Another Great Moment in Government-Run Healthcare

Because of misguided government policies, health care in America is expensive and inefficient.

But it’s always possible to have a system that is even worse. I have often cited the United Kingdom, which has genuine socialism (government employs the doctors and runs the hospitals).

However, as part of an ongoing series about “great moments in government-run healthcare,” today we’re going to look north to Canada

Here are some excerpts from a news report about a massive failure by Canada’s system, which may be even worse than the one in the United Kingdom.

Authored by Amy Judd and Kylie Stanton, the article explains how a woman from British Columbia named Allison Ducluzeau traveled to the United States to save her life.

It all started last year at Thanksgiving when Ducluzeau said she started to feel pain in her abdomen. …She started doing tests, an ultrasound, and a CT scan, but she said everything would take weeks to get an appointment. …the results of the CT scan indicated it looked like it might be something called peritoneal carcinomatosis, which is abdominal cancer.” …her doctor referred her to the BC Cancer Agency. …She said she didn’t even see an oncologist with BC Cancer until two-and-a-half months later but at that point, she had already received treatment somewhere else. …Ducluzeau decided to get treatment with Sardi in Baltimore. …Before she left, Ducluzeau said she called BC Cancer to ask how long it might be to see the oncologist was told it could be weeks, months, or longer, they had no idea. …No word at all from (BC Cancer) until after I flew to Baltimore, had my surgery and got home.”

You may be thinking that there is nothing surprising about this story. Especially if you remember the Hypocrite of the Year from 2010.

But here’s the shocking part.

Ducluzeau said the surgeon told her. “…I suggest you talk to your family, get your affairs in order, talk to them about your wishes, which was indicating, you know, whether you want to have medically assisted dying or not.”

Yes, you read correctly. The government’s helpful suggestion was that she should kill herself.

I guess that would have been a cost savings for taxpayers, but hardly an ideal approach since Canada already has demonstrated a better way of dealing with fiscal policy (though Paul Krugman missed the boat).

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Least Surprising Headline of All Time

I periodically use “Least Surprising Headline” to call attention to articles citing very predictable outcomes.

• Pandemic spending being a magnet for fraud.
• European politicians finding another excuse to expand government.
• Bailouts not solving problems.
• Cost overruns on government infrastructure.

I’m going to add to that list today, but first let’s refresh our understanding of how government-caused “third-party payer” makes America’s health care system very expensive and inefficient.

The key insight is that consumers have little incentive to be smart shoppers when they perceive that other people are paying the bill. And health providers, needless to say, have little incentive to control costs when they know consumers care very little about prices.

Is this a big problem?

No, it is not a big problem. It is a giant problem. Here’s a chart, based on the federal government’s data, showing the share of health expenditures that are paid directly by consumers.

In the chart, I show the year that Obamacare was enacted. Notice that the legislation didn’t have an effect on the trendline, either the year it was enacted or in subsequent years as it was implemented.

And since Obamacare didn’t reduce the problem of third-party payer, one might guess that it didn’t solve the problem of rising health expenditures.

That guess would be correct, as shown in this column by Megan McArdle, which includes a predictably unsurprising headline.

…in 2022, the United States spent 16.6 percent of its gross domestic product on health care, while the next-highest spender, Germany, spent only 12.7 percent… As the Affordable Care Act took shape almost 15 years ago, its architects started looking for…savings… All these years later, we still haven’t found the magic money pot. …Obamacare contained a lot of elements that were expected to realize significant cost savings while actually improving the quality of care. …What this demonstrates is how hard it is to actually change the system in ways that generate major savings. …the wonks hunting for magic pots of money have mostly turned out to be chasing rainbows.

I could pat myself on the back for predicting back in 2009 that Obamacare would be a fiscal mistake.

But that would be like congratulating myself for predicting it gets dark at night.

P.S. Repealing Obamacare would be a good step, but it’s just one of many changes that are needed to enable a market-based health system.

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Phantom Austerity at the U.K.’s Government-Run Health System

I often bemoan the fact that government intervention has created an expensive and inefficient health system in the United States.

But that does not mean I want a total government takeover of the health sector like in the United Kingdom.

Given the problems with the U.K.’s National Health Service, that would be like jumping out of the frying pan and into the fire.

Interestingly, many folks on the left also recognize that the NHS has problems. But they claim that long waiting lines and needless deaths are the result of too little money.

For example, in a column for the New York Times, Allyson Pollock and Peter Roderick complain that their country’s government-run health system is being starved of funding.

…you don’t have to work in a hospital to know that Britain’s N.H.S. is in the most serious crisis of its history; you just have to be injured, or ill. Thousands of people are estimated to have died in the last year because of overwhelmed ambulance and emergency services. There are 7.2 million people in England, more than 10 percent of the population, on waiting lists for treatments… That the flagship health care service of one of the wealthiest countries in the world is in such a state is shocking, but not without explanation. Decades of marketization, 10 years of Conservative austerity and a pandemic have hollowed out the N.H.S… A government-commissioned report released last year called the years between 2010 and 2020 the N.H.S.’s “decade of neglect.” …The N.H.S. as Britons have known it — accessible, free at the point of use, cherished — is becoming something else. But as long as there are still people willing to fight for it, it’s not too late to save it.

If you read the full column, you might notice something very odd.

The authors share lots of data about the poor performance of the U.K.’s government-run system. And they share some good data about patient dissatisfaction.

But when they complain about how this is the fault of austerity, they don’t share any numbers.

That made me very suspicious, sort of like the dog that didn’t bark from Sherlock Holmes.

So I want to the website for the U.K. Office of National Statistics and found the data showing the breakdown of annual government spending and I looked at the numbers for health expenditures.

Lo and behold, there was no austerity.

If you look closely, there was a very brief slowdown in the rate of growth starting in about 2010, but there were never budget cuts.

Indeed, the burden of NHS spending grew by an average of more than 6.7 percent over the past 25 years – much faster than inflation over the same period.

The moral of the story is that the NHS is doing a lousy job, but it’s not because of a shrinking budget.

It’s failing because big government is bad government (the same lesson we learn when looking at more government and lousy results in the United States).

P.S. I mentioned at the start of the column that I don’t like the current health system in America and that I also don’t like the idea of a British-style system. If you want to know the better approach, click here, here, here, here, here, here, and here.

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The Continuing Failure of Government-Run Healthcare in the United Kingdom

I’m routinely critical of the many ways that government intervention has created an expensive and inefficient health system in the United States.

But there are countries where government causes even greater problems. So when I want to feel good about America’s clunky healthcare system, I look at the mess across the ocean.

The United Kingdom has a socialist health system. And it’s real socialism, with government running the hospitals and employing the doctors and nurses.

And this produces predictably bad results.

I’ve shared numerous horror stories about that approach (see here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, and here), but this report from David Parsley is so astounding that even some of my knee-jerk leftist friends may reconsider their support for big government.

Ukrainian refugees who travelled to the UK to escape the war are risking their lives by returning to their homeland to seek urgent medical treatments after giving up on the NHS. Due the NHS pressures and long waiting lists for procedures, Ukrainians living with families across the UK are taking the perilous trip back into a war zone where they are treated by doctors immediately despite Russian bombardments of their towns and cities. …Maiia Habruk escaped Kyiv last spring along with around five million fellow citizens and found a safe haven with a couple in south east London. But she returned to Ukraine in mid-December after failing to get the treatment she needed from her local hospital in Lewisham. …She decided the only way to get the treatment she believed she required was to make the 24-hour trip back to Ukraine, which includes a flight to Poland and a long and dangerous train journey to Kyiv. …Maiia, who witnessed almost daily bombing raids by the Russians while in Kyiv, knows three other Ukrainians in London who sought emergency health procedures back in their war-torn country due to the lack of availability of quick treatment from the NHS.

These people were engaging in cost-benefit analysis. They compared the risk of death, injury, or suffering from Russian bombs to the risk of death, injury, or suffering from languishing on a waiting list in the United Kingdom.

And they decided Russian bombs were the better option.

This disaster is attracting attention in other nations. The Wall Street Journal opined two days ago about the NHS.

The American left can’t seem to quit its desire for single-payer Medicare for All. So it’s worth noting that the United Kingdom, which already has a system resembling that socialist dream, is rethinking it amid another winter of healthcare misery. …Waiting times for ambulances for the most serious calls are getting longer, with the average response time reaching 10 minutes 57 seconds in December, compared to a target of seven. Once patients reach the emergency room, 35% now face waits above four hours… As of November, some 7.2 million patients have been referred for treatment but are waiting for it to start. Of those, 2.9 million have been waiting more than 18 weeks. The NHS considers itself a success if it starts treatment within that four-month window, which is the epitome of defining failure down. …Excess deaths in 2022 were the most since 1951, excluding the pandemic. …The U.S. suffers a chronic problem of healthcare financing but not of health-care delivery. Britain shows that with single-payer you end up with both. The U.K. also shows that single-payer’s biggest victims are low-income people who can’t afford to opt out.

Yet there are nonetheless American politicians who want to copy this failed system.

Allister Heath of the U.K.-based Telegraph has a grim assessment of his nation’s government-run system.

…the NHS is finished. It is broken beyond repair, ruining the lives of hundreds of thousands, and threatening the social fabric and economic performance of our nation. …this 75-year experiment in health socialism has failed appallingly, culminating in a surge in excess deaths, waiting lists that aren’t worthy of a civilised nation, inhumane strikes, intolerable delays for ambulances, explicit rationing… NHS spending is up 12 per cent in real terms since 2019-20; there are 13 per cent more doctors and 11 per cent more nurses, and yet the service delivered 5 per cent fewer treatments in the first nine months of 2022 than in the same period in 2019. …Its six pillars – that it is “free” at the point of use, the full state ownership of hospitals, its complete dependence on taxpayer funding, its supposed culture of altruism, its nature as a shared moral project uniting rich and poor, and its centrally planned workforce – are the very causes of its disintegration.

P.S. I can’t resist some closing comments about the politics of government-run health care.

The first story cited above includes these comments from left-of-center U.K. politicians.

Labour’s shadow health secretary Wes Streeting told i “Vladimir Putin is dropping bombs on Ukrainian hospitals, yet patients are travelling back to Kyiv rather than face NHS waiting lists. …Liberal Democrat health spokesperson Daisy Cooper said: “It’s a damning indictment of the government’s record on the NHS that Ukrainian refugees are returning to a war-torn country to access health care.”

Accurate criticisms, to be sure. But both Labour and the Lib Dems simply want to dump more money in the system.

But the so-called Conservative Party does exactly the same thing, as the Wall Street Journal noted in its editorial.

Former Prime Minister Boris Johnson in 2021 pledged an additional £36 billion over three years for the NHS and related home and nursing-home care, funded by a payroll-tax increase. Mr. Sunak and Chancellor Jeremy Hunt followed in November with another £3.3 billion a year for the next two years.

And Allister Heath made a similar observation in his column.

The Cameron-May-Johnson survival strategy was to “neutralise” the NHS by refusing to contemplate difficult reforms, genuflecting endlessly at its altar, prioritising it in every Budget, greatly boosting its funding after Brexit and worshipping it hysterically during the lockdowns; yet, in the end, it was the NHS that neutralised the Tories. Small-state, high-growth Toryism is incompatible with an unreconstructed NHS, with its need for ever-higher taxes. How long will the Conservatives continue to lie to themselves about this?

This is a good opportunity to revisit my “what’s the alternative?” argument.

Self-styled right-of-center parties have to choose whether to become tax collectors for the welfare state or whether to push for entitlement reform. There’s no other alternative.

P.P.S. There is one group of people who are net winners from the U.K.’s government-run system.

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The “Public Option” and the Future of Employer-Provided Health Insurance

Last night’s train-wreck debate reinforced my disdain for politicians.

But let’s ignore the immature theatrics from Trump and Biden and focus on one of their policy disagreements.

The two candidates squabbled over whether creating a government-administered health plan (see page 31 for a description of Biden’s so-called  “public option“) would lead to the demise of the current system of employer-provided health insurance.

For what it’s worth, there are two big reasons why I’m not a fan of the current employer-based system.

• It is propped up by a huge distortion in the tax code known as the “healthcare exclusion.”
• It leads to over-insurance and therefore exacerbates our third-party payer problem.

That being said, I’m very aware of the fact that politicians are always capable of making things worse (the “lather-rinse-repeat cycle” of government failure).

So let’s consider this key question: Government intervention has made our health system expensive and inefficient, but would a “public option” make things better or worse?

About two months ago, I shared this video which explains why the so-called public option will wind up being an expensive boondoggle.

Given the track record of health entitlements, I think the video you just watched is correct. A public option would be a fiscal nightmare.

But does that mean it also would be a threat to the employer-based system of private health insurance?

I think the answer is yes, largely because the subsidies that will make the system more expensive are also the subsidies that will make the public option seem like a good deal.

Let’s use two analogies to get this point across.

• Fannie Mae and Freddie Mac dominate housing finance, not because government-created entities are efficient, but because they use subsidies from the federal government to under-price private competitors.
• Parents know private schools produce much better educational outcomes than government schools, but most families opt for the inferior option because it’s already being financed by their tax dollars.

I fear the same thing will happen with the so-called public option. Politicians (in their never-ending efforts to but votes) will keep increasing the subsidies. That will make employer-based health plans seem less attractive by comparison.

And there will also be political pressure to provide an ever-more-extensive set of benefits (as illustrated by the cartoon). That will also make employer-based health plans seem less attractive by comparison.

The net result of all this is that even though the vast majority of workers are happy with their current employer-provided health plans, Biden’s public option will slowly but surely squeeze them out of the market.

The bottom line is that we’ll wind up with single-payer, government-run healthcare, but politicians would be sneaking it in the back door.

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Coronavirus Lessons from Europe

I wrote recently how government regulation and bureaucratic inefficiency are hindering an effective response to coronavirus in the United States.

And I also wrote yesterday about one foolish response from Washington to the crisis.

But what about developments in other nations? Are there lessons to be learned?

Henry Olsen, writing in the Washington Post, contemplates how Italy is very vulnerable because of stagnation, dependency, and debt.

Italy…has essentially shuttered its economy to fight its enormous health crisis. …Effectively, millions of Italians are out of work. These actions would shock any economy. But Italy’s economy is already weak, and has been for decades. Its gross domestic product has barely grown over the past 20 years. Its unemployment rate, at 9.8 percent, is one of the highest in Europe. Worse still, Italy is one of the most heavily indebted nations in the world. Government debt stood at 138 percent of GDP before this crisis hit… Italy’s economic crisis will ultimately put serious pressure on the euro. …If Italy’s economic hit weakens its banks sufficiently, the European Central Bank could be forced to step in with a large bailout. …Italians would likely face years of depression and stagnation… Italy’s economic lockdown is sending clear warning signs that a fiscal meltdown is coming.

Henry also speculates in the column that Italy’s current left-populist government will be replaced by a right-populist government. Furthermore, he thinks this could lead to the country abandoning the euro (the currency shared by many European nations) and going back to a national currency.

For what it’s worth, that would be a mistake.

A major problem in Italy is that populist politicians want people to believe the fairy tale that it’s possible to consume more than you produce.

That currently happens in Italy when politicians borrow money and spend it.

If the country gets rid of the euro and goes back to the lira, politicians will also be able to print money and spend it.

In other words, Italy’s populist politicians would have another way of undermining prosperity.

(I’m not a big fan of the European Central Bank’s easy-money policies, but it’s always possible to go from bad to worse.)

Meanwhile, Joseph Sternberg of the Wall Street Journal opines about lessons that can be learned from Europe about government-run healthcare.

Scientists around the world have worked overtime to get a handle on Covid-19, yet one great unknown remains. We still don’t know for sure whether this is only a medical crisis, or also a medical system crisis. …Doctors in Italy know what to do to treat severe cases, such as using ventilators in intensive-care units. But hospitals lack the beds and equipment for the influx of patients and Italy doesn’t have enough doctors even to make the attempt. Ill patients languish in hospital corridors for want of beds, recovering patients are rushed out the door as quickly as possible, and exhausted (and sometimes sick) doctors and nurses can’t even muster the energy to throw up their hands in despair. …U.K. policy makers understand what such analyses portend—because underinvestment in Britain’s creaking health-care system is even worse. …As a result, British authorities…are desperate to hold off on a mass outbreak until the socialized National Health Service has recovered from its chronic winter crisis. …the NHS…already falls to pieces every year with the normal ebb and flow of cold-weather ailments. Each winter crisis becomes a bit more acute, and this year was no exception. As of December, only 80% of emergency-room patients were treated within four hours of arrival, down from 84% in the depths of the previous two winters.

Interestingly, not all European nations are created equal.

…the U.K. and Italy are significantly more dependent on direct government financing of health-care than is France or Germany. Government accounted for 79% of total health-care spending in the U.K. in 2017, according to Eurostat, and 74% in Italy. Germany and France both rely on compulsory insurance schemes with varying degrees of subsidy and government meddling, but outright government expenditure amounts to only 6% of total health spending in Germany and 5% in France. …politicians already have made decisions that may seal a country’s coronavirus fate…the important choices may have already come in the guise of technocratic health spending and investment decisions made largely out of public view over many years. How lucky do Europeans feel?

The moral of the story is that coronavirus vulnerability may be worse in nations where government has the most control over healthcare.

Since the disease is a “black swan” (i.e., an unexpected big event), we should be cautious about drawing too many policy conclusions. After all, any nation with a severe coronavirus outbreak is going to face major problems.

That being said, it may be worth noting that Germany and France have an approach that’s more akin to Obamacare while the system in Italy and the United Kingdom is more akin to Medicare for All.

Either policy is greatly inferior to the free market, but it does raise the question of whether it’s a good idea to jump from a frying pan into a fire.

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Don’t Copy the United Kingdom’s Government-Run, Single-Payer Health System

I’m on my way back to the United States from England. My election-week coverage (starting here and ending here) is finished, but I’m still in the mood to write about the United Kingdom.

Yesterday, I shared some “Great Moments in British Government” and today I want to look at the U.K.’s single-payer health scheme.

The National Health Service (NHS) is inexplicably popular. Boris Johnson and Jeremy Corbyn basically competed over who would dump the most money into the system.

This near-universal affection is a mystery. There’s a lot of data suggesting the system doesn’t work.

Consider these details from a column by a British doctor.

One of the most curious political phenomena of the western world is the indestructible affection in which the British hold their National Health Service. No argument, no criticism, no evidence can diminish, let alone destroy, it. …Yet again, however, the NHS is in ‘crisis.’ The British Red Cross has called the present situation an incipient humanitarian crisis, as if the country were now more or less in the same category as Haiti after a hurricane… The current NHS has a budget 50 per cent greater than it had 10 years ago. It employs 25 per cent more doctors than it did then. …but the net result, according to those who say the present situation is the worst ever, is that it is less able than ever before to perform satisfactorily its most elementary tasks such as treating emergencies promptly. …The difference in the standard mortality rate of the richest and poorest is now almost double what it was when the NHS began. …in 2014 the Commonwealth Fund of New York, a foundation whose purpose is to promote an effective, efficient and equitable health care system, published a report in which it compared 11 western health care systems. …The measure on which it was next to worst was the number of deaths preventable by health care. …thousands of people die every year in Britain who would have been saved in any other country in Europe.

Here are some passages from a recent editorial by the Wall Street Journal.

The NHS managed to treat only 83.6% of emergency-room patients within four hours in October, compared to 89.1% a year earlier and well short of the government’s target of 95%. …The NHS also missed its target for 93% of patients with suspected cancer to be seen by a specialist within two weeks of referral by a family doctor. In September, 90.1% of patients saw a specialist within two weeks, down from 91.2% in September 2018. A bureaucrat or Senator Elizabeth Warren might think that’s good enough for government work. But it’s definitely not for the nearly 10% of patients and their families who had to live with a suspected cancer diagnosis… Politicians who want a U.S. version of the NHS via Medicare for All should explain why they want Americans to catch this British disease.

Here are some insights from a former British hospital director.

…the people at the very top of the NHS’s regional and national organisations still truly believe in command and control. They are the only people left who still believe in the power of the five year plan to solve pressing public policy problems. They set targets in the same way as the managers of the Soviet tractor factories… The hospital I was involved in had a problem with its A&E waiting times. We were provided with “help” from multiple NHS intervention teams. There were so many of them that they arrived in a bus… Each of them wanted slightly different information, each had a different view of what the problem was… After several weeks of this they came up with an action plan containing 147 individual actions, each of which then had to be measured and monitored and reported back to the intervention teams. We all knew that the action plan was there to tick the box required by the central bureaucracy, not to solve the problem. …Every profession has its own powerful union, dressed up as a professional body, that is quite happy to hold their employer to ransom. When I was on the hospital board it took two years of negotiations to get the pharmacists to work shifts so that the pharmacy could stay open until 7pm.

Even the left-leaning Guardian recognizes there are major problems.

British households will need to pay an extra £2,000 a year in tax to help the NHS cope with the demands of an ageing population, according to a new report that highlights the unprecedented financial pressures on the health system. …The report said the NHS has been struggling to cope… Niall Dickson, chief executive of the NHS Confederation, which commissioned the report and represents 85% of NHS bodies, said: “This report is a wake-up call. And its message is simple – if we want good, effective and safe services, we will have to find the resources to pay for them.” …“If we are to have a health and social care system which meets our needs and aspirations, we will have to pay a lot more for it over the next 15 years. This time we won’t be able to rely on cutting spending elsewhere – we will have to pay more in tax…” The report said…the money would have to be found from the three main sources of government revenue: income tax, VAT or national insurance.

An expert from the U.K.’s Taxpayers Alliance exposes some warts in the NHS.

Hardly a day goes by without stories of how cash-strapped the service is and how it is on the brink of collapse. According to pretty much everyone in the newspapers, on the TV, and on social media the solution is simple – more money. …The NHS is certainly in a sickly state, but more money is not the solution. International league tables frequently rank the NHS near the bottom in terms of healthcare quality. Moreover, the UK ranks 19th out of 23 for mortality amenable to healthcare and 20th out of 24 developed countries for cancer survival. The failings of the NHS are perhaps best summed up by The Guardian…: “The only serious black mark against the NHS was its poor record on keeping people alive”. …A specific ‘NHS tax’ is a particularly bad idea. …throwing more money at the NHS is not an adequate solution. Scotland spends more money per capita on healthcare than England, but has longer waiting times for appointments and slower response times for ambulances. …As the head of the NAO Amyas Morse observed… “Over the last ten years, there has been significant real growth in the resources going into the NHS, most of it funding higher staff pay and increases in headcount. The evidence shows that productivity in the same period has gone down, particularly in hospitals.”

Sally Pipes of the Pacific Research Institute also reveals some NHS shortcomings.

The United Kingdom’s single-payer system is in turmoil. It’d be foolish to import that failed model. The NHS has rationed care for decades. But wait times and delays have gotten markedly worse in recent months. The NHS recently canceled 55,000 non-urgent operations… Last month, nearly 15 percent of emergency-room patients had to wait more than four hours to be seen by a physician. The conditions are so bad in U.K. hospitals that, in a letter to the nation’s government, 68 British emergency room physicians recently complained about patients “dying prematurely in corridors” as a result of overcrowding. …no amount of money can fix a system in which government bureaucrats, and not markets, determine how to distribute healthcare resources.

Bruce Bawer is certainly not impressed with the NHS.

…the Brits have been brainwashed for generations into thinking their NHS is some kind of miracle. …What makes this NHS-worship especially grotesque is that the NHS, far from being successful, is a world-class disaster. Last July the BBC reported that the NHS was “increasingly” rationing such treatments as “hip and knee replacements and cataract surgery … as well as drugs for conditions such as arthritis.” …the NHS has always “covertly” rationed health care…cutting corners, canceling operations and doctor appointments, and extending already long waiting times even for urgent treatments. In October came reports that patients’ obesity and tobacco use were increasingly being used as excuses for denying them care. In November, a Cambridge University study concluded that 120,000 Brits had perished unnecessarily during the previous seven years…hospitals all over Britain — including operating rooms and maternity wards — were infested by cockroaches, maggots, insects, and rats. …the NHS is no role model. On the contrary, its history is a cautionary tale — and its prospects are nothing less than nightmarish.

Charles Hughes of the Manhattan Institute shares some grim news about the NHS’s performance.

A tracker from the BBC found that for 18 months hospitals across England, Wales, and Northern Ireland have failed to meet any of their three key targets, namely four-hour waits at the emergency department, cancer care within 62 days, and treating at least 92 percent of patients for planned hospital care or surgery within 18 weeks.  Waiting lists have ballooned. As of August 2017, the most recent month of data available, 409,000 had been waiting longer than 18 weeks for hospital treatment, an increase of almost 73,000 from the previous August. The median wait now stands at 7.1 weeks. …Citizens dissatisfied with rationing and wait times are turning to alternative options, forbidden in Canada. About 10 percent of people purchase supplemental private insurance for more timely treatment, many through company offerings. …Profit-driven hospital firms have seen a 15-25 percent year-on-year increase in the number of patients paying for their treatment themselves. People are also venturing abroad in their quest to get needed medical care. According to the Office of National Statistics, the total number of people leaving the U.K. for medical care surged from 48,000 in 2014 to almost 144,000 in 2016.

Some of the rationing and delays are simply due to government incompetence.

Some of it involves targeting certain segments of the population.

The NHS will ban patients from surgery indefinitely unless they lose weight or quit smoking, under controversial plans drawn up in Hertfordshire. The restrictions – thought to be the most extreme yet to be introduced by health services – immediately came under attack from the Royal College of Surgeons. …In recent years, a number of areas have introduced delays for such patients – with some told operations will be put back for months, during which time they are expected to try to lose weight or stop smoking. …The criteria also mean smokers will only be referred for operations if they have stopped smoking for at least eight weeks, with such patients breathalysed before referral.

My understanding is that the NHS does a good job with emergency care (you get maimed in a car accident) and a decent job with routine care (your annual check-up).

But you’re in big trouble if you have a chronic condition. Like people with cancer in Scotland.

More than 1,300 cancer patients in Scotland suffered agonising delays of more than two months to start treatment last year in breach of government targets. New figures show that, on average, 110 patients every month waited longer than 62 days for medical care after they were red-flagged by doctors for suspected cancer. The disclosure has prompted a wave of fresh criticism of the SNP, which in 2007 made a manifesto pledge to “ensure” suspected cancer patients were diagnosed and treated within 62 days.

I want to close by basically replicating some of my conversations from this past week with ordinary people in and around London.

When I highlighted shortcomings of the NHS, they routinely got defensive, admitted that their system isn’t perfect, and then attacked the American health system.

I think I surprised them by then stating that the U.S. healthcare system is a convoluted mix of waste and inefficiency.

I basically tried to give them this short speech, pointing out that our problems also are caused by government.

The Brits mess up their system by having the government directly provide medical care. We mess up our system with government-created third-party payer. In either case, the results aren’t pretty.

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“Medicare for All” Would Copy the Bad Features of the U.K.’s Government-Run System

The so-called Green New Deal is only tangentially related to climate issues.

It’s best to think of it as the left’s wish list, and it includes a paid leave entitlement, government jobs, infrastructure boondoggles, and an expansion of the already bankrupt Social Security system.

But the most expensive item on the list is “Medicare for All,” which is a scheme concocted by Bernie Sanders to have the government pay for everything.

Would this be a good idea? In a column for Forbes, Sally Pipes of the Pacific Research Institute explains that government-run healthcare in the United Kingdom has some very unfriendly features.

Nearly a quarter of a million British patients have been waiting more than six months to receive planned medical treatment from the National Health Service, according to a recent report from the Royal College of Surgeons. More than 36,000 have been in treatment queues for nine months or more. …Consider how long it takes to get care at the emergency room in Britain. Government data show that hospitals in England only saw 84.2% of patients within four hours in February. …Wait times for cancer treatment — where timeliness can be a matter of life and death — are also far too lengthy. According to January NHS England data, almost 25% of cancer patients didn’t start treatment on time despite an urgent referral by their primary care doctor. …And keep in mind that “on time” for the NHS is already 62 days after referral.

If this sounds like the VA health care system, you’re right.

Both are government run. Both make people wait.

And both produce bad outcomes. Here’s some of the data from the British system.

Unsurprisingly, British cancer patients fare worse than those in the United States. Only 81% of breast cancer patients in the United Kingdom live at least five years after diagnosis, compared to 89% in the United States. Just 83% of patients in the United Kingdom live five years after a prostate cancer diagnosis, versus 97% here in America.

Just like I told Simon Hobbs on CNBC many years ago.

The best part of Sally’s column is that she explains how the flaws in the U.K. system are being copied by Bernie Sanders and other supporters.

Great Britain’s health crisis is the inevitable outcome of a system where government edicts, not supply and demand, determine where scarce resources are allocated. Yet some lawmakers are gunning to implement precisely such a system in the United States. The bulk of the Democratic Party’s field of presidential candidates — including Senators Kirsten Gillibrand, Kamala Harris, and Elizabeth Warren — co-sponsored Senator Bernie Sanders’s 2017 “Medicare for All” bill. That plan would abolish private insurance and put all Americans on a single government-run plan… Britons face long waits for poor care under their country’s single-payer system. That’s not the sort of healthcare model the American people are looking for.

The bottom line is that Medicare for All would further exacerbate the third-party payer problem that already plagues the health care system.

And that means ever-escalating demand, rising costs, and inefficiencies.

There are only two ways of dealing with the cost spiral. One option is huge tax increases, which would result in a massive, European-style tax burden on the lower-income and middle-class taxpayers.

Taxpayers in the U.K. endure higher burdens than their counterparts in America, But they also suffer from the second option for dealing with the cost spiral, which is rationing.

Some of the data was in Ms. Pipes’ column.

If you want more examples (and some horrifying examples), you can click stories from 2017, 2016, 2015, 2014, 2013, and 2012.

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Protectionism, Obamacare, and Atlas Shrugged

I very much suspect Obama partisans and Trump partisans won’t like this column, but the sad reality is that both Obamacare and Trump’s protectionism have a lot in common.

• In both cases, government is limiting the freedom of buyers and sellers to engage in unfettered exchange.
• In both cases, the fiscal burden of government increases.
• In both cases, politicians misuse statistics to expand the size and scope of government.

Today, let’s add another item to that list.

• In both cases, the Washington swamp wins thanks to increased cronyism and corruption.

To see what I mean, let’s travel back in time to 2011. I wrote a column about Obamacare and cited some very persuasive arguments by Tim Carney that government-run healthcare (or, to be more accurate, expanded government control of healthcare) was creating a feeding frenzy for additional sleaze in Washington.

Congress imposes mandates on other entities, but gives bureaucrats the power to waive those mandates. To get such a waiver, you hire the people who used to administer or who helped craft the policies. So who’s the net winner? The politicians and bureaucrats who craft policies and wield power, because this combination of massive government power and wide bureaucratic discretion creates huge demand for revolving-door lobbyists.

I then pointed out that the sordid process of Obamacare waivers was eerily similar to a passage in Atlas Shrugged.

Wesley Mouch…issued another directive, which ruled that people could get their bonds “defrozen” upon a plea of “essential need”: the government would purchase the bonds, if it found proof of the need satisfactory. …One was not supposed to speak about the men who…possessed needs which, miraculously, made thirty-three frozen cents melt into a whole dollar, or about a new profession practiced by bright young boys just out of college, who called themselves “defreezers” and offered their services “to help you draft your application in the proper modern terms.” The boys had friends in Washington.

Well, the same thing is happening again. Only this time, as reported by the New York Times, protectionism is the policy that is creating opportunities for swamp creatures to line their pockets.

The Trump administration granted seven companies the first set of exclusions from its metal tariffs this week and rejected requests from 11 other companies, as the Commerce Department began slowly responding to the 20,000 applications that companies have filed for individual products. …several companies whose applications were denied faced objections from American steel makers. …companies that have applied for the exclusions criticized the exercise as both long and disorganized. “This is the most screwed-up process,” said Mark Mullen, president of Griggs Steel, a steel distributor in the Detroit area. “This is a disservice to our industry and the biggest insult to our intelligence that I have ever seen from the government.”

From an economic perspective, it certainly is true that this new system is “disorganized” and “a disservice” and an “insult to our intelligence.” Those same words could be used to describe the welfare state, the EEOC, farm subsidies, the tax code, and just about everything else the government does.

But there’s one group of people who are laughing all the way to the bank, The lobbyists, consultants, fixers, and other denizens of the swamp are getting rich. Whether they’re preparing the applications, lobbying for the applications, or lobbying against the applications, they are getting big paychecks.

And the longer this sordid protectionist process continues, we will see a repeat of what happened with Obamacare as senior-level people in government move through the revolving door so they can get lucrative contracts to help clients manipulate the system (yes, Republicans can be just as sleazy as Democrats).

Washington wins and we lose.

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Journalistic Alchemy: Washington Post Magically Transforms a Spending Cut into a Tax Increase

I don’t focus much on media bias because journalists generally aren’t dishonest. Instead, they choose which stories to highlight or downplay based on what advances their political agenda. Though every so often I’ll highlight an example of where bias leads to an egregious (maybe even deliberately dishonest) mistake.

• Like the time a column in the New York Times argued that “austerity” kills people, but the examples cited were countries where the burden of government spending was higher.
• Or the time that the Washington Post said that a $71 billion increase in Medicaid spending was a 25 percent cut?
• And how about when the New York Times published a story about schools being “starved of funding” when even a cursory look at the data would confirm outlays have climbed substantially.

Now we have an addition to that collection from a WonkBlog column in the Washington Post. The piece starts with an accurate observation that the tax plan on Capitol Hill isn’t a long-run tax cut.

Senate rules require the Tax Cuts and Jobs Act not to add to the federal deficit after 10 years. …The bill aims to cut corporate taxes in perpetuity…but they actually need to raise money to offset the permanent corporate tax reduction.

Yes, as I wrote two weeks ago, the long-run tax cuts have to be offset by long-run revenue increases. So that part of the column is fine.

We then get this rather dubious assertion.

Republicans are paying for a permanent cut for corporations with an under-the-radar tax increase on individuals.

In part, it’s a dodgy claim because there are provisions in the bill that collect more revenue from companies, such as the partial loss of interest deductibility and various base erosion rules. So if he wanted to be accurate, the author should have begun that sentence with “Republicans are partially paying for…”

But that’s only part of the problem. As you can see from this next excerpt, he cites a former Democrat staffer and doubles down on the allegation that individual taxpayers will be coughing up more money to Uncle Sam because of the legislation.

This chart, playing off what the Senate’s former top tax aide and New York University professor Lily Batchelder pointed out on Twitter on Friday evening, makes vividly clear where Republicans ultimately raise that money. …we know it’s individual taxpayers who ultimately bear the cost of the tax bill.

And here’s the chart that ostensibly shows that you and me are going to pay more money so evil corporations can enjoy a tax cut.

Notice, however, the part I circled in green. It shows that Republicans are repealing Obamacare’s individual mandate as part of their tax reform plan, and it also shows that repeal has budgetary effects.

So how is this a tax increase (the pink portion of the bar chart), as the Washington Post wants us to believe?

Needless to say, the honest answer is that it isn’t a tax hike. Getting rid of the mandate means people won’t get “fined” by the IRS if they choose not to buy health insurance. If anything, that should count as a tax cut.

But that’s not what’s represented by the pink part of the bar chart. Instead, it shows that when you get rid of the mandate and consumers choose not to get Obamacare policies, that automatically means that insurance companies will get fewer subsidies from Uncle Sam (getting access to that cash was one of the reasons the big insurance companies lobbied for Obamacare).

In other words, the chart actually is showing that corporate rate reduction is partially financed by a reduction in spending, which is a win-win from my perspective.

By the way, you don’t have to believe me. On page 9 of the Joint Committee on Taxation’s revenue estimate (which presumably will be posted on the JCT website at some point), you find this footnote about the “outlay effect” of repealing the mandate.

At the risk of stating the obvious, an “outlay effect” is when a change in law causes a shift in government spending. That’s what’s happening, not a tax increase on individuals.

By the way, the author sort of admits this is true in a passage buried near the bottom of the column.

…a number of analysts argue that it’s wrong to consider the loss of insurance related to the end of the ACA mandate a tax increase, because it reflects individuals’ choice not to get insurance.

That’s a pathetic attempt at justifying a dishonest article.

Here’s the bottom line.

1. Individuals will be paying less money to the IRS because of this provision, not more.
2. The fiscal impact of the provision is less spending, not more tax revenue.

Sadly, most readers will have no idea that they were deliberately misled.

P.S. The “alternative inflation measure” in the bill (the red portion of the bar chart) arguably is a tax increase. Or, for those who persuasively argue that it’s a more accurate measure, it’s a provision that will result in individual taxpayers sending more money to Uncle Sam compared to current law since the new measure (chained CPI) will result in smaller inflation adjustments to tax brackets and the standard deduction.

P.P.S. If repealing just one small piece of Obamacare will save about $300 billion over the next decade, imagine how much money we could save if the entire law was repealed.

P.P.P.S. Since I’ve previously explained how politicians use alchemy to turn spending increases into tax cuts, I guess it’s not surprising that some folks are using the same magic to turn spending cuts into tax increases.

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Two Cheers for the Fiscal Changes in the GOP’s Obamacare Repeal-and-Replace Legislation

As I wrote yesterday (and have pontificated about on many occasions), the main problem with America’s healthcare system is that various government interventions (Medicare, Medicaid, Obamacare, tax code’s healthcare exclusion, etc) have created a system where people – for all intents and purposes – buy healthcare with other people’s money.

And as Milton Friedman wisely observed, that approach (known as “third-party payer”) undermines normal market incentives for lower costs. Indeed, it’s a green light for ever-higher costs, which is exactly what we see in the parts of the healthcare system where government programs or insurance companies pick up most of the tab.

For what it’s worth, I’m not overflowing with confidence that the new Obamacare-replacement proposal from Republicans will have much impact on the third-party payer crisis. And it probably doesn’t solve some of the Obamacare-specific warts in the system. If you want to get depressed about those issues, read what Michael Cannon, Philip Klein, and Christopher Jacobs have written about the new GOP plan.

But healthcare in America is also a fiscal issue. And if we’re just looking at the impact of the American Health Care Act on the burden of government spending and taxes, I’m a bit more cheerful.

The Congressional Budget Office released its official score on the impact of the legislation. Here’s the excerpt that warmed my heart.

Outlays would be reduced by $1.2 trillion over the period, and revenues would be reduced by $0.9 trillion. The largest savings would come from reductions in outlays for Medicaid and from the elimination of the Affordable Care Act’s (ACA’s) subsidies for nongroup health insurance. … parts of the legislation would repeal or delay many of the changes the ACA made to the Internal Revenue Code… Those with the largest budgetary effects include: • Repealing the surtax on certain high-income taxpayers’ net investment income; • Repealing the increase in the Hospital Insurance payroll tax rate for certain high-income taxpayers; • Repealing the annual fee on health insurance providers; and • Delaying when the excise tax imposed on some health insurance plans with high premiums would go into effect.

And fellow wonks will be interested in this table.

By the way, the “two cheers” in the title may be a bit too generous. After all, there should be full reform of Medicare and Medicaid. Though I suppose some of that can happen (at least Medicaid, hopefully) as part of the regular budget process.

It’s also unfortunate that Republicans are creating a new refundable tax credit (and when you see the term “refundable tax credit,” that generally is a sneaky euphemism for more government spending that is laundered through the tax code, sort of like the EITC) to replace some of the Obamacare subsidies that are being repealed.

So it’s far from ideal.

For those who want to see the glass as being half-full rather than half-empty, however, Ryan Ellis has a very upbeat assessment in a column for Forbes.

It’s a net spending cut of over $1.2 trillion and a net tax cut of nearly $900 billion over the next decade. …the score shows that the AHCA would be a large and permanent tax cut for families and employers….This should lower the tax revenue baseline considerably, perhaps even by half a percentage point of the economy.

I like starving the beast, so I agree this is a good thing.

And I also agree with Ryan that the resulting lower tax burden on dividends and capital gains is very positive. After all, double taxation is probably the most pernicious feature of the internal revenue code.

The most pro-growth tax cut in the bill is the elimination of the so-called “NIIT” or “net investment income tax.” It adds on a 3.8 percentage point surtax on savers and investors. By eliminating NIIT, the bill cuts the capital gains and dividends tax from 23.8 percent in 2017 to 20 percent in 2018 and beyond. …The contribution limit to HSAs is doubled, from nearly $7000 for families today to $14,000 starting in 2018.

But I’ll close with some sad news. If the legislation is approved, that probably means no more Obamacare-related humor. If this makes you sad, you can easily spend about 30 minutes enjoying Obamacare  cartoons, videos, and jokes by clicking here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, and here.

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The U.K.’s Government-Run Healthcare System Is Working Wonderfully…for Bureaucrats

Back in 2013, I got very upset when I learned that senior bureaucrats at the IRS awarded themselves big bonuses, notwithstanding the fact that the agency was deeply tarnished by scandal because of its efforts to help Obama’s reelection campaign.

That’s when I decided to put forth my “First Theorem of Government,” which simply states that the public sector is a racket for the benefit of a ruling class comprised of bureaucrats, interests groups, cronies, and other insiders.

They have figured out how to line their pockets and live very comfortable lives at the expense of people in the economy’s productive sector.

The same thing is true on the other side of the Atlantic Ocean. The U.K.-based Daily Mail reports that senior bureaucrats in the country’s government-run healthcare system get lavish taxpayer-financed pension.

Hundreds of NHS managers have amassed million-pound pension pots while presiding over the worst financial crisis in the history of the health service… As patients face crippling delays for treatment, A&E closures and overcrowded wards, bureaucrats have quietly been building up huge taxpayer-funded pensions. They will be handed tax-free six-figure lump sums on retirement, and annual payouts from the age of 60 of at least £55,000 – guaranteed for life.

Here are some of the details, all of which must be especially aggravating for the mistreated patients who suffer because of substandard care from the government.

Nearly 300 directors on NHS trust boards have accrued pension pots valued at £1million or more; At least 36 are sitting on pots in excess of £1.5million – with three topping a staggering £2 million; The NHS pays a staggering 14.3 per cent on top of employees’ salary towards their pension – almost five times the average of 3 per cent paid in the private sector; …About 500 earn more than the Prime Minister – after Health Secretary Jeremy Hunt ordered them to ‘show restraint’ on executive pay. …the scheme every year pays retired staff £10 billion more than it takes in. That black hole has to be filled by the taxpayer. The subsidies enable NHS executives – including managers, human resources bosses and directors of ‘corporate administration’ – to build up vast pensions, at minimal personal expense.

Here’s the bureaucrat with the biggest pile of loot from taxpayers.

The biggest single beneficiary is Professor Tricia Hart, who retired as chief executive of South Tees Hospitals NHS Foundation Trust in January with a £2.6 million pension. That figure entitled her to a lump sum of at least £335,000 on retirement, plus an inflation-proof annual pension of £110-115,000. …at least four HR directors have amassed million-pound pensions.

By the way, I have nothing against people accumulating big nest eggs. Even if they work for the government.

My objection, as discussed in yesterday’s column about state and local bureaucrats in America, is when bureaucrats have special taxpayer-financed deals.

Especially, as we see all too often in the U.K., when taxpayers don’t even get good healthcare in exchange for the lavish salaries and benefits.

Almost four million people are now waiting for cataract surgery, hip and knee replacements and other routine operations. The number of people forced to wait more than four hours in A&E has doubled in two years. And wards are full of elderly people who cannot be discharged – because there are no care home places for them.

A spin doctor tried to rationalize and justify the cozy scheme for bureaucrats.

…a spokesman for NHS Pensions stressed that…The amounts individuals accrued were a result of the ‘rules and regulations’ of the NHS scheme. ‘What people get paid is a matter for NHS trusts,’ he added.

I’m amused by the assertion that the lavish pensions are the result of simply following the “rules and regulations.” That’s precisely the point. Government insiders write the rules and regulations and they inevitably produce systems that are very good for them and not so good for taxpayers.

I’m also amused (and when I write “amused,” I actually mean “irritated” or “appalled”) at the claim that compensation levels are “a matter for NHS trusts”. If the spin doctor was talking about a private company, I would agree. As I’ve argued before, pay levels in private companies should be determined by managers and stockholders.

But we’re talking in this case about pay levels in a government bureaucracy. And notwithstanding the elitist attitude of some government officials, taxpayers have every right to get outraged when they learn that their money is being squandered on excessive pay and gold-plated benefits.

It’s a problem all over the world.

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The Best and Worst Developments of 2015

What were the most noteworthy events from 2015?

Regarding bad news, there’s unfortunately a lot of competition. But if I’m forced to pick the very worst developments, here’s my list.

Resuscitation of the Export-Import Bank – I did a premature victory dance last year when I celebrated the expiration of the Export-Import Bank’s authority.  I should have known that corrupt cronyism was hard to extinguish. Sure enough, Republicans and Democrats conspired to re-authorize the Ex-Im Bank and transfer wealth from ordinary Americans to politically connected corporations.

Expansion of IMF authority – I also did a premature victory dance in 2014 when I lauded the fact that Congress did not approve increased bailout authority for the International Monetary Fund. Sadly, as part of the year-end spending agreement, Congress agreed to expand the IMF’s authority so it could continue to push for higher taxes around the world.

Busting the spending caps (again) – When I wrote last August that maintaining the spending caps was a key test of GOP integrity, I should have known that they would get a failing grade. Sure enough, Republicans deliberately fumbled the ball at the goal line and agreed to higher spending. Again.

Supreme Court ignores law to bail out Obamacare (again) – Back in 2012, the Supreme Court had a chance to rule whether Obamacare was an impermissible expansion of the power of the federal government. In a truly odious decision, Chief Justice John Roberts ignored the Constitution’s limits on federal powers and decided we could be coerced to buy health insurance. Last year, he did it again, this time by bailing out a key part of Obamacare by deciding to arbitrarily ignore the wording of the law.

Business-as-usual transportation bill – The desire of Congress to fund pork-barrel transportation projects is at least somewhat constrained by the amount of revenue generated by the gas tax. There was an opportunity for reform in 2015 because proposed spending was much higher than the trajectory of gas tax revenue, but rather than even engage in a discussion of good policy options, politicians merely bickered over what combination of tax hikes and budget gimmicks they could put together to keep the pork projects flowing.

Creeping support on the right for the value-added tax – When I wrote early last year that the 2016 election might create an opportunity for tax reform, I was being hopeful that we might get something close to a simple and fair flat tax. Yet probably the biggest news so far in this election cycle is that a couple of candidates who presumably favor small government – Rand Paul and Ted Cruz – have proposed to impose a value-added tax without fully repealing the income tax.

There’s very little good news to celebrate. Here’s my tragically sparse list, and you’ll notice that my list of victories is heavy on style and light on substance. But let’s take what we can get.

Semi-decent Republican budgets – The budget resolution produced by Congress technically doesn’t embrace specific policies, but the it’s nonetheless noteworthy that the House and Senate approved numbers that – at least conceptually – are based on genuine Medicaid and Medicare reform.

Support for spending caps – Notwithstanding the fact that GOP politicians won’t even abide by the limited spending caps that already exist, I’m somewhat encouraged by the growing consensus for comprehensive spending caps akin to the ones in place in Switzerland and Hong Kong. Heck, even international bureaucracies now agree spending caps are the only effective fiscal rule.

Good election results from the Wolverine State – It was great to see Michigan voters reject a gas tax increase that was supported by the political elite.

More companies escaping the IRS – I heartily applaud when companies figure out how to re-domicile in jurisdictions with better tax law to escape America’s high corporate tax rate and self-destructive worldwide tax system. And I’m glad these “inversions” continue to take place even though the Obama Administration is trying to stop them.

A glimmer of reality at the New York Times – I realize I’m scraping the bottom of the barrel in my search for good news, but the fact that the New York Times published a column acknowledging that feminist economic policies backfire against women hopefully is a sign that sensible thinking is possible in the establishment media.

Gun control flopping – It’s great to see that the left has totally failed in its effort to undermine 2nd Amendment rights.

Limits on asset forfeiture – The final bit of good news from 2015 was the just-before-Christmas announcement by the Obama Administration that the odious practice of asset forfeiture would be modestly curtailed.

I would offer predictions for 2016, but since my big prediction from last year that we would have gridlock was sadly inaccurate, I think I’ll avoid making a fool of myself this year.

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Evil, Knee-Jerk, Wingnut Libertarians and Conservatives Are Wrong to Say Obamacare Is a Total Job Killer

Time for a mea culpa.

In the past, I’ve criticized Obamacare for a variety of reasons.

• I’ve argued that it’s a fiscal boondoggle.
• I’ve pointed out that it’s grossly inconsistent with the Constitution.
• I’ve complained that it’s undermined the rule of law.
• And it undermined growth by increasing marginal tax rates.
• Moreover, I’ve explained how it exacerbates the real problem in our healthcare system, which is government-caused third-party payer.

But I’m not here to apologize for those views.

Instead, I feel obliged to issue somewhat of a retraction for my assertion that Obama care is a job killer.

Some of you may be scratching your heads, particularly if you read these passages from an article earlier this week in The Hill.

ObamaCare will force a reduction in American work hours — the equivalent of 2 million jobs over the next decade, Congress’s nonpartisan scorekeeper said Monday. The total workforce will shrink by just under 1 percent as a result of changes in worker participation because of the new coverage expansions, mandates and changes in tax rates, according to a 22-page report released by the Congressional Budget Office (CBO). …the law changes incentives over the years for the workers themselves both in part-time and full-time positions.

And if you go to the actual CBO report, you’ll see that the story is accurate. And the CBO report is very consistent with some of the academic research on the issue.

So why, then, am I issuing a mea culpa on Obamacare and jobs?

Well, some readers may have concluded from my writings that Obamacare is an absolute job killer.

Yet, as we see from this story in the Kansas City Star, there may be some jobs being created because of the so-called Affordable Care Act. Here are some relevant excerpts.

H&R Block expects more customers to feel the impact of the Affordable Care Act when they do their taxes early next year, providing a source of growth for the Kansas City-based business. A year ago, Block invested in marketing and training its tax preparers… “We think we’re going to start to reap the benefits of that investment,” Block chief executive Bill Cobb said Tuesday during a strategy session with analysts. …the company said an early effort will be aimed at getting back customers the company lost last year.

To be sure, H&R Block isn’t explicitly saying that it will have additional employees, but I think we can infer that some new positions will be created as the company takes advantage of the fact that many taxpayers will be overwhelmed by the complexities and penalties that are part of Obamacare.

With this in mind, I’m going to be very careful in the future to state that the President’s law is a net job killer or a relative job killer.

After all, I wouldn’t want anyone to accuse me of being unfairly or inaccurately critical of government-run healthcare. Even in cases when the jobs being created are evidence of bad legislation rather than a good economic climate.

P.S. I’m not a big fan of H&R Block. Assuming they didn’t support Obamacare, I don’t blame them for enjoying the extra profits they’ll earn because of the law. But the company has supported government rules to block competition in the tax-compliance industry. And I remember many years ago being part of a debate in Louisiana where a representative from H&R Block argued against the flat tax. Gee, I wonder why?

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Three Not-so-Great Moments in Government-Run Healthcare

Government intervention has messed up the healthcare sector, leading to needlessly high prices and massive inefficiency.

Fixing the mess won’t be easy since it would involve addressing several contributing problems, including Medicare, Medicaid, the healthcare exclusion in the tax code, Obamacare, and the mess at the Veterans Administration.

But at least we know the right solutions. We need entitlement reform and tax reform in order to restore a genuine free market and solve the government-created third-party payer crisis.

And to bolster the case for reform, we’re going to look at three new examples of how government intervention makes the healthcare system worse rather than better.

For our first example, let’s look at a new report from the National Center for Policy Analysis, which compares what happens when the federal government decides to build a hospital with a similar project constructed by a local government with private-sector involvement.

We’ll start with a look at Veterans Administration project.

…the VA hospital in Denver, Colorado, was run-down, crowded and outdated. …the VA considered renovating the medical facilities of the Fitzsimons Army Medical Center at a cost of $30 million. Then, the University of Colorado Hospital offered to open jointly-operated facilities for $200 million. VA officials passed on both ideas due to cost concerns. Instead, officials sought and received approval for a stand-alone facility.

That decision was very costly for taxpayers.

The VA failed to produce a design that could be built for its budget of $604 million, ultimately causing a budget-busting $1 billion overrun. …Soon, the plan to build an affordable replacement morphed into the most extravagant and expensive hospital construction project in VA history.

And, as is typical of government projects, the cost to taxpayers was far higher than initial estimates used to justify the project.

Now let’s look at another project, this one in Dallas, Texas.

…the original Parkland Hospital was built in Dallas to serve the young city’s indigent population. …its aging facilities could no longer meet the demand of 1 million patients admitted each year. …The project to rebuild Parkland, split roughly 60/40 in revenue sources, was accountable to both the public and its private donors. …Project managers hired an independent auditor to monitor all project transactions. Budget progress reports were made available to both Parkland’s Board and the public.

The final outcome was far from perfect (after all, local governments are also quite capable of wasting money). But the involvement of the private sector, combined with the fact that the local government was spending its own money, created incentives for a much better outcome.

On the first day of construction, Parkland’s project team was $100 million over budget. But a flexible design, and a willingness to balance needs and wants, allowed the team to deliver a larger, more cost-effective hospital than originally conceived for a mere 6 percent increase in budget.

And here’s a chart from the NCPA report that perfectly captures the difference between the federal government and a project involving a local government and the private sector.

Can you think of a better argument for local private-public partnerships over the federal government?

Yet policy keeps moving in the wrong direction in Washington.

The Obamacare boondoggle was all about increasing the federal government’s control and intervention in the healthcare sector.

And this brings us to our second not-so-great example of government-run healthcare.

The New York Times has a story with a real-world example showing how the President’s failed legislation is hurting small businesses.

LaRonda Hunter…envisioned…a small regional collection of salons. As her sales grew, so did her business, which now encompasses four locations — but her plans for a fifth salon are frozen, perhaps permanently.

And why can’t she expand her business and create jobs?

Because Obamacare makes it impossible.

Starting in January, the Affordable Care Act requires businesses with 50 or more full-time-equivalent employees to offer workers health insurance or face penalties that can exceed $2,000 per employee. Ms. Hunter, who has 45 employees, is determined not to cross that threshold. Paying for health insurance would wipe out her company’s profit and the five-figure salary she pays herself from it, she said.

And Ms. Hunter is just the tip of the iceberg.

For some business owners on the edge of the cutoff, the mandate is forcing them to weigh very carefully the price of growing bigger. “There’s kind of a deer-in-headlights moment for those who say, ‘I have this new potential client, but if I bring them on, I have to hire five additional people,’” said Philip P. Noftsinger, the payroll unit president at CBIZ, a financial services provider for businesses. “They’re really trying to assess how much the 50th employee is going to cost. …Added to that cost are the administrative requirements. Starting this year, all companies with 50 or more full-time workers — even those not yet required to offer health benefits — must file new tax forms with the Internal Revenue Service that provide details on employee head count and any health insurance offered. Gathering the data requires meticulous record-keeping. “These are some of the most complex informational returns we’ve ever seen,” said Roger Prince, a tax lawyer.

Here’s another real-world example.

The expense and distraction of all that paperwork is one of the biggest frustrations for one business owner, Joseph P. Sergio. …He is reluctant to go over the 50-employee line and incur all of the new rules that come with it. That makes bidding for new jobs an arduous and risky exercise. …”If you ramp up, and it pushes you over 50, there’s all these unknown costs and complicated rules. Are we really going to be able to benefit from going after that opportunity? It freezes you at a time when you need to be moving fast.”

And don’t forget that while Obamacare discourages entrepreneurs from creating jobs, it also discourages people from seeking jobs.

That’s the kind of two-for-one special that’s only possible with big government!

Now that we’ve cited examples of bad policy from the Veterans Administration and Obamacare, let’s turn to Medicare for our third example.

Veronique de Rugy of the Mercatus Center writes about rampant Medicare fraud in her syndicated column.

Medicare is rife with fraud, and every year, billions of dollars are improperly paid out by the federal government’s giant health care bureaucracy. According to the government’s latest estimates, Medicare fee-for-service (parts A and B) made $46 billion in improper payments last year. And Medicare Advantage (Part C) and Medicare Prescription Drug Coverage (Part D) combined for another $15 billion in improper payments. Even more disturbing is the possibility that these numbers underestimate the annual losses to taxpayers from fraud and bureaucratic bungling. According to the work of Harvard University’s Malcolm Sparrow, fraud could account for as much as 20 percent of total federal health care spending, which would be considerably higher than what the government’s figures indicate.

None of this should be a surprise. Medicare has a notorious history of waste, fraud, and abuse.

But there is a glimmer of good news. There’s actually a program to identify and recover wasted funds.

The RAC program is geared toward correcting improper payments… The auditors thus pay for themselves with the money they recoup instead of simply being handed a lump-sum check. That the RAC program has an incentive to reduce wasteful spending and save taxpayers money makes it fairly unusual among government initiatives.

Unfortunately, no good deed goes unpunished in Washington.

…bureaucrats are set to greatly diminish the program’s effectiveness in 2016. Rather than empower these fraud hunters, they are drastically reducing the number of paid claims that auditors can review every 45 days (from 2 percent down to just 0.5 percent). The new limits will make it that much harder for auditors — whose cost already amounts to just a drop in the bucket — to recoup taxpayer losses.

I’ve also written about this absurd effort to curtail the RAC program, but Veronique makes a critically important observation that has widespread applicability to so much of what happens with government.

Agency failure is routinely rewarded in Washington with bigger budgets and greater authority, but here success will not be.

This, in a nutshell, is the difference between the private sector and the government.

In my speeches, I sometimes point out that people in the private economy make mistakes all the time, but I also explain that the incentive to earn profits and avoid losses creates a powerful incentive structure to quickly learn from mistakes.

That means resources quickly get reallocated in ways that are more likely to boost economic efficiency and increase growth and living standards.

In government, by contrast, this process is reversed. Bureaucrats and politicians reflexively argue that failure simply means that budgets should be expanded.

All of which explains why these cartoons are such perfect depictions of government.

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Some Victims of Obamacare Deserve to Suffer

Shortly after Obamacare was enacted, I started writing about groups victimized by the law. But after highlighting how children, low-income workers, and retirees were disadvantaged by government-run healthcare, I soon realized that I wasn’t saying anything new or different.

Heck, Obamacare has been such a disaster that lots of people have been writing lots of good articles about the law’s failure and how various segments of the population are being unjustly harmed.

So I chose a different approach. I decided to identify groups that deserve to suffer because of the law. Or at least to highlight slices of the population that are not very deserving of sympathy.

Some politicians and staffers of Capitol Hill, for instance, are very upset about the prospect of being subjected to the law that they inflicted on the rest of the country. Gee, my heart breaks for them.

The bureaucrats at the IRS are agitated about the possibility of living under Obamacare, even though the IRS got new powers as a result of the law. How sad, cry me a river.

Professors at Harvard University, including many who supported Obamacare, are now upset that the law is hurting them. Oh, the inhumanity!

Now we have another group to add to this list. And this group is definitely in the deserve-to-suffer category.

That’s because we’re going to look at the big insurance companies that supported Obamacare, but now are squealing because the law isn’t working and they’re not getting the bailouts they were promised.

Here are some excerpts from a column by the irreplaceable Tim Carney of the Washington Examiner.

Until recently, the insurance giants saw Obamacare as a cash cow. They are now finding the law’s insurance marketplaces to be sickly quagmires causing billions in losses. …United Healthcare, the nation’s largest insurer, last week announced it was suffering huge losses in the exchanges. …The company forecast $700 million in losses on the exchanges. Fellow insurance giant Aetna also said it expected to lose money on the exchanges, and other insurers said enrollment was lower than they expected.

This seems like a feel-good story, very appropriate for the holidays. After all, companies that get in bed with big government deserve bad consequences.

But hold on to your wallet.

…Obamacare insiders — the wealthy and powerful operatives who alternate between top government jobs and top industry jobs — are hustling to find more bailout money for insurers. Republicans, if they are able to hold their ground in the face of lobbyist pressure, can block the bailout of Obamacare and its corporate clientele. …Obamacare included…a three-year safety net for insurers who do much worse than expected, paid for by an extra tax on insurers who do much better. The Centers for Medicare & Medicaid Services (CMS) had announced in October that insurers losses for 2014 entitled them to $2.87 billion in bailout payments… The problem is that super-profitable insurers did not pay nearly that much into the bailout fund.

This means there will be a fight in Washington. The Obama White House wants to bail out its corporate cronies. But there’s not enough money in the bailout fund.

And, thanks to Senator Rubio of Florida, the government can’t write checks out of thin air.

In late 2014, Sen. Marco Rubio, R-Fla., inserted into the so-called Cromnibus spending bill a provision that prohibited CMS from paying out more in risk corridor payments than it takes in. Profitable insurers — not taxpayers — must subsidize their less profitable peers.

Unfortunately, the Obama Administration oftentimes doesn’t care what the law says.

CMS announced last week that the government was going to find a way to pay the insurers their full bailout, anyway. …CMS also declared the unfunded portion of Obamacare’s initial promised insurer bailout was nevertheless an “obligation of the United States Government for which full payment is required,” even though at least under the current appropriation law it is illegal.

Tim outlines the incestuous relationship between Big Insurance and the Obama White House, all of which makes for nauseating reading.

But here’s the part that matters for public policy.

Rubio’s provision…expires along with the current government funding law on December 11. The Obamacare insiders, led by Slavitt and Tavenner, will fight to free up their bailouts and put the taxpayers on the hook for their losses caused by the law they supported.

In other words, we’re about to see – as part of upcoming appropriations legislation – if Republicans have the intelligence and fortitude to retain Rubio’s anti-bailout provision.

This should be a slam-dunk issue. After all, the American people presumably will not favor bailouts for corrupt health insurance corporations.

Especially since Obamacare is still very unpopular.

But what if Obama says “boo” and threatens to veto spending legislation if it doesn’t give him carte blanche bailout authority? Will GOPers be so scared of a partial government shutdown that they instantly surrender?

After all, when there was a shutdown fight in 2013, Republicans suffered a horrible defeat in the 2014 mid-term elections. Right? Isn’t that what happened?

Oh…wait…never mind.

P.S. Let’s not forget that there is one very tiny segment of America that has unambiguously benefited from Obamacare.

P.P.S. If you have any friends who work for the corrupt health insurance companies that are worried about a potential loss of bailout money, you can cheer them up this Christmas season with some great – and very appropriate – action figure toys.

P.P.P.S. Since we’re closing with sarcasm, here’s the federal government’s universal bailout application form.

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Obamacare Is Still a Disaster

Like many Americans, I’m suffering from Obamacare fatigue.

Before the law was implemented, I repeatedly explained that more spending and more intervention  in the health sector would worsen a system that already was suffering from too much government.

And since the law went into effect, I’ve pointed out – over and over again – the predictably negative effects of giving the government even more control.

So I’m tempted to wash my hands of the issue.

But that would be wrong, particularly since advocates of statism disingenuously might claim that silence somehow means acceptance or approval.

Moreover, we need to continuously remind ourselves that big government doesn’t work just in case there’s a chance to enact good reforms after Obama leaves office.

With that in mind, let’s look at recent developments that underscore the case against government-run healthcare.

How about the fact that Obamacare is extremely vulnerable to fraud?

…the GAO report showed that federal auditors 11 out of 12 times were able to gain subsidized coverage with fictitious applications, three of the successful applications never provided citizenship or immigration documentation. The investigators in each case were able to obtain $2,500 or around $30,000 annually in advance premium tax credits.

And what about the fact that the Obamacare co-ops have been a big flop?

Nonprofit co-ops, the health care law’s public-spirited alternative to mega-insurers, are awash in red ink and many have fallen short of sign-up goals, a government audit has found. Under President Barack Obama’s overhaul, taxpayers provided $2.4 billion in loans to get the co-ops going, but only one out of 23 — the one in Maine — made money last year, said the report out Thursday. Another one…was shut down by regulators over financial concerns. The audit by the Health and Human Services inspector general’s office also found that 13 of the 23 lagged far behind their 2014 enrollment projections.

Or what about the fact that deductibles have increased under Obamacare?

A survey released earlier this week by the Kaiser Family Foundation found that..deductibles have risen almost three times as fast since 2010 for employer-sponsored plans.

And should we care that Obamacare has meant rising health care costs?

…the actuaries estimated that health spending that year jumped by 5.5 percent, a bigger rise than the country had experienced in five years. …The actuaries cited three main reasons they think health spending is set to tick up. One is the aging of the population… Another is the improving economy… But the third, and a big one, was Obamacare’s coverage expansion.

All of the aforementioned things are contrary to what Obamacare supporters promised.

Though since I focus on policy rather than politics, I’ll take this opportunity to point out that higher deductibles in some ways are a good thing. Which is why I’ve defended Obamacare’s Cadillac tax.

But now let’s look at two additional Obamacare developments. And both represent very bad news.

First, new scholarly research shows that Obamacare will be bad news for all income levels, and even will be of questionable value to those getting big subsidies (h/t: Marginal Revolution).

…the average financial burden will increase for all income levels once insured. Subsidy-eligible persons with incomes below 250 percent of the poverty threshold likely experience welfare improvements that offset the higher financial burden, depending on assumptions about risk aversion and the value of additional consumption of medical care. However, even under the most optimistic assumptions, close to half of the formerly uninsured (especially those with higher incomes) experience both higher financial burden and lower estimated welfare.

In other words, people generally were making sensible choices when they had some degree of freedom.

But now that they’re being coerced into Obamacare, many of them are worse off. Even in many cases if they’re the ones getting subsidized!

Second, we now know that President Obama’s promise to lower health insurance premiums by $2,500 was laughably misleading.

But it’s not simply that the President exaggerated. As Investor’s Business Daily explains, the numbers actually have gone in the other direction

Since 2008, average family premiums have climbed a total of $4,865. The White House cheered the news, saying it was a sign of continued slow growth in premium costs. …Slightly less higher premiums aren’t what President Obama promised Americans when he ran for office touting his medical overhaul. He specifically said his plan would cut premiums. “We will start,” Obama said back in 2008, “by reducing premiums by as much as $2,500 per family.”

And keep in mind that Obama’s claim of big savings was not a one-time, off-the-cuff comment.

As you can see in this video, it was a pervasive part of his campaign for further government control of the health care system.

But the real story isn’t prevarication by a politician. That comes with the territory.

The real issue is that our healthcare system is more screwed up because government now is playing a bigger role.

And keep in mind that fixing the problem means a lot more than simply repealing Obamacare. We also need to deal with spending programs such as Medicare and Medicaid and address tax preferences and regulations that encourage over-insurance.

After all, never forget that our real healthcare crisis is a giant government-caused third-party payer problem.

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Single-Payer Meltdown in Vermont: The Best-Ever Argument for Federalism

I’m a big fan of federalism for both policy and political reasons.

Returning programs to the states is the best way of dealing with counterproductive income-redistribution policies such as welfare, Medicaid, and food stamps.

Federalism is also the right way of unwinding bad education schemes like Obama’s Common Core and Bush’s No Bureaucrat Left Behind.

And the same principle applies for transportation, natural disasters, and social issues such as drugs.

And I can’t resist pointing out, for the benefit of those who think such things matter, that federalism is also the system that is consistent with our Constitution’s restrictions on central government power.

Simply stated, federalism is good news because we get innovation, diversity, and experimentation. States that make wise choices will be role models for their peers. And it’s also worth noting that states that screw up will provide valuable lessons as well.

But sometimes a real-world example is the most compelling evidence of all. And the news that Vermont has cancelled its proposed single-payer healthcare scheme (as predicted by Megan McArdle) shows us why federalism is such a good concept.

Let’s start by reviewing what’s happened. Here are some excerpts from a report published by the Daily Caller.

Vermont Gov. Peter Shumlin is canceling his dream plan to create a single-payer health system in the state, he announced Wednesday. …“In my judgment, now is not the right time to ask our legislature to take the step of passing a financing plan for Green Mountain Care.” The problem is, of course, how to pay for it. Even while plans were moving forward for a 2017 launch of the single-payer system, to be called Green Mountain Care, Shumlin had held off on releasing a plan for how to pay for the system, waiting until his announcement Wednesday.

So why didn’t Shumlin simply call for a big tax hike? Or look for more handouts from Washington? Or what about those fanciful assumptions that socialist health care would be more efficient?

Well, that basically was the plan.

Tax hikes required to pay for the system would include a 11.5 percent payroll tax as well as an additional income tax ranging all the way up to 9.5 percent. Shumlin admitted that in the current climate, such a precipitous hike would be disastrous for Vermont’s economy. …the report also admits that the single-payer system won’t save money as Vermont officials had planned. While both previous reports on Green Mountain Care had assumed “hundreds of millions of dollars” in savings in the very first year of operation, Shumlin’s office is now admitting that’s “not practical to achieve.” …Shumlin also cited slow economic recovery in Vermont as reason to delay, and hopes to try again in the future. But its failure, especially on economic grounds, is a resounding defeat for single-payer advocates.

Yes, this is a “resounding defeat” for socialized health care.

But it’s important to understand why Shumlin’s plan collapsed. He and other politicians obviously figured out (notwithstanding their claims when running for office) that a huge tax hike, combined with “free” healthcare, was a recipe for state disaster.

Productive people and businesses would have emigrated, while freeloaders and scroungers would have immigrated. The state would have gone into a downward spiral.

So even though Shumlin is a hard-core leftist, and even though Vermont’s electorate is so statist that the state came in first place in the Moocher Index, all these advocates of socialized healthcare were forced to recognize real-world constraints imposed by the existence of other states.

So the productive people of Vermont (at least the ones that haven’t already escaped) should be very thankful for federalism. Competition among the states, as well as freedom of movement between states, is a wonderful check on the greed and foolishness of the political class.

The crowd in Washington, by contrast, has more flexibility to impose bad policy since moving from one country to another is far bigger step than simply moving from, say, California to Texas.

Nonetheless, this also explains why I like tax competition among nations. I want greedy politicians to be haunted to at least some degree by the fear of tax flight so that they will think twice before imposing new burdens. But that’s a subject we’ve reviewed on many occasions, so no need for further details.

The bottom line is that Vermont did face real-world competitive pressure. And that meant the state’s politicians didn’t think they could successfully raise enough money to finance socialist healthcare.

This reminds me of this famous Margaret Thatcher quote about other people’s money.

I’m disappointed that I couldn’t find a clip of her actually making that statement. But if you want to see the Iron Lady in action, you can click here or here.

Let’s conclude by noting that the nation with the most decentralization and federalism is Switzerland, and that country does very well notwithstanding having different languages and cultures.

Which helps to explain why federalism is a very practical solution to the ethnic division in Ukraine.

P.S. Even though the focus of today’s column is federalism rather than policy, I can’t resist pointing out that the single-payer system in the United Kingdom generates some truly horrifying results.

P.P.S. If socialized healthcare is so wonderful, then why do politicians from countries which have that system travel to the United States for treatment?

P.P.P.S. Shifting to another topic, I’ve written before that left wingers criticize tax havens, yet it seems every rich leftist utilizes low-tax jurisdictions. Well, Business Week reports that “corporate inversions” also were created by a leftist.

John Carroll Jr., invented a whole category of corporate tax avoidance and successfully defended it in a fight with the Internal Revenue Service. …The first corporate “inversion,” as Carroll’s maneuver came to be known, was obscure then and is all but forgotten now. Yet at least 45 companies have followed the lead of Carroll’s client…and shifted their legal addresses to low-tax foreign nations.  …A committed liberal, he…once considered leaving the practice to work for antiwar candidate George McGovern’s 1972 presidential campaign. …McDermott’s chief financial officer at the time, says he sometimes puzzled over Carroll’s motivations. “It was always an enigma to me,” Lynott says. “We knew this guy was a Democrat, and yet he would take on the government in a New York minute over a tax issue. There was nothing liberal about his thinking as far as the tax code was concerned.” …The IRS fought the case for seven years, giving up in 1989 only after a federal appeals court upheld a U.S Tax Court decision in the company’s favor.

So I like what Mr. Carroll achieved, but I guess we have to say he was a hypocrite. But, then again, statists specialize in hypocrisy.

P.P.P.P.S. I can’t resist sharing one more unrelated item. The 2008 crisis presumably showed the downsides of too much debt.

Well, time for a quiz: Who do you think has responded most intelligently and least intelligently to the lessons from that crisis?

Your choices are households, financial institutions, corporations, and governments.

I imagine nobody will be surprised by this chart from the BBC.

So what lessons can we draw from the chart?

Well, politicians in developed nations have been raising taxes over and over again, so perhaps we should conclude that higher taxes simply lead to more debt because our “leaders” can’t resist spending other people’s money.

And that’s precisely the point. Experts such as Steve Hanke, Brian Wesbury, Constantin Gurdgiev, Fredrik Erixon, and Leonid Bershidsky have all pointed out the ever-increasing burden of government in Europe.

Higher taxes are only a “solution” if the goal is bigger government and more red ink.

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Health Care Update: Everything from Medicaid’s Ever-Rising Fiscal Burden to a (Very Tepid) Defense of Jonathan Gruber

I’ve been fretting for a long time that poorly designed entitlement programs are going to turn America into a decrepit welfare state.

Medicare obviously is a big part of the problem, but the fraud-riddled Medicaid program may be even worse.

The program is a nightmare for both federal taxpayers and state taxpayers.

In an article for the Daily Caller, John Graham of the Independent Institute has some very grim analysis of the fiscal black hole otherwise known as Medicaid.

In 2014, total Medicaid spending is projected to grow 12.8 percent because Obamacare has added about 8 million dependents. A large minority of states have chosen to increase residents’ eligibility for Medicaid by expanding coverage to adults making up to 138 percent of the federal poverty level. Unfortunately, more states are likely to expand this welfare program. This is expected to result in a massive increase in the number of Medicaid dependents: From 73 million in 2013 to 93 million in 2024. Medicaid spending is expected to grow by 6.7 percent in 2015, and 8.6 percent in 2016. For 2016 to 2023, spending growth is projected to be 6.8 percent per year on average. This comprises a massive increase in welfare dependency and burden on taxpayers.

But the actual numbers may be worse than these projections.

…official estimates often low-ball actual experience. This is because it is hard to grapple with how clever states are at leveraging federal dollars. …The incentive lies in Medicaid’s perverse financing merry-go-round. In a rich state like California, for example, the federal government (pre-Obamacare) spent 50 cents on the dollar for adult dependents. So, if California spent 50 cents, it automatically drew 50 cents from the U.S. Treasury. And most states had a bigger multiplier. Which state politician can resist a deal like that? …The situation will deteriorate because Obamacare’s Medicaid expansion significantly increases states’ perverse incentives to game Medicaid financing. …Newly eligible Medicaid beneficiaries will be fully financed by the federal government for 2014 through 2016. Then, it slides down until the federal government funds 90 percent of their costs starting in 2020, with the states footing 10 percent. Recall the cunning with which states developed ways to abuse federal taxpayers when they could only double their money from Uncle Sam. The new normal is that they will be able to get nine times their money!

By the way, these numbers would be even worse if it wasn’t for the fact that many states refused the lure of “free” federal money to expand Medicaid.

So what’s the solution? Graham suggests federalism is the answer.

A reform in the right direction would be to get rid of the federal match in favor of a block grant, based on a simple measurement of the population in each state, and precisely define a limited federal commitment.

He’s exactly right, at least in the short run.

Let’s copy the success of welfare reform and turn over a fixed amount of money – along with concomitant authority and responsibility – to state governments and let them figure out the best way of delivering health care to lower-income populations.

In the long run, of course, I’d like to phase out the block grant so that states are responsible for both collecting the money and providing the services.

But before we get to the point of adopting health care policies for an ideal libertarian society, we first have to stop the bleeding (or, to be more accurate, hemorrhaging) and stabilize the program.

And that’s why I fully agree that the federalism approach, in the form of block grants, is the right policy.

Here’s my video on the topic.

And since I’m sharing videos, I can’t resist commenting on the latest “Gruber-gate” scandal. The MIT professor and Obamacare insider (he got $400,000 of taxpayer money to help design the plan) has become an embarrassment for the left because he has been caught on tape saying that the legislation relied on deception. He even said that proponents of Obamacare took advantage of the “stupidity” of American voters.

You can watch the most well-know example by clicking here. But he also denigrated supposedly “stupid” Americans in this video.

I want to defend one small component of Gruber’s statement.

But I want to be completely clear that I’m not defending his elitist disdain for ordinary Americans. Indeed, I don’t think voters are stupid. Instead, to the extent they’re uninformed, it’s the result of serial dishonesty from Washington or because they’ve decided it’s not worth their time to pay attention to the crowd in DC (the “rational ignorance” hypothesis).

The part of Gruber’s statement that has merit is that he’s talking about the fact that there’s a big loophole in the tax code for fringe benefits. To be more specific, tens of millions of Americans get part of their compensation in the form of fringe benefits such as health insurance. Yet while workers are taxed on their “cash” income, they are not taxed on their “fringe benefit” income (a policy sometimes called the “healthcare exclusion”).

And this has created, over time, a very inefficient system of over-insurance.

To understand why this system doesn’t make sense, just think about your homeowner’s insurance or auto insurance. Those policies, unlike health insurance, work reasonably well and costs remain relatively stable. Why is there a big difference?

The difference is that employee income that is diverted to health insurance avoids both income tax and payroll tax, so there is a significant monetary incentive for gold-plated plans. And these plans often include insurance coverage for ordinary medical expenses, which contributes to the problem of third-party payer.

No wonder health insurance is so costly. After all, imagine what would happen to the price of your homeowner’s insurance if it had to cover the cost of a new couch? Or repainting the hallway? Or what about the cost of your auto policy if it covered the cost to fill up with gas or get an oil change?

We instinctively recognize that this would be insanely inefficient and expensive, yet that’s how our health insurance system operates thanks to a giant tax preference.

So Gruber was right to say it’s a problem. And I’ve even said that addressing the exclusion is a very tiny silver lining in the awful dark cloud of Obamacare.

But now that I’ve bent over backwards to say something nice, now let me point out that Gruber (and Obama and other statists) didn’t have the right solution. Yes, they wanted to cut back on the tax exclusion, but only because they wanted to use the money for other purposes (such as subsidies that also exacerbate the third-party payer problem).

The right approach, by contrast, is to phase out the healthcare exclusion and use every penny of revenue to “pay for” lower tax rates. That way you get a win-win situation for the economy. A more rational, market-based healthcare system and a less punitive tax code for productive behavior.

Now that we’ve addressed a serious point, let’s laugh about the fact that Gruber’s comments have created a big headache for the White House. We’ll start with this Steve Kelley cartoon.

And here’s Gary Varvel’s take on the honesty of the Obama White House on the topic of health care.

Last but not least, Lisa Benson optimistically suggests that the serial dishonesty of Obamacare supporters may be undone by the Supreme Court.

Which would be poetic justice, since Professor Gruber also was caught on tape – over and over again – stating that Obamacare only allowed subsidies for people getting insurance policies through state-based exchanges.

And now the Supreme Court will decide whether those subsidies, notwithstanding statutory language, can be provided via the federal exchange.

Though I’m not holding my breath since certain Justices on the Court already have demonstrated that they’re willing to put politics above the law.

P.S. Just in case I wasn’t sufficiently clear, good tax reform also is good health reform. That was one of the points I made in my tax reform speech at the Heritage Foundation and I suspect I’ll continue making that argument until we win or I’m dead (and I don’t want to take odds on which happens first).

P.P.S. On a more upbeat note, the House of Representatives approved budgets in 2011, 2012, 2013, and 2014 that assume Medicaid gets block-granted to the states. So that reform may actually happen while I’m still breathing.

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Obamacare Could Cause Two Million additional Adults to Leave Labor Force and Become Trapped in Government Dependency

What’s the worst economic development during Obama’s reign?

Some would say it’s the higher tax burden.

Some would say it’s the wasteful faux stimulus.

Others would say it’s the fiscal nightmare of Obamacare.

And others would say it’s the loss of millions of workers from the labor force.

I suppose there’s no objective way to pick the most ill-conceived policy, but if you think the biggest problem is either Obamacare or falling labor force participation, then I have some very grim news that will confirm your fears.

According to new research, it appears Obamacare will drive many more people from the labor force. More specifically, the Medicaid expansion will alter – in a very destructive way – the tradeoff between labor and leisure.

Researchers Laura Dague, Thomas DeLeire, and Lindsay Leininger argue in a National Bureau of Economic Research working paper that Medicaid enrollment will lead to significant and lasting reductions in employment among childless adults. …Dague and her colleagues conclude that if the Medicaid expansion enrolls about 21 million additional adults, anywhere from 511,000 to 2.2 million fewer people will be employed. Furthermore, they argue that the Medicaid expansion will knock almost a full point off of today’s labor force participation rate — or share of the civilian population that is working — a measure of economic health that is already at its lowest point since 1977. …This research provides strong evidence for the contention that enrolling in Medicaid traps people in poverty and makes it harder for them to make their way into the middle class. Furthermore, it links the Medicaid expansion to the weakening of our nation’s economy.

By way of background, Medicaid is the federal government’s healthcare entitlement for (supposedly) poor people, while Medicare is the entitlement for old people. And, as part of Obamacare, the eligibility rules for Medicaid were dramatically weakened.

But the new research cited above shows that if you give people “free” health care, that makes them less likely to work.

Particularly when you combine that freebie with food stamps, housing subsidies, welfare, and other handouts.

That’s obviously bad news for taxpayers, who bear the direct cost of a bloated welfare state.

But it’s also bad for the less fortunate. They get trapped in a web of dependency, both because handouts reduce the incentive to work (humorously depicted here and here), band also because they face very high implicit marginal tax rates if they actually try to escape government dependency.

But Obama and other leftists probably see this as a feature, not a bug.

After all, those who are lured into being dependent on government presumably have an incentive to vote for those who give them the most goodies.

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Laughing at another Spectacular Obamacare Failure

As you can imagine, there’s a lot to choose from in the contest for the most spectacular waste of tax dollars.

But the politicians in Oregon must really want the prize, because they managed to flush several hundred million dollars down a rat hole by putting together a state-run Obamacare website that has to be abandoned because it is so dysfunctional.

And if the Oregon website is so bad that it’s switching to the much-derided Washington Obamacare website, it must be a disaster of unparalleled dimensions!

Here are some excerpts from an AP report.

After months of trying to get its problem-plagued online health exchange to work, Oregon on Friday officially gave up on the state portal… Officials say fixing the existing system would be too costly at $78 million and would take too long. …Oregon’s exchange is seen as the worst in more than a dozen states that developed their own online health insurance marketplaces. The general public still can’t use Cover Oregon’s website to sign up for coverage in one sitting. Instead, Oregonians must use a time-consuming hybrid paper-online process to sign up for insurance — despite $134 million the state paid Oracle Corp. to build the online exchange. …In March, the federal Government Accountability Office announced an investigation of Oregon’s exchange, including looking at whether the federal government can reclaim grant money given to Cover Oregon if taxpayer funds were mismanaged.

Heck, it’s not just the GAO that’s investigating.

The FBI reportedly is probing the failed launch of Oregon’s ObamaCare insurance exchange, joining several other agencies looking into the multimillion-dollar program that was scrapped last month.  …the FBI has interviewed several people as part of the inquiry. The Oregonian reported that the bureau held a 90-minute meeting with a former Republican lawmaker who detailed potential wrongdoing — including suspicions that the state showed the feds a misleading demonstration to keep money flowing. …A U.S. House committee already is probing the Oregon debacle, as is the Government Accountability Office. The state received more than $300 million in federal grants to launch and operate the health care system. Much of what it has spent so far has gone to Oracle Corp.

But let’s be fair. Not all of the $300 million was squandered on the failed website.

The politicians also coughed up $3 million for this video, which presumably was supposed to lure people to the non-working website but probably just made people think Oregon is infested by patchouli-soaked deadbeats.

The video almost stands by itself as a form of left-wing self parody.

But what makes it especially amusing is that it generated this amusing segment on one of HBO’s programs.

Well done.

I don’t watch TV, so I don’t know if the guy who did this segment is on the right, the left, or somewhere in between.

But it would be nice to have a talk show host who is willing to go after all sides, unlike Colbert and Stewart who clearly bend over backwards to curry favor with the White House.

Anyhow, if you like videos that use humor to mock government-run healthcare, here are some good options.

*The head of the National Socialist Workers Party finds out he can’t keep his health plan.

*A creepy version of Uncle Sam wants to know about your sex life.

*Young people discover that they’re screwed by Obamacare.

*One of the biggest statists of the 20th century is angry that the Obamacare exchanges don’t work.

*A cartoon video showing how to buy coffee in an Obamacare world.

But never forget that this is a serious issue. Government has screwed up the healthcare system, yet politicians then use the mess they create to justify even more intervention.

The only effective solution is economic liberty.

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Obamacare: The Never-Ending Gift that Repeatedly Teaches Us that Big Government Doesn’t Work

Sigh. Another day, another grim Obamacare update.

Actually, we have two updates on the never-ending disaster of government-run healthcare.

Our first story comes from the Washington Times, which reports that the company hired to fix the failed Obamacare website is way behind schedule and way over budget.

Fixing the Obamacare website to get it ready to handle a second round of enrollments will cost the federal government $121 million… The deal, which Accenture announced on its website Tuesday, costs more than the $93.7 million it took to build HealthCare.gov in the first place. It’s also $30 million more than the government projected for fixes just a few months ago… “There doesn’t seem to be a light at the end of the tunnel for Obamacare website expenses,” said House Oversight and Government Reform Committee Chairman Darrell E. Issa, California Republican.

I’m mystified, by the way, why taxpayers always have to cough up more money on these contracts.

If some company promises to do X in exchange for Y amount of money, shouldn’t that contract be binding?

Instead, this is just the latest chapter in the endless book of government cost overruns.

Our second story comes from the Washington Examiner, which reports that there are some big problems with Obama’s supposed success of bribing and coercing people into Obamacare.

…officials from President Obama down have touted 8 million Americans signing up for coverage through the program’s exchanges. But, among other things, they haven’t revealed how many of those individuals formally completed their enrollment by paying their premiums. …>what the committee heard back was that just 67 percent of individuals signing up for health insurance through the federal health exchange as of April 15 paid their first month’s premiums and actually completed enrollment.

Gee, if that’s a success, I’d hate to see a failure.

And the story also notes that the White House has been unable to trick sufficient numbers of young people into overpaying for healthcare. That’s very bad news for the insurance companies that put their trust in government.

In addition, just 25 percent of enrollees were between the ages of 18 and 34, according to the report. The administration had been aiming for roughly 40 percent of enrollees to come from this younger demographic to help offset the cost of providing coverage to older and sicker participants.

I guess this means stupid birth control ads weren’t enough to get young folks to flush away their dollars.

Geesh, no wonder I’m tempted to feel sorry for the President.

But let’s not forget that there actually are some people who are benefiting from Obamacare. It’s too bad, though, that we can’t all be corrupt DC insiders.

Let’s close with some cartoons from Townhall. Since we’ve already talked about the absurdity of counting coerced enrollments as an indicator of success, we may as well share a funny Glenn McCoy cartoon that makes the same point.

If you like this cartoon, Ted Cruz’s office put together a satirical – yet accurate – look at the “success” Obama has achieved. And this Eric Allie cartoon has the same message.

And here’s Henry Payne on Obama’s mission-accomplished moment. Reminds me of the low-expectations theme Lisa Benson used in another very amusing Obamacare cartoon.

Yup, the mission has been accomplished. A few million more Americans are now more dependent on government (which Mark Steyn explained was one of the left’s main goals) and the political class has made it harder for people to achieve the American dream.

P.S. Switching topics, I can’t resist sharing this Michael Ramirez cartoon.

That’s because it reminds me of this joke about what would happen if Noah tried to build the ark today.

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More Obamacare Failure

If Obamacare is a success, as the White House and establishment media would like us to believe, then why is the Obama Administration so anxious to hide the numbers?

After all, surely we haven’t set the bar so low that the Administration can claim victory simply because it has coerced and/or bribed a few million people into an Obamacare plan?

Here’s some of what the Wall Street Journal recently wrote about a very suspicious change in the way the government measures health insurance coverage.

Out of the blue, the Census Bureau has changed how it counts health insurance—at the precise moment when ObamaCare is roiling the insurance markets. Since 1987, the Current Population Survey, or CPS, has collected information on the health-insurance coverage status of Americans. …But this year the Census revamped the CPS household insurance questions, muddying comparisons between the pre- and post-ObamaCare numbers. …Robert Pear of the New York Times obtained internal Census documents that note that the new CPS system produces lower estimates of the uninsured as an artifact of how the questionnaire is structured. …For changes this substantial, standard procedure would be to ask the new and old questions concurrently. With an overlap, researchers could study changes over time using the long-term historical information without introducing bias, as well as interpret emerging developments with new tools. …this sudden change will undermine public trust in the supposedly nonpartisan institutions of government. Muddying a useful source of information about ObamaCare’s results is definitely unfortunate, but our guess is that it wasn’t coincidental.

Allow me to re-phrase that last sentence. The disingenuous change to the Census data on insurance is about as coincidental as the Administration’s efforts to re-define poverty and about as random as the IRS’s decision to only undermine and attack the political rights of Tea Party groups.

But there’s more to say about Obamacare than merely pointing out dishonest manipulation of government data.

We also have some very bad news for taxpayers.

Here’s what Chuck Blahous wrote for E21, starting with an observation of how the media wants to boost Obama.

Earlier this month there was tremendous press attention to new data indicating that enrollment in the Affordable Care Act (ACA)’s health insurance exchanges had surpassed 7 million. …much of the press, desperate to write something positive after months of reporting on website glitches and insurance plan cancellations, characterized the milestone as good political news for ACA supporters.

I’ve already explained that the supposed good news is actually bad news, but Chuck has some very important details on how taxpayers are especially vulnerable.

…what is unfolding before our eyes is a colossal fiscal disaster, poised to haunt legislators and taxpayers for decades to come.It is quite possible that the ACA is shaping up as the greatest act of fiscal irresponsibility ever committed by federal legislators. …the ACA is a commitment to permanently subsidize comprehensive health insurance for millions who could not otherwise afford it, which the federal government has no viable plan to finance. Moreover, experience shows that it is very difficult to scale back such spending once large numbers of Americans have been made dependent.

The article includes a graph that compares the early costs of major entitlement programs.

As you can see, Obamacare’s fiscal burden is second only to Medicare.

Chuck then explains that the costs in the early years for new entitlements are just a drop in the bucket.

…after these initial rollouts, Social Security, Medicare and Medicaid costs grew far faster than originally envisioned, sometimes due to subsequent legislation, sometimes due to unanticipated healthcare cost growth. It wouldn’t be surprising for either factor to affect the ACA, which would be even more problematic… We do know that the ACA’s financing mechanisms are already falling apart. The ACA’s much-reported website glitches and enrollment shortfalls had actually suggested an upside; if enrollment continued to fall short of previous projections, it was possible that some of the fiscal damage could be contained. But if enrollment has picked up as the law’s financing mechanisms disintegrate, the fiscal damage will be worse than anticipated.

Needless to say, this is hardly shocking news.

Entitlements inevitably become fiscal swamps and the costs almost always are far higher than the early estimates.

Here’s an oldie-but-goodie video I narrated on the topic of ever-climbing taxpayer burdens for health entitlements.

I’d like to claim that this video proves I have great insight and brilliance, but that would be akin to claiming superior ability for predicting that Chicago is warmer in July than in February.

P.S. Since we’re on the topic of government-run healthcare, I recently wrote about Vermont’s plans for a single-payer system.

Except I didn’t really write about the Green Mountain State’s experiment with socialism. Instead, I used the opportunity to discuss third-party payer, which is America’s real government-created healthcare problem.

Now it’s time to say something specifically about what’s happening in Vermont. Though, to be more accurate, all I really need to do is quote Megan McArdle’s column from Bloomberg.

Of the plans that states have hatched for the Affordable Care Act, none has been bolder than that of Vermont, which wants to implement a single-payer health-care system, along the lines of what you might find in Britain or Canada.

Except Vermont politicians haven’t bothered to find a way to pay for this boondoggle.

Vermont needs to find some way to pay for it. Although Act 48 required Vermont to create a single-payer system by 2017, the state hasn’t drafted a bill spelling out how to raise the additional $1.6 billion a year (based on the state’s estimate) the system needs. The state collected only $2.7 billion in tax revenue in fiscal year 2012, so that’s a vexingly large sum to scrape together. …Paying for this program would likely make Vermont the highest-taxed state in the nation, by quite a lot.

Megan thinks the cost would so high that Vermont will abandon the scheme. And she has a very optimistic assessment on what this means nationally.

…this is going to be expensive. So expensive that I doubt Vermont is actually going to go forward with it. This should be instructive for those who hope — or fear — that Obamacare has all been an elaborate preliminary to a nationwide single-payer system. It isn’t. The politics are impossible, and even if they weren’t, the financing would be unthinkable.

I very much hope she’s right, and I’ve actually expressed optimism that Obamacare has changed (in a favorable way) the political dynamics on the healthcare issue.

But I’m still not quite as hopeful as Megan.

Leftists are too clever to make an all-or-nothing push for single-payer on the national level. They know that’s too risky.

But they have been quite adept at incremental changes to expand the role of government and undermine markets.

And if they ever get a new source of revenue, like an energy tax, financial transactions tax, or a value-added tax, then they’ll be able to push for even more statism.

P.P.S. If you want some fun reading about single-payer, check out these horror stories about the system in the United Kingdom.

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Obamacare, Atlas Shrugged, and the Imperial Super-President

Just like Clark Kent could change into Superman, President Obama has a remarkable ability to change into King Obama.

Tired of that pesky Constitution? Irritated that the Founding Fathers created a system based on separation of powers? Well, there’s a superhero to overcome those obstacles.

Faster than a last-minute Obamacare reg! More powerful than the Tenth Amendment! Able to leap the enumerated powers clause in a single bound! (“Look! Up in the sky!” “It’s a bird!” “It’s a plane!” “It’s SuperPresident!”)… Yes, it’s SuperPresident … strange visitor from corrupt Chicago, who came to Washington with powers and hubris far beyond those of the Founding Fathers! SuperPresident … who can change the course of the Constitution, bend the Bill of Rights in his bare hands, and who, disguised as Barack Obama, mild-mannered uniter who stops the rise of the oceans and heals the planet, fights a never-ending battle for redistribution, statism, and the French way!

And what has our superhero done lately?

He’s arbitrarily and unilaterally changed the Obamacare law.

Since it’s the 18th time he’s done that, this may not seem very newsworthy. But the latest change is particularly interesting because the President is ordering certain companies to maintain their existing payrolls.

Check out this blurb from a Fox News story.

Obama officials made clear in a press briefing that firms would not be allowed to lay off workers to get into the preferred class of those businesses with 50 to 99 employees. …Firms will be required to certify to the IRS–under penalty of perjury–that ObamaCare was not a motivating factor in their staffing decisions. To avoid ObamaCare costs you must swear that you are not trying to avoid ObamaCare costs.

When this story first came to my attention, thanks to James Taranto, something seemed eerily familiar.

Where had I read about a government ordering companies to freeze in place their employment levels.

I went through all the usual suspects in my mind. Was it Argentina? Was it France? How about California?

And then it struck me that life was imitating fiction. Obama’s policy is so bad that it resembles a scene in an Ayn Rand novel.

In her most famous work, Atlas Shrugged, the political elite try to halt the economy’s decline by imposing Directive 10-289, which seeks to freeze in place all factors of production – including the number of workers at each firm.

All workers, wage earners and employees of any kind whatsoever shall henceforth be attached to their jobs and shall not leave nor be dismissed nor change employment.

Obama’s latest diktat doesn’t go nearly as far as Directive 10-289, thankfully, but it’s more than a bit disturbing that we’ve gotten to the point where a bunch of hacks in Washington think that they have the right to tell private companies how many people they’re allowed to have on the payroll.

But I guess we shouldn’t be surprised.

This isn’t the first time that the real-world unfolding of Obamacare has resembled a scene from Atlas Shrugged. Back in 2011, I wrote about how the waiver process for escaping the law was almost identical to the corrupt system of unfreezing railroad bonds in the book.

P.S. While searching online to get the details of Directive 10-289, I saw that John Sexton, writing for Breitbart, beat me to the punch.

P.P.S. If you prefer to get anti-statism satire from Superman instead of Atlas Shrugged, you may enjoy this cartoon.

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Obamacare and the Corruption of the Rule of Law

We’ve reached the stage where Obamacare is the punchline to a bad joke.

The law has been a disaster, both for the economy and for the Democratic Party. Not that we should be surprised. You don’t get better healthcare with a poisonous recipe of higher taxes, added government spending, and more intervention.

With any luck, Obamacare will be a textbook example of why we should never again give power to a bunch of political hacks and dreamy-eyed central planners.

Because when they try to buy votes and create more dependency with Rube Goldberg schemes, the results are…well, we see the cluster-you-know-what of Obamacare unfolding before our eyes.

Not that anyone should be surprised. Remember what happened when politicians decided government would make housing more affordable?

And remember what happened when politicians decided government should extend American tax law into other nations?

Simply stated, grandiose plans for expanded government don’t end well.

But this isn’t a normal public policy issue.

The Obama Administration has just announced that it arbitrarily will be ignoring one of the requirements in the law, and this is the executive branch’s 18th unilateral change to Obamacare.

We have to ask whether the American political system is being corrupted by a White House that doesn’t feel bound by the rule of law.

To put it mildly, the Wall Street Journal is not impressed.

…the law increasingly means whatever President Obama says it does on any given day. His latest lawless rewrite arrived on Monday as the White House decided to delay the law’s employer mandate for another year and in some cases maybe forever. …last summer the Treasury offered a year-long delay until 2015 despite having no statutory authorization. …Now the new delay arrives amid a furious debate about jobs after a damning Congressional Budget Office report last week, only this time with liberals celebrating ObamaCare’s supposed benefits to the job market. …Oh, and the Treasury also notes that, “As these limited transition rules take effect, we will consider whether it is necessary to further extend any of them beyond 2015.” So the law may be suspended indefinitely if the White House feels like it. …The text of the Affordable Care Act specifically says when the mandate must take effect—”after December 31, 2013″—and does not give the White House the authority to change the terms. Changing an unambiguous statutory mandate requires the approval of Congress, but then this President has often decided the law is whatever he says it is.

I admit that part of me wants Obamacare delayed as much as possible.

After all, even more jobs will be lost if the employer mandate is properly enforced, and that would add to an already anemic employment situation.

But America isn’t Argentina, or some other Banana Republic, where the law is based on the arbitrary and capricious decisions of some political thug.

At least it shouldn’t be.

If the President wants to change the law, he should propose legislation and send it to Congress.

But it’s obvious what that isn’t happening. The White House understands that it would be forced to make concessions to get the changes it wants.

So why not make a mockery of the rule of law instead?

As nicely illustrated by the Lisa Benson cartoon.

This is such a depressing topic that we need to close this post with some cartoons about the failure of Obamacare.

We’ll start with Henry Payne, who uses an Olympics theme.

Gary Varvel has some fun mocking the left about being “liberated” from the drudgery of employment.

Fans of James Bond my remember a certain scene from Goldfinger, and Glenn McCoy recreates that scene.

Steven Breen looks at the law’s impact on jobs.

And Robert Gorrell makes a nice point about labor supply incentives.

These are all amusing cartoons, but let’s not forget that Obama will get the last laugh if the final result is more dependency and a permanent expansion of the welfare state.

At some point, we need to restore genuine market forces and get a lower-cost, more-efficient healthcare system.

And that means not only repealing Obamacare, but also addressing all the other programs and policies which have caused the third-party payer crisis.

P.S. Here’s some good news showing we’re not quite at the same level as Argentina.

You may remember what I wrote back in 2012 about the IRS seeking to impose new restrictions on the tax preparation industry.

This was a power grab with no legal justification. Indeed, it seems to have been an example of crony capitalism since H&R Block wanted to shut down low-cost competitors.

That was the bad news. The good news is that the Institute for Justice sued to block the IRS/H&R block scheme.

And the great news is that the D.C. Circuit Court of Appeals just drop-kicked the IRS thugs into a dumpster.

Here’s part of the Court’s decision, as reported in the Washington Post.

It might be that allowing the IRS to regulate tax-return preparers more stringently would be wise as a policy matter. But that is a decision for Congress and the President to make if they wish by enacting new legislation…. The IRS may not unilaterally expand its authority.

Let’s keep our fingers crossed that the Courts do the same – by defending the rule of law – on future Obamacare decisions.

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Crying about Obamacare, but also Laughing at Obamacare

I asked back in September whether all the bad news about Obamacare meant it was time to feel sorry for President Obama and other statists.

Some people apparently didn’t realize I was being sarcastic, so I got some negative feedback.

I’ve since learned to be more careful with my language, and subsequent columns about Obamacare developments have used more direct rhetoric such as Obamacare disaster, Obamacare Schadenfreude, and the continuing Obamacare disaster.

Well, I don’t even know if there are words that can describe the latest bit of bad news about Obamacare. The Congressional Budget Office, which usually carries water for those who favor bigger government, has been forced to acknowledge that Obamacare is going to wreak havoc with America’s job market.

Today’s Wall Street Journal has a column on the topic, giving considerable and deserved credit to Casey Mulligan, an economics professor at the University of Chicago who has produced first-rate research on implicit marginal tax rates and labor supply incentives.

Rarely are political tempers so raw over an 11-page appendix to a dense budget projection for the next decade. But then the CBO—Congress’s official fiscal scorekeeper, widely revered by Democrats and Republicans alike as the gold standard of economic analysis—reported that by 2024 the equivalent of 2.5 million Americans who were otherwise willing and able to work before ObamaCare will work less or not at all as a result of ObamaCare. As the CBO admits, that’s a “substantially larger” and “considerably higher” subtraction to the labor force than the mere 800,000 the budget office estimated in 2010. The overall level of labor will fall by 1.5% to 2% over the decade, the CBO figures. Mr. Mulligan’s empirical research puts the best estimate of the contraction at 3%. The CBO still has some of the economics wrong, he said in a phone interview Thursday, “but, boy, it’s a lot better to be off by a factor of two than a factor of six.”

That’s a lot of lost jobs, which is going to translate into lower levels of economic output and reduced living standards.

By the way, I can’t resist quibbling with the assertion that CBO is “widely revered” and that it’s the “gold standard of economic analysis.”

Utter nonsense. CBO helped grease the skids for Obamacare by producing biased numbers when the law was being debated.

And that’s just the tip of the iceberg. CBO also produces “analysis” which implies that you maximize growth with 100 percent tax rates. And the bureaucrats at CBO also are reflexive advocates of Keynesian economics, which is why they claimed that Obama’s so-called stimulus was creating jobs even though unemployment was rising.

So you can understand why I don’t like citing CBO numbers, even when they happen to support my position.

As far as I’m concerned, the bureaucracy should be shut down. And if Republicans win the Senate in the 2014 elections, it will be interesting to see whether they have the brains to at least reform CBO to limit future damage.

But I’ve digressed long enough. Let’s get back to the WSJ column about the latest Obamacare disaster.

Our friends on the left are in a very tough position.

…liberals have turned to claiming that ObamaCare’s missing workers will be a gift to society. Since employers aren’t cutting jobs per se through layoffs or hourly take-backs, people are merely choosing rationally to supply less labor. Thanks to ObamaCare, we’re told, Americans can finally quit the salt mines and blacking factories and retire early, or spend more time with the children, or become artists. Mr. Mulligan reserves particular scorn for the economists making this “eliminated from the drudgery of labor market” argument, which he views as a form of trahison des clercs. …A job, Mr. Mulligan explains, “is a transaction between buyers and sellers. When a transaction doesn’t happen, it doesn’t happen. We know that it doesn’t matter on which side of the market you put the disincentives, the results are the same. . . . In this case you’re putting an implicit tax on work for households, and employers aren’t willing to compensate the households enough so they’ll still work.” Jobs can be destroyed by sellers (workers) as much as buyers (businesses).

By the way, just in case you’re an unsophisticated rube like me, Wiktionary says that trahison des clercs means “a compromise of intellectual integrity by members of an intelligentsia.”

Which is a pretty good description of leftists who are twisting themselves into pretzels trying to rationalize that joblessness and government dependency are good things.

And Prof. Mulligan makes the right analogy.

He adds: “I can understand something like cigarettes and people believe that there’s too much smoking, so we put a tax on cigarettes, so people smoke less, and we say that’s a good thing. OK. But are we saying we were working too much before? Is that the new argument? I mean make up your mind. We’ve been complaining for six years now that there’s not enough work being done. . . . Even before the recession there was too little work in the economy. Now all of a sudden we wake up and say we’re glad that people are working less? We’re pursuing our dreams?” The larger betrayal, Mr. Mulligan argues, is that the same economists now praising the great shrinking workforce used to claim that ObamaCare would expand the labor market. He points to a 2011 letter organized by Harvard’s David Cutler and the University of Chicago’s Harold Pollack, signed by dozens of left-leaning economists including Nobel laureates, stating “our strong conclusion” that ObamaCare will strengthen the economy and create 250,000 to 400,000 jobs annually.

Gee, that “strong conclusion” about an increase in jobs somehow turned into a cold reality that the economy might lose the equivalent of 2.5 million jobs.

This is very grim news. We can be happy that there’s now even more evidence that big government doesn’t work, but we should never forget that there are real victims when statist policies lead to less growth and more joblessness.

So let’s try to bring some cheer to a dismal situation with some new Obamacare cartoons.

Our first entry is from Chip Bok, who is mocking the New York Times for writing that fewer jobs was “a liberating result of the law.”

Gary Varvel’s analysis of the job impact has a seasonal theme.

And the great Michael Ramirez points out that the death panel has been very busy.

Lisa Benson picks up on the same theme, pointing out that at least Granny is still safe.

And Henry Payne makes a subtle, but superb point about labor supply incentives.

Just like this Chuck Asay cartoon, this Wizard-of-Id parody., and this Robert Gorrell cartoon.

Let’s now look at another Lisa Benson cartoon. It’s not about the job losses, but the underlying foolishness of how Obamacare is designed.

And if you like cartoons with sharks, here’s a classic one about Keynesian economics.

Let’s close with a couple of cartoons that look at the big picture.

Glenn McCoy shares a warning label.

And Steve Breen also has a warning label about Obamacare, but it’s much quicker to read.

Last but not least, Scott Stantis looks at one of the side effects of Obamacare.

Stantis, by the way, produced the best-ever cartoon about Keynesian economics.

P.S. If you want to learn more about how redistribution programs such as Obamacare trap people in dependency and discourage them from the job market, click here.

There are even some honest leftists who recognize this is a serious problem.

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New CBO Numbers Show a Remarkably Simple Path to a Balanced Budget

A just-released report from the bean counters at the Congressional Budget Office is getting lots of attention because the bureaucrats are now admitting that Obamacare will impose much more damage to the economy than they previously predicted.

Of course, many people knew from the start that Obamacare would be a disaster and that it would make the healthcare system even more dysfunctional, so CBO is way behind the curve.

Moreover, CBO’s deeply flawed estimates back in 2009 and 2010 helped grease the skids for passage of the President’s failed law, so I hardly think they deserve any applause for now producing more realistic numbers.

But today’s post isn’t about the Obamacare fiasco. I want to focus instead on some other numbers in the new CBO report.

The bureaucrats have put together their new 10-year “baseline” forecast of how much money the government will collect based on current tax laws and the latest economic predictions.

These numbers show that tax revenue is projected to increase by an average of 5.4 percent per year.

As many readers already know, I don’t fixate on balancing the budget. I care much more about reducing the burden of government spending and restoring the kind of limited government our Founding Fathers envisioned.

But whenever the CBO publishes new numbers, I can’t resist showing how simple it is to get rid of red ink by following my Golden Rule of fiscal restraint.

Here’s a chart showing projected revenue over the next 10 years, along with lines showing what happens if spending (currently $3.54 trillion) follows various growth paths.

The two biggest takeaways are that a spending freeze (similar to what we got in 2012 and 2013) would almost balance the budget in 2016 and would definitely produce a budget surplus in 2017.

I also highlight what would happen if politicians merely limited spending so it grew at the rate of inflation, about 2.3 percent per year. Under that scenario, the budget would be balanced in 2019 (actually a $20 billion surplus, but that’s an asterisk by Washington standards).

In other words, there is no need to raise taxes. It’s very simple to balance the budget without extracting more money from taxpayers.

This means the Simpson-Bowles people are wrong. The Domenici-Rivlin folks are wrong. Senator Patty Murray is wrong. Jeb Bush and Lindsey Graham are wrong. And (here’s a surprise) the Obama Administration is wrong.

And we have some additional evidence. It’s a chart taken directly from the CBO report and it shows that revenues over the next 10 years will be above the long-run average. This is because even weak growth slowly but surely produces more revenue for Washington, in part because it gradually pushes people into higher tax brackets.

And this chart just looks at the next 10 yeas. If you peruse the long-run fiscal projections, you’ll see that the tax burden is projected to increase dramatically over the next several decades.

The moral of the story is that there should be tax cuts (ideally as part of tax reform), not tax increases.

P.S. Just in case you think I was being unfair in my description of the Congressional Budget Office, keep in mind that these are the bureaucrats who advise Congress that economic performance increases when taxes go up.

P.P.S. And even though CBO is finally admitting some of the flaws in Obamacare, the bureaucrats are still unrepentant Keynesians. Check out this excerpt from a story in yesterday’s Washington Post.

Rep. Chris Van Hollen (Md.), the top Democrat on the committee, cited the CBO’s finding that the law will “boost overall demand for goods and services over the next few years,” This is because people benefiting from its expansion of Medicaid and insurance subsidies will likely have extra money to spend, which “will in turn boost demand for labor over the next few years,” the report says.

So CBO would like us to believe that the more money the government redistributes, the more growth we’ll get. I guess this explains why France is such an economic dynamo.

More seriously, this is the same flawed analysis that allowed CBO to claim the so-called stimulus was creating jobs as employment was falling.

You can understand why I’ve written that Keynesian economics is the left’s perpetual motion machine.

P.P.P.S. Here’s a Center for Freedom and Prosperity video that I narrated back in 2010, which explains why it is simple to balance the budget. The numbers in the video obviously need to be replaced with the ones I shared above, but the analysis is still right on the mark.

P.P.P.P.S. And if you want to know how to achieve the modest spending restraint needed to balance the budget, the Swiss “debt brake” would be a good place to start.

It’s really a spending cap, and it’s worth noting that the Swiss budget has increased by only 2 percent per year since voters imposed the law back in 2001.

Or maybe we could somehow hope that politicians would simply be responsible, like lawmakers in Canada and New Zealand in the 1990s. Or we could reincarnate Reagan. Or even bring back Clinton.

P.P.P.P.P.S. Since we started this post by talking about how Obamacare is undermining the economy, let’s close with a great example of Obamacare humor.

Remember Pajama Boy? Well, he’s back for an encore performance thanks to some very clever people at Americans for Prosperity.

There’s no update, by the way, on whether being without a job impacts his chances of getting a date with Julia. They’d make such a good couple.

This is amusing, but it surely isn’t as funny as President Obama’s Chief Economist, who actually argued with a straight face that it was a good sign that Obamacare was leading people to drop out of the labor force because unemployment  “might be a better choice and a better option than what they had before.”

Sort of reminds me of this Chuck Asay cartoon, or this famous set of wagon cartoons.

Dependency for more and more people. Such an inviting concept…until this happens.

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…and even More Obamacare Humor

I’m beginning to think the Obama White House has a sinister and devious plot to undermine the productivity of people who believe in small government.

Yes, I know I’ve written that it doesn’t make sense to believe in conspiracy theories, but every time I think about writing a long and serious article on some important economic issue, I get distracted by some new jokes, cartoons, and mockery of the slow-motion, long-lasting train wreck of Obamacare.

Consider, for instance, the White House’s new effort to trick young people into buying over-priced health insurance policies (humorously depicted here). It features this dorky guy in pajamas.

Well, as you can imagine, people are having lots of fun mocking this image. And that’s time they could spend discussing free markets and small government instead!

And I’m guilty as well.

But let’s at least enjoy the moment. Here’s my favorite bit of satire, which mixes Obamacare with the President’s “selfie” at Mandela’s funeral.

Obama probably has unhappy memories of that moment, by the way.

Our next example is downright weird, but is it any stranger than the image the White House put together?

Our final selection in the “Pajama Boy” series adds the entitlement mentality to the mix.

I’m guessing this is because Pajama Boy is still living at home thanks to the weak Obama economy and the dismal job market.

Our last example of new Obamacare humor deals with the fact that the White House has hired someone from Microsoft to work on the website. I don’t know whether that means healthcare.gov will be as clunky and useless as Internet Explorer, but some clever person has put together this image.

If you like website-related humor about Obamacare, this Hitler parody is definitely worth watching.

And if you like Obamacare humor videos, here’s a very unsettling one about the government having a database about our sex lives.

P.S. If you really want to let the Obama White House succeed in undermining your productivity, you can easily spend about 30 minutes enjoying more Obamacare  cartoons, videos, and jokes by clicking here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, here, and here.

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Least Sympathetic Obamacare Victims…Ever

I have great sympathy for almost all segments of the population that have been disadvantaged by Obamacare.

Among the victims are many relatively powerless people, including children, low-income workers, and retirees.

It’s equally tragic that millions of families – notwithstanding the President’s oft-repeated promise – already have lost their insurance plans, and it’s a crisis that this number could swell to more than 50 million over the next year.

And taxpayers, needless to say, are going to incur heavy burdens because of the President’s reckless new entitlement.

Heck, compared to all these groups, the unfortunate people who merely had to endure the “third world experience” of the Obamacare website should consider themselves lucky.

Yet even though I am brimming with empathy for the victims of Obamacare, there is one group that is suffering and I can say without hesitation or reservation that the people affected don’t tug on my heart strings or engender feelings of sympathy.

I’m referring to the staffers on Capitol Hill. According to a Politico story, some of these folks are having to pay more thanks to the President’s scheme to expand government’s control over the healthcare system. Here are the key excerpts.

Veteran House Democratic aides are sick over the insurance prices they’ll pay under Obamacare, and they’re scrambling to find a cure. “In a shock to the system, the older staff in my office (folks over 59) have now found out their personal health insurance costs (even with the government contribution) have gone up 3-4 times what they were paying before,” Minh Ta, chief of staff to Rep. Gwen Moore (D-Wis.), wrote to fellow Democratic chiefs of staff… In the email, Ta noted that older congressional staffs may leave their jobs because of the change to their health insurance.

Oh no, they might leave? Perish the thought! Surely they have more money to waste, more regulations to impose, and higher taxes to approve.

You may detect a slight tone of sarcasm in my remarks, but that’s for a good reason. First of all, many of these staffers are only in an unpleasant situation because their bosses voted for Obamacare. If they want to complain, perhaps they should schedule a meeting with the power-hungry politicians that caused the mess in the first place.

Second, I have a hard time feeling much empathy for these people when the Obama Administration already has arbitrarily and illegally altered the law so that taxpayers will cover 75 percent of their health insurance expenditures. I realize there’s an entitlement mentality in Washington, but you would think these people would have some sense of shame!

Let’s finish by enjoying some new cartoons. Here’s one from Gary Varvel on the economic burden of Obamacare, which appeals to me for obvious reasons.

By the way, if you like the Aflac duck and the GEICO gecko, here’s another Varvel cartoon you’ll appreciate.

Now we have a Bob Gorrell cartoon that starkly exposes the President’s illegal changes to Obamacare.

In other words, this bit of satire turned out to be reality.

Nate Beeler has a very good cartoon that captures Obama’s disdain for the suffering of ordinary people.

It fits in well with the Ramirez cartoon in this post.

Then we have Jerry Holbert showing a way to really punish Iran.

Sort of like what Rand Paul said (quoting me!) about Syria.

Last but not least, here’s another Varvel cartoon that sums up what Obama staffers are trying to do.

Surprisingly, this is only the second time I can recall sharing a cartoon featuring Humpty Dumpty.

But don’t laugh too hard at these cartoons. Obama may get the last laugh if he can survive the short-run political damage and create more long-run government dependency.

P.S. Actually, the title of this post is wrong. There is a group of people in America who don’t like Obamacare and – believe it or not – they are even less deserving of sympathy than the army of staffers on Capitol Hill.

P.P.S. Let’s keep our fingers crossed that politicians don’t deal with this issue by re-hiring the taxpayer-financed “grief counselors” who were used to console Democratic staffers after the 2010 elections.

P.P.P.S. Here’s a very funny parody video about the Obamacare disaster.

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The Continuing Obamacare Disaster

You know things are going poorly for the Obama White House when even the New York Times is writing about the “third world experience” of Obamacare.

Heck, it’s almost gotten to the point where I feel sorry for the President.

But I guess I must be a mean-spirited anti-government ideologue, because I can’t stop myself from mocking the President’s ill-fated healthcare scheme. Whether I’m sharing funny cartoons or sarcastic videos, I can’t resist the temptation to kick Obamacare while it’s down.

In this spirit of love and togetherness, let’s take a look at some recent news about the law.

McClatchy News has a big expose that reveals the magnitude of the President’s if-you-like-your-insurance-you-can-keep-it prevarication. Let’s review a couple of excerpts from the story, beginning with a comparison of the President’s promise and the staggering revelation that as many as 52 million Americans may have the rug pulled out from under them.

Even as President Barack Obama sold a new health care law in part by assuring Americans they would be able to keep their insurance plans, his administration knew that tens of millions of people actually could lose those their policies. …report in 2010 said that as many as 69 percent of certain employer-based insurance plans would lose that protection, meaning as many as 41 million people could lose their plans even if they wanted to keep them and would be forced into other plans. Another 11 million who bought their own insurance also could lose their plans. Combined, as many as 52 million Americans could lose or have lost old insurance plans.

Amazingly, the President continues to be truth-challenged.

Obama insisted anew Thursday that the problem is limited to people who buy their own insurance. “We’re talking about 5 percent of the population who are in what’s called the individual market. They’re out there buying health insurance on their own,” he told NBC. But a closer examination finds that the number of people who have plans changing, or have already changed, could be between 34 million to 52 million. That’s because many employer-provided insurance plans also could change, not just individually purchased insurance plans.

Now let’s examine an example of what this means. The Weekly Standard reports on what has happened to some citizens from flyover country.

In North Dakota, only 30 people have so far signed up for Obamacare. Meanwhile, 35,000 people have already or will be losing their existing health insurance plans in that state alone.

But that’s not the only bad news for the President’s statist healthcare scheme.

It seems that Obamacare is a gold mine for crooks and con artists. Let’s look at parts of a New York Times story.

To the list of problems plaguing President Obama’s health care law, add one more — fraud. …State and federal authorities report a rising number of consumer complaints, ranging from deceptive sales practices to identity theft, linked to the Affordable Care Act. …Some level of fraud or abuse is predictable with any big government program… But now, the technical failures troubling the HealthCare.gov website, as well as the law’s complexity, threaten to make matters worse. …Authorities warn that in some cases the come-ons are merely a ruse to get people to divulge sensitive Medicare and banking information. …Medicare has also long been a magnet for swindlers, thanks to its sheer scale and complexity. The troubled rollout of the new health care law has amplified the problem.

By the way, this story doesn’t even mention the possibility and risk of hackers and identity thieves breaking into the massive government databases that will be created as a result of Obamacare.

And if you’ll allow me to briefly digress, the same danger exists if politicians create the huge tracking-and-monitoring database that would be necessary if state politicians get the authority to tax out-of-state Internet sales.

Returning to the topic of Obamacare, it’s also worth noting that the growing burden of taxes and spending isn’t part of the aforementioned stories. Yet can there be any doubt that the program’s failures will lead to even more spending?

Not that any of us should be surprised. That’s almost always been the case when politicians create new entitlement programs. Indeed, I would pat myself on the back for making exactly this predication about Obamacare, but anybody with a room-temperature IQ knew this would happen, so I can’t claim any special insight.

But this does give me a reason to share this new Lisa Benson cartoon.

Needless to say, I’m enjoying the ongoing Obamacare disaster. But not just for reasons of Schadenfreude. The cluster-you-know-what of Obamacare is good news because it increases our chances of repealing the law in a few years (just as I predicted back in April).

But not just our chance to repeal Obamacare. We may actually have a chance to deal with the larger government-caused problems in our healthcare system, all of which lead to third-party payer and undermine the efficiency and low costs that exist when there is a genuine free market.

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