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Posts Tagged ‘Boondoggle’

The International Monetary Fund isn’t my least-favorite international bureaucracy. That special honor belongs to the Organization for Economic Cooperation and Development, largely because of its efforts to undermine tax competition and protect the interests of the political class (it also tried to have me arrested, but I don’t hold that against them).

But the IMF deserves its share of disdain. It’s the Doctor Kevorkian of global economic policy, regularly advocating higher taxes and easy money even though that’s never been a recipe for national prosperity.

And it turns out that the IMF also is schizophrenic. The international bureaucracy’s latest big idea, garnering an entire chapter in the October World Economic Outlook, is that governments should spend more on infrastructure.

Barack Obama’s former chief economist supports the IMF scheme. Here some of what he wrote for the Washington Post.

…the IMF advocates substantially increased public infrastructure investment, and not just in the United States but in much of the world. It further asserts that under circumstances of high unemployment, like those prevailing in much of the industrialized world, the stimulative impact will be greater if this investment is paid for by borrowing… Why does the IMF reach these conclusions? …the infrastructure investment actually makes it possible to reduce burdens on future generations. …the IMF finds that a dollar of investment increases output by nearly $3. …in a time of economic shortfall and inadequate public investment, there is a free lunch to be had — a way that government can strengthen the economy and its own financial position.

Wow, That’s a rather aggressive claim. Governments spend $1 and the economy grows by $3.

Is Summers being accurate? What does the IMF study actually say?

It makes two big points.

The first point, which is reflected in the Summers oped, is that infrastructure spending can boost growth.

The study finds that increased public infrastructure investment raises output in the short term by boosting demand and in the long term by raising the economy’s productive capacity. In a sample of advanced economies, an increase of 1 percentage point of GDP in investment spending raises the level of output by about 0.4 percent in the same year and by 1.5 percent four years after the increase… In addition, the boost to GDP a country gets from increasing public infrastructure investment offsets the rise in debt, so that the public debt-to-GDP ratio does not rise… In other words, public infrastructure investment could pay for itself if done correctly.

But Summers neglected to give much attention to the caveats in the IMF study.

…the report cautions against just increasing infrastructure investment on any project. …The output effects are also bigger in countries with a high degree of public investment efficiency, where additional public investment spending is not wasted and is allocated to projects with high rates of return. …a key priority in economies with relatively low efficiency of public investment should be to raise the quality of infrastructure investment by improving the public investment process through, among others, better project appraisal, selection, execution, and rigorous cost-benefit analysis.

Perhaps the most important caveat, though, is that the study uses a “novel empirical strategy” to generate its results. That should raise a few alarm bells.

So is this why the IMF is schizophrenic?

Nope. Not even close.

If you want evidence of IMF schizophrenia, compare what you read above with the results from a study released by the IMF in August.

And this study focused on low-income countries, where you might expect to find the best results when looking at the impact of infrastructure spending.

So what did the author find?

On average the evidence shows only a weak positive association between investment spending and growth and only in the same year, as lagged impacts are not significant. Furthermore, there is little evidence of long term positive impacts. …The fact that the positive association is largely instantaneous argues for the importance of either reverse causality, as capital spending tends to be cut in slumps and increased in booms… In fact a slump in growth rather than a boom has followed many public capital drives of the past. Case studies indicate that public investment drives tend eventually to be financed by borrowing and have been plagued by poor analytics at the time investment projects were chosen, incentive problems and interest-group-infested investment choices. These observations suggest that the current public investment drives will be more likely to succeed if governments do not behave as in the past.

Wow. Not only is the short-run effect a mirage based on causality, but the long-run impact is negative.

But the real clincher is the conclusion that “public investment” is productive only “if governments do not behave as in the past.”

In other words, we have to assume that politicians, interest groups, and bureaucrats will suddenly stop acting like politicians, interest groups, and bureaucrats.

Yeah, good luck with that.

But it’s not just a cranky libertarian like me who thinks it is foolish to expect good behavior from government.

Charles Lane, an editorial writer who focuses on economic issues for the left-leaning Washington Post, is similarly skeptical.

Writing about the IMF’s October pro-infrastructure study, he thinks it relies on sketchy assumptions.

The story is told of three professors — a chemist, a physicist and an economist — who find themselves shipwrecked with a large supply of canned food but no way to open the cans. The chemist proposes a solvent made from native plant oils. The physicist suggests climbing a tree to just the right height, then dropping the cans on some rocks below. “Guys, you’re making this too hard,” the economist interjects. “Assume we have a can opener.” Keep that old chestnut in mind as you evaluate the International Monetary Fund’s latest recommendation… A careful reading of the IMF report, however, reveals that this happy scenario hinges on at least two big “ifs.”

The first “if” deals with the Keynesian argument that government spending “stimulates” growth, which I don’t think merits serious consideration.

But feel free to click here, here, here, and here if you want to learn more about that issues.

So let’s instead focus on the second “if.”

The second, and more crucial, “if” is the IMF report’s acknowledgment that stimulative effects of infrastructure investment vary according to the efficiency with which borrowed dollars are spent: “If the efficiency of the public investment process is relatively low — so that project selection and execution are poor and only a fraction of the amount invested is converted into productive public capital stock — increased public investment leads to more limited long-term output gains.” That’s a huge caveat. Long-term costs and benefits of major infrastructure projects are devilishly difficult to measure precisely and always have been. …Today we have “bridges to nowhere,” as well as major projects plagued by cost overruns and delays all over the world — and not necessarily in places you think of as corrupt. Germany’s still unfinished Berlin Brandenburg airport is five years behind schedule and billions of dollars over budget, to name one example. Bent Flyvbjerg of Oxford’s Said Business School studied 258 major projects in 20 nations over 70 years and found average cost overruns of 44.7 percent for rail, 33.8 percent for bridges and tunnels and 20.4 percent for roads.

Amen. Governments are notorious for cost overruns and boondoggle spending.

It happens in the United States and it happens overseas.

It’s an inherent part of government, as Lane acknowledges.

In short, an essential condition for the IMF concept’s success — optimally efficient investment — is both difficult to define and, to the extent it can be defined, highly unrealistic. As Flyvbjerg explains, cost overruns and delays are normal, not exceptional, because of perverse incentives — specifically, project promoters have an interest in overstating benefits and understating risks. The better they can make the project look on paper, the more likely their plans are to get approved; yet, once approved, economic and logistical realities kick in, and costs start to mount. Flyvbjerg calls this tendency “survival of the unfittest.” …Governments that invest in infrastructure on the assumption it will pay for itself may find out that they’ve gone a bridge too far.

Or bridge to nowhere, for those who remember the infamous GOP earmark from last decade that would have spent millions of dollars to connect a sparsely inhabited Alaska island with the mainland – even though it already had a very satisfactory ferry service.

Let’s close with two observations.

First, why did the IMF flip-flop in such a short period of time? It does seem bizarre for a bureaucracy to publish an anti-infrastructure spending study in August and then put out a pro-infrastructure spending study two months later.

I don’t know the inside story on this schizophrenic behavior, but I assume that the August study was the result of a long-standing research project by one of the IMF’s professional economists (the IMF publishes dozens of such studies every year). By contrast, I’m guessing the October study was pushed by the political bosses at the IMF, who in turn were responding to pressure from member governments that wanted some sort of justification for more boondoggle spending.

In other words, the first study was apolitical and the second study wasn’t.

Not that this is unusual. I suspect many of the economists working at international bureaucracies are very competent. So when they’re allowed to do honest research, they produce results that pour cold water on big government. Indeed, that even happens at the OECD.

But when the political appointees get involved, they put their thumbs on the scale in order to generate results that will please the governments that underwrite their budgets.

My second observation is that there’s nothing necessarily wrong with the IMF’s theoretical assertions in the August study. Infrastructure spending can be useful and productive.

It’s an empirical question to decide whether a new road will be a net plus or a net minus. Or a new airport runway. Or subway system. Or port facilities.

My view, for what it’s worth, is that we’re far more likely to get the right answers to these empirical questions if infrastructure spending is handled by state and local governments. Or even the private sector.

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Years ago, I shared a very funny poster that suggests that more government is hardly ever the right answer to any question.

Yet in Washington, the standard response to any screwup by government is to make government even bigger. Sort of Mitchell’s Law on steroids.

And that’s exactly what’s happening with the Ebola crisis. The bureaucracies that have received tens of billions of dollars over the years to preclude a crisis are now expecting to get rewarded with more cash.

Governor Jindal of Louisiana debunks the notion that more money for the bureaucracy is some sort of elixir. Here’s some of what he wrote for Politico.

In a paid speech last week, former Secretary of State Hillary Clinton attempted to link spending restraints enacted by Congress—and signed into law by President Obama—to the fight against Ebola. Secretary Clinton claimed that the spending reductions mandated under sequestration “are really beginning to hurt,” citing the fight against Ebola: “The CDC [Centers for Disease Control and Prevention] is another example on the response to Ebola—they’re working heroically, but they don’t have the resources they used to have.” …In recent years, the CDC has received significant amounts of funding. Unfortunately, however, many of those funds have been diverted away from programs that can fight infectious diseases, and toward programs far afield from the CDC’s original purpose. Consider the Prevention and Public Health Fund, a new series of annual mandatory appropriations created by Obamacare. Over the past five years, the CDC has received just under $3 billion in transfers from the fund. Yet only 6 percent—$180 million—of that $3 billion went toward building epidemiology and laboratory capacity. …While protecting Americans from infectious diseases received only $180 million from the Prevention Fund, the community transformation grant program received nearly three times as much money—$517.3 million over the same five-year period. …Our Constitution states that the federal government “shall protect each of [the States] against Invasion”—a statement that should apply as much to infectious disease as to foreign powers. So when that same government prioritizes funding for jungle gyms and bike paths over steps to protect our nation from possible pandemics, citizens have every right to question the decisions that got us to this point.

What Governor Jindal is describing is the standard mix of incompetence and mission creep that you get with government.

Bureaucracies fail to achieve their stated goals, but also divert lots of resources to new areas.

After all, that’s a great way of justifying more staff and more money.

Especially since they can then argue that they need those additional resources because they never addressed the problems that they were supposed to solve in the first place!

Here are some excerpts from a story in the Washington Free Beacon, starting with some whining from the head bureaucrat at the National Institutes of Health, who wants us to be believe that supposed budget cuts have prevented a vaccine for Ebola.

“Frankly, if we had not gone through our 10-year slide in research support, we probably would have had a vaccine in time for this that would’ve gone through clinical trials and would have been ready,” said NIH Director Francis Collins, blaming budget cuts for his agency’s failure to develop a vaccine for the deadly virus.

Yet take a look at how the NIH has been squandering money.

However, the Washington Free Beacon has uncovered $39,643,352 worth of NIH studies within the past several years that have gone to questionable research. For instance, the agency has spent $2,873,440 trying to figure out why lesbians are obese, and $466,642 on why fat girls have a tough time getting dates. Another $2,075,611 was spent encouraging old people to join choirs. Millions have gone to “text message interventions,” including a study where researchers sent texts to drunks at the bar to try to get them to stop drinking. The project received an additional grant this year, for a total of $674,590. …The NIH’s research on obesity has led to spending $2,101,064 on wearable insoles and buttons that can track a person’s weight, and $374,670 to put on fruit and vegetable puppet shows for preschoolers. A restaurant intervention to develop new children’s menus cost $275,227, and the NIH spent $430,608 for mother-daughter dancing outreach to fight obesity. …Millions went to develop “origami condoms,” in male, female, and anal versions. The inventor Danny Resnic, who received $2,466,482 from the NIH, has been accused of massive fraud for using grant money for full-body plastic surgery in Costa Rica and parties at the Playboy mansion.

Origami condoms?!? I’m almost tempted to do a web search to see what that even means, particularly since there are male, female, and anal versions.

But even without searching online, I know that origami condoms have nothing to do with stopping Ebola.

The Centers for Disease Control also have a long track record of wasting money. Here are some odious details from a Townhall column.

So now the federal health bureaucrats in charge of controlling diseases and pandemics want more money to do their jobs.

Gee, what a surprise.

Maybe if they hadn’t been so busy squandering their massive government subsidies on everything buttheir core mission, we taxpayers might actually feel a twinge of sympathy. At $7 billion, the Centers for Disease Control 2014 budget is nearly 200 percent bigger now than it was in 2000. …Yet, while Ebola and enterovirus D68 wreak havoc on our health system, the CDC has been busying itself with an ever-widening array of non-disease control campaigns, like these recent crusades: Mandatory motorcycle helmet laws. …Video games and TV violence. …Playground equipment. …”Social norming” in the schools. …After every public health disaster, CDC bureaucrats play the money card while expanding their regulatory and research reach into anti-gun screeds, anti-smoking propaganda, anti-bullying lessons, gender inequity studies and unlimited behavior modification programs that treat individual vices — personal lifestyle choices — as germs to be eradicated. …In 2000, the agency essentially lied to Congress about how it spent up to $7.5 million earmarked each year since 1993 for research on the deadly hantavirus. …The diversions were impossible to trace because of shoddy CDC bookkeeping practices. The CDC also misspent $22.7 million appropriated for chronic fatigue syndrome and was investigated in 2001 for squandering $13 million on hepatitis C research.

By the way, you may be wondering why we have both the National Institutes of Health as well as the Centers for Disease Control.

Is this just typical bureaucratic duplication?

No, it’s typical bureaucratic triplication, because we also have the Office of the Assistant Secretary for Preparedness and Response at the Department of Health and Human Services.

And as Mollie Hemingway explains in The Federalist, this additional layer of bureaucracy has been MIA on Ebola, perhaps because the head bureaucrats diverted funds to a political crony.

…nobody has even discussed the fact that the federal government not ten years ago created and funded a brand new office in the Health and Human Services Department specifically to coordinate preparation for and response to public health threats like Ebola. The woman who heads that office, and reports directly to the HHS secretary, has been mysteriously invisible from the public handling of this threat. And she’s still on the job even though three years ago she was embroiled in a huge scandal of funneling a major stream of funding to a company with ties to a Democratic donor—and away from a company that was developing a treatment now being used on Ebola patients.

Here are some additional details.

…one of HHS’ eight assistant secretaries is the assistant secretary for preparedness and response, whose job it is to “lead the nation in preventing, responding to and recovering from the adverse health effects of public health emergencies and disasters, ranging from hurricanes to bioterrorism.” …“Lurie’s job is to plan for the unthinkable. A global flu pandemic? She has a plan. A bioterror attack? She’s on it. Massive earthquake? Yep. Her responsibilities as assistant secretary span public health, global health, and homeland security.” …you might be wondering why the person in charge of all this is a name you’re not familiar with. …why has the top official for public health threats been sidelined in the midst of the Ebola crisis?

Perhaps because of the scandal.

You can—and should—read all about it in the Los Angeles Times‘ excellent front-page expose from November 2011, headlined: “Cost, need questioned in $433-million smallpox drug deal: A company controlled by a longtime political donor gets a no-bid contract to supply an experimental remedy for a threat that may not exist.”…The donor is billionaire Ron Perelman, who was controlling shareholder of Siga. He’s a huge Democratic donor… The award was controversial from almost every angle—including disputes about need, efficacy, and extremely high costs.

So what’s the bottom line?

The Progressive belief that a powerful government can stop all calamity is misguided. In the last 10 years we passed multiple pieces of legislation to create funding streams, offices, and management authorities precisely for this moment. That we have nothing to show for it is not good reason to put even more faith in government without learning anything from our repeated mistakes.

And that’s the most important lesson, though a secondary lesson is that big government means big corruption.

Big government is incompetent government.

Writing for The Federalist, John Daniel Davidson puts everything in context, explaining that big, bureaucratic states don’t do a good job.

The government’s response to the outbreak has exposed the weakness of the modern administrative state in general, and the incompetence of the White House in particular. …The second nurse to contract Ebola, Amber Vinson, traveled from Cleveland to Dallas on a commercial flight Monday and checked herself into the hospital Tuesday with Ebola symptoms. She called the CDC before she boarded the flight and reported she had a temperature of 99.5—yet CDC officials didn’t stop her from boarding the plane. …Thus continues a pattern of crippling naiveté and ineptitude from the White House on…the Ebola outbreak. On the press call, Frieden explained that you can’t get Ebola from sitting on a bus next to someone who’s infected, but if you have Ebola then don’t use public transportation because you might infect someone. …whether it’s funding or regulation, it’s becoming clear that government “everywhere putting its hands to new undertakings” isn’t working out all that well. …In a hundred years, when Americans read about the U.S. Ebola outbreak of 2014 and antiquated government agencies like the FDA that hampered the development of a vaccine, they’ll laugh at us. …Likewise, future Americans will probably scoff at us for thinking our FDA, in its current form, was somehow necessary or helpful, or for how the Department of Health and Human Services could spend almost a trillion dollars a year and yet fail to prevent or adequately respond to the Ebola outbreak.

And if you want a humorous look at the link between bloated government and incompetent government, Mark Steyn nails it.

Since we’ve shifted to humor, somebody on Twitter suggested that this guy is probably in line to become Obama’s new Ebola Czar.

Last but not least, here’s the icing on the cake.

I mentioned above that we have bureaucratic triplication thanks to NIH, CDC, and HHS. And I joked that the guy in the Holiday Inn might become the President’s new Czar, creating bureaucratic quadruplication (if that’s even a word).

Well, that joke has now become reality. The Washington Examiner is reporting that Obama has named an Ebola Czar. But the guy in the video will be sad to know he didn’t make the cut.

President Obama has chosen Ron Klain, former chief of staff for two Democratic vice presidents, as his Ebola czar, the White House said Friday. …In choosing Klain, Obama is selecting a D.C. insider and veteran of numerous political battles to spearhead a campaign with major implications on his own legacy and how Democrats fare in the November midterms.

Great. I’m sure a lobbyist and former political operative will have just the skills we need to solve this crisis.

I’m going out on a limb and predicting that he’ll say the solution is more money and bigger government. And we know how that turns out.

Yup, it’s a bird, it’s a plane, it’s government man to the rescue!

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Michael Strain of the American Enterprise Institute looks at the topic of infrastructure spending and I’m left with mixed feelings.

Some of what he writes is very good.

Yes, the claims of an “infrastructure crisis” by President Obama, many liberals…are exaggerated. …yes, existing laws and regulations turn infrastructure projects into boondoggles that take an order of magnitude longer to complete than necessary and cost more than they should.

Amen, particularly with regard to the absurd notion that America is suffering some sort of crisis. The International Institute for Management Development in Switzerland, publisher of the World Competitiveness Yearbook, puts the United States in first place when ranking nations on the quality of infrastructure.

Moreover, the just-released Global Competitiveness Report from the World Economic Forum puts the United States in 12th place for infrastructure, which also is a rather high score (if you want to know where the United States does lag, we’re in 73rd place for wastefulness of government spending, 82nd place for burden of government regulation, and 102nd place for the total tax rate on profits).

And I also agree with his second point about infrastructure programs being very vulnerable to waste (see here and here for jaw-dropping examples).

But I’m nervous that he nonetheless wants to a new program of infrastructure investment.

…conservatives should put that skepticism aside and proceed — as always, with apprehension and great prudence — with a program of infrastructure investment.

Though maybe this isn’t a bad idea. After all, he specifically says that the new government spending would be based on what generates a good rate of return.

We shouldn’t follow the left’s approach to infrastructure stimulus, calculating the number of jobs we’d like to create. …a conservative approach to infrastructure would begin with a question: What are some projects that we actually need to fund? We all know by now that “shovel ready” projects are rare. So we should take some time to actually figure out which projects offer the highest value to society.

Sounds like he’s wised up since he wrote in favor of Keynesian “stimulus” earlier this year.

Unfortunately, later in his most recent article, he does use failed Keynesian theory to justify his call for more infrastructure spending.

A multi-year program will help growth and employment over the next few years, when the economy will probably still need a boost.

But let’s set that aside. If there are sound economic reasons to build a road, I’m not going to be opposed simply because Keynesians support the spending for the wrong reason.

Indeed, I don’t even necessarily object that he entitled his article, “How the government can spend billions of dollars on a new policy and still win conservative support.”

My one real problem with Strain’s column is that he wants Washington to be involved. He specifically refers to:

…the federal government’s share of the money to pay for these infrastructure projects.

Sigh.

We should be eliminating the Department of Transportation, not giving it more money to waste. That’s the answer I give when some people want a higher federal gas tax to fund more transportation spending. And it’s the answer I give when others whine about a supposed deficit in the federal highway trust fund.

The answer is federalism, not more centralization.

Want some very timely evidence in support of my position? Here are some excerpts from a new Wall Street Journal report on how infrastructure programs are ridiculously wasteful.

The most expensive train station in the U.S. is taking shape at the site of the former World Trade Center…the terminal connecting New Jersey with downtown Manhattan has turned into a public-works embarrassment. …How could such a high-profile project fall eight years behind schedule and at least $2 billion over budget? An analysis of federal oversight reports viewed by The Wall Street Journal and interviews with current and former officials show a project sunk in a morass of politics and government. …When completed in 2015, the station is on track to cost between $3.7 and $4 billion, more than double its original budget of $1.7 billion to $2 billion. …“the station is a national symbol for government waste…,” Mr. LaVorgna said.

So why am I citing a boondoggle project in New York City when I want to disagree with Strain’s call for more federal spending?

Because thanks to existing federal handouts, I’m paying for a big chunk of it!

…the Federal Transit Administration…is funding $2.87 billion of the train station project.

And when Uncle Sam is paying part of the tab, state and local politicians are more than happy to squander money in hopes of memorializing themselves.

The terminal’s delays and cost overruns were “certainly unfortunate,” said Mr. Pataki, a driving force in the early years of the World Trade Center redevelopment. “But I think 50 years from now, people are going to say, ‘Wow, they did it the right way.'”

But let’s ignore headline-seeking and glory-hunting politicians. What we should care about it getting good value when the government spends our money.

My point is that we’re more likely to get acceptable results (not great results since I realize that waste isn’t limited to Washington) when state and local governments are raising and spending their own money.

When other people pick up the tab, by contrast, you get absurd examples of waste.

P.S. I also heartily recommend this National Review column on getting the federal government out of the infrastructure business.

P.P.S. And don’t forget that the private sector should play a bigger role in building and operating roads.

P.P.P.S. I’m in Mexico City, having just spoken to the Society of Trust and Estate Professionals on the latest developments in the campaign by high-tax nations to cripple tax competition.

They had a nice gala dinner last night, which was the favorite part of the trip for the Princess of the Levant.

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Since I’m a policy dork, I was much more enthusiastic about rallying opposition to bad policies such as FATCA and a global network of tax police.

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Since I primarily work on fiscal policy, I normally look at the budgetary impact of entitlement programs. And the numbers are very grim.

But I’m also an economist, so I periodically comment on how government intervention undermines the efficient functioning of markets in the healthcare field.

Last but not least, I’m also a taxpayer, so I can’t resist occasionally expressing my frustration at how the government is a giant pinata of waste fraud and abuse. And government-run healthcare seems especially vulnerable.

Huge amounts of money bilked from taxpayers for supposed counseling sessions financed by Medicare and Medicaid.

Medicare getting scammed to pay for plastic surgery.

Russian diplomats scheming to get their healthcare costs covered by Medicaid.

We now have another example to add to the list.

The Washington Post has an excellent expose on how government incompetence has made Medicare a prime target for fraudsters and other crooks.

…in a Los Angeles courtroom, Bonilla described the workings of a peculiar fraud scheme that — starting in the mid-1990s — became one of the great success stories in American crime. The sucker in this scheme was the U.S. government.The tool of the crime was the motorized wheelchair. The wheelchair scam was designed to exploit blind spots in Medicare, which often pays insurance claims without checking them first. Criminals disguised themselves as medical-supply companies. They ginned up bogus bills, saying they’d provided expensive wheelchairs to Medicare patients — who, in reality, didn’t need wheelchairs at all. Then the scammers asked Medicare to pay them back, so they could pocket the huge markup that the government paid on each chair. …The government paid. Since 1999, Medicare has spent $8.2 billion to procure power wheelchairs and “scooters” for 2.7 million people. Today, the government cannot even guess at how much of that money was paid out to scammers.

Wow. Billions of dollars of fraud and the government to this day still can’t figure out the level of theft.

And wheelchair fraud is just a small slice of the problem.

…while it lasted, the scam illuminated a critical failure point in the federal bureaucracy: Medicare’s weak defenses against fraud. The government knew how the wheelchair scheme worked in 1998. But it wasn’t until 15 years later that officials finally did enough to significantly curb the practice. …Fraud in Medicare has been a top concern in Washington for decades, in part because the program’s mistakes are so expensive. In fiscal 2013, for instance, Medicare paid out almost $50 billion in “improper payments.”

You won’t be surprised to learn that fraud is so lucrative because the government routinely over-pays for items.

…The original equipment scam had sprung up in the 1970s, at a time when Medicare was young and criminals were still learning how to steal its money. Doctors, for example, could bill Medicare for exams they didn’t do. Hospitals could bill for tests that patients didn’t need. The equipment scam was the poor man’s way in, an entry-level fraud that didn’t require a medical degree or a hospital. …“Let me put it to you this way: An $840 power wheelchair, Medicare pays close to $5,000 for. So there’s a huge profit margin there. Huge,” said one California man who participated in a recent fraud scheme involving wheelchairs.

So this isn’t just a story about government incompetence and taxpayer ripoffs, it’s also a story which shows why third-party payer is a recipe for excessive healthcare spending.

The good news is that the wheelchair scam is slowly fading away.

The bad news is that the overall problem of a poorly designed entitlement system ensures that scammers and other crooks will simply come up with other ways to pillage taxpayers.

Today, even while the wheelchair scam is in decline, that same “pay and chase” system is allowing other variants of the Medicare equipment scam to thrive. They aren’t perfect. But they work.  In Brooklyn, for instance, the next big thing is shoe inserts. Scammers bill Medicare for a $500 custom-made orthotic, according to investigators. They give the patient a $30 Dr. Scholl’s.

Geesh.

When examining entitlements, I’ve  argued that Medicaid reform is the biggest priority.

But perhaps the rampant fraud means Medicare should be addressed first.

Though the right answer is to reform both programs, which is why I’m so pleased that the House of Representatives has approved the Ryan budget for four consecutive years, even if each new proposal allows more spending than the previous one. What matters most if that Ryan’s plan block grants Medicaid and creates a premium support system for Medicare.

Those reforms won’t eliminate waste, fraud, and abuse, but the structural reforms will make it harder for crooks to take advantage of the programs.

P.S. If you want more background information on Medicare, here’s a post that explains why the program is so costly even though seniors don’t enjoy first-class benefits.

P.P.S. And here’s my video explaining why Medicare desperately needs reform.

But keep in mind we also need reform of Medicaid and Social Security.

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When government suppresses the free market and takes over the healthcare sector, you get some really odd results.

Consider these stories from Sweden:

 A man sewing up his own leg after getting frustrated with a long wait.

The government denying a wheelchair to a double amputee because the bureaucrats decided his impairment might not be permanent.

Speaking of amputations, an unfortunate man was put on such a long waiting list that his only treatment, when he was finally seen, was to have his penis removed.

Today, we’re going to augment that list. But not with another story from Sweden, which is actually a much better country in terms of public policy than most folks realize.

Instead, we’re going to look at some great moments in government-run healthcare in both the United States and the United Kingdom.

Our first story is from the Chicago Tribune and it deals with Medicaid and Medicare spending.

But we’re not going to look at the aggregate data. Those numbers are very sobering, to be sure, and you can click here and here to learn more about that problem.

Instead, we’re going to drill down into the details and get some up-close evidence of why the programs are so costly. Simply stated, providers learn how to bilk the government.

A few years ago, Illinois’ Medicaid program for the poor noticed some odd trends in its billings for group psychotherapy sessions. Nursing home residents were being taken several times a week to off-site locations, and Medicaid was picking up the tab for both the services and the transportation.  And then there was this: The sessions were often being performed by obstetricians and gynecologists, oncologists and urologists — “people who didn’t have any training really in psychiatry,” Medicaid director Theresa Eagleson recalled. So Medicaid began cracking down, and spending plummeted after new rules were implemented.Illinois doctors are still billing the federal Medicare program for large numbers of the same services, a ProPublica analysis of federal data shows. Medicare paid Illinois providers for more than 290,000 group psychotherapy sessions in 2012 — more than twice as many sessions as were reimbursed to providers in New York, the state with the second-highest total. Among the highest billers for group psychotherapy in Illinois were three OB-GYNs and a thoracic surgeon. The four combined for 37,864 sessions that year, more than the total for all providers in the state of California. They were reimbursed more than $730,000 by Medicare in 2012 just for psychotherapy sessions, according to an analysis of a separate Medicare data set released in April.

Some of the specific examples are beyond belief. Keep in mind as you read the next passage that there are only 365 days in a year, and only about 261 workdays.

Of the Illinois OB-GYNs billing for group psychotherapy, Dr. Josephine Kamper had the highest number of sessions. She was paid for 10,399 sessions in 2012, at a cost to Medicare of $207,980. …Another OB-GYN, Lofton Kennedy Jr., billed for 9,154 group psychotherapy services. He declined to comment. The third-highest-billing OB-GYN, Philip Okwuje, charged Medicare for 8,584 group therapy sessions.  

Illinois isn’t the only place where taxpayers are getting ripped off.

A Queens, N.Y., primary care doctor, Mark Burke, was paid for more sessions than anyone else in the country — 20,841. He accounted for nearly one in every six sessions delivered in the entire state of New York in Medicare, separate data show. He did not return messages left at his office. Another large biller was Makeba Gordon, a social worker in Detroit. She was reimbursed for nearly 5,000 group therapy sessions for her 26 Medicare patients, an average of 190 each. She also billed for 2,820 individual psychotherapy visits for the same 26 patients, who allegedly would have received an average of 298 therapy sessions apiece in 2012. Gordon could not be reached for comment.

And I’m sure you won’t be surprised to learn that the bureaucracy in Washington doesn’t seem overly worried about this preposterous waste of money.

Aaron Albright, a spokesman for the U.S. Centers for Medicare & Medicaid Services, said in an email that Medicare has no policy regarding which physicians may perform group psychotherapy. During such sessions, “personal and group dynamics are discussed and explored in a therapeutic setting allowing emotional catharsis, instruction, insight, and support,” according to rules set out by one of Medicare’s contractors.

The second story comes from the United Kingdom.

Regular readers know that the government-run healthcare system in the United Kingdom is an ongoing horror story of denied care, sub-standard care, and patient brutality (click here to see some sickening examples).

You would think the U.K.’s political class would respond by trying to use money more effectively.

You would be wrong. The bureaucrats somehow have decided that tax monies should be used to finance a sperm bank, even though private sperm banks already exist.

Here are some excerpts from a report in the Daily Mail.

Britain is to get its first NHS-funded national sperm bank to make it easier for lesbian couples and single women to have children.For as little as £300 – less than half the cost of the service at a private clinic –  they will be able to search an online database and choose an anonymous donor on the basis of his ethnicity, height, profession and even hobbies. …The National Sperm Bank will be based at Birmingham Women’s NHS Foundation Trust, which currently runs an existing NHS fertility clinic and recruits sperm donors from the local population. Funded by a £77,000 Government grant, the bank will be run by the National Gamete Donation Trust (NGDT) which this year received  an additional £120,000 of public money to organise egg and sperm donation.

Some have criticized the initiative because it will purposefully increase the number of fatherless children.

…the move – funded by the Department of Health – is largely designed to meet the increasing demand from thousands of women who want to start a family without having a relationship with a man. Critics last night called it a ‘dangerous social experiment’ that could result in hundreds of fatherless ‘designer families’. …Ms Witjens rejected suggestions that children suffer adverse consequences from lacking a father figure. …Ms Witjens pointed to the removal of the reference to a ‘need for a father’ in the Human Fertilisation and Embryology Act, when taking account of a child’s welfare when providing fertility treatment.

I’m sympathetic to the argument that children do best in conventional households with fathers, but my main reaction to this story is that government shouldn’t try to either penalize or subsidize unconventional households.

And a government-sponsored sperm bank definitely falls into the latter category.

But I’m not surprised. Governments love to squanders other people’s money, and the U.K. government has considerable expertise (if you can call it that) in this regard.

Heck, the U.K. healthcare system is even financing boob jobs. But we’re not talking about reconstructive surgery for women who had mastectomies. They pay for breast augmentation for women who claim “emotional distress.”

Though maybe the U.K. government deserves a special prize. It developed a giveaway program that was so convoluted that nobody signed up to take the money.

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You won’t know whether to laugh or cry after perusing these stories that will be added to our “great moments in government” collection.

For instance, did you realize that American taxpayers were saddled with the responsibility to micro-manage agriculture in Afghanistan? You’re probably surprised the answer is yes.

But I bet you’re not surprised that the money was flushed down a toilet. Here are some excerpts from a report on how $34 million was wasted.

American agricultural experts who consider soybeans a superfood…have invested tens of millions of U.S. taxpayer dollars to try to change the way Afghans eat. The effort, aimed at making soy a dietary staple, has largely been a flop, marked by mismanagement, poor government oversight and financial waste, according to interviews and government audit documents obtained by the Center for Public Integrity. Warnings by agronomists that the effort was unwise were ignored. The country’s climate turns out to be inappropriate for soy cultivation and its farming culture is ill-prepared for large-scale soybean production. Soybeans are now no more a viable commercial crop in Afghanistan than they were in 2010, when the $34 million program got started… The ambitious effort also appears to have been undone by a simple fact, which might have been foreseen but was evidently ignored: Afghans don’t like the taste of the soy processed foods.

Sadly, this $34 million boondoggle is just the tip of the iceberg. It’s been said that Afghanistan is the graveyard of empires. Well, it’s also the graveyard of tax dollars.

…the project’s problems model the larger shortcomings of the estimated $120 billion U.S. reconstruction effort in Afghanistan, including what many experts depict as ignorance of Afghan traditions, mismanagement and poor spending controls. No one has calculated precisely how much the United States wasted or misspent in Afghanistan, but a…special auditor appointed by President Obama the following year said he discovered nearly $7 billion worth of Afghanistan-related waste in just his first year on the job.

I’m guessing that most of the $120 billion was squandered using traditional definitions of waste.

But using a libertarian definition of waste (i.e., money that the federal government should not spend), we can easily calculate that the entire $120 billion was squandered.

Let’s now discuss another example of American taxpayer money being wasted in other nations. I’ve written previously about the squalid corruption at the Export-Import Bank, but Veronique de Rugy of Mercatus is the go-to expert on this issue, and she has a new article at National Review about “a project in Brazil that, if it goes bust and the Brazilians can’t pay the American contractor, your tax dollars will end up paying for.”

And what is this project?

…an Export-Import Bank–backed deal to build the largest aquarium in South America…the taxpayer exposure is $150,000 per job “supported.” Some people in Brazil are rightly upset about this. The Ex-Im loan may have lower interest rates and better terms than a regular loan, but this is probably money the indebted and poor Brazilian government can’t afford. …a real problem with the Ex-Im Bank: On one hand, it gives cheap money to large companies who would have access to capital markets even in its absence. But on the other hand, it encourages middle-income or poor countries to take on debt that they probably can’t afford, whether the products purchased are “made in America” or not.

Gee, aren’t we happy that some bureaucrats and politicians have decided to put us on the hook for a Brazilian aquarium.

But let’s try to make the best of a bad situation. Here’s a depiction of what you’re subsidizing. Enjoy.

Subsidized by American taxpayers

I hope you got your money’s worth from the image.

Perhaps I’m being American-centric by focusing on examples of bad policies from the crowd in Washington.

So let’s look at an example of government foolishness from Germany. It doesn’t involve tax money being wasted (at least not directly), but I can’t resist sharing this story because it’s such a perfect illustration of government in action.

Check out these excerpts from a British news report on over-zealous enforcement by German cops.

A one-armed man in Germany has received a full apology and refund from the police after an overzealous officer fined him for cycling using only one arm. Bogdan Ionescu, a theatre box office worker from Cologne, gets around the usually cycle-friendly city using a modified bicycle that allows him to operate both brakes – one with his foot. But on 25 March he was pulled over by a police officer who, he says, told him he was breaking the law. Under German road safety rules, bicycles are required to have to have two handlebar brakes. After a long argument at the roadside, the officer insisted that Mr Ionescu’s bike was not roadworthy and issued him with a €25 (£20) fine.

At least this story had a happy ending, at least if you overlook the time and aggravation for Mr. Ionescu.

Our last (but certainly not least) example of foolish government comes from Nebraska, though the culprit is the federal government.

But maybe “disconcerting” would be a better word than “foolish.”

It seems that our friends on the left no longer think that “dissent is the highest form of patriotism.” In a very troubling display of thuggery, the Justice Department dispatched a bureaucrat to “investigate” a satirical parade float.

Here’s some of what was reported by the Washington Times.

The U.S. Department of Justice has sent a member of its Community Relations Service team to investigate a Nebraska parade float that criticized President Obama. A Fourth of July parade float featured at the annual Independence Day parade in Norfolk sparked criticism when it depicted a zombie-like figure resembling Mr. Obama standing outside an outhouse, which was labeled the “Obama Presidential Library.” The Nebraska Democratic Party called the float one of the “worst shows of racism and disrespect for the office of the presidency that Nebraska has ever seen.” The Omaha World-Herald reported Friday that the Department of Justice sent a CRS member who handles discrimination disputes to a Thursday meeting about the issue. …The float’s creator, Dale Remmich, has said the mannequin depicted himself, not President Obama. He said he is upset with the president’s handling of the Veterans Affairs Department, the World-Herald reported. “Looking at the float, that message absolutely did not come through,” said NAACP chapter president Betty C. Andrews.

If you look at the picture (and other pictures that can be seen with an online search), I see plenty of disrespect for the current president, but why is that something that requires an investigation?

There was plenty of disrespect for the previous president. And there as also disrespect for the president before that. And before that. And before…well, you get the idea.

Disrespect for politicians is called political speech, and it’s (supposedly) protected by the First Amendment of the Constitution.

That’s even true if the float’s creator had unseemly motives such as racism. He would deserve scorn if that was the case, and parade organizers would (or at least should) have the right to exclude him on that basis.

But you don’t lose your general right to free speech just because you have unpopular and/or reprehensible opinions. And the federal government shouldn’t be doing anything that can be construed as suppressing or intimidating Americans who want to “disrespect” the political class.

P.S. Since we’re on the topic of politicized bureaucracy, we have an update to a recent column about sleazy behavior at the IRS.

According to the Daily Caller, there’s more and more evidence of a big fire behind all the smoke at the IRS.

Ex-IRS official Lois Lerner’s computer hard drive was “scratched” and the data on it was still recoverable. But the IRS did not try to recover the data from Lerner’s hard drive, despite recommendations from in-house IRS IT experts to outsource the recovery project. The hard drive was then “shredded,” according to a court filing the IRS made to House Ways and Means Committee investigators.

Gee, how convenient.

I used to dislike the IRS because of the tax code. Now I have an additional reason to view the bureaucrats with disdain.

P.P.S. One last comment on the controversy surrounding the parade float. Racism is an evil example of collectivist thinking. But it is also reprehensible for folks on the left to make accusations of racism simply because they disagree with someone.

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It’s difficult being a libertarian.

In addition to all the other challenges (such as trying to convince people stealing doesn’t become okay simply because the government is the middleman), I get conflicted about government waste.

You’re probably thinking I’m wandering off the libertarian reservation. After all, aren’t libertarians big opponents of boondoggles, government waste, and pork-barrel spending?

All true, but here’s my challenge: I also don’t want “efficient government.”

In other words, our goal should be to shrink government, not to make it “work better.” To understand the point I’m making, ponder these questions:

Do we want government to efficiently lure people into dependency?

Do we want government to efficiently socialize health care?

Do we want government to efficiently cartelize the agriculture sector?

I hope the answer to all these questions is “NO,” which is why I generally focus my work on structural changes to shrink the size and scope of government.

But every so often, notwithstanding everything I just wrote, I can’t resist pointing out really absurd examples of wasteful spending. And today we have two jaw-dropping examples.

We know that government bureaucracies like palatial buildings and that cost overruns are the rule rather than the exception. Well, one of the new bureaucracies created by the Dodd-Frank bailout bill is setting records for extravagance with its new headquarters.

The newly created Consumer Financial Protection Bureau is renovating the Washington, D.C., headquarters it rents—at a cost per square foot that is more expensive than Trump World Tower in New York City. The CFPB project is estimated to cost taxpayers more than $215 million… Cost projections have increased $65 million in six months and $120 million since last year’s estimate. Some of the building’s extravagant features include a four-story glass staircase, two-story waterfall and a sunken garden.

But what’s really amazing is that all this money is being spent on a rented building and that the cost of renovating is far greater than what was spent on building (yes, building, not just renovating) some of the world’s most famous landmark structures.

Now for our second example.

We’ve all heard about how big chunks of education spending get wasted on bureaucracy and don’t get used for classroom instruction.

And we read about how welfare bureaucrats consume a lot of money that supposedly is targeted to help poor people.

This principle also applies to other forms of government spending.

CNN reports that the federal government’s program for emergency food aid around the world is such a cluster-you-know-what that barely a bit more than one-third of money is actually spent on food for crisis-stricken regions.

International typhoons, hurricanes, and earthquakes leave behind devastating scenes of poverty and need. If you had about a $1.5 billion every year to send food to such desperate areas, how would you do it? …The way the U.S. provides international food aid is an antiquated and bureaucratic tangle. Food largely has to be purchased here in the U.S., and then shipped on boats by U.S. cargo carriers to the trouble spots. The Government Accountability Office says that 65% of the money for this aid program is spent on shipping and business costs – not on food. … it’s a system that has helped shipping companies and unions win billions in government contracts, companies like Maersk. …There’s also the transport workers unions. …The two leading maritime unions gave more than “three quarters of a million dollars to members of the current House of Representatives in the 2012 election cycle,” according to the Center for Public Integrity.

Geesh, what a typical example of insider corruption.

This is yet another piece of evidence for my view that disaster relief is not a function of the federal government.

P.S. Regarding the theme of today’s column, Fred Smith, the founder and former President of the Competitive Enterprise Institute, told me on more than one occasion that we should “be thankful we don’t get all the government we pay for.”

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