Originally published at American Thinker. 

In recent years, Americans have learned a hard truth: “Fool me once, shame on you; fool me twice, shame on me.” During COVID-19, we were told to trust the experts, obey mandates, and silence our dissent. Over time, the truth emerged—much of what we were sold was false, and the price we paid in lives, education, and finances from their false narrative scam was extreme.

Now, many of those same voices are repeating another falsehood: that cutting Medicaid will cause Americans to die.

Recently, Rep. Chip Roy (R-Texas) and 19 House conservatives called for “structural reforms” to Medicaid in a letter supporting the GOP’s reconciliation bill. The bill proposes ending the enhanced federal match for Medicaid expansion and equalizing matching rates for work-capable adults. This would contribute to $880 billion in less expected spending than otherwise over the next decade. Predictably, the media and progressive lawmakers responded with panic. House Minority Leader Hakeem Jeffries declared that such reforms would cause “people to die.”

But repeating a lie doesn’t make it true.

Medicaid is failing. Cutting its excesses and restoring its core purpose isn’t cruelty—it’s compassion. Structural reform is the only path forward if we want to protect the truly vulnerable and improve access to care.

Medicaid was created in 1965 as a safety net for the most vulnerable: low-income children, pregnant women, people with disabilities, and the elderly. But that mission has been lost. Starting with the ACA, followed by the emergency declaration for COVID-19 and thereafter, the federal government greatly expanded Medicaid enrollment. They expanded eligibility standards and suspended verification—millions of healthy, working-age adults were added to the program, many of whom no longer qualify.

Millions of Americans were thrown out of work by the Biden administration lockdowns and thus lost their employer-supported health insurance. Biden allowed them to enroll in Medicaid. According to the Bureau of Labor Statistics, at least 63% of these adults have returned to work and regained access to employer-sponsored insurance. Yet they remain on Medicaid, straining the program and crowding out those who truly need help.

​As a result, access to health care has plummeted. After the ACA’s Medicaid expansion, wait times to see a primary care doctor in mid-sized cities rose from 99 to 122 days. Under the Biden administration, that delay has reached 132 days. Meanwhile, nearly one-third of physicians refuse new Medicaid patients due to low payments and excessive red tape. In Texas, fewer than half do.

This leads to death-by-queue—patients with government “coverage” die waiting in line (a queue) for care. According to the British Medical Journal, even a one-month delay in cancer diagnosis raises the risk of death. Medicaid patients are now waiting four months or longer.

​This is what we call the healthcare seesaw: as more people are given government health insurance, Medicaid or Tricare, access to care declines. COVID-era policies forced millions of non-vulnerable Americans onto the rolls, diverting the system’s limited resources away from those it was designed to serve, those who truly need help.

The seesaw can be rebalanced. By reinstating eligibility reviews and narrowing enrollment to the medically vulnerable, we can improve care for those who need it most. Fewer enrollees mean shorter wait times, more participating providers, and better outcomes.

​This reform doesn’t hurt the poor and medically vulnerable—it helps them. 

Medicaid’s dysfunction is not just about who is covered. It’s also about how the money is spent. Nearly half of U.S. healthcare spending—more than $2 trillion annually—is wasted on what we call BURRDEN: Bureaucracy, Unnecessary Rules and Regulations, interfering Directives, and Enforcement for Non-compliance.

This is bureaucratic diversion—where dollars meant for care are redirected into bloated administrative systems. Between 1970 and 2024, while the number of physicians increased 150 percent, the number of healthcare bureaucrats expanded more than 4,400 percent!  As Brian Blase of the Paragon Health Institute and economist Paul Winfree noted recently, Medicaid is plagued by improper payments, waste, and misaligned incentives that reward states for expanding rolls rather than delivering outcomes.

As bureaucracy grows, care shrinks. This is another healthcare seesaw: more red tape (BURRDEN), less healing. Cutting bureaucratic waste would allow more dollars to reach doctors and patients—where they belong.

Let’s be clear: Medicaid is broken. It’s bloated, mismanaged, and failing the very people it was built to protect. The solution is not more funding and empty coverage promises—it’s structural reform.

Congress is right to demand eligibility checks, spending caps, and funding flexibility. Approaches like block grants to states and consumer-directed models, including no-limit Health Savings Accounts, can get medical care where and when it is needed by empowering patients, rewarding providers, and reducing waste.

In contrast to the dire warnings, Medicaid reform will not kill Americans. It will save lives—by restoring access, improving quality, and directing limited resources to the truly medically vulnerable.

We were fooled once, by our own government, no less! There won’t be a second time.

​How do we make sense of inflation, government overreach, or why housing costs keep climbing? It all comes back to basic economic principles—ideas too often ignored by those crafting the laws that shape our lives. So this week on This Week’s Economy, I’m kicking off a new Econ 101 series to reconnect the fundamentals of economics with the everyday issues Americans face. These aren’t abstract theories. They’re tools for protecting prosperity.

In today’s episode, I explain what economics really means, why strong institutions and secure property rights are the foundation of growth, and how bad incentives and broken systems have left our economy in a fragile state. You can catch the full episode on YouTube, Apple Podcast, or Spotify.
Visit: VanceGinn.com
Subscribe: VanceGinn.Substack.com

(0:00) - Introduction to Economics and Its Importance
(6:20) - The Role of Institutions in Economic Growth
(13:50) - Current Economic Policies and Their Impacts

Originally published at AIER's The Daily Economy.​

California leads the nation in more ways than one — taxes, regulations, and, once again, gas prices. As of mid-May 2025, the average gasoline price in California is $4.85 per gallon, far above the national average of $3.26, according to GasBuddy and AAA.

And it’s getting worse. A March 2025 study by USC Professor Michael Mische forecasts California’s fuel prices could spike 75 percent to over $8 per gallon within the next year. That’s not hyperbole — that’s the trajectory unless policymakers reverse course.

The culprit? It’s not oil companies or global demand. It’s decades of state-level tax hikes, regulatory overreach, and misguided climate mandates that have warped the gasoline market in California. This is a man-made problem — a case study in government failure, not market failure.

What Really Drives Gas PricesAccording to the US Energy Information Administration (EIA), gasoline prices are generally shaped by five components: crude oil prices, refining costs, distribution and marketing, taxes, and regulations. In California, taxes and regulatory costs alone account for more than $1.30 per gallon — nearly double the national average.
California has the highest gas tax in the country, at $0.678 per gallon, not including additional fees and environmental surcharges. Add in the Cap-and-Trade program, the Low Carbon Fuel Standard (LCFS), and boutique fuel blends that are required only in California, and it becomes clear why Californians pay more.

And things are deteriorating further. The Mische study warns that with refinery closures due to hostile permitting processes and low expected returns under California’s climate mandates, fuel supply in the state could drop by 20 percent by 2026, even as demand stays relatively stable. Fewer refineries and rigid fuel standards will mean tighter supply and higher prices.

Texas vs. California: A Tale of Two Fuel MarketsTo see how bad California’s policies are, look no further than Texas. As of May 2025, Texas drivers pay about $3.00 per gallon, nearly two dollars less than Californians. Texas levies a combined state gasoline tax of just $0.20 per gallon, and its regulatory structure is streamlined and energy-friendly.

Texas refineries aren’t subject to California’s carbon credit system or forced to produce costly special-blend fuels. And because it allows for a more competitive and open fuel market, the state benefits from both lower wholesale prices and more efficient distribution. The difference is stark — and instructive.

The Fallacy of “Green” Fuel MandatesSupporters of California’s approach claim high prices are a necessary cost for fighting climate change. But what if those policies aren’t actually working?

California’s greenhouse gas emissions have declined, but much of the reduction has come from cleaner electricity generation, not gasoline policies. Meanwhile, low-income and working-class Californians are being punished at the pump while driving older, less fuel-efficient vehicles.

This amounts to a regressive tax that hurts the very people politicians claim to protect. Worse, these rules don’t reduce global emissions — they just push energy production and refining out of the state and overseas, often to countries with weaker environmental standards.

The Economic Cost of Fragmented Fuel Policies
In my academic work, including a peer-reviewed paper and subsequent research (SSRN profile), I’ve documented how state-level fragmentation of fuel markets — through taxes, environmental programs, and infrastructure restrictions — creates costly inefficiencies that drive up prices.

These policies discourage new investment in refining and fuel transportation. They create artificial shortages. And they increase transaction costs that ultimately fall on consumers.

In short, California’s model is a textbook case of how overregulation and government micromanagement destroy affordability without delivering proportional benefits.

What Should Be Done Instead?The answer isn’t new subsidies or “green” credits. It’s not banning gas-powered cars or rationing vehicle miles. The solution is to embrace free-market capitalism and the principles Milton Friedman championed: let prices reflect market conditions, not bureaucratic preferences.

That means:

• Repealing California’s Cap-and-Trade and LCFS programs.
• Standardizing fuel blends to match those used nationwide.
• Halting the gasoline tax increases scheduled under current law.
• Encouraging private investment in refining and fuel infrastructure.

The federal government could help by streamlining interstate pipeline permitting and revisiting federal environmental rules that duplicate or exacerbate state mandates. But the real change must come from Sacramento.

Conclusion: A Crisis of Policy, Not PriceCalifornia’s high gas prices aren’t the product of global volatility or greedy corporations. They’re the result of a long series of deliberate policy choices that make fuel harder to produce, harder to transport, and harder to afford.

When government picks winners and losers in energy markets, consumers lose. And when politicians mistake control for competence, they create systems that serve ideology rather than reality.

It’s time to abandon the myth that high gas prices are the price of progress. California has created a man-made fuel crisis — and only free-market reforms can solve it.