Originally published on RealClear Markets.

The Trump administration has opened a Section 232 national security investigation into imported medical products. It is being sold as a supply-chain resilience effort. But it is a tax on Americans that raises healthcare costs for patients.

The Commerce Department’s probe covers medical equipment, personal protective equipment, and a wide range of health technologies used every day in hospitals and clinics. The scope is so sweeping that it now threatens robotics and medical devices—the tools modern medicine depends on.

Supply-chain vulnerabilities are real. COVID exposed weaknesses, especially for critical supplies. But tariffs are the wrong tool. They do not build domestic capacity on a meaningful timeline and impose immediate costs on families.

Tariffs are taxes. They are not paid by foreign governments. They are paid by American importers and passed through to hospitals, providers, insurers, employers, and families. That is why tariffs are a particularly bad way to raise tax revenue: they hide the tax, distort decisions, and raise costs across the economy.

President Trump has highlighted the revenue appeal of tariffs in his State of the Union remarks, even suggesting tariffs could replace other taxes. But “revenue” from tariffs is money taken from Americans through higher prices at home. There is nothing conservative about a hidden tax that hits working families hardest.

Healthcare is the worst place to run this experiment. Medical supply chains are global because they rely on specialization, scale, quality controls, and reliable access to components. Even when a device is assembled in America, key parts are often sourced internationally. A tariff hits finished devices and the inputs that make them. When you tax the supply chain, you tax the care.

Hospitals cannot simply stop buying essential supplies and equipment. Providers cannot delay purchases of critical tools without affecting patient care. Higher costs do not disappear. They get passed through as higher charges, higher negotiated rates, higher premiums, and higher out-of-pocket bills.

The supply-chain mechanicsbehind this pass-through are complex. When procurement costs rise or supplies tighten, healthcare systems absorb strain, and patients feel it downstream. Tariffs are not an abstract policy lever. They land in exam rooms and operating rooms.

A large hospital system that spends hundreds of millions of dollars each year on devices and supplies can face millions—or tens of millions—more in additional costs under broad tariffs. Rural and safety-net hospitals operating on thin margins get squeezed first. The people harmed first are the people with the least ability to pay more: seniors on fixed incomes, families with high deductibles, and patients who cannot absorb another surprise bill.

Tariffs also weaken domestic competitiveness in the name of strengthening it. Medical devices operate in a globally integrated market with complex sourcing and distribution. Taxing key inputs does not make American manufacturers stronger. It raises their costs, reduces investment flexibility, and makes the sector less nimble.

If policymakers want stronger supply chains and more domestic production, they should start with the barriers at home that actually deter investment: regulatory delays, compliance burdens, and uncertainty that slow expansion. They should diversify sourcing through trusted allies and redundancy rather than pretending the U.S. can reshore everything overnight without major cost increases. 

Resilience comes from competition and flexibility, not from a blunt tax that hits every hospital purchase order immediately. Free trade remains the path to prosperity because it lowers costs, expands choice, and strengthens the economy's productive capacity, including in healthcare. The same principle applies to medical tools.

If this Section 232 investigation results in more tariffs, Washington will be taxing pacemakers, insulin pumps, imaging machines, and the supplies that keep hospitals running. That does not make America healthier or safer. It makes healthcare more expensive—right when families can least afford it.

Originally published at The Daily Economy. 
​
A recent cyberattack on the University of Mississippi Medical Center shut down clinic operations for nine days, disrupting appointments and access to care across Mississippi. According to the center’s own official system update, scheduling, communications, and clinical workflows were all impacted.

Nine days without normal access to care is not just a cybersecurity problem. It is a market structure problem.

The University of Mississippi Medical Center is not simply another hospital. It is Mississippi’s only academic medical center and serves as the state’s primary hub for specialty care, physician training, and complex services. By its own description, it provides levels of care “unavailable anywhere else in the state.” That concentration means when UMMC goes down, much of Mississippi’s advanced care capacity goes down with it.

In a competitive system, that should not happen.

When a major provider in most industries goes offline, others step in. Capacity shifts. Customers reroute. The system bends but does not break. In Mississippi, it broke.

A System Built to Concentrate

That fragility is not an accident. It is the result of policy.

Mississippi has long enforced certificate-of-need laws that require government approval before new hospitals, surgical centers, or major medical services can open or expand. These laws are often justified as cost-control measures. In practice, they limit entry and protect incumbents.

Mississippi’s version is among the more restrictive. Applications can cost tens of thousands of dollars, and existing providers are allowed to challenge potential competitors. The effect is predictable. Fewer entrants. Slower expansion. Less redundancy.

Policy analysis by the Mississippi Center for Public Policy found that, without CON restrictions, Mississippi could have supported 30 percent more rural hospitals and 13 percent more ambulatory surgical centers, thereby increasing access in underserved areas. A comparable state without such restrictions would have roughly 165 hospitals, compared with Mississippi’s 116, a difference of more than 30 percent in total capacity in 2017.

That missing capacity matters most when something goes wrong.

Fragility Has Consequences

The cyberattack did not create Mississippi’s access problem. It exposed it.

When a single institution serves as the backbone of a state’s healthcare system, any disruption becomes systemic. Patients do not simply go elsewhere. In many cases, there is nowhere else to go.

That means delayed diagnoses, postponed treatments, and worsening conditions. It means longer wait times in an already strained system. And in extreme cases, it can mean preventable harm.

Across the country, wait times for physician appointments are already rising, particularly for primary and specialty care. Systems with limited competition are less able to absorb shocks, making those delays even more severe when disruptions occur.

This is what lack of competition looks like in practice. Not just higher prices, but reduced resilience.

The Financing Problem

Market structure is only part of the story. The way healthcare is financed amplifies the problem.

Most healthcare dollars do not flow through patients. They flow through insurers, employers, and government programs. That disconnect weakens the most important signal in any market: price.

When patients are not paying out of pocket, providers compete less on value and more on navigating reimbursement systems. Administrative costs rise. Innovation slows. Capacity becomes rigid rather than responsive.

This is the core issue identified in the Empower Patients framework. Healthcare in the United States is dominated by third-party control rather than patient decision-making.

The result is a system that is both expensive and fragile.

What Competition Looks Like

When competition is allowed, the results differ.

Transparent providers such as the Surgery Center of Oklahoma publish prices upfront and often deliver care at significantly lower cost than traditional hospital systems. Direct Primary Care practices offer faster access, longer visits, and predictable pricing by operating outside insurance billing.

These models do more than reduce costs. They add capacity. They create alternatives. They make the system more resilient.

If one provider goes offline, others are available.

Mississippi has fewer alternatives because policy has limited their growth. Even when regulators approved a new hospital in Biloxi, the process revealed how difficult it is to add capacity. The state issued a certificate of need in 2012 for a replacement facility, but incumbent hospitals sued to block the project, delaying it for years, arguing it was not a true replacement. That prolonged fight stemmed from the original plan to build a new hospital to replace Gulf Coast Medical Center after it was destroyed by Hurricane Katrina. In short, even obvious community needs can be slowed by legal challenges from existing providers. 

The pattern continues: recent consolidation has further strengthened dominant systems on the Gulf Coast, and policymakers pursue only incremental changes to certificate-of-need laws, while others call for a broader overhaul of the state’s restrictions.

A map depicting states where an incumbent competitor may object to a new facility. Image credit: The Mississippi Center for Public Policy.

​A Warning for Policymakers

The Mississippi cyberattack should be viewed as a warning, not an anomaly. It revealed how vulnerable a healthcare system becomes when competition is restricted and capacity is concentrated. What looks efficient on paper can be fragile in practice.

Mississippi is not an outlier. 35 states and DC operate under certificate-of-need laws that limit the number of new providers and expansion. States have been working to improve their CON laws, reflecting a growing recognition that the current structure is too rigid. But incremental reform will not solve a structural problem.

A Better Path Forward

A more resilient healthcare system that empowers patients requires more than cybersecurity upgrades. It requires policy change.

First, remove barriers to entry that prevent new providers from entering the market. In Mississippi, the state could support 30 percent more rural hospitals and 13 percent more ambulatory surgical centers, meaning more options for patients and more capacity when disruptions occur.

Second, shift financing toward patient control. When individuals manage their own healthcare dollars, they have an incentive to seek value, compare options, and demand better service.

Third, reduce regulatory burdens that divert resources from care to compliance.
​
These changes would not only lower costs. They would make the system stronger.

The Real Lesson

Mississippi’s healthcare system did not fail because of a cyberattack alone. It failed because it lacked the flexibility and redundancy to respond. One hospital system should never be a single point of failure for an entire state.
​
The way to prevent that is not more centralization. It is more competition, more capacity, and more patient control. That is the lesson Mississippi offers — and it is one policymakers across the country should take seriously.

Originally published on Substack. 

Yesterday, I submitted written testimony to the Texas House Select Committee on Health Care Affordability with a straightforward message: stop layering new mandates onto a broken system and start rebuilding health care around patients.

That is the foundation of my work at Ginn Economic Consulting, my recent piece Empower Patients, Not Bureaucracies, and the broader Empower Patients Initiative, which I helped advance with Americans for Tax Reform and Dr. Deane Waldman. The same framework is also developed in our re-released book with a different title, Become an Empowered Patient.

The core point is simple: affordable care will not come from empowering more bureaucracies. It will come from empowering patients.

That should be the North Star for Texas policymakers.

Texans do not need another study to know health care is broken. They live it every month through rising premiums, higher deductibles, surprise bills, delayed care, shrinking physician independence, and wages squeezed by employer-sponsored coverage. They see a system with more “coverage” but less affordability, less transparency, and less trust.

That is not a functioning market. It is a heavily distorted system shaped by third-party payment, government favoritism, and bureaucratic control.

Coverage Is Not Care

One of the biggest mistakes in health policy is treating coverage and care as if they are the same thing.

They are not.

A bigger insurance card does not automatically mean better access, lower prices, or stronger outcomes. In practice, the opposite often happens. When patients are disconnected from real prices, doctors are buried in compliance, and payment is routed through layers of insurers and government programs, the system becomes more expensive and less personal at the same time.

That is why serious reform should not begin with “How do we expand bureaucratic coverage?” It should begin with “How do we restore the patient-doctor relationship and let markets work again?”

That is the animating principle of the Empower Patients Initiative: move power away from institutions and back to people.

The Tax Code Helped Create This Mess

One of the most underappreciated drivers of our current system is the federal tax exclusion for employer-sponsored insurance.

That policy helped push coverage into the workplace, hide the true cost of compensation, reward more expensive plans, and disconnect patients from the actual price of care. It encouraged a world where employers, insurers, and government programs make most of the decisions while patients try to navigate the consequences.

That is one reason I argued in Empower Patients, Not Bureaucracies and Solving the Healthcare Affordability Crisis that the real problem is not a lack of bureaucratic oversight. It is a system of warped incentives that suppresses price signals, shields payers from accountability, and leaves patients with less control than they should have.

That is not a market failure. It is a policy failure.

Transparency Helps Only If Patients Can Act

There is plenty of discussion right now about price transparency. Good. People should know what care costs.

But transparency alone is not enough.

What price are we talking about? The hospital list price? The negotiated insurer rate? The Medicare reimbursement? The cash price? The patient’s out-of-pocket estimate? Those can be radically different numbers. So if lawmakers simply require more price posting without changing who controls the dollars and the decisions, transparency becomes one more compliance exercise.

Transparency without ownership is noise.

For transparency to matter, patients need the power to act on the information. That means more direct primary care, more cash-pay options, more flexible health savings arrangements, and fewer barriers blocking real alternatives. That is why the Empower Patients Initiative focuses on restoring buyer-seller relationships in health care rather than just adding new reporting requirements to the old system.

The Reform Agenda Texas Should Pursue

If Texas wants to lead, it should stop trying to patch over a broken structure and instead move toward a patient-centered market.

That means expanding direct primary care and direct doctor-patient contracts. It means reducing mandates that drive up premiums. It means pairing catastrophic coverage with patient-controlled accounts. It means removing barriers to entry so more providers can compete. It means protecting independent physicians from regulatory overload. And it means treating transparency as a tool instead of pretending it is the cure.

I have made that case consistently in Empower Patients, Not Bureaucracies, Solving the Healthcare Affordability Crisis, and Stop Propping Up Obamacare. The common theme is simple: if you keep subsidizing and regulating a broken structure, you get a more expensive version of the same broken structure.

The better answer is more freedom, more competition, and more direct accountability.

Fix Medicaid by Trusting Texans

The same principle applies to Medicaid.

Medicaid is supposed to help vulnerable Texans, but too often it traps them in a system with weak access, low provider participation, and expensive, hospital-centered care. Texas should not define success by how well it processes claims through a bureaucracy. It should define success by whether patients can actually get timely, quality care.

That means pushing for more state flexibility, more patient-centered options, and more room for innovative delivery models outside the usual administrative maze. A Texas model should focus on portable dollars, direct care, community and charitable support, and stronger incentives for responsible use of resources.

Trust Texans more. Trust Washington less.

Don’t Chase Every Villain of the Week

There is also a growing temptation to fixate on individual middlemen, especially pharmacy benefit managers.

They deserve scrutiny. But they are not the root problem.

PBMs are one manifestation of a third-party payment architecture that distorts incentives across the whole system. If lawmakers regulate one intermediary without fixing the underlying money flow, the dysfunction will simply reappear somewhere else.

That is why policymakers should focus less on chasing symptoms and more on repairing the structure itself. Fix the incentives. Fix the payment distortions. Fix the barriers to direct exchange. A lot of the middleman pathology shrinks once patients and doctors regain more control.

This Is Economic and Moral

At bottom, this is not just an economic issue. It is a moral one.

Patients are not billing codes. Doctors are not paper-pushers. Families should not need a bureaucratic decoder ring just to get basic care. A decent health system should be built on trust, choice, responsibility, useful transparency, and accountability grounded in voluntary exchange.

That is why the Empower Patients Initiative matters. It is not just another policy package. It is a shift in orientation away from bureaucratic control and back toward a system that treats people like adults.

That is how we improve access.

That is how we lower costs.

That is how we get better outcomes.

That is how we let people prosper.

Three Takeaways for Policymakers

1. Shift control to patients.

Expand direct primary care, patient-controlled accounts, cash-pay competition, and other models that reconnect people to doctors and prices, as outlined in the Empower Patients Initiative.

2. Fix incentives, not symptoms.

Reduce mandates, unwind third-party distortions, and stop propping up bureaucratic structures that separate patients from care, as I argued in Empower Patients, Not Bureaucracies and Stop Propping Up Obamacare.

3. Use transparency wisely.

Transparency helps only when patients can act on it with real alternatives and more control over their own health care dollars.

Health care reform should start with a simple test:

Does this policy move power from bureaucracies to patients?

If yes, advance it.

If no, reject it.

That is the standard Texas should use.

Thank you for reading, for supporting my work, and for sharing it with others. I’m grateful for the opportunity to keep doing this through Ginn Economic Consulting, helping provide a North Star for policymakers who want sound reforms that actually let people prosper. If you are a policymaker, organization, or media outlet looking to go deeper on these reforms, I am always glad to speak at events, do interviews, join podcasts, and meet with leaders across Texas and the country.
​
You can read more at vanceginn.com, subscribe at vanceginn.substack.com, explore the broader reform framework at EmpowerPatients.info, and get the book Become an Empowered Patient.

Originally published on Substack. 

​Yesterday, I submitted written testimony to the Texas House Select Committee on Health Care Affordability with a straightforward message: stop layering new mandates onto a broken system and start rebuilding health care around patients.

That is the foundation of my work at Ginn Economic Consulting, my recent piece Empower Patients, Not Bureaucracies, and the broader Empower Patients Initiative, which I helped advance with Americans for Tax Reform and Dr. Deane Waldman. The same framework is also developed in our re-released book with a different title, Become an Empowered Patient.

The core point is simple: affordable care will not come from empowering more bureaucracies. It will come from empowering patients.

That should be the North Star for Texas policymakers.

Texans do not need another study to know health care is broken. They live it every month through rising premiums, higher deductibles, surprise bills, delayed care, shrinking physician independence, and wages squeezed by employer-sponsored coverage. They see a system with more “coverage” but less affordability, less transparency, and less trust.

That is not a functioning market. It is a heavily distorted system shaped by third-party payment, government favoritism, and bureaucratic control.

Coverage Is Not Care

One of the biggest mistakes in health policy is treating coverage and care as if they are the same thing.

They are not.

A bigger insurance card does not automatically mean better access, lower prices, or stronger outcomes. In practice, the opposite often happens. When patients are disconnected from real prices, doctors are buried in compliance, and payment is routed through layers of insurers and government programs, the system becomes more expensive and less personal at the same time.

That is why serious reform should not begin with “How do we expand bureaucratic coverage?” It should begin with “How do we restore the patient-doctor relationship and let markets work again?”

That is the animating principle of the Empower Patients Initiative: move power away from institutions and back to people.

The Tax Code Helped Create This Mess

One of the most underappreciated drivers of our current system is the federal tax exclusion for employer-sponsored insurance.

That policy helped push coverage into the workplace, hide the true cost of compensation, reward more expensive plans, and disconnect patients from the actual price of care. It encouraged a world where employers, insurers, and government programs make most of the decisions while patients try to navigate the consequences.

That is one reason I argued in Empower Patients, Not Bureaucracies and Solving the Healthcare Affordability Crisis that the real problem is not a lack of bureaucratic oversight. It is a system of warped incentives that suppresses price signals, shields payers from accountability, and leaves patients with less control than they should have.

That is not a market failure. It is a policy failure.

Transparency Helps Only If Patients Can Act

There is plenty of discussion right now about price transparency. Good. People should know what care costs.

But transparency alone is not enough.

What price are we talking about? The hospital list price? The negotiated insurer rate? The Medicare reimbursement? The cash price? The patient’s out-of-pocket estimate? Those can be radically different numbers. So if lawmakers simply require more price posting without changing who controls the dollars and the decisions, transparency becomes one more compliance exercise.

Transparency without ownership is noise.

For transparency to matter, patients need the power to act on the information. That means more direct primary care, more cash-pay options, more flexible health savings arrangements, and fewer barriers blocking real alternatives. That is why the Empower Patients Initiative focuses on restoring buyer-seller relationships in health care rather than just adding new reporting requirements to the old system.

The Reform Agenda Texas Should Pursue

If Texas wants to lead, it should stop trying to patch over a broken structure and instead move toward a patient-centered market.

That means expanding direct primary care and direct doctor-patient contracts. It means reducing mandates that drive up premiums. It means pairing catastrophic coverage with patient-controlled accounts. It means removing barriers to entry so more providers can compete. It means protecting independent physicians from regulatory overload. And it means treating transparency as a tool instead of pretending it is the cure.

I have made that case consistently in Empower Patients, Not Bureaucracies, Solving the Healthcare Affordability Crisis, and Stop Propping Up Obamacare. The common theme is simple: if you keep subsidizing and regulating a broken structure, you get a more expensive version of the same broken structure.

The better answer is more freedom, more competition, and more direct accountability.

Fix Medicaid by Trusting Texans

The same principle applies to Medicaid.

Medicaid is supposed to help vulnerable Texans, but too often it traps them in a system with weak access, low provider participation, and expensive, hospital-centered care. Texas should not define success by how well it processes claims through a bureaucracy. It should define success by whether patients can actually get timely, quality care.

That means pushing for more state flexibility, more patient-centered options, and more room for innovative delivery models outside the usual administrative maze. A Texas model should focus on portable dollars, direct care, community and charitable support, and stronger incentives for responsible use of resources.

Trust Texans more. Trust Washington less.

Don’t Chase Every Villain of the Week

There is also a growing temptation to fixate on individual middlemen, especially pharmacy benefit managers.

They deserve scrutiny. But they are not the root problem.

PBMs are one manifestation of a third-party payment architecture that distorts incentives across the whole system. If lawmakers regulate one intermediary without fixing the underlying money flow, the dysfunction will simply reappear somewhere else.

That is why policymakers should focus less on chasing symptoms and more on repairing the structure itself. Fix the incentives. Fix the payment distortions. Fix the barriers to direct exchange. A lot of the middleman pathology shrinks once patients and doctors regain more control.

This Is Economic and Moral

At bottom, this is not just an economic issue. It is a moral one.

Patients are not billing codes. Doctors are not paper-pushers. Families should not need a bureaucratic decoder ring just to get basic care. A decent health system should be built on trust, choice, responsibility, useful transparency, and accountability grounded in voluntary exchange.

That is why the Empower Patients Initiative matters. It is not just another policy package. It is a shift in orientation away from bureaucratic control and back toward a system that treats people like adults.

That is how we improve access.

That is how we lower costs.

That is how we get better outcomes.

That is how we let people prosper.

Three Takeaways for Policymakers

1. Shift control to patients.

Expand direct primary care, patient-controlled accounts, cash-pay competition, and other models that reconnect people to doctors and prices, as outlined in the Empower Patients Initiative.

2. Fix incentives, not symptoms.

Reduce mandates, unwind third-party distortions, and stop propping up bureaucratic structures that separate patients from care, as I argued in Empower Patients, Not Bureaucracies and Stop Propping Up Obamacare.

3. Use transparency wisely.

Transparency helps only when patients can act on it with real alternatives and more control over their own health care dollars.

Health care reform should start with a simple test:

Does this policy move power from bureaucracies to patients?

If yes, advance it.

If no, reject it.

That is the standard Texas should use.

Originally published at National Review.

Washington keeps talking about inflation, tariffs, and taxes. But if policymakers are serious about lowering costs and strengthening the economy, they cannot ignore a burden quietly making life more expensive: lawsuit abuse.

The tort system matters in a free society. If someone is harmed by negligence or fraud, that person should be able to seek relief in court. A sound tort system can compensate victims and deter wrongdoing. But unfortunately, the litigation industry often looks like a business model built to extract massive settlements, enrich trial lawyers and outside financiers, and shift the costs onto everyone else.

​This is not some niche legal issue. Rather, it is an affordability issue that hurts American families, workers, entrepreneurs, and consumers. The widespread abuse of the civil justice system is a direct drag on growth, wages, investment, and opportunity.

Tort costs reached an estimated $529 billion in 2022, equal to 2.1 percent of GDP and about $4,200 per household. Those costs have been rising faster than both inflation and the broader economy, and they are projected to surpass $900 billion by 2030 if the upward trend continues.

Excessive tort costs also raise average prices across the economy by about 1.3 percent, adding roughly $320 billion in annual inflation costs to households. Total consumer losses from higher prices and lower earnings are estimated at about $674.4 billion per year, or roughly $5,135 per household.

Some essentials get hit even harder. For example, prescription drugs are estimated to be about 9 percent more expensive because of excess tort costs. Likewise, home insurance and health insurance are pricier.
​
Call it what it is: a tort tax. Families pay it, whether they know it or not.

Main Street gets hammered, too. Businesses with $10 million or less in annual revenue account for only a modest share of commercial activity, yet they bear roughly 48 percent of commercial tort costs. That means the firms least able to absorb legal uncertainty are the ones most likely to postpone hiring, shelve expansion plans, raise prices, cut services, or even shut down entirely.

The latest jobs report by the National Federation of Independent Businesses found that only a net 12 percent of small-business owners plan to create new jobs in the next three months, the lowest reading since May 2025. Entrepreneurs are thinking twice before taking risks, while workers get fewer opportunities. In a country already worn out by affordability pressures, this is unnecessary self-inflicted damage.

One of the biggest drivers of abuse is the Multidistrict Litigation (MDL) Act of 1968. In theory, MDL was introduced to efficiently consolidate similar federal cases. In practice, it has become an assembly line for weak or poorly vetted claims. Materials submitted in the federal rules process in recent years indicate broad concerns that some large MDLs include unsupportable claims.

For example, there are currently over one dozen municipalities suing American fire-truck manufacturers for alleged anticompetitive practices. Many of them are experiencing budget problems, such as federal or state cuts. Since each plaintiff is seeking the maximum of $5 million in damages, the lawyers have a strong incentive to recruit additional parties for a larger settlement.

Yet, the lawyers in such cases typically keep much of the money from contingency fees and other payments, while adding a substantial cost to many American businesses.

The good news is that states are beginning to respond. 

In 2025, Georgia enacted S.B. 68 and S.B. 69, targeting abusive practices and increasing transparency around third-party funding for litigation. Iowa took a similar step in 2023 with H.F. 161, which limits noneconomic damages in medical malpractice cases while preserving high awards for severe injuries. Additionally, Texas has debated similar reforms, such as S.B. 30 in 2025, to discourage the rise of frivolous tort lawsuits and to reduce settlement fees that are inappropriately large.

The choice is not between justice and reform. That is the lazy framing trial lawyers prefer. The real choice is whether courts will remain places to resolve genuine harm, or continue to be vehicles for wealth transfer and economic distortion.
Tort reform will not solve every affordability problem in America. But it would remove one of the dumbest, costliest burdens we impose on ourselves. And right now, families could use every break they can get.

Originally published on Substack.

Some in Washington have suddenly discovered affordability while the Trump administration continues to blame Biden or say people “feel” okay.

Americans are right to be upset.
​
As the new Cato Institute affordability handbook (authored by Cato scholars, such as Ryan Bourne, Romina Boccia, Norbert Michel, Scott Lincicome, Travis Fisher, Colin Grabow, and others) notes, by early 2026 consumer prices were still about 24 percent higher than five years earlier, while borrowing costs on mortgages, car loans, and credit cards had also jumped.

Families do not experience the economy through press releases. They experience it through rent, groceries, insurance, health care, child care, and monthly payments that still do not fit comfortably inside a paycheck.
But here is the problem Washington keeps refusing to face: most of the political class wants to solve affordability with the same tools that made it worse.
Cap prices. Punish profits. Expand subsidies. Add mandates. Restrict trade. Pick winners. Manage outcomes.
That is not a cure. It is just more politics in place of markets.
As I argued in Affordability Is the Test—and Washington Keeps Failing It, families do not care whether economists say inflation has cooled if the cost of everyday life is still elevated. Affordability is the issue because it decides whether households can actually live, save, build, and plan. The answer is not more management from above. It is more room for the private economy to work.
The North Star
A key insight in Cato’s handbook is that affordability is not one problem. It is several: the aftermath of persistent inflation, expensive credit, and supply restrictions in housing, energy, health care, transportation, food, and finance.

But the policy North Star is still simple. If you want lower costs and more options, you have to make it easier to produce, easier to build, easier to invest, easier to compete, and easier to adapt.

That lines up closely with what I have been writing.

In Families Flourish Under Free-Market Capitalism, I made the point that affordability is not primarily a demand problem. People will always want more and better things. The real issue is whether policy allows enough supply, innovation, and competition to meet those wants at lower cost. In The State of the Economy: Texas, DFW, and Beyond, I put it even more plainly: affordability is a supply problem. That is the lens policymakers should use.

Housing Is the Clearest Example

Cato’s housing chapter makes the point Washington still struggles to say out loud: housing is expensive because too many governments make it hard to build housing.

Zoning rules, minimum lot sizes, parking mandates, accessory dwelling restrictions, manufactured-housing barriers, and other local rules suppress supply and push up prices. That is not a market failure. That is a policy choice failure.

That is why I have emphasized in my housing testimony before the Texas Senate and in Rethinking Housing Affordability that affordability gets worse when government blocks supply and then blames investors, demand, or capitalism. You do not make homes cheaper by preserving scarcity. You make them cheaper by letting more homes get built.

Health Care Is No Different

The health-care section of Cato’s handbook is just as blunt: subsidies do not solve affordability problems. In many cases, they are the problem because they separate consumers from prices and drive spending through third parties. The result is more spending without real cost discipline.

That tracks directly with my own work in Solving the Healthcare Affordability Crisis, where I argued that we do not need more bureaucratic middlemen controlling dollars and decisions. We need more direct relationships, more price transparency, and more consumer control. If you keep subsidizing a broken financing structure, you do not get affordability. You get a more expensive version of the same broken system.

Tariffs and Price Controls Make It Worse

This is where both parties really go off the rails.

Cato’s handbook points to tariffs, transportation restrictions, and food-market interventions as drivers of higher prices. That should not surprise anyone. Tariffs are taxes. Protectionism is a hidden cost on households. And price controls do not make things cheaper to produce; they just distort supply, access, and investment.

I have made that case repeatedly in my own work. In Price Controls Won’t Fix America’s Insurance Crisis, I argued that politicians keep reaching for caps and controls instead of addressing the barriers and distortions causing the problem. In my free-trade writing, I have also stressed that tariffs may sound tough, but they squeeze working households and raise costs across the economy. If the goal is affordability, you do not tax the things people buy and the inputs businesses need.

Markets, Not Mandates

The broader lesson from the Cato handbook is one I think policymakers need to hear again and again: affordability does not come from smarter political micromanagement. It comes from freer markets.

That means tighter fiscal and monetary discipline so Washington does not reignite inflation. It means fewer subsidies and mandates that mask costs instead of lowering them. It means fewer tariffs and trade barriers that raise everyday prices. It means clearing away the rules that choke off housing, energy, health care, and transportation supply. And it means respecting the role of prices and profits in guiding decisions better than politicians ever can.

That is the North Star.

Americans do not need more affordability theater. They need the freedom to produce, build, compete, and choose.

Three Takeaways for Policymakers

1. Affordability is mostly a policy problem, not a market failure.

Cato’s handbook shows that today’s cost pressures come from inflation, expensive credit, and supply restrictions across key sectors.

2. The cure is more supply and competition, not more control.

That is true in housing, health care, and trade.

3. The North Star should be economic freedom.

If policymakers want lower prices and more opportunity, they should stop replacing markets with politics and start letting people prosper.

Washington may call this the year of affordability.

Good.
​
Now it should stop doing the very things that make life unaffordable.

Originally published at PJ Media. 

In March, Tennessee’s Senate Finance Committee voted to send SB 2040 to the full Senate. Their reasoning is simple: banning pharmacy benefit managers (PBMs) from owning or operating pharmacies in the state will lower drug prices.

It sounds great. But senators who voted in favor of the legislation are ignoring top state officials who have warned that SB2040 is far more likely to raise costs, reduce access, and hit low-income Tennesseans first.

Start with the stakes. TennCare covers about 1.4 million Tennesseans and runs about $19.2 billion a year. It serves roughly 20% of the state, covers about half of births, and insures about half of Tennessee’s children. When TennCare takes a financial hit, it’s not “the system” absorbing it — it’s pregnant women, kids, seniors, and people with disabilities.

That’s why TennCare’s testimony should matter. In a recent legislative hearing, the program’s chief pharmacy officer warned SB 2040 would cause “a significant member impact on access to treatment” and “a significant fiscal impact.” TennCare’s director added the agency has data showing “with reasonable certainty” that there will be a fiscal impact.

The estimate is about $66 million in added TennCare costs — roughly $24 million on taxpayers and $42 million borne by patients. That means a bill marketed as “patient protection” functions like a cost increase on poor Tennesseans. For families already stretched by groceries, rent, and gas, higher costs don’t improve health — they lead to delayed or skipped prescriptions and worse outcomes later.

​Fiscal staff are warning about the mechanisms behind that cost: higher drug acquisition costs, higher dispensing fees, and higher administrative costs from renegotiating pharmacy networks and reimbursement arrangements. That’s what happens when the government forces a restructuring rather than letting competition work.

This comes at the worst time. Tennessee’s comptroller has warned the coming year will be the tightest budget year in nearly eight years. Adding tens of millions in new TennCare costs without credible proof of better outcomes or lower net prices is a bad trade.

There’s also a serious access risk. CVS has warned that SB 2040 could force the closure of 134 Tennessee pharmacy locations. Maybe that’s negotiating pressure, maybe it’s real. But lawmakers shouldn’t gamble with pharmacy access — especially in rural areas where people don’t have multiple options.

Here’s the bigger economic point: PBMs didn’t invade a free market. They expanded inside a third-party payer system dominated by government programs, mandates, and opaque pricing. 

When patients are disconnected from prices, complexity grows and intermediaries fill the gap. Banning a business model doesn’t fix those incentives. It piles state control on top of federal distortions and then acts surprised when costs rise.

​Other states are already learning the hard way. Arkansas’ PBM ownership ban was blocked via a preliminary injunction, and Iowa’s PBM crackdown was also hit with a preliminary injunction. Tennessee shouldn’t rush into a costly policy trend that’s both economically shaky and legally unstable.

If lawmakers want a better approach that puts patients first, the answer is to empower patients by expanding competition and reducing barriers at the point of care — not banning ownership structures. A practical step is empowering pharmacists and reducing state restrictions that limit capacity and raise overhead.

As the full Senate considers SB2040, lawmakers should answer one question: why impose a restructuring that TennCare says will raise costs and reduce access — especially for the poor — without clear evidence it will lower drug prices or improve outcomes?

Originally published on Pelican Institute.

When the government makes it illegal to open new nursing homes or add beds where people need care, that is not health policy. It is protectionism. 

And in Louisiana, HB 199 would keep that protectionism in place for years longer by extending the state’s moratorium on new nursing facilities and additional beds. Supporters may call that stability. Economically, it is something else: a state-backed restriction on supply that protects incumbent providers while leaving seniors and their families with fewer options at higher costs. 

To be fair, supporters of the bill are not inventing concerns out of thin air. Long-term care is a difficult sector. 

Nursing homes depend heavily on Medicaid financing, face workforce shortages, and serve medically fragile people. Some lawmakers worry that allowing too much new capacity too quickly could strain staffing, weaken existing operators, or create uneven access to labor. 

Those are legitimate concerns. But they are not a convincing case for extending a moratorium. They are arguments for addressing workforce, reimbursement, and quality oversight directly—not for making new supply illegal.

That distinction matters. Louisiana already has a facility need review process to determine whether additional nursing home capacity is allowed. On top of that, it has a moratorium. In other words, the state is not merely regulating quality and safety. 

It is actively suppressing competition. That may help existing providers avoid pressure from new entrants, but it does not help families searching for better care, closer locations, or more modern facilities. It replaces consumer choice with political gatekeeping. 

And Louisiana is doing this just as the state gets older. The Louisiana Department of Health says older adults are the fastest-growing demographic in the state and now make up nearly 20 percent of the population. 

Nationally, the Administration for Community Living reports that someone turning 65 today has nearly a 70 percent chance of needing some form of long-term care. That does not mean every senior will need a nursing home bed, of course. But it does mean demand for long-term services is rising, not falling. 

Extending a moratorium in the face of that reality is like seeing storm clouds and outlawing umbrellas. 

The economic problem is straightforward. When the government restricts supply, it reduces the incentive to compete on quality, price, and innovation. Existing firms become insulated from challengers. New providers with better models, more private rooms, newer facilities, or stronger service have a harder time entering the market. 

Families are left with fewer choices, especially in fast-growing areas. That is not how healthy markets work. Competition is not a threat to quality. In most sectors, it is one of the best ways to improve it.

Louisiana already licenses nursing homes and can enforce health and safety standards directly through the Department of Health’s regulatory framework. Families can also compare providers using the federal Care Compare and Five-Star system.

If the concern is poor care, staffing weakness, or bad inspections, then target those failures. A moratorium does none of that. It is a blunt instrument that avoids the real problem while preserving the market position of those already in it. 

Even the amended version of HB 199 quietly reveals the weakness of the case for extension. Lawmakers added a requirement for the state to gather more data on nursing facility occupancy, hospital days tied to discharge problems, and reasons facilities refuse admissions. 

But this also raises an obvious question: if the state still needs better data to assess whether the moratorium is justified, why extend the moratorium first? That is backward policymaking. The economically sound approach would be to gather the evidence, identify actual shortages and bottlenecks, and then remove barriers where demand is strongest. 

So yes, there are arguments for HB 199. Supporters can claim it offers short-run stability for existing providers in a difficult market. But those benefits are narrow and largely concentrated among incumbents. 

The broader costs are bigger: less entry, less investment, weaker competitive pressure, fewer options for families, and a long-term care system that is less able to adapt to an aging population.

Louisiana does not need more nursing home protectionism. It needs more accountability, more transparency, and more capacity. 

Lawmakers should reject HB 199 and stop confusing government-imposed scarcity with sound policy. A provider that can meet the rules, hire the staff, and earn families’ trust should be allowed to compete.