Reining in Civil Forfeiture

Medicare for All Threatens Health

Disrupting the Colorado “Blueprint”

Fouling Up Federalism

SUMMER 2019 CONSERVATIVE IDEAS FOR ADVANCING LIBERTY

CONTENTS | SUMMER 2019 The Federal Government EDITOR’S NOTE Does Too Much 2 18 ROUND UP NE ADVANTAGE OF OUR FEDERAL as civil asset forfeiture. Civil asset forfeiture Obamacare vs. system is that it sets up a kind of allows law enforcement agencies to seize Health Care, O competition in policymaking. The property on the mere suspicion that it has been Welfare and ability of citizens to vote with their feet keeps used in a crime and keep the property unless Responsibility, states on the lookout for better ways of doing the owner can prove otherwise. As Darpana Sunsetting things. States that have problems in common Sheth writes, the problem is not only that this Regulations, can learn from each other’s experiences. Policies shifts the burden of proof from the government Capitalism Is that work well in one state can be replicated in to the accused, but that the process itself makes Pro-Diversity others. Most critically, states can discover what it difficult for property owners to even get a doesn’t work without having to impose a bad hearing before an impartial judge. 4 Fouling Up Federalism solution on the entire country. Since 2014, 33 states have passed laws That’s how it’s supposed to work—in theory. limiting the ability of state and local law In practice, federal lawmakers think there is enforcement agencies to use civil asset TOOLKIT The Police nothing states do that shouldn’t be shaped by forfeiture. The federal equitable sharing Washington’s priorities. We can see that hubris program, however, lets local law enforcement How to Reach Can Take Your at work in three of our feature articles here, most agencies participate in joint operations with Millennials, 22 especially in our cover story by Mike Nichols. He federal agencies and keep a share of the Minorities, and Stuff: The Civil notes that there are now at least 1,386 federal proceeds from forfeitures—thus evading state Women with Forfeiture grant-in-aid programs that spend $728 billion per limits. States could pass laws forbidding their Conservative Ideas year. Why, you might ask, must taxpayers send so law enforcement agencies from participating in Reforms We much money to Washington, merely so that the the federal program—and seven of them have. 10 Still Need federal government can send it back to the states? Congress, however, could do all citizens a favor The answer is control. When the money comes by eliminating the equitable sharing program back to the states, it comes with conditions on entirely and putting limits on the use of civil CALENDAR how the money must be spent. Those strings asset forfeiture by federal agencies. There are often compel state and local policymakers to bills before Congress that would do just that. 36 13 make absurd choices. One case in point: $60,000 States are also helping fix the mess 26 30 spent on an elevator in a middle school; the Obamacare has made of health insurance. Seven Fighting for elevator is hardly ever used, but the expense states have used Obamacare waivers to create PICTURING POLICY satisfied a “maintenance of effort requirement” alternative financing programs that, on average, Spending the Soul of More , that guarantees the school district’s receipt of have reduced health insurance premiums by Greatly Exceeds Colorado Less Health Care: A Health Plan federal money in future years. 7.5 percent from 2018. Non-waiver states saw Revenues There is a kind of prisoner’s dilemma going an average increase of 3.1 percent. Yet some AN INTERVIEW WITH How Medicare for President on: States may be free to make better choices lawmakers still pine for top-down federal 39 JON CALDERA for All Threatens Trump and by refusing the federal money; but the savings control of health care financing. They are Patient Health Congress that such choices generate would simply end pushing a bill that would create a Medicare for up being redistributed to other states. The only All program. As Kevin Pham details, universal © 2019 The Heritage Foundation | 214 Massachusetts Avenue, NE | Washington, DC 20002 | (202) 544-4400 way to fix the problem is for Washington to health care entitlements have a history of Alex Adrianson, Editor | , President | , Vice President of Communications | Jim Weidman, Editorial Director | decide to get out of the business of bribing states reducing, not expanding, the supply of health Taylor Dabney, Designer with taxpayers’ money. Whence will come the care. Even worse, the bill would provide virtually Founded in 1978 by The Heritage Foundation, The Insider is a quarterly journal of conservative ideas for promoting liberty in . leadership for that agenda? no escape for either patients or doctors to Contact the editor: [email protected] ALEX ADRIANSON edits The Insider. Have a story idea? Washington has also interfered with state contract outside of Medicare. If you like your Nothing in these pages is to be construed as necessarily reflecting the views of The Heritage Foundation or as an attempt to aid or hinder Want to connect with him? the passage of any bill before Congress. Email [email protected] efforts to put the brakes on an abuse known health plan, too bad for you. DABNEY AND TAYLOR IMAGES BUTT VIA GETTY MARCUS COVER: EUNIKASOPOTNICKA/ LIVING_IMAGES/GETTY; TOP; CLOCKWISE: IMAGES VIA GETTY JOE AMON/THE DENVER POST IMAGES; GETTY

2 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 3 their way, 1.5 million more people subsidies). [John Merline, “Democrats have been introduced, mainly for would be forced off plans they like. Are Pro-Choice, Except When It Comes sick-leave claims, to limit over- No matter. Democrats say this is to Health Care,” Issues & Insights, utilization and outright cheating. “junk insurance” that nobody should May 22] [Nima Sanandaji, “The Swedish be buying. Lesson: Welfare States Create Moral But that, too, is a lie. The welfare state erodes Hazard,” , May 17] A new study from the Manhattan responsibility. Nima Institute found that short-term Sanandaji writes: Idaho puts sunset rules in action. plans often provided better coverage James Broughel writes: at lower cost than comparable The World Value Survey gives Obamacare plans. strong support for the claim that Something rather remarkable In Fulton County, Ga., for example, norms in the Nordic just happened in Idaho. an Obamacare silver plan will cost countries have eroded. The state legislature a 30-year-old non-smoker $467 In the 1981–84 survey, opted to—in essence— a month, for a plan with $2,000+ for example, 82 percent repeal the entire state deductible, and an almost $8,000 out- of Swedes agreed regulatory code. The of-pocket maximum. with the statement In a 1981–84 cause may have been A comparable short-term plan— “Claiming government survey, 82 dysfunction across with a slightly higher deductible but a benefits to which you legislative chambers, lower out-of-pocket maximum—has are not entitled is percent of but the result is premiums of just $250 a month. never justifiable.” In Swedes serendipitous. A new That’s 46 percent cheaper. the 2010–14 wave, agreed with governor is presented The study also found that while merely 55 percent held the statement with an unprecedented most if not all Obamacare plans the same view. The opportunity to repeal available in any given market are pattern is found in the “Claiming an outdated and HMO plans—which provide no other Nordic nations government burdensome regulatory coverage for providers outside the as well. This fall in benefits to code and replace it with plans’ narrow networks—many responsibility seems a more streamlined of the short-term plans are PPOs, to be stabilizing lately, which you are and sensible set of rules. which typically have much broader following tax cuts and not entitled Other states should be provider lists. significant reductions in is never paying close attention. The study’s author, Chris Pope, welfare-state generosity. The situation Obamacare vs. Health Care, Welfare goes on to say that short-term plans A number of justifiable.” came about due “cover a significantly larger share of attitude studies in In 2010–14, to the somewhat and Responsibility, Sunsetting medical costs than ACA exchange Sweden conclude that merely 55 unconventional nature plans for the same premiums.” a significant portion percent held of Idaho’s regulatory What’s “junk” about that? of the population has process. Each year, the Regulations, Capitalism Is Pro-Diversity When looked come to consider it the same view. state’s entire existing into short-term plans, it came to a acceptable to live on body of regulations similar conclusion, finding them sickness benefits even expires unless Protecting Obamacare is not the same as off by limiting short plans to just three months. “more consumer-friendly and less if you aren’t sick. A survey from reauthorized for an additional year protecting health care. John Merline writes: The rule mandating this didn’t go into effect like ‘junk’ insurance than Democrats 2002, for example, showed that 60 by the legislature. In most years, until late 2016, and [President] Trump reversed originally charge.” percent of Swedes believed that it was reauthorization happens smoothly, [O]nce Obamacare went into effect and it the first chance he got. More importantly, the people acceptable to claim sick leave when but not this year. premiums in the individual insurance market Every study that’s looked into it concluded buying these short-term plans you were not sick. Four years later, a Instead, the legislature wrapped spiraled upward—doubling from 2013 to 2017, that Trump’s reversal would expand insurance don’t consider them “junk.” In fact, center-right government was elected up an acrimonious session in and up another 27 percent in 2018—the short- coverage, with some estimates as high as 4 satisfaction rates are at 91 percent, on the promise to cut the welfare April without passing a rule- term insurance market exploded. It rocketed up million. Unfortunately, several Democratic according to eHealth, which is benefits and taxes significantly. In reauthorization bill. As a result, by 121 percent in just Obamacare’s first two years. states reimposed the Obama limits. And those significantly higher than the 70 fact, Swedish governments on both come July 1, some 8,200 pages of ROUND UP highlights key work produced by Rather than recognize this for what it was—a in the House want to do so nationwide. percent satisfaction rate among the right and the left have reduced regulations containing 736 chapters conservative and classical liberal think tanks. clear sign that Obamacare was failing—the The nonpartisan Congressional Budget Obamacare enrollees (most of whom the generosity of the welfare system. of state rules will expire. Any rules Submit ideas at [email protected] Obama administration tried to kill this market Office says that if those House Democrats got IMAGES DESIGNER491/GETTY are getting generous premium Additionally, gatekeeping functions the governor opts to keep will have

4 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 5 to be implemented as emergency What they have had instead is up 3 percent from the year before, regulations, and the legislature will an unlimited right of access to a and up 59 percent from 2.42 million consider them anew when it returns waiting list from which (with a few at the end of March 2010. According next January. exceptions) they will not be excluded. to research by the House of Commons Gov. Brad Little, sworn into office This right of access is not equivalent Library, “Once estimates for missing in January, already had a nascent red to a right to treatment, as any data are included the waiting list tape cutting effort underway, but the notional right to treatment has little is currently thought to be at 4.31 impending regulatory cliff creates value in practice if it is available only million—up 7 percent year-on-year some new dynamics. Previously, at the end of a two-year waiting time. and 42 percent over five years.” [Tim each rule the governor wanted cut The right to health care is unlimited Evans, “London Calling: Don’t Commit would have had to be justified as a in the long term but is strictly limited to Nationalized Health Care,” The new rulemaking action; now, every in the short term when Heritage Foundation, regulation that agencies want to keep health care is actually May 3] has to be justified. The burden of required, at the very proof has switched. [...] least, to relieve pain The Trump trade policy The Idaho case also highlights or discomfort. Experience on China hasn’t figured the power of sunset provisions—or Today, many out enforcement. automatic expiration dates built hundreds of thousands shows that Derek Scissors writes: into laws or regulations. In the past, of people are on NHS people have academic research has found that waiting lists, and never had an [E]nforcing acceptable sunset provisions are sometimes countless tens of Chinese behavior on ineffective. Legislatures and agencies thousands are trying absolute right intellectual property often readopt regulations without to get on a list. After to free and requires far stronger much thought. To work well, sunsets decades of reforms and equal treatment action than the United may need to be structured such extra tens of billions of States has ever taken. that large swaths of rules expire pounds invested, out on demand. China is highly simultaneously, with reauthorization of 4 million patients What they indebted. It will responsibilities falling to the admitted to NHS have had rapidly age over the legislature rather than regulators. hospitals for routine next generation. Its exactly one Chinese firm. We’ve researchers found that 74 percent low birth weights, the U.S. statistical Sunsets are perhaps most useful when treatment in 2007, instead is an natural resources are failed to act on our own, and no deal of American variation in life ranking improves significantly. rules are allowed to lapse and then more than half still unlimited right depleted. Its economy with Beijing can make that more expectancy—indeed, the largest They write: “When adjusting forced back through the rulemaking had to wait at home of access to thus increasingly likely. [Derek Scissors, “A Better source of variation—was attributable neonatal mortality to exclude deaths process all over again. That way they more than 18 weeks a waiting list. relies on innovation, Approach to China Trade,” American to behavioral and metabolic of infants born weighing less than can be subjected to public scrutiny, before receiving as the Communist Enterprise Institute, April 17] risk factors. 1,000g [about 2.2 pounds], the United cost-benefit analysis, and perhaps that treatment. Party recognizes. The recent annual declines in States ranked fifth relative to the even court challenges. [James Broughel, While government The catch is the Bad data are boosting Medicare American life expectancy, based on other countries, with 1.61 deaths per “Idaho Repeals Its Regulatory Code,” ministers frequently shy away from party requires state-owned (near-) for All proposal. The data from the Centers for Disease 1,000 live births, compared with a Mercatus Center, May 9] talking about the parlous realities of monopolies, in banking, oil, telecom, spends a lot more per person on Control and Prevention, were largely mean of 1.70 for all 11 countries.” waiting times, figures indicate that and many other sectors. Sheltered health care than other economically attributable to increased drug Comparisons of infant mortality Government-run health care gives 12 percent—almost half a million from competition, state enterprises advanced countries, yet has lower overdoses (opioids) and suicides. between the United States and you the right to be on a waiting people—waited more than a year for have little reason to innovate. To spur life expectancy and higher infant Then, there is the special category other countries are often flawed list. Tim Evans writes: their treatment and care during 2006 growth in these areas, China leaves mortality rates than many of those of infant mortality. “Our infant because definitions of terms and and 2007. [...] itself no choice but acquire foreign countries. The problem, says Sen. mortality rate, kids and babies who measurements are different. Against the popular view that While the number of people technology, by hook or crook. Bernie Sanders and others, is that are dying, is the highest,” says [Rep. As Sally Pipes, president of the the [National Health Service] on NHS waiting lists dropped America can’t change this with we don’t have Medicare for All. But, Pramilla] Jayapal [D-Wash.]. Pacific Research Institute, notes, provides free and unlimited health between 2008 and 2011, not least enforcement offices or constant writes , non-medical The truth is more complicated. “The United States … counts every live care, history demonstrates that the because greater collaboration with meetings. It requires retaliation factors and bad statistics, are the In their 2018 study, the JAMA birth in its infant-mortality statistics. supply of NHS services has always private hospitals enabled greater against offenders severe enough to real sources of these variations researchers report that American But France only includes babies been limited in significant ways. responsiveness, the waiting list for put them out of business, in order in outcomes: infant mortality is indeed higher than born after 22 weeks of gestation. In Experience shows that people have NHS treatment has grown since 2012. to deter others. In 27 months, the in 10 other high-income countries. Poland, a baby has to weigh more never had an absolute right to free In summer 2018, the figure stood at Trump administration has taken In a 2017 study for the Journal of Notably, however, the researchers than 1 pound, 2 ounces to count as a

and equal treatment on demand. 4.12 million people on waiting lists, major (public) IP action against IMAGES BECKER/GETTY DAVID the American Medical Association, also found that when adjusting for live birth.

6 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 6 THE INSIDER SUMMER 2019 7 “The World Health Organization little money but cost a lot in notes that it is common practice in compliance, writes Chris Edwards: several countries, including Belgium, France, and Spain to ‘register as More than a dozen European live births only those infants who countries used to have wealth survived for a specified period taxes, but nearly all of these beyond birth.” countries repealed them, including Note also that the United States Austria, Denmark, Finland, France, has high rates of pre-term births. Germany, Iceland, Ireland, Italy, American medical professionals, the Netherlands, , and including those participating in Sweden. Wealth taxes survive only in Medicaid, will thus intervene Norway, Spain, and Switzerland. in complex and difficult cases Before repeal, European wealth and literally spend hundreds of taxes—with a variety of rates and thousands of dollars to save the life of bases—tended to raise only about 0.2 a premature infant. percent of gross domestic product Medical professionals in other in revenue, based on Organization countries do not necessarily make for Economic Cooperation and the same moral and financial Development data. That is only commitments. [Robert Moffit, “Ignore 1/40th as much as the U.S. federal Medicare for All Advocates’ Claims on income tax raises. Life Expectancy in US. Here Are the Yet for little revenue, wealth Facts.” , April 18] taxes are difficult to administer and enforce. They may require taxpayers The movement that demands ACTRESS LORI LOUGHLIN ARRIVES AT the John Joseph Moakley U.S. Courthouse in Boston on April to report the values of financial 3, 2019. Loughlin and her husband are among dozens of parents facing charges in a college admissions diversity thinks everybody What this example demonstrates goods that the varying millions cheating scandal. securities, homes, furniture, artwork, should want the same things. Sen. is that the market does not provide of individual purchasers want. jewelry, antiques, vehicles, boats, Elizabeth Warren’s call to break up splendid variety as a wasteful Warren’s call for breaking up Amazon, pension rights, family businesses, Amazon is a call to reduce consumer frivolity. Even in the absence of a like Sanders’s complaint about In a better world, the answer to common complaint to me is that farm assets, land, intellectual choice, writes James Hanley: profit motive, variety is necessary to deodorants and sneakers, although both of these questions would be college transcripts have become property, and much else. But accommodate human differences. [...] nominally aimed at the corporation, “Yes.” But we live in the world higher less and less meaningful. After all, owners do not know the market Amazon’s true value to consumers Some will argue that there’s a effectively targets individuals for education has created, where the virtually all new college graduates values of many assets, and values is not low cost and free shipping but difference between need and want, their decisions to choose goods and “pressure of schooling” is virtually no sport nothing but Aes or Bs on their change over time, so costly wealth- the great variety of goods it makes that shoes and aircraft safety are services that they decide best meet pressure at all. transcripts. For the same reason, tax compliance would only make available to people, both directly and different than deodorant. Oddly, their personal needs and desires. Consider these facts: A 50-plus- grade inflation also hinders the accountants wealthy. from third-party sellers. [...] though, they never push this [James E. Hanley, “Save Amazon from year nationwide study of the history ability of graduate school admissions And what about wealth held The need for variety to meet argument to its logical end and Elizabeth Warren,” Foundation for of college grading finds that, in the boards to differentiate meaningfully abroad? There is no way the Internal human needs is rediscovered every condemn variety in music. But as Economic Education, April 1] early 1960s, an A grade was awarded among student transcripts. Revenue Service would be able to time there’s value in discovering economist Art Carden recently wrote in colleges nationwide 15 percent of So, the answer to the question, track down and value everything U.S. it. For example, in WWII, the U.S. about the death of Keith Flint, the After you bribe your way into the time. But today, an A is the most “How did these unqualified students residents owned on a global basis. Army discovered that there were no frontman for the British electronic school, then what? Thomas Lindsey common grade given in college; the manage to graduate from these elite In the 1970s, the British Labour average pilots when it tried to design band The Prodigy, “[e]conomic writes that the admissions scandal percentage of A grades has tripled, to institutions?” is straightforward: government pushed for a national a standard cockpit to decrease pilot- growth [...] means much more “has depended for its success on 45 percent nationwide. Seventy-five When an A is the most common grade wealth tax and failed. The minister error. Not even one of the thousands than material production.” How the ‘other’ college scandal: rampant percent of all grades awarded now given in college, how hard is it to in charge, Denis Healey, said in of pilots they measured was average many styles of music do we need? grade inflation”: are either Aes or Bs. The National graduate? [Tom Lindsay, “The ‘Other’ his memoirs, “We had committed on the 10 most important measures, Materially, none. Immaterially, Association of Colleges and Employers College Scandal: Grade Inflation Has ourselves to a Wealth Tax; but in five so seats and control mechanisms had as many as all those stressed out As one writer wondered, “Wouldn’t reported in 2013 that “66 percent of Turned Transcripts into Monopoly years I found it impossible to draft one to be made adjustable to the variation American workers want to help admission under false pretenses employers screen candidates by grade Money,” , March 30] which would yield enough revenue to in pilots’ torso, leg, and arm sizes. themselves relax after a hard day result in the kids flunking out? point average (GPA).” be worth the administrative cost and They learned something unwary at work. Wouldn’t their lack of merit be As I recounted here, employers Europe doesn’t have wealth taxes political hassle. [Chris Edwards, “Why clothing shoppers have learned time Amazon has made its fortune revealed by the simple pressure of have known about grade inflation anymore. Such taxes, European Europe Axed Its Wealth Taxes,” Cato PAT GREENHOUSE/THE BOSTON GLOBE VIA GETTY IMAGES VIA GETTY GLOBE GREENHOUSE/THE BOSTON PAT and again: One size fits all doesn’t. on offering the great variety of the schooling?” IMAGES SMITH COLLECTION/GADO/GETTY for years, which is why their most policymakers have learned, raise Institute, March 27]

8 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 9 aisle to pass the Voting Rights Act of They represent thousands of pro- investment in their professional 1965. Republicans like Rep. Charles business, pro-economic-freedom success is left to chance. From (Mac) Mathias of Maryland and Sen. professionals who continue to learning appropriate dining Jacob Javits of New York were the stay engaged in the success of etiquette to dressing for the success champions who carried the bill across their communities. of the C-Suite, Gloucester makes the finish line. This rich history is True engagement is an intentional the investment. important, but engagement with and sometimes uncomfortable two- Most critically, the institute does the issues people care about now is way street. We conservatives put not teach students to be conservatives, necessary to encourage new audiences efforts into short-term outreach and but rather trains them to consider to look at our agenda and solutions scratch our heads when the results all points of view (including the for America. yield nothing. The reason the results conservative one) about problems such Even though growing the base is are disappointing is because most as poverty, disinvestment, community what everyone wants, it is hard to efforts are designed for quick victories policing, and education. get conservatives to actually do it on Election Day. The efforts being How to Reach Millennials, Minorities, right. We have more examples of the made are not to build relationships Speak Up wrong way to engage than effective with minority communities to In 2015 our firm, Bass Public engagement. For example, the understand their concerns. Affairs, was hired by ’s and Women with Conservative Ideas wrong way to reach out to African Success will come only presidential campaign. BY DEANA BASS WILLIAMS AND DEE DEE BASS WILBON Americans is to visit black churches if we are focused on long- That April, Carson on the Sunday before the Tuesday term efforts at building was invited to speak of a close election. The wrong way trust and earning the at Al Sharpton’s If you talk to anyone about shaping the future of distinctions should make all Americans to engage women is to convene a right to be heard. We Three concrete National Action this nation, they will tell you that there are certain cautious. Over a century ago, the “separate but panel of all male legislators to talk regret to say that there Network conference. demographics that must be touched—millennials, equal” doctrine in the Supreme Court’s Plessy about abortion. Simply throwing are very few examples actions give Many prominent women, and minorities. And so I tell people that v. Ferguson (1896) decision moved America your content on every social media of conservatives making you a chance conservatives criticized unless our ideas are reaching those demographics, many steps away from the goal of being one platform available is the wrong way to an effort and doing it the of reaching Carson for accepting then we are going to be looking at a shrinking perfect union where all men are created equal. engage millennials and Generation Z. right way. The longest, the invitation. They said minority view in this country. The court’s decision in Brown v. Board of There are no sure-fire recipes most consistent effort new audiences: attending would only —Kay Coles James, President, Education (1954) began to march us back in the for 100 percent success, but sitting to reach minorities with show up, legitimize Sharpton. The Heritage Foundation right direction. on your hands and doing nothing is conservative ideas that speak up, Such thinking will But sincere efforts to expand the a guaranteed recipe for failure. Our we have seen is The and shut up kill any true efforts at INORITIES, WOMEN, AND conservative movement to deliberately include decades of outreach experience have Gloucester Institute. reaching new audiences millennials are three communities underrepresented groups are not an exercise in taught us that three concrete actions It was founded over a and learn. with conservative ideas. M least likely to identify as conservatives. identity politics; they are an effort to unite, not give you a chance of reaching new decade ago by Kay Coles Carson’s participation in The survival of the conservative movement is divide. At its very core, identity politics builds audiences: show up, speak up, and James (now president of The Heritage the forum did not legitimize Sharpton. possible only if we grow our number among walls between the races. What we propose is shut up and learn. Foundation) and her husband Sharpton is made legitimate by the these groups. It is not at all rocket science. Yet breaking down walls by identifying shared Charles James. Its mission is to train hundreds of thousands of people who in the 30 plus years that we have identified as beliefs with new audiences. Failure to do so will Show Up and nurture the next generation of watch his MSNBC cable program and conservatives and in the 20 years that we have render the conservative movement a dinosaur, a Show up has long been the minority leaders to be better critical listen to his Sirius XM radio show. worked in the conservative movement, we have footnote in American history. outreach mantra. It is a simple thinkers and well-informed citizens. He is legitimate because of his huge seen efforts to expand the base fail miserably. Many conservatives believe the history of enough concept. If we don’t show The Gloucester Institute shows influence in social media. Ignoring The failure has been so glorious that the only the Republican Party (which has tended to be up, we have no chance of reaching up and sticks around. We have been him and the audience he attracts way to fail better would be to fail on purpose. the home of conservatives) should play a role in new audiences. Some conservatives blessed to see first hand the real-time doesn’t erase him or his ideas from the Conservatives naturally bristle at talk of building alliances with African Americans and are eager to show up, but the big investment Gloucester makes in the public square. expanding the base to women, minorities, women. Republicans take pride in roots that question is where? Most people are lives of minority college students Ignoring Sharpton only and millennials. The rejection comes not stretch back to strong and early support of the familiar with the NAACP and the who participate in the institute’s means ignoring his audience and because of some covert racism or sexism women’s suffrage movement and the abolitionist National Urban League. But, there Emerging Leaders program. Students leaving space for liberals to define or an unwillingness to be inclusive. Rather, movement. How many times have you heard are a number of great community from diverse political backgrounds conservatives. When Sharpton conservatives oppose making appeals based on Republicans beam about being the party of organizations that present avenues are given the opportunity to meet introduced Carson, he said they may demographics. Conservatives rightly believe Lincoln and the Emancipation Proclamation? for engagement. For example, African and discuss issues with Cabinet- not agree on the day of the week, but dividing the sexes and races pits communities It is, in fact, true that Democratic President American sororities and fraternities level officials, national community he appreciated Carson’s willingness

against one another. Separation by such Lyndon Johnson needed support from across the IMAGES ELENABS/GETTY are more than mere college cliques. advocates, and business leaders. No to join him on stage. The audience

10 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 11 welcomed Carson with polite applause. walks of life who were pro-choice. top three concerns of millennials. However, by the end of his remarks, We were honest and transparent Millennials’ and Generation Z’s they were applauding enthusiastically in our invitation, making sure that concerns for income inequality have and rushing the stage to shake his each woman invited understood that created what most conservatives hand and to snap selfies. we were pro-life and interested in would view as a misguided love affair Carson may have won over only hearing how they arrived at their pro- with socialism. The best way to 10 people in that audience, but that’s choice stance. engage millennials on this issue is to how the movement grows—a few Most of the women had never shut up and listen to their concerns. people at a time. But even more actually talked through why they Listening to millennials might important, he did not cede ground considered themselves pro-choice. surprise you. We have created allies and leave open an opportunity for the Fewer still had ever heard the and eliminated adversaries when we liberal narrative about conservatives explanation of what happens during a are silent long enough to hear and to thrive. Ninety-nine percent of the late-term abortion. understand their goals. When we audience was African American. How Yes, it was a bit terrifying, but listen to millennials, it is clear that often do conservatives penetrate it was important for us to speak they do not despise America or even the liberal base with a up on the issue. The find fault with authority and order. direct message? roundtables were They simply have a huge heart for Carson’s speaking among the most the down-and-out. They root with at the NAN conference amazing, deeply passion for the underdog. Ultimately, would have been identity Engagement moving conversations they want the same outcome we want: politics if he had sought means not only we have ever had. The healthy, thriving communities. to engage a black conversations were We are capitalists, audience with a different talking about uncomfortable but and we are always inspired and message than he used issues that are necessary. In the end, impressed when millennials in our with white audiences. we made an impact mentoring group share their heart important to Loveland, Colorado. He did not change his in two areas. First, for low-income, disadvantaged A FRACKING RIG OPERATES NEAR message. He also did not you, but also we actually changed communities. Because we believe believe the hype from shutting up to minds about abortion. in attacking policy not people, we the mainstream media listen to issues But for those women do not call millennials misguided or Sharpton himself who remained pro- snowflakes when they articulate Fighting for the Soul of Colorado: who paints pictures of importance to choice, they no longer plans that amount to little more of conservatives as the communities painted all conservative than wealth redistribution. Because unfeeling hypocrites you want pro-lifers with the we have spent time listening to them An Interview with Jon Caldara whose values are to reach. broad-brush strokes of and not attacking them, when we out of touch with unfeeling hypocrites. lay out basic truths of how socialism regular people. and wealth distribution have only ON CALDARA IS THE PRESIDENT JON CALDARA: They have been fulfilling The national news media does a Shut Up and Learn worked in Smurf Village, they are far of the Independence Institute in their mission of turning Colorado into fine job of painting such a picture of Finally, engagement means not more inclined to listen. J Colorado. In last November’s elections, . They have put restrictions on oil conservatives when it comes to issues only talking about issues that are Heritage Foundation founder Colorado Democrats captured all of the and gas development that will slowly choke like abortion. If we actually believe important to you, but also shutting Ed Feulner often reminds the state’s constitutional offices and both off the industry here in Colorado. They have the major news outlets, women came up to listen to issues of importance conservative movement that it is legislative chambers—the first time that has committed the state to the National Popular to near riots because states like to the communities you want to better to add and multiply than to happened since 1936. Since then, a blitz of Vote plan, under which we pledge our electoral Georgia and Alabama have curbed reach. Here again lies the rub. divide and subtract. As we look to leftist lawmaking is turning Colorado into a votes to the presidential candidate who receives access to abortions. In reality, women Conservatives have an aversion to the future, the most effective way to progressive laboratory. We talk with Caldara the most popular votes nationwide. In other are far more outraged and disgusted the idea that different demographics multiply is to show up, speak up and about the challenge of running a free-market words, they have given our electoral votes to the by late-term abortions and the have concerns that are not shared by all means, shut up and learn. in a state where progressives hold voters in California and New York. passage of pro-infanticide legislation by the overall community. It seems all the power. They passed a so-called “red flag” law on like that of New York. offensive to say that thoughts, ideas, Mrs. Bass Wilbon and Mrs. Bass guns, but it isn’t really a red flag law. It’s more In 2017, as Planned Parenthood and policy are not race-, gender-, and Williams are the founders of Bass Public THE INSIDER: You have described the work of of a gun-ban law that takes away a gun owner’s marked its 100th anniversary, Bass age-neutral. Affairs and GROWTHComms.com, the Left since the election as an effort to turn presumption of innocence. They’ve put price Public Affairs hosted a series of The issue of income inequality an annual conference for Colorado into Venezuela. What have Colorado caps on pharmaceutical drugs. They’ve given

roundtables with women from all consistently ranks as one of the conservative communicators. IMAGES VIA GETTY DENVER POST HELEN H. RICHARDSON/THE lawmakers been up to? cities the green light for raising minimum wages.

12 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 13 They’ve passed a new sex-ed law that tax revenues generated by oil and gas JON CALDARA, PRESIDENT OF THE Independence Institute, discusses how tax mandates students be taught about extraction. So, it’s not just a betrayal of increases would hurt the Colorado economy. the transsexual lifestyle. They’ve what the people voted on last fall; it is created more corporate welfare for going to hurt working families the most. feel-good green energy. I grew up in TI: I’m going to be like a sideline Colorado, and I’ve never seen such a TI: Are there going to be electoral reporter asking an athlete to tell lurch to the Left in my life. consequences of that policy? us about the game he just lost, but would you care to diagnose what’s TI: How do the new the oil and gas JC: Well, we will find out next year gone wrong for the liberty-loving restrictions work? How are those in 2020, but I will say that there movement in Colorado? going to affect Colorado’s economy? has already been a consequence. Rochelle Galindo, the representative JC: It’s an easy thing to diagnose. JC: It’s important to know the in House District 50, a large part The Left, some 15 years ago, looked background. In the last election, of Weld County, was on her way to at the Independence Institute and there was a fracking ban put on the being recalled when she read the tea realized that if they did the kind of ballot. They called it a set-back; it leaves and resigned. According to the work that we do, but added a couple would have set back how far you polling we had, the voters were going zeros to the end of the budget, they could go in developing oil and gas to remove her from office, and it only could build a political infrastructure. resources. It would have put oil makes sense. Like the representative So, the difference is quite simply on and gas development out of reach of a ski town voting to make skiing the donor level. You have people on of nearly 80 percent of Colorado. illegal, she voted directly against the the Left who are willing to invest a lot The people defeated that by about a interests of her constituents. more money into politics to get their 10-point margin. goals. There is a hardcore group we So instead the legislature passed TI: State lawmakers are not the call the “gang of four” that funded what they call local control of oil and only ones pushing new gun control a plan that has been come to be gas, which means that all the city initiatives, right? and most intolerant town in all my actions. She came home crying attitudes about how political battles known as The Blueprint, which was councils that hate oil and gas will run of Colorado. They will bend over after they berated her for it. Mind are fought have also changed. How so? originally about getting civil unions them out of business. But if a locality JC: I’ve taken a personal stand on a law backwards to help certain people with you, this happened in a school that and then gay marriage approved. supports oil and gas development, that my hometown of Boulder passed. lifestyles that they like or people with puts up posters urging diversity and JC: I grew up in the ’70s, and I So you have donors who not only then that does not necessarily mean it They call it an assault weapon ban. different religious views or different tolerance on students. remember good liberals. They were put up the money, but they put the will be allowed, because now the state Not only does it outlaw the purchase ethnic groups, but when it comes to very principled people who fought money into political infrastructure has changed the regulatory structure and ownership of lots of different people whose lifestyle includes gun TI: And those restrictions are a burden for inclusion of all sorts of people, but before they put it into candidates. and the oversight committee. types of semi-automatic weapons, ownership, the message is pretty clear: above and beyond the state’s red flag they would always say things like: The Colorado Republicans (who are Basically, the new law says: If the but it also outlaws any magazine We don’t want you ugly people in our law, right? ends don’t justify the means. You’re the conservatives) have been using locals don’t shut down your oil and more than 10 rounds. I announced lily white town, so we’re going to make innocent until proven guilty. The the same playbook for the past half gas development, the state will. that I would not comply with this law. it illegal for you to live the lifestyle you JC: The state passed a red flag law, process matters. Now the Left is a century. They give money to their They had a grandfathering period. have, and hopefully you’ll just leave. which in concept is not necessarily promoting changes in law that rip away candidates. That candidate rents an TI: Is that an overreach for legislators If I self-identified as a gun owner, So, I’m in open defiance of that. a bad idea, but in the details it is a process and the rights of dissenters office, he rents a phone system, he then if the people didn’t want it? brought myself to the police for an Through the Mountain State’s Legal gun grab idea. It creates a process in order to get what they consider the rents computers, he rents databases, investigation, opened up my guns Foundation, I’ve filed a federal in which gun rights can be denied to right result. The oil and gas bill is a and he rents people (i.e., workers) for JC: It is, without a doubt, an overreach. for inspection, ran through another complaint about it, which is tied up in those who are deemed a danger to perfect example. The red flag bill is a maybe four to six months. Win or lose, But beyond that, it is hurting the very background check, and paid for it the courts right now. But, at any point, others, but in so doing it rips away the perfect example. In the past, ACLU- at the end of the campaign, all that people about whom progressives again, and then paid for another fee, my house could be raided, and I could presumption of innocence, and puts type liberals would have come out infrastructure comes crashing down. claim they care. Much of Colorado’s they would give me a permission slip be arrested. the burden of proof on the accused. against these things, but not today. It’s The Left instead built an workforce, particularly up north, to keep what I already own. Former roommates or old girlfriends disturbing to see. At least in Colorado, infrastructure that built the are working-class families who I don’t see that the tolerant people TI: But you’re not in jail yet, right? can make an accusation and have you the progressive movement is hardcore databases, that built the think tanks, make a decent living and keep their of Boulder would treat any other group disarmed, and then you have to fight intolerant, and what they want is what that built the legal firms, that built communities going through oil and of people this way. My hometown of JC: I’m not in jail yet, but it is a to get your rights back after you’ve they want, and they’ll get it any way the voter registration firms, that gas development. Up in Weld County, Boulder is kind of the Berkeley of the difficult thing, particularly for been disarmed. they can, and getting what they want built the polling outfits, that built where most of the oil in development is Rockies, and they pride themselves my family. My daughter, who was includes ending gun ownership, ending the investigative reporting outlets located, hundreds of millions of dollars on their diversity and their tolerance. a sophomore in high school, got TI: You’ve written that policy changes fossil fuel development, and ending to push a narrative. They invested in per year go to education thanks to But in fact they are the most undiverse bullied by her fellow students for IMAGES VIA GETTY JOE AMON/THE DENVER POST are only part of the story—that liberals’ educational choice. those activities first, and over time

14 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 15 that built up a movement that allowed TI: Many of our readers run state- can have victories, even if they are a fundraising platform for liberty- speech and pulling the rug out from plane. We haven’t seen a hijacking them to win. To put it another based policy organizations. For those incremental victories. promoting projects, and you are conservatives and libertarians. The since 9/11. I wish we could say the way, conservatives in Colorado who are thinking about broadening And then the last step of the training teachers how to use guns to idea of FreedomFy is to have a safe same thing about school shootings. traditionally bet on horses. The their work from policy to these other process is actually going into political defend their schools. How are those space where the center-right can progressives in Colorado were rich, areas, what’s the first step? battle. That means lobbying on efforts going? come together for common interests. TI: Why should we pay attention to and they bought the racetrack. legislation, putting measures on the The other thing you mentioned what’s going on in Colorado? JC: The very first step is an admission. ballot, submitting public-interest JC: Both of those projects help us is our FASTER training. It stands TI: We know that the business I think it’s almost like an alcoholic comments, and working with 501c(4)s build a coalition for liberty. The for Faculty and Staff Training in JC: I grew up in Colorado. Colorado community is happy to donate admitting he has a problem. For and other organizations to get the idea with FreedomFy is to have Emergency Response. While many was always the place where people to whoever has power. How has too long, liberty-minded policy punch going. We even get involved in a GoFundMe or Act Blue for people talk about school shootings, came to unleash their talents, to the current dominance of the Left organizations have been willing to be recall campaigns. conservatives and libertarians, a we’re one of the few groups that is write their own biographies, to take affected your ability to raise funds? right at the expense of winning, but We think about freedom. That’s place where people can put up their actually doing something about risk, and to be free to make their Has it changed your strategy? they’re not mutually exclusive. the think tank stuff. We talk about projects, get funding, the danger. We train own decisions. That’s always been The first part of any political freedom. That’s the distribution of and meet other people school administrators the Colorado culture. That culture JC: It’s good and bad. There are movement is to have the right our ideas. Then we work to build a who are like-minded. and teachers how to of longing to be free to make your many Colorado conservatives who policies and the right intellectual team, the coalition. So we try to act A case-in-point defend their schools own decisions is being replaced have donor fatigue, because they’ve ammunition, and that’s about freedom. And of how this works: with firearms, and with a California culture, where we been using the old playbook of giving what our policy groups then finally we try to Rob Natelson did a The same plan, how to provide tactical demand to make decisions for other their money to candidates. Since we do so very well. But make change, which is tremendous amount of The Blueprint, is emergency triage after people. That battle is now playing were focused on building long-term then you have to figure when we create freedom. research and writing being deployed a shooting. There are out in Colorado, and our goal is to political infrastructure, we never out how to engage so That is our four- on the National Popular 178 school districts in celebrate and return to the true Conservatives in other states, really received much of their money that your ideas become in Colorado step process. Vote Compact, which Colorado. Over 30 of Colorado culture. to begin with. Those donors are burnt politically relevant, so now Colorado has sadly including in them now allow trained There was a reason why Ayn out, and I can’t blame them, because that they are actually traditionally bet TI: Is it fair to say joined. Because of that Texas. People teachers to carry a Rand put her mythical Galt’s Gulch their political investments haven’t part of the political fight. that right now you’re work, activists had the concealed weapon. in Colorado. This was a place that on horses. The say it can’t paid off. We have four steps. progressives focusing on steps one, ammunition to try to There are now many drew people who loved liberty like However, there seems to be a The first step is doing two and three, because refer the measure to happen in Texas. schools in Colorado a magnet. Now it draws people who growing realization that our work the intellectual work— in Colorado step four requires more the people—that is, to Well, people where a would-be like the comparatively lower house here at the Independence Institute that is, policy think tank were rich, and people who agree with overturn what the used to say it shooter knows he will prices, and the skiing, and the ability to build what we call a permanent work. The next part is they bought the you holding power? legislature did. We’re face armed resistance to coerce other people. freedom infrastructure is the right the distribution work, the only state whose couldn’t happen from adults who have We are in a battle for Colorado’s racetrack. strategy. That work includes coalition which requires realizing JC: No. You would legislature approved in Colorado. been trained to protect soul, and if we fail, it’s not just building, journalism—including that people don’t come be wrong. the compact without If Texas goes, our children. Colorado that’s at risk. The same investigative reporting—legal work, to you. You have to sell it For instance, our even a single token My daughter, for plan, The Blueprint, is being deployed market research, and talent-building. to them. We do that through our news investigative reporting played a key Republican vote. The game over; the instance, goes to a in other states, including in Texas. All these things are necessary, but aggregator Complete Colorado. We do role in getting the recall of Rochelle group who organized nation goes. school that does not People say it can’t happen in Texas. so many on our team want to just that through our television program Galinda started. Our reporting built the opposition is a allow armed teachers. Well, people used to say it couldn’t skip over them. There is a growing on Colorado Public Television. I the narrative that put the pressure citizen group. They There’s a proud sign happen in Colorado. If Texas goes, realization that these activities need write a column in the Denver Post. on her to resign. We put things on needed money to print their posted outside that says nobody here game over, goes. That’s to be funded if we’re going to ever win We do talk radio programs. We have the ballot that we think will bring petitions. They went to FreedomFy. really has a gun, so it will take a long why our job is to build and create back our state. podcasts. We’re a media force, and we voters to the polls. A few years ago we They wanted to get $15,000 to help time to stop you. We want to send the the antidote to this blueprint, and So, I’m very optimistic that people have five ways to distribute our work. put a measure on the ballot to open offset printing costs. They were able opposite message. bring Colorado back, so that we can are waking up to this fact. They The next part is the coalition up negotiations between unions and to raise $22,000. More importantly, Also, it breaks the false narrative inoculate other states from this don’t want to see Colorado turn into building, because winning politically school districts to the public, so that they raised it from about 400 people. that educators, and particularly terrible experiment. California. They are aware that our is a game of addition. Or, as we say, taxpayers, students, and teachers Those 400 people then have a women, don’t support guns. It That’s why Colorado has outsized demographics are changing, that freedom is a team sport. So we work could see what was happening. We connection and can be asked to carry reminds me quite a bit of the air importance. If you care about people are rushing to Colorado from quite a bit on coalition building, lobby down at the capital on bills. So those petitions. So they’ve got 400 marshal program created after preserving a free country, then you the failed big government states of trying to get our dysfunctional we are very involved in all four of potential foot soldiers in their battle, 9/11. About 10 percent of all federal should have your eye on Colorado— California, and Illinois, and New York. center-right team to communicate those categories. and that’s the addition part. pilots carry a concealed weapon, and hopefully your resources helping That’s changing the political system better with one another, to work We keep hearing that platforms and they’ve been trained by the out in Colorado. We must find the here. It’s not too late, but we must get together for common causes, and TI: Your outreach work takes a like GoFundMe, and YouTube, air marshals on how to respond if antidote, and we will, if we can get the moving on it right away. to try to do it smartly so that we variety of forms. You’ve launched and Facebook are squelching free somebody tries to take over their resources to do it.

16 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 17 Fouling Up Federalism How Federal Grant-in-Aid Programs Drive Irrational Policymaking and Undermine Democratic Accountability

BY MIKE NICHOLS

S PART OF THE SUCCESSFUL EFFORT One of those ways was the streetcar, now officially to lure the Democratic National Convention to known as The Hop. A Milwaukee in the summer of 2020, city leaders The federal government, in the end, financed $69 mil- have promised free, unlimited rides to convention-goers lion of the $128 million Hop; the rest of the initial funding on their shiny, new, mostly federally funded, $128 mil- came from local tax incremental financing districts (a dif- lion streetcar. ferent tale of abuse for a different day). This is entirely fitting. The Hop has been running since last fall on only about The streetcar, a classic example of political “grant- two miles of track in a small portion of downtown Milwau- standing” that has all the makings of a colossal boondog- kee. Predictably, it is already plagued by what appears to be gle, has never been subject to normal economics. It would low ridership (the city says the system that counts the num- never have been built if riders or local taxpayers actually ber of riders is busted, but it’s hard not to notice completely had to pay the cost of the thing. And it’s altogether unclear empty cars), tracks that dead-end in the middle of streets whether anyone will really use it if and when the city and may never lead anywhere, and widespread disinterest starts to charge fares regularly. among almost anyone who has someplace else to sleep. The only reason the streetcar exists at all is that 28 years Never mind the fact that Milwaukee tore out its orig- ago, the federal government for some reason gave the Mil- inal streetcars in the middle of the last century because waukee area close to $300 million for a bus-only highway even then—way back before Uber or electric scooters or between Milwaukee and Waukesha County to the west. the prospect of driverless vehicles—they were already a Turned out that the governor at the time, Tommy Thomp- nostalgic thing of the past. son, wasn’t really up for a bus-only highway, so other Wis- Unfortunately, the waste and lack of common sense consin politicians spent the next 25 years (yes, 25 years) on display along the new tracks today isn’t just a problem trying to find a way to avoid losing all that free, federal cash. for Milwaukee.

18 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 19 Those grants awarded way back in 1991 are known as fed- Almost half of those 313 workers, in fact, appear to be per- erwise,” district business manager Kristin DeBruine said. Americans are starting to see local and state government eral grants-in-aid, and they are even more ubiquitous today. forming purely administrative duties rather than anything “That simply just doesn’t make sense at all.” the same way that they see the federal leviathan—and no directly affecting what happens in the state’s classrooms. In Waupaca County, meanwhile, federal rules pro- wonder; they are often one and the same. Grants-in-Aid That includes accountants, grant specialists, administrators, hibit special education students from riding on buses with Our fundamental finding is simple: There is tremendous There are many types of direct, domestic federal spending, attorneys, and human resources personnel. non-special education students, requiring districts to operate disquietude and repugnance, to borrow terms used in the Fed- including contracts, direct entitlements, and a wide variety of In addition to the federal bureaucracy, in other words, two duplicative bus routes, said Drew Niehans, business manager eralist Papers, among the people. And one of the primary rea- grants. Researchers and writers in the Badger Institute’s Proj- often duplicative bureaucracies have been constructed at the of the Weyauwega-Fremont School District. sons is the flow of federal money that for so long has increased ect for 21st Century Federalism spent the better part of three local and state level. “This not only limits our routes but will also not always politicians’ popularity is also undermining their credibility years investigating just one: grants-in-aid—funds that flow Wisconsinites paid over $53 billion in taxes to the federal be in the best interest of the (special education) students as and ultimately the great experiment that is America. directly from federal coffers to state and local governments. government in 2017 alone, according to the Internal Revenue it will isolate them,” he said. At the same time, that money is in essence buying a very Grants-in-aid were relatively rare until the 1960s when Service Data Book. Some of that money stays in Washington, Niehans was one of hundreds of school officials—teachers, tenuous and brittle obedience that can last only as long as President Lyndon Johnson made them a focal point of his D.C., or is spent outside the country. But these other bureau- administrators, and school board members—who responded the grants do and is, in the meantime, costing the states and War on Poverty. Today, they are so prevalent that the gov- cracies have been constructed to make sure that much of that to a series of Badger Institute surveys in 2017 and 2018 asking their residents dearly. ernment essentially has stopped counting how many such money returns to where it came from in the first place. them about how federal involvement in their schools affects State governments today are too often no longer these grant programs even exist, but Chris Edwards of the Cato “The paperwork—it needs to be checked 52 ways to Sun- them and their students. “visible guardians of life and property” Institute recently put the number of such programs at 1,386. day. I can’t even imagine how many personnel they have The predominant opinion: Giving written of in the Federalist Papers. The total outlay rose from $7 billion in 1960 to an esti- whose sole job is just checking boxes,” said Ted Neitzke, a more flexibility to local educators and Nor are their activities regularly and mated $728 billion in 2018. The system has grown so quickly former school superintendent referring to the bureaucracy parents would help schools operate plainly before the public eye. They are that most states today get about one-third of their revenues in the state Department of Public Instruction. more efficiently and effectively—and more distant, more detached, more from the federal government. it would be better for the students. State governments today like the federal government because We looked at Wisconsin as a microcosm of what’s hap- An Even Bigger Problem are more distant, more in so many ways that is exactly what pening all across America. In Wisconsin alone, if you include Overspending and bureaucratic bloat are enormous con- Why It Continues detached, more like they are. the University of Wisconsin System, more than 10,000 cerns. The Congressional Budget Office now projects that Sometimes, local leaders take the States have become beggars and full-time-equivalent “state employees” are actually paid with federal debt held by the public will reach 96 percent of gross federal money to protect legitimate the federal government sycophants and have abdicated their federal dollars. Multiply that by 50 and you see the extent of domestic product (or $29 trillion) by 2028—the largest per- programs. Sometimes, politicians take because in so many ways own responsibilities. the problem. centage since 1946. the money for purely political reasons. that is exactly what they It is clear that the eventual costs Some departments of state government, as a result, have But the grants also incentivize poor policy decisions, There is still some political currency, of continuing apace, the incessant become little more than offshoots of Washington, D.C.: decrease local accountability and innovation, transfer author- particularly among redistributionists, are. States have become growth of federal debt, the loss of ity to unelected bureaucrats, and generally foster a culture of in showing that you can bring back as beggars and sycophants time and money and American inge- ■■ Fully 73 percent of the Wisconsin Department of unrealistic and illogical expectations. Everything is expected much federal loot as possible. Politi- and have abdicated their nuity, the cost in dollars at the state Workforce Development’s 1,603 workers are paid with to be free—and not just streetcar rides for the DNC. cians love these grants. Those in the own responsibilities. and local level, the greatly dimin- federal funds. The Badger Institute’s recent book, Federal Grant$tand- nation’s capital get to claim they are ished trust and confidence, the loss of ■■ At the Department of Children and Families, 48 per- ing, demonstrates how Americans are bridling at the helping constituents (i.e., voters) back liberty—which is really just the abil- cent are paid with federal funds. intrusiveness of the federal government in their lives and home; and politicians back home get to ity to live a purposeful life in what- ■■ At the Department of Transportation, it’s 25 percent. simultaneously shaking their heads at the absurdity. brag about securing federal money to build the latest road ever way one chooses without government interference—is There is, admittedly, plenty to laugh about. or streetcar. threatening the dual system of governance that the Founding Through grants-in-aid, the federal government inserts In 2011, for instance, Oostburg School District officials in To the extent the loot flows to special interests back home, Fathers envisioned. itself into everything from environmental issues to research Sheboygan County spent nearly $60,000 to build an elevator maybe it is a winning voter-turnout strategy. But we have our The system has to be disentangled. But how exactly? on aging. Wetland management, hunter safety, water qual- in its middle school. doubts. Americans, exposed time and again to such absurdi- Increase transparency. Demand metrics. Try to limit the ity, nutrition and health issues, crime victim assistance, land The school had no students or staff using wheelchairs, and ties, have lost faith in the people who govern them. amount of money the federal government has to offer, and acquisition, and gang resistance are just a few of the policy there is handicapped access elsewhere in the building—so Asked how much trust and confidence they have in the illustrate how accepting that money is self-defeating to the areas that are subject to federal control through grant-in- nobody really needs or uses the elevator except occasion- executive and legislative branches, almost 60 percent of states and the people who live in them. Most importantly, aid programs. ally when a grandparent enters the school through a nearby respondents to a 2018 Gallup poll said that they have either devolve power and responsibility back to the states. Reas- Almost nowhere is the intrusion as pronounced, however, entrance after hours to watch a basketball or volleyball game. “not very much” or “none at all.” sert the basic principles of federalism that the Founders so as in the education realm. Nearly half (49 percent) of employ- Local school officials built it to satisfy federal “mainte- There is a troubling disconnect between the people and brilliantly conceived. ees in the Wisconsin Department of Public Instruction (DPI), nance of effort” requirements that demand they spend at least the leaders, a sure sign of an unhealthy republic. After all, merely making local taxpayers pay for the things 313 workers, are federally paid and essentially work for the the same amount of local tax dollars year after year or face a Sadly, this distrust of the federal government now has that their local political leaders propose surely would result federal government. loss of federal funding. In other words, even if school districts infected America’s views of state and local governments as in better decisions—or, at the very least, limit the number of Over the past two decades, federal aid to DPI has grown find ways to save money, they still are compelled to spend it. well. Only 20 percent of Americans currently have a great “free” rides on the $128 million Hop. twice as fast as the agency’s budget—and much of that federal “We would not have put (the elevator) in without the deal of trust and confidence in their state government, and money is spent on administration and bureaucracy rather required use of the money, as it is only used for after-school the percentage who have a great deal of trust and confidence Mr. Nichols is president of the Badger Institute. The institute’s than bettering the lives and minds of Wisconsin’s children. activities, and the cost would not have allowed us to do it oth- in their local government is only slightly higher at 23 percent. book Federal Grant$tanding is available at badgerinstitute.org.

20 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 21 The Police Can Take Your ■■ When local economics suffer, forfeiture activity increases, suggesting police make greater use of forfeiture when local budgets are tight. A 1 percentage point increase in Stuff: The Civil Forfeiture local unemployment—a standard proxy for fiscal stress— is associated with a statistically significant 9 percentage point increase in seizures of property for forfeiture.

Reforms We Still Need “These results add to a growing body of evidence suggest- ing that forfeiture’s value in fighting crime is exaggerated and that police do use forfeiture to raise revenue,” said Brian Kelly, an associate professor of economics at Seattle Univer- sity and the author of the study.

Reform So Far It is no surprise that reforming civil forfeiture is an issue that crosses party lines. Forfeiture reform is part of both the national Republican and Democratic party platforms. Since 2014, when the launched its national ini- tiative to end forfeiture abuse, over 350 editorials from outlets, including and The Washington Post, have called for civil forfeiture reform. And polls have repeat- edly shown that the overwhelming majority of Americans oppose civil forfeiture. The latest poll in October 2018 found that 63 percent of Americans oppose letting law enforcement keep the proceeds from forfeited property and 69 percent oppose a federal program called Equitable Sharing, which lets local and state agencies work with federal officials to seize BY DARPANA SHETH property for forfeiture in exchange for up to 80 percent of for- feiture proceeds. This program allows local law enforcement agencies to bypass state laws that limit the use of civil forfei- ture or the forfeited assets that agencies can keep. ERARDO SERRANO WAS DRIVING TO What Is Civil Forfeiture? insufficient by the seizing agency, the property is automati- Legislators have responded to this clarion call for reform: Mexico to visit family when he was stopped at the Welcome to the upside-down world of civil forfeiture, cally forfeited. Additionally, under federal and most state laws, Since 2014, 33 states and the District of Columbia have G border crossing in Eagle Pass, Texas. Serrano, a U.S. where law enforcement agencies can seize your property once the government proves that the property is more than reformed their forfeiture laws. Fifteen states now require a citizen and legal gun owner, had forgotten that he left five low- without ever charging you with a crime and keep it or its likely connected to a crime, the burden is on property own- criminal conviction (though not necessarily of the property caliber bullets in the center console of his truck. U.S. Customs proceeds to pad its budget. Unfortunately, Gerardo’s story ers to prove they are innocent; that is, they must prove that owner) to forfeit most or all types of property using civil for- and Border Protection agents used his unintentional slip-up as is not unique. Tens of thousands of Americans have been they did not know about the illegal use of their property. This feiture. The gold standard for reform is New Mexico, which an opportunity to seize and hold Serrano’s truck on the grounds stripped of their property and then have faced the neces- completely reverses the presumption of innocence, a hallmark like North Carolina and Nebraska, has abolished civil for- that he was knowingly transporting “munitions of war.” sity and expense of navigating a procedural maze to get it of the American justice system that the Supreme Court has feiture outright. Without a single vote in opposition, Repub- Serrano was never charged with any crime. After detain- back. Between 2001 and 2018, the Departments of Justice repeatedly clarified applies to civil as well as criminal cases. lican Gov. Susana Martinez, (a former prosecutor) signed ing him for four hours, CBP agents told him he was free to go. and the Treasury kept more than $42 billion through forfei- Defenders claim that civil forfeiture is a valuable this landmark reform in 2015. Now, law enforcement in New But they were using civil forfeiture to keep his truck. Serrano ture. In just one year, 2016 (the most recent year for which crime-fighting tool. But a recent study published by the Insti- Mexico can forfeit property only after convicting the owner was required to post a bond of 10 percent of the value of the detailed data are publicly available), the Justice Depart- tute for Justice concludes that the nation’s largest forfeiture of a crime. Vitally, all forfeiture money must be deposited in truck—around $3,800—just to contest the seizure and get his ment obtained 13,339 assets valued at more than $1.8 billion program does not help police fight crime. Specifically, the the general fund, removing the financial incentive to seize case before a judge. But for over two years, the agency held through forfeiture. study finds: property and preventing forfeiture from becoming a law- Gerardo’s truck without ever filing a forfeiture complaint Civil forfeiture gives law enforcement financial incentives enforcement slush fund. and taking the matter to a judge. to seize property, and does so without adequate safeguards ■■ More forfeiture proceeds do not translate into more While other states have not abolished civil forfeiture, they During those two years, Gerardo spent thousands of dol- of property owners’ rights. For example, at the federal level, crimes solved, despite claims that forfeiture gives law have enacted significant reforms to the civil proceedings. lars on rental cars and payments to insure and register the most forfeitures are accomplished administratively, without enforcement more resources to fight crime. Sixteen states and the District of Columbia now require the truck, which he could not drive. No court ever approved the any judicial oversight. Once property is seized, the burden is ■■ More forfeiture proceeds do not mean less drug use, even government to prove that a property owner knew about ille- seizure of Gerardo’s truck, and Gerardo never had an oppor- on the property owner to file a claim to contest the seizure. If though forfeiture is claimed to rid the streets of drugs by gal use of his property in order to obtain a forfeiture order,

tunity to argue to a judge that he should get the truck back. the owner fails to do so, or files a claim that is deemed late or LIVING_IMAGES/GETTY crippling drug dealers and cartels financially. thereby restoring the presumption of innocence. Twenty-two

22 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 23 FROM LEFT: FIVE FORGOTTEN LOW-CALIBER bullets were all it took for Gerardo Serrano to lose his truck. The U.S. Customs and Border Protection Agency found the bullets in the center console of Serrano’s truck and claimed he was trying to smuggle arms into Mexico. IN MARCH OF 2017, PHIL Parhamovich was pulled over by the Wyoming Highway Patrol. Officers pressured him to sign a waiver, wrote him a ticket for not wearing a seatbelt, and then took $91,800 in cash they had found in the car. A Wyoming state judge eventually ordered the money returned to Parhamovich in December 2017. RUSTEM KAZAZI WAS PLANNING TO use $58,100, packed in a carry-on suitcase, to fix up a house and purchase a property in Albania. But, without charging him with any crime, the Customs and Border Protection Agency seized his money at Cleveland Hopkins International Airport. Six months later, with the help of the Institute for Justice, a federal judge ordered CBP to return the money. NURSE ANTHONIA NWAORIE WAS PLANNING to start a medical clinic in Nigeria when the Customs and Border Protection Agency seized $41,377 of her money at Houston International Airport. Unknowingly, she was in violation of a federal law requiring travelers to file a report when they leave the country with more than $10,000 in cash. Eventually, the CBP offered to give the money back if Nwaorie signed a Hold Harmless Agreement. Nwaorie is now the class representative in a class action lawsuit seeking to stop the CBP’s practice of asking property owners to waive their rights in order to get their property returned.

states and the District of Columbia have mandated new Amendment Integrity Restoration (“FAIR”) Act, H.R. 1895, two publicly available databases on the use of civil forfeiture. all civil forfeitures pursued by the Justice Department are reporting requirements for seizure and forfeiture activity. and the Deterring Undue Enforcement by Protecting Rights As far as the bill goes, however, it does not address the core processed administratively, rather than judicially. And seven states (including Nebraska and New Mexico) and Of Citizens from Equitable Sharing and Seizures (“DUE financial incentives fueling abuse. In many of these cases, the value of the property seized is the District of Columbia have passed legislation preventing PROCESS”) Act, H.R. 2835, would substantially overhaul The FAIR Act, introduced on March 27, 2019, by Rep. Tim worth less than the cost of hiring an attorney. So even those who state and local law enforcement from participating in the fed- federal forfeiture practices, which were last amended almost Walberg, R-Mich., and Rep. Jamie Raskin, D-Md., and four can afford counsel make the rational economic decision not to eral Equitable Sharing program as a way of bypassing state two decades ago with the Civil Asset Forfeiture Reform Act other co-sponsors of both parties, provides for comprehensive contest the forfeiture when doing so would cost more than their limits on the use of civil forfeiture. of 2000. reform. In addition to the first four procedural protections property. Additionally, as noted above, the decision as to whether At the federal level, Congress recently passed legislation True to its name, the DUE PROCESS Act, introduced on provided by the DUE PROCESS Act, the FAIR Act removes the a claim is timely or sufficient is made, not by a judicial officer, but that stops the Internal Revenue Service from using civil for- May 17, 2019, by Rep. James Sensenbrenner, R-Wis., with financial incentive of law-enforcement agencies to seize and by officials within the seizing agency. In any other kind of fed- feiture to raid the bank accounts of small-business owners. bipartisan support, provides necessary safeguards for own- forfeit property in two ways. First, it redirects all forfeiture eral civil-enforcement action, the government is required to file a The Clyde-Hirsch-Sowers RESPECT (Restraining Excessive ers fighting to regain property seized by the police. proceeds from the Department of Justice’s Assets Forfeiture complaint before an enforcement action occurs. There is no legit- Seizure of Property through the Exploitation of Civil Asset First, it restores the presumption of innocence by properly Fund to the General Fund of the U.S. Treasury, restoring Con- imate reason for reversing this procedure in forfeiture cases by Forfeiture Tools) Act, passed as part of broader IRS reforms, is placing the burden of proof on the government to show that gress’s constitutional authority to appropriate funds. requiring the property owner to file a claim in order to trigger the named after Institute for Justice clients who had their entire the property owner knew about illegal use of his property. Second, the FAIR Act abolishes the Equitable Sharing Pro- government’s duty to file a complaint. bank accounts seized solely because they frequently deposited Second, it raises the standard of proof in civil-forfeiture gram and thereby prevents state and local law enforcement Administrative forfeitures should be abolished to ensure or withdrew cash in amounts under $10,000. Although they proceedings to “clear and convincing evidence.” Under cur- from evading their own stricter state laws by partnering with that property owners have the full legal protections available were never charged with any crime and the funds were legally rent law, the government needs to meet only a preponderance federal authorities. Congress should not undermine states in the judicial system. Ultimately, however, the best reform earned, the IRS claimed they had “structured” their financial of evidence standard—i.e., show that property is more likely that are seeking to protect their citizens’ constitutional remains to abolish civil forfeiture altogether and replace it transactions to avoid the reporting requirement for financial than not connected to a crime. rights and govern their own law-enforcement practices. The with criminal forfeiture. transactions of $10,000 or more. Through laws prohibiting Third, for those who cannot afford counsel, the DUE PRO- FAIR Act is key to respecting principles of federalism. In a just system, forfeiture acts as a form of punishment “structuring,” the IRS confiscated more than $242 million in CESS Act guarantees legal representation in administrative for those who have been found guilty of wrongdoing. If an more than 2,500 cases from 2005 to 2012. After high-profile and judicial forfeiture proceedings. Administrative Forfeitures individual has not been found guilty, then no punishment is media coverage, including a front-page feature in The New Fourth, it extends the RESPECT Act’s limits on currency Still Unaddressed appropriate. No one in America should lose their property York Times and an editorial in The Wall Street Journal, the IRS seizures for “structuring” to the Justice Department. While both federal bills go a long way toward addressing without being convicted of a crime. changed its policy to limit forfeiture for currency “structuring” Fifth, it allows defendants an opportunity to contest the deficiencies of federal forfeiture law, neither addresses As for Gerardo, he ultimately got his truck back but only only to cases when the funds in question are derived from an the pretrial restraint of property needed to pay for counsel, administrative forfeitures, which constitute most federal after he filed a federal class-action lawsuit challenging the illegal source or used to conceal illegal activity. The RESPECT overturning the U.S. Supreme Court’s distressing decision in forfeitures. There is a widespread misconception that constitutionality of CBP’s practices. In addition to seeking Act codifies this policy change so that it cannot be reversed Kaley v. United States. As Chief Justice noted in forfeitures are overseen by a judge. But most forfeitures at damages, the class action seeks a court order requiring CBP with a stroke of the pen by a future administration. However, his dissent, this decision “allow[s] the government to initiate the federal level are done by the seizing agency itself, without to provide prompt hearings to all owners of vehicles it seizes. it does not address similar “structuring” forfeitures by the a prosecution and then, at its option, disarm its presump- any judicial involvement. This means that the seizing agency The lawsuit is currently before the U.S. Court of Appeals for Justice Department or any other type of forfeitures. tively innocent opponent by depriving him of his counsel of acts as investigator, prosecutor, and jury while the property the Fifth Circuit, which will hear argument next term. choice—without even an opportunity to be heard.” owners never see a judge or have their day in court. Without Reforms Currently in Congress Finally, the DUE PROCESS Act increases oversight and judicial review, the sole determination of whether forfeiture Ms. Sheth is a senior attorney at the Institute for Justice and Broader reform bills have been introduced in the House transparency of federal forfeiture programs by requiring is warranted is made by the seizing agency, which stands to director of its National Initiative to End Forfeiture Abuse. She

of Representatives with bipartisan support. Both the Fifth an annual audit of federal civil forfeitures and by creating JUSTICE FOR INSTITUTE gain financially from the proceeds. Indeed, 88 percent of represents Gerardo Serrano in his federal class action lawsuit.

24 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 25 House of Representatives) that mandates: all Americans be Fee-for-Service Medicare Provides provided health care coverage, with benefits determined by Less Value than Private Plans the Department of Health and Human Services; all benefits Medicare itself offers some useful insight into the efficacy be paid on the basis of the Medicare fee schedule, and prac- of government health care compared to private health care. tically all private health plans would be illegal. This would Traditional Medicare, also known as Parts A and B, operates be a radical government takeover of health financing—one on a fee schedule and is the model on which Medicare for All that ignores fundamental economic reality at the peril of is based. Part C is Medicare Advantage, a program created in Americans’ health. 2003 under which Medicare beneficiaries can choose from competing private plans. Medicare Already Distorts Health Care In a broad study of over 2 million beneficiaries of both American health care is often called market-based, but the traditional Medicare and Medicare Advantage, the research fact is that the single largest health care payer in the United firm Avalere found that patients with more complex health States is the federal government. Medicare and Medicaid care needs fared better under Medicare Advantage plans account for approximately 40 percent of national health than in traditional Medicare. spending, according to data from the As a case-in-point, consider diabe- Centers for Medicare and Medicaid tes—one of the most important risk Services. As the government already factors for many health issues, includ- controls an outsized portion of the ing heart attack, stroke, and kidney health care market, rules and regu- Medicare Advantage disease. Beneficiaries in Medicare lations that the government applies plans provide higher Advantage had a diabetic complica- to Medicare and Medicaid tend to tions rate of 8.2 percent as compared influence the practices of private quality care and manage to 17.1 percent for those covered under insurers. For instance, the Evalua- chronic conditions better. traditional Medicare. At the same tion and Management Services (E/M) Yet, Medicare for All will time, health care costs for Medicare guidelines for documentation were Advantage beneficiaries were 5.7 per- originally intended for use by physi- move the entirety of cent less than those for traditional More Medicare, Less Health Care: cians to bill Medicare; they have since American health care to Medicare patients. been adopted across the entire health the traditional model that Patients on Medicare Advantage care sector. produces worse health plans were also hospitalized 23.1 per- How Medicare for All (The E/M guidelines have been cent less and had 32.7 percent fewer little changed since 1997, when most outcomes at a higher cost. emergency room visits than patients documentation was done with pen and covered by traditional Medicare. It Threatens Patient Health paper. This has been an enduring det- should be emphasized that the two riment to efficient health care that is completely untouched study populations mirror one another in demographics and BY KEVIN LEE PHAM by Medicare for All.) degree of morbidity. Medicare reimbursement rates also create problems for These results show the value of competition in health the health care system. The Congressional Budget Office care: Medicare Advantage plans provide higher quality found that for similar services, prices ranged from 11 to 139 care and manage chronic conditions better, which is critical T IS A BIPARTISAN NOTION THAT AMERICAN national populations also account for some of the variance in percent greater for private insurance as compared to the fees for aging populations. Yet, Medicare for All will move the health care is in dire need of reform. American health health care outlays. Our superior cancer survival rates speak for traditional Medicare. The Center for Medicare and Med- entirety of American health care to the traditional model I care spending constitutes 18 percent of the gross domes- to the immense economic and social value we place on the icaid Services has the legal authority to set prices for itself, that produces worse health outcomes at a higher cost than tic product of the largest national economy on the planet. By individual life. which it does through a fee schedule based on criteria that the Advantage model. contrast, the country that is number two in GDP spent on At the same time, insurance premiums have been climb- were implemented in 1989. health care is the immensely wealthy nation of Switzerland, ing inexorably for decades, leaving Americans desperate for Providers must charge private payers higher prices in order Medicare’s Price Controls whose health care spending comes in at only about 12 per- relief and policymakers searching for answers. Decades of to be able to cover costs. Medicare for All does not seek to alle- Make It Harder to Find Care cent of its GDP, according to data from the Organisation for legislative and regulatory interaction between the govern- viate the market distortion but, rather, eliminates the market All the current deficiencies of traditional Medicare will Economic Cooperation and Development. ment, health insurers, and hospitals have drained massive itself. While prices can be forced lower by bureaucratic diktat, only get worse as physicians start disappearing from med- One reason we spend so much on health care relative to amounts of value from the U.S. system. such a move does not repeal the laws of economics, which tell ical practice. other countries is that the United States is a hub of medical Some lawmakers believe Medicare for All will rein in us that all resources are limited and have alternative uses. According to the 2018 Physicians Foundation Survey, innovation and technology. New procedures and experimen- health care expenditures. Sen. Bernie Sanders, I-Vt., and Without prices to provide signals about the relative value of more than 1 in 5 physicians either limit the number of Medi- tal drugs provide great value to American patients, but we Rep. Pramila Jayapal, D-Wash., have introduced a Medicare alternative uses of resources, those resources will be misal- care patients they see or refuse to see them at all. For Medic-

pay more to obtain them. Differences in health statuses of for All proposal (S. 1804 in the Senate and H.R. 1384 in the IMAGES IMAGES/GETTY GLOW located and critical health care needs will go unmet. aid, the number is almost 1 in 3.

26 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 27 The situation is particularly bad in primary care. True Section 107 of the Medicare for All bill says: “it shall be to its name, primary care is generally the entry point into unlawful for— (1) a private health insurer to sell health insur- the medical system, and access to it is associated with bet- ance coverage that duplicates the benefits provided under ter health outcomes. According to the survey, 32 percent of this Act.” In other words, it will be expressly illegal for any primary care physicians limit or refuse Medicare patients; private company or employer to provide health benefits that the figure is 36 percent for Medicaid patients. compete with the government, although the bill is gracious While the Physicians Foundation Survey did not ask the enough to allow insurers or employers to provide for every- reason doctors limit or refuse Medicare or Medicaid patients, thing not covered in the legislation. the results show that salaried physicians were less likely This provision to outlaw private plans that duplicate gov- than doctors who own their own practice to refuse these ernment coverage, allowing only the sale of supplemental patients. Over 50 percent of practice owners limit or refuse plans, is similar to Canadian Medicare, which covers all Medicare patients. Practice owners feel the brunt of the dif- Canadian citizens. In , approximately 30 percent of ference between private and government payments, whereas health care spending is private spending, with 12.4 percent employed physicians are often paid in a manner agnostic of coming from private insurers, according to the Canadian the insurance type. Institute for Health Information. The Canadian system, how- ever, does not include dental, vision, and prescription drug Universal Care Gives You coverage, and this is generally the space in which Canadian Access to a Waiting List insurance operates. Medicare for All Fixed payments in government would leave almost no room for the programs are discouraging physi- private sector. Essentially, cosmetic cians from treating government-in- surgery and experimental drugs sured patients. What happens when, Fixed payments in would be the only areas in which pri- by law, everyone is a government-in- vate provision is allowed. sured patient? government programs are If Medicare for All passes, you will The United Kingdom’s National discouraging physicians not keep your health care plan. And Health Service provides a sobering from treating government- you will not be able to find one if you example. The NHS has set itself the insured patients. What so choose. Proponents of Medicare viduals would have to opt out in order to avoid it. Likewise, practice medicine outside of participation in the program. goal of treating all emergency patients for All argue the loss in choice is a participation as a provider technically would be voluntary. Patients would have little other option than to accept the within four hours of their arrival at happens when, by law, worthy tradeoff, but they will have to But the bill makes it virtually impossible to practice medi- medical decisions of the HHS secretary. hospital. Yet, when surveyed by the everyone is a government- countenance the government’s having cine without participating in the program. Medicare for All disregards what we know of markets and British Medical Association, British insured patient? the final say in health care choices Under Title III, nonparticipating providers could not bill of the laws of supply and demand; though the law mandates physicians have consistently cited between patient and provider. Title II the government for services offered under Medicare for All. medical coverage for all, it does nothing to increase the num- inadequate resourcing and staffing of Medicare for All gives the secretary And if the provider does furnish such a service, he or she ber of providers of medical care. And without more providers as contributing to emergency patient wait times frequently of health and human services authority to determine what would have to submit an affidavit affirming the service and of health care, there will not be more health care. in excess of four hours. The problem came to a head in 2018 items or services are “medically necessary or appropriate for could not participate in Medicare for All or treat anyone cov- when a particularly virulent strain of influenza and a heat maintenance of health.” If the government program works ered by it for a period of one year. Real Solutions wave caught the NHS with a dire shortage of hospital beds. as planned and is administered by a wise and benevolent Thus, if a patient wants to avoid waiting for an appoint- There is a great deal to be done to improve American Average wait times skyrocketed, and tens of thousands of pro- bureaucracy, then there should be no problem. Real world ment with a physician and contract with one privately, that health care. Increasing transparency for health care prices cedures were delayed or canceled in an attempt to alleviate examples tend to suggest otherwise. physician either would have to renounce his participation in is a good start. Regulatory reform could free providers the staff workload. The situation has deteriorated such that The NHS, for instance, decided to cut or limit coverage Medicare for All, which would cover practically everyone in from the burdens of bureaucratic paperwork and empower NHS England is planning to eliminate the four-hour stan- for certain procedures in an effort to control costs, deeming the United States, or he already must have been practicing patients as consumers to make informed decisions about dard altogether. certain procedures, such as tonsillectomies, “unnecessary.” outside the program. their own health. There are certain indications for tonsillectomy, including There likely would be a market for direct primary care It is the American spirit to innovate our way to better Medicare for All Would Practically airway obstruction or recurrent infection, and the necessity physicians, otherwise known as concierge medicine doctors, solutions, and any future reform must allow innovation to Outlaw Private Medicine of it should be decided in the clinic rather than by a govern- but it is unrealistic to expect these services to be widely avail- happen rather than strong-arm the country into what this NHS offers one great advantage over Medicare for All: the ment bureaucracy. Even routine procedures are not safe from able to the average American. or that politician thinks is a good idea. Medicare for All has British system allows physicians, insurers, and patients to cutbacks in the event of shortages of hospital beds, and some In essence, we would see a two-tiered medical system: one been presented as a remedy to our problems, but based on all contract privately for health care services. Private insurance 50,000 scheduled operations were canceled due to last year’s for most Americans, and one for wealthy Americans. This we know, the cure will be worse than the disease. plans are often used in the United Kingdom by patients who harsh flu season. is a common complaint in Canada, and one of the ways the have grown frustrated with NHS waiting times, and such It is theoretically possible for an individual to avoid that Canadian Medical Association has suggested to address it Mr. Pham is a medical doctor and a freelance writer on plans have recently regained popularity. Medicare for All, kind of government intrusion into his health choices. Enroll- is by contracting more with, interestingly, private insurers. health care policy. He is a former graduate fellow in health

by contrast, would outlaw this exact behavior. ment in Medicare for All would not be required, but indi- IMAGES EUNIKASOPOTNICKA/GETTY Medicare for All would make it nearly impossible to policy at The Heritage Foundation.

28 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 29 RESIDENT SAYS HE WANTS Some employers were actually doing that before health reform that will be better than Obamacare, Obamacare. They used an account called a Health Reim- A Health Plan for P better than what we had before Obamacare, and bursement Arrangement (HRA), providing tax-free funds better than Medicare for All. And he’s not alone. Sixty-nine employees could use to buy their own health insurance. percent of U.S. voters say health care remains a top priority, But with Obamacare came regulations and threats of steep according to Pew Research Center. And, according to a Her- employer fines that effectively deep-sixed this option. itage Foundation poll conducted in March, an overwhelm- Thankfully, the Trump administration is reversing President Trump ing majority of Americans say our health care system should course. Beginning next January, employers will be able to offer lower costs and higher quality care (97 percent), and use HRAs to help employees obtain their own coverage with should give people more choices (94 percent). the administration’s blessing. To make those goals a reality, health reforms should focus The Council of Economic Advisers estimates this change and Congress on making it as easy as possible for people to access innova- will affect 11 million workers. But it would affect far more if tions such as: states cleaned up their individual markets to make them a more attractive option. BY MARIE FISHPAW AND JOHN C. GOODMAN 1. Personal, portable health insurance that travels with them Congressional action should codify what the adminis- from job to job and in and out of the labor market. tration has already done and expand the reform in several ways. In particular, states need broad authority to authorize 2. Round-the-clock communication with their personal phy- insurance products that meet their residents’ needs, rather sicians by phone, email, and Skype. than meeting Obamacare’s expensive mandates. Congress also needs to give states the freedom to make reforms that 3. Telemedicine, so they can even “visit” the doctor from would lower costs and expand access to care. home—avoiding traffic, long waits, and unneeded emer- gency-room visits. Round-the-Clock Medical Care Concierge doctors used to be available only to the rich. 4. Centers of excellence that specialize in chronic health Today, direct primary care is far more affordable. Atlas MD conditions (including preexisting conditions) and actively in Wichita, Kansas, for example, provides all primary care compete for patients. along with 24/7 phone and email access and generic drugs for less than what Medicaid pays. It helps patients gain access 5. Accounts owned and controlled by patients who are willing to specialist care and diagnostic tests, with minimal waiting. to manage their own care, including most forms of chronic The cost: $50 per month for a middle-aged adult and $10 per care and even routine surgery. month for a child. There are 790 direct-primary-care practices like Government should not mandate these changes. If Atlas in the United States, according to Philip Eskew, the employees and their employers like the arrangements they founder of Direct Primary Care Frontier. Typically, now have, they should be able to keep them. But govern- they provide round-the-clock access to a physician via ment needs to get out of the way, cut red tape and conflicting phone, email, and Skype. These practices have a number requirements, and quit interfering with the opportunity for of attractive features—and an excellent track record: They people to have better options. expand access to care, improve the quality of care, reduce The Trump administration has already implemented overall health-care spending, and report high levels of executive actions that have brought us closer to all five of patient satisfaction. these goals. But to complete the reforms, Congress needs to This development has the potential to radically transform enact legislation. the way medicine is practiced in the United States. The only Here are some particulars. things standing in the way are unwise public policies. A number of employers are creating access to direct pri- Personal and Portable Health Insurance mary care as an employee benefit. However, under current In an ideal world, most people would own their own health law they cannot put tax-free dollars into an account and let insurance and take it with them as they traveled from job to employees use the money to select a direct-pay doctor of job and in and out of the labor market. Some employers may their choosing. have better insurance than is available on the open market. The Trump administration has directed federal agen- But others might prefer to make a cash contribution to help cies to see if HRA accounts and health savings accounts (see employees pay their own premiums rather than provide below) can be used as vehicles to overcome the current reg-

SERGEY TINYAKOV/GETTY IMAGES TINYAKOV/GETTY SERGEY insurance directly. ulatory obstacles.

30 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 31 In addition, the administration hopes to make Medicare viders. As of January 1, doctors in Medicare Advantage plans more open to direct primary care. Under the arrangement, and accountable-care organizations have been able to bill Medicare would pay a fixed monthly fee to a physician or Medicare if they use phone, email, Skype, and other technol- physician group instead of the traditional fee-for-service ogies to consult with patients remotely to determine if they payments. In return, the physicians would provide virtu- need an in-office visit. Patients can be anywhere, including ally all primary care. The fees would range from $90 to their own homes. Doctors can also bill Medicare to review $120 a month, depending on the patient’s age and medi- and analyze medical images patients send them. And they can cal complexity. bill for telemedical consultations with other doctors. While this is a good start, more is needed to make direct But these are baby steps. Congress needs to liberate tele- primary care widely available to Medicare patients. The medicine once and for all. reason: Most direct-primary-care doctors have opted out of all third-party insurance arrangements, including Medi- Access to Centers of Excellence care. These doctors cannot contract with a Medicare patient On the Obamacare exchanges, there has been a race to the unless they are in Medicare. Further, once in Medicare, doc- bottom as health plans try to attract the healthy and avoid tors won’t be free to engage in the type of innovation that the sick. Increasingly, enrollees have been denied access to makes direct contracting so successful. the best doctors and the best facilities. In Dallas, for example, Congress can and should eliminate this Catch-22. no individual insurance plan includes Southwestern Medi- cal Center, which may be the best medical research center in Access to Telemedicine the world. In Texas generally, cancer The ability to deliver medical care patients with Obamacare insurance remotely is growing by leaps and don’t have access to MD Anderson bounds. It promises to lower medical Cancer Center in Houston. This pat- costs, increase quality, and reduce the Telemedicine promises tern is repeated all over the country. time and travel cost of patient care. The most successful Obamacare For example: to lower medical costs, insurers are Medicaid contractors. increase quality, and The plans that have survived in the ■■ After hip and knee replacements reduce the time and travel exchanges look like Medicaid man- at Tallahassee Memorial Health- aged care with a high deductible. The Care, patients are transported to cost of patient care. networks include only those doc- rehab facilities, nursing homes, The problem? Medicare tors who will accept Medicaid fees and even their own homes—where doesn’t pay for it. coupled with all the hassle of man- follow-up observations are made aged-care bureaucracy. with video cameras. Before Obamacare, most states had ■■ A nurse at Mercy Virtual Hospital in St. Louis can use a risk pools for the small number of people who entered the camera in a hospital room in North Carolina to see that individual market with an expensive preexisting condition an IV bag is almost empty. She can then call and instruct and were denied access to ordinary insurance coverage. The diabetic care, and heart disease. To make the market work who have health problems. “Better” means lower premiums, a nurse on the floor to refill it. The telemedicine cameras risk-pool plans looked like garden-variety Blue Cross plans, better, medical records need to travel with the patient from lower deductibles, and broader networks of providers. And are powerful enough to detect a patient’s skin color. Micro- with access to almost all doctors and hospitals. While some plan to plan, and insurers need to be able to design better people who are sick or in low-income households must be free phones can pick up patient coughs, gasps, and groans. risk pools had problems—such as being over-subscribed and risk-adjustment mechanisms rather than being forced into to use their existing subsidies to pick the right plan for them, unable to take new customers—those problems were discrete federal government-designed systems. rather than being warehoused into Medicaid or Obamacare. The problem? Medicare doesn’t pay for any of those ser- and addressable. How can these changes be made? Here it is even more States must not only show unmistakable progress in this vices. And since private insurers and employers tend to pay Obamacare threw out this model in favor of a D.C.-de- critical that government clear away today’s barriers and let respect, but also establish as a goal a market in which sick the way Medicare pays, the entire country is missing out on signed solution. The result? Access to care for people with private markets function. people can get access to the doctors they need—without rais- incredible advances in telemedical technology. preexisting chronic conditions has seriously deteriorated. The CMS has taken steps in that direction using its ing costs for everyone else, as Obamacare does today. This situation is not an oversight. The Social Security That needs to change. rulemaking and waiver authorities. Seven states have used It doesn’t take new federal mandates and programs to Act allows Medicare to pay for telemedicine only under Entities such as Cancer Treatment Centers of America waivers to lower health insurance premiums. In Maryland, reach these goals. Rather, the Trump administration’s reg- strictly limited circumstances. For the most part, doctors need to be able to enter the individual market, restrict enroll- premiums that had been expected to rise 30 percent actually ulatory relief has amply demonstrated that we move in the can examine, consult with, and treat patients remotely only ment to patients who have cancer, and receive a premium that fell by 13 percent thanks to state reforms. right direction when states are allowed to escape existing in rural areas, and even there, patients can’t be treated in covers their expected costs. Congressional action will almost certainly be needed mandates that have distorted market incentives and led to their own homes. Instead of expecting every health plan to be all things to to complete the task. Ideally, states should be given broad our current problems. The Centers for Medicare & Medicaid Services (CMS) all patients, we should encourage specialization. We need authority to reform their private individual markets, with Congress could help empower the states to carry out PHOTO CREDIT PHOTO THE_BURTONS/GETTY IMAGES THE_BURTONS/GETTY recently eased the restrictions on telemedicine for some pro- focused facilities for such chronic conditions as cancer care, CREDIT PHOTO one important proviso: Conditions must get better for people needed reforms by enacting the Health Care Choices Pro-

32 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 33 or access to care. However, the potential for these accounts Both insurers and their enrollees would do better still is much greater. if they considered traveling for care. Health City Cayman Right now, patients use HSAs primarily to pay small med- Islands offers high-quality hip and knee replacements for ical bills below their deductibles. But these accounts could one-half to one-third less than what the procedures cost in and should be used in just about every aspect of medicine, California. Employers have found employees not very recep- including expensive surgery, chronic illness, custodial care, tive to medical travel. But let the patient have $30,000 in an and emergency-room visits. HSA with the opportunity to save $10,000 or more, and the For example, there is mounting evidence that patients suf- willingness to travel is likely to soar. fering from diabetes, heart disease, cancer, and other chronic To take advantage of the full potential of HSAs, we need illnesses can (with training) manage a lot of their own care three policy changes: (1) People should be able to use com- as well as—or better than—traditional doctor therapy can. pletely flexible HSAs, wrapping them around any health-in- If they are going to manage their own surance plan and using them to pay care, they will do an even better job if for any medical costs the plan does they are also managing the money that not cover; (2) they should be able to pays for that care. use their HSAs to pay premiums as In addition, patients could—spend- If patients control the well as out-of-pocket expenses; and ing from an HSA that they own and money, it will flow toward (3) health plans should be allowed control—manage almost all the money to have “shared savings programs,” used for primary care, including rou- cost-saving options. where enrollees who choose better tine doctor visits and most diagnostic They will substitute less and cheaper care get to keep their tests. If patients control the money, it expensive phone and share of their savings in their HSA. will flow toward cost-saving options. The Trump administration They will substitute less expensive email consultations for recently made a major announce- phone and email consultations for doctor’s-office visits; ment with respect to the first of these doctor’s-office visits; they will shop for they will shop for better changes. Going forward, employees better prices on everything from blood prices on everything with HSAs will be exempt from the tests to mammograms; and they will high-deductible requirement for the opt for walk-in clinics and free-stand- from blood tests to treatment of chronic disease. This ing emergency care instead of hospital mammograms; and means that the employer or insurer emergency rooms when appropriate. they will opt for will be able to provide first-dollar On the East Coast and the West coverage for some services without Coast, Uber-type doctor visits at walk-in clinics and running afoul of HSA regulations. nights and on the weekends are an free-standing emergency The reform agenda proposed here increasingly popular alternative to care instead of hospital would radically transform the U.S. the emergency room. A doctor house health-care system by empowering call costs about $100, and the doctor emergency rooms patients, liberating markets, and remov- usually arrives within an hour. Emer- when appropriate. ing government obstacles to lower-cost, gency rooms typically charge about higher-quality, more accessible health five times more. Give patients control of the money and you care. It builds on emerging successes by innovators empowered PRESIDENT TRUMP SIGNS AN intended to improve quality and price transparency in health care, June 24, 2019. will see this service all over the country. by President Trump: doctors trying new ways of delivering care, HSAs can also help control the cost of expensive surgery. states trying new ways of healing broken private markets, and For example, WellPoint (Anthem) in California limited patients demanding better care at lower costs. posal, developed by the Health Policy Consensus Group and Patient Power the amount it would pay for hip and knee replacements to President Trump should build on these successes and supported by more than 100 conservative leaders across the How can we control health-care costs and at the same time $30,000 for its CALPER enrollees. Patients could get the work with Congress to clear away the barriers blocking these country. This proposal would block-grant Obamacare funds improve quality and create greater access to care? Here is procedure done at any hospital, but if the cost was greater innovators from spreading their wings. That’s the way to pro- to the states and give them wide discretion to reform their one answer: Give patients control over more of their health- than that amount, they had to pay out of their own pockets. vide better care at lower costs. individual health-insurance markets. The Center for Health care dollars. This experiment had a dramatic effect, bringing down the and the Economy estimates that this proposal would lower Roughly 25 million people now manage some of their own cost of surgery across all of California. But the impact would Ms. Fishpaw is the director of domestic policy studies at health-care premiums by as much as a third, would insure health-care dollars through health savings accounts (HSAs), have been even more dramatic if WellPoint had deposited The Heritage Foundation. Mr. Goodman is president of the about the same number of people as Obamacare, and would which they own and control. The evidence shows that these $30,000 in the account of every patient who was a candidate Goodman Institute and the author of Priceless (Independent better protect people with preexisting conditions and high patients are conservative shoppers in the medical market- for surgery. That way, if a patient found a hospital whose cost Institute, 2012). A version of this article was previously PHOTO CREDIT PHOTO health costs. place—saving money without any deterioration in the quality IMAGES MARK WILSON/GETTY was, say, $28,000, the patient would enjoy a $2,000 “profit.” published at National Review.

34 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 35 Close Encounters of a Judicial High School Conference at the 17 Kind: The Sometimes Alien World 2-5 Reagan Ranch, Young America’s of State Judges and State Constitutional Foundation, The Reagan Ranch Center, Santa Law, Ashbrook Center, Myers Convocation Barbara, Calif. Center, Ashland University, Ashland, Ohio, Noon Claremont Institute 40th Anniversary 3 Cruise, Crystal Serenity, Barcelona. Spirit of Las Vegas: Nevada Policy 17 Research Institute’s Anniversary Fall Briefing featuring Kimberly Strassel, Dinner, The Venetian, Las Vegas, 6 PM – 9 PM 7 Center of the American Experiment, Ordway Center for the Performing Arts, St. The Founders Divided, Center Paul, 6 PM – 9:30 PM 17-19 for Constitutional Studies, Utah Valley University, Orem, Utah Washington Policy Center Annual Dinner,  11 Hyatt Regency, Bellevue, Wash., 6 PM YOUNG AMERICA’S FOUNDATION HOSTS MANY events for students, including the High School Free Enterprise Leaders Conference (Sept. 13-14), The Road to Introduction to Constitutional Law: Freedom Seminar: Secrets to Advancing Free Enterprise Over Socialism (Sept. 20-21), and events for both high school and college students at the Reagan Ranch in 100 Supreme Court Cases Everyone The Future of Work, Mercatus California (Oct. 2-5 and Nov. 8-9). This photo was taken at their 41st National Conservative Student Conference in July. 18 Should Know, , Washington, 11-12 Center & Niskanen Center, D.C., Noon Mercatus Center, Arlington, Va.

The Road to Freedom , SEPTEMBER Campus Culture of Intellectual 20-21 Seminar: Secrets to 11-13 Omni Shoreham Hotel, 13 Freedom: How Trustees Can Help, Advancing Free Enterprise Over Socialism,  Washington, D.C. Panic Attack: Young Radicals in the American Council of Trustees and Alumni, Young America’s Foundation, Reston, Va. 4 Age of Trump featuring Robby Soave, Allegheny College, Meadville, Pa. Conscious Capitalism CEO Goldwater Institute, Arizona State University In the Footsteps of 15-17 Summit, Hyatt Lost Pines Memorial Union, Tempe, Ariz., 5 PM – 7 PM High School Free Enterprise 22-30 Churchill: A TFAS Trip from Resort, Austin, Texas 13-14 Leaders Conference, Young England to Morocco, The Fund for American Cribsheet: A Data-Drive Guide to Better, America’s Foundation, Reston, Va. Studies, London Eighth Annual AEI-CRN Housing 9 More Relaxed Parenting, from Birth 16 Conference, American Enterprise to Preschool, Cato Institute, Washington, ’s A Century of Ideas: New Regional Institute & Collateral Risk Network, American D.C., Noon 13-24 Mediterranean Cruise, ms 24 Orders and New Ways of War: Enterprise Institute, Washington, D.C., Koningsdam, Rome. Europe, the Middle East, and Asia, Hoover 8 AM – 1:15 PM The Supreme Court’s 2019 Term, John Institution, Hauck Auditorium, Stanford, Calif., 9 Locke Foundation, 4800 Six Forks Road, Constitution Day Celebration, 4:30 PM James G. Martin Center for Academic Suite 220, Raleigh, N.C., Noon 14 Claremont Institute, Chapman 17 Renewal Fourth Annual Policy Banquet,  University, Orange, Calif. Florida Tech & Innovation Carolina Country Club, Raleigh, N.C., 6 PM Conversations with Tyler: Alain Bertaud, 24-25 Summit, James Madison 9 Mercatus Center, ASPIRE at One World Does Capitalism Help or Harm Institute, DoubleTree by Hilton Orlando East Athena Roundtable, American Council Observatory, New York, 6 PM 16 Women? A Debate, Cato Institute, and University of Central Florida Fairwinds 18 of Trustees and Alumni, Ronald Washington, D.C., 6:30 PM Alumni Center, Orlando Reagan Building & Center, A Good Provider Is One Who Washington, D.C. 10 Leaves, American Enterprise Institute, The Supreme Court: Past and The Wealth of Religions, American Washington, D.C., 3 PM 17 Prologue, Cato Institute and The 26 Enterprise Institute, Washington Fall George M. Yeager Family Foundation, Cato D.C., 12:15 PM 18-19 Meeting: Populism, Markets, The Human Cost of War: Assessing Institute, Washington, D.C., 10:30 AM – 7 PM and Political Economy, Ritz Carlton Tysons 11 Civilian Casualties Since 9/11, OCTOBER Corner, McLean, Va. Cato Institute, Washington, D.C., Noon Common Law Originalism: 2019 17 Walter Berns Annual Constitution A Century of Ideas: Tax and Monetary The Case for Space: How the The Fund for American Studies Day Lecture with James Stoner, American 2 Reform: From Ideas to Actions over One 23 Revolution in Spaceflight Opens up a 12 Journalism Awards Dinner,  Enterprise Institute, Washington, D.C., Hundred Years, , Hauck Future of Limitless Possibility, Cato Institute, Metropolitan Club, New York, 6 PM 5:30 PM Auditorium, Stanford, Calif., 4:30 PM Washington, D.C., 6 PM PHOTO COURTESY OF YOUNG AMERICA’S FOUNDATION AMERICA’S OF YOUNG COURTESY PHOTO

36 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 37 Philanthropy Roundtable Triumph of Liberty Gala Dinner & 23-24 Annual Meeting, Park Hyatt 8 Truman-Reagan Medal of Freedom Aviara, Carlsbad, Calif. Ceremony, Victims of Communism Memorial Federal Spending Greatly Exceeds Revenues Foundation, Union Station, Washington, Washington Policy Center Eastern D.C., 6 PM Spending and Revenue Projections under 24 Washington Annual Dinner,  Current Policies for the Next Three Decades Davenport Grand Hotel, Spokane, Wash., 6 PM Fall College Retreat at the 8-9 Reagan Ranch, Young America’s Cato Institute Policy Perspectives Foundation, The Reagan Ranch Center, Santa 25 2019, Intercontinental Barclay Hotel, Barbara, Calif. New York, 10:30 AM – 2 PM PERCENTAGE OF GDP Independent Women’s Forum Annual Rediscovering America Awards Gala, DAR Constitution Hall, STIMULUS 13 30% 25-27 Weekend: Abraham Washington, D.C., 6 PM – 10 PM Lincoln’s Washington, DC, Ashbrook Center, 29.3% Washington, D.C. Our Populist Moment, Ashbrook 14 Center, Myers Convocation Center, 29-November 1 Ashland University, Ashland, Ohio, Noon Annual Meeting,  37th Annual Monetary Conference— The Broadmoor, Colorado Springs 14 Fed Policy: A Shadow Review,  26% Cato Institute, Washington, D.C., 8:30 AM – William F. Buckley Jr. Prize Dinner,  5:30 PM 30 National Review Institute, The Breakers, Palm Beach, Fla., 5 PM – 10 PM Foreign Policy Research Institute 14 Annual Dinner, Union League of NOVEMBER Philadelphia, Philadelphia, 6 PM – 9 PM 22% A Century of Ideas: Hoover’s One National Lawyers Convention, Historical averages 4 Hundred Years of War, Revolution, and 14-16 , Mayflower (1968-2017) Peace, Hoover Institution, Hauck Auditorium, Hotel, Washington, D.C. 20.3% Stanford, Calif., 4:30 PM Georgia Legislative Policy Forum, SPENDING 19.8% A Roadmap to Health Care Price 15 Georgia Public Policy Foundation, 4 Transparency in Massachusetts, Pioneer Renaissance Atlanta Waverly Hotel and Institute, Massachusetts State House, Boston, Convention Center, Atlanta, 7:30 AM – 3 PM 18% 1:30 PM – 3:30 PM 17.4% A Century of Ideas: Labor and Herman Kahn Award Gala, Hudson 19 Capital Market Policy, Hoover REVENUE 6 Institute, New York, 6 PM – 9 PM Institution, Hauck Auditorium, Stanford, Calif., 4:30 PM Liberty Forum & Freedom Dinner, 6-7 Atlas Network, Crowne Plaza Tax Prom, Tax Foundation, National Times Square Hotel and Intrepid Museum 21 Building Museum, Washington, 14% Manhattan, New York D.C., 6 PM 1970 1980 1990 2000 2010 2020 2030 2040 2048 Cato Institute Policy Perspectives 2019, DECEMBER 8 Ritz-Carlton, Chicago, 10:30 AM – 2 PM States & Nation Policy Summit,  JW American Legislative Exchange Goldwater Institute Annual Dinner, 4-6 SOURCE: Congressional Budget Office, The 2018 Long-Term Budget Outlook (www.cbo.gov/publication/53919), 8 Marriot Scottsdale Camelback Inn Resort, Council, Westin Kierland Resort and Spa, as presented in Chart 5 in The Heritage Foundation, Blueprint for Balance: A Federal Budget for Fiscal Year 2020, Scottsdale, Ariz., 6:30 PM Scottsdale, Ariz. (www.heritage.org/sites/default/files/2019-06/BlueprintforBalance_AFederalBudgetforFY2020.pdf), p. 15, May 2019.

38 SUMMER 2019 THE INSIDER THE INSIDER SUMMER 2019 39 NON-PROFIT U.S. POSTAGE PAID TWIN CITIES, MN PERMIT NO. #29418

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Government-Run Health Care Is Government-Rationed Health Care t this General Practitioners surgery in ALondon, if your problems don’t fit their schedule, then you’ll have to schedule again. Britain’s National Health Service promises free medical care for all, but the reality is free access to a waiting list. Four million Britons currently wait for routine surgery. In the United States, proponents of Medicare for All want to make the federal government the financer of virtually all medical care for Americans, which means it would decide what procedures are covered and how much doctors will be paid. To learn more, read our feature beginning at page 26.

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