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March 29, 2018 12:39PM

Republicans’ St Augustine‐​like Fiscal Virtue‐​signalling

The Washington Post reports that “House Republicans are considering a vote on a ‘balanced-budget amendment’” (BBA) to the constitution, having just backed a $1.3 trillion omnibus spending bill which will worsen the deficit considerably.

With deficits now projected to rise as high as 5.3 percent of GDP by 2019, this move amounts to the worst kind of “fiscal virtue signaling” on behalf of the GOP leadership. The vote appears designed to tell voters that the GOP favors fiscal restraint, safe in the knowledge the amendment is near-certain to fail, given the hurdles in the Senate alone and despite all recent evidence to the contrary.

There will therefore be a lot of rightful mocking and dismissiveness from the commentariat on this move. But two points from the conclusions on my recent paper on fiscal rules should be borne in mind.

First, lots of people will use this hook to come out and say a BBA is bad economics, particularly given that overwhelmingly mainstream economists oppose a requirement at the federal level for the books to balance every year.

But countries around the world have developed much more sophisticated fiscal rules which in effect balance budgets over the economic cycle. Switzerland’s is even part of its constitution, and it appears to work pretty well. Fiscal rules really can really help to shape responsible budget outcomes, provided they smooth spending by capping it around trend revenues (rather than requiring balance every year), and avoid scope for overoptimistic assumptions or creative accounting by politicians.

Second and crucially, though, fiscal discipline – even to get to the stage of introducing and abiding by rules – requires political and public buy-in. At the moment, the equilibrium in Washington is instead for higher spending and more borrowing, and a continual reluctance to countenance reform of entitlement programs which drive the dreadful long-term debt projections.

Republicans had the opportunity, after the tax cuts, to explain to voters that if they liked their tax cuts, and wanted to keep their tax cuts, then fiscal restraint over a number of years was necessary. Now, even getting to a stage where a BBA could kick in would likely take years given the high deficit, and the political difficulties of cutting spending.

No doubt there are some Republicans who still care and worry about balancing the books. But with this proposed vote, the GOP instead is preaching like St Augustine: “Lord give me fiscal discipline, but not yet.” The best way of locking in fiscal responsibility is to practice it.

Read my full paper on fiscal rules and the experience of other countries here.

March 29, 2018 11:38AM

Poking the Panda: Hawks Push Stronger U.S. Support for Taiwan

Taiwan’s supporters in Congress and the Trump administration are pushing unprecedented measures to increase Washington’s backing for the island’s de facto independence from China. On March 1, the Senate passed the Taiwan Travel Act, which the House of Representatives had previously approved in January. The TTA states that it should be the policy of the United States to authorize officials at all levels to visit Taiwan to meet with their counterparts and allow high-level Taiwanese officials to enter the United States for meetings with U.S. officials. Notably, the TTA specifically encouraged interaction by “cabinet-level national security officials.”

As I note in a new article in China-U.S. Focus, although the measure does not compel the executive branch to change policy, it clearly underscores the congressional desire for closer U.S. ties, especially defense ties, with Taiwan’s government. Since the Senate passed the legislation with no dissenting votes, it reinforced the intensity of the congressional position. That President Trump signed the legislation instead of letting it go into effect without his signature signaled his agreement with the substance.

Although it was not a legal requirement, Washington’s policy since it switched official diplomatic relations from Taipei to Beijing in 1979 has been to authorize only low-level (usually economic) policymakers to interact with their Taiwanese counterparts. Prominent officials such as the President, Secretary of State, and Secretary of Defense, refrain from doing so. That situation is now likely to change.

Congressional activists also are pushing a new gesture of support for Taiwan, even though Beijing’s strong protests in response to the TTA have barely begun to subside. Two key Republican senators, John Cornyn (R-TX) and James Inhofe (R-OK), are urging President Trump to approve the sale of F-35 fighters to Taipei. Cornyn is the assistant majority leader and Inhofe is a senior member of the Armed Services Committee, so their support for such a sale is not a minor matter.   

U.S. arms sales to Taiwan always are a sensitive issue with the Chinese government. Beijing contends that the communique President Reagan signed in 1982 committed the United States to phase-out all such sales. U.S. leaders respond that the promise was conditional on Beijing’s willingness to rule out the use of force to compel Taiwan’s reunification with the mainland—a renunciation China has never made. A provision in the 1979 Taiwan Relations Act authorizes the sale of defensive arms to Taipei, but it is quite a stretch to regard F-35s as a defensive weapon system.

Since President Trump’s election, Beijing’s suspicions have grown that the United States intends to dilute, if not abandon, the “one-China” policy that has governed bilateral relations since the 1970s. The concerns soared with the much-discussed December 2016 telephone conversation between President-elect Trump and Taiwanese President Tsai Ing-wen. No previous president-elect since Washington’s recognition of the PRC as China’s rightful government had ever interacted with a Taiwanese leader. Trump alleviated Beijing’s concerns when he assured President Xi Jinping in February 2017 that Washington remained fully committed to the one-China policy, but passage of the Taiwan Travel Act and the new congressional push for F-35 sales undoubtedly revive China’s worries.  

Trump’s appointment of John Bolton as his new national security advisor also likely elevates Beijing’s apprehension. Bolton is a longtime, passionate supporter of an independent Taiwan. Not only did he previously urge the United States to establish diplomatic relations with Taipei, he even suggested redeploying U.S. troops currently stationed on Okinawa to Taiwan to demonstrate the firmness of Washington’s commitment to the island’s security.

It is hard not to empathize with the aspirations of a vibrant, capitalist democracy like Taiwan. In a just world, the Taiwanese would have every right to determine their own political destiny and not be pressured into reunifying with the mainland—especially as long as the PRC remains a repressive, one-party state. But we do not live in a just world, and China regards reunification as a vital interest for which it is prepared to go to war.

The Taiwan Travel Act and the proposed F-35 sale signify an emphatic pro-Taiwan tilt and a serious policy change. Even if the Trump administration does not fully implement the TTA and approve the arms sale, a future administration now has congressional authorization and encouragement to do so. Some of the statements already coming from China’s state-controlled media are worrisome. The semi-official Global Times suggested that Beijing’s response to the latest provocations might need to be “military” in nature. That is not a minor concern. The Taiwan Relations Act states that Washington would regard any Chinese military coercion of Taiwan as a grave breach of the peace in East Asia. There is little doubt that America would be entangled in such a conflict.

U.S. leaders are playing a very dangerous game when they flirt with measures that undermine the one-China policy. Greater caution is imperative.

March 29, 2018 10:57AM

Explaining the Bolton Appointment, and Why It’s Dangerous

Ever since President Trump appointed John Bolton to be the new national security advisor last week, a torrent of commentary has poured forth about the hawkish Fox News pundit and American Enterprise Institute senior fellow, who once served as United Nations Ambassador for 18 months in the George W. Bush administration. Two pieces published today, however, stand out for their precision and insight. 

The first is by The Atlantic's Peter Beinart, whose central argument is that Bolton is not the learned foreign policy scholar many believe him to be. While Bolton certainly has years of experience, it hasn't been of the right kind. Bolton's "militancy," his "incessant, almost casual, advocacy of war," Beinart argues, is positively "Trumpian: The less evidence you have, the more certain you sound."

Bolton's analysis and prognostications - particularly about Iraq, Iran, and North Korea - have so frequently been proven wrong by events that it can be tedious to lay it all out. Beinart does a good job of it, but his real insight is to suggest a possible explanation for why Bolton has been so extremely hawkish, and wrong, for so long. 

[I]f Kissinger is right that “[high] office teaches decision making, not substance” and that it “consumes intellectual capital; it does not create it,” then the narrow professional experience through which Bolton has amassed his intellectual capital matters a great deal. He has never served in the military. He has never studied another region of the world, or another period of history, at the graduate level. He has spent his entire adult life in the interlocking world of hawkish think tanks, Washington law firms, Republican politics, and the right-wing media. And he manifests that narrowness in the smugly insular worldview he brings to his new job.

Over the past two decades, Bolton has written dozens of columns and essays, often for the flagship publications of the American right. To read them is to enter a cocoon. His writing is filled with assertions—about the purity of America’s intentions, the motivations of its adversaries, the uselessness of diplomacy, and the efficacy of war—for which he offers either feeble evidence or no evidence at all.

Do read the whole thing.

The second must-read on Bolton's appointment comes from Josh Shifrinson, assistant professor of international affairs with the Bush School of Government at Texas A&M University. In the Washington Post's Monkey Cage blog, Shifrinson argues that an extremist like Bolton can rise to the top of television punditry, and now to immense power as the president's right-hand man on all things national security, only because of America's peculiar place atop the international system. The unusual outsize power of the United States in the post-Cold War era has several implications for foreign policy.

First, it is a permissive environment for foreign policy activism in that there are few external constraints on the exercise of U.S. might. We face fewer negative consequences for strategic blunders and foolish wars, compared at least to states that face retaliation from peer competitors.

Second, this peculiar position of U.S. dominance means that domestic politics and the idiosyncrasies of individual leaders matter more for foreign policy than it otherwise would amid a more equal balance of power. "All this means sage leadership that screens policy ideas is especially important," Shifrinson writes. "With an inexperienced leader like Trump in the Oval Office, Bolton’s views can gain traction partly because America still reigns as the sole superpower."

Third, while other powers, like China, are beginning to compete with the U.S. in the economic and diplomatic spheres, America still reigns supreme in the miltiary arena. Using force and projecting power are our comparative advantage, and so Washington's incentive is to play to this strength, wisely or not.

Both Beinart and Shifrinson illustrate just how hazardous it is to have a man like Bolton in the Oval Office advising a man like Trump. If his history of erroneous analysis and impulsive support for elective wars is any guide, Americans should be bracing for a bumpy remainder to the Trump presidency. 

March 28, 2018 9:58AM

The Highly Positive Impacts of Vouchers

It looks like we have another terrible case of cherry-picking the evidence. But this time it’s shockingly misleading. Instead of simply pretending that the evidence on school choice is “mixed,” the Center for American Progress took it a step further by saying that the voucher evidence is “highly negative.” They are absolutely wrong. Here’s why.

The Four Evaluations

Their review of the research relies on only four voucher studies – Indiana, Ohio, Louisiana, and D.C. Two of these studies – Indiana and Ohio – are non-experimental, meaning that the researchers could not establish definitive causal relationships. But let’s go ahead and entertain them anyway.

The Ohio study used an econometric technique called regression-discontinuity-design, which can only replicate experimental results when a large number of students are used right around a treatment cutoff point. The intuition behind the method is that it is essentially random chance that students fall just around either side of the cut point, and therefore the students are randomly assigned to the voucher treatment or not.

The Ohio program used a cutoff variable - the performance of the child’s public school – to determine program eligibility. However, the researchers used student observations that were not right around the cut point and even removed the observations that were closest to the discontinuity. In other words, the authors could not establish causality, and it is more likely that the children assigned to receive the voucher program were less advantaged than those who were ineligible. After all, students in lower-performing public schools were the ones that were eligible for the choice program.

Even then, the model with the largest sample size actually found that being eligible for the program led to positive test score impacts. But the authors at CAP never mentioned that.

The Indiana study was also non-experimental, as it compared voucher students to those remaining in traditional public schools. But let’s look at it anyway. While the authors did find small negative effects of the program on test scores initially, voucher students caught up to public school students in math and performed better in reading after four years. How in the world can a positive result like this be “highly negative?” Weird.

The Louisiana experiment did find large negative effects on test scores in the first two years. However, voucher students caught up to their public school peers in both math and reading after three years. The CAP authors argue that the main model – although clearly preferred by the Louisiana research team – is less “accurate” because of the “restricted sample size.” That is odd, as using more control variables (and a consistent sample) usually makes econometric models more accurate – not less. Another thing that is odd: the CAP authors chose not to report the positive Ohio results – which came from their larger sample of students – and instead chose to report the negative results – which came from a sample that was less than a tenth of the size. Why the change in criteria?

The CAP review heavily relies on the most recent experimental evaluation of the D.C. voucher program. It just so happens to be one of the only two voucher experiments in the world to find negative effects on student test scores.

The first-year evaluation of the D.C. voucher program found a 7.3 point loss in math scores and no effects on reading scores. However, the CAP authors overstated this loss by saying that the effect was "the same as missing 68 days of school." But that suggests voucher students lost ground in all subjects, while the D.C. experiment concluded that voucher students did not lose any learning in reading.

What’s more – prior research has found that switching schools – for whatever reason – reduces student math achievement by at least a tenth of a standard deviation. After all, students and schools need to adjust to their new environments. That the average voucher student only lost 7.3 points  from switching schools suggests that the private schools in D.C. may have actually had positive effects on academic outcomes net of the temporary negative effects of a one-time school switch.

Further, the recent D.C. evaluation only looks at students after one year – when they are still adjusting to their new schools. And the meta-analysis of 19 voucher experiments shows that voucher programs’ effects on test scores get better over time. In fact, the positive test score trend was found in both Louisiana and Indiana. In addition, about half of the students in the control group in the D.C. experiment went to schools of choice. In other words, the first-year loss in math scores was relative to a mix of students in both traditional public schools and public charter schools.

And we cannot forget about the unequal playing field in our nation’s capital. D.C. voucher students only receive around $9,600 per year, while children in charter schools receive 46 percent more resources, while students in traditional public schools receive around 3 times the amount of education dollars. It’s amazing that D.C. voucher students are doing as well as they are with such a huge funding disadvantage.

The True State of the Evidence

So what does the evidence actually say?

When synthesizing any body of research, we ought to rely on the most rigorous studies – the experiments. We should also look at all of the studies so we are sure not to fall prey to cherry-picking.

Eleven of the 17 existing voucher experiments in the United States find positive effects on test scores for some or all students, and a recent meta-analysis of 19 voucher experiments around the world finds positive effects overall. Only 2 of the 17 experimental evaluations find any negative effects on student test scores – and those are also the only two evaluations solely looking at effects after the first year.

But what about the students that are left behind in public schools? It turns out that competition benefits those students as well. At least 24 studies exist on this topic. And 23 of the 24 studies find positive effects on student achievement for kids in public schools. None of these studies find negative effects.

But we shouldn’t only look at test scores. After all, families do not care all that much about test scores, especially since test scores are weak predictors of long-term outcomes. It just so happens that private school choice programs have much more positive effects on non-test score outcomes.

I found 11 studies in my review of the most rigorous studies linking private school choice programs to civic outcomes like student tolerance levels and political participation. The majority of the studies found large positive effects. For instance, researchers from Harvard University and the University of Arkansas found that children that won a random lottery to use the D.C. voucher program were about 90 percent more likely to permit individuals from groups they oppose to give a speech in their community. No studies found negative effects. And another review by Patrick J. Wolf similarly found that private school choice largely improves civic outcomes.

Only one experiment – in D.C. – links a voucher program to high school graduation. And it finds that winning the lottery to use a voucher increases the likelihood that a student will graduate high school by 21-percentage points. That is huge.

Another systematic review of the evidence finds that voucher programs lead to racial integration. In fact, 7 of the 8 rigorous studies that exist on the topic find positive effects. None of the studies find negative effects. Unsurprisingly, when vouchers allow disadvantaged children to leave their segregated neighborhood schools, society becomes more integrated.

It’s time we set the record straight. The preponderance of the evidence suggests that private school choice improves test scores, high school graduation rates, tolerance, civic engagement, criminality, racial integration, and public school performance. And, of course, all of these benefits come at a lower cost to the taxpayer.

With the substantial body of scientific evidence suggesting precisely the opposite, claiming that voucher impacts are “highly negative” is almost as absurd as saying that the Earth is flat. Anyone making such a claim needs to seriously reevaluate their position.

March 27, 2018 3:42PM

The Founding Fathers Favored a Liberal Immigration System

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Alex Nowrasteh had an excellent post yesterday on how the western tradition on immigration and naturalization formed the basis of the Founders’ views on those subjects and resulted in the most liberal policies in the world at the time. The debates at the Constitutional Convention highlight his point, showing just how liberal the Founders had become on immigration and naturalization.

At one point, Gouverneur Morris offered an amendment that would require 14 years of citizenship, rather than four, before a person could serve as a senator, “urging the danger of admitting strangers into our public Councils.” Charles Pinckney of South Carolina seconded the motion, recalling “the jealousy of the Athenians on this subject who made it death for any stranger to intrude his voice into their legislative proceedings.”

Yet as Alex notes, the Romans—rather than the Greeks—informed the views of most founders on naturalization, and most of the representatives at the convention opposed the Morris amendment for fear of, as future Chief Justice of the Supreme Court Oliver Ellsworth put it, “discouraging meritorious aliens from emigrating to this Country.” Alexander Hamilton argued that the “advantage of encouraging foreigners was obvious and admitted,” asserting that “persons in Europe of moderate fortunes will be fond of coming here where they will be on a level with the first Citizens.”

Father of the Constitution James Madison “was not averse to some restrictions on this subject, but could never agree to the proposed amendment” in part “because it will discourage the most desirable class of people from emigrating to the U.S.” In other words, not only were the Founders opposed to restricting the free movement of people into the United States, but they opposed restrictions on citizenship that they felt would discourage immigrants from using that freedom. Madison spoke of “great numbers” who would wish to come to the United States.

The goal of a “liberal” Constitution was one that the representatives repeated often (if not always pursued). In a separate conversation on the issue of qualifications to serve in office, Benjamin Franklin noted that the “Constitution will be much read and attended to in Europe, and if it should betray a great partiality to the rich, it will not only hurt us in the esteem of the most liberal and enlightened men there, but discourage the common people from removing to this Country.” On this amendment, he made the same point, stating he “was not against a reasonable time, but should be very sorry to see anything like illiberality inserted in the Constitution.”

Madison agreed, further arguing that the amendment “will give a tincture of illiberality to the Constitution.” Edmund Randolph of Virginia “reminded the Convention of the language held by our patriots during the Revolution, and the principles laid down in all our American Constitutions.”

James Wilson of Pennsylvania, who helped produce the first draft of the Constitution, was himself an immigrant from Scotland and raised the possibility of himself “being incapacitated from holding a place under the very Constitution which he had shared in the trust of making.” He noted that two other representatives—Robert Morris, originally of England, and Thomas Fitzsimons, originally of Ireland—shared the same situation. Furthermore, Wilson described “the discouragement & mortification [immigrants] must feel from the degrading discrimination now proposed,” noting that he had himself “experienced this mortification.” He said it “was wrong to deprive the government of the talents virtue and abilities of such foreigners as might chose to remove to this country.”

Madison and Franklin argued against the anti-immigrant conspiracy theories of the day that held that foreign governments would leverage their expatriates to their advantage. Franklin noted, “When foreigners after looking about for some other Country in which they can obtain more happiness, give a preference to ours, it is a proof of attachment which ought to excite our confidence and affection.” Madison added that foreign governments’ “bribes would be expended on men whose circumstances would rather stifle than excite jealousy and watchfulness in the public.”

Even those who favored a longer restriction on citizenship made clear that it was by no means out of opposition to immigration. George Mason of Virginia stated that he was “for opening a wide door for emigrants.” Moreover, he opposed an outright ban on naturalized citizens serving in the Senate in light of those foreigners who supported the cause of independence. Even Gouverneur Morris “ran over the privileges which emigrants would enjoy among us, though they should be deprived of that of being eligible to the great offices of Government; observing that they exceeded the privileges allowed to foreigners in any part of the world.”

Morris lost the vote 7 to 4, but the convention did adopt a higher standard of nine years on a second vote of 6 to 4. Yet despite this, their statements make clear that the Founding Fathers had a conception of citizenship and immigration that shares little in common with today’s nationalists. They wanted the most open possible society where foreigners could aspire to full citizenship in a reasonable time frame and receive equal treatment to citizens as soon as possible.

March 27, 2018 1:00PM

A New Approach To Poverty

A letter in the New York Times from Joel Berg, the chief executive of Hunger for America, caught my eye because it encapsulates the political debate about financial poverty and what to do about it.

Progressives believe that increasing the disposable incomes of the poor via minimum wage rises, expansions of tax credits and benefits (reform conservatives agree here), and government provision of services is the way to go. Plenty of conservatives want to reform existing welfare programs with work requirements or reforms to reduce disincentives  to encourage people to earn their way to higher incomes.

Let's put aside debate about what the "correct" measure of poverty is. What links the two is that both consider financial poverty (understood commonly) as being about nominal incomes. In one view you alleviate it by transferring money or have government take on the funding of services to reduce out-of-pocket costs. On the other, you incentivize people to earn it.

Income, however obtained, is of course crucially important to individual well-being. Money matters, as do the debates about the efficiency and trade-offs of all these programs.

But focus by policy experts, politicians and the media on the “income-based” narrative of poverty alleviation has left a huge blind spot: that many government policies worsen the finances of the poor by raising the prices of important everyday goods and services. This means any level of income goes less far in satisfying needs - worsening the financial plight of the poor directly, but also driving the very demands for more redistribution and higher minimum wages we see.

Think about housing and the role of zoning and land-use planning laws in raising prices. Child care costs are likewise driven up by stringent staff-child ratios in certain states, without appearing to raise overall quality. Highly regressive tariffs are imposed on imported clothing. Sugar programs and milk marketing orders raise both sugar and dairy prices.

The poor spend the highest proportion, on average, on what we might consider “essential” goods and services. Shelter, food, transport, utilities and apparel together account for 68.3 percent of the $25,318 spent on average by the poorest fifth of households. And yet in all these areas, policies at the federal, state and local levels often structurally raise market prices by restricting supply, raising compliance costs, institutionalizing monopoly power and much else.

Of course all of these interventions are introduced for other reasons: to prevent urban sprawl, to raise the quality of child care, to deal with environmental externalities or to “protect” certain industries, and much else. But the fact is these policies cumulatively raise the cost of living significantly for the poor, and increase the demand for higher government spending and intervention to alleviate poverty. In fact, it most cases they are doubly damaging, as often they reduce economic efficiency too.

This presents an opportunity for libertarians to offer a different perspective on the poverty debate. We should highlight how existing government interventions drive up the cost of living for the poor, and propose a targeted assault on them as a significant “first do no harm” anti-poverty agenda. Serious analysis on how these policies are regressive has been done before, but they are rarely all pulled together into a single narrative that says governments should prioritize undoing these interventions as a nationwide poverty reduction effort.

There are theoretical reasons to think that such an argument – that freer markets are part of the solution to poverty, rather than its cause – could get a better hearing today.

With the US deficit already projected to rise to 5.3 percent of GDP by 2019, the scope for raising structural government spending is low. Liberalization of these markets could even reduce the need for spending in certain areas by reducing the demand for government. We appear to have hit diminishing returns where redistribution is concerned anyway. Poverty rates have remained stubborn despite huge increases in transfer spending since the 1970s. Housing and child care costs are regularly in the news. Left-wing commentators and public intellectuals worry about the regressive nature of zoning and occupational licensing laws, and conservatives worry about regulations which impeded economic growth. More and more evidence (not least the recent paper on Seattle) now suggests that there are significant trade-offs for policies such as minimum wage increases too.

A “cost of living” agenda would be neutral on the welfare state and so could attract bipartisan support too. You do not have to believe existing anti-poverty programs have completely failed to acknowledge their effectiveness can be undermined by bad policies elsewhere which drive up living costs. You do not have to believe they are a success to believe that it is prudent and just to improve the financial position of the poor by reducing living costs as a quid pro quo for cutting welfare programs.

The main political barriers to such an agenda are two-fold. First, the vested interests who “win” from the various interventions and protections will resist. Second, comprehensive supply-side reform across a number of different areas and levels of government is tough to coordinate, and does not provide the focus that campaigning on one area - wages or tax credits - does.

Nevertheless, it is a worthwhile agenda. Before calling for major changes to welfare spending, one way or the other, politicians should realize the destructive consequences of their own policies on the living standards of the least well-off. That’s why over the coming few months, I am going to try to map out the contours of what an anti-poverty cost of living agenda might look like.

March 27, 2018 12:18PM

Making the Case, Once Again, That the Opioid Crisis Is a Product of Drug Prohibition, Not Doctors Prescribing to Patients

Martha Bebinger reports for National Public Radio station WBUR about the rise in fentanyl-laced cocaine. She cites numerous accounts of college students using cocaine to stay awake while studying for exams, or while attending campus parties, and then falling into a deep sleep after the initial cocaine rush. Some don’t wake up. Others get revived by the opioid overdose antidote naloxone.

Massachusetts state police recorded a nearly three-fold increase in seizures of cocaine laced with fentanyl over the past year. And the Drug Enforcement Administration lists Massachusetts among the top three states in the US for seizures of cocaine/fentanyl combinations. The DEA says the mixture is popularly used for “speedballing.” The original recipe used heroin mixed with cocaine in order to minimize the negative effects of the “come-down” after the rush of cocaine. Cocaine mixed with heroin is very unpredictable and dangerous. When it is mixed with fentanyl—five times the potency of heroin—it is even more dangerous.

There is a debate among law enforcement as to whether the cocaine is accidentally laced with fentanyl by sloppy underground drug manufacturers, or whether the mixture is intentional. There have been several reports of cocaine users who were unaware that the cocaine they were snorting or smoking contained fentanyl.

Connecticut state health statisticians keep track of opioid overdoses that included cocaine. While the majority of the time the overdose is from the classic “speedball” combination of heroin and cocaine, they have noted a 420 percent increase in fentanyl/cocaine in the last 3 years. However, Massachusetts does not register drug combinations when it records “opioid overdoses,” so it is unknown just what percentage of the 1,977 estimated opioid overdose deaths in Massachusetts last year were in combination with cocaine or other drugs. New York City keeps detailed statistics. In 2016, cocaine was found in 46 percent of the city’s opioid deaths, heroin and fentanyl were involved in 72 percent of opioid overdose deaths, and 97 percent of all opioid overdose deaths involved multiple drugs.

Meanwhile, President Trump and most state and local policymakers remain stuck on the misguided notion that the way to stem the overdose rate is to clamp down on the number and dose of opioids that doctors can prescribe to their patients in pain, and to curtail opioid production by the nation’s pharmaceutical manufacturers. And while patients are made to suffer needlessly as doctors, fearing a visit from a DEA agent, are cutting them off from relief, the overdose rate continues to climb.

The overdose crisis has always primarily been a product of drug prohibition—not of doctors treating patients.