If you’ve ever been to a hospital, you’ve probably noticed that it’s not like Wal-Mart. You can’t wander around inspecting medical services on offer, weighing different options, and reading price tags.
You may have already considered different options before arriving at the hospital—if you went to the trouble of scheduling an appointment to hear a second opinion, and if treating your condition wasn’t urgent. And while you might get a bill for copays or deductibles, you’re not likely to see any real prices for procedures.
That our arrangements in health care are different from those of other economic sectors is an example of what Emile Durkheim called a “social fact.” The role of third parties—insurers, employers, government—in providing and paying for health care is so obvious that most people rarely stop to consider whether it must be that way.
There is a mythology behind these arrangements that was laid out explicitly by Kenneth Arrow in his 1963 paper, “Uncertainty and the Welfare Economics of Medical Care.” Arrow argued that the suppression of market forces in medical care is society’s way of adapting to the special qualities of medical care that make markets in medicine function imperfectly. As he put it: “It is the general social consensus, clearly, that the laissez-faire solution for medicine is intolerable.”
Among those special qualities, said Arrow, were the uncertain and irregular consumption of medical care, the impossibility of examining the product before receiving it, the difficulty of measuring its effectiveness and of comparing its outcomes, and the specialized knowledge required to practice medicine, which gives providers an informational advantage over consumers—and thus an unusually large ability to influence the demand for their own product.
All these factors make it difficult for a patient to shop for medical care as he might shop for new shoes. But none of those qualities make health care truly unique. In other areas, we insure against the risk of large losses—e.g., to our homes and automobiles—without suppressing real insurance prices.
We can’t know for certain how much a college education will add to our marketable skills until we attend the classes. And by definition, students know less about what they are learning than their teachers. But nobody thinks prospective students cannot make informed decisions on the basis of college reputations, tuitions, and private ratings.
Arrow also fails to consider whether imperfect markets are better or worse than imperfect government intervention. Separating the consumption of care from the paying for care means that in health care few people have an incentive to ensure that a dollar spent purchases a dollar of value. But the federal government has expanded third-party payment—not only by being the largest payer for medical care but also through making employers the primary providers of private health insurance.
What are called market failures are in fact often market opportunities for an entrepreneur to provide a new solution. But the search for solutions gets cut short when the government dictates how things will be done. To take one example, noted by Robert Graboyes in our interview at page 14, electronic medical records could provide a lot of value in health care, but they do not do so right now because they are organized not for clinical purposes but for administrative purposes determined by the federal government.
In order to bring more market forces into health care, we need first to repeal Obamacare. Second, we need to make the policy changes described by Robert Moffit at page 20. In particular, capping the tax exclusion on employer-provided health insurance, providing a parallel benefit for individually purchased insurance, and liberalizing restrictions on Health Savings Accounts will put consumers back in charge of health care decisions and encourage them to shop for value—necessary steps for unleashing in health care the competitive forces that have transformed vast swaths of our economy over the past 50 years.
Mr. Adrianson is Editor of The Insider.
If you hear that Congress has a new health care reform plan, you’ll probably have questions like: How will my insurance plan be affected? Will my coverage change? Can I still choose my doctor? How much will it cost me?
You probably won’t ask: What conveniences in service will be ushered in by these reforms? What new treatments and therapies will we have in the future if these reforms are passed? Will we forgo new cures because of these policies?
That’s to be expected since innovation is by its nature surprising. And there is also the fact that what we have called health care reform has mostly been about reforming the financing of health care. Yet how we pay for health care, and which policies we employ to control its costs can help or hinder the pace of medical innovation. At stake in health care reform is not just who pays how much for today’s cures, but whether we will have cures and delivery mechanisms tomorrow that we don’t have today.
Robert Graboyes, who is a fellow at the Mercatus Center, has studied health care innovation and he argues that American health care is stuck in a “Fortress” mentality—too focused on avoiding risk and defending existing health care providers from new sources of competition. As a result, he says, health care has not seen the kinds of disruptive innovation that other sectors of the economy—in particular information technology—have seen in the past 25 years. We talked with Graboyes about what innovation we might see soon if we can get our health care policy right.
* * *
The Insider: What kind of health care innovations do you think we ought to be seeing that we are not seeing?
Robert Graboyes: I’ll begin with new classes of drugs—some tailored to a particular individual’s genome.
A more down-to-earth realm is electronic health records. People of both parties salute the idea. They assume EHRs will bring efficiencies, and yet what we’ve gotten is a muddle that physicians absolutely hate. The current set-up doesn’t serve clinical purposes very well. They’re not all that useful to the doctors or the patients. They are mainly designed for the administrators and insurers.
How often do you have to write down your name and address? How much time does your doctor spend asking questions you’ve answered a hundred times before? And how much information is lacking? I go to several doctors—a primary care physician, some specialists. Each of those doctors wastes time asking questions that really ought to be in some sort of central record.
The problem is the development of electronic health records is being heavily determined by federal law—in particular the HITECH Act, which is part of the Affordable Care Act. It’s not designed for clinical purposes. It’s not designed to please the doctors or the patients.
The development of electronic health records is being heavily determined by federal law. It’s not designed for clinical purposes. It’s not designed to please the doctors or the patients.
On another front: three years ago, the least expensive prosthetic hand cost about $5,000. On average they were more like $30,000 or $40,000 until a puppet maker in Washington State and an injured carpenter in South Africa collaborated to develop 3D-printed prosthetic hands that cost between $20 and $50. Now, the Food and Drug Administration did not interfere with them; they were exempt from the approval process. However, if the makers were to decide to motorize the hands or add sensors, the hands would be classified as medical devices and likely fall under FDA scrutiny. As a result, some of the most interesting development in this area is no longer happening in the United States. It’s happening in Colombia, Paraguay, and Chile where, I’m told, their governments have made clear that innovators are welcome to develop those things there.
Then there’s the business structure of care: I wrote not long ago about direct primary care. In this practice model, service is typically available 24/7/365. You pay a fee of around $60 monthly and after that there’s no additional charge for your primary care.
One particular direct primary care company offered to a couple of states to provide care for $1 per day ($365 per year) per person for undocumented immigrants. States are paying huge sums for that population to go to emergency rooms when they become ill.
Under this proposal, the undocumented immigrants would get all their primary care from this provider and they wouldn’t have to go to the ER anymore. The government said that would be great, but then they would consider the provider to be an insurer and regulate it accordingly. The company argued it was not an insurer; it was a primary care provider that just had a different payment system. The government said: That’s fine, but we’ll consider you an insurer. So it threw away the opportunity to save a lot of money.
TI: Is the problem badly written regulations, badly implemented regulations, or something more fundamental with the design of health care?
RG: All of the above, but mostly fundamental design problems. You can’t really “design” the health care system, but we try mightily, and that is part of the problem. There’s a long list of policies that ultimately have to be altered, and they are mostly not part of the health care reform debate we see on television everyday now.
The Medicare reimbursement system divorces the prices of health care from the actual underlying costs of producing care. It’s a price control system. If something doesn’t go into the Medicare reimbursement protocols, it’s not going to be compensated, and that’s the death knell for that technology. The problem leaks into both Medicaid and private insurance plans; they lean very heavily on the design and structure of Medicare’s pricing formula. So, Medicare’s reimbursement system is the biggest problem.
The second is the FDA’s approval process.
The third is the bias in both federal and state laws toward the establishment of multipurpose general hospitals instead of specialty hospitals. In some countries, specialty hospitals gain great skills and efficiencies by doing enormous volumes of relatively few procedures.
The next big group of problems are regulations at the state level. We have laws that limit hospital competition. Scope of practice regulations that prevent substitution of expensive physician labor with less expensive, perfectly competent non-physician health care providers like nurse practitioners. Corporate Practice of Medicine Doctrine laws that restrict the business structure of health care companies and make it difficult for skilled managers to bring their synergies into health care.
In some states, medical licensure laws make it difficult for out-of-state physicians to move there and begin practicing. Regulations make it difficult to purchase from less expensive international providers. It’s hundreds and thousands of separate regulations and laws that together slow the development of new technologies and business structures.
TI: What other things can states do on their own to eliminate the bottlenecks holding up innovation?
RG: First of all, they can get rid of certificate-of-need laws. In CON states, when a hospital, or even a physician’s practice in some cases, wants to buy a particular piece of equipment, they have to obtain permission from the state. It’s an expensive and time-consuming process. They are quite often rejected. So it stifles competition.
Secondly, they can change scope of practice laws to allow nurse practitioners, pharmacists, a variety of other non-physician health providers to provide services independently, autonomously. Some states have already taken this step and it works quite well.
Corporate Practice of Medicine Doctrine highly restricts who can own, and invest in health care businesses and physician practices. To a large extent, that cuts people with management efficiency expertise out of the health care field. Various laws restrict who may employ whom. I used to work at a couple large places that had in-house doctors for employees. In some states that’s simply not possible; it’s illegal for a company to hire a doctor to see patients at the company. There were a couple of years in which that was basically where I got my primary care. Luckily, I was young and healthy. I actually did have a primary care doctor at some distance, but it was very nice to be able to go to the 17th floor and see the doctor on any given day.
There’s a company I have written about—Opternative—that uses a laptop and a smart phone to provide at-home autonomously-done eyeglass refraction examinations. (Each exam is certified afterward by an ophthalmologist—an M.D.) So if you need a new pair of eyeglasses, if you want to get a new prescription, then you can do the examination at home; it is clinically on par with going to an office and paying someone else to do the refraction. And yet, some states have banned this. And by the way it’s sometimes “red states” that have been first to try and first to stop the technology.
Some states are very open to telemedicine; others are not. In a sense, my mother’s life was saved by telemedicine. She happened to be communicating with my nephew, who is a doctor. She was 92 and he was talking to her via FaceTime. She described a sore she had, he asked questions, and observed her through the iPad’s camera. She didn’t think that she was particularly sick, but the conversation and visuals suggested she might be at the beginning stages of septic shock. Had she just gone on instinct and waited a day or so to call her doctor for an appointment, she may well not have survived. But thanks to essentially an amateur bit of telemedicine, she was able to get another year of life.
Some states make professional telemedicine virtually impossible.
Some states make professional telemedicine virtually impossible. They have put into place restrictions that say, for instance: Yes, you can use telemedicine, but only with a doctor you have met personally. So, if your doctor is asleep, or away, or seeing someone else, you wouldn’t have access to it.
So, there are tremendous benefits to telemedicine, especially in rural states, where you tend to be more isolated. Or if you’re a single mother with three or four kids, it’s very difficult to find a way to get to the doctor’s office if one of the children is sick, and telemedicine offers more opportunities. Telemedicine can mean earlier and less expensive diagnosis.
TI: So is it correct to say that current reform efforts are too focused on policies affecting the demand side and not enough on supply side issues?
RG: Absolutely. I think that’s the critical weakness of current debate. We’re moving the deck chairs around and ignoring the icebergs.
Before the Affordable Care Act there were about 200,000 primary care physicians in America. There were several times that number of specialists. There were a number of hospital beds, and nurses, and lab machines, and other resources. We had formulas for mixing these things into care—recipes for how you take resources and make care from it. So the ACA in 2010 promises care to 20 million to 30 million people. Plus, it promises the rest of the American population relatively free access to about 65 preventative services. So it promises a lot more on the demand side but it does not really increase the supply of resources or change what we do with those resources.
So, if you’ve had about a week of introductory economics then you know that if you have a vertical supply curve and you move the demand curve to the right—i.e. you increase demand without touching the supply—then what you get is higher prices not more care. So, what the ACA did was create a lot of winners and a lot of losers both in terms of the care they got and the financial burdens they bear.
Now, there have been a number of conservative or Republican alternatives for replacing the ACA, and essentially you can make the same criticism of them all: They shift around the demand, they change some of the cost structure, they change who is in front of whom in the queue. But again that does not make serious changes in either the available resources or what we do with those resources. There are quite a number of policies that could actually change the recipes, change the resources. That’s what we’re not doing but that’s ultimately what we’re going to have to do to get to these innovations that should be happening.
Recently, I’ve been pushing a thought experiment I call the Calendar Test: You’ve got a doctor who works 10 hours a day. Five hours is administration, reading charts, reading journal articles, having meetings, dealing with insurers, etcetera. And for five hours he sees 20 patients for 15 minutes apiece. Now somebody goes out on the street and hands out four gift coupons to people saying they’re entitled to a checkup and examination today. Now the doctor either has to work longer hours, cut all the appointments short, or kick four prior appointments out. The alternative is to loosen the doctor’s calendar by shifting part of the care to non-physician providers, to machines, and to patients themselves. Neither the ACA nor conservative plans do much to promote these alternatives.
TI: Isn’t fiddling on the demand side simply the inevitable consequence of getting government involved in the business of health care? That’s what government knows how to do—put people in programs and tell them they are covered—right?
RG: Yes, the government does that. Are they good at it? That’s a whole different issue. Unfortunately, the way the federal and state governments do health care suffers from the same problems that come from centrally planned economies. You get price controls. You get misallocation of resources. You get a skewing of priorities. I would like to see the government spending less time flooding people into programs.
Health care is just the about the only major product in one’s life where you don’t have any motive to lean over the fence and ask your neighbor for his thoughts. We ask about lawn mowers and restaurants and cars and most anything else. But in health care we have built this set of walled cities for separate populations. I will never have the same policy my next-door neighbor has. We have nothing to talk about; we have no basis for comparison or reason to have the conversation.
Over the years, the federal government has decided that old people ought to be in Medicare, poor people ought to be in Medicaid, military people ought to be in Tricare, veterans in the VA, federal government employees should be in the Federal Employees Health Benefit Plan, employees of big businesses ought to be in plans of one variety, people in small businesses ought to be in a different kind of plan, American Indians ought to be covered by the American Indian Health Service, and individuals who don’t fit these categories should be in individual plans. There’s very little mobility between any of these walled cities.
What we’ve gotten is a rather fragmentary system where for artificial reasons, competition doesn’t work and we do not get the sort of positive feedback moves that you get in every industry in America.
TI: Are there any examples of government successfully retreating from a sector of the economy that can serve as a model for health care reform?
RG: Yes. A great example is information technology. In the very early 1990s—the early days of the internet and cellular technology—it appeared that Congress was going to tighten up the regulations to regiment the information technology industry. But instead, there was a concerted effort to persuade them otherwise, and a bipartisan consensus to go in one direction flipped and became a bipartisan consensus to step away from tight oversight. So the government which had originally built and owned the internet and set rules for it, stepped to the side and said: Let’s let the market do it. They were aware there would be problems, that there would be dangers in doing this, and yet, for one time, they said: Rather than trying to imagine every problem in advance and stopping it before it happens, let’s let things proceed, see what the market does, and when problems develop, we’ll deal with them as we go along.
I argue that the computer on your desk and the industry in which they’re embedded is every bit as dangerous as medical care. Incompetent or malevolent agents using computers can do an awful lot of damage to you, as can the same in medicine. And yet, Congress stepped away and we got the Internet Age.
Imagine instead that we had gone to a world where if you wanted to design a new app or a new cellphone, you would have to get something like FDA approval. Say we had a Federal Department of Apps that made you spend millions of dollars and 15 years of waiting to get approval for your app.
Last year, in the 21st Century Cures Act, Congress loosened the regulation of software in medical devices. Medicine and information technology overlap in quite substantial ways. I don’t want to say that medicine at this point is a sub-field of IT, but at times it can seem that way. A lot of the things that will change medicine in the next 20 years will be the use of diagnostic devices, thus reducing an awful lot of the practice of medicine to algorithms that can be handled by machines.
I went to a dinner a couple of months ago with a group of medical school professors and public policy experts—a very impressive group. The question came up: How much of what we call medicine is reducible to algorithms that could be learned by a machine? I think the lowest estimate in the room was 80 percent. The highest estimate was 97.5 percent.
Recently, a woman in Japan was diagnosed with leukemia, but the doctors weren’t having any success treating her, and they were very frustrated. After months of frustration, they consulted with Watson, the IBM computer that won on “Jeopardy!” Watson examined her patient chart, asked some questions, went out on the Web, read 20 million articles on cancer and came back with a diagnosis. She had, said Watson, a very rare type of leukemia that the human doctors had missed for all those months. Watson did this in 10 minutes.
So we’re going have to look at a lot of liability laws. How we deal with these things legally will be a big factor in determining whether that kind of capability is accepted and used.
We are entering an era now where we have medical devices that allow individuals—people who don’t know anything about medicine—to handle a great number of the procedures that used to be limited to a physician.
I have an example about myself. About a year ago I had a bout of atrial fibrillation. My heart went into arrhythmia. Since that time, I carry a small, inexpensive device on my cell phone, just pasted onto the back of my iPhone, that allows me to do an electrocardiogram in 30 seconds and very quickly get a diagnosis as to whether my heart is in normal rhythm. I don’t have to go to a doctor to do that. If I want to, I can punch a button and the device will send the EKG to a doctor instantly and I can get a quick reading for very little cost.
Last year, I thought I was having an episode on a remote road in Western Pennsylvania and I used this device to ascertain that, no I was doing just fine. My heart rate was a little faster than usual, but there was nothing wrong with it. And I then calmly got back on the road and continued driving the remaining four hours home instead of going to a hospital. A $99 device saved somebody $2,000 or $3,000, which would have been the cost had I actually gone to the ER, gotten wired up, and gotten checked out.
We are about to see a very rapid multiplication of devices like this. I expect that in the next 20 years, an awful lot of what you used to go to the doctor to do, you will do yourself at home, quickly, at any hour. You will get results that are clinically about as good as a doctor would give you—or maybe better.
One of my co-authors on a forthcoming paper, an expert in electronic health records, believes that devices will give the typical patient the same technical capability as a Harvard trained technical team provides today. You will have that in your home at all times.
TI: It sounds like you are an optimist in spite of the many flaws in government policy. Is that right?
RG: I am extremely optimistic about the future. The question is going to be: Where does this innovation happen? Will the best innovations start happening in other countries because we have put impediments in the way? Some other countries could well leapfrog over us. There is a chain of cardiology hospitals in India—called Narayana Health—that are among the best if not the best cardiology hospitals in the world today. They do massive numbers of heart operations, so their surgeons get better and better. They run the hospital kind of like Toyota runs a car factory.
A couple of years ago, a bypass operation at the Cleveland clinic cost around $106,000. At Narayana it was $1,600. And their outcomes rival or beat any of our places here. A former president of the American Medical Association told me he had visited a cardiology hospital in India and added that he had never been in an institution of that quality in his entire medical career. Two or three years ago, Narayana opened a hospital in the Caribbean just a little ways south of Miami. With an hour and a half plane ride you can be having surgery there. I’m trying right now to ascertain what the difference in the cost is. You won’t get a bypass for $1,500 there, as you would in India. But you can get it at quite a substantial discount over what it costs in the United States. A lot of these hospitals catering to medical tourists have American-trained doctors, American-board-certified doctors.
If we don’t progress enough here, then people will look to other countries for sources of care. The technologies are multiplying at such a rate that I think it’s actually going be quite difficult for American regulatory authorities to exert the control over medicine that they once had.
Jill Rothrock’s experiences with the welfare system in Maine came full circle in 2012. Five years earlier, Rothrock, a mother of two, was introduced to the system after enrolling in the Temporary Assistance for Needy Families, or TANF, program in 2007. But when forced to transition off of public assistance—the result of Gov. Paul LePage’s reforms to Maine’s welfare programs—she was hired by the state Department of Health and Human Services as a clerk in the agency that administered her benefits.
It took years for Rothrock to get to that point, though. For more than two decades, the mother of two battled drug and alcohol addiction. Her struggle came to a head in 2007, when she was arrested after picking up a prescription for Vicodin at a pharmacy in Bucksport, Maine. Rothrock had called in the prescription herself, a practice she took up after moving to Maine from her home state of New Jersey when she was 29 years old. And her arrest in 2007 was rock bottom, Rothrock said.
Facing three felony charges, Rothrock attended drug court, which provides community-based treatment services to people with substance abuse. She graduated from the program, and her charges were dropped from felonies to misdemeanors. Rothrock then cleaned up (she’s now approaching 10 years of sobriety) and enrolled in the TANF program. Rothrock then began searching for a full-time job.
To receive benefits through TANF, recipients must work, volunteer, attend school or vocational training, or actively search for employment. Rothrock complied with the rules of the program and began receiving benefits for more than four years while she worked part-time for periods of time and was on unemployment for others.
But by 2011, things in Maine were about to change. LePage, a Republican, took office, and the newly elected governor had campaigned on reforming the welfare system. One of his first changes was to reinstate a 60-month lifetime limit on TANF eligibility. By that time, Rothrock was quickly approaching the end of her five years.
“It came down to the wire,” Rothrock told The Daily Signal last year. “I knew my TANF was closing, and I had to secure a job or I would have no income.”
The young mother began working with state employees through Maine’s TANF-ASPIRE, or Additional Support for People in Retraining and Employment, program. TANF recipients are required to go through the ASPIRE program, where they’re assisted with job searches, training, and education. Rothrock started working 30 hours each week at a nonprofit and began to see noticeable changes in herself.
“I got in there, and that’s when everything started to come back—my work ethic, and how much I loved working,” she said.
A mentor paired with Rothrock eventually pushed her to apply for a position with the Maine Department of Health and Human Services, the very agency that was overseeing the changes to the TANF program that had impacted her life. And she got the job. In 2012, the Maine Department of Health and Human Services hired Rothrock as a clerk and in 2014, she was promoted to the eligibility department, working on discrepancy reports the state receives from the federal government.
Once the money starts coming in, it’s the best feeling in the world. My confidence started to come back.
As she transitioned off of the TANF program, the state provided her with transitional benefits like childcare and supplemental food stamps.
Rothrock admits it was “scary not to have that safety net down there.” But she said the 60-month time limit enacted by LePage forced her to “do what I had to do to get off benefits and start making my own money again.”
“Once the money starts coming in,” she said, “it’s the best feeling in the world. My confidence started to come back.”
Born Into It
LePage spoke about the cycle of poverty and the shortfalls of the current welfare system often while on the campaign trail in 2010. But the Republican didn’t just talk the talk. He lived it.
One of 18 children, LePage grew up in Lewiston, Maine, and lived in poverty throughout his childhood. His earliest memories are riddled with tragedy, LePage revealed in a candid interview with the Portland Press Herald in 2014. He said he remembers his house almost burning to the ground, remembers his father kicking him on the ground when he was 11 years old, and remembers tripping over his brother’s dead body in their home.
After an especially brutal incident with his father, who drank heavily on the weekends, left him with a broken nose and jaw, LePage left home at just 11 years of age. The future governor held a variety of jobs when he wasn’t at school, delivering groceries and gathering empty glass bottles for a Pepsi-Cola truck driver he befriended. Those odd jobs gave way to work in a bakery and, eventually, entrance to Husson College in Bangor.
It’s at that point in his life where LePage said he wants his memories to begin. Some of LePage’s 17 siblings, meanwhile, traveled a much different path. Some died, others cycled on and off the welfare rolls, and others spent time in jail.
LePage’s formative years gave him a front row seat to the ways that welfare traps people in poverty, so much so that when running for governor in 2010, he made welfare reform a centerpiece of his campaign.
“I was born into this,” LePage told The Daily Signal last year. “I understand it. I come from a family of 18 kids. I watched it my whole life.”
After besting Independent Eliot Cutler in the 2010 gubernatorial race by less than 2 percentage points, LePage and his administration got right to work.
Where LePage is boisterous and blunt, the woman tasked with overseeing the implementation of the governor’s welfare reforms is measured and careful, and spent most of her life as a Democrat. Mary Mayhew, commissioner of the Maine Department of Health and Human Services, has led the agency since LePage selected her to do so 2011. The two share the same goals of reforming the welfare system, but their experiences with the system differ.
While LePage experienced the welfare system first hand, Maine Democrats initially worried Mayhew didn’t have enough experience with welfare programs. Today, Mayhew has no trouble rattling off the figures for how much her agency spent before and after the reforms were implemented, and can cite the drop in TANF caseloads and individuals on food stamps. But what she primarily focuses on is the people whose lives have been changed by moving from welfare to work.
“It isn’t just the first job. It’s the next job,” Mayhew told The Daily Signal. “It’s the momentum from having that self-confidence, that when one believes in their ability, [they have] the drive to succeed. And government will get in the way of that when it builds and creates dependency. It stifles that individual strength when we’ve designed welfare programs that discourage employment.”
“When we focus on an individual’s disability rather than what they’re capable of, we fundamentally take away from that pathway,” she continued.
When Mayhew took over the state’s largest agency, Maine was ranked sixth in the nation for the percentage of its population on food stamps and sixth in the nation for the percentage of its population in the TANF program, according to the Maine Department of Health and Human Services. The state also ranked second for the percentage of its population on Medicaid.
But that’s changed since LePage and Mayhew began enacting reforms to welfare just months after the new administration was in place. In his budget for 2012 and 2013, LePage reinstated the 60-month lifetime cap on eligibility for the TANF program, the program born out of President Bill Clinton’s Personal Responsibility and Opportunity Act. The welfare reform of the mid-1990s initially imposed a five-year limit on eligibility in TANF, but states like Maine waived the time limit for several years. After the 60-month time limit took effect in January 2012, the number of individuals in the TANF program dropped from 36,626 to 23,833 by January of the following year, according to the state. Caseloads continued to fall for the next six years, and by January 2017, there were 10,880 individuals enrolled in TANF.
LePage and Mayhew next turned their attention to the Supplemental Nutrition Assistance Program—food stamps. President Clinton’s 1996 welfare reform required adults without children who were between the ages of 18 and 49 to either work at least 20 hours per week, volunteer six hours per week, or participate in a vocational training program in order to receive food stamps. State officials could ask the federal government to waive the work requirement for childless adults if their state had high unemployment or job shortages, and Maine did just that every year since 2008.
What we all know and appreciate is that a job is more than just the income it generates. It’s the self-esteem it builds, the self-worth, the self-confidence it restores, and what it means in terms of human dignity.
But in July 2014, LePage and Mayhew announced the state would no longer request a waiver for the work requirement for childless adults on food stamps and focus instead of ensuring that those on food stamps had a job.
“What we all know and appreciate is that a job is more than just the income it generates,” Mayhew said. “It’s the self-esteem it builds, the self-worth, the self-confidence it restores, and what it means in terms of human dignity.”
“Strong, independent individuals build strong families and strong communities,” she continued.
Like with participation in TANF, the state saw a decline in enrollment in the food stamp program. After LePage reinstated the work requirement, caseloads for childless adults on food stamps dropped from 13,332 in December 2014 to 2,678 in March 2015, according to the state. By September 2015, that number fell further to 1,886.
According to a February 2016 report from The Heritage Foundation, the drop in food-stamp caseloads of childless adults can, in part, be attributed to off-the-books employment. The study from scholars Robert Rector and Rachel Sheffield noted that by working “hidden jobs,” food stamp recipients didn’t have to report their earnings and could therefore maintain their benefits. But reinstating the work requirement required those recipients to report to welfare offices, which interfered with work. “Faced with a work requirement, many recipients with hidden jobs simply leave the rolls,” Rector and Sheffield wrote last year. “No doubt, a significant part of the rapid caseload decline in Maine involves flushing fraudulent double-dippers out of the welfare system.”
According to an April 2016 report from the Maine Office of Policy and Management, childless adults who left the food stamp program after the work requirement was reinstated saw their incomes grow an average of 114 percent in the year after the policy took effect. For childless adults who continued receiving food stamps and complied with the work requirement, incomes increased 20 percent in the year after it was reinstated.
Childless adults who left the food stamp program after the work requirement was reinstated saw their incomes grow an average of 114 percent in the year after the policy took effect.
Mayhew, who put an emphasis on using data to inform policy decisions when she took the helm of the Maine Department of Health and Human Services, said the information the agency now has proves their reforms were successful.
“We don’t believe that government can be all things to all people,” Mayhew said. “We believe that no one should be dependent on government, and that the best pathway out of poverty is a job, and that government wants to continue to perpetuate its role and function, and we’re trying to reduce the footprint of government in this state to get government out of the way and allow individuals and communities and the state to flourish.”
More Reforms Coming
In addition to reinstating the time limit for TANF and work requirement for childless adults on food stamps, the Department of Health and Human Services began placing photos on Electronic Benefit Transfer (EBT) cards in April 2014. That policy is intended to reduce the fraudulent use of such cards. LePage’s administration also started requiring drug tests for drug felons applying for welfare, and imposed a $5,000 asset test for households without children receiving food stamps, another provision of federal law that was previously waived.
And LePage and Mayhew aren’t done. Earlier this month, Mayhew’s agency asked the federal government for permission to prohibit food stamp recipients from using their benefits to buy soda and candy. The Maine Department of Health and Human Services attempted to do that last year, but the Obama administration denied their request—a move that prompted a fiery response from LePage.
LePage and Mayhew also have a laundry list of policy changes they’re working to codify into state law. Those include asking the legislature to pass bills requiring photos on EBT cards, prohibiting the state from waiving the work requirement for childless adults on food stamps, and further reducing the time limit for TANF from five years to three years.
“What is so critically important for everyone to understand is where Maine started in 2011 as an incredibly entrenched welfare state, where we were leading the country in the percentage of our population enrolled in Medicaid, enrolled in TANF, enrolled in food stamps, and the fact that today, we are in the middle of the pack,” Mayhew said.
Indeed, from 2011 to 2015, Maine fell among the ranking of states with the highest percentage of the population enrolled in Medicaid, food stamps, and TANF. The state now ranks 24th for people on Medicaid, 23rd for people on food stamps, and 25th for people on TANF.
‘It Can Be Done’
Today, Maine’s welfare reforms have been billed as a success. And with Republicans now controlling the White House and both chambers of Congress, a door has opened for GOP lawmakers to look to Maine as a model for what can be accomplished at the federal level.
Support is already building. Sen. Mike Lee (R-Utah), and Rep. Jim Jordan (R-Ohio), introduced legislation last year based on Maine’s reforms and the 1996 welfare reforms. Their bill, called the Welfare Reform and Upward Mobility Act, implements stricter work requirements for childless adults and focuses on helping food stamp recipients with job training and job searches.
Jordan said he plans to introduce the legislation again this year. “We just have way too many policies in place that are disincentivizing work,” Jordan told The Daily Signal. “We want to [and] we should incentivize work. Work is good. It’s one of the things that makes America such a special place—we have this tremendous work ethic.”
Additionally, House Speaker Paul Ryan unveiled his own anti-poverty plan last year that, among other things, would require childless adults participating in the food stamp and TANF programs to work. President Donald Trump, meanwhile, hasn’t formally committed to pursuing welfare reform at the federal level, but at this year’s Conservative Political Action Conference, or CPAC, he hinted that it could be coming.
“It’s time for all Americans to get off of welfare and get back to work,” the president said at the annual gathering of conservatives. “You’re going to love it.”
Republicans in Congress already have a lot they want to accomplish legislatively this year—Obamacare’s repeal, tax reform, securing the border, and passing a budget for 2018. But despite their busy schedule, Jordan said GOP lawmakers still have an appetite for welfare reform.
“It’s just common sense,” he said. “It’s treating taxpayers with respect, and it’s going to help those individuals depending on a government program get to a better position in life.”
Mayhew, on the other hand, is more skeptical about Congress’s ability to get welfare reform across the finish line. “I am concerned that individuals in Congress will still be too consumed with their re-election and not focused enough on the future of this country that depends on having the right decision made today,” she said. “The level of disruptive change that needs to occur cannot be overstated.”
Mayhew said at her own agency, she faced obstacles in the form of both personnel and infrastructure. There was an “entrenched culture” within the bureaucracy, she said, and the technology within the Maine Department of Health and Human Services was antiquated, which initially limited her ability to gather reliable data. But in the six years since LePage and Mayhew took office, the state has invested in a forecasting model to analyze the effectiveness of their reforms.
Mayhew expects President Trump will face many of the obstacles she and LePage did, but on a much grander scale. Still, her message to policymakers in Washington, D.C., is simple.
“It can be done,” she said. “Against all odds, against all odds in Maine, we’ve transformed Maine’s DHHS welfare programs. […] Not only have we done it, but we’re stronger today for having advanced these reforms. We’re stronger economically, we have more plentiful jobs available, we are contributing to a brighter economic future for the individuals and families in this state, and the exact same debate needs to be occurring in
Mayhew expects President Trump will face many of the obstacles she and LePage did, but on a much grander scale. Still, her message to policymakers in Washington, D.C., is simple.
“It can be done,” she said. “Against all odds, against all odds in Maine, we’ve transformed Maine’s DHHS welfare programs. […] Not only have we done it, but we’re stronger today for having advanced these reforms. We’re stronger economically, we have more plentiful jobs available, we are contributing to a brighter economic future for the individuals and families in this state, and the exact same debate needs to be occurring in Washington.”
Ms. Quinn is a senior news reporter for The Daily Signal.
On the morning of May 10 at the Broadmoor Hotel in Colorado Springs, conservative and classical liberal leaders from around the country and the world will convene to discuss ideas and strategies for promoting public policies based on individual liberty and the rule of law. It will be the 40th such gathering of the annual Resource Bank.
The event spans five decades (from 1978 to 2017—or, from the pre-Reagan era to the Trump presidency). Over those years, the panelists and the speakers at Resource Bank have discussed issues aplenty. But more than that, they have presented ideas on how to win battles for liberty. We present here a selection of those ideas. To sum up this amalgam of advice, in order to win battles for liberty, we must: take the fight seriously and expect to sacrifice personally for the cause of liberty; challenge the cultural institutions controlled by the Left; reach people in their daily lives not just on the campaign trail; support liberty-based reforms from wherever they spring; be willing to lose the political battle in order to build the movement for liberty; and appeal to people’s moral instincts with a vision of man as worthy of liberty.
* * *
Politics Is Civil War by Other Means
Remarks delivered April 21, 1988, at the 11th Annual Resource Bank.
[U]p until the [Robert] Bork nomination [to the Supreme Court], all of us failed to appreciate that the Left in this country has come to understand politics as civil war. The Left at its core understands in a way that Grant understood after Shiloh that this is a civil war, that only one side will prevail, and that the other side will be relegated to history. This war has to be fought with the scale and duration and savagery that is only true of civil wars. While we are lucky in this country that our civil wars are fought at the ballot box, not on the battlefield, nonetheless it is a true civil war. So the deliberate, systematic smearing and destruction of Bork was normal. It was precisely what would happen in a civil war. You can expect from here on that the hard Left […] will try by chameleon-like actions to destroy our country. In fact these individuals practice being chameleons; they are who they have to be today in order to be acceptable. But they do not represent American values. The hard Left will systematically root us out and destroy us if they can. We underestimated that, and frankly we underestimated how socially dominant they would be. For instance, there are corporations that insist on funding socialists who then teach their grandchildren to despise them. We also underestimated how dominant and entrenched they would be in academia, the news media, and on Capitol Hill. As a consequence, the Left continues to seize the moral high grounds in policy debates. […]
What must we do to address our problems adequately? First, we must begin to teach the simple model of visions, strategies, projects, and tactics. This is particularly important for those of you who are policy entrepreneurs in your own states. If you do not have a vision to define what you are trying to accomplish, how can you have strategies to accomplish it? If you do not have strategies, how can you possibly assign projects? […] Finally, you have to have tactics. But how can you have tactics unless you know what the vision and strategy are? […]
It is very important to understand this model in order to address issues at an adequate order of magnitude. At what level are we dealing? President Reagan never understood, for example, that the problem of getting the State Department to call Nicaragua a Communist state was a vision-level problem. But if he could not solve that one-word problem, he could not win the struggle for public understanding in America. The President did not understand why the State Department rejected the word: They do not believe the Soviet Union is a Communist country. […] They think of Communism as the strange fantasy of right-wing Neanderthals who occasionally are allowed to occupy the White House. During these periods the State Department believes it is saving the world from the U.S. Because the president could not raise his understanding to the right level, he would just get irritated occasionally about this tactical failing. […]
[L]et me suggest that it does not matter how biased the media is: In the long run it will cover you, because it is in the media’s interest to fill up the paper and air time. Ultimately they will begin to cover your activities. They may not cover you favorably. That does not matter. Bad coverage beats no coverage, and eventually bad coverage leads to better coverage. Hiding from the media because you cannot control what it says never works in America, because the news media is the nervous system of our culture. Sooner or later you will find an audience and you will have communicated with enough people who will like what you are doing despite the bad coverage.
Mr. Gingrich represented Georgia’s 6th Congressional District from 1979 to 1999 and was the Speaker of the House of Representatives from 1995 to 1999.
* * *
Conservative Reforms Happen from the Ground Up
Remarks delivered April 23, 1999, at the 22nd Annual Resource Bank.
I think what historians will most stress when they look back at these closing years of the 20th century is the dramatic public policy reforms in state and local government.
You remember that song from the Woodstock generation: “This is the dawning of the age of Aquarius”? Well this is the dawning of the age of accountability and governors and mayors of both parties are using conservative ideas to have conservative policy achievements that will go down as one of the great domestic policy transformations of this century—as significant as the Progressive Era, the New Deal, the Great Society or the tax cuts and deregulation of the Reagan years.
One of the most dramatic policy victories has been the 50 percent reduction in crime in New York City. Think about that—50 percent reduction in just a few years. This achievement had nothing to do with President Clinton’s pathetic federal program to put more cops on the street. It resulted from conservative ideas and from commonsense police management policies.
Police commissioner Bill Bratton decided to hold police precinct commanders responsible for cutting crime in their precincts and to replace them if they failed to do so. He replaced more than half of the 76 precinct commanders. That’s commonsense, but commonsense is missing in the liberal welfare state. Other cities are now replicating his policies and they’re achieving similar results and guess who benefits the most from this—poor people who now see stores coming back to Harlem, who can now raise money for their schools without getting robbed, who can take the bus home at night.
The liberals said poverty causes crime. It turns out it was crime that caused poverty and as we diminish crime, we are helping lift people out of poverty. […]
I want to share with you very briefly, three concerns I have about the conservative movement that are limiting our effectiveness. The first is our disarray over the war in Kosovo. Thanks to the ineptitude of President Clinton and his disastrous air campaign, foreign policy and defense have once again become central to national debate. But if we conservatives are to persuade the American people that we can manage foreign policy better than the liberals, we need a consensus among ourselves about the first principles of using military force.
My second concern is the sharp decline of conservative, grassroots activism on federal tax and spending questions. Congress and the public hear from the labor unions, the rent seekers, the special interests. They don’t hear as much from the tax-and-spending limitation movement. So, guess which way Congress is voting. And guess why federal taxes as a proportion of national income are at an all-time peace-time high.
Our movement is devoting extraordinary creative energy to building the case for long term, fundamental tax reform and that’s good. But, we also have to push for the spending cuts that can give us tax cuts today.
Finally, I’m not sure we’re doing enough to repair the fabric of American life in communities like Littleton, Colorado, and other towns across the land. This should be conservatism’s cultural moment. We offer the ideas that America needs—marriage, family, religion, personal responsibility, and common decency in the way people treat and talk to each other. This is not primarily the work of public policy; this is primarily the work of civil society. And conservatives are creating successful models of private, voluntary institutions that are repairing our culture: Prison Fellowship, Best Friends, the National Fatherhood
Initiative, Cornerstone Schools, the Marriage Savers Movement, the National Foundation for Teaching Entrepreneurship. You know many others. We’re just not doing this enough.
Mr. Myerson was Vice President of Education Affairs at The Heritage Foundation from 1993 to 2001. Since 2001, he has been the President of the Philanthropy Roundtable.
* * *
Competition Spurs Self-Government
Remarks delivered April 11, 2002, at the 25th Annual Resource Bank.
There are countries where impossible dreams have been achieved. This year, for the first time, a former Communist country has a free economy according to The Heritage Foundation’s annual Index of Economic Freedom. And even more remarkable, it is not only a “free economy,” but one of the freest in the world. This country is called Estonia, and I had the honor to serve two terms as its Prime Minister.
Estonia’s ranking in fourth place in the Index of Economic Freedom makes it Europe’s most free-market-oriented economy. […]
A large number of experts and politicians have asked how we did it. In planning our “jump to nowhere,” we tried to learn from the experiences of other countries that had undertaken a transition from Left-wing socialist utopia to free-market economy.
Some key lessons emerged. One is to take care of politics first and then to proceed with economic reform. Don’t underestimate the importance of a new, modern constitution and democratic legislature with free elections. In some transition countries, the importance of the rule of law has not been understood, and this has been a huge mistake. No kind of general understanding, best effort, or wishful thinking can replace a sound and constantly improving legal environment. There can be no market economy and democracy without laws, clear property rights, and a functioning justice system.
The second lesson is summed up by a well-known advertising slogan: “Just do it.” In other words, be decisive about adopting reforms and stick with them despite the short-term pain they bring. To put it briefly: no pain, no gain. Of course, that is easy to say and hard to do.
The most basic and vital change of all, however, must take place in the minds of people. In the era of socialism, people were not used to thinking for themselves, taking the initiative, or assuming risks. Many people had to be shaken free of the illusion—common in post-Communist countries—that somehow, somebody else was going to come along and solve their problems for them. It was necessary to energize people, to get them moving, to force them to make decisions and take responsibility for these decisions.
To achieve this change, we had to wake up the people. First competition had to be supported. In 1992 Estonia abolished all import tariffs and became one big “free trade zone.” Foreign competition pressed local enterprises to change and restructure their production. At the same time, Estonia stopped all subsidies, support, and cheap loans to enterprises, leaving them with two options—to die or to begin working efficiently. Surprisingly, a lot of them chose the second option.
Mr. Laar was the Prime Minister of Estonia from 1992 to 1994 and from 1999 to 2002.
* * *
In Defeat Lies the Seeds of Victory
Remarks delivered April 30, 2004, at the 27th Annual Resource Bank.
A decade ago, when I first ran for Congress, Republicans dreamed of eliminating the federal Department of Education and returning control of our schools to parents, communities, and states. Ten years later, I took my oath of office in the 107th Congress to join the revolution and they hand me a copy of H.R. 1. One—as in our Republican Congress’s number one priority: the “No Child Left Behind Act,” the largest expansion of the federal Department of Education since it was created by President Jimmy Carter.
In the end, about 30 House conservatives and I fought against the bill and were soundly defeated by our own colleagues. Our Reaganite belief that education was a local function was labeled “far right” by Republicans and the President signed the bill into law with a smiling Ted Kennedy at his side.
Conservatives were told to bear up: This was the exception, not the rule.
And so, relieved to have that experience behind me, I anxiously awaited a new H.R. 1 for a new Congress—an H.R. 1 that I could be proud of. At the onset of the 108th Congress, I was handed another H.R. 1: the Medicare Prescription Drug Bill, the largest new entitlement since 1965.
To the frozen man it was obvious. Another Congress. Another H.R. 1. Another example of the ship of our movement veering off course.
Actually, this bill started out promising. The President asked Congress for a very limited program: extending existing welfare benefits to seniors just above the poverty level—where most of the one-in-four seniors without prescription drug coverage reside.
Many conservatives, myself included, were prepared to support this limited benefit. I told the President that we shouldn’t make seniors choose between food, rent, and prescription drugs. We were a better country than that.
Yet instead of giving the President the limited benefit he requested, Congress set sail to create the largest new entitlement since 1965—a massive one-size-fits-all entitlement that would place trillions in obligations on our children and grandchildren without giving any thought about how to pay for it.
Conservatives in the House were faced with a difficult choice: Oppose the president we love or support the expansion of the big government we hate.
In the end—with the stalwart support of The Heritage Foundation and its courageous president—25 rebels decided to make a stand for the principle of limited government.
It is said, “In fire gold is tested,” and so it is. While much has been made of the pressure that my colleagues and I endured, we also witnessed the unprecedented pressure placed on The Heritage Foundation and its president to conform to the majority’s will. Instead of capitulating, Ed Feulner, Stuart Butler, and The Heritage Foundation confirmed the confidence of tens of thousands of their supporters over the decades by standing firm.
When all the votes were counted, we were one rebel short. In the end the bill passed. The welfare state expanded. And the ship of conservative government veered off course. […]
However, as recent developments suggest, I will always believe that the stand we took mattered—even in defeat. Sometimes a small group of people can take a stand, be defeated, and still make a difference.
In 1836, less than 200 men fought against thousands of Mexican forces to defend an ancient Christian mission on the plains of Texas. Though they died to the last man, the Texas volunteers within those missionary walls exacted such a horrific toll on the army of Santa Anna that Colonel Juan Almonte privately noted; “One more such glorious victory and we are finished.”
And so they were. The inspiration of the men who made their stand at the Alamo fueled the victory that Sam Houston would lead just six weeks later.
“One more such glorious victory and we are finished.” One more big-government education bill … one more new government entitlement … one more compromise of who we are as limited-government Republicans and our majority could be finished.
What then is the state of the movement? It is strong on the advance, but veering off course from our commitment to limited government.
The time has come for conservatives to retake the helm of this movement and renew our commitment to fiscal discipline and to what we know to be true about the nature of government: Conservatives know that government that governs least governs best. Conservatives know that as government expands, freedom contracts. Conservatives know that government should never do for a man what he can and should do for himself.
Mr. Pence represented Indiana’s 6th Congressional District from 2003 to 2013, was Governor of Indiana from 2013 to 2017, and is currently Vice President of the United States.
* * *
Freedom Withers Unless We Sustain a Moral Vision of Man
Remarks delivered April 24, 2008, at the 31st Annual Resource Bank.
The proper response to human need is neither the welfare state nor the Randian sneer, but a reverence for the human person. To confront such needs requires a full sense of that majestic dignity that each of us bear in our nature, as well as a good grasp of the truths contained within economics. The principle of subsidiarity aids us in limiting the power of the state, precisely in reverence for people.
This principle says that human needs are best met at their most local level where people can act as neighbors to people in need. It says that government assistance should normally occur in cases of emergency, and even then it must be limited both in depth and duration. It must never be a substitute for the private institutions that bear the prime responsibility for helping the poor to raise themselves out of poverty. To politicize charity—as I’m afraid the Bush administration’s faith-based initiatives have done in using tax money to enable alleged good works—disregards the passion and the power of people working in their local congregations, in their local municipalities and neighborhoods, and even discourages those authentic efforts. It is these very efforts that are critical to the creation of a harmonious, prosperous, and caring society. To set up a mechanism whereby the best private and religious charities end up becoming beholden to politicians is to forget that one day it may not be George Bush that they’re beholden to, but it may be a President Obama or a President Clinton. […]
In a trenchant analysis of the free society, Friedrich Hayek offered the following sobering speculation: “It may be that as free a society as we have known it carries within itself the forces of its own destruction, that once freedom is achieved it is taken for granted and ceases to be valued.” Hayek then asked: “Does this mean that freedom is valued only when it is lost, that the world must everywhere go through a dark phase of socialist totalitarianism before the forces of freedom can gather strength anew?” The answer is, says Hayek, “It may be so, but I hope it need not be.”
For a deed of moral courage on behalf of human liberty? We will be able to raise a vast army.
Hayek offers what I consider a partial remedy. He says:“If we are to avoid such a development, we must be able to offer a new liberal program which appeals to the imagination. We must make the building of a free society once more an intellectual adventure, a deed of courage.” He is right of course. But I would add something which I think Hayek would certainly agree with. We must make the re-building of the free society a moral adventure as well. For its construction was morally inspired in the first place. It emerged from a particular moral vision of man and his inherent and transcendent dignity.
In an essay, “The Weight of Glory,” C. S. Lewis memorably describes the anthropology that I’ve attempted to outline tonight. He says, “You have never talked to a mere mortal. Nations, cultures, arts, civilizations—these are mortal, and their life is to ours as the life of a gnat. But it is immortals whom we joke with, work with, marry, snub, and exploit—immortal horrors or everlasting splendors.”
By all means, let us go about the critical task of demonstrating the hows and the whys and the utility of economic freedom. But in doing so, let us remember one thing: People will never go to the barricade for a point of utility. But for a moral adventure? For a deed of moral courage on behalf of human liberty? We will be able to raise a vast army.
Rev. Sirico is Founder and President of the Acton Institute for the Study of Religion and Liberty.
The late Peter Schramm once wrote: “In America, each generation has to be educated in our principles of right, the natural rights that stem from those principles, and about our constitutional soul, which gives these rights their functional order. […] In this unique country—this novus ordo seclorum—citizens have to be made because it is not enough that they be born.”
While some surveys show post-millennials to be more libertarian than other generations, many of these young adults are or will soon be encountering a system of higher education that is beset with strikingly illiberal trends. America’s universities have long been a hive of multiculturalists who want students to believe there is nothing special about America worth learning. And now there is a student reform movement that demands safe spaces, trigger warnings, the checking of (others’) “privileges,” the right to shout down and shut down speakers they dislike, and limits on the free speech of students themselves. In short, they want to be given rights that cannot exist in a free society—because they want to be protected from a free society.
Too many university administrators, meanwhile, would rather avoid the sensitivity mob (and perhaps gain new powers as the arbiters of acceptable thought) than defend the university as a place of open inquiry. In short, higher education is training students not to be engaged citizens but servile subjects. So we ask: What can be done to better transmit the ideas of a free society to the younger generations?
* * *
We can draw up a list of great and good works designed to explain the fundamentals of a free society to the young. Unfortunately, this is no longer enough. The very structures of our education system have been turned against liberty, and so the solution must be structural as well.
The very structures of our education system have been turned against liberty, and so the solution must be structural as well.
The College Board has taken advantage of its near monopoly over advanced placement testing to force a distorted and Left-biased version of American and Western history upon the next generation. The remedy to this is an open market in college placement testing, where competing companies can turn to traditional and conservative scholars to devise alternative curricula for states and school districts.
By promulgating speech codes, disinviting speakers, and confining free speech to narrow and highly regulated “zones,” many university administrators have become hostile to free speech. Too often these administrators are unable or unwilling to enforce discipline upon students who interfere with the expressive rights of visiting speakers, or with the rights of their fellow students to listen to those speakers. Faculty once kept weak-kneed administrators honest, but a powerful plurality of faculty members has now turned against the classic liberal vision upon which freedom of speech is based. Boards of trustees are generally too timid to assert themselves against administrative abuses of free speech.
The remedy for all this is state-level legislation that would re-establish the priority of free speech at public university systems, ban speech codes and narrow “free speech zones,” discourage speaker disinvitations, create a discipline policy for students who interfere with the expressive rights of others, and establish trustee-run oversight systems that would subject the administrative handling of free speech to public scrutiny. This legislation would apply to public university systems, which are already under the jurisdiction of the First Amendment, even if the place of free speech on those campuses has been neglected or abandoned.
Private universities should be informed that their receipt of federal aid will henceforth be conditioned on their willingness to protect freedom of speech. Through an amendment to the Higher Education Act, due for reauthorization this year, federal aid can be structured to achieve most of what legislatures can mandate for public universities under state-level free-speech legislation.
Finally, trustees, administrators, alumni, and the general public should start a movement to make John Stuart Mill’s classic brief for liberty of thought and discussion, On Liberty, the mandated “common reading” for entering freshmen. Common readings assigned to all entering freshman are now found at most colleges. These readings are not classroom assignments but come from the university as a whole. So it is entirely appropriate for trustees to require that instead of the ephemeral ideological tracts generally given as summer readings to incoming students, a classic defense of free speech should be assigned instead.
These steps would be only the beginnings of an effort to reclaim the American academy for the classic conceptions of liberty that have heretofore served as its proper foundation. Yet a very significant beginning they would be.
Mr. Kurtz is a senior fellow at the Ethics and Public Policy Center.
* * *
A crucial step in the spreading of the ideas of a free society to younger generations is to first open their often-closed minds. The recent, shocking mob at Middlebury College that not only prevented scholar Charles Murray from giving a talk on his latest book, but also led to violence that injured the professor who had introduced him shows the depth of the problem.
A great many young Americans have been taught that it is actually bad to listen respectfully to any ideas that run counter to the “progressive” beliefs they have been imbued with. It is common to hear these students declare that such ideas must never be heard and should be opposed by any and all means. This shows a grave educational failure—but also an opportunity.
All of us who cherish a free society and fundamental civility should press college leaders to make at least a short seminar on the importance of intellectual freedom and rational discussion a part of the curriculum. Students must learn that there can be no progress in society if some people can use force to silence those who challenge the conventional wisdom about anything. They should be taught that their own freedom of speech and that of everyone else depends on tolerance and mutual respect. They should have to read and discuss John Stuart Mill’s On Liberty.
Of course, students must be told that if they disrupt free speech, they will be subject to punishments up to expulsion, but that isn’t enough. We must do all we can to eliminate the root causes of intolerance, which is the belief among many Leftists (students and otherwise) that they have a monopoly on truth and righteousness. Once that has been reduced or eliminated, the ideas of the free and truly liberal society will spread.
Mr. Leef is Director of Research at the James G. Martin Center for Academic Renewal.
* * *
Young people do not look with awe or a sense of wonder at an iPhone, a computer, or the incredible medical miracles happening every day. But they should. Our tremendous material wealth; extended life expectancy; falling infant mortality; and even our enjoyment of arts, culture, sports, and recreation are brought to us by freedom and the free market system.
To ensure that the rising generation appreciates our free enterprise system, I offer several recommendations.
Teach economics in high school and college. According to the Council for Economic Education, only 20 states currently require high school students to take a course in economics. That is less than half of the country and two fewer states than in 2014. The American Council of Trustees and Alumni reports that only 3 percent of colleges and universities require economics. Yet economics affects virtually every aspect of life, from personal finance and public policy to international affairs and culture.
Improve the teaching of economics. Emphasis in an economics course should be on the way the world works, not simply on graphs and equations that are easy to test but difficult to relate to human behavior. The economic way of thinking, if taught right, can be applied to nearly all aspects of life. Therefore, the best economics is taught by doing economics, not talking about it. A variety of games and activities can be used to teach how trade creates wealth and why property rights are essential to prosperity. Economics should not be taught as “the dismal science,” but as a remarkable study of how prices coordinate the activities of millions of strangers from diverse backgrounds to produce mutual gain.
Support and send young people to “the alternative university.” There are many outstanding conservative and libertarian organizations that offer seminars, conferences, and academic programs that present ideas missing in college classrooms, including the one I lead. Young people must take advantage of this “alternative university.” Doing so will not only inoculate students so they are less prone to the propagandizing taking place in most classrooms, but it will connect them to a network of peers who share their ideas and values. Because these conservative and libertarian organizations are vastly outspent by the Left, donors should be generous in their support of organizations working with young people.
Read important articles and foundational books. At the risk of neglecting many outstanding contributions, I will suggest a few:
“I, Pencil” by Leonard Read, Economics in One Lesson by Henry Hazlitt, The Law by Frederic Bastiat, the novel Atlas Shrugged by Ayn Rand, The Federalist Papers, and Friedrich Hayek’s The Road to Serfdom. There are dozens and dozens of other classics out there. Choose ones that are age- appropriate and cover the range of concerns to those who favor freedom and free markets.
Author Jonah Goldberg has observed that “capitalism is the greatest collective enterprise in the history of humanity. It is the most successful cooperative endeavor ever undertaken. It has just one flaw. It doesn’t feel like it.” Freedom and free markets allow billions of people in this world to pursue their interests and improve their living standards without interference from elites who think they can plan a better life for them. We should celebrate that and teach the next generation why they should too.
Mr. Ream is the President of the Fund for American Studies.
* * *
Karin Agness Lips:
We can’t depend on universities to educate the next generation of leaders on basic civics. A 2015 study found that 46 percent of college graduates don’t know the term lengths for members of Congress and one-third of college graduates can’t identify the Bill of Rights as a name given to a group of constitutional amendments. It is necessary for conservative groups to fill this vacuum with programs to educate the next generation of leaders on our Constitution.
We must engage with the next generation of leaders now, meeting and connecting with them where they spend their time.
We must engage with the next generation of leaders now, meeting and connecting with them where they spend their time. For example, having an active presence on social media is important. And not just on Facebook, but staying updated on whatever is the most popular platform. Earlier this year, my organization, the Network of enlightened Women, launched a social media campaign across various platforms, #ShesConservative, encouraging conservative college women to share with the hashtag #ShesConservative why they self-identify as conservative. Through this initiative, these women became spokeswomen for limited government and freedom. This was an effective way to meet our audience of college women where they are on social media and give them an opportunity to be part of the conversation.
Ms. Lips is the Founder of the Network of enlightened Women (NeW).
* * *
Alan Charles Kors:
A “cultural” Left that loathes the American experience—the steady advance of equal justice under law in a society of individual responsibility, economic freedom, and limited government—now commands our Ed Schools, K-12 education, so-called “higher” education, and the children’s media. These closed-shop political fiefdoms deliberately are failing utterly to communicate the values of individual rights, critical mind, and actual, comparative historical understanding to the rising generation. The greatest scene of human liberation and mobility in human history is presented to its children as a caste system.
Conservative philanthropy seems to believe that a chair or two in Economics will suffice to end a juggernaut of closed-minded indoctrination across the board. It won’t. There are only two options. One: End the subsidies of taxpayer support for those who teach contempt for the taxpayers themselves; impose an end to political litmus tests where public educational hiring is involved; give parents educational choice; and found alternative institutions that combat the toxic trash at all levels. In short, fight back with courage, economic resources, real toleration, intellectual rigor, and moral will against those who would destroy our civilization. Two: Give up the fight and enjoy the waning days, betraying our absolute obligation to pass on the freedom and dignity of America to the next generation. There is no middle-ground.
Mr. Kors is the Henry Charles Lea Professor of History at the University of Pennsylvania.
Americans love the free market, even if they don’t realize it. From our coffee to our cars to our work environments, we demand choice and the ability to personalize. Give them options and they will choose; more is always better.
When individuals are empowered to prefer a specific beverage, mode of transportation, or quality of life, it not only makes products better but it makes us happier.
We are watching this principle come to life in the health care debate—members of Congress who are fighting to preserve ObamaCare do so in the name of choice, while members who are fighting to “repeal and replace” are also doing so in the name of choice. The difference lies in who chooses—the government or you.
This is the heart of the argument, not only for politicians on Capitol Hill but for all of us as we talk to coworkers, neighbors, family, friends. Health care matters to everyone, and the decisions made in D.C. affect us for better or worse. If you believe the best health care policy is created by the free market, now’s the time to talk about it.
You may be hesitant given the accusations and myths on repeat in the news cycle, but we have the opportunity to make positive changes to bad policy. Let’s seize the moment and set the record straight.
To make the case for free market health care, show how the free market delivers more choice, lower costs, and better care.
The Free Market Produces More Choice
Both sides of the health care debate lean on choice. The train comes off the tracks when we talk about who chooses, especially when we defend our position with fancy words and phrases like “capitalism” and the “free market.” Both lead to good reform, but it’s best to use less controversial words for the sake of persuasion. Instead, support your argument with a simple word: “choice.”
The common ground you’ll establish at the beginning of the conversation is that we want everyone to have access to quality, affordable health care. You might think this goes without saying, but you’d be wrong. Say it, and say it first. Doing so makes you seem reasonable and not radical.
Once you establish common ground, continue the discussion by acknowledging the choice problem created by Obamacare.
Problem: For the past seven years, the government has been given the power to choose, and it’s safe to say they’ve chosen poorly. The American people have:
- Lost their doctors. Insurers have responded to the cost pressures created by Obamacare’s insurance regulations by negotiating lower reimbursement rates with providers. Some doctors have refused to accept those lower rates, which forces their patients in those plans to find a new doctor.
- Lost their insurance. According to an Associated Press tally across 30 states, there were 4.7 million cancelled policies in 2014, the first year Obamacare was fully implemented.
- Lost their options. Heritage Foundation analysts Aylene Senger and Edmund Haislemaier have found that 70 percent of U.S. counties will have only one or two insurers in 2017. That figure is up from just 36 percent last year.
Merely stating the problem isn’t enough, though. People crave solutions. Once you highlight the problem that most resonates with the person you’re talking to, give them hope via a solution or two.
Solution: Here’s how the free market can do it better!
For example, a one-size-fits-all model doesn’t work. Asking someone to pay for something they don’t want or need is unfair, so let’s get rid of mandates that force services on patients. Men shouldn’t pay for OBGYN coverage, young people should be able to choose catastrophic rather than comprehensive plans, and those who disagree with abortion and/or gender reassignment procedures shouldn’t have to purchase a plan that includes either.
If you want to put “care” back into “health care,” spread the message that doing so begins with you—every person, regardless of income level or pre-existing conditions, should be empowered to choose a plan that works for him or her.
The Free Market Lowers Costs
Once you establish why and how the free market allows for more choice, now’s your chance to prove that more choice inevitably leads to lower costs. Thank you, competition.
Again, start with common ground—we want all people to have access to quality, affordable health care. Then move to talk about the cost problem created by Obamacare.
Problem: For the past seven years, Obamacare has removed choice from the equation and we’ve watched prices skyrocket. According to a report by the Department of Health and Human Services, premiums will increase by a shocking average of 25 percent in 2017.
- Because government oversight often means government intervention in the form of restrictive policies, taxes, and regulations. As a result, insurance companies dropped out of the market because they don’t want to (or can’t) comply.
- Because Obamacare funneled more and more people—many able-bodied who could buy insurance on their own—into an unsustainable entitlement system (Medicaid), and taxpayers were asked to pick up the tab.
- Because the government banked on more people paying into the system. Young, healthy people have chosen to pay the cheaper penalty rather than enroll in an expensive Obamacare plan, which means the exchanges are covering more older, sicker patients who cost more money.
It’s ironic the Democrats named their government takeover of health care the Affordable Care Act.
Take your pick of examples that show why costs have soared and then talk about solutions.
Solution: Increased choice, not a one-size-fits-all model, leads to lower costs. It’s a win-win! Here’s an example to illustrate:
We’ve already established that the patient knows best what coverage he/she needs, so he/she should be given the power to choose. And choice drives down costs because of competition.
When price-competition is allowed among providers in different states, it enables insurance companies to promote coverage for the best service at the lowest possible price. If provider A knows that provider B offers better coverage at a lower rate for one segment of the population, provider A is forced to do the same or risk losing business.
Competition is a good thing, and works in the best interest of the consumer. If we appreciate competition between car dealerships when shopping for a new car, or competition between car insurance providers when shopping for car insurance, let’s apply this principle to health care—one of the most personal decisions we’ll ever make.
The Free Market Provides Better Care
Now for a challenge: At this point the conversation will inevitably turn to those with pre-existing conditions or low-income individuals.
These are reasonable concerns, but remember the common ground: All people should have access to quality, affordable health care.
Unfortunately, Obamacare made a bad situation worse. The health care system we had prior to 2010 was in need of free-market reform, but the reform we got didn’t address (in a sustainable way) people with pre-existing conditions and the albatross that is Medicaid.
In this conversation, you have two areas of common ground to use: All people should have access to quality, affordable health care and the need for reform prior to 2010. Then move to address the current problem.
Problem: Coverage is not care.
Government programs are invariably designed to get people “covered”—and thus secure their votes—at the lowest cost to the government. But as Medicaid roles expanded, care decreased.
As able-bodied adults were added to the roles (think: 27-year-old adult who can work but struggles to afford health care), the number of patients per doctor increased resulting in longer wait times and more tax payer funds. The people Medicaid is supposed to help aren’t being helped and are actually being hurt.
Solution: Free-market solutions lead to better care for all, especially the most vulnerable.
- Don’t penalize people for changing/losing their job. Congress got it right when they put in protections for people with pre-existing conditions, but when they passed those reforms, they failed to extend them to the individual market. All it takes is for Congress to extend those same protections to people buying insurance on their own. So when people move jobs, they take their coverage with them. If someone with a pre-existing condition has been paying for insurance since day one, they shouldn’t be penalized if they decide to switch jobs.
- Keep Medicaid for those who truly need it. A federal safety net should exist, but it should be only for those who truly need it. For others who are struggling to afford health care (remember, it’s more affordable when competition is present) let’s invite states to set up premium support programs as well which results in more choice at a lower cost.
- Innovation saves lives. Better care also looks a lot like innovation, because innovation leads to treatment and prevention. When government gets involved, costs go up and innovation goes down.
Take the Human Genome Project for example. As science was trying to find a way to sequence DNA and map human genes in the 1980s, the government tasked the National Institute of Health with the project in 1984. Thirteen years and almost $3 billion later, they were finished.
Around the same time, a private company, Celera Genomics, tackled DNA sequencing on its own. The result? They finished three years before the government did and for a fraction of the cost—10 times less to be exact ($300 million vs. $3 billion).
The free market can provide faster breakthroughs in science that can lead to better care for everyone.
This is just one of many examples where the free market can provide faster breakthroughs in science that can lead to better care for everyone.
The one positive result of Obamacare? Its failure is making the best case for a free market approach. Obamacare removed choice and increased cost; the free market allows us to choose what we want when we want it in order to increase our options and lower costs. Sign me up!
If my coffee order isn’t one-size-fits-all, I don’t want my health care coverage to be either.
Ms. Hallberg is a visiting fellow at The Heritage Foundation and President of District Media Group.
Defeating ISIS and bringing peace to Syria will require something that doesn’t yet exist: a non-Islamist, non-Russian-backed force that can fight effectively. Creating one, writes James Philips, will be a diplomatic challenge:
Washington has few reliable allies inside Syria. Syrian Kurdish militias tied to the Kurdistan Workers’ Party (PKK) are an effective military force, but close cooperation with them complicates relations with Turkey. Ankara has been fighting the PKK, which has been designated as a terrorist group by both the U.S. and the European Union, off and on since 1984. The Trump Administration should end U.S. support for Syrian Kurdish militias linked to the PKK. To stabilize Syria in the long run, Washington and Ankara must agree on which groups to support and cooperate closely in providing that support.
Non-Islamist rebel groups in northern Syria have been weakened by defections, in part due to a lack of external support, as Turkey threw its support behind the Muslim Brotherhood and Saudi Arabia and Qatar favored even more radical Salafist groups. But in southern Syria, the Southern Front, a coalition of secular, moderate, and tribal militias supported by Jordan, France, and the U.S., may be more reliable allies, particularly in securing the Jordanian border and preventing ISIS infiltration.
Washington should press Turkey, other NATO allies, Saudi Arabia, and other Gulf allies to contribute significant ground troops and special operations forces to defeat ISIS on the ground inside Syria. The U.S. could provide advisers, air support, logistical support, airlift, intelligence, surveillance, search and rescue support, and other enablers. Meanwhile, the U.S. should reassess its aid program for Syrian rebels and continue aid only to non-Islamist groups willing and able to fight ISIS effectively. It must also do a better job of vetting them to prevent arms from falling into the wrong hands. […]
Neither Russia nor Iran is a useful ally against ISIS and both actively undermine U.S. national interests and allies. Russia has paid lip service to the fight against ISIS, but has launched most of its air strikes against other rebel groups, including some supported by the U.S. Siding with Russia, which has been accused of committing war crimes in Syria, would discredit the U.S. in the eyes of most Syrians and many Sunni Arabs outside of Syria. The Trump Administration should not repeat either its predecessor’s overestimation of Moscow’s willingness to cooperate in Syria or its underestimation of Moscow’s interest in undermining U.S. influence in the Middle East.
Although most attention has been focused on Russia’s air campaign, Iran and its surrogates have spearheaded most of the Assad regime’s ground offensives. Tehran’s sectarian policies have made a bad situation worse by fueling Sunni Arab support for ISIS in Syria as well as in Iraq. In the long run, Iran poses a much greater threat than ISIS or al-Qaeda. […]
Some of America’s Arab allies have supported Sunni extremist groups against the Assad regime and Iran, which they view as their greatest enemy. Kuwait, Qatar, and Saudi Arabia continue to turn a blind eye to the activities of fundraisers for Islamist extremist groups seeking donations from private individuals in their kingdoms. The U.S. should press all of its allies to crack down on the flow of such funds and insist that rebel groups they support break all ties with [Jabhat Fateh al-Sham]. Washington also should ask its allies to deploy more military forces to attack ISIS and provide greater aid for Syrian refugees.
[James Phillips, “How President Trump Can Improve U.S. Syria Policy,” The Heritage Foundation, March 3]
* * *
There’s no excuse for Congress not to roll back the regulatory state. Over the years, Congress has given administrative agencies a lot of power to determine national policy. Typically, Congress passes laws that set forth a broad goal while letting the agencies fill in the details with the regulations they write. Under this set-up, if agencies write rules that are too costly relative to any benefits, Congress gets to blame the bureaucrats for whom nobody voted. It turns out that Congress can reclaim its authority over—and accountability for—the regulatory state without rewriting all the laws that created it. Paul Larkin Jr. explains how:
Passed into law in 1996, the Congressional Review Act allows Congress to invalidate an agency rule by passing a joint resolution of disapproval, not subject to a Senate filibuster, that the president signs into law. Under the Congressional Review Act, Congress is given 60 legislative days to disapprove a rule and receive the president’s signature, after which the rule goes into effect. But the review act also sets forth a specific procedure for submitting new rules to Congress that executive agencies must carefully follow. If they fail to follow these specific steps, Congress can vote to disapprove the rule even if it has long been accepted as part of the Federal Register. In other words, if the agency failed to follow its obligations under the Congressional Review Act, the 60-day legislative window never officially started, and the rule remains subject to congressional disapproval. The legal basis for this becomes clear when we read the text of the Congressional Review Act. According to the statute, the period that Congress has to review a rule does not commence until the later of two events: either (1) the date when an agency publishes the rule in the Federal Register, or (2) the date when the agency submits the rule to Congress. This means that if a currently published rule was never submitted to Congress, then the nonexistent “submission” qualifies as “the later” event, and the rule remains subject to congressional review. This places dozens of rules going back to 1996 in the congressional crosshairs.
[Paul J. Larkin Jr., “This Little-Used Tool Could Help Congress Undo Years of Government Overreach,” The Daily Signal, February 14]
If the regulatory state is the Death Star, then the Congressional Review Act might be its thermal exhaust port.
* * *
Yes, we can balance the federal budget. It’s as simple as holding the growth in expenditures below the growth in the economy, says Daniel Mitchell:
Under current law, tax revenues over the next 10 years are projected to grow by an average of 4.2 percent each year.
If left on autopilot, the burden of government spending will rise by an average of 5.2 percent each year.
If that happens, the federal budget will consume 23.4 percent of economic output in 2027 compared to 20.7 percent of GDP in 2017.
Under that do-nothing scenario, the budget deficits jumps to $1.4 trillion by 2027.
But what happens if there is a modest bit of spending restraint? What if politicians decide to comply with my Golden Rule and limit how fast the budget grows every year? […]
[I]f GOPers actually decide to do the right thing, the grim numbers in the CBO’s new report quickly turn positive.
If spending is frozen at 2017 levels, there’s a budget surplus by 2021.
If spending is allowed to grow 1 percent annually, there’s a budget surplus by 2022.
If spending is allowed to grow 2 percent annually, there’s a budget surplus by 2025.
If spending is allowed to grow 2.63 percent annually, the budget is balanced in 10 years.
If spending is allowed to grow 2.63 percent annually, the budget is balanced in 10 years.
With 2.63 percent spending growth, the burden of government spending drops to 18.4 percent of GDP by 2027.
[Daniel J. Mitchell, “New CBO Numbers and the Simple Formula for Good Fiscal Policy, Part I,” Cato Institute, January 25]
* * *
Where did the campus safe space culture come from, anyway? Mitch Pearlstein finds a clue in the work of Neil Gilbert, the Milton and Gertrude Chernin Professor of Social Welfare and Social Services at the University of California, Berkeley. Pearlstein sums up Gilbert’s argument in his article “Institutionalized Discontent,” (Society, August 2016) this way:
“Over the last several decades federal regulations and funds have created an alternative bureaucracy within universities that is devoted not to the core academic mission of teaching and research, but to improving the social climate of university life.” The “legitimacy and power” of this new bureaucracy, he writes, “depend on heightening the perception that academic life involves a dangerous environment, from which students need protection.” This perceived need, he continues, has led to campaigns for “safe spaces”; efforts to help students “recognize micro aggressions”; educating and training them in “sexual assault prevention”; and demanding faculty participation in “sensitivity training.” Among other rote requirements.
How big is this new bureaucracy? Neil reports that between 2000 and 2015, “the number of full-time, ladder-rank teaching faculty at Berkeley increased by 1%, while the number of full-time staff providing student services and health care increased by more than 100%, at which point they outnumbered the teaching faculty by 13%.”
[Mitch Pearlstein, “Political Correctness and Alternative Bureaucracies,” Center of the American Experiment, March 24]
* * *
Thieves keep better books. If the police suspect that your property has been used to commit a crime, they can typically seize it through civil asset forfeiture. They don’t have to charge you with a crime; they don’t even have to suspect that you’ve committed a crime. They merely have to suspect that somebody has committed a crime with your property. The way it works is that you have to prove your property is innocent in order to get it back. A variety of conservative and libertarian organizations argue that the practice violates property rights and have been working to convince legislators to eliminate it. Increasing the challenge of holding law enforcement agencies accountable for their use of the practice is the paltry state of official records tracking the practice and the property seized. Angela C. Erickson, Jennifer McDonald, and Mindy Menjou write:
[Thirteen states] do not appear to require any form of property tracking, leaving in doubt even such basic questions as what was seized and how much it was worth, who seized it, when it was seized, where it was seized, and why it was seized. Without such information, agencies may have trouble tracking what they have, returning property to rightful owners, and meeting legal deadlines and obligations. […] [A]gencies in just 11 states, as well as the [Department of Justice], record whether forfeitures happen under civil or criminal procedures, and only six states track whether an individual whose property was seized was ever charged with a crime. Just three states and the DOJ record who, if anyone, filed a claim to retrieve seized property. […]
[Thirty-two states require] no reporting at all on how agencies use forfeiture proceeds. […]
Nearly half of states do not produce statewide [forfeiture] reports at all […] . And most of the remaining states produce reports that are missing critical information. In particular, too few states—just 17—and the U.S. Department of Justice provide agency-level data, and only eight states and the U.S. departments of Justice and the Treasury include data about expenditures. […]
Nineteen states keep agency-level forfeiture records but neither publish them online nor officially declare them public records, meaning that records may be difficult to identify—and that law enforcement agencies may try to deny freedom-of-information requests for their release. […]
[Thirty-five] states never require financial audits of agency forfeiture accounts […] .
Currently, only six states and the U.S. departments of Justice and the Treasury [require] annual independent financial audits of forfeiture accounts—the gold standard for ensuring that audits are regular and timely, and for avoiding conflicts of interest.
[Angela C. Erickson, Jennifer McDonald, and Mindy Menjou, “Forfeiture Transparency & Accountability: State-by-State and Federal Report Cards,” Institute for Justice, January 16.]