If all you did was listen to the politicians and commentators, you’d think America’s health care system was on the verge of collapse. Nothing could be further from the truth. There are problems, but most of them have been caused by the self-same reformers who’ve been trying for more than two decades to “fix” it.
Much progress has been made since the New York Times and presidential candidate Bill Clinton declared a crisis existed and proposed solving it by increasing the role played by the government in managing the delivery of services and prices. Once the voters learned the potential adverse impacts on the quality of care they received, the debate changed.
Through it all, America has continued providing the best care anywhere. The spirit of invention and innovation that is the hallmark of our civilization exists robustly in the health care sector and, because it does, people are living longer, generally healthier lives. Yet, instead of encouraging that, scholars and policymakers continue to focus on flattening the cost curve through fiat. Price controls and rationing may reduce the perceived costs of medical care but won’t solve the problem.
The real solutions will come from innovations in care. That means continuing the development of radical new treatments that were unthinkable a generation ago and, in a few cases, going back to what was working before the government messed things up.
One place where looking back is already helping us move forward is kidney dialysis. In 1972, thinking they were helping, Congress passed legislation creating a Medicare program to pay for dialysis treatment and patients with end-stage renal disease gravitated to more expensive, center-based care using machines built for use in centers that are large, hard-to-use, and too expensive for home use.
In 1973, 40 percent of dialysis patients received treatment at home. Today, 90 percent receive treatment at dialysis centers and hospitals — at much greater cost and at greater risk to their health because the entire time they are there, checking in, checking out, waiting for and receiving treatment, they’re in the company of others who might be sick with something like COVID-19 that science tells us preys on those whose immune systems are compromised.
We spend more than $110 billion on kidney disease, the ninth leading cause of death in the United States. More than 37 million Americans have some form of this disease and the money paying for their dialysis comes from Uncle Sam through Medicare. That’s not sustainable.
The alternative to spending more is to spend smarter. The Trump Administration, which earlier this year announced a plan to “shake up” the kidney care medical complex is pushing for a return to home-based hemodialysis as a cost-saving measure and one more in line with patient concerns. His executive order on the issue included a direction to the Department of Health and Human Services to develop policies to reduce the number of Americans getting dialysis treatment at dialysis centers.
That’s the right move. The in-home care alternative will have the biggest impact in the shortest amount of time. The current care cycle, where treatment begins when it’s too late to stop disease progression. Must be broken. Instead of throwing more money at dialysis clinics, the priority is being repurposed in the right place, on early diagnosis, better patient education, and comprehensive and holistic care services.
Home-based options for hemodialysis, where blood is pumped out of the body under supervision into a machine that acts as a kidney and filters the blood before returning it to the body, and peritoneal dialysis, where blood vessels in the lining of the belly filter the blood with the help of a cleansing fluid, exist and should be utilized to the fullest extent possible.
Starting in 2021, ESRD patients will also be able to enroll in Medicare Advantage plans – great for the ESRD patients, but it could increase premiums for all seniors if we don’t help these plans negotiate for fair rates and prevent costs from rising. The Centers for Medicare and Medicaid Services should remove any roadblocks that exist to making this option viable.
With COVID-19 is changing how people go about their lives, the incentive to adapt and innovate in the health care sector is there. Telehealth, which was generally frowned upon before the current crisis, has taken off like a moonshot. Changing the kidney dialysis model to one where the care is mostly provided at home could liberate those receiving treatment now held prisoner by their illness and could lead the transformation of American medicine. Anyway, it’s worth a try.
Generally, when we think of multibillion-dollar military contracts, we think of advanced weapon systems or other cutting-edge technologies. However, a recent Pentagon contract that is intended to overhaul how the military moves service members’ household belongings has hit the news. In an attempt to both save taxpayer money and provide a streamlined, more reliable, and higher quality moving experience for military families, the Pentagon recently requested proposals to revamp and privatize these moving services for America’s military families. The initial contract is valued at more than $7 billion, and with future options and extensions, could exceed $20 billion.
The contract process has been marred with serious misfires. The problem is that the Pentagon originally awarded the Global Household Goods Contract to American Roll-On Roll-Off Carrier Group (ARC) under questionable circumstances. ARC’s capacity to actually perform the contract is doubtful. ARC’s bid was more than $2 billion higher than competitors who actually have experience and a real track record.
Another problem was that ARC’s proposal incorrectly listed Wallenius Wilhelmsen Logistics AS as its parent company. The listed parent company pleaded guilty to bid-rigging and price-fixing only four years ago and faced a fine of $100 million. On top of that, the Department of Justice indicted three former and current executives in the matter.
It turns out that ARC’s parent company is actually Wallenius Wilhelmsen ASA which didn’t plead guilty to bid-rigging or price-fixing. However, Wallenius Wilhelmsen ASA is the parent company of both ARC and the convicted company, Wallenius Wilhelmsen Logistics AS, so there is a real and formal corporate genealogical relationship between the ARC and the bid-rigging and price-fixing company.
The contract award was challenged or protested on these and other grounds (a total of nine specific grounds). Normally, protests take up to four months to review, but the Pentagon’s TRANSCOM took only two weeks to review its original decision before reinstating it. TRANSCOM only looked at the bid-rigging and price-fixing conviction issue and ignored all the other issues. TRANSCOM’s review was focused more on technicalities than real-life concerns.
Bid-rigging and price-fixing issue aside, the formal protests of the contract award to ARC included eight other grounds any one of which would be sufficient to overturn the contract award. As previously mentioned, ARC’s bid was more than $2 billion higher than other bids, which were found to be both responsive and technically solid. Why would the Pentagon be willing to pay an extra $2 billion for nothing?
It gets worse. Not only is ARC’s bid $2 billion higher than its competitors, but ARC doesn’t have the capacity to deal with the massive number of moves that will happen in 2021 due to the 2020 military moves that were postponed and disrupted by COVID-19. ARC has less than 100 employees to oversee all military moves and related subcontractors. Moreover, ARC does not have any experience in military moves, so ARC can’t seriously argue that they have state of the art experience that will allow them to get the job done with so few people.
This contract is a once in a generation chance to reorganize the military’s moving system to create better accountability and in the end better results for America’s military families, all while saving money. However, it seems unlikely to turn out well if the new moving contract is to be administered by a company with a corporate genealogy that includes bid-rigging and price-fixing. Moreover, ARC’s large team of subcontractors includes a large number with a questionable performance history. If the goal is to reduce costs and improve moving experiences, this seems a poor way to accomplish the stated goals.
The Pentagon has made a big mistake in awarding this contract to ARC. If the goal is to improve quality, streamline processes, and reduce costs, you don’t select a company with zero experience that lacks the capacity to deal with the significant number of military moves that occur every year, and that has bid-rigging and price-fixing convictions with $100 million fines in its corporate family tree. On top of all of that, you don’t overpay by $2 billion.
It is time for the Pentagon to get this right and not dig in its institutional heels in defense of its original misjudgment.
The US House of Representatives is getting closer to voting on the Butch Lewis Act, which failed to pass last year. While a number of provisions in the current version of the legislation make it an unworthy solution, the truth is the problem it attempts to address is real and the legislation even with its flaws does create the opportunity to amend and improve it so that a serious financial crisis can be avoided. Conservatives should consider this an opportunity.
Many multi-employer pension and defined pension plans are now on the brink of failure. They carry over $600 billion of unfunded liabilities and are dangerously close to failing. Millions of retired Americans in states like Pennsylvania, Wisconsin, Michigan, Minnesota, Ohio, Nevada, Florida, Colorado, Maine and New Hampshire could lose their retirement. If that happens, they will be thrust onto the welfare rolls and the fruits of their life’s work will be lost.
Even those who don’t have such pensions, are at risk. The 2008 housing bubble that triggered a huge economic slowdown, impacted everyone — not merely those whose mortgage was foreclosed upon. And we spent the next five plus years in economic turmoil and that was used as an excuse to grow the government. So we paid twice — first with the economic downturn and lost jobs and second, when government spending and debt grew dramatically and government’s penchant to over regulate drastically expanded.
President Trump could ensure his reelection in 2020 and conservatives in the House could insure a return to the majority as well — if they can fashion a sustainable, conservative fix to the pending multiemployer pension plan crisis.
In 2016, Trump won a number of states narrowly — states like Pennsylvania, Wisconsin, and Michigan. In those states and many others — Ohio, Colorado, Nevada, Minnesota, Maine, New Hampshire and Florida — there are millions of citizens who are participants in multi-employer pension plans. Each of these potential voters has family and friends which only multiplies their electoral influence. By stepping in and averting this potential economic pitfall, Trump would win millions of blue collar voters in key states. Likewise, GOP congressmen who had a difficult year in 2018, could find themselves swimming with the current and regain the majority if they can take the opportunity to use the Butch Lewis Act as a starting point to address the multiemployer pension plan crisis in a conservative and sustainable way. Even Senate Republicans could see their majority grow if they move helpful legislation.
In Pennsylvania, there are more than 493,000 participants in multi-employer pension plans. In Michigan, there are more than 440,000 multi-employer pension participants. In Wisconsin, there are almost 150,000. Ohio has almost half a million. Florida has more than 340,000. Colorado has almost 200,000. In Maine, more than 50,000. In Nevada almost 135,000. In Minnesota, more than 278,000.
In each case, those numbers could either expand upon Trump’s 2016 victory, or flip a state that he narrowly lost in 2016, to make it part of his expanded victory in 2020. And once you account for family friends and relatives, those numbers only increase the potential for an impressive reelection victory.
For GOP members of Congress, this provides a powerful way to win the support of working class voters and pave the way to reclaiming the majority in the House and help the Senate preserve and grow its majority.
It may be tempting to leave this problem to fester and then let some future President and Congress deal with it when this pending crisis becomes a full blown, current crisis. But that’s dangerous and risky. The far Left has repeatedly signaled that they won’t let a “crisis go to waste.” They will use any crisis as an excuse to grow government, bust the budget and further smother economic opportunity with burdensome regulations. So solving this now is actually the conservative thing to do. It protects taxpayers and it can keep government growth in check.
A workable and permanent solution will include a number of important principles. First, the affected pension plans must be reformed by requiring them to meet more rigorous and realistic actuarial standards. Second, the reform must engage all the stakeholders to share in the costs, including at least temporarily, the retirees — rather than passing off the costs to taxpayers. Third, modest loan guarantees must be authorized to help pension plans that make the required reforms. This will allow them to get through their short term cash crunch and get back on a firm actuarial footing when the loans would be fully repaid. Fourth, the Pension Benefit Guarantee Corporation (PBGC) must be reformed to make it function as a real insurer where risks and cost balance out. If nothing is done, the PBGC will be bankrupt within 6 years — leaving taxpayers to make good on its promises which will cost hundreds of billions.
If President Trump and GOP conservatives become the champion of a wise pension plan solution like this, they can easily win re-election in 2020, regain the House majority, and expand their Senate majority. That is why the Butch Lewis Act with all its problems, presents conservatives with a real opportunity to fashion a solid conservative solution that benefits all Americans.
By Elizabeth Harrington • Washington Free Beacon
The special counsel investigation into the 2016 election has cost taxpayers over $25 million and counting.
Robert Mueller’s office released its latest expenditures spanning from April 1, 2018, through Sept. 30, 2018, finding the special counsel racked up over $8.4 million in five months.
The statement of expenditures reveals Mueller and his team of lawyers cost over $4.5 million for salaries and rent, and an additional $3.9 million in resources from the Department of Justice.
Personnel compensation and benefits cost taxpayers $2,886,270, including $1 million for special counsel office employees, and $1.9 million for Department of Justice employees who have been detailed to the investigation. Continue reading
While Puerto Rico is still recovering from last year’s severe hurricane damage, the all too predictable push to blame the tragedy on the Jones Act appears to have passed — for now. But almost like clockwork, this false blame game will be replayed whenever opponents of the Jones Act think they can spread falsehood during times of tragedy to gain a political advantage. When that next moment comes, the tired, oft-repeated, and baseless arguments will be trotted out once again.
The Jones Act, or more precisely, the “Merchant Marine Act of 1920,” simply requires goods shipped between U.S. ports to be shipped on American vessels crewed by Americans. It does not limit foreign vessels from bringing goods to US ports. It only prevents foreign ships from carrying cargo between two or more US ports. This has a number of homeland security benefits as well as ensuring that our military has a robust merchant marine sea lift capability and ship repair industry.
Some may assume that Americans are burned out on debating the Jones Act’s merits every time there’s a hurricane or some other event that supplies the pretext to blame the nearly 100 year old law. But when I recently spoke at a public policy conference, I saw Continue reading
Some Republicans were complaining that they didn’t know what was in the massive $1.3 trillion “omnibus” spending bill they voted on this week. But it’s what’s not in the bill that’s the most troubling.
Republicans used to love to trot around copies of ObamaCare, pointing out how its massive size — around 2,300 pages — was a sign of runaway government.
The spending bill Congress just approved is nearly as big, weighing in at 2,232 pages. And, like ObamaCare, no one who voted on it had read the bill before casting their ballots.
Then there’s the amount of money we’re talking about. That $1.3 trillion is what will be spent in just the next six months. And that represents just a fraction of what the government will spend, since it doesn’t include Social Security, Medicare, Medicaid, ObamaCare or welfare. Continue reading
By Lewis M. Andrews • National Review
Talk to the people of Illinois about America’s looming public-pension crisis, and they’ll tell you it’s not looming — it’s already here. This month, a statute went into effect giving Comptroller Susana Mendoza the right to make up for any town or county’s delinquent pension payments by seizing its share of sales, excise, and other taxes collected by the state. The result is that municipalities across Illinois have been scrambling to either cut services or raise taxes.
Mattoon officials have announced that ambulance services will be scuttled to pay pension bills a half-million dollars higher than last year’s, while Springfield’s budget director, Bill McCarthy, says he will have to “reduce other services just to meet pension obligations.” Normal will handle the problem through property-tax increases, while Danville has imposed a separate “public safety pension fee,” which will cost residents up to $267 annually. East St. Louis, which depends almost exclusively on its share of tax money from state’s Local Government Distributive Fund, could soon see its entire budget confiscated to satisfy pension obligations.
With a national pension asset shortfall calculated as high as $6 trillion — and with accelerating benefit payouts to retiring Baby Boomers — Illinois is sadly not the only state where voters are being hit with revenue surcharges or deprived of essential services. Florida localities will have to allocate an additional $178.5 million in their upcoming budgets to pension payments; Continue reading
Government shutdowns are petty, but they're rarely as detrimental as pundits and politicians fear.
By US News•
For various reasons it’s become popular to threaten to shut down the federal government. Whether that goes back to the Reagan years when Democrats would run out the clock on the fiscal year to try and force spending increases the White House didn’t want or the years in which the tea party Republicans decided the American people would stand with them in closing the government to stop Obama initiatives, there are people in government who believe hanging the “Closed” sign on the Washington Monument is a political winner.
It isn’t. It makes everyone involved look petty and small. The American political process is by design deliberative. The founders designed a system that forced compromise between regions of the country, between politicians of dissimilar views and of competing interests at all levels of government. Pushing the government to close because there’s no money to run it is akin to taking one’s ball home from the playground because the other kids will not agree to play the game by the rules you want.
All that said, the government never really shuts down. The president is allowed far too much discretion to declare services essential, meaning all kinds of people get to stay on the job without pay, working away as usual processing government checks, funding grants, administering programs and doing all kinds of things that, while they might be the purpose for which people get up and go to work each day, would hardly be classified as “essential” in any kind of real emergency. Continue reading
Earlier this month, President Donald J. Trump signed a space policy directive to “restore American leadership in space.” To the excitement of many, this directive includes sending men back to the Moon and perhaps even Mars. The prospect of making dreams a reality once again is enthralling, something we will do, echoing a previous chief executive, not because it is easy but because it is hard.
To do all this, to optimize performance and ensure a successful, modern-day space program, government appropriators must adhere to a standard set of business protocols. It is essential NASA and the White House have clear goals in mind and ensure the interests of the country are at the heart of every mission. Stating the objective of going to the moon is not enough; bureaucrats need to take the process a step further and iron out precisely what it wants to achieve, how much it will cost to do so, and why the country will be better off as a result.
It is true few companies would turn down a government contract – after all, no one’s checks clear better than Washington’s – but that is not license for decision-makers to issue them carelessly. Every mission must have the clear intent of either advancing national security interests or significantly increasing the country’s scientific progress before the disbursement of taxpayer funds begin. The general rule of thumb should be that if extensive research from private firms has not been conducted on a given topic, it is likely not worth the federal government pursuing.
By Heather Wilhelm • National Review
Ah, the holiday season. It’s a magical time, bursting with joy and merriment, the laughter of children, jolly parties, twinkling lights, mildly terrifying mall-dwelling Santas . . . and the faint sounds of caterwauling blue-state politicians shrieking that the GOP tax bill signals the end of civilization as we know it.
Can you hear it? Fire and brimstone! The weeping and gnashing of teeth! According to Nancy Pelosi, this reshuffling of government regulations amounts to “Armageddon” and “the worst bill in the history of the United States Congress.” California governor Jerry Brown labeled the tax bill “evil in the extreme.” According to Bernie Sanders, the proposal amounts to “class warfare” and “one of the greatest robberies in American history.” In terms of sheer melancholy drama, comedian Patton Oswalt might win the prize: Because of the GOP tax bill, “there’s no America now. Not the one we knew. Sorry, feeling real despair this morning.” Continue reading
by Ali Meyer • Washington Free Beacon
President Donald Trump’s proposed budget for 2018 would reduce the deficit over the next decade by $160 billion and increase GDP at the same time, according to an analysis from the Congressional Budget Office.
Trump’s budget proposes a cut back in mandatory and discretionary spending that would not only reduce the deficit, but the debt as well.
Relative to the size of the economy, federal budget deficits are projected to decline by 2.6 percent to 3.3 percent of gross domestic product over the next 10 years. This would mean that the deficit would be roughly one-third smaller than it was originally projected to be.
Trump’s budget also aims to reduce the debt to 80 percent of GDP, which is 11 percentage points below the budget office’s baseline. By the end of the next decade, debt held by the public is projected to decline by 0.6 percent of GDP. Continue reading
by Ali Meyer • Washington Free Beacon
Subsidies for health insurance purchased through the marketplaces established under the Affordable Care Act are projected to more than double over the next decade, according to a report from the Congressional Budget Office.
The report, which evaluated spending for various means-tested programs or programs that offer benefits to those who earn income under a certain threshold, found that spending on Obamacare subsidies will total $42 billion in 2017 and are estimated to more than double to $97 billion by 2027.
In fiscal year 2016, payments for subsidies totaled $31 billion and, according to the budget office, payments will grow rapidly in 2017 and 2018 largely due to the growth in enrollment. Continue reading
by Ali Meyer • Washington Free Beacon
Outstanding federal debt is projected to hit $28.2 trillion over the next decade, according to a report from the Congressional Budget Office.
At the end of this year, outstanding federal debt is expected to climb to $19.4 trillion and to rise by $8.8 trillion in the next ten years.
The federal government’s budget deficit, which is the difference between how much money the government spends and how much money it takes in through tax collection, will be $590 billion by the end of 2016, $152 billion more than the previous year. Continue reading
The Virginia Governor put together a large economic development package—and bragged about bringing jobs—on the basis of fabricated promotional materials from a Chinese company.
by Steve Albertson • The Bull Elephant
Just over a year ago, in November 2014, Virginia Governor Terry McAuliffe beamed with pride at having concluded a deal to bring 349 jobs to the ailing economy around Appomattox. The plan was to use various state economic development incentives, including an upfront payment of $1.4 million from the Governor’s Opportunity Fund. From the Governor’s press release at the time:
Governor Terry McAuliffe announced today that Lindenburg Industry, LLC, a subsidiary of a Chinese-owned corporation, will invest $113 million to establish an industrial honeycomb manufacturing operation in the Town of Appomattox in Appomattox County. This project, which represents the first new company announcement in Appomattox in 15 years and the largest since Thomasville Furniture began construction in 1972, is a direct result of the Governor’s meeting with company officials in Beijing, China during his Asia Marketing Mission last month. Virginia successfully competed against North Carolina for the project, which will create 349 new jobs.
But, as it turns out, McAuliffe’s enthusiasm about prevailing over the Tar Heel State was misplaced. You see, the Chinese “company” has now apparently bailed out, without refunding the Governor’s check. It seems that folks in North Carolina were a wee bit more responsible with taxpayer funds. They did background research that the Governor’s office did not. In fact, an investigation by The Roanoke Times found that: Continue reading