondents to the Gallup-Healthways Well-Being Index (which I’ve discussed previously).

Yes, in an absolute sense, their access to care improved. According to the Huffington Post’s Jonathan Cohn, this means “Another Argument From Obamacare Critics Is Starting To Crumble.” Oh dear. However, even Citizen Cohn admits “[t]he picture from the raw data is a little muddled” and “like all academic studies, this one will be subject to scrutiny that, over time, could call its findings into question.” Well, I won’t call them into question, just point out what is obvious from the abstract itself: Obamacare is dong a terrible job increasing access to care.

Among the 507 055 adults in this survey, pre-ACA trends were significantly worsening for all outcomes. Compared with the pre-ACA trends, by the first quarter of 2015, the adjusted proportions who were uninsured decreased by 7.9 percentage points; who lacked a personal physician, −3.5 percentage points; who lacked easy access to medicine, −2.4 percentage points; who were unable to afford care, −5.5 percentage points; who reported fair/poor health, −3.4 percentage points; and the percentage of days with activities limited by health, −1.7 percentage points. Coverage changes were largest among minorities; for example, the decrease in the uninsured rate was larger among Latino adults (−11.9 percentage points than white adults. Medicaid expansion was associated with significant reductions among low-income adults in the uninsured rate (differences-in-differences estimate, −5.2 percentage points), lacking a personal physician (−1.8 percentage points), and difficulty accessing medicine (−2.2 percentage points).

B.D. Sommers, et al., “Changes in Self-Reported Insurance Coverage, Access to Care, and Health Under the Affordable Care Act, JAMA: The Journal of the American Medical Association, 314:4 (July 28, 2015)

The uninsured dropped by 7.9 percentage points, but those who lacked a personal physician dropped only 3.5 percentage points. In other words, 56 percent of those who got insurance under Obamacare still lack access to a personal physician. With respect to Medicaid, it was worse. The number of Medicaid dependents dropped 5.2 percentage points, but the number lacking a personal physician dropped only 1.8 percentage points. That means 65 percent of those newly enrolled in Medicaid still lack a personal physician.

That does not look like success to me. It looks like spending a whole lot of money for little result.

* * *

For the pivotal alternative to Obamacare, please see the Independent Institute’s new book, A Better Choice: Healthcare Solutions for America, by John C. Goodman.

Atlas Shrugs

AtlasThree months ago, the CEO of Gravity Payments, a Seattle credit card processing firm, announced that all of the firm’s employees would be paid a minimum of $70,000 a year, according to this story. Now, the firm has fallen on hard times, and some of the firm’s “higher valued” employees have quit. One employee who quit said, “He gave raises to people who have the least skills and are the least equipped to do the job, and the ones who were taking on the most didn’t get much of a bump.” Another who quit said, “Now the people who were just clocking in and out were making the same as me. It shackles high performers to less motivated team members.”

The real-world Gravity Payments sounds a lot like the fictional Twentieth Century Motor Company from Ayn Rand’s novel, Atlas Shrugged, and while the quotations from the real-world employees who left Gravity Payments do not sound quite as passionate as the fictional John Galt, the message is the same.

Rand’s novel was first published in 1957 and has been continuously in print since. I am not the first to observe that many real-world events since the publication of Rand’s novel closely resemble events in the fictional world she described. Here is another example.

Tennessee’s Fracking Controversy

ShaleGasShale gas deposits underlie about a third of the State of Tennessee. Tapping that low-carbon resource is essential if electric utilities there and across the nation have any hope of complying with the Environmental Protection Agency’s Clean Energy Plan, which mandates a 30 percent reduction in carbon dioxide emissions by 2030.

Yet environmental groups are fighting furiously against proposals to recover Tennessee’s abundant natural gas supplies because doing so requires expanding hydraulic fracturing (“fracking”) of the state’s shale formations. That opposition is both perverse and disingenuous of people demanding action against climate change, not by shifting from coal to natural gas, but instead by relying more heavily on solar and wind power to meet the nation’s energy needs.

“Perfect” energy options have become the enemy of “good” and practical ones.

Generating electricity from renewables hinges on the availability of other energy sources on days when the weather isn’t cooperating. Without natural gas as a backup, the sun and the wind are not reliable enough to supply today’s energy demands. Solar and wind combined contribute less than 5 percent of the nation’s electricity requirements – and that share would be much smaller but for tax credits and state mandates requiring greater reliance on renewable energy sources.

Wind turbines, on average, generate electricity 25 percent of the time and solar arrays are online even less regularly. The nation’s base-load natural gas and nuclear-powered plants, in contrast, produce electricity over roughly 90 percent of the day and the year.

Although energy companies have been buying mineral rights to the Chattanooga Shale in the eastern part of the state, fracking has yet to take hold in a big way because it hasn’t been profitable at today’s low natural gas prices. But if and when those prices rise or new drilling innovations reduce the cost of fracking, gas production will take off.

Even now, though, TVA needs the state’s natural gas – and additional nuclear power – to reduce its reliance on coal-fired electricity generators. And Tennessee needs the jobs and other huge economic benefits that will come with more natural gas production.

There’s a lot at stake. The University of Tennessee wants an energy company to frack on about 8,000 woodland acres maintained as an outdoor laboratory on the Cumberland Plateau. The lease revenues potentially total hundreds of millions of dollars. The university has proposed using some of that revenue to support research on fracking’s environmental risks. But corporate funding of public institutions of higher learning is anathema to Greens and some faculty members, who contend that such a pact with the “Devil” creates a conflict between the public’s interest and that of external sponsors.

The reality is that universities nationwide face mounting pressures to increase corporate funding to offset ongoing reductions in government spending on teaching and research. There’s nothing wrong with this. To the contrary, private financial support for universities has led to breakthroughs in everything from biotechnology and computing to public health. Why not use oil and gas money to support good science at Tennessee’s flagship school on fracking or to endow a chair in petroleum engineering?

Fracking is underway nowadays in a dozen states around the country. Shale formations underlie a wide swath of Appalachia, and the oil and gas industry is eager to expand its fracking operations into New York, North Carolina, and Maryland. No one can deny the huge economic potential of the Chattanooga Shale, which is an extension of the giant Marcellus Shale to the northeast.

Fracking ordinarily involves injecting large amounts of water underground under high pressure, but the Chattanooga Shale is too fragile for that, so nitrogen gas is injected instead. That process reduces the quantity of water needed for drilling, leaving more available for irrigation and other uses. Hence, there is little or no need for wastewater injection wells in Tennessee, a recovery technique that has been linked to incidents of groundwater contamination – but only a few of them – since fracking began in the 1940s.

The growth of shale-gas production has produced unquestionable environmental benefits. Natural gas has less than half the carbon content of coal. Owing largely to a switch from coal to gas in electricity generation, U.S. greenhouse-gas emissions have fallen to 1990 levels. Fifteen years ago, gas accounted for 16 percent of national electricity production; its share has increased to 27 percent today. Coal use has gone in the opposite direction, plummeting from 51.3 percent of the total in 2000 to 39 percent today.

Neither Tennessee nor any other state can meet the EPA’s carbon-dioxide reduction goal without natural gas and nuclear power. If fracking is banned, electricity prices will go up, heating prices will rise, and the jobs created by the resurgence of U.S. manufacturing, all of which can be attributed to falling energy prices, will go by the wayside.

Still Won’t Stand with Rand

7374836_SLast week I published a piece on Rand Paul. In particular, I argued that Paul or any other “libertarian” political figure would not generate the changes desired by those who value liberty.

The responses to this post have been numerous. Many people agree with me. For others, it’s as though I backhanded their mothers in suggesting that Rand Paul isn’t the savior of America or its politics.

I’d like to offer some additional reflections on a possible “President Paul” or any other libertarian or free market candidate and address some of the more frequent comments and questions regarding the piece.

Some have said that I am too critical of Paul and his political activities in my original piece. “He has to introduce bills to encourage freedom,” “He’s voted against military activity, etc. etc.” I think Paul’s voting record and the content of the bills he’s introduced speak for themselves. What constitutes a “freedom-friendly” policy is at least somewhat subjective, so I’ll leave that issue alone and discuss what is more substantive.

People claimed I advised libertarians abstain from all political participation. Further, they read my article as suggesting that the optimal amount of resources to devote to political activities is zero.

However, nowhere does my argument imply that those who are inclined to political activity should stop. If one feels a desire to work in the political arena, or has a notion of civic duty when it comes to voting, etc., by all means continue.

Moreover, the piece does not say that all political actions are moot. Indeed, they are not. The policies enacted by government absolutely have an impact on citizens. Just look at rent controls, minimum wage laws, and any U.S. foreign policy. There is no doubt that political actions influence on our daily lives. Sometimes, good policies lead to good outcomes—but I’d argue this has little to nothing to do with the personal convictions of the political actors making these decisions and everything to do with the incentives they face.

What I am saying is that a theoretical President Paul would not be a champion of liberty. In fact, I will make the stronger claim that no politician in the American political system will be a true champion of personal freedom.

Why? The reasons I argue this point are those I mentioned in the original post—the ideas brought forth by Nobel laureates F.A. Hayek and James M. Buchanan. As Hayek pointed out, the “right politicians” elected by populace won’t actually be good. In “Why the Worst Get on Top” Hayek discusses how an “American socialism” would not be meaningfully different than Russian socialism. His core argument is still relevant when discussing the American political system. Add to this Buchanan’s point that political actors respond to incentives based on their personal preferences and the constraints they face.

What Hayek and Buchanan are pointing to, and what I hope to convey here, is that there is a bigger problem when it comes to trying to achieve change through politics. That is, it’s the institutional structure of the political system that’s the problem and not the people involved. One of the comments I came across on several occasions stated something to the effect of, “we [those who value liberty] have to play with the hand we’re dealt,” “you come to the table or you’re served for dinner,” or, “we have to play the game.” What all of these comments suggest is that, even though we might not like it, it is necessary to support libertarian(ish) political candidates in order to achieve meaningful reforms.

What I am saying, drawing from Hayek and Buchanan is that a public actor’s political stripes doesn’t mean much at all. It’s not the players that are the problem; it’s the game they are playing. Without changes in the rules governing the political process, swapping out Democrats for Republicans, Republicans for Libertarians, or any other party makes no substantive difference. Look at the trends in government policy over the past several decades. Regardless of who was in power, we’ve experienced continuous growth in the scale and scope of government and the further erosion of our freedoms.

Not all, but many Paul supporters seem to neglect or downplay this idea. They will use the rhetoric of freedom and say that the system is broken, but don’t seem to realize that Paul is a political actor just like all the rest. As I tried to point out, he’s a public official making decisions based on his own self-interest. The fervor displayed by many Paul supporters is the same type of political tunnel vision we see in supporters of Obama, Clinton, and Donald Trump. They are quick to criticize the political process, but trust it to be solution to the problem. These positions are in direct conflict.

So what do we do? If I claim that politics isn’t a fruitful avenue, can I suggest anything productive? First, I’d say that our battleground is one of ideas, not politics. As I’ve written elsewhere, ideas matter. I would also suggest one of the most important things we can do is recognize and point out that it’s government that’s the problem. There are other ways for individuals to coordinate their behavior than relying on an inherently flawed political system. How else do we bring about change? If the rules of the game are the problem, how to do we change the rules? For that, I cannot claim to have an answer (if I did, I’d collect my Nobel prize and retire.) In fact, the entire field of Constitutional Political Economy has been wrestling with this question of rules for decades. How we change these rules is unclear. What is clear, however, is that we cannot rely on the current system to be the genesis of these changes.

Health Spending Growth Moderate in Second Quarter (Maybe)

senior-health-care_squareA recent report by actuaries working for the Centers for Medicare & Medicaid Services estimates that the rate of growth of health spending, subdued for many years, is picking up again: “The health share of US gross domestic product is projected to rise from 17.4 percent in 2013 to 19.6 percent in 2024.”

Readers of this blog’s discussion of regular releases of GDP estimates by the Bureau of Economic Analysis knew this was coming. Yesterday’s release of the advance estimate of second quarter GDP confirms that health spending is chewing up more and more of a slow-growing economy.

Comparing Q2 2015 to Q2 2014, GDP increased by $570.5 billion, of which $106.7 billion was health services. That’s about one dollar in every five.

Comparing Q2 2015 to Q1 2015, health spending growth looks a lot tamer: $21.6 billion of $191.2 billion GDP growth. That is only one dollar in ten, about half of what it has been running at. However, the advance estimate is subject to significant revision. Last quarter’s slow growth of health spending may be idiosyncratic and/or inaccurate.

Technical note: When I discuss health services in these quarterly GDP releases, I mean only health services. I do not include purchases of medical equipment, or facilities construction. While I include Medicare and Medicaid, I do not include Veterans Health Administration or other government benefits. So, these dollar figures undercount the amount of our economy consumed by the government-health complex.

(See: Measuring the Economy: A Primer on the GDP and the National Income and Product Accounts, Bureau of Economic Analysis, October 2014, pages 5-2 and 5-3; Micah B. Hartman, et al., “A Reconciliation of Health Care Expenditures in the National Health Expenditures Accounts and in Gross Domestic Product,” Research Spotlight, Survey of Current Business, September 2010, pages 42-52.)

Janet Napolitano Makes History as University of California Pension Reformer


University of California President Janet Napolitano

In an effort to control skyrocketing retirement costs in the massive University of California system, U.C. employees hired after July 1, 2016, will be able to choose a 401(k)-style pension plan, the first time this has been offered. Governor Jerry Brown and U.C. president Janet Napolitano negotiated the agreement, which was enshrined in the state budget approved recently by the California legislature.

Perhaps even more historic, however, are the arguments made by Napolitano in favor of 401(k) pensions.

Napolitano told the Sacramento Bee that, regarding 401(k)s: “This is where the pension world is moving, and for public institutions, it makes a lot of sense. It’s much more portable, so for many people that will be an attraction.”

Napolitano is correct on both points. The private sector largely abandoned old-fashioned defined-benefit pensions decades ago. Less than 15 percent of the “Fortune 100″—America’s largest companies—offer a defined-benefit pension anymore. Percentages are even lower for smaller companies. And more state and local governments across America offer 401(k)s than ever before.

Also, as I show in my new book California Dreaming: Lessons on How to Resolve America’s Public Pension Crisis, 401(k)s are often a better approach to retirement security for modern workers who do not stay with the same employer for 20, 30, or 40 years as was common in the past. Defined-benefit pension plans, which are “backloaded,” made more sense under the old “hire and retire” model when workers stayed with the same employer for decades. Modern workers in the private sector and public sector want more job flexibility, and 401(k)s are generally superior under these conditions.

The details of U.C.’s new 401(k) pension plan must be worked out by July 2016, but as Napolitano said: “Pension reform needs to happen. It’s the responsible thing to do.” I strongly agree, and I welcome Janet Napolitano to the populist cause of people across the political spectrum in California who correctly recognize that the current public pension system is unsustainable. Switching to 401(k)s going forward is a better approach to retirement security that will help spare our children and grandchildren from being crushed by future pension costs.

Medicaid’s Poverty Trap Illustrated

stethoscope and dollarThe tragic story of a disabled woman trapped in poverty by the hodge-podge of ways the U.S. finances health care illustrates why we need to sweep the whole thing away and give everyone a universal, refundable tax credit:

On a crisp California morning in February 2012, my sister-in-law, Marcella Wagner, was driving down the interstate toward Chico State University, where she had just entered the nursing program.

To avoid a collision, she jerked the wheel hard, and her car veered off the freeway. It rolled over, crushing the roof. The other driver sped off, never to be found.

But Marcella was left a quadriplegic, paralyzed from the chest down and with little use of her hands. She will need a wheelchair and round-the-clock personal care assistance indefinitely.

Marcella qualified for Medi-Cal because she is disabled, but because Medi-Cal is for poor people, Dave and Marcella have to be poor to receive it.

As a family of three with one disabled member, they are allowed to keep $2,100 of Dave’s $3,250 monthly earnings to live on. The rest of Dave’s earnings, $1,150, would go to Medi-Cal as the family’s share of cost. That is, any month in which Marcella incurred medical expenses, she and Dave must pay the first $1,150. To our surprise, if Dave earned more money, the extra amount would also go to Medi-Cal: The cost sharing is a 100 percent tax on Dave’s earnings.

Essentially, the way they meet the income test is for Medi-Cal to skim off Dave’s income until they are in fact poor.

(Andrea Louise Campbell, “How Medicaid forces families like mine to stay poor,”, July 28, 2015)

This is the “poverty trap” imposed by means-tested welfare programs that I have discussed before. The best way to fix it is through a fixed sum, universal tax credit, as described by Senior Fellow John C. Goodman in his new book, A Better Choice.