I flew home to San Diego from visiting family in Baltimore last week. The view out my window over Houston, my connecting city, was crystal clear. The picture reminded me of my first plane ride late in my teenage years. How, I wondered at the time, did everything work together to create what, from the air, looked so harmonious? I had not the faintest idea. The question led me to study economics, first at Penn State and then at MIT, where I earned a doctorate after mastering, among other concepts, Adam Smith’s “invisible hand.” It explains the order I sought to understand.
As I observed Houston from the air, my age now decades older, the importance of interstate roads was obvious. Without them, I’d see the minor roads jam-packed. The private airport we flew over could never handle the traffic at Houston’s IAH, a vast airport that’s supported the city and region’s growth. Schools and parks were visible every few minutes of flying. Zoning was apparent as well. Finally, the air was clean; there was no smog to hide the view.
I realized that we rarely take the time to appreciate that all this “order” is thanks in large measure to the government—at the federal, state, and local levels—and the taxes that support it.
In the Presidential and Vice-Presidential debates this season, I wish there had been a robust discussion of the role of government and what would be lost if our government no longer functioned or functioned as well. (And what we’d gain if our politics functioned better, but that is a topic for another day.) The devastating losses from Florida to western North Carolina from the recent hurricanes are but one example of efforts that demand a government ready to help. Without it, recovery would be impossible.
Healthcare is another example. Vance presented Trump’s alternative plan to the Accountable Care Act (ACA) in the Vice Presidential debate. They advocate two risk pools—one for healthy people and one for those with pre-existing conditions. The promise is lower insurance rates for the healthy. We’ve been here before as a nation, and that approach doesn’t work. Individuals with pre-existing conditions are priced out of the market, or insurers refuse to cover them. It’s the same issue we see today with home insurance in high flood or fire risk communities.
The genius of the ACA was in eliminating the use of pre-existing conditions to price or deny insurance. The policy then grouped people into shared risk pools. The result? People without access to employer group insurance (which never had a pre-existing condition clause) got group insurance at affordable rates or with a federal subsidy if needed. Healthy individuals can now select a cheap, high-deductible plan to protect from a bankruptcy-inducing health crisis.
Only the government could step in and make this change to our health system. Another change? Under Biden, we also saw the federal government bargain with big pharma to lower the price of some prescription drugs for Medicare and Medicaid recipients. Every other nation does this negotiation; why not the US?
The government could do a lot more to lower healthcare costs. One is to reduce avoidable patient harm, which Medicare and Medicaid are working hard on. Another is to mandate a common administrative form across all insurers. That would go a long way toward reducing the administrative costs of our healthcare system, which are about 5% higher than those of other nations.
Think for a moment about the broad scope of government: The legal system, environmental work, drug and food protections, our stellar national park system, roads, airports, trains, and ports, research that has led to medical and technological breakthroughs, public universities and PK-12 systems, National Defense, safe workplaces, and more. All are the result of government investment, functions or regulations.
Much about Trump and Vance worries me, but here is a top worry: They want to take a far deeper cut into our federal civil service function and make it beholden to the whims of the team populating the White House. This move would be devastating to the effective functioning of our federal workforce. Federal service would no longer be an attractive career for professionals, as the doors would swing one way and then another as White House political parties changed.
We need experts, not hackers and grifters, to help those hurt by hurricanes. We need Department of Justice leaders who serve the people, not the President. Drug approvals should be neither political nor pay-to-play. National Parks belong to us, not industry. You get my drift.
Your vote is your voice about what matters. Before you vote, take a moment to reflect on the role of the Federal Government.