Almost All Increase in Health Coverage Due to Return of Benefits: An Update

52956886 - close up photo of blood pressure measurementThe best measurement of people who lack health insurance, the National Health Interview Survey published by the Centers for Disease Control and Prevention (CDC), has released early estimates of health insurance for all fifty states and the District of Columbia in the first half of 2016. There are three things to note.

First: 69.2 percent of residents, age 18 to 64, had “private health insurance” (at the time of the interview) in the first half of this year, the same rate as persisted until 2006 (page 1, Figure 1; and page A5, Table III). Obamacare has not achieved a breakthrough in coverage. It has just restored us to where we were a decade ago.

Second: The NHIS includes people with Obamacare coverage (via the exchanges) as privately insured. These comprised 4.8 percent of the population, aged 18 to 64 (page 5, Figure 8). So, slightly fewer than 64.4 percent had employer-based coverage. (A small number of people still have non-exchange individual policies.) That proportion is about the same as from 2010 through 2013 (page A5, Table 3). So, employer-based coverage has held steady.

Third: There has been a significant change from private coverage to government welfare (primarily Medicaid). The shift has been about five percentage points since 2006 and ten percentage points since 1997 Page 1, Figure 1). This trend was especially pronounced among children. In the first half of this year, 42 percent of children had government welfare for medical spending, little changed since 2010. However, between 2000 and 2010, the proportion doubled from about 20 percent to about 40 percent of children (page 2, Figure 2).

Critics of Obamacare who focus on its increasing the proportion of people dependent on Medicaid (a welfare program) ignore the great expansion of Medicaid dependency years before anyone had heard of Barack Obama.

* * *

For the pivotal alternative to Obamacare, see Priceless: Curing the Healthcare Crisis and A Better Choice: Healthcare Solutions for America, by John C. Goodman, published by Independent Institute.

Perspectives on the President Elect

55407307_MLLike many Americans, I was surprised with the results of our recent presidential election. I had assumed, like so many others, that a Clinton presidency was inevitable.

Obviously, I was wrong.

Since the election, friends, students, and others have asked what I think of President-elect Trump. While I tend to shy away (especially with students) from endorsing or disparaging any particular candidate, I feel comfortable discussing particular policies.

Now, President-elect Trump’s consistency with regard to what policies he will implement has been remarkably inconsistent. He has published, however, his “100 Day Plan,” a list of initiatives he says he will work to implement his first 100 days in office.

I thought I’d take this opportunity to discuss my thoughts regarding some of his proposals. As a caveat, what follows largely ignores the all-important issue of political feasibility. (For better or worse, I think a lot of these proposals will be extremely difficult, perhaps impossible, to implement.)

Money in Politics

55416821 - hands holding us dollar bills and small money pouch. toned pictureWe’ve heard the complaints about how money influences politics, but the recent presidential election shows that money doesn’t always Trump voter preferences.

Before the primary elections, Jeb Bush had raised far more money and received more support from major Republican figures than other Republicans in the race; yet he was one of the earlier casualties in the fight for the nomination.  In the general election, Hillary Clinton raised far more money for her campaign than Donald Trump did for his.  Trump won the primaries and the general election, despite being outspent by his opponents.

Much of the discussion turns on the First Amendment’s guarantee of freedom of speech.  If people are prevented from spending money to make their viewpoints heard, this would seem to me (but not to everybody) to be a clear violation of the First Amendment.  The 6-5 Supreme Court decision in the Citizens United case shows the division of views on the financing of political speech.

Money influences politics, of course, but the 2016 election shows that those who spend the most are not always able to buy the election outcome they want.

In Politics, Innovation Isn’t Always Progress

40299973 - statue of liberty at sunset as viewed from brooklyn new yorkBoth Donald Trump and Hillary Clinton called for innovative solutions for what ails America. For the former it was a new fence on our southern border that will supposedly be funded by Mexico; for the latter it was free (i.e., taxpayer subsidized) college tuition.  Fresh ideas, they told us, could “make America great again” and render us “stronger together.”

Neither campaign stopped to consider that it was an innovation that led to our current woes, one that most Americans view as their country’s greatest contribution to political science: the U.S. Constitution.

Undoubtedly, blaming America’s “paramount law,” as Chief Justice John Marshall called the Constitution, seems like scandalous heresy.  Americans are taught that their fledgling nation was going down the tubes until ratification of the Constitution in 1788 ensured that the United States of America would survive the failures of the Articles of Confederation. The standard narrative portrays the Federalists, the proponents of the new Constitution, as visionaries and paints the Anti-Federalists, who opposed ratification, as men of little faith with no concept of future American greatness.

What the conventional tale leaves out are Confederation’s significant accomplishments.

Entitlement Mentality?

59198107 - microphone in focus against blurred crowd. filming protest.I’m not sure what to think about the anti-Trump protests following the election.  If the protests occurred before the election (and there were some), I’d think the protesters were expressing their views that people should not vote for Trump or support his policies.  Now that he’s been elected, that decision is behind us, and Trump has done nothing since the election that warrants a protest.  What are they protesting?

They could be protesting the system itself—the electoral institutions that led to Trump’s victory.  Probably not, though.  Surely they would have been happy with the system had it chosen Clinton.  They could be protesting their fellow citizens who voted for Trump.  Those voters are the ones who determined the outcome of the election.  Trump was just one of their choices.

What I’m seeing in the protesters is an entitlement mentality.  A democratic election in which they happily participated didn’t go their way, so they are protesting the outcome that didn’t give them what they wanted.  They are acting like spoiled children, maybe because they are spoiled children.

Faith and Courage on Hacksaw Ridge

Hacksaw_Ridge_posterWith faith comes conviction; with conviction comes courage; with courage comes action; with action comes leadership; with leadership comes social change. That chain could easily encapsulate the main storyline of Hacksaw Ridge, an engaging and sobering biopic focused on the heroic acts of World War II medic Desmond Doss.

Desmond Doss was a Seventh Day Adventist when he enlisted in the Army to fight during World War II. His faith had deep personal roots, a reaction to his violent childhood where he was physically encouraged to fight with his brother and was abused by his alcoholic father. His pacifism arose in the aftermath of a fight where he nearly killed his brother as a child (at least in the film version of the story). He interpreted the commandment “thou shalt not kill” as literal and universal (he was also a vegetarian). Allegiance to this commandment wouldn’t normally be a problem, unless you enroll in the Army during wartime. Doss felt the call to serve his country after the Japanese attacked Pearl Harbor, and he reasoned he could serve his country by saving the lives of men as a medic. So, he joined as a Conscientious Objector, and became one of the few enlistees to be granted CO status.

The story, however, is as much about Doss’s comrades as it is about his own life. Doss (played artfully in an understated performance by Andrew Garfield of The Social Network and Spider-Man fame) remains steadfast in his faith and pacifism even as he is faced with physical abuse by his fellow recruits in basic training, relentless pressure by his commanding officers (played by Vince Vaughn and Sam Worthington) to quit, a court martial that nearly landed him in jail for the remainder of the war, and a relentless deluge of bullets, mortar shells, and artillery barrages in one of the bloodiest battles of the war (Okinawa). His fellow soldiers are resentful of his unwillingness to even train with a rifle, believing his beliefs are simply cover for cowardice. This resentment continues as they enter battle, but are won over by Doss’s unflinching courage and dedication to saving them as their company is decimated and eventually overrun by the Japanese.

Doss saved at least 75 U.S. soldiers in real life, and the movie does a great job of giving the audience a close up of many of them as Doss carries them on his back in the midst of battle, hides them from roving Japanese patrols, and lowers them down a 400 foot cliff to safety on the beach. He stayed on the ridge to save his comrades, despite their abuse and doubts, even after his company had abandoned their positions. His bravery and commitment to each of them, regardless of how badly they treated him, changed their hearts and their understanding of courage. Doss was the first Conscientious Objector to earn the U.S. military’s highest honor—the Medal of Honor—and viewers will have no doubt why at the end of the immersive film.

Hacksaw Ridge takes a few liberties—Doss actually served in three major battles in the Pacific in addition to Okinawa (Guam and Leyte), and his heroic acts unfolded over weeks rather than days, among others more minor—but the film stays largely true to the real-life story. The battle scenes have been likened to Saving Private Ryan in their realism, earning a R rating and an element that shouldn’t surprise audiences that have seen director Mel Gibson other movies such as Braveheart or The Passion of the Christ. He doesn’t spare his audiences from the brutal horror of war, and that serves the purpose of the story while honoring the faith-driven courage of Doss. Indeed, the graphic nature of the scenes, death, and injuries on both sides of the battle are essential to conveying the depth of his faith. Physically exhausted and emotionally drained, Doss keeps his faith, imploring God to give him the strength “save one more.” These aren’t mere words in dialogue; they were words he uttered to himself at the moment as a video interview of the real-life Doss shows at the end of the film.

The cinematography is awe inspiring, from the vistas of the land beach to the devastated ground strewn with corpses, maimed humans, and burnt foliage even though the film is a bit plodding in the first 30 minutes as Doss’s backstory is fleshed out. The pace quickens, however, once Doss enters boot camp, and he faces the hostility of other recruits. Gibson uses several pivotal plot points, including a moment when his fiancée encourages him to quit to avoid being imprisoned for disobeying an officer, to bring the audience along as Doss’s each test solidifies his convictions and emboldens him to continue. One of the more memorable moments in the film is near the end the battle, when Doss picks up the rifle of a wounded soldier as the Japanese advance on their position. The soldier—his drill instructor (Vaughn) from boot camp—smiles wryly thinking that Doss is finally going to give in and take up the rifle to defend himself and their position. Instead, he uses the rifle to fashion a stretcher to pull his abusive sergeant to safety (as the sergeant shoots at the enemy during their retreat).

Libertarians and conservatives put a lot of thought, time, and effort into the importance of building the voluntary institutions necessary to maintain a civil society. Too little attention, in my view, is put into the importance of faith in providing the courage to challenge and overcome those political and social forces that undermine and destroy it. Hacksaw Ridge uses the faith and courage of Desmond Doss to show just how important those elements of character are, and how their sincere and steadfast application change hearts and minds. Although Hacksaw Ridge can be viewed as an anti-war film, the story is more than testimony to the brutality of war and the nobility of pacifism; it’s an extended, unflinching reflection on the nexus between faith, courage, and leadership in a place where the descriptor “hell” understates the true magnitude of the horror people face and how souls are tested.

Will More Government Oversight Prevent Medicaid Abuse of the Disabled?

36914302 - caregiver holding elderly patients hand at homeThe Office of Management and Budget (OMB) has designated 16 programs as “high error,” meaning that money goes offside due to fraud, waste, and abuse. Medicaid, the joint state-federal program that subsidizes medical services for low-income people, ranks highly on the list. The U.S. government considers almost ten percent of its $297.7 billion contribution to Medicaid—$29.1 billion—to be paid “improperly.”

The Department of Justice has had significant success tracking down and charging those who bill Medicaid and Medicare falsely. However, there is an even worse type of abuse happening in Medicaid: actual physical abuse of the most vulnerable patients in the system. This abuse often goes hand-in-hand with financial fraud in the area of personal-care services.

According to the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services, Medicaid spending on in-home personal care of disabled people has grown ever since a 1999 judgment that many disabled people were being institutionalized in violation of their civil rights.

Reflections on Donald Trump’s Election

55986706_MLAs the markets and pundits react to Donald Trump’s enormous upset victory, let me offer my own reactions. As an economist, I will focus on matters pertaining to economic policy.

The Danger of Hubris and Denial. Everybody recognizes that the “experts” and polls were totally wrong. Indeed, I was listening to NPR around 6 p.m. Eastern time on Election Night, and these commentators were all but speculating on President Clinton’s Cabinet. Later, around midnight, I was curious how NPR’s anchors would handle the blow. I am only slightly exaggerating when I say that the explanation was, “Trump motivated more bigots than we expected.”

Yet this type of reaction reflects a complete evasion of the media elite’s own failings. Indeed, part of the support for Trump came from people who are not bigots but are sick and tired of being called names simply for disagreeing about the proper size of government.  I didn’t vote for Trump—I no longer vote, as a matter of principle—but I have had discussions with plenty of Trump supporters in the past two years. I don’t know a single person who approved of his boorish comments about women; they were all voting for him despite his obvious flaws as a person.

Is a Trump Revolution in the Offing?

23231312 - trump international hotel, las vegas, nevada - february 2, 2012 - donald trump speaking with the media

I have now demonstrated to my complete satisfaction that as a political prognosticator I am a total bust. Not that I put much effort into trying, to be sure, but I certainly developed firm ideas as the politicking proceeded over the past year or more. When Donald Trump first appeared on the horizon as a presidential hopeful, his actions struck me, as so much about the man and his ideas has struck me, as a bad joke. I gave him no chance of gaining the Republican nomination. After he had surprised me by doing so, I gave him a negligible chance at best of winning the election against Hillary Clinton, who was the overwhelming favorite of the political establishment and the beneficiary of a powerful political machine. Thus, my record in regard to Trump so far has been: wrong and wrong again. Of course, many others no doubt saw the matter much as I did, but companionship in error is no basis for excusing my incorrect judgments.

Now that Trump has been elected, many people—including some of my close acquaintance—are practically wailing and gnashing their teeth at the prospect of a Trump presidency. I understand why they feel as they do. I myself look forward to his actions in office with the greatest trepidation. I have always regarded him as a loose cannon, a man so ill-anchored in any visible principles and so lacking in genuine understanding and wisdom about economic and governmental affairs that I have marveled at observers who expected him to do this or that. To me, he has been and remains a complete crap shoot. At this point it is difficult to think of anything he might do that would come as a complete surprise to me, inasmuch as a vast set of possibilities seems always to be “on the table” for him.

The U.S. Military: The Cost of the Sacred Cow

10087412_MLCriticizing the U.S. Armed Forces is largely taboo. For many, U.S. military programs are a sacred cows, something to be shielded from criticism and any sort of objection. Even those who are usually critical of other forms of government spending and growth balk at the idea of cutting military spending or reducing the U.S. military’s bootprint.

Indeed, even among many economists, issues surrounding the military and “national defense” more generally are largely immune from criticism. Consider, for example, that national defense is often the textbook example of a “pure public good.” A pure public good is one that is both “non-rival” and “non-excludable.” In theory, one person’s use of national defense does not diminish another person’s use and there is no way for the government to effectively deny protection to one person. (As an aside, my frequent coauthor, economist Chris Coyne, makes a very good argument for why we should rethink this idea.)

The concept of defense as a pure public good, and the way economists and others model national defense, have important implications. When making decisions regarding military operations, it is almost always assumed, by academics, politicians, and lay people alike, that decisions are made in the “public interest.” That is, those responsible for defense policy set aside their own wants and instead focus on maximizing some broader social welfare function. In essence, it becomes a math problem.

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