The West’s Fight for Self-Government

by Carl Graham

THE FEDERAL GOVERNMENT OWNS NEARLY HALF of all land west of Nebraska, and it is increasingly using that ownership to cut Western states off from the natural resources and tax bases they need to take care of themselves. National polls show a lack of trust in the federal government and a growing reluctance to accept its expanding power. But the one-two punch of resource ownership and the flow of federal funds gives the federal government a seemingly free hand to dictate how Western states educate their kids, manage their economies, and provide core public services. In effect, they are becoming states of dependence.

Many of these states are pushing back to restore a balance between individual and states’ rights and responsibilities on one hand versus the federal estate and federal government intrusions on the other. But this Western backlash against federal overreach could also ripple across the country and help set the tone for Americans’ future relationships with their federal overseers.

Much of the growth in federal power is being done under the aegis of cooperative federalism, where the federal government basically buys the rope and lets the states hang themselves. Many Western states would like to get rid of that rope by asking a very simple question: Why not govern ourselves? Why accept being states of dependence?

Just imagine if America could restore that proper balance and make government more accountable by bringing it closer to home; if we could have a servant instead of a master, a government that works for us, not against us. Imagine being able to decide our future; to figure out how to best educate each of our kids, how to steward our lands, and to provide for our public safety and services using local solutions that take into account local resources and local needs rather than imposed or one-size-fits-all dictates.

But increasing federal power doesn’t allow us to govern ourselves, and we can get an idea of who is most at risk by looking at who’s manning the barricades against overreaching and often counterproductive federal policies. The West is the proverbial canary in the coalmine as the federal government is able to impose more of its power and create greater dependence by controlling access to Western resources.

If the federal government owned half the casinos in Las Vegas and started shutting down blackjack tables, how many people would lose their jobs? If they owned half the Florida beaches and started fencing them off, what would that do to the local tax base?

That’s why you see Nevada ranchers getting on their horses and riding to the district Bureau of Land Management offices to protest new grazing restrictions. It’s why ATV riders in Utah are protesting trail closures on public lands that they have used responsibly for generations. It’s why county commissioners in New Mexico are threatening to break locks—installed by federal officials—that block access to water that ranchers have used responsibly and improved since before New Mexico was even a state. And it’s why Utah certified public accountants called upon the legislature to get a better handle on the inherent risks of depending on federal funds to perform core state functions.

The primary vulnerability to federal overreach in the West is the states’ lack of control over their own resources. The primary driver for that lack of control is the simple fact that they don’t own the land those resources are on and under. Fifty percent of all land, over 600 million acres, west of the Colorado/Nebraska line is owned by the federal government, making up 91 percent of all federal lands in the nation. That’s enough land to cover every state on the Eastern Seaboard, plus Kansas, plus Texas, plus France. That’s just unfair: Western states are cut off from 50 percent of their tax base and have little say over 50 percent of their economic potential, just because they came to the Union later in our nation’s history.


If the federal government owned half the casinos in Las Vegas and started shutting down blackjack tables, how many people would lose their jobs? If they owned half the Florida beaches and started fencing them off, what would that do to the local tax base? Las Vegas has casinos. Florida has beaches. The West has natural resources. Taking 50 percent of anyone’s or any industry’s livelihood off the table is going to hurt in ways that are as obvious as they are avoidable.

Some say these lands are national treasures that belong to all of us. Yes, some of them are. But not a lot of them. Nobody is seriously talking about taking over or closing down national parks, or wilderness areas, or other unique or fragile places. These special lands are the exception and should remain the exception. But they comprise a small fraction of the federal estate in the West.

Generally speaking, those types of special lands make up less than 15 percent of federal holdings in any given Western state. The vast majority are lands amenable to (and originally designated for) multiple uses, including recreational, aesthetic, and economic purposes. That’s 20 million to 30 million acres—an area the size of Virginia—within each Western state that can and should be used with the complementary goals of conserving the land and bettering the human condition.

Five states are somewhere in the process of demanding control of federal lands to further those goals. Utah has passed a law, the Transfer of Public Lands Act, which demands that most of those multiple-use lands be turned over to state control. Four other states, Montana, Wyoming, Idaho, and Nevada, are studying the pros and cons of making similar demands. Those states will consider bills similar to Utah’s during their 2015 legislative sessions, while several others will step up their efforts to study the issue.

Work is also being done at the congressional level by Rep. Rob Bishop (R-Utah) and others. In the end, though, just as each parcel of land will have its own unique best use, each state is probably going to have its own tailored solution. These are lands with trillions of dollars in resources, billions of dollars in potential tax revenues, and hundreds of thousands of jobs being increasingly locked up by people who really don’t understand what is at stake. And it’s not just dollars and cents.

It’s ironic that many of the very people who rightly care about diversity are also acting to choke off an entire way of life. They are imposing their values on the rural production economy in ways and with effects that they often don’t understand. Most Western states are working to stop that—to protect the lands, enhancing conservation and bettering of the human condition, while using those lands for enjoyment and productivity now and long into the future. In short, to be proper stewards.

Western states’ lack of control over their resources opens another means of federal imposition and control. The federal government accounts for an increasing portion of state budgets, often to those states’ detriment. On average, about a third of state spending is provided by federal funds. In Western states, one of the reasons for this increased dependence is lack of access to their revenue base. But these federal funds are not gifts. They are being used to tell Westerners how to educate their kids; how to provide for public safety; how to run their businesses, their charities, and their government; and how to take care of their environment and resources.

This dependence isn’t just a Western problem. It’s happening with states across the nation. Much of the federal funding for the states is discretionary spending. As interest rates return to historical norms, discretionary spending will be further squeezed between entitlement spending (which cannot be cut except through program reforms) and servicing the national debt (which is a legal obligation of the government). Again, Western states are the canary in the coalmine because of the combined effects of their dependence and lack of flexibility in addressing future federal budget surprises. So they need to create a plan for when the next federal funding crisis occurs.

States need to have their eyes wide open to see federal funds and the strings that are attached to them. They need to measure the risks of accepting those funds against the rewards. They need to do what we all do in our everyday lives: prepare. They need to plan for that day when those funds dry up so that the right programs are cut or maintained. It’s unbelievable that states don’t already have that level of foresight or haven’t done that basic planning, but they don’t and they haven’t.

This type of responsible pushback and planning also goes beyond just wanting to do the right things. It advances conservatism and conservative principles. These are winning issues for a center-right country. They show the costs of and provide alternatives to going down the wrong path.

This task is important because the Left is working to change the electoral map. It’s trying to create a permanent majority by making more people dependent on, more beholden to, and just flat-out scared of criticizing a stronger federal bureaucracy.

The Left increases dependence through increased benefits. Food stamp recipients are at record numbers. ObamaCare raises the cost of health care and then subsidizes the increase. What a deal! They’ve taken a basic need and turned it into a government-issued privilege like a driver’s license.

The Left’s policies are also increasing the number of individuals and businesses beholden to big government by explicitly picking winners and losers.

“Crony capitalist” is an oxymoron. If you’re a capitalist, you want to have your goods and services out there in the marketplace. You want to compete and succeed on your merits. If you are a crony corporatist, on the other hand, you use connections to get targeted subsidies or special tax treatment. You get regulations to impede competition. You want a government that’s big and powerful enough to pick winners and losers. Increased dependence is a small price to pay if you get to help them do the picking.

The Left is also trying to build its permanent majority by creating fear: browbeating, threatening, and silencing its opponents. We’ve seen political leaders publicly berating and calling on federal agencies to target private citizens who are engaging in legal speech. They threaten their opponents’ jobs and privacy over political and religious beliefs.

They are able to do these things because of the dependence that we as a society have tacitly approved—by accepting dependence, becoming beholden, or succumbing to fear. We’ve got to cut those apron strings and restore our independence and our ability to govern ourselves. We need ideas that we can unite behind as a center-right nation, and the federal lands and federal funds issues meet that standard.

It’s clear that these are winning issues in the West. Tom, a rancher in Malta, Mont., shouldn’t be forced off land that his grandfather homesteaded because George Soros saw Dancing with Wolves and wants to put bison out there.

Jose, who comes from an original land-grant family, shouldn’t lose access to land in New Mexico that his family has responsibly grazed and improved since the 1600s because some San Francisco billionaire held a fundraiser with his rich buddies and wants to make room for a jumping mouse.

A home-care provider in Boise, Idaho, should not lose her job over a 10 percent across-the-board federal budget cut while the state continues to run an “Eat Your Vegetables” public service announcement because it comes from a different pot of money. States should be able to prioritize those things and fund the people and programs that are really needed.

What we’re witnessing—and participating in—is a philosophical war for the West and the freedoms we all cherish. It’s a movement to restore the proper balance between individual fulfillment, the betterment of the human condition, and federal power. We can show working-class families, the old Reagan Democrats, that there is somebody out there fighting for them and that there is a path forward for them that enhances their traditional values of hard work, family, and community. We can move these issues forward if we can control our resources and our priorities.

But it’s not enough to preach to the choir about these issues. A lot of the folks who want to make those resources available belong to the rural production economy that is having a very difficult time having its voice heard. They are effectively being disenfranchised because their voice is smaller than the urban voice right now. The problem is simple math: There are more urban voters than there are rural voters, and they don’t always share the same sets of values.

What are urban voters? That’s not a code word or a dog whistle. The urban/rural distinction is measured by population density but also a sense of connectedness (or disconnectedness) with the rural production economy. There are values, ethics, and lifestyles attached to that economy that make it work. The further one gets from the land, the less understanding one has of the lifestyle that makes it work, and the more likely one is to shove those values aside without caring about or even recognizing the harm that’s being done.

So if you go out west to Billings, Mont., to Albuquerque, N.M., or to Boise, Idaho, most of the people you meet will be at most one or two generations removed from somebody who actually worked the land and its many resources. They understand those rural values. They understand what’s needed for that rural production economy. People in larger urban areas don’t understand the lifestyle and values that make that economy work, to say nothing of the logistics or scales. So they will, sometimes unintentionally, harm the very people, families, and communities that put electricity in their outlets, gas in their cars, and food in their pantries; and provide so many other things that a modern society needs to survive.

Self-determination, self-government—that’s what is really at stake right now in this war for the West that is picking up steam. It’s not about dollars and cents. What really matters for those who have the most to lose is basic fairness.

When rural Americans put on their boots in the morning, they’re not just going to work. They’re preserving the traditional values and ideals that made this country great. They’re powering the greatest economy in the world. They’re building a stronger, more environmentally responsible, and sustainable future through a rural production economy that values hard work, family, and community. There are people who don’t understand the importance of that, and who are working very hard to prevent rural Americans from pursuing happiness and providing the building blocks of the American dream.

Self-determination, self-government—that’s what is really at stake right now in this war for the West that is picking up steam. It’s not about dollars and cents. What really matters for those who have the most to lose is basic fairness. It’s about preserving the viability and the values of our rural production economy and building a united majority of Americans who understand that good intentions alone don’t build great nations.

Our philosophical war is in the West, but hopefully you’ll create your own revolt in your own back yard. There are many of us canaries in the coalmine who would be happy to help you.

Mr. Graham is Director of the Center for Self-Government in the West at the Sutherland Institute.


How to Get a Health Care System that Answers to the Patient

by Grace-Marie Turner

OBAMACARE DOESN’T AND CAN’T WORK. It is a rolling disaster that is wreaking havoc on the American economy and health care sector. Americans are experiencing first-hand the damage the law is doing. It is making their health insurance more expensive, driving doctors out of practice, and undermining the goal of improved health care. And the law doesn’t even come close to universal coverage—leaving at least 31 million uninsured, according to estimates by the Congressional Budget Office.

So what should we do to fix the mess? Some conservatives want Republicans to rally around one bill to replace ObamaCare and then take that plan to the voters for the November elections. That approach, however, entails both political and policy risks that can be mitigated with a different strategy. Conservatives should focus first on laying out a vision of true competition and patient choice, gaining a mandate from voters to begin to pass “repeal and replace” bills in the next session of Congress based upon the vision of providing people with access to quality, affordable, innovative health care.

The Conservative Opportunity

The case for conservative reforms should start with this bedrock truth: ObamaCare never could have worked as originally concocted. So far, 42 major changes have been made to the law—16 by Congress, 24 by the administration, and two by the Supreme Court when it declared the individual mandate penalty to be a “tax” and also gave states the option to expand Medicaid. Congress has passed legislation that has been signed into law to, for example, repeal the onerous reporting requirements for small businesses, cut funding for health insurance co-ops, and eliminate a “Ponzi-scheme of the first order”—the long-term care insurance program.

And without legal authority, the administration has delayed the employer and individual mandates; delayed payment cuts to Medicare Advantage plans; allowed individuals to “self attest” their eligibility for subsidies; given congressional staffers, labor unions, and others waivers from the law’s specific requirements; illegally exempted the U.S. territories from ObamaCare; illegally distributed tax credits through the federal exchanges; and more. All of these changes are a taciturn admission that ObamaCare is fundamentally flawed. As The Wall Street Journal observed in an editorial, “Obama repeals ObamaCare.” The law that was enacted on March 23, 2010, is not the one that is being implemented.

Conservatives should see ObamaCare’s disruptive changes as an opportunity to make progress toward a system of true competition and patient choice. However, conservatives need to work through the problem strategically. Trying to pass a major replace bill now would be a trap. That approach would require some tough choices that ObamaCare supporters would deride, just as then-Sen. Barack Obama criticized Sen. John McCain’s reform proposals during the 2008 presidential campaign. The Left would home in on the details, forcing conservatives to get into the weeds of policy before they have had a chance to describe their larger vision of reform. Anyway, such a bill would hit a brick wall in the Senate and go nowhere.

Meanwhile, the policy problem is that replacing ObamaCare in one step risks creating more turmoil in an already roiled marketplace. Millions of people lost their health insurance because the policies they chose and liked didn’t conform to ObamaCare’s rules and mandates. Millions have been forced into the exchanges to get coverage, and 87 percent of those in the exchanges receive generous subsidies from taxpayers. Meanwhile, businesses inside and outside the health care sector have made significant and expensive changes to comply with the law and its tens of thousands of pages of regulations. Conservatives need an approach that minimizes the risk of throwing people out of the coverage they currently have while lifting burdens on businesses so they can focus on creating jobs and rebuilding our economy.

When critics say that we might as well stick with ObamaCare because conservatives don’t have a plan, we can answer: You are right that conservatives don’t have a better idea about how to write their own 2,700-page bill that is filled with mandates on individuals, businesses, physicians, health plans, and states; that creates 20 taxes sucking $1 trillion out of the economy; that cuts Medicare by $716 billion over 10 years; that spends $2.6 trillion over 10 years; and that still leaves 31 million people uninsured.

When candidate Obama ran for president, he offered voters a white paper, not a written health reform bill. Conservatives in Congress should follow that model and develop an outline for reform based on a vision of true competition and patient choice in health care. Many options have already been offered. These include a plan offered in the Senate by Sens. Orrin Hatch (R-Utah), Tom Coburn (R-Okla.), and Richard Burr (R-N.C.); plans offered in the House by Reps. Steve Scalise (R-La.), Phil Roe (R-Tenn.), and Tom Price (R-Ga.); and proposals from think tanks, such as the 2017 Project, Generation Next, and the “Room to Grow” proposal from the YG Network.

Then, if Republicans should win enough seats to take control of the Senate in the November elections, they can send bills to the President’s desk to begin to roll back the law and present their own targeted solutions. The bills would have a much better chance of getting through the Senate than any do in this Congress. They still would still face the president’s veto pen as he tries to protect his signature legislation. However, if the bills have enough support from Democrats, then it will be increasingly difficult for the president to veto legislation that gives relief from the law’s most onerous provisions. Speaker of the House John Boehner has brought more than 50 bills to the floor of the House of Representatives to repeal all or parts of ObamaCare, and most have received significant support from Democrats. The Speaker knows that Republicans can’t repeat the mistake that Democrats made in passing health reform legislation on a strictly partisan basis. Bringing Democrats to the table is an essential part of advancing free-market health reform.

Conservatives Have the New Ideas

When critics say that we might as well stick with ObamaCare because conservatives don’t have a plan, we can answer: You are right that conservatives don’t have a better idea about how to write their own 2,700-page bill that is filled with mandates on individuals, businesses, physicians, health plans, and states; that creates 20 taxes sucking $1 trillion out of the economy; that cuts Medicare by $716 billion over 10 years; that spends $2.6 trillion over 10 years; and that still leaves 31 million people uninsured. They don’t have a better idea for how such a bill could be written.

But we do have many market-friendly health care policy tools ready. Some say there are too many ideas, with more than 200 health care reform bills offered in the House of Representatives. They offer solutions that would allow the health care sector to respond to demands for more affordable choices in health insurance and would create true competition, not the fake choices offered by ObamaCare.

The goal of health reform should be to make sure that people have access to health care from the doctors and hospitals of their choice and that they have the peace of mind of knowing they are protected if they get sick or hurt and need expensive care.

Having seen the failures of ObamaCare, the American people are open to new ideas to give them genuine choice so they can pick their doctors and hospitals and seek out better care and coverage through real competition. We know untold innovations leading to better care and coverage would emerge—if we could get the incentives right.

Conservatives have been arguing since before the HillaryCare battles for properly-structured subsidies to help the uninsured afford health insurance. We also have argued that people should be able to have insurance that is portable so they don’t lose it as they move through life’s changes. And we have argued vociferously that we should give those confined to the Medicaid ghetto the opportunity to have the dignity of private insurance.

Nina Owcharenko and Robert Moffit of The Heritage Foundation set out the challenge in the Spring 2014 issue of The Insider:

We should be ready and able to present the American people with health reform legislation that is competently crafted, meaning it will be free of the glitches and technical deficiencies that often undercut health reform proposals. It must also be consequential, meaning that its enactment will materially improve the lives of millions of Americans by broadening access to health insurance and quality care while controlling costs through the power of the free market. And most importantly, it must be principled, meaning that it is crafted to expand personal liberty and revitalize civil society, giving individuals and families direct control over their health care dollars and decisions. The opportunity is here for conservatives to usher in a renaissance in American health care.

Patient-Centered Health Care

We need targeted solutions built around a new vision for health care reform that puts doctors and patients at the center. Here are some key principles to guide those reforms.

We must start with resetting the incentives to empower individuals to participate more actively in caring for their health and managing their health care decisions. That means giving them more control over—and more responsibility for—their choices and spending.

Incentives Matter. We must start with resetting the incentives to empower individuals to participate more actively in caring for their health and managing their health care decisions. That means giving them more control over—and more responsibility for—their choices and spending. More than four out of five Americans with health coverage today are getting direct or indirect subsidies for their coverage. These subsidies are often invisible, mistargeted, and inflationary; and they are present in private health insurance, in the ObamaCare exchanges, and in Medicare and Medicaid. They create massive market distortions and lead to hundreds of billions of dollars in wasteful spending.?We don’t need to spend more, but we do need to spend more wisely. Conservatives want to address this problem by realigning tax incentives for those with private insurance and restructuring public programs. The goal is to empower people to shop for the plans that work best for them and their families, coverage they can own and keep with them from year to year in a market that responds to their demands for better, more affordable choices. Some reform proposals would offer tax deductions and others tax credits structured in different ways to help the uninsured. And these incentives can work in Medicaid and Medicare, too. Programs like the popular Medicare Advantage program—which the Obama administration is trying to cripple—give seniors the option of picking private plans that are competing to offer different networks, benefits, prices, etc. Some states, like Florida, are having success with similar programs for Medicaid.

Consumers Need Transparency. Empowered consumers need to be informed consumers. The Obama administration recently released data on how much doctors are paid by Medicare. It was a sloppy list and the information was often misleading—not accounting, for example, for practices such as multiple doctors billing through a single physician. But the list was a start. Since governments pay for half of the nation’s $2.7 trillion annual health care expenses, this data could be better mined for more useful information.?States are acting, too. Two organizations, the Catalyst for Payment Reform and the Health Care Incentives Improvement Institute, assessed state efforts at making pricing information accessible to consumers. Massachusetts and Maine got Bs, but almost all of the other states received an F. That report card and earlier ones prompted states such as North Carolina and Arizona to pass legislation requiring hospitals to post a full menu of the prices they’ve negotiated with insurers for a long slate of services. Many other states have taken similar action.?Some may disagree with government-mandated transparency, but historically government regulation to ensure consistent standards and clear information in the marketplace has been considered a legitimate function of government.

ObamaCare puts insurers in a straitjacket by forcing them to offer plans that cover a long list of benefits that it defines as “essential,” ignoring what consumers may prefer and constraining what insurers may charge and how they may offer the plans. Without those restrictions, we would see greater variety in health plans.

Competition Produces More Choices at Lower Prices. In a true market, we would see health insurers and health care providers competing for the consumer’s business by being creative in benefit design and service delivery. The result would be better products at cheaper prices. But government thwarts competition in health care and health insurance.

ObamaCare puts insurers in a straitjacket by forcing them to offer plans that cover a long list of benefits that it defines as “essential,” ignoring what consumers may prefer and constraining what insurers may charge and how they may offer the plans. Without those restrictions, we would see greater variety in health plans.

We could see, for example, five-year plans that reward policyholders for maintaining good health. If a policyholder met certain health markers, then some of the premium would be refunded. Other insurers might offer indemnity policies that pay a fixed sum for certain procedures, such as heart surgery or knee replacements, giving consumers incentives to shop for the best value. Still other insurers might sell plans that combine health savings accounts with catastrophic insurance structured in new ways. The possibilities are endless.

More competition is equally important for improving the delivery of medical services. Private, physician-owned hospitals, for example, provide better care at lower prices than the mega-hospitals. The mega-hospitals, however, succeeded in limiting competition by lobbying for and winning a provision in ObamaCare that outlaws any new private, physician-owned hospitals. Also, new care delivery models could allocate the time of medical professionals more efficiently, such as by allowing para professionals to perform tasks that Medicare requires doctors to do today.

Another benefit of market competition is that once people get used to real choices, they will fight to keep them, even in public programs. Earlier this year, the Obama administration, sticking to its “Washington knows best” strategy, tried to limit the number of drugs and plans available to seniors in Medicare Part D. The huge backlash forced the administration to withdraw the proposed rule.

Reforms Should Protect Those with Pre-Existing Conditions. People who have health insurance should have a guarantee that if they have insurance, they can keep it and not see their premiums soar if they get sick. A few sensible insurance rules could provide that security. Free-market solutions also could give people the chance to buy insurance protection against a Change in Health Status so their premiums don’t soar if they have a major, expensive illness. Also, high-risk pools run by the states can help in creating a safety net for those who have difficulty purchasing coverage in the regular market. The federal government could encourage best practices by showcasing states that have the most successful programs.

Innovation Will Give Us New Treatments—If Government Gets Out of the Way. It is difficult to overstate the importance of continued innovation to transform our health sector. But innovation is being crippled by taxes and regulations that force companies to navigate a bureaucratic maze rather than focus on the discovery of new and better treatments and cures. Right now, our third-party payment system, barriers to entry, protectionist state regulations, expensive and outmoded processes at the Food and Drug Administration, and insider-driven Medicare reimbursement rates strongly favor the costly established incumbents and make it nearly impossible for new entrants to introduce disruptive innovations.

If we could unleash the innovators, we would see an explosion of revolutionary technologies to save lives, ease suffering, and reduce costs. Our health sector could be transformed by 3-D printing to create medical prostheses, drugs individualized to match peoples’ genetic profiles, nanobots to repair malfunctioning genes, and countless other exciting innovations. Further, smarter and more robust use of information, including Real World Data, could improve care delivery, speed the development of new medicines, and allow us to learn which treatments work best for which patients.

Getting from Here to There

Strategically, conservatives can learn from the process of enacting ObamaCare. The public is as strongly opposed to the law today as it was when it was enacted in 2010; however, the business community and other special interests were strong-armed to back the law and often were granted key favors and protections in exchange for their support.

All of these interests must be consulted in the next step of the policy battles. Democratic Senate leaders took the lead in 2009 in holding dozens of round-table meetings with leaders from all sectors of the health care industry—businesses, unions, patient groups, and many others.

So the first step should be holding a series of listening sessions. Questions we should ask include: Where did ObamaCare completely fail? What could have worked if it had been structured differently? Are any parts of the law working? Answers to those questions will help when conservatives move to the writing of reform bills.

Conservatives in Congress also will need to heed the popularity of certain provisions of ObamaCare—the one’s that dominate the talking points of the law’s supporters: coverage for those with pre-existing conditions, allowing 26-year-olds on their parents’ plans, and ending lifetime dollar limits on coverage. They must devise ways to allow those provisions following conservative principles.

Policy Prescriptions for Fixing Health Care

Move to a Patient-Centered Health Care Sector. Reform should offer more choices of health coverage that provides better value and that gives people the security of insurance that can follow them wherever they go. Some key policy prescriptions for reform of the private insurance market:

Tax fairness: Tax benefits should be available to those without access to employer coverage to help with the direct purchase of health insurance. Tax benefits should encourage cost consciousness.

Pre-existing conditions: High-risk pools run by the states will help in creating a strong safety net for those with difficulty purchasing coverage in the regular market because of their personal health status. The federal government could make risk pool funds available to the states to incentivize them to relax health insurance regulations and mandates that make insurance more costly and that impede competition.

Insurance security: People who have health insurance should be able to keep it through guaranteed renewal of health insurance and not see their premiums soar if they get sick.

Fiscal responsibility: Reform must adhere to fiscal responsibility, with no new taxes or increases in net federal spending.

State flexibility: States should have a prominent role in reforming their health insurance markets rather than having health insurance micromanaged by the federal government. States should have the power to create or encourage the creation of programs and purchasing pools to enhance the buying power of patients and small businesses. But the purchasers and consumers of care ultimately should be the final decision makers.

Create Choice of Private Plans in Public Programs. Reform should provide more options for Medicaid recipients, Medicare beneficiaries, and others in public programs to escape the restrictions that inevitably come from price controls and from government micromanaging benefits.

Improving Medicare: Protect and improve the Medicare Advantage program which gives seniors the option of selecting private plans in Medicare offered on a level playing field with regular Medicare. Expand competition and choice, using the competitive Medicare Part D prescription drug benefit program as the model.

Private plan choice in Medicaid: Allow people to escape Medicaid by letting them assign the value of their Medicaid benefit to private coverage of their choice. That step will give them better access to private physicians and the opportunity to use employer contributions, their own funds, or other resources to buy even better coverage.

State flexibility in running Medicaid: Allow states to adjust payment rates to encourage greater physician participation in Medicaid. Also, reform the “Washington knows best” mentality that forces states to plea for changes to their Medicaid programs and allow them instead to implement long-overdue innovations to improve the delivery of care.

The Big Picture

Pollster Daniel Yankelovich is a master at seeing megatrends in society. He says that public opinion progresses through predictable stages, from dawning awareness of a problem, to growing sense of urgency, discovering that tough choices must be made, wishful thinking, and finally to weighing choices and making responsible judgments.

For all of its massive flaws, ObamaCare has put the American people through a searing educational process. People are smarter now. They continue to be frightened about government power over their health care. They now realize that they aren’t going to get their health care for free, and it may even cost them more. They also see that government giving them choices can actually mean fewer of the choices they want.

Compassion Runs Strong

Americans are scared, vulnerable, and even angry about the upheaval in health care, but we can’t ignore the fact that the vein of compassion still is strong. At a recent focus group discussion, a young woman said she had had health insurance for her family through her husband’s job. But because of ObamaCare, their premiums soared. The family policy which had cost $400 per month would more than double to $900. She decided to keep her husband and children on the policy, and she would go without. She’s uninsured because of ObamaCare but said that’s OK if that means a child with cancer now can get treatment who otherwise couldn’t. Other women in the room women nodded agreement.

This moment is an opportunity for conservatives to touch the core values of Americans with new solutions.

Backers of ObamaCare want Americans to think they can get health care only if their deeply flawed law stays in place. In fact, people would get better health care at a lower cost with fewer strings attached if consumers, rather than politicians or government bureaucrats, made their own decisions about the health care and insurance coverage that are right for them.

We are stuck in a 20th century industrial model of health care in a 21st century age of information and innovation. If consumers were empowered to make their own choices with better incentives, transparent prices, and flexibility with benefits, then genuine competition—not ObamaCare’s fake competition—would flourish, giving people countless options we can’t even imagine today. We can have better health care that is more accessible to millions more people if we let the miracle of the free market unleash creative solutions. The future is waiting.

Ms. Turner is Founder and President of the Galen Institute, a think tank devoted to advancing ideas and policies to create a patient-centered health sector.


How to Increase Bequest Gifts to Your Organization

by Mark L. James

U.S. NON-PROFIT ORGANIZATIONS received over $23 billion in bequest gifts in 2012, according to Giving USA: The Annual Report on Philanthropy for the Year 2012. What makes this significant source of funding even more noteworthy is that less than 5 percent of all decedents over the age of 55 in 2012 made charitable bequests. Therefore, over 95 percent of your donors over age 55 will benefit from your assistance in helping them to complete their charitable estate plans. In addition, the 5 percent of your donors who currently do have an estate plan can easily include a gift to your organization by simply amending their current plan.

This article provides your organization’s development team members with three action steps to help them close more bequest gifts. These steps can be helpful even if your organization does not have a formal planned giving program; they can be integrated into your daily routine even if your primary focus is on current gifts. This article also provides helpful advice development teams members can give to their donors to facilitate the estate planning process.

1. Identify Two or Three Supportive Estate Planning Lawyers in Your Community to Whom You Can Refer Your Donors

Bequest gifts can be made either through a will or living trust, or by beneficiary designation. To have a bequest gift written into a will or living trust, it is best to have the documents prepared by a lawyer. Unfortunately, many donors don’t have a will or living trust because they don’t know an estate planning lawyer who can help them. Therefore, the first step to increase your bequest gifts is to locate two or three estate planning lawyers in your community who are supportive of your organization’s mission. If you provide your donors with the names of two or three friendly estate planning lawyers, you have not only provided a valuable service for your donor, but have also minimized the possibility that a potential bequest gift gets derailed by an antagonistic lawyer.

Unfortunately, finding conservative estate planning lawyers in your community may be easier said than done. Indeed, one of the most common questions fundraisers ask me is how to find estate planning lawyers in their communities. This task may not be an easy one, but, by using the following tools, you should be able to locate at least two or three such lawyers.

Ask People Who Know You. The easiest way to find helpful lawyers is to ask those who are already familiar with you and your organization. People who may be able to make lawyer referrals include your current and former Board members and your accountant. You could also seek lawyer referrals from your existing donors and your colleagues at other conservative organizations in your area.

Search Online Directories. A second tool to find conservative estate planning lawyers is to search online lawyer directories. One helpful online directory is provided by the Christian Legal Society. The web address is clsnet.org. To search this directory, click on the “Resources” tab on the home page. Next, click on the “Find a Lawyer” sub tab to open the “Referral Directory.” Enter your state, and the practice area “Wills/Trusts/Estates/Probate.” The result is a list of lawyers’ names, cities and contact information. These are lawyers who identify themselves as Christian and whose practice areas include estate planning. This is an initial list of potential conservative estate planning lawyers in your area.

Martindale.com is a second useful online directory. To access this directory, click on “I Want to: Find a Lawyer or Law Firm,” on the home page. A screen will open that can be used to search for estate planning lawyers. To select a practice area, choose both “Trusts and Estates (all)” and “Wills (all).” The only other item to fill in is your state. The directory will then list estate planning lawyers in your state. This list can be further narrowed by county and city. This refinement will provide a list of lawyers in your community who do estate planning. One additional useful refinement in locating supportive lawyers is to enter the name of a conservative law school in addition to your state and the practice areas. For example, I graduated from Regent University Law School, and when I add to my search Regent Law alums, I discover estate planning lawyers throughout the country who probably share my conservative values.

Visit the Lawyers. Once you identify potential lawyers, it is important to meet them before referring any donors to them. When I was a planned giving officer, I consistently tried to contact new prospective lawyers in the cities within my region. I would tell them that I was looking for estate planning lawyers in their community to whom I could refer my organization’s donors who need wills or living trusts. I would also request a 10-minute meeting to introduce myself and my organization. These brief meetings were beneficial. They solidified good relationships with helpful lawyers and also prompted me to remove others from my list of referral lawyers for a variety of reasons.

2. Share Simple Bequest Ideas with Your Current Donors

Once you have at least two estate planning lawyers to whom you can refer your donors, the second step is to research your current donors to identify those over 55. These are your best prospects with whom to engage in conversations about leaving a legacy with your organization.

Start with the Basics. The purpose of the legacy conversation is to inform your bequest gift prospects about how to include your organization in their estate plans. This task can be done either through individual appointments with your donors, or by inviting them to an estate planning seminar. There are several benefits of estate planning seminars for interested donors. One is that it is a great way to deepen their understanding of what you do. It may also be an opportunity for donors to meet an estate planning lawyer if you have one present at the seminar.

If a donor already has an estate plan, help him or her add a codicil (to a will) or an amendment (to a living trust) that includes a bequest gift to your organization. If the donor does not have a will or living trust, help him or her get a new will or a living trust that includes a bequest gift.

Bequest gifts can also be made via beneficiary designations. These include gifts of life insurance, IRAs, and investment accounts using Transfer on Death instructions. A beneficiary designation gift is much simpler to implement than drafting a new will or living trust, since your donor does not need a lawyer to name your organization as a beneficiary. Therefore, when discussing simple bequest ideas, be sure to mention gifts via beneficiary designation.

One way to help your donors get a good start is to give them a simple questionnaire that helps them start to think about their plans for their will or trust.

3. Stay Engaged in the Process

The third step to increase bequest gifts to your organization is to stay engaged in the process. This is important because it is easy for the estate planning process to get derailed. One way to help your donors get a good start is to give them a simple questionnaire that helps them start to think about their plans for their will or trust. The donor also gets to see the broad subject matter that will be discussed in the initial estate planning interview with the lawyer. This can help the donor feel more comfortable in the first meeting.

Obviously, there can be no bequest gift unless the wills and/or trusts are signed. Therefore, it is important to stay in touch with your donors who begin the process. Gentle questions to your donors concerning how their estate planning process is proceeding can be helpful in encouraging them to finish what they started.


Bequest gifts are a major untapped source of funds for many organizations. The first step to secure more of these gifts is networking with local estate planning lawyers to help your donors with the process. The second step is to spend time with the right donors sharing simple bequest ideas with them. Lastly, the third step is not only to help them get started in the process, but also to be a resource to help them complete it. Actually, there is a fourth step. Be sure you complete your own will or living trust that includes a bequest gift to your own organization!

Questions That Can Jump-Start a Conversation about Estate Planning

What is it about our nonprofit that motivates you to support us?

What do you see as some of the long-term challenges that we face here at (insert charity’s name)?

What role do you see (insert charity’s name) playing in addressing these challenges?

Given your long-time and faithful support of (insert charity’s name), would you be willing to remember us in your estate plan?

Mr. James is a private practice estate planning lawyer in Lancaster, Pa. He has been involved in planned giving for almost 30 years and is a member of The Heritage Foundation’s Legacy Society. He can be contacted at markj@hublaw.com.