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Why Sen. Bernie Sanders' "Medicare-for-All" Won't Work

Senator Bernie Sanders (D-VT) recently said, “…we have to move toward a Medicare for all, single-payer system.”

For years now “Medicare-for-All” has been the rallying cry for single-payer advocates.  It is, if nothing else, shrewd marketing.  Medicare is very popular with the American public.  For example, a Harvard School of Public Health 2013 survey found 72 percent of respondents had either a very favorable or somewhat favorable opinion of Medicare.  What better way to promote single-payer than to rename it after a popular program?

However, you will seldom see advocates of Medicare-for-All explain exactly why Medicare is so popular.  In other words, presumably Medicare is popular because it functions well, but why does it function well?  

The closest such advocates come is an explanation like this:

[Medicare-for-All] would replace today’s welter of private health insurance companies with a single, streamlined public agency that would pay all medical claims, much like Medicare works for seniors today.

But surely a program like Medicaid has those qualities too, yet Medicaid is lousy and, hence, far less popular.  After all, you don’t see the left calling for “Medicaid-for-All.”  

Furthermore, wouldn’t it be useful for all public health care programs to know why Medicare works so well?  Presumably if we understood what it was about Medicare’s structure that caused it to work well, we could then shape programs like Medicaid in a similar way so that they function much better.

As I explain in chapter two of my forthcoming book, Medicare’s Victims, Medicare’s success is based not on anything in Medicare’s structure, but on political power. Seniors, Medicare’s main population, have a great deal of political power—the ability to influence Congress—when it comes to Medicare policy. 

For starters, seniors vote at higher rates than the population at large in both presidential and non-presidential elections. For example, here are the voter turnout rates of those ages 65-74 versus all ages in 2010 and 2012:


Seniors receive good coverage from Medicare because their voting behavior gives them political clout. If they have serious problems with Medicare, it won’t be long before members of Congress hear about it. In turn, members of Congress know that to maximize the support they receive from seniors means keeping seniors satisfied with their Medicare coverage and, if possible, expanding the benefits they receive under Medicare. 

Not only do seniors vote, because so many live in retirement communities and visit senior centers, they are easy to organize should the need arise.  Exactly how many retirement communities there are in the U.S. is not known. However, retirement communities that include medical facilities like nursing homes—known as Continuing Care Retirement Communities—number about 2,000. Senior centers—places where seniors can gather for socialization and support—number about 11,000.  With that degree of political power, seniors are seldom denied the services they want in Medicare.

Groups that lack such political power tend not to fare as well under Medicare.  For example, there are roughly 9 million disabled people on Medicare.  Yet to get on Medicare, most disabled people have to endure a two-year waiting period.  Furthermore, the disabled on Medicare have, on average, more difficulty accessing and affording medical care than seniors.  The reason is that the disabled vote at much lower rates than seniors and are not nearly as easy to organize.

Political power (or the lack of it) also goes a long way in explaining why Medicaid is a lousy program.  Medicaid is the government health care program for the poor. The poor vote at some of the lowest rates of any group in our country.

So, would a system of Medicare-for-All improve health care for the poor?  Would it, as one pundit recently claimed, “improve healthcare for tens of millions, perhaps even hundreds of millions, of Americans”?  Well, unless Medicare-for-All changes the voting habits of the poor, then no, it wouldn’t.  

Members of Congress want to get reelected, and they will cater to those groups who are important to that goal and neglect groups that are not.  Thus, under a system of Medicare-for-All health care resources will tend to go toward groups that have political power, such as seniors and the relatively well-to-do.  Those without such power will lose out.


Medicare's Victims: Available One Week from Today

My book, Medicare’s Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physicians, will be available next Monday, July 6.  You can pre-order now at  Both paperback and Kindle versions are available.

In the coming days I’m going to blog about some of the themes in the book.  For today, I’m going to leave you with the description of the book and the praise it has received from John C. Goodman:

Summary: In Medicare’s Victims, you’ll read the intimate stories of patients and physicians who have struggled with Medicare, and then you’ll learn how the particular Medicare policy has caused their plight. The patients who are victims of Medicare are often the sickest of the sick, whether it is the disabled who are on Medicare’s two-year waiting period; seniors who fell into Part D’s donut hole; or patients who are harmed because they receive too much treatment or not enough. The physicians who are victims are ones who struggle to provide the best care for their patients while Medicare’s reimbursement system, in effect, punishes them for it. They all tend to have one thing in common: lack of political power. For example, people who are seriously ill are relatively few in number. As such, they do not have the numbers necessary to impact elections. Further, people who are ill are generally not engaging in the networking, meetings and other activities necessary to form effective political organizations. Thus, Congress seldom feels the pressure to change the policies that harm these people. In the end, you’ll learn how we can reform Medicare so that patients and physicians are put in control of their own medical decisions and, thus, will be much less likely to be victimized.


Praise: David Hogberg has produced a tour de force. He has identified Medicare’s hidden victims and explained why bureaucracy, price-fixing, suppression of the marketplace and unwise regulations all combine to deny millions of patients the high quality, low cost medical care they should be receiving. I know of no other place where you can find a more comprehensive treatment of Medicare’s worst problems. This is must reading for everyone in health policy. —John C. Goodman, President of the Goodman Institute


How Will the Pope's Position Affect the Poor and the Presidential Election?

How will Pope Francis’s climate change encyclical impact the world’s poorest citizens? And will it affect the upcoming presidential election? Bonner Cohen of the National Center for Public Policy Research and Bill Galston of the Brookings Institution had a thoughtful conversation about the possibilities in their June 24 appearance on the Al Jazeera America program “Inside Story with Ray Suarez.”

“Millions of Catholics live in parts of the world which are very vulnerable,” noted Cohen. “What we really don’t want to do, I think, is impose policies that would deny these people access to electricity or make their access to electricity more difficult.  That’s where I think the Pope has to be very very careful here, because if he favors policies that will ultimately put some of the good things about the modern life out of the reach of the most vulnerable, he will ultimately wind up perpetuating poverty and putting himself behind policies that will lead to shorter life expectancies, and that’s not something I think any of us want.”

So how will presidential candidates respond to Pope Francis’s climate change encyclical, and will it matter? 

Cohen expects the Republican candidates “to say, ‘Listen, we need to be very careful in going about this, because first of all, do no harm.  Don’t impose policies that ultimately hurt people, denying them access to the many amenities of modern ingenuity that have our lives much more livable than our parents, grandparents and great-grandparents could possibly have imagined.’

“On the Democratic side,” Cohen continued, “you will probably see the Pope’s words evoked many many many times.”

However, will all of this even matter in the presidential election?  Cohen notes that Pew Center surveys indicate that American voters see climate change as last priority.


Horace Cooper Rumbles with Thom Hartmann on Trade, Trans Fats, Climate Change and Women's Health Funding

On June 17, Horace Cooper held back no punches as part of “The Big Picture Rumble” on the RT Network. Host Thom Hartmann moderated the panel that also included Bryan Pruitt of and TJ Helmstetter of the Progressive Change Campaign Committee.

Flabbergasted that congressional Republicans were supporting President Obama’s controversial trade bill, liberal host Hartmann asked the panel why, and Cooper bluntly responded: “It turns out Trade Promotion Authority is a positive good in and of itself and we are happy, we are HAPPY, to see the President of the United States embrace that concept.”

Next topic: the FDA’s recent ban of trans fats.  While the show’s liberals thought this issue was a no-brainer, Pruitt noted that industry was already making the move toward healthier food without requiring a mandate, and Cooper pointed out that this ban will likely have an economic impact. “The problem is that you’re targeting an industry and making them bear all of the costs while we claim to spread out the benefits to all of society,” Cooper noted. “That’s how you kill jobs.”

Does the Pope’s new encyclical on climate change promote policies that help — or hurt — the poorest in the world?  Cooper says the truth isn’t what you might expect: “Poor people are disproportionately impacted by climate change regulation policies.  They are overwhelmingly going to be the front line of those harmed by these policies.”

On the issue of women’s health funding, Cooper said there’s a quick solution for those wanting to protect that budget line item: “This problem will go away if Planned Parenthood and the other abortuary operators decide that they’re no longer going to do that and they’ll just stick to STD testing, they’ll stick to cervical screenings and the like, and then you won’t have this problem… We are funding abortion mills all across this country and Americans… don’t support them.”


Justice Scalia May Be Snarky, But He's Also Quite Correct

Justice ScaliaJustice Scalia

The Washington Post's Wonkblog staff, in an article published at 10:33 AM today, says Associate Justice Antonin Scalia "may have already won for snarkiness" in his dissent in the Obamacare case handed down today.

It is amusing that the Post published this mere minutes after the decision was handed down, making it impossible for the Wonkblog staff to have read the entire decision and opinions. I suspect they went straight to Justice Scalia's dissent and read little, if anything, else.

So Justice Scalia wins for snarkiness in the Post's eyes not just for today, but apparently for his entire tenure at the high court.

Regardless, the article is worth reading, as it quotes a page and a half of Scalia's very on-point opinion, saving readers the need to read less perceptive justices before getting to Justice Scalia.

Or you could just read Justice Scala below. If you don;t have time for all of it, read the part at the end I put in bold. Justice Scalia is a good man. We need more like him.

Today's opinion changes the usual rules of statutory interpretation for the sake of the Affordable Care Act. That, alas, is not a novelty. In National Federation of Independent Business v. Sebelius, 567 U. S. ___, this Court revised major components of the statute in order to save them from unconstitutionality. The Act that Congress passed provides that every individual "shall" maintain insurance or else pay a "penalty." 26 U. S. C. §5000A. This Court, however, saw that the Commerce Clause does not authorize a federal mandate to buy health insurance. So it rewrote the mandate-cum-penalty as a tax. 567 U. S., at ___ - ___ (principal opinion) (slip op., at 15 - 45). The Act that Congress passed also requires every State to accept an expansion of its Medicaid program, or else risk losing all Medicaid funding. 42 U. S. C. §1396c. This Court, however, saw that the Spending Clause does not authorize this coercive condition. So it rewrote the law to withhold only the incremental funds associated with the Medicaid expansion. 567 U. S., at ___ - ___ (principal opinion) (slip op., at 45 - 58). Having transformed two major parts of the law, the Court today has turned its attention to a third. The Act that Congress passed makes tax credits available only on an "Exchange established by the State." This Court, however, concludes that this limitation would prevent the rest of the Act from working as well as hoped. So it rewrites the law to make tax credits available everywhere. We should start calling this law SCOTUScare.

Perhaps the Patient Protection and Affordable Care Act will attain the enduring status of the Social Security Act or the Taft-Hartley Act; perhaps not. But this Court’s two decisions on the Act will surely be remembered through the years. The somersaults of statutory interpretation they have performed (“penalty” means tax, “further [Medicaid] payments to the State” means only incremental Medicaid payments to the State, “established by the State” means not established by the State) will be cited by litigants endlessly, to the confusion of honest jurisprudence. And the cases will publish forever the discouraging truth that the Supreme Court of the United States favors some laws over others, and is prepared to do whatever it takes to uphold and assist its favorites. I dissent.


Rush Limbaugh 1, Pope Francis, 0 - But Why?


Rush Limbaugh, at the end of the first hour of his June 22 show:

It's not just climate change for the Pope. The Pope has now said that the weapons manufacturers cannot call themselves Christians, yet he wondered why the allies did not bomb the railroads leading to the concentration camps. I'm not kidding you here.
Regrettably, Rush really isn't kidding. The Pope is saying it can be immoral not to use weapons, but it is immoral to make them.

How can it be immoral to make something if it is immoral not to use them afterward?

As a condition of employment, the Swiss Guards who guard popes are required to be Roman Catholics. They also are trained in the use of weapons and are prepared to use them.

Does Pope Francis believe his guards are bad Catholics because they are prepared to use weapons to protect his life?

Pope Francis apparently has chosen to speak out on public policy without first developing consistent views.

I think his decision to do so is unfortunate. On the matter of guns, he comes across as confused and even hypocritical. This does no benefit to the Pope nor to his cause (gun control?).

Pope John Paul II and Pope Benedict earned the respect of tens of millions, if not hundreds of millions, of people, to the tremendous benefit to the Catholic Church specifically and to Christianity and to the world in general. Is Pope Francis about to squander it?


Project 21's Kevin Martin Commends SC Governor Nikki Haley for Pressing for Removal of Confederate Battle Flag

Kevin MartinKevin Martin

Project 21's Kevin Martin is praising South Carolina Governor Nikki Haley's decision to push for removal of the Confederate Battle Flag from that state's capitol grounds:

I commend South Carolina Governor Nikki Haley for making the courageous call for the removal of the Confederate Battle Flag from the capitol grounds in Charleston.

As a Southerner myself, I have become accustomed to seeing the Confederate Battle Flag in and around the South over the years. For some, it is about their heritage. For others, with racist views, it is a tool and symbol of intimidation. For many Black Americans, the Confederate Battle Flag is a reminder of the Dixiecrat South that was resistant to the equal treatment of Blacks in America.

Dylann Roof was one of those people who thought he could use the Confederate Battle Flag as his own personal tool of intimidation. He took his racist hatred even further when he entered Emanuel AME Church with the intent to gun down innocent Black worshippers in cold blood in an action he thought would spark the race war he desired.

Mr. Roof must now sit in his jail cell with the realization that he only brought the people of Charleston and South Carolina further together in unity. That unity has lead many in South Carolina to realize that now is time to remove the Confederate Battle Flag from the capitol grounds.

Like Governor Haley, I realize a way to discredit people like the reprehensible Mr. Roof is to take away the symbols that inspire them. There will be those who see this as a partisan political victory and others as a partisan political defeat. I say to both that we cannot allow this racist to divide us. We must remember the victims of Emanuel AME Church first and foremost. If we allow partisanship to drive what is right and what is wrong, people like Mr. Roof are the real winners.

As I am a veteran, Southerner and American, freedom of expression has always been near and dear to my heart. If you are proud Southerner with ancestors who fought in the civil war, feel free to fly the flag of the Confederacy, but also remember that the Confederate Battle Flag has been hijacked over time by racists like Dylann Roof, and that, for many Black Americans, the battle flag is a symbol of resistance to our equal treatment in the South by the civil rights era racist Dixiecrats.

We are all Americans at the end of the day and we will heal from this latest mass shooting by an individual who was motivated by hate, but unless we remain united once the dead have been buried and the mourning is over then we have handed victory to people like Mr. Roof.

Removing the Confederate Battle Flag from the capitol grounds of Charleston is a first step forward in the direction of unity.


Medical Records: Got Privacy?

Twila Brase is a public health nurse and the founder of the Citizens’ Council for Health Freedom.  CCHF specializes in protecting medical privacy and in ways to opt out of ObamaCare and other government programs.  (For example, check out CCHF’s website called ITSMYDNA.ORG.)

In the below interview Brase explains how privacy is at great risk due to ObamaCare and HIPAA, how our medical records could be used in the future to deny us care, and what she means by our health care system needs a “Wedge of Freedom”.  It’s about a half hour long, but well worth your time.



Health Care Odds & Ends: ObamaCare Exchanges One Problem For Another

1. First the “Front End” of the ObamaCare website was a problem.  Now the “Back End” is.  The Office of Inspector General for the Department of Health and Human Services released a report stating that the Center for Medicare & Medicaid Services “did not effectively ensure the accuracy” of $2.8 billion in exchange subsidies.  That’s bureaucracy-speak for “a lot of subsidies went to people who shouldn’t have received them.”

The Washington Examiner notes:

In late 2013, when was a useless, glitchy mess for members of the public, government officials had another, less-noticed problem on their hands.

Everyone knew — many from experience and many from the news coverage — that the website the government had built to connect Americans with subsidized insurance policies did not work very well on the front end for months after its launch. The dirty secret, though, was that the back-end of the site had not even been built — the part that was supposed to make sure subsidies were set properly and insurers received payments on behalf of each customer.

Congress noticed this even then, and asked Health and Human Services Secretary Kathleen Sebelius about it in a December 2013 hearing. She reassured members that it would be up and running eventually, and added, “There’s a manual workaround for virtually everything that isn’t fully automated yet.”

Only now it is becoming clear how inadequate the agency’s preparations had been.

Yeah, about $2.8 billion worth of inadequacy.

2. Of the people who faced higher insurance costs due to ObamaCare, only 1 in 5 received a subsidy. Ed Haislmaier at the Heritage Foundation notes that while the “stated purpose [of the exchange subsidies] was to help more low-income individuals purchase health insurance, the subsidies also served to mask the significant health insurance premium increases that would inevitably result from the law’s new insurance benefit requirements and regulations.  For instance, if a 45-year-old received $540 annually in subsidies, he may not realize that the premium for the lowest-cost health insurance plan in his area actually had increased by $600 a year thanks to Obamacare regulations—because the government was paying most of that additional cost.”

The problem is that “the design of the subsidies also created one of the Affordable Care Act’s biggest inequities. Namely, the number of people getting the new subsidies is only a small subset of the much larger number of people whose coverage is subject to the law’s new requirements that drove up health insurance premiums.”  ObamaCare “regulation increased health insurance costs for 20.9 million covered by individual or small-employer group policies in the 34 states affected by King v. Burwell. Of those, 18 percent received an offsetting subsidy and 82 percent did not.”

Hope and change!

3. 41 percent of people on the exchanges who were previously insured would like their old insurance back.  The Foundation for Government Accountability (FGA) has released an extensive survey of people who have insurance on the ObamaCare exchanges.  Turns out, all is not as rosy as ObamaCare supporters claim.  (I know, what a shocker.)  For example, most people did not purchase a plan on the exchange because it was cheaper:


And about 4 in 10 would like to have their old policy back:


The survey also asked, “ObamaCare outlawed many health insurance plans that were available before 2014. If Congress re-opens the law, should they allow people to buy the types of plans that used to be sold before 2014?”


The FGA survey has loads of good stuff. When you get time, take a look.


ObamaCare Premium Hikes for 2016—Ignore Them at Your Own Risk

Today the National Center is releasing my latest National Policy Analysis entitled “ObamaCare Premium Hikes for 2016—Ignore Them at Your Own Risk.”

It examines in depth the requested premium increases for individual policies on the ObamaCare exchanges for 2016 that were released via the federal website “Rate Review” back in early June.  The release of this data garnered a lot of attention, since many of the requested increases were very high.  This elicited a response from ObamaCare supporters that can be best summarized as:

At Mother Jones, Kevin Drum said not to worry, that “we’ve all seen this movie before.” Drum claims these are just rates that insurers are requesting. A “few months from now, the real rate increases—the ones approved by state and federal authorities—will begin to trickle out,” he wrote. “They’ll mostly be in single digits, with a few in the low teens. The average for the entire country will end up being something like 4-8 percent.”

Well, this is something we’ve seen before.  The problem, as this table shows, is that it is getting worse:

There were 121 policies with requests for premium hikes above double digits in 2015, while there are 231 in 2016, an increase of almost 91 percent.*  For 2016 there are 26 policies with requests for hikes over 40 percent, and 12 over 50 percent.  There were none in 2015.

And Drum will probably be disappointed if he thinks state and federal regulators will reduce the rate increases for 2016.  Of the 38 exchanges examined in the NPA, only Kansas, Oregon, Texas and Washington did not approve all of the rate increases insurers requested for 2015. And only one policy was denied the requested rate increase in each of those states.

In short, the rate hikes for 2016 represent the beginning of the death spiral for the ObamaCare exchanges. Read more here.

*Initially said 46 percent.  Sorry for the error.


Ambulance Transport and Medicare's Victims

On July 6, I have my first book coming out entitled Medicare’s Victims: How the U.S. Government’s Largest Health Care Program Harms Patients and Impairs Physicians. One of the main themes of the book is that patients and physicians who struggle with Medicare usually lack political power.  In other words, they lack the ability to influence Congress to make changes in Medicare policy that would help them.

There are many reasons why they lack political power, but a big one is that they simply lack the numbers.  That is, there are too few of them to have any impact at the voting booth or to hire lobbyists to lobby on their behalf.

Case in point is a new program that Medicare has launched in New Jersey, Pennsylvania and South Carolina to cut down on the cost of non-emergency ambulance transports.  Unfortunately, the crack down has put some patients like Robert Browning, who genuinely need the ambulance ride, in a tough situation.

Browning is bed-ridden with leg wounds and needs an ambulance transport to the Community Medical Center for weekly treatment.  Browning now has to get approval from the Centers for Medicare & Medicaid Services (CMS) before Medicare will pay for an ambulance ride.  Browning gets his ambulance rides from Abba Medical Transportation.  Unfortunately, he is one of 20 patients who “whose claims were denied, and [Abba] had to stop transporting most of them, officials said. They couldn’t understand the reason; at times it seemed like they couldn’t get patients approved no matter how much documentation they provided.”

Now, Browning has to pay $250 out of pocket for each ride.  ”’We’re paying for it now,’ Kathie Browning said. ‘I don’t have a choice.’”

Some background:  Medicare pays for ambulance rides to the hospital and other facilities for patients who are confined to their beds and cannot be moved in a wheelchair. However, some ambulance companies seem to be abusing the service (and, perhaps, some patients are too). The cost of non-emergency ambulance transports have skyrocketed in some states.  In California, such transports rose 554 percent from 2002-2011.  In New Jersey, it rose 144 percent.  So, last year, CMS began a pilot project to eliminate such abuse.

But as happens with so many government efforts to root out fraud and abuse, those with genuine need get caught up in the net meant to catch the fraudsters.  That appears to be what has happened with Browning.

My guess is that this program will eventually expand beyond the three states in the pilot project, and patients like Browning will suffer.  The reason?  Well, here’s how Alide Walker, billing manager for Abba, put it: “I feel like they’ve been given the word, ‘You need to save money,’ and they’re saving money on the backs of patients that don’t have a voice for themselves.”

That’s correct.  There are no groups lobbying for Medicare patients who are having trouble getting access to non-emergency ambulance rides.  Nor are these patients likely to ever be a force at the voting booth.  I don’t have any hard statistics, but my guess is there are maybe a few thousand people like Robert Browning who are on Medicare at any given time in the U.S.  Spread that out accross 50 states and 435 House Districts, and it’s almost negligible.

Because the sick usually lack political power, they are unable to change government policy that causes them harm.  And that’s one of the biggest problems of any government health care system.


Ban Flavored E-cigarettes?

Tobaccocigarettee cigDPCW

Cities and states around the country are considering banning the sale of flavored e-cigarettes. The city of Minneapolis, for instance, is considering legislation on the issue this week. In my letter to the bill’s sponsors I explain why doing so would actually undermine public health.

Dear Council Members Gordon and Yang,

I am writing to share my perspective with you on the legislation under consideration that would, among other things, ban the sale of most flavored e-cigarettes at almost all retailers. 

I’m a senior fellow at the National Center for Public Policy Research, where I analyze policy related to public health issues. I’ve testified on these issues at the United Nations, at FDA scientific meetings, and at state and local legislative hearings.

My concern regarding this legislation is that a ban on the sale of flavored e-cigarettes in almost every retailer where adult smokers buy their products-  would have the unintended consequence of undermining, rather than protecting, public health. 

The Health Department’s report on the legislation completely ignored the potential benefits of e-cigarettes as a method of harm reduction. The idea is that smokers, especially those that have had a hard time quitting, would find e-cigarettes a viable alternative to smoking. Flavors play an important role in helping adult smokers transition from smoking to using e-cigarettes.

E-cigarettes often contain nicotine, but do not produce the myriad deadly chemicals from combustible cigarettes, and are as such dramatically less harmful.

In fact, the FDA’s top tobacco regulator, Mitch Zeller, explains that there is a “continuum of risk” among different nicotine containing products.

Mr. Zeller told the Robert Wood Johnson Foundation’s New Public Health, “The other example is if at the end of the day people are smoking for the nicotine, but dying from the tar, then there’s an opportunity for FDA to come up with what I’ve been calling a comprehensive nicotine regulatory policy that is agency-wide and that is keyed to something that we call the continuum of risk: that there are different nicotine containing and nicotine delivering products that pose different levels of risk to the individual.


Zeller explained that, “Right now the overwhelming majority of people seeking nicotine are getting it from the deadliest and most toxic delivery system, and that’s the conventional cigarette. But if there is a continuum of risk and there are less harmful ways to get nicotine, and FDA is in the business of regulating virtually all of those products, then I think there’s an extraordinary public health opportunity for the agency to embrace some of these principles and to figure out how to incorporate it into regulatory policies.”

In other words, the FDA is aiming to use regulatory policy to move people down the continuum of risk. The city of Minneapolis should endorse the Obama administration’s approach and seek policies that further, rather than undermine, the FDA’s science-driven policy. 

Any analysis of the e-cigarette market will show that flavored e-cigarettes- flavors other than the flavors regularly found in cigarettes- are very appealing to adult smokers who are switching to e-cigarettes. 

This explains why, in its proposed “deeming regulation,” the FDA has so far resisted suggestions to restrict the sale of flavored e-cigs to adults, for this very purpose. 

The FDA is currently doing pattern of use -or PATH - studies- to determine how e-cigarettes are being used in the real world- and to determine the role of flavors on helping people move to lower risk products. The FDA is correct to evaluate the science and use it to develop appropriate regulations to protect public health- before regulating. I encourage the council to do the same.

The council should consider other means to achieve the intended and laudable result- reducing underage tobacco and e-cigarette use.  For instance, more effective enforcement on the current state-wide ban on sales of e-cigarettes to minors would be a more narrowly tailored way to prevent underage use of all tobacco products and e-cigarettes. Doing so would minimize the unintended consequence of removing flavors which appeal to adult e-cigarette users who are reducing their harm by no longer smoking cigarettes.

I’d be happy to discuss this with you in more detail if you are interested.


Jeff Stier

Senior Fellow, National Center for Public Policy Research

Director, Risk Analysis Division 


Remember Robert Stethem

On this day in 1985, the lifeless body of Navy diver Robert Stethem was dumped on the tarmac of the Beirut International Airport by Hezbollah terrorists who hijacked TWA flight 847.

Prior to his execution, he had reportedly been beaten and tortured.  Why?  Stetham was targeted because he was a member of the American military.


Stethem grew up in the Washington, D.C. suburb of Waldorf, Maryland.  To honor him, the Charles County government dedicated a group of athletic fields in his name.  The facility includes a stone monument to Stethem.

It seems, however, that Charles County officials and virtually everyone else have now forgotten Stethem’s sacrifice to our nation.


My wife and I drove the 25 miles from our home in Northern Virginia to the Robert D. Stethem Memorial Sports Complex on Sunday the 14th (the date the memorial there erroneously lists as when he died) to pay our respects.  We found the gates of the facility chained up and secured with three padlocks.  Not wanting to trespass, we left the flowers we brought attached to the sign along the main road.

From the looks of the county parks and recreation as well as the general government web sites, it appears officials in Charles County are oblivious to or uninterested in the major anniversary of one of their greatest heroes and facility namesake.  Locally, one community did remember – but the county as a whole may be taking a pass.  A quick Google search seems to indicate everyone else has similarly forgotten the sacrifice of Robert Stethem.


Please take a moment to remember Master Chief Constructionman Stethem (posthumously promoted from steelworker 2nd class).  He wasn’t Chris Kyle or Rob O’Neill – he was merely a humble serviceman returning home from an innocuous assignment abroad.  He was targeted for heinous abuse, a bullet to the temple and carelessly thrown from the hijacked plane solely because of his nationality and his vocation.

Of the four hijackers, only one was caught and convicted (but subsequently walked free).  Another died in 2008 – an apparent victim of an act of terrorism.  The others have disappeared.


Terrorism, 30 years later, remains a major problem facing the United States and the world.  Do not let Robert Stethem, or other victims of cowardly acts of terrorism, be forgotten.


Despite High Jobs Numbers for May, Obama Still Has the American Economy in a Ditch

In his ongoing analysis of the state of the American economy under President Obama’s stewardship, Project 21 member Derryck Green isn’t feeling so great these days about having been right in his previous month’s speculation that the economy was already on a downward slide.

Derryck’s dismay over that, and poor economic indicators all over the place, are now on display — including what’s found in today’s federal unemployment report — and chronicled in his latest edition of “About Those Jobs Numbers”:

Told ya so.

Trust me, however, I regret being right.  When it comes to being right about our tanking economy, there’s nothing to be gained in gloating.

In last month’s “About Those Jobs Numbers,” I lamented the recently-posted and very weak 0.2 percent growth in the national gross domestic product (GDP).  I feared the GDP could be worse than stated, and I suggested at the time that “[t]here are economists who believe that this number will actually be revised to show negative growth once all the numbers are known.”

It was.  The GDP did really shrink by 0.7 percent upon a revision to the report announced in late May.  No growth whatsoever.  A contraction of the economy, in fact.  It’s the fourth quarter during the course of the Obama Administration in which this has happened.  And it could be worse this time.  Jeremy Lawson, the chief economist at Standard Life Investment, speculated in the Washington Post that the economy may now “rebound more slowly” than it had after previously negative quarters due to “downward [economic] pressures that are more persistent than in the past.”

Of course, the Obama Administration and its supporters are trying to play this bad news off as a by-product of the snowy weather.  “Climate change” is an implied culprit — what they used to call “global warming.”  Jason Furman of the White House Council of Economic Advisers, for example, told the Post that the economy consistently underperformed “in parallel with intensifying winter weather.”

It’s almost summer, yet I don’t see many indicators of new economic improvement.  It’s true there is still some remaining ice on the ground from Boston’s terrible storms, but it’s no excuse for a sluggish economic nationwide.  Blaming the weather is a cop-out.  Furman appears to be right.  Unfortunately.

The sad fact of the matter is that the U.S. economy is still in a “ditch”.  After all those years of his leadership and the assurance from Barack Obama when he first ran for president that he would get the American economy out of that ditch and back on track, we seem to instead be on the verge of even more economic peril.  For example:

  • Raoul Pal of the Global Macro Investor newsletter told CNBC that “[t]here is a probability that the U.S. goes into recession this year…”
  • Back in March, the “Bloomberg ECO U.S. Surprise Index,” an alternative economic measurement pegged to how well actual economic figures matched predictions, was at its lowest success rate since the depths of the 2009 recession.  Chief Investment Officer Jack Ablin of BMO Private Bank told Bloomberg Business it could be “an early indication of a momentum shift” for the U.S. economy.
  • Economic historian Peter J. Wallison of the American Enterprise Institute argued the economy is being set up for another tumble right now.  In his new book, Hidden in Plain Sight, Wallison wrote about a “false narrative” that demonizes banks and lauds increased regulation as a cure for America’s economic ills is being successfully perpetrated by the political left.  This lie covers up a potential new crisis rooted in the same mistakes — particularly bad mortgage loans — that caused the last economic crisis.

All of this makes the newest jobless figures from the federal Bureau of Labor Statistics (BLS) — which some may try to celebrate — all the more troubling.

The official unemployment rate rose to 5.5 percent.  And the U-6 alternative rate, the indicator many people feel is the better predictor of the full unemployment picture because it adds the underemployed and able-bodied who quit looking to the official rate, remains around twice as high at 10.8 percent.  While 280,000 jobs were reportedly created in May, above the advance prediction of 201,000 jobs that was made just prior to the government announcement by the private payroll company ADP, the elation at the higher-than-expected number can only be fleeting.  That’s because the labor force participation rate remained an anemic 62.9 percent.  It’s been low like that for far too long.

Per usual, and very unfortunate at that, is also the fact that the constituencies having had the most faith in the President thus far are doing the worst under his jobs-creation agenda (or lack thereof).  Black unemployment, for instance, is up to the double-digits again at 10.2 percent (5.5 points more than whites) — with black teens suffering terribly through an astronomical jobless rate of 30.1 percent (passing back into the 30s, where it has been for much of the Obama presidency).  Hispanics are experiencing an unemployment rate of 6.7 percent.  There were an estimated 50.6 million women who were unemployed in May.

During the last month, there were some major layoffs announced despite the unexpectedly high job-creation number cited today by the BLS.  Perhaps the most noteworthy was that banking giant JPMorgan Chase would be cutting around 5,000 jobs over the course of the next year.  If this bank fails, will it be saved like big banks were in the last crisis — and saved at taxpayer expense?

It was the energy sector that seemed to take the worst hit.  Murray Energy, a coal-mining company based in the east, announced that approximately 1,800 miners would be laid off.  Alpha Natural Resources similarly announced economic worries were forcing the company to let more than 400 of its miners go as well.  Murray Energy CEO Robert Murray didn’t mince words, blaming the layoffs on “the ongoing destruction of the United States coal industry by President Barack Obama.”

But mining losses are not the only fossil fuel jobs lost in May.  In the oil industry, Schlumberger Limited announced plans to cut 20,000 employees in its oilfield services operations.  Halliburton Company is also cutting 9,000 jobs worldwide, while Baker Hughes Incorporated is shedding 10,500 jobs.

All this bad news about jobs comes as consumer prices continue to increase.  Recently-released statistics show that April was the third month in a row with increased consumer costs — climbing 0.3 percent since January.

Homeownership appears to be in decline, allegedly bringing devastating side effects along with the trend.  A new report by the National Association of Realtors found that the plunging rate of homeownership is possibly contributing to a wealth gap.  In a survey of 100 metropolitan areas, it was found there was a decline in homeownership that went hand-in-hand with an increase in the gap between the rich and poor.  This happened in over 90 of those municipalities that were studied.

Lawrence Yum, the chief economist for the Realtors, said: “Homeownership plays a pivotal role in the U.S. economy and has historically been one of the primary sources of wealth accumulation for middle-class families… [H]ome ownership has plunged to a rate not seen in over two decades.  As a result, the country has become more unequal as the number of homeowners has fallen while the number of renters has significantly risen.”

Diminishing homeownership seems to have become so much of a problem that people are compensating for it by rebranding the American Dream.  According to the results of a survey commissioned by the American Institute of Certified Public Accountants (AICPA), only 11 percent of people now consider homeownership as the best indicator of financial success.  Replacing it is the goal of having ample savings for retirement.  AICPA’s Ernie Almonte said: “We’re seeing that today’s American Dream is greatly shifted from the one defined by previous generations.  No longer are home ownership and upward financial mobility the hallmarks of financial achievement.”

Therein lies a potential problem.

As I mentioned last month, there are too many people who aren’t saving for the retirement stability that so many now prize as the hallmark of success.  I noted that another survey of Americans found that “only 65 percent of workers polled have anything saved for retirement.  Only 28 percent say they have more than $1,000 saved for retirement, and more than a third said they haven’t saved any money at all for retirement.”

One cannot truly be preparing for a secure future and not be anticipating a nonexistent or debilitated Social Security benefit at the same time.  While the politicians seemingly ignore the problem, there’s no denying that the money going into Social Security’s coffers is being paid out to others almost as quickly and the notion of the peoples’ investment being secure is a myth.

People simply should not expect Social Security to be there for them if they fail to save enough.  It’s no longer a reliable safety net, much less a hammock.  Former Federal Reserve Chairman Alan Greenspan, one of the most respected living economists, recently called the Social Security Trust Fund “a meaningless instrument” because there are no actual savings in it — just “current expenses.”  With the national debt “way underestimat[ed]” and the possibility of more unanticipated expenses such as new bank bailouts in the future (think JPMorgan Chase), Greenspan expressed grave pessimism about the nation’s fiscal health.

It’s a potential “perfect storm” of pain for the American economy.  Jobs are being lost, costs are rising and the traditional means of securing wealth and a stable future are slipping away.

The ditch Obama complained about in 2008 has not been overcome.  Instead, it would appear to have grown into a chasm from which the vehicle that is the American economy won’t be able to escape unless it’s super-charged very soon.

Obama asked for a shot at saving it in 2008 and failed spectacularly. 


Save Ferris: How the 80s Favorite Truant Might Rank among America’s Most Wanted Today

Principal Rooney never caught the misbehaving Ferris Bueller.  Had Matthew Broderick’s character been apprehended, at least in today’s overcriminalized society, Ferris might be very sorry he ever even thought about skipping school!

While the 30th anniversary of the release of the “Ferris Bueller’s Day Off” film won’t occur until 2016, fanboys figured out that the actual day off – based on the real baseball game seen in the film – was 30 years ago June 5, 2015.

On his epic (and fictional) day off, Bueller, his girlfriend Sloane and best friend Cameron ditched school, went for a joyride, crashed a fancy restaurant and watched the Chicago Cubs lose to the Atlanta Braves.

They also appear to have broken a lot of laws that day that now carry serious consequences thanks to our penalty-obsessed system of laws.  If they were to do a reboot of “Ferris Bueller’s Day Off” today, it might end up looking a lot more like an episode of “Law and Order.”

Based on a 2013 analysis by San Diego criminal defense attorney Peter M. Liss and a 2009 thread on Ask MetaFilter, a laundry list of probable crimes the trio were involved in that day can be compiled: truancy (naturally), computer hacking, auto theft, identity theft (of both a police officer and the “Sausage King of Chicago”), speeding, running out on a check (presumably), copyright fraud, attempted odometer fraud, willful destruction of an automobile, jaywalking, trespass and underage drinking.

Some of those crimes, such as the theft and destruction of Cameron’s father’s classic car, are serious crimes with serious penalties for malicious intent.  Some of the others, however, may be petty crimes in comparison that nonetheless have serious repercussions.  Liss suggested, “this one day out could result in some serious criminal penalties, including lengthy jail or prison sentences.”  The one thing Liss held in the trio’s favor was that their youth and presumed lack of criminal records might result in lenient sentences.

But Ferris possibly violated copyright fraud for singing “Twist and Shout” on that parade float.  Copyright fraud penalties include jail time.  Odometer fraud can also land one in jail in some states.  And who knows what the feds might do to a computer hacker – especially a recidivist such as Matthew “WarGames” Broderick.

What was thought of as fun and games in the 80s can now be serious business in our overcriminalized nation.  People can chuckle at the movie, but the overzealous attitude of government today could have a modern-day Bueller in a courtroom instead of a movie theater.

Consider what’s happened to schoolchildren and their parents in the Washington, D.C. area in the last few years.  Most famously, there was a 12-year-old girl who was prosecuted for eating French fries on a train.  More recently, an eight-year-old boy was suspended from school for eating a Pop-Tart into the shape of a gun.  Just this year, a family came under investigation by Child Protective Services after the parents allowed their children to walk to a nearby park alone.

These real-life examples are even more mind-boggling than what’s up on the silver screen.  It shows just how much our government has gotten out of control in wanting to set rules.

Ferris meant no harm in his high jinks in the same way that girl caused no harm with her fries or those parents meant about their kids wanting to go outside and play.  Yet they ran afoul of the law – at great expense of time, dignity and money.  And the boy with the Pop-Tart gun has a very unusual entry that remains on his permanent record.

Laugh all you want at what’s up on the screen, but don’t forget the real-life drama of overcriminalization all around us.


Montana: More Evidence Death Spiral Bearing Down on ObamaCare Exchanges

More evidence that the ObamaCare exchanges are heading for a death spiral, this time from Montana:

Health insurers selling individual policies on Montana’s Affordable Care Act marketplace say rate increases are likely next year after they suffered losses they attribute in part to initial under­estimates of the costs of the new business.

Companies are filing requests for higher rates.

I’ve tracked down the average requested premium increases for companies on the Montana exchange.  They range from 22.4 percent to 45.1 percent*: 


Those are the types of rate hikes that can drive some of the younger and healthier folks to drop their insurance, leaving the insurance pool older and sicker.

Here are some of the losses driving those requested hikes:

PacificSource, which has its headquarters in Springfield, reported a loss of about $17 million last year. It serves about 275,000 customers on commercial insurance, Medicare plans and managed Medicaid plans.

The Montana Health Co-op, a new nonprofit insurer, lost about $4 million last year on $30 million worth of business, said its CEO, Jerry Dworak. The co-op insures about 25,000 people in Montana and another 19,000 in Idaho.

Last week I published a National Policy Analysis, entitled “The ObamaCare Death Spiral Rears Its Head,” looking at big rate increases proposed by insurers on the exchanges of five states: Maryland, Oregon, New Mexico, South Dakota and Tennessee. Montana is the newest addition to the list, and to listen to a VP of PacificSource it won’t be the last:

“What we’re seeing across the country is that nearly all health insurers, large and small, are losing money in the individual marketplace,” said Todd Lovshin, vice president and Montana regional director for PacificSource,which offers policies on Montana’s marketplace.

*This blog post originally stated the highest premium increase was 46.6 percent.  That has been corrected to 45.1 percent.


Someone Should Ask Sen. Sanders If Ben and Jerry's Offers Too Many Choices of Ice Cream

By my rough count, Ben and Jerry’s sells over fifty flavors of ice cream. Thus, it’s ironic that Ben and Jerry helped Senator Bernie Sanders kick off his campaign for president given the Senator’s recent remarks about having choices:

You can’t just continue growth for the sake of growth in a world in which we are struggling with climate change and all kinds of environmental problems. All right? You don’t necessarily need a choice of 23 underarm spray deodorants or of 18 different pairs of sneakers when children are hungry in this country. I don’t think the media appreciates the kind of stress that ordinary Americans are working on

For a good laugh, see Reason’s “Bernie Sanders Save The Children Fund”:

Let me make one relatively quick comment:  Sen. Sanders appears to think that a free-market economy is a zero-sum game.  One person wins (the person getting the choice of deodorants or sneakers), while another loses (the hungry child).  Of course, any economist worth his weight will tell you a free-market economy is dynamic.  Both sides of a transaction win.  In the long run, that leads to the creation of more wealth which, among other things, means less starving children.  

I wonder if it ever occurs to Sanders that children are better off in America because we have so many choices of products.  Producing more choices means hiring more people, which means jobs, which means you get to eat.  But, of course, that has probably never occurred to him.  After all, he still believes the bogus notion that there are hungry children in America.


Krugman Wrong Again? Death Spiral Rears Its Head

In a new National Policy Analysis, I examine whether predictions of an insurance “death spiral” on the ObamaCare exchanges have been proven wrong.  

The first sign of a death spiral is insurance companies requesting big premium increases, usually in the range of at least 20 percent.  However, that didn’t happen on the exchanges in 2015.  Here’s Paul Krugman on that:

“There is no death spiral: On average, premiums for 2015 are between 2 and 4 percent higher than in 2014, which is a much slower rate of increase than the historical norm.” The lack of death spirals is one thing that “should inspire major doubts about [conservative] ideology.” According to Krugman, those who made predictions about death spirals aren’t admitting their errors but “pretend[ing] that [they] didn’t make the predictions [they] did.” This is serious stuff since refusing “to accept responsibility for past errors is a serious character flaw in one’s private life. It rises to the level of real wrongdoing when policies that affect million of lives are at stake.”

As I note in my NPA, “who says that a prediction of a death spiral is completely wrong if a death spiral doesn’t occur immediately? Indeed, while I personally expected the death spiral to begin in 2015, there is no rule saying that it always happens right away.”

Going into 2015, insurers expected that most of the losses they took on the exchanges would be covered by an ObamaCare program known as the “risk corridor.”  Under this program, taxpayers would help offset insurer losses.  As such, there was little incentive for insurers to raise premiums if the medical claims they paid exceeded what they received in premium income.

But now that Congress has stopped the risk corridor from handing out taxpayer money, insurers are starting to ask for hefty premium hikes going into 2016.  For example:

  • Five insurance companies on Oregon’s exchange are proposing average premium increases ranging from 25.6 percent to 52 percent. 

  • In Tennessee, Blue Cross/Blue Shield is asking for an average increase of 36.6 percent and Community Health Alliance is proposing a 32.6 percent increase. 

  • In New Mexico, Health Care Service Corp. is requesting a premium hike of 51.6 percent.

The death spiral appears to be rearing its head.  Of course, these could be just flukes. We’ll know more in the weeks ahead as more companies release their requests for premium increases.  But, as I say in the NPA, “at this point, the one thing that is certain is that it is much too soon for ObamaCare proponents to say that the death spiral prediction is wrong. To do so is to jump the gun. I wonder if Paul Krugman regards that as a ‘serious character flaw’… or just stupidity?”


ObamaCare Exchange Imposes Cap on Specialty Drugs: What Could Go Wrong?

A while back I predicted that insurers on the ObamaCare exchanges would be able to charge large co-pays for high-priced speciality drugs indefinitely, since only a small number of people take specialty drugs. Given their small numbers they would not to amount to significant political force, at least one strong enough to change policy.

Well, that theory has been proven wrong to an extent, at least in California:

[The Consumers Union] and other advocates took their concerns to Covered California, the agency that implements the Affordable Care Act in the state. The advocates argued there should be a limit on how much consumers have to pay for these drugs. 

 Apparently, they are getting their wish:

The agency agreed, and Thursday the board voted to cap the monthly out-of-pocket costs for specialty drugs. Starting in 2016, most people will only have to pay a maximum of $150 or $250 per prescription, per month. These caps are for Covered California’s so-called silver and platinum plans. Bronze plans will have caps of $500.

This policy will only apply to the 2.2 million people who buy coverage on the individual market. A bill under consideration in the California Legislature would extend that protection to many people with employer-based plans, as well.

Well, since the money to pay for specialty drugs grows on trees, I don’t see a problem here.  I mean, it’s not like anything could happen to health insurance premiums, right?


Understanding Exactly Why “Freedom Is Not Free”

As we head into the Memorial Day weekend, Project 21 member Charles Butler has a message for those who might not understand the meaning behind a holiday that many trivialize or merely consider the beginning of summer fun:

People often use phrases and idioms that sound cool and hip without really understanding their true meaning.  We will definitely be hearing one phrase of that sort this weekend: “freedom is not free.”

When people who have never served in the military use the phase “freedom is not free,” I often find it to be done in a very convoluted and disingenuous manner on many levels.  For example, we lost dozens of American lives fighting to hold Ramadi almost a decade ago, and yet campaign promises essentially gave the Iraqi town to ISIS terrorists just this week.  These brave men and women who died in service to our nation will be mourned this weekend.  Fathers, mothers, sons, daughters, husbands and wives will be missed.

A price was paid in Ramadi for freedom, but then the investment was squandered.  That’s not right.

Americans of all ages, socio-economic status, politics, ethnicity and gender use “freedom is not free” as if they know exactly what it means to put service to their country and the commitment to an ideal before one’s own self interest.  They often do not.  The truth is that only a fraction of Americans under 50 have served their country in uniform.  Many really don’t seem to feel it is their obligation these days.

So we can establish people are often unclear on the concept of “freedom is not free.”  It’s a shame.  When people use it, do they at least even know its origins?  The honest answer is probably not.  But that’s OK.  To help, here is some background and credibility for them as we prepare to observe Memorial Day weekend.

The origin of “freedom is not free” is credited to retired U.S. Air Force Colonel Walter Hitchcock of the New Mexico Military Institute.  It is meant to express gratitude for the service of members of the military, implicitly stating that the freedoms enjoyed by those living in democracies today are only possible due to the risks taken and sacrifices made by those in the armed services.  It conveys respect — specifically to those who gave their lives in defense of our freedom.

“Freedom is not free,” for example, is engraved onto a portion of the Korean War Veterans Memorial, Washington, D.C.  While it should be a powerful phrase to all, it is particularly important to veterans.

Those of us who have served our country honorably salute and say an often-silent prayer for our fallen brothers and sisters who fought so Americans can enjoy the rights and freedoms granted to them by our Constitution.  When you are at a BBQ or watching the game this weekend, please take a moment to say at least a silent “thank you” to veterans for their service.  You might also donate to veterans’ charity to lend a helping hand to those vets who have fallen on hard times.

And you might also say a prayer for those still serving.  They seem to need it these days.

Memorial Day should not be political.  But the U.S. military has nonetheless been the object of mass social and political experiments under this and other presidential administrations.  The dishonor and immorality now being implemented in the military is an abomination.  I have spoken with many active and retired military personnel, and they all have a common complaint: the Obama Administration is disruptive and degrading to the military’s ability to do its job.  The political agenda imposed by this White House, they say, is endangering lives.

That’s why my prayer is that God protects our brave men and women, and that He gives them the support they need to do their job and return home safely and healthy to their families.   Amen.

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