Fellows with Friedman
Medicaid is a governmental program created to provide health insurance for America’s most vulnerable individuals. While noble in nature, the program has not achieved its goals. As Scott Atlas argues, the program’s $500 billion cost is expected to rise to $890 billion by 2024, according to the Centers for Medicare and Medicaid Services. However, spending more on the program will not lead to better care for beneficiaries, 57% of whom are low-income minorities. In fact, the expansion of Medicaid is misguided.
Besides the financial aspect of the program, patients also have difficulty in getting a physician to see them. Some 55% of doctors in major metropolitan areas refuse to take new Medicaid patients, according to a 2014 report by Merritt Hawkins. In addition, the Department of Health and Human Services reported that same year that 56% of Medicaid primary-care doctors and 43% of specialists weren’t available to new patients.
When patients do manage to see doctors, they typically experience outcomes worse than those by similar patients under private insurance—more in-hospital deaths, more complications from surgery, worse post-treatment survival rates, and longer hospital stays. Medicaid also does not significantly improve patients’ measured physical health outcomes when compared with patients without insurance, as found by a randomized study conducted by the Oregon Health Study Group. What accounts for these failures? As stated by Atlas, Medicaid’s restricted access to drugs, specialists, and technology is likely to blame.
To learn more about the issues behind Medicaid, read “How Medicaid Fails The Poor” by Scott W. Atlas.
To learn more about how to improve health-care choices, lower costs, and improve quality of care, watch the video below.
Another governmental program in need of examination is the National Park Service (NPS).A 2015 poll found that 74% of Americans were satisfied with the government’s handling of national parks, despite their overall dissatisfaction with the federal government. However, the parks are not receiving adequate funding. There are now 84 million acres in the national park system, including 59 national parks, 20 of which were added after 1980, and 353 national monuments, battlefields, and historic sites. Every year Congress creates more parks, a trend often referred to as “park-barrel politics.” Yet, adding parks only makes it more challenging to maintain national parks and monuments.
As Terry Anderson argues, the park service is already experiencing a backlog of maintenance projects, including deteriorating roads, buildings, and sewage systems. These maintenance projects will cost $12 billion to fix, and the NPS mostly receives less than it requests from Congress for its operating budgets. The federal budget has continued to grow, yet the NPS budget has not. Between 2005 and 2015, the federal budget grew by 39%, but the NPS operating budget increased by only 1.7%. Meanwhile, park attendance in 2015 reached a record of 305 million visits.
Watch the following video in which Terry Anderson explain how to get the politics out of America’s national treasures.
Like many other governmental programs, federal entitlements were adopted for functional purposes but have had adversary effects. An entitlement program is defined as a “statutory mandate or requirement of the United States to incur a financial obligation unless that obligation is explicitly conditioned on the appropriation in subsequent legislation of sufficient funds for that purpose.” In other words, entitlement programs are those that guarantee benefits to any individuals who meet the eligibility criteria, regardless of need. Typical entitlement programs include Social Security retirement and disability insurance, veterans’ pensions and health care, Medicare, Medicaid, unemployment insurance, Temporary Assistance to Needy Families (TANF), food stamps, Supplemental Security Income (SSI), the earned-income tax credit, and the Affordable Care Act’s health insurance subsidies.
While these programs were created to assist individuals who were destitute through no fault of their own, the programs increasingly have become inefficient and costly. Entitlements have also grown over time because of a force John Cogan calls “the equally worthy claim,” where eligibility for benefits continually expands until programs no longer resemble their initial, honorable intentions. Neither tax revenues nor revenues generated by the national economy have been able to keep pace with their rising growth, bringing the national debt to a record peacetime level.
In The High Cost of Good Intentions, Cogan provides a comprehensive history of these federal entitlement programs. Combining economics, history, political science, and law, he reveals how the creation of entitlements brings forth a steady march of liberalizing forces that cause entitlement programs to expand.
The following video also provides an overview of entitlement programs and their cost.