Category Archives: Public Policy and Governance

It’s The Fine Print Stuff That Will Kill Us

Here’s what really, really worries me. Not the big, well-reported activities of our lawless, corrupt administration, but the things that administration is doing that don’t get much–if any–attention. Those are things that erode the ability of the federal government to govern properly, and enhance the ability of fraudsters and grifters to exercise power and rip taxpayers off. 

Few if any of us follow or understand the consequences of nefarious actions taking place in “the weeds” of governance. When government agencies are run by honorable people, that isn’t a big problem–but when the people we’ve installed are intent upon figuring out ways to stay in power and rob us blind–it enables the grift.

Two recent examples:

Talking Points Memo has recently reported on game-playing at the Census Bureau.

A proposed Commerce Department rule would exclude undocumented immigrants and other non-citizens from the census, and stop the census from collecting most demographic data on Americans. (The exclusion of immigrants would violate the Constitution, but to this administration, that’s a feature, not a bug.)

As the linked report notes, these changes would have several enormous negative impacts:

They would change allocations of power in Congress, shifting it toward red states. When the federal government apportions congressional seats after the census, a count that excludes non-citizens would see fewer congressional seats apportioned to blue states, and, as a result, more apportioned to red states.

The changes would futher skew the Electoral College, which is based on each state’s congressional allotment. Fewer seats for blue states in Congress would mean blue-state voters with less power to elect the president.

The proposed changes would also eliminate a crucial source of data. A refusal to collect data on race and other demographics would eliminate access to information that is critical to both the government’s grant-making process and to researchers.

And finally, the changes would make it much harder to challenge maps that are racially gerrymandered, since accurate data is critical to such challenges.

Example number two: in the Bulwark, Catherine Rampell recently reported on what she called “Trump’s gift to the money launderers.”

Biological, social, and financial parasites are all flourishing, because the Trump administration has destroyed the institutional capacity necessary to detect and eradicate them.

In the latest (non-GI-related) development, the Department of the Treasury announced this week that it would destroy the government’s registry of shell-company ownership. This is an anti-corruption database that Treasury is by law required to maintain, so that law enforcement can more easily “follow the money” when investigating crimes.

Even worse, the Trump administration will also destroy all the data it has already collected, so that no future presidential administration or local police department can use it, either.

“It’s like Trump ordering the deletion of the FBI’s entire fingerprint database,” former congressman Tom Malinowski (D-N.J.), a champion of the 2021 law that created the corporate registry, told The Bulwark.

They’re effectively salting the earth, so that sex traffickers, scam artists, drug lords, money-launderers, and tax cheats can roam free not only through the end of Trump’s time in office but long after he’s out, too.

As Rampell writes, when Trump was re-elected, “suddenly cracking down on corruption and money-laundering was no longer so appealing to the federal government.”

At least some outlets are reporting on these examples. (The Prospect also has an explanation of the effect of the proposed Treasury rule.) I have absolutely no doubt that there are hundreds of other, similar efforts being made by the clowns and crooks who are currently in charge of the machinery of our federal government. (Periodically, we do hear about the deletion of credible, science-backed data at HHS at the behest of RNK, Jr., the crank who is currently in charge of the nation’s health…)

If America were being taken over by the mafia, the picture wouldn’t be much different.

While we Americans are distracted by the “big stories”–the culture wars on “woke” and transgendered folks, the official racism, the Iran debacle, the blatant corruption–the mob is working behind the scenes to buttress minority rule and protect their criminal enterprises. And a GOP-ruled Congress is facilitating it all.

Talk about “stopping the steal!” If the November mid-term doesn’t flush them all out, it may be too late to reverse the destruction. 

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About Those Healthcare Costs

The day before yesterday, I posted one of my periodic columns about America’s costly and insane approach to health care.

I often think of a former student–a hospital administrator– who corrected me when I referred to America’s healthcare “system.” “We don’t have a system,” he explained. “We have an industry.” In the wake of my most recent post, I came across two examples that once again validated the accuracy of his correction.

The American Prospect published an article describing what it termed a “government face plant”–lawmakers are now admitting that a reform intended to address surprise billing–situations where patients are hit with unexpected charges–instead created a parallel system with new middlemen that has actually increased health care costs. After explaining how this effort increased costs, the article essentially echoed the analysis of every health care expert.

The situation has been mirrored in U.S. health care so often that yet another layer of extractive bureaucratic waste is, well, no surprise. A confounding administrative system is deemed broken, and a new administrative system replicates the problem in a slightly different way. The solution is well known enough that every industrialized country has adopted it in some form—universal public insurance—but it’s zealously opposed by the very industries benefiting from a fragmented status quo.

The same day I came across the Prospect article, I also read about a recent study from Yale University, focused upon Bernie Sanders’ Medicare For All proposal. The study concluded that a single-payer Medicare for All system would not only be economically viable, but that it would save over $1 trillion in annual health spending while improving the quality and access to care.

“We estimate that a single-payer universal health care system would reduce US national health expenditure by $1041.2 billion annually, or 19.7% of current spending,…” a group of five Yale University researchers wrote. “Our findings indicate that the principal barrier to universal coverage in the USA is not the absence of resources, but their allocation.”

The researchers also concluded that a universal model could save as many as 114,174 lives every year.

The savings are projected to come primarily from five sources:

$377.5 billion by paying no more than other countries for prescription drugs;
$286.3 billion by eliminating bureaucracy and waste;
$285.7 billion by curbing fraudulent billing;
$100 billion by preventing costly emergency room and hospital visits; and
$295.6 billion by reimbursing providers fairly for the care they provide.

Senator Sanders welcomed the additional support. The article quotes him pointing out that we are at a time when “15 million Americans are being thrown off the healthcare they have and 20 million Americans have already seen their premiums double, on average, as a result of Trump’s so-called ‘Big Beautiful Bill.'”

The need to adopt a single payer system has never been greater–or more obvious.

The linked article also reports the results of another research project, this one a consumer financial survey conducted by JG Wentworth. It exposed a problem it identified as “unique to our flawed private system:” It seems that an overwhelming majority of Americans are foregoing preventative care, concerned that they can’t afford it. That trend is especially prevalent among young adults between 18 and 28. In that age group, those avoiding preventative care represent an astonishing 94% of the demographic.

The consequences of skipped or postponed care cannot be overstated; according to a KFF survey, nearly two out of ten adults say their health worsened after avoiding treatment because of cost. This same phenomenon has bled over to prescriptions, where four out of ten adults say they aren’t taking their medicine as prescribed.

Moreover, delaying care and being unable to afford life-saving medications often result in costly and preventable trips to the emergency room, straining our public health infrastructure and leading to worse outcomes for patients.

As the article concluded,

With the Trump administration spending billions of dollars per week to wage a pointless war in the Middle East, and even asking us to pay for the construction of his golden ballroom, there’s no question that universal health care would be a better use of public funds.

“A universal health care system in the US would not require the country to spend more on health care. It would require it to spend less,” Yale researchers concluded. “A system that covers everyone, costs $1 trillion less, and averts more than 100,000 deaths annually requires no new discovery to implement, only enactment.”

If common sense were just a bit more common….

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Socialized Medicine

Americans have been refusing to adopt a national healthcare system for more years than I can count, dismissing such approaches as a vilified “socialized medicine” and insisting that we take our broken bones and heart attacks into the “free market.”

That “free market” has been very costly. America spends more than any other first-world country on health care–data shows that healthcare consumes roughly 18% of our total GDP–about twice as much as those other countries. We also have one of the lowest life expectancies and poorest health outcomes of first-world countries, and are the only major developed country without a national healthcare system.

Most of us know the drawbacks: some 8% of Americans have no health insurance, enormous sums ostensibly spent for healthcare actually go to insurance-company paperwork and profit, the linking of health coverage to employment burdens business…the list goes on.

Most Americans are aware of the foregoing consequences of our refusal to recognize that healthcare is not an area where a market approach makes sense. What is less well understood is that government already pays most healthcare costs–but does so in the least efficient, least cost-effective way. I certainly didn’t understand that until I joined a task force at the university, and was astonished by that revelation. Health insurance for government employees at all levels, grants for most medical research, and provision of a wide variety of government programs, amounted to some 70% of all medical costs at that time. It’s undoubtedly higher now.

American healthcare is an incredibly wasteful patchwork…

I thought of that epiphany when I read a recent Substack from Paul Krugman, addressing Dr. El-Sayed’s advocacy of Medicare for All. He explained that–despite the labeling of that position as somehow beyond the pale of a capitalist country–an enormous percentage of U.S. healthcare is already socialized. As he says, the government’s role is so large that U.S. healthcare is better described as partially privatized socialism than as anything resembling a free market.

Well over 100 million Americans are covered by government programs, and private health insurance in the U.S. isn’t just highly regulated–it is also heavily subsidized. And then there’s job-related coverage.

If your employer pays you $10,000, that’s taxable income. But if your employer pays $10,000 toward a company health insurance plan that meets certain criteria, it isn’t taxable. That’s a huge effective subsidy, running at more than $300 billion a year. Take that subsidy into account, along with the more than $100 billion per year spent subsidizing policies purchased under the ACA, as well as the outlays on Medicare and Medicaid, and net effect is that the government pays for more than two-thirds of Americans’ health insurance.

Moreover, government programs are popular. Medicare has an 82 percent favorable rating and Medicaid comes in at 73 percent. Private insurers, on the other hand, are widely disliked and repeatedly accused of denying essential care in order to grow their bottom lines.

As Krugman writes,

The case for viewing insurers as parasites is strong. Many Medicare benefits are now delivered via Medicare Advantage, that is, plans paid for by the government but run through insurance companies. MedPAC, an independent advisory commission, estimates that last year Medicare Advantage plans were overpaid by $84 billion, thanks to practices such as “upcoding,” in which patients’ health problems are overstated to get larger sums from Medicare.

Assessing the waste from employer-based insurance is harder, but most evidence suggests that private insurers have substantially higher administrative costs than Medicare does. Furthermore, the complexity of private insurance, with multiple payers all trying to deny care when they can, is a huge burden both on providers — doctors, nurses, and hospitals — and on patients.

Krugman points to evidence that Americans may be getting fed up with our “market” system of unaffordable premiums, rampant claim denials, and byzantine claim administration. He also notes that funding healthcare insurance through taxation would benefit middle-income households, who would pay less while high-income households would pay more. And–in a point that particularly resonates with me–in such a system, the U.S. would stop wasting large sums on pointless administrative costs.

El-Sayed is an epidemiologist who was born and raised in Michigan and who served as the executive director of Wayne County’s Department of Health, Human, and Veterans Services from 2023 to 2025. He holds two doctorates, is not a member of DSA and rejects the socialist label. If we’re honest, his electoral chances will have far more to tell us about anti-Muslim bigotry than about a Medicare for All system that most Americans would welcome.

If his name was Smith, I think he’d be a shoo-in.

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Indiana’s Pathetic Todd Young

Red Indiana has two Republican Senators. One is Jim Banks, an ultra-MAGA Christian nationalist slavishly devoted to Trump– an ideologue beyond the reach of law or logic. The other is Todd Young, who–if he possessed a spine– might have been a thoughtful and able lawmaker. But Young has instead been a loyal Trumpian, going along to get along–presumably to foreclose the threat of being primaried by a Banks clone.

Despite his service as a Marine, Young voted against efforts to invoke the War Powers Act—in other words, against a measure that would have asserted Congress’s constitutional authority over Trump’s insane war against Iran. He voted twice against impeachment, and–in my view, worst of all–he has voted to confirm each and every clown, crook and incompetent that Trump has nominated–most recently, the demonstrably corrupt and odious Todd Blanche.

Time after time, Young has dutifully fallen into line behind this incomparably corrupt administration.

Hoosiers and all Americans are experiencing the results, including a ridiculous and unnecessary war, accompanied by war crimes, that we are in the process of losing; the return of inflation; job losses; mounting deaths from the return of measles (which had been eradicated); disruption of important medical research;  efforts to revise accurate history, retreat from environmental protections; virulent official racism; and Trump’s persistent, innumerable assaults on democratic norms  and constitutional principles.

Recently, Young has engaged in a transparent effort to distract from his thus-far spineless performance by authoring a bill to impose limits on stock trading by those in Congress. According to the Indiana Capital Chronicle, he sees greater limits on stock trading by members of Congress as “a basic step toward restoring public trust.”

Excuse me, but what would really restore public trust is a voting record supportive of the U.S. Constitution and Bill of Rights, and evidence that  he and other Senators and Representatives took their obligations as a co-equal branch of government seriously.

Here’s what the Chronicle reported:

Young’s position is being highlighted in advertising by the Endless Frontier Innovation Fund, an Indianapolis nonprofit formed in 2024 by Republicans tied to Young.

The group’s website says its aim is to promote “economic and national security by supporting principled and innovative leaders who advance America’s standing in today’s technological age.”

Endless Frontier’s only apparent advertising has been to support Young on the stock trading issue, which began online with Google in May, according to Google’s ads transparency tracker.

A spokesman for the organization said “stock trading scandals have tarnished the reputation of Congress” and that “there is no more pressing issue today than passing a stock trading ban for members of Congress.”

Again–while I agree that such a ban is called for– I would point out that there are many more pressing issues, and many other reasons for the current, “tarnished” reputation of our federal legislature.

The group isn’t required to disclose its funding sources and it did not answer questions from the Capital Chronicle about who has given it money and how much it was spending to promote Young’s position.

“Senator Young has been a champion in the effort to ban stock trading by members of Congress. We also plan to make sure Hoosiers know to thank the House members who recently voted in favor of stock ban legislation,” said a statement from group spokesman Luke Thomas, a former press secretary for the state Republican Party.

Young faced no Republican challengers when he ran for a second Senate term in 2022. But his distance from President Donald Trump’s brand of politics has led to rumblings of a primary challenge in 2028.

His “distance” from Trump? Don’t make me spit out my coffee!

Forgive me if I have a rather different “take” on Young’s sudden, very public “good government” activity. I think it is better understood as an effort to distract Hoosier voters from the consequences of Young’s slavish acquiescence to Trump’s agenda–an agenda with which even Red state citizens are becoming disenchanted. Young is no idiot. Unlike Banks, he undoubtedly understands the incredible damage the lawless Trump administration is doing to America.

I can’t help thinking of the pop-culture use of the word “Squirrel!” as a shorthand for efforts to change someone’s focus (popularized by a talking dog in the movie Up).

Todd Young’s effort to ban Congressional stock trading is his version of shouting “Squirrel!”

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As Predicted…

Last month, I posted about the likely–and probably intended--consequences of Indiana’s imposition of work requirements on Medicaid recipients. The new rule requires Indiana folks who are enrolled in the Healthy Indiana Plan (Indiana’s Medicaid program) to prove to state government that they are working at least 80 hours a month in order to keep their enrollment in the program. Indiana’s new requirements are even more stringent than the national ones contained in Trump’s obscene “Big Beautiful Bill.”

Most Hoosiers on Medicaid are either disabled, elderly folks in nursing homes, or children, and they are exempt from work requirements. Data confirms that almost all Medicaid recipients who are able to work, do work.

At the same time, Indiana made it harder for poor Hoosiers to access SNAP--otherwise known as food stamps. Trump’s “Big Beautiful Bill” cut SNAP funding by $186 billion — making it the largest cut ever to the food program. Then Indiana’s lawmakers passed additional restrictions, so that Hoosiers on SNAP now face both a smaller federal program and new state eligibility rules.

Federal changes to SNAP require households to report the citizenship status of members, limit the value of the assets such households can own to $3000, and expanded work requirements for adults ages 55 to 64.

It’s worth considering what attitudes motivated these new and even more onerous requirements. Indiana already leads the nation in kicking people off Medicaid. Our MAGA legislators show no appetite for helping poor Hoosiers; they seem convinced that people receiving government benefits are all lazy, sneaky and probably corrupt and that helping them access healthcare or food stamps constitutes “fraud and waste.” Our legislators blithely ignored the negative evidence from other states with work requirements, just as they ignored predictions from experts that the added costs of administering those requirements would exceed any savings. Instead, they joined other Red states intent upon making life more difficult for the poorest among us.

Paul Krugman recently weighed in on the results, which he labeled “an explosion in misery.”

Krugman addressed the effects of Trump’s “Big Beautiful Bill” on food stamps and health insurance. He found that these were two areas where “things have gotten dramatically worse just in the past year and are continuing to get worse.”

Here’s what has happened. So we have what everybody still calls food stamps, though it’s officially Supplemental Nutrition Assistance Program. But we have a situation now where the One Big Beautiful Bill didn’t exactly cut the rate of benefits, but what it did was to impose work requirements.

You might say, well, shouldn’t people who can work work? Yeah, but that’s not really what’s happening. What’s happening is that people who can work and do work —because among those who can work who are receiving food stamps, the vast majority do in fact work — must show proof of work. And that is, for many such people, a basically impossible burden.

I mean, think of who is likely to be on food stamps. They may well be irregularly employed. They certainly may not have a job where they can call up the HR department and get the necessary forms. They are also presented with a complicated paperwork requirement. We’re talking about people who are, to some extent, lacking in formal education. But above all — I’ve never been poor, thank God — but as everyone who’s studied or been poor can tell you, the biggest issue of poverty in some sense is the cognitive burden, the constant struggle to just make ends meet, which is a huge burden on everything else.

It isn’t just the cruelty of these cuts. It’s the mountains of evidence demonstrating that they end up costing us all–that when a society refuses to provide poor children with food and medical care, they grow into adults who cost that society more– and when you do provide sustenance and medical care, we all benefit.

As Krugman points out, nutritional and health assistance to children has been shown to have an enormous payoff for society as a whole. Study after study confirms that children who received food stamps or Medicaid in their early years “grow up to be healthier, more productive adults who pay more in taxes and are less likely to need government assistance. The rates of return on both the food stamp program and Medicaid, the original aid for health care for the poor, are enormous.”

You’d think a “pro-business” mindset would see these programs as an investment with guaranteed returns, but MAGA’s inhumanity has trumped that recognition. (Double-entendre intended.)

Whoever said “the cruelty is the point” wasn’t wrong.

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