Archives: 11/2009

$98 Billion in Improper Payments

The Obama administration and its allies in Congress want the federal government to expand its role in subsidizing health care. We are told that this expansion will restrain rising health care costs. But an OMB report yesterday that the government made $98 billion in improper payments last year – $55 billion of which came from Medicare and Medicaid – ought to raise suspicions about that claim.

According to Reuters, OMB Director Peter Orszag told reporters that the embarrassing figures from Medicare and Medicaid demonstrate the need for health care reform. I would concur if “reform” meant reducing the government’s role in health care. However, he means the opposite, which raises the question of how giving more money to an already waste-prone and bureaucratic federal health system can possibly make sense for the economy.

The administration has promised to cut down on improper payments with the aid of a new executive order. According to the Associated Press:

Under the executive order, every federal agency would have to maintain a Web site that tracks improper payments, error rates and outstanding payments. If an agency doesn’t meet targets for reducing error rates for two years in a row, the agency director and responsible official will have to directly report to OMB to explain the delinquency and new actions they will take.

Somehow I doubt this will amount to much of a deterrent. The AP also said the administration plans to impose penalties on government contractors who receive improper payments. But last month it was reported that “the Department of Defense awarded nearly $30 million in stimulus contracts to six companies while they were under federal criminal investigation on suspicion of defrauding the government.”

Democrat Tom Carper, chairman of the Senate subcommittee on federal financial management, seemed to partly understand the broader meaning of the improper payment estimates:

It goes without saying that these results would be completely unacceptable in the private sector, as they should be in government, especially at a time of record deficits…Unfortunately, these numbers may still be just the tip of the iceberg since they don’t even include estimates for several major programs, including the Medicare prescription drug plan.

Yes, Senator, which is precisely why bigger government – be it stimulus, bail outs, or health care reform – is an inferior option to letting the marketplace provide for our wants and needs.

Carper is also right about the $98 billion figure being the “tip of the iceberg.” As has been noted here before:

The Government Accountability Office estimates that the two major government health programs are currently losing a combined $50 billion annually to such payments. But that estimate probably low-balls the actual losses. Harvard’s Malcolm Sparrow, a top specialist in health care fraud, estimates that 20 percent of federal health program budgets are consumed by improper payments, which would be a staggering $150 billion a year for Medicare and Medicaid.

See this essay for more on fraud and abuse in government programs.

McCain: Interests of Defense Contractors May Conflict with US National Interest

USA Today reports that retired military officers join the boards of directors of, or become employees of, defense contractors and take home big bags of money doing so.  Not surprising.  At the same time, the paper reports, lots of them are being paid by the Pentagon to be “senior mentors” of their former colleagues. Not being government employees, but rather independent contractors, these folks aren’t subject to government ethics rules.  To take one example, as chairman of BAE Systems, Gen. Anthony Zinni is clearing almost a million a year, in addition to his $129,000 per year government pension.  In addition to all that, the Pentagon pays him about $2,000 per day to “mentor” people at DOD.

As the article points out, information is almost invaluable to the defense contractors in these contexts.  The knowledge of what’s going on at DOD is extremely useful for planners at the defense companies, and so while the retired officers are protesting that being paid nearly $2,000 per day by DOD for their work as mentors is “way below the industry average,” it increases their value to, and presumably their compensation from, their military-industrial employers.  As one coordinator of the mentors program told the retired officers, “you’re getting paid in two ways–monetarily and informationally.”

This isn’t too surprising a story, but the crowning irony comes as Sen. John McCain calls for an ethics rewrite and offers his view that “the important thing is that [the involved officers] avoid the appearance of conflict.” This is a puzzling remark coming from a man whose top foreign-policy adviser was collecting hundreds of thousands of dollars from the Georgian government to lobby McCain at the same time he was being paid by McCain to advise him on foreign policy.

McCain’s thoughts about conflict of interest in that instance?  He was “so proud” of his lobbyist-cum-adviser.  Presumably once McCain issued his ridiculous “today we are all Georgians” fatwa it became a patriotic duty to take money from foreign governments to represent their interests.  But in the case of the proposed reforms–which would attempt to institute some semblance of transparency in these mentoring deals–one can only wish the senator from Arizona the best.

What Will the Reid Bill Cost?

Michael Cannon has some astute analysis of the Senate health care bill below. I posted these thoughts at Politico’s Arena:

According to the Chamber of Commerce polls, strong majorities in every state they polled believe the health care bills will increase the deficit. In this case the public’s cynical instincts are almost certain to be more accurate than the computer models of the CBO. As David Dickson of the Washington Times reviewed yesterday, government health care programs have a history of cost overruns.

And not small overruns, like overdrawing your checking account – massive, order-of-magnitude cost overruns. Is that because politicians intentionally overstate the benefits and underestimate the costs of their proposals? Or just that computer models aren’t very good at predicting how entitlements programs change behavior? Either way, just look at the record: In 1967, the House Ways and Means Committee said the entire Medicare program would cost $12 billion in 1990. The actual cost in 1990 was $98 billion. In 1987, Congress projected that Medicaid would make special relief payments to hospitals of less than $1 billion in 1992. The actual cost, just five years after the projection, was $17 billion. Similarly, Medicare’s home care benefit was projected in 1988 to cost $4 billion in 1993, but the actual cost – again, just five years after the projection – was $10 billion.

The government is running a trillion-dollar annual deficit already, and Congress and the president propose to create a new program that promises to cover millions more people with health insurance, drag currently insured people onto government programs, and save billions of dollars in the process. No wonder levels of trust in government are at record lows.

Tear Down This Wall … between the U.S. and Cuba

The House Foreign Affairs Committee is holding a hearing today on the almost 50 year old ban on travel to Cuba. The ban is part of a broader economic embargo in place since the early 1960s that was supposed to bring about change in the island’s oppressive, communist regime.

Instead, the embargo and travel ban have needlessly infringed on the freedom of Americans, weakened our influence in Cuba, and handed the Castro government a handy excuse for the failures of its Caribbean socialist experiment.

I wrote an op-ed recently advocating change in U.S. policy toward Cuba, and delivered a talk on the same theme at Rice University in 2005.

Will Congress finally change this failed U.S. policy?

Don’t Blame Obama for Bush’s 2009 Deficit

Some critics are lambasting President Obama for record deficits. This is not a productive line of attack, largely because it puts the focus on the wrong variable. America’s fiscal problem is excessive government spending, and deficits are merely a symptom of that underlying disease. Moreover, if deficits are perceived as the problem, that means both spending restraint and higher taxes are solutions. The political class, needless to say, will choose the latter approach 99 percent of the time. A higher tax burden, however, simply means that debt-financed spending is replaced by tax-financed spending, which is akin to jumping out of the frying pan and into the fire, or vice-versa.

In addition to being theoretically misguided, critics sometimes blame Obama for things that are not his fault. Listening to a talk radio program yesterday, the host asserted that Obama tripled the budget deficit in his first year. This assertion is understandable, since the deficit jumped from about $450 billion in 2008 to $1.4 trillion in 2009. As this chart illustrates, with the Bush years in green, it appears as if Obama’s policies have led to an explosion of debt.

But there is one rather important detail that makes a big difference. The chart is based on the assumption that the current administration should be blamed for the 2009 fiscal year. While this makes sense to a casual observer, it is largely untrue. The 2009  fiscal year began October 1, 2008, nearly four months before Obama took office. The budget for the entire fiscal year was largely set in place while Bush was in the White House. So is we update the chart to show the Bush fiscal years in green, we can see that Obama is partly right in claiming that he inherited a mess (though Obama actually deserves a small share of the blame for Bush’s last deficit since earlier this year he pushed through both an “omnibus” spending bill and the so-called stimulus bill that increased FY2009 spending).

It should go without saying that this post is not an argument for Obama’s fiscal policy. The current President promised change, but he is continuing the wasteful and profligate policies of his big-spending predecessor. That is where critics should be focusing their attention.

Reid Health Bill Perpetuates the $1.5 Trillion Fraud

Senate Majority Leader Harry Reid (D-NV) has finally unveiled his massive 2,074-page health care bill.  The Congressional Budget Office reports that the insurance-expansion provisions would cost the feds $848 billion over 10 years.  To raise those funds, the bill would tax wages, medical devices, prescription drugs, sick people, health insurance premiums (twice), HSAs, FSAs, HRAs, and – why not? – cosmetic surgery.  The remainder would supposedly come from $491 billion of Medicare cuts, even though Medicare’s chief actuary says such cuts are “unrealistic” and “doubtful.”  But don’t worry.  Somehow, this thing’s gonna reduce the deficit.

Of course, that $848 billion only accounts for part of the federal government’s share of the tab.  There is other new federal spending.  My read is that the CBO estimates $998 billion of total new federal spending – though I’ll be waiting for former CBO director Donald Marron to provide a more authoritative tally.

And then there are costs that Reid and his comrades have pushed off the federal budget.  For example, the $25 billion unfunded mandate that Reid would impose on states.  Total so far: just over $1 trillion.

But the biggest hidden cost is that of the private-sector mandates.  In both the Clinton health plan and the Massachusetts health plan, the private-sector mandates –- the legal requirements that individuals and employers purchase health insurance –- accounted for 60 percent of total costs.  That suggests that if the Reid bill’s cost to federal and state governments is $1 trillion, then the total cost is probably $2.5 trillion, and Harry Reid – like House Speaker Nancy Pelosi – is hiding $1.5 trillion of the cost of his bill.

Without a cost estimate of the private-sector mandates, Reid has not yet satisfied the request made by eight Democratic senators for a “complete CBO score” of the bill 72 hours prior to floor consideration.

Fortunately, by law, the CBO must eventually score the private-sector mandates.  When that happens, the CBO will reveal costs that the bills’ authors are trying to hide. When that happens, the CBO will present the new federal spending on page 1, new state spending maybe on page 10, and the cost of the private-sector mandates on page 20 or something.  Democrats will tout the figure on page 1.  But the bill’s total cost will the sum of those three figures -– a sum that will reveal the costs that the bill’s authors have been hiding.

The House passed its bill without a complete CBO score.  The Senate should not follow suit.

I’ve written previously about this massive fraud here, here, here, and here.

(Cross-posted at Politico’s Health Care Arena.)

Short of Funds? Give the Feds More Power

In 2006, the National Transportation Safety Board found that 298 subway cars in the Washington Metrorail system are “vulnerable to catastrophic telescoping damage” and should be replaced or reinforced immediately. They weren’t, which was a major reason why nine people died in a rail collision last June.

In 2007, supposedly fail-safe circuits in Metrorail’s train detection and control system began to “intermittently malfunction.” This contributed to at least one near miss before the fatal crash, and was the other major reason why nine people died in June.

Clearly, the Washington Metropolitan Area Transportation Authority is short of funds. It still has not begun to replace the 298 cars; instead, it is merely inserting them into the middle of trains so that, in the event of a crash, the will be buffered by newer (and hopefully stronger) cars.

According to the Federal Transit Administration, it will cost nearly $50 billion to bring rail lines in Washington and five other urban areas – New York, Chicago, Philadelphia, Boston, and San Francisco – up to a “state of good repair.” Current rates of spending are not even adequate to keep these systems in the miserable condition they are in today. As an official with New York’s Metropolitan Transportation Authority says with resignation, “there will never be enough money” to restore New York’s rail system to a state of good repair (see p. 15).

The problem, of course, is that rail transit does not come close to paying for itself out of transit fares. Fares cover about 60 percent of the cost of operating Washington’s Metrorail system, but none of the costs of building or maintaining it – and has one of the highest cost recovery ratios in the industry. Transit agencies have convinced most legislators that transit shouldn’t have to pay for itself – but that leaves them perennially short of funds and their patrons in danger of deadly accidents.

Legislators love to fund “ribbons, not brooms” – that is, new, highly visible projects such as the $5.2 billion silver line to Dulles Airport rather than the cost of maintaining the existing system.

So what’s the solution? How about federal regulation of transit agencies? That won’t solve any of the problems, but at least we’ll have a whole new layer of bureaucracy to blame the next time people are killed in a train crash.

The real solution is to stop building expensive rail transit lines that cities can’t afford to maintain. Transit should be privatized, which will lead transit companies to run vehicles – mostly buses – where people want to go, not where bureaucrats and politicians decide they ought to go.