Support for Trump’s Medicaid Proposal


Last week I discussed President Trump’s plans to improve Medicaid (Trump Improving Medicaid). His administration has proposed offering states block grants to design their own plans to improve Medicaid efficiency and control costs so that those who need Medicaid the most will get the treatment they need.

Support for this program comes now from an unexpected place. Insurance industry analyst, Robert Laszewski, says those who support ObamaCare should support Trump’s proposal.

Laszewski is a strong supporter of Medicaid expansion, if not the failed provisions of ObamaCare. He believes Republicans should expand Medicaid eligibility in all states as ObamaCare permits.

The Trump proposal would enable states to choose to accept either a single annual lump-sum payment, or a lump-sum payment based on the number of able-bodied adults in that state’s Medicaid program. The proposed block grant program would not apply to people traditionally eligible for Medicaid such as pregnant women, poor children, and the disabled.

Currently 36 states have expanded Medicaid eligibility under the ObamaCare rules. That means anyone, even able-bodied adults, earning 138% of the Federal Poverty Level (FPL) or less is eligible. States get reimbursed 90% of their costs from the federal government on these patients, but less on those eligible by the old guidelines.

This expansion of Medicaid eligibility has produced much higher usage of Medicaid by this newly eligible population than those previously enrolled; 16 times higher according to some studies. The result of these higher than expected costs has been tremendous strain on state budgets. The Trump proposal is designed to address this situation.

There is wide variation in the eligibility of Medicaid enrollees in those 14 states that have not expanded Medicaid. The graphic below shows this variation:

Wisconsin has created its own Medicaid expansion apart from ObamaCare by allowing anyone earning up to 100% of FPL to be eligible, but not accepting the ObamaCare rules that permit up to 138% of FPL.

Critics of the new Trump proposal argue that by fixing funds for Medicaid at a growth rate lower than paid in the past will result in less money and therefore fewer benefits and fewer people covered. Laszewski calls out these critics: “In my mind, the people that are opposing the Trump administration’s block grant proposals are letting their ideology stand in the way of millions of people becoming eligible for substantial, if not optimal, Medicaid benefits.”

If you favor expanded Medicaid eligibility to all 50 states, you should favor the Trump proposal.

School Choice – The Key to the American Dream


We hear a lot in the media lately about injustice and inequality in our country. People are protesting for fair and equal treatment of blacks and other people of color. They are calling for reparations that will somehow make up for the sins of our forefathers and give blacks a better chance to achieve the American dream.

Why aren’t these same people protesting for school choice?

Education is the key to escaping poverty. There is no argument on this point. Without an education, there is no future. Without an education there is no American dream. Yet the same people who tell us we aren’t “woke” enough to understand the plight of the African-Americans in this country, oppose school choice.

Thomas Sowell is a black economist and senior fellow at Stanford University’s Hoover Institution who has a new book coming out called Charter Schools and Their Enemies. In a recent Op-ed in The Wall Street Journal, he extolls the virtues of charter schools. In particular, he holds up the example of The Success Academy of New York City. Sowell writes, “Their predominantly black and Hispanic students already pass tests in mathematics and English at a higher rate than any school district in the entire state. That includes predominantly white and Asian school districts where parental income is some multiple of what it is among Success Academy students.

There has long been an accepted educational dogma that blacks and Hispanics from low-income neighborhoods can’t compete with higher-income whites. But charter schools are proving this dogma incorrect. Given the choice to attend these schools, blacks and Hispanic students from these low-income neighborhoods are succeeding.

Why do Democrats and civil rights leaders oppose charter schools and school choice?

Sowell explains: “The success of New York City’s charter schools is not only a threat to educational dogmas. Competition from charter schools is an existential threat to traditional public schools in low-income minority communities, which tend to have even lower educational outcomes than traditional public schools as a whole.”

Not only are these low-income minority children in charter schools outperforming the public schools, they’re doing it in the same buildings! In 28 classes in these buildings, fewer than 10% of the students reached the “proficient” level on statewide tests. All 28 classes were in traditional public schools. All charter school classes at the same grade levels in the same buildings did better– including six grade levels where the charter school majorities reaching the “proficient” level ranged from 81% to 100%.

The opponents of charter schools and school choice insist that charter schools “skim the cream” of students, leaving the public schools worse off. This seems plausible – until you understand that admission to New York City charter schools is by lottery– and not by students’ academic records or test results.

Even considering that more motivated students are more likely to enter the lottery, only a fraction of those who enter the admissions lottery win. The majority of these motivated students remain in the traditional public schools. In 2019 there were more than 50,000 New York City students on waiting lists to transfer into charter schools.

The real reason that Democratic politicians and civil rights leaders oppose charter schools and school choice is because they depend on the support of teachers’ unions to get elected. The success of charter schools means the loss of taxpayers’ support for public schools. It is estimated that if every child in New York City seeking to enter a charter school could be accepted, it would mean the loss of over a billion dollars a year to the public schools and teachers’ unions.

In an effort to thwart charter schools, opponents have tried to limit the number of charter schools allowed – regardless of whether these charter schools are good, bad or indifferent. Most states have such laws, though the only purpose these laws serve is to impede the exodus of students from traditional public schools. In cities across the nation, public school officials are blocking charter schools from using school buildings that have been vacant for years to prevent transfers into charter schools from taking place.

School choice is all about creating competition in the school system that raises the quality of education for everyone. Competition always raises quality and lowers the cost of any product in the marketplace. Education is no different. School choice will raise the standards for educating children of all races and all income levels. It will weed out poor-performing schools and teachers and select only for the best of both. The losers in this scenario are poor teachers, teachers’ unions, and politicians who depend upon their support. It’s time those who profess to be concerned about the future of blacks and other minorities show their true colors – by supporting school choice and charter schools.

Former Secretary of State Condoleeza Rice has called school choice “the civil rights issue of our times.” It’s time the civil rights leaders turned their backs on the teachers’ unions and started supporting the children of the people they claim to serve.

Covid Models Get It Wrong


I admit I’m jealous. In my profession as an orthopedic surgeon, I’m not allowed to make mistakes. If I do, someone is sure to file a medical malpractice case against me. But in the world of meteorologists – and Covid models – mistakes are ignored with no loss of credibility. When are we going to learn?

Case in point is the University of Washington Institute for Health Metrics and Evaluation (UW), which has been consistently wrong about predicting Covid future experience but is still quoted by the media. It’s about time we stopped talking about their models.

The Wall Street Journal has also had enough. Their editorial board has called out their mistakes. Here’s some of their predictions from the recent past:

  • UW forecast New York would need 49,000 regular beds and 8,000 ICU beds at the peak of the pandemic.
  • N. Y. Governor Andrew Cuomo’s experts projected 140,000 regular beds and 40,000 ICU beds needed.
  • Actual regular beds needed was 18,825 and 5,225 ICU beds at the peak
  • Actual regular beds needed were only 38% and ICU beds 65% of the UW model predictions – even though New York was the epicenter of the pandemic.
  • Actual regular beds and ICU beds needed were only 13% of Governor Cuomo’s experts’ predictions


Governor Cuomo now admits their mistakes. “All the early national experts, ‘Here’s my projection model.’. . . They were all wrong. They were all wrong. . . There are a lot of variables. I understand that. We didn’t know what the social distancing would actually amount to. I get it, but we were all wrong.”

Despite the media’s attempts to overhype the resurgence of cases, the actual numbers are tell a different story. In Texas, hospitalizations have been climbing, but weekly fatalities are down 40% from a month ago. Covid patients occupy fewer than 55 of all hospital beds, and more than a quarter are available. Even in Houston, where the largest increases in hospitalizations have occurred, Covid patients occupy only 6% of hospital beds. More than 20% are unused.

Covid-19 patients take up a small share of ICU beds in most states that have reopened including California (16%), Texas (11%), Georgia (10%), Utah (9%), Wisconsin (8%) and Florida (7%). Nearly all states have plenty of hospital beds and ICU capacity.

Yet the UW models are once again predicting dire expectations and the media is promoting their claims despite their earlier mistakes. UW now projects that reopening will cause deaths to triple in California and increase six-fold in Florida and Arizona through September. I live in Florida – and I’m not worried.

Stanford epidemiologist John Ioannidis discusses models and why their predictions are often wrong in a new paper. He says models overshot by making faulty assumptions about virus reproduction rates and homogenous susceptibility. A Massachusetts General Hospital model predicted more than 23,000 deaths within a month of Georgia reopening but the state had only 896.

Ioannidis writes, “In the presence of strong groupthink and bandwagon effects, modelers may consciously fit their predictions to what is the dominant thinking and expectations – or they may be forced to do so. Forecasts may be more likely to be published or disseminated, if they are more extreme.”

In other words, the worse the prediction, the more the media will accept and promote it. No wonder the media – and the models -have lost all credibility.