The Obama administration sold -- well, it pitched ObamaCare to the public with this promise: "It's time we put the health of American families back in the hands of consumers – not the insurance industry."
The Veterans Health Administration shows how incompetent the federal government is when it comes to making medicine a patient-centered enterprise. After decades of mistreating veterans, the VHA achieved some successes in the past decade or so, such as adopting electronic medical records and improving on some measures of quality. Yet serious deficiencies remain. Today's Los Angeles Times reports that the VA's disability system is a nightmare for soldiers and sailors disabled in combat:
John Lamie survived six roadside bombings in Iraq, only to have the Department of Veterans Affairs refuse to accept three months' worth of medical tests he underwent for jaw and shoulder wounds — tests performed by VA-approved doctors at VA facilities...
Many veterans wounded in Iraq and Afghanistan are being buffeted by a VA disability system clogged by delays, lost paperwork, redundant exams, denials of claims and inconsistent diagnoses. Some describe an absurd situation in which they are required to prove that their conditions are serious enough for higher payments, yet are forced to wait months for decisions.
"You fight for your country, then come home and have to fight against your own country for the benefits you were promised," said [Clay] Hunt, 28, who served in Iraq and Afghanistan as a Marine Corps sniper.
It took Hunt, who lives in Brentwood, 10 months to receive VA disability payments for his injuries after the agency misplaced his paperwork...
Some veterans wait up to six months to get their initial VA medical appointment. The typical veteran of the Iraq or Afghanistan wars waits 110 days for a disability claim to be processed, with a few waiting up to a year. For all veterans, the average wait is 161 days...
Lamie, 25, an Army combat engineer who risked his life uncovering and defusing roadside bombs in Iraq, declared bankruptcy in April. He is unable to work because of his combat injuries, he said, and VA delays have left him short of cash to support his wife and four children. He gets $311 a month in food stamps."I did everything the VA asked of me, but they block you at every turn," Lamie said from his home in Georgia. "They play with people's lives...They drag their feet, hoping you'll give up. A lot of people do. Not me."...
When he volunteered for the Marine Corps, Hunt recalled, a selling point was lifelong medical care if he were wounded."But then the time comes to get those benefits, it turns into a lifelong battle with the VA to get what you were promised," he said...
The experience has left [Lamie] drained and disillusioned. He said he couldn't even look at his old Army uniform anymore.
"I can't stand the sight of it after what I've gone through with the VA," he said. "I'm not proud anymore."
ObamaCare will produce similar horrors, and for the same reason: all economic systems serve the people who control the money. Under ObamaCare and the VA, patients don't control the money. The government does.
Returning that money to consumers would put patients first, whether they're veterans or other civilians. But such reforms won't mean a thing until we repeal ObamaCare.
The economic tragedy unfolding in Greece is the welfare state taken to its logical conclusion. When groups of people use the state to live at the expense of others, the feedback loop about the costs of those transfers is attenuated -- often by design. The welfare state therefore makes commitments that it cannot honor. By the time creditors or taxpayers say, "Enough," the welfare state has created a clash between expectations and means that leads to unrest and hardship -- a clash that never had to occur.
Reuters reports that this tragedy is playing itself out in Canada, where the Medicare system is straining the budgets of taxpayers and provincial governments -- even as Canada remains infamous for providing inadequate access to care. According to Reuters, the provincial government in populous Ontario predicts that "health care could eat up 70 percent of its budget in 12 years, if all these costs are left unchecked." Toronto-Dominion Bank senior economist at Derek Burleton remarks:
There's got to be some change to the status quo...We can't continually see health spending growing above and beyond the growth rate in the economy because, at some point, it means crowding out of all the other government services. At some stage we're going to hit a breaking point.
The provinces are contemplating measures that would further reduce access, such as ratcheting government price controls downward, "health taxes" on medical services, and (gasp!) charging patients. (Speaking of feedback loops, an economist at Scotia Capital reasons that patients "will use the services more wisely if they know how much it's costing...If it's absolutely free with no information on the cost and the information of an alternative that would be have been more practical, then how can we expect the public to wisely use the service?")
The Greek and Canadian dramas are a preview of what the welfare state, aided by its most recent expansion, will provoke here in the United States. Again, Reuters:
Canada, fretting over budget strains, wants to prune its system, while the United States, worrying about an army of uninsured, aims to create a state-backed safety net.
Burleton captures the problem nicely:
[F]rom an economist's standpoint, we point to the fact that sometimes Canadians in the short term may not realize the cost.
Indeed, that's the very essence of the welfare state, and why its logical outcome is crisis.
Last week, I referred obscurely to "folks wanting to install the FCC as the Internet’s regulator," cautioning that this same Federal Communications Commission is our national censor.
A friendly correspondent points me to an article in Ars Technica about the demand for speech controls coming from the same groups that want the FCC to control the Internet's infrastructure, groups such as Free Press, the Media Access Project, and Common Cause.
Is there a parry to the charge that this is a demand for censorship? The signatories to the regulatory filing "respectfully request that the FCC . . . inquire into the extent and effects of hate speech in media, and explore possible non-regulatory ways to counteract its negative impacts."
The filing does not contain the words "First Amendment" or "free speech." It means "non-regulatory" the way a cop eyeballing someone and slapping his palm with a billy club is "non-regulatory."
The FCC is experienced with "non-regulatory" coercion. Hearings in Congress have explored how the agency uses arm-twisting to get what it wants outside of formal regulatory processes. As law professor Lars Noah testified in 1999:
Arm twisting refers to an agency's use of threats either to impose a sanction or withhold a benefit in hopes of encouraging nominally voluntary compliance with a request that the agency could not impose directly on a regulated entity. This informal method of regulation often saddles parties with more onerous regulatory burdens than Congress had authorized, accompanied by a diminished opportunity to pursue judicial challenges.
An FCC with the power to regulate Internet access services would use it to control Internet content. There's no place for the FCC in monitoring or administering speech controls, nor in controlling our communications infrastructure, the Internet.
Robert VerBruggen of NRO believes that the only difference between allowing taxpayers to direct their own funds according to their individual preferences and having the government pool all tax dollars and distribute them according its collective preference is political, not principled. A mere technicality rather than a fundamental distinction.
Moreover, VerBruggen contends that it is dishonest to use tax credits instead of direct government spending.
If that’s true, why don’t we voucherize charitable giving?
The feds should eliminate the charitable tax deduction and send out the average (tax-forgiven) amount donated per adult to every citizen in the country to donate as they wish! Would this be more honest? Is there no fundamental difference between these two approaches?
Sure, some people would complain about how their tax dollars were being redistributed to, say, support abortion clinics or the Catholic Church or PETA. They would carp about how they, as taxpayers who earned that money in the first place, should be the ones to direct their money to the charity of their choice. They would complain that pooling the money and doling it out to people who didn’t earn it to use at their own discretion, according to some criteria determined by the government, is unfair and wrong. Are these just technicalities?
Is direct government spending on universal charity vouchers really no different than giving individual taxpayers the freedom to donate to the charities of their choosing?
Would universal charity vouchers be preferable to the individual tax deductions for charitable donations that we have today, from the standpoint of minimizing compulsion and social tension? To claim that school vouchers are equal to or better than tax credits on these grounds is to claim that universal government charity vouchers would be better than the system we have today.
“By letting citizens do the government’s job of allocating tax money to the preferred area,” VerBruggen insists, “politicians can avoid controversy, claiming they’re merely enabling ‘donations.’” He therefore concedes, “so maybe there’s something to Coulson’s argument about avoiding social conflict, if only because people mistakenly think there’s a meaningful difference between the two funding mechanisms.” While VerBruggen supports direct government vouchers, using “[tax expenditures] is a dishonest way to get them.”
VerBruggen seems pre-committed to charity vouchers. It's the only honest thing to do. Anyone else on board with that?
The nation is facing a fiscal emergency. Debt is exploding and federal spending exceeds revenues by more than $1 trillion a year. To fix the problem, policymakers should pursue reforms on two paths.
First, policymakers should start identifying programs for termination, privatization, and devolution to the states. If a business conglomerate overexpanded and its spending ran ahead of revenues, prudent managers would start shedding low-value operations and refocusing on core activities. The federal government should do the same.
Second, policymakers should adopt new rules to bring greater discipline to federal budgeting. Right now, it’s anarchy on Capitol Hill with every member and interest group pushing for more dollars. Very few members consistently defend restraint.
The solution is for Congress to pass a law limiting annual increases in overall federal spending. Rep. Lamar Smith (R-TX) recently introduced legislation to do just that. His SAFE Act (H.R. 5323) would cap annual growth in the federal budget to inflation plus population growth.
Smith’s bill, which has 34 co-sponsors, would cap growth in all spending including defense, nondefense, and entitlements. If spending this year was $3.70 trillion, inflation was 2 percent, and population growth was 1 percent, then federal spending next year would be limited to $3.81 trillion. If Congress failed to get spending under the limit by the end of the year, the president’s budget office would be required to apply an across-the-board cut, or sequester. I’ve discussed some of the details of such a spending limit in this congressional testimony.
Rep. Smith’s spending restraint legislation is exactly the type of budget process reform that Republicans should be championing. The idea of a cap on overall spending was supported by tea partiers in their Contract from America, and it’s easy for the average citizen to understand. The idea is simply that the government’s budget shouldn’t grow faster than the average family’s budget.
With a budget cap in place, it would be easy for voters and activists to know whether Congress was living up to a basic standard of fiscal prudence. If members of Congress tried to cheat on the legal spending limit, or tried to repeal it, citizens could impose political pressure on the spendthrifts. A simple and rigid budget limit would be a high-profile symbol of restraint for people to rally around and defend.
The chart below shows actual spending since 1990 and a budget limit of population growth plus inflation, with those variables averaged over the prior five years. In the 1990s, Congress generally kept spending under the limit. Over ten years, actual spending rose an average 4.2 percent annually, which was less than the 4.6 percent average growth of the limit. By contrast, spending growth during the 2000s has far exceeded the limit, illustrating where today’s huge deficits came from.
In sum, the nation can move back toward fiscal sanity by voting out the big spenders of both parties and voting in a reform-minded Congress to terminate programs and shrink the budget. Then, if Congress passed a law capping overall spending it would lock-in those cuts and make them harder to reverse later on. This two-part process could help ratchet-down the size of government over time.
Notes: Rep. Smith does not specify a five-year average for his spending limit variables, as I’ve assumed here. Also note that federal spending is calendar year data from the National Income and Product Accounts, Table 3.2.
The political process often resembles an unseemly racket as politicians take money from people who earn it and give it to another group in exchange for campaign cash and political support. The modern bureaucracy is a good example. Government workers have now become a cosseted elite, with generous pay, extravagant benefits, lavish pensions, and ironclad job security. In exchange for this privileged status, they reward the politicians with millions of dollars of support and a host of in-kind contributions. I have documented many of these outrages in my "Taxpayers vs. Bureaucrats" series at the International Liberty blog. Well, now we have a video detailing how the government workforce has morphed into a fiscal nightmare for taxpayers.
There are three things in the video that deserve special emphasis. First, bureaucrats are vastly overpaid. The government data cited in the video show that total compensation for the federal civil service is twice as high, on average, as it is for workers in the productive sector of the economy. There are some bureaucrats who deserve above-average pay, such as scientists dealing with nuclear weapons, but it is outrageous that the average drone in the federal bureaucracy is getting twice as much compensation as the taxpayers (serfs) who pay their salaries.
Second, this mini-documentary debunks the silly argument (put forth by government employee unions, of course) that bureaucrats are underpaid compared to the private sector. The Department of Labor has data looking at voluntary departure rates by profession. If government workers were being underpaid, you would expect them to be more likely to leave their jobs in order to take new positions in the (supposedly higher paid) private sector. Instead, the video reveals that people in the private sector are six times more likely to switch jobs than federal bureaucrats.
Third, the video concludes with the essential point that most federal bureaucrats should be paid nothing because they work for departments and agencies that should not exist.
Last but not least, Chris Edwards deserves special mention. Much of the material in this video came from his work on this issue.