Florida’s Financial Health Care Follies, and a Problem with a Part-Time Legislature

FloridaSenateThe one constitutional responsibility of Florida’s legislature is to pass a budget — something Florida’s solidly Republican House and Senate could not do by the end of their regular legislative session. The big issue that divided them was how to deal with the Affordable Care Act’s mandates.

Here’s the issue. Florida has been receiving about $1.3 billion a year in a Low Income Pool (LIP) grant from the federal government to help offset the costs hospitals incur from uninsured patients. The Obama administration is replacing LIP funding with Medicaid grants to states that expanded their Medicaid programs under the Affordable Care Act. Florida has not expanded its Medicaid program, so the Obama administration says it will not get the Medicaid money nor the LIP funding.

The state Senate wants to expand Medicaid and get the federal money. The House does not want the Medicaid expansion. There’s the impasse. Meanwhile, Governor Rick Scott is suing the federal government to get the LIP money restored, claiming that the federal government is using the threat of funding cuts in order to try to force the state to expand a program it does not want to expand. The federal government is telling Floridians, who pay federal taxes just like everyone else, that it will send their tax dollars to other states unless they bow to this federal pressure to expand Medicaid.

In 1990 Medicaid made up less than 10% of Florida’s state government budget. Now it makes up more than 30%. It seems reasonable for Florida’s legislature to decide they won’t expand the program further, and it seems unreasonable for the federal government to coerce any state into expanding its expenditures on any program. The federal government passed the Affordable Care Act. They should not be requiring states to administer and pay for it. I’m siding with the Florida House and the governor on this one.

There is another interesting wrinkle in this division between the Florida House and the Florida Senate. Florida has a “part-time” legislature, so most legislators have other jobs. The president of the Florida Senate, Andy Gardiner, is vice president of Orlando Health, a network of hospitals that receives state funding. His annual pay of nearly $200,000 a year includes incentives based partly on the financial performance of the hospitals in his network. Gardiner has a direct personal incentive to push for Medicaid expansion, even as the House and governor oppose it.

Conflicts of interest show up often in every legislature, but this specific example might point toward a problem with “part-time” legislatures, which almost require legislators to have outside financial interests.

Florida’s Constitution requires a budget to be passed by July 1, and with the regular legislative session now over, I expect a special session to be called and a budget passed. Unlike market transactions, where people exchange for their mutual benefit, politics is a game of winners and losers, so however this plays out, one side will win and the other will lose.

This isn’t Republicans against Democrats. Both the House and Senate are solidly Republican. This is just an example of how the political process divides people and creates conflict, even among people who mostly agree with each other.

Obamacare’s State-Based Exchanges Struggle with Surging Costs

Money-Spiral-Image-for-PostObamacare’s health insurance exchanges are a real problem. States that established exchanges as “active purchasers” of health insurance, instead of just clearinghouses, have higher premiums. So, what is the point of them? Further, the federal government threw billions of dollars at states to set up exchanges, with zero accountability.

Things are not improving. From the Washington Post:

Nearly half of the 17 insurance marketplaces set up by the states and the District under President Obama’s health law are struggling financially, presenting state officials with an unexpected and serious challenge five years after the passage of the landmark Affordable Care Act.

Many of the online exchanges are wrestling with surging costs, especially for balky technology and expensive customer call centers — and tepid enrollment numbers. To ease the fiscal distress, officials are considering raising fees on insurers, sharing costs with other states and pressing state lawmakers for cash infusions. Some are weighing turning over part or all of their troubled marketplaces to the federal exchange, HealthCare.gov, which now works smoothly.

Well, whether the federal exchange “works smoothly” or not is a discussion for another day, although I would beg to differ with the WaPo. A more appropriate description of healthcare.gov might be that it works illegally, because it pays tax credits to insurers without any legal basis for doing so.

That is the question in the Supreme Court case King v. Burwell. If the Supreme Court decides for the plaintiff, healthcare.gov will effectively wind down (because it won’t have any more access to taxpayers’ money). With state-based exchanges failing, the future of Obamacare is in great doubt.

* * *

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.

Galeano vs. Rangel: A Conflict of Visions in Latin America

liberty_for_latin_america_180x270In 2009, President Hugo Chávez caused a stir when he presented President Barack Obama with a literary gift titled Open Veins of Latin America. The author, Uruguayan writer Eduardo Galeano, an icon of the left, died last month. It so happens that 2015 is also the fortieth anniversary one of the best books about the developing world, The Latin Americans — Their Love-Hate Relationship with the United States, written by Venezuela’s Carlos Rangel. Unfortunately, the translation of the title misses the powerful connotations of the Spanish title.

Galeano spent his life mythifying Latin America; Rangel, who committed suicide in 1988, spent his demythifying it. The Uruguayan enjoyed the protection of a vast left-wing apparatus. The Venezuelan was one of the left’s favorite targets in the 1970s and 1980s.


Why Don’t You Own Your Own Health Information?

health_informationDavid Brailer, MD, was the first head of the Office of the National Coordinator of Health Information Technology (ONC), appointed by President George W. Bush. Today, he is a venture capitalist.

Last week in the Wall Street Journal, Dr. Brailer noted that a law passed in 1996 governs our access to health information. Clearly, it needs updating:

This brave new digital world has one huge risk: You don’t own your health information. In 1996 the U.S. passed a law called HIPAA (Health Insurance Portability and Accountability Act) requiring hospitals, physicians, labs, pharmacies and other “covered entities” as well as the health plans and their “business associates” (for example, an information-technology vendor) to protect how your data is stored and released. But not without delays, often for months. You can’t force a covered entity to give your data to someone you choose, and you can’t stop them from giving it to someone they choose. Health apps? Most aren’t covered by HIPAA at all, and can do whatever they want with your information.


Competition and Cooperation

choice_180x270Competition is often used to describe market activity, and cooperation is often used to describe political activity, but competition more accurately describes politics and cooperation more accurately describes markets.

Market activity is based on voluntary exchange, and transactions take place only if all parties agree. Parties engage in voluntary exchange for their mutual benefit, which is cooperation at its finest. All parties benefit, or the transaction does not take place.

In politics, it is almost always the case that people involved have conflicting agendas, and when one side wins, the other loses. This is obvious at the national level, where the Republican Congress finds itself at odds with the Democratic president. At first it might appear that the conflict comes from party differences–Republicans versus Democrats–rather than being an inherent characteristic of politics, but a look at Florida politics provides evidence that politics leads to conflict.


Health Spending Crushing a Stalled Economy

health_costsMarch’s estimate of last year’s fourth quarter Gross Domestic Product (GDP) showed that health spending was chewing through a weak economy. Today’s release of the advanced estimate of this year’s first quarter GDP might best be described as health spending crushing a stalled economy.

GDP barely budged, increasing by a trivial 0.2 percent annualized. Although personal consumption expenditures increased at a much higher rate, the largest component of that increase was health services, which contributed 0.62 percent to the change in GDP. (Housing and utilities, at 0.59 percent, was second.) Investment spending and exports were in the tank.

Seasonally adjusted at annual rates, GDP increased by only $6.3 billion from the fourth quarter. Health services consumption, on the other hand, increased by $23 billion. This is a dramatic increase in a segment of GDP committed to a government-controlled and relatively unproductive sector of our economy.

Campaign Finance Reform—After I’m Elected

Election pledgesWho knew that the New York Times had embraced irony?

In a news piece—not its opinion page—”Clinton Fundraisers Show Scope of Family Network“:

WASHINGTON — Hillary Rodham Clinton is tapping some of the biggest donors to her family’s philanthropy for her presidential campaign, even as the charity is under scrutiny over its own fundraising practices.

Starting what could be a $1 billion-plus fundraising effort, Clinton began raising money for her presidential bid Tuesday in New York, the state she represented in the Senate. The hosts’ connections with the Clinton Foundation show how intertwined the charity is with Clinton’s political career. Even her campaign finance director, Dennis Cheng, had a leading fundraiser role at the foundation before departing for the campaign.

The former secretary of state has faced persistent questions about the foundation’s acceptance of donations from foreign countries and its corporate ties in recent weeks.

And as she starts holding fundraisers this week, plenty of overlap can be seen between long-term political donors and foundation funders.

In New York, Clinton’s first event was at the home of fashion designer Lisa Perry, a longtime Democratic donor to Hillary Clinton’s campaigns, and husband Richard C. Perry. A hedge fund executive, Richard Perry has donated between $250,000 and $500,000 to the Clinton Foundation, according to the foundation’s voluntary disclosures, and supported Hillary Clinton’s Senate and presidential bids.

A second event is co-hosted by Alan Patricof, the finance chairman for Clinton’s Senate campaigns. He and his wife donated between $100,000 and $250,000 to the foundation.

Speaking to 150 donors gathered in a midtown Manhattan apartment at the third event of the day, Clinton stressed her commitment to reforming the campaign finance system — and her goal of raising $100 million for her primary campaign.

[Read the rest, here.]

“Reform for thee but not for me!”

Do Drones Degrade al Qa’ida?

drone2On April 23, the White House announced that one of their drone strikes had killed two al Qa’ida hostages, one Italian and one American.

A few weeks back I discussed the evidence regarding drones and civilian casualties. I argued that, as opposed to being “surgical instruments” capable of eliminating terror groups while minimizing damage to civilians, drones may in fact be worse at reducing “collateral damage.”

Civilian casualties are not the only talking point when it comes to drones. One area of particular interest involves drones’ supposed ability to eliminate al Qa’ida and other terrorist groups more effectively than other means. Nowhere is this idea more clearly demonstrated than in President Obama’s 2013 address on drone policy.

[Drones] are effective…. Dozens of highly skilled al Qaeda commanders, trainers, bomb makers and operatives have been taken off the battlefield…. [T]he primary alternative to [drones] would be the use of conventional military options…. Conventional airpower or missiles are far less precise than drones.

So, are drones really more precise than conventional air power? Has the increased use of drones over the past several years worked to degrade and dismantle terror groups?

If you were expecting a resounding “yes,” I’m sorry to disappoint. Available evidence indicates that drones are not inherently better than other means at taking out terror threats. In fact, drones may have led to an expansion of terrorism activity domestically and abroad.

Proponents of drone use often credit drones as a tool for eliminating “high level” fighters, or leaders of terrorist groups. These targets are particularly important from the perspective of the military. The idea is that by eliminating the leaders of terrorist groups, the structure of the group will weaken and eventually dissolve.

However, drones may not be eliminating these “high value” targets. Reports state that since 2008, drone strikes have killed very few terrorist leaders. Researchers at Stanford and NYU, for example, found that such targets comprised a mere two percent of total casualties. Government reports have shown that drones have killed twelve times as many low-level to mid-level fighters than leaders of al Qa’ida and the Taliban.

As opposed to eliminating these groups, there is evidence that these strikes may be increasing the recruiting ability of terrorist groups. To give just one example, one researcher found that countries in which these strikes have been conducted have seen significant jumps in terror attacks, as much as 58 percent in some cases. Similarly, other research has found that drones strikes not only fail to eliminate al Qa’ida recruitment, but lead to an increase in propaganda output.

This evidence leads to a much broader policy question: Are offensive strikes the best way to eliminate terrorists in the first place? Again, evidence suggests we may want to look to other means to degrade terror groups. It’s been found that most terrorist groups (43 percent) break apart as members of the group decide to pursue changes via their state’s political process. Other groups (40 percent) are broken apart by local operations. A mere seven percent of terror groups are actually ended by military force.

Just as the issue of civilian casualties is important when discussing the U.S. use of drones, it is important to examine whether or not drones are actually achieving the stated objectives of thwarting terrorists. While it appears that strikes have taken out some high-level targets, this group is incredibly small compared to the overall number of casualties. As opposed to eliminating terror, U.S. drone strikes may have the opposite effect.

Tax Freedom Day, 2015

TaxFreedomDayThe Tax Foundation announces “Tax Freedom Day” every year to mark the date on which the average U.S. taxpayer has earned enough income to pay in full all federal, state and local taxes owed. The date this year is today, Friday, April 24, 2015.

“Tax Freedom Day” is determined by taking the ratio of the estimated total tax burden imposed by governments at all levels ($4.8 trillion) to national income. That works out to 31 percent, and 31 percent of the 365-day calendar year falls on April 24. Tax Freedom Day thus is an estimate across all Americans, but it captures the idea that in 2105, the average person must earn income for 114 days in order to “pay” his or her tax bill and therefore can “keep” everything earned from now until December 31.

Obviously, not everyone is required to pay all of the taxes included in the Tax Foundation’s calculation. Only smokers pay federal, state and local excise taxes on cigarettes, for example. And, fortunately, not everyone dies; estate taxes apply only to the heirs of those who do. But “Tax Freedom Day” supplies a rough and ready estimate of the weight of the heavy hand of government on the average American.

Trends are more informative. Tax Freedom Day this year is three days later than it was last year, reflecting an increase in the total tax burden on the average American. It was latest in 2000 (May 1). The date of Tax Freedom Day varies not only over time, but also across states. It occurs earliest this year in Louisiana (April 2) and latest in Connecticut and New Jersey (May 13). The Tax Foundation also estimates that the typical American household owes more in taxes than it spends on housing, food and clothing.

Since voters are “rationally ignorant” (not “stupid” as MIT economist Jonathan Gruber once said was the reason Congress enacted the Affordable Care Act), the Tax Foundation, where I serve as a policy adviser, supplies an easily understood if imperfect measure of what government costs them. If one looks impartially at the programs and policies those tax revenues partly finance (much money spent at the federal level is borrowed), one must conclude that what government mainly does is to transfer income from taxpayers in general to well-organized special interest groups, including farmers, private corporations, peddlers of “green” alternatives to fossil fuels and too many others to list.

Tax Freedom Day is both a cause for celebration and a sobering reminder of what Justice Oliver Wendell Holmes, Jr. called the “price we pay for a civilized society.” The current price is way too high.

Barack Obama Has the Last Word on the Medicare “Doc Fix”

DoctorObamaOn April 15, President Obama signed the so-called Medicare “doc fix,” a bill that I previously warned would recruit Republicans onto Obamacare’s B-Team. I had also hoped that they would reject the bill, especially after Medicare’s Chief Actuary delivered an even harsher verdict on its consequences than the Congressional Budget Office had. Unfortunately, massive majorities of Democrats and Republicans in both the House and Senate voted to increase deficits by $141 billion in 10 years and half a trillion dollars in 20 years.

During the three-week period the secretly negotiated “doc fix” legislation was being rushed through Congress (“rushed” because the Senate was in recess for most of it), I wrote an article suggesting Republicans who voted for it might be casting their first vote for Obamacare.

Well, don’t take my word for it.


  • MyGovCost.org
  • FDAReview.org
  • OnPower.org
  • elindependent.org