Were GAO Warnings about Healthcare.gov Unheeded?

A Government Accountability Office report on last fall’s HealthCare.gov debacle, released Wednesday in advance of a House Energy and Commerce subcommittee hearing Thursday, details what went wrong. But the bigger questions involve the culture that led administration officials to ignore–and even publicly repudiate–the warning signs that the GAO flagged well before the federal health exchange Web site crashed last October.

Much of the GAO report delves into details of federal contracting policy. But a passage on Pages 3 and 4 illustrates broader problems:

In our June 2013 report on CMS efforts to establish the federal marketplace, we concluded that certain factors–such as the evolving scope of marketplace activities required in each state—suggested the potential for implementation challenges going forward. In comments on a draft of that report, HHS [the Department of Health and Human Services]… expressed its confidence that marketplaces would be open and functioning in every state on October 1, 2013.

The June 2013 GAO report predicted in clear language many of the problems that eventually plagued the federal exchange:

Much progress has been made, but much remains to be accomplished within a relatively short amount of time….However, certain factors, such as the still-unknown and evolving scope of the exchange activities CMS will be required to perform in each state, and the large numbers of activities remaining to be performed–some close to the start of enrollment–suggest a potential for implementation challenges going forward….Whether CMS’s contingency planning will assure the timely and smooth implementation of the exchanges by October 2013 cannot yet be determined.

Despite these warnings, officials asserted that all was well with Affordable Care Act implementation–until the Web site crashed on Oct. 1.

This week’s GAO report notes that the cost of the contract for a new company to repair the federal exchange nearly doubled–from $91 million to $175 million–over the past six months. The administration explained some of the expense, but the GAO noted that not all of the increase is attributable to the reasons the administration cited. “We continue to believe that a further assessment is needed to ensure that costs as well as requirements are under control and that the development . . . is on track to support the scheduled 2015 enrollment process,” the report said.

Part of effective governance involves adhering to contracting procedures that ensure taxpayers receive value for money and establishing an internal culture that acknowledges faults and in which people work in a transparent manner to resolve them. The GAO report demonstrates how the administration fell short in both respects.

This post was originally published at the Wall Street Journal Think Tank blog.

Obamacare Challenges: Where the Conventional Wisdom Falls Short

Since the U.S. Court of Appeals for the D.C. Circuit struck down an Internal Revenue Service regulation implementing Obamacare, some observers have predicted that the IRS rule would ultimately be upheld. The regulation extends federal subsidies to individuals purchasing insurance from federal exchanges and not just state-run exchanges, as the Affordable Care Act specifies. But when it comes to legal challenges regarding the health-care law, the conventional wisdom has sometimes been wrong.

Consider, for instance, the Supreme Court’s decision upholding Obamacare two years ago. The day that the court ruled in June 2012, President Barack Obama said: “Earlier today, the Supreme Court upheld the constitutionality of the Affordable Care Act.

Actually, the court was more nuanced. On Page 58 of the ruling in National Federation of Independent Business v. Sebelius, the justices wrote: “The Affordable Care Act is constitutional in part and unconstitutional in part.” While the court upheld the individual mandate as a permissible exercise of the taxation power, it struck down provisions of the ACA’s expansion of Medicaid as unconstitutional “economic dragooning that leaves the States with no real option but to acquiesce in the Medicaid expansion.”

Two years later, a digital campaign on the White House Web site argues for states to expand Medicaid under the ACA–and warns of dire consequences for those that do not. But the administration embarked on the campaign because the Supreme Court made Medicaid expansion optional for states.

It’s also worth noting that seven of the nine Supreme Court justices agreed that it was unconstitutional to mandate Medicaid’s expansion. Those seven justices included Stephen Breyer, previously a staffer for Sen. Edward Kennedy, and Elena Kagan, a former solicitor general in the Obama administration. So those predicting that some judges and justices would preserve the IRS rule based solely on which president appointed them to the bench may yet be disappointed.

Legal decisions don’t always break down along party lines or meet political talking points. That’s something to bear in mind as the cases wind through the courts.

This post was originally published at the Wall Street Journal Think Tank blog.

An Obamacare Bombshell

Just when advocates of Obamacare claimed that the law was taking root and becoming more popular, a federal appeals court tossed a massive monkey wrench in that narrative.

Earlier this morning, the Court of Appeals for the D.C. Circuit overturned an Internal Revenue Service ruling that allows individuals in states where the federal government runs insurance exchanges to receive insurance subsidies.

Because the federal government operates insurance exchanges in 36 states, the ruling—which the Obama administration will almost certainly appeal—places much of the Obamacare regime into question. Conservatives argued repeatedly that the law only allowed for federal subsidies in “an Exchange established by the state.” Supporters of the legislation, while conceding that the law was poorly and hastily drafted, argued that Congress intended to extend subsidies to individuals in both federally-run and state-run exchanges, and that the IRS exercised appropriate discretion in tailoring the rule to meet that intent. Today the Appeals Court clearly disagreed.

The ruling provides yet more evidence of the problems inherent in legislating on such a massive scale, which I noted earlier this morning. Even under the most favorable interpretation taken by the law’s supporters, Congress rushed to pass a sloppily worded document, leaving it to unelected bureaucrats to decipher lawmakers’ true intent. The plaintiffs—and the court in its ruling—believe that the administration clearly overstepped its authority, a fact that will no doubt energize those concerned about the executive exceeding its power. Regardless, either interpretation makes a compelling against future attempts to enact major policy changes on such a broad scale in such a fast manner.

This post was originally published at the Wall Street Journal Think Tank blog.

Obamacare and the Pitfalls of Congressional Legislating

Weeks before Congress embarked on its final push to put Obamacare on the statute books, then-House Speaker Nancy Pelosi infamously stated that Congress had to pass the bill “so that you can find out what’s in it.” But last week, a staffer at the heart of drafting the legislation admitted that Congress itself failed to comprehend the implications of the provisions it imposed upon the American people.

On Friday, a Capitol Hill newspaper published a story outlining the history of Obamacare’s employer mandate and whether the administration might delay its implementation still further. In the article, Yvette Fontenot—a lobbyist who helped write the bill for then-Senate Finance Committee Chairman Max Baucus and later worked on implementing the legislation at the White House—admitted that when Mr. Baucus’s staff drafted the employer mandate, “we didn’t have a very good handle on how difficult operationalizing the provision would be at that time.”

Indeed, the employer mandate has proved difficult to implement. Defining who counts as a full-time employee across a variety of industries and creating databases to track employees’ hours have taxed regulators and companies alike. While the administration has cited these difficulties in twice delaying the mandate’s implementation, the law’s critics take a different view—believing the administration postponed the mandate to avoid potential stories about job losses prior to the 2014 elections.

Likewise, the import of Ms. Fontenot’s admission. Liberals and supporters of a strong executive might argue that her comments highlight the need for agency rulemaking, rather than placing final authority in the hands of inexpert legislators and overtaxed congressional staff—essentially saving Congress from itself. House Speaker John Boehner obviously disagrees. The Ohio Republican views the impending House vote exploring legal action against the administration as one way for the legislature to regain its authority.

But more broadly, conservatives would argue that Ms. Fontenot’s comments highlight the need for a more deliberative—and more humble—Congress, one quicker to acknowledge its own flaws, and change its processes accordingly. Recall that Max Baucus—the prime congressional author of Obamacare—said four years ago that he didn’t want to “waste my time” reading the legislation, because “we hire experts.” But one of those “experts” now says she didn’t understand how one of the major portions of the bill would work. It makes a very compelling argument that Congress, rather than relying on agency employees to resolve its self-imposed problems, should instead revert to the Hippocratic oath, and focus first and foremost on doing no legislative harm.

This post was originally published at the Wall Street Journal Think Tank blog.

CBO Forecast Points Up the Need for Entitlement Reform

The Congressional Budget Office’s annual long-term budget forecast prompted numerous news articles about a potential slowdown in the growth of health spending and what that would mean for Medicare and other programs. But federal entitlement spending in the short and medium term will be defined much more by the demographics of an aging population–10,000 baby boomers reach retirement age every day–than by whether policymakers can bend the proverbial cost curve in health care.

The CBO admits as much. In Box 1-1 (Pages 22-23) of its report, the budget office compares the relative weight of three factors in increased health spending: the aging of the population; excess cost growth; and newly created (and in the case of Medicaid, expanded) entitlements under Obamacare. Over the next 10 years and the next 25 years, the effects of an aging population exceed the effects of cost growth when it comes to spending on federal programs.

Because demographics put greater pressure on federal entitlement spending over the next generation than excess cost growth, efforts to bend the health-care cost curve–even if successful–miss the larger problem: If per-beneficiary costs rise not a penny, growing numbers of beneficiaries would still create their own fiscal pressures. For instance, under Medicare’s current structure, a couple about to retire stands to receive three times as much in benefits as they paid in Medicare payroll taxes during their working lives.

Resolving the spending pressures in federal entitlements will require more than efforts to reduce the growth in health-care costs. Broader structural reforms–such as additional means-testing for entitlement programs, or a premium support structure for Medicare–must be an important element of the discussion.

The CBO forecasts were not nearly as sanguine as some coverage suggested. Overall debt-to-GDP projections for the next 25 years rose compared with the CBO’s estimates from September, partly because of reduced projections for economic growth. These projections emphasize the need to enact structural entitlement reforms soon–before the demographic wave of the coming years fully hits. Unfortunately, those focused on the idea that “bending the curve” can save them from the tsunami may not recognize the error of their ways until it is too late.

This post was originally published at the Wall Street Journal Think Tank blog.

Over 1,200,000,000,000 Reasons to Repeal Obamacare

A PDF of this document is available on the America Next website.

Regardless of their opinions on Obamacare, the American people remain unified on one key issue: When it comes to health care and heath insurance, they are most worried about its rising costs. And on that front, Obamacare—by President Obama’s own standards—has fallen woefully short. Analysis conducted by America Next quantifies the dollar impact behind President Obama’s broken promise that his health plan would reduce costs—providing over 1.2 trillion reasons why Obamacare has failed and should be repealed.

The Promise

During his 2008 campaign, then-Senator Obama promised on numerous occasions that his plan would reduce premium costs for the average family by $2,500 per year.1 His campaign staff went even further; Jason Furman, the campaign’s economic policy director—and currently the Chairman of President Obama’s Council of Economic Advisors—alleged that “we think we could get to $2,500 in savings by the end of the first term, or be very close to it.”2

The Reality

Contrary to candidate Obama’s promise, health insurance premiums have continued to rise every year President Obama has been in office. Compared to a baseline year of 2008—the year Barack Obama was elected—the average family premium for employer-sponsored coverage rose by more than $2,500—$3,671, to be precise.3 Over that same period, Americans have faced a cumulative $6,388 per individual, and $18,610 per family, in higher premium costs because President Obama failed to achieve the reductions he promised from his health plan.

The Economic Impact

Individually, ever-rising insurance premiums place a tremendous squeeze on a hollowed-out American middle class—but collectively, these costs amount to a massive weight on an American economy struggling to grow. All told, the American people have faced $1.2 trillion in higher health insurance premiums due to Obamacare’s failure to deliver.

These higher premiums affect economic growth—by directing resources into the health care sector that could otherwise be used to expand manufacturing, create new technologies, etc.

Given annual full-time private sector compensation rates, the amount spent on higher health insurance premiums equals the cost of an average of 3.9 million jobs each year, and nearly 6 million jobs in 2013 alone. With the labor force participation rate at 36-year lows, Obamacare’s failure to deliver lower health insurance premiums represents a further drag impeding the growth of the economy and jobs.4

A Better Way

Even as Obamacare has failed to deliver on its promise to reduce health insurance premiums—raising premiums and health costs due to higher mandates, regulations, and new government spending—the America Next health plan can provide the relief from rising costs that Americans need and deserve. Rather than focusing on a massive expansion and re-structuring of the health care system, the America Next plan focuses like a laser beam on reducing health costs. Analysis by independent, non-partisan experts confirms the plan’s effectiveness; when considering proposals similar to those in the America Next plan, the Congressional Budget Office concluded in 2009 that they would lower small business health insurance premiums by 7 to 10 percent, and reduce individual health insurance premiums by 5 to 8 percent.5 Compared to the premium increases projected under Obamacare, the reforms in the America Next plan could provide thousands of dollars in real relief for families struggling from high insurance premiums.6

Need for Full Repeal

In August 2012, Politifact examined the Obama campaign’s 2008 promise of lower premiums with the inexorable trend of rising health costs:

In assessing this promise, we consider the following: An author of the $2,500 figure has disavowed its use as it relates to premiums alone. An independent health care analyst projects that premiums will go up for the typical family. The federal agency implementing [Obamacare] did not provide evidence that premiums will go down for the typical family. We rate this a Promise Broken.7

The American people recognize the President’s rhetoric as a promise broken too. It’s why Obamacare should be repealed in its entirety, and why conservatives should focus on alternatives—such as those in the America Next health plan—that will lower health costs and premiums, not raise them further.

 

1. A video compilation of candidate Obama’s remarks on this issue from the 2008 campaign is available at http://freedomeden. blogspot.com/2010/03/obama-20-promises-for-2500.html.
2. Kevin Sack, “Health Plan from Obama Spurs Debate,” New York Times July 23, 2008, http://www.nytimes.com/2008/07/23/ us/23health.html?pagewanted=print.
3. Kaiser Family Foundation and Health Research and Educational Trust, “Employer Health Benefits: 2013 Annual Survey,” August 2013, http://kaiserfamilyfoundation.files.wordpress. com/2013/08/8465-employer-health-benefits-20132.pdf, Exhibit 1.11, p. 31.
4. Bureau of Labor Statistics, Labor Force Participation Rate series, http://data.bls.gov/timeseries/LNS11300000. 5. Congressional Budget Office, analysis of House Republican substitute amendment to H.R. 3962, November 4, 2009, http:// cbo.gov/sites/default/files/cbofiles/ftpdocs/107xx/doc10705/ hr3962amendmentboehner.pdf.
6. Congressional Budget Office, Letter to Sen. Evan Bayh regarding premium effects of the Patient Protection and Affordable Care Act, November 30, 2009, http://cbo.gov/ sites/default/files/cbofiles/ftpdocs/107xx/doc10781/11-30premiums.pdf; press release by House Ways and Means Committee Ranking Member Dave Camp, November 5, 2009, http://waysandmeans.house.gov/news/documentsingle. aspx?DocumentID=153186.
7. J.B. Wogan, “The Obameter: Cut the Cost of a Typical Family’s Health Insurance Premium by up to $2,500 a Year,” Politifact August 31, 2012, http://www.politifact. com/truth-o-meter/promises/obameter/promise/521/cutcost-typical-familys-health-insurance-premium-/.

Methodology

Insurance Coverage: The analysis utilizes Census Bureau data regarding the number of individuals with private, employer-provided health insurance and private, directly purchased health insurance. The analysis further uses data from the Department of Health and Human Services’ Medical Expenditure Panel Survey (MEPS) to categorize the number of Americans holding family insurance coverage, and the number of Americans with self-only insurance plans. The average number of participants in a family plan comes from a breakout of family policies purchased by size, as reported by ehealthinsurance.com.

Premiums: The analysis incorporates data from the Kaiser Family Foundation/ Health Research and Education Trust annual survey of employer-provided health insurance to determine average premiums. For those Americans with direct-purchase insurance, premiums data come from annual reports on the Cost and Benefits of Individual Health Insurance issued by ehealthinsurance.com.

The analysis assumes the $2,500 reduction in average family premiums by the end of President Obama’s first term would be achieved as a $625 reduction each year (i.e., $625 reduction in 2009, $1,250 reduction in 2010, $1,875 in 2011, and $2,500 in 2012), with no additional reductions thereafter. The relevant reductions for self-only plan premiums are $927 for employer-provided insurance and $1,077 for directly-purchased insurance over the course of President Obama’s first term— based on the ratio of individual to family premium costs in 2008, when the promise was made.

Aggregate Estimates: The analysis calculated total impact of the broken promise by multiplying the number of individuals in each group (self-only employer-provided, family employer-provided, self-only direct-purchase, and family direct-purchase) by the difference between actual and promised premiums for the particular group.

Jobs Estimate: To illustrate the economic opportunity costs of the broken promise, the analysis divided the aggregate premium impact by the average employee compensation for full-time, private sector employees in the relevant year, as compiled by the Bureau of Labor Statistics’ Employer Costs for Employee Compensation Survey.

Gov. Jindal Op-Ed: Your Health Care: Obama’s $18,000 Broken Promise

How would you feel if someone promised to give you a car, and then reneged on that pledge?  That’s how all Americans should feel when it comes to Obamacare — because Barack Obama’s failed and discredited campaign promise to lower health insurance premiums has cost the average American family an amount equal to the price of many new cars.

During his 2008 campaign, one of then-Senator Obama’s most audacious promises was that his health plan would reduce premiums by $2,500 for the average family.  His repeatedly made his pledge on videotape; you can view those promises here.  But health insurance premiums have continued to rise — not just despite Obamacare, but in many cases because of the law’s new regulations and mandates.

A new analysis by the think-tank America Next, where I serve as honorary chairman, quantifies the massive scope of the broken promise.  Compared to 2008 — the year President Obama was elected — Americans have faced a cumulative $6,388 per individual, and $18,610 per family, in higher costs because President Obama’s health plan has failed to achieve its promised premium reductions.  Overall, that amounts to $1.2 trillion in higher premium costs due to Obamacare’s failure to deliver.

The administration has put forth all sorts of excuses about why its law hasn’t met the expectations the president himself set. One of them is that the law’s major provisions only took effect in January, so Obamacare needs more time to achieve savings.

But, in July 2008, Jason Furman—then the Obama campaign’s economic policy director, and now the Chairman of President Obama’s Council of Economic Advisors—told the New York Times that “we think we could get to $2,500 in savings by the end of the first term, or be very close to it.”

The fact that Democrats delayed full Obamacare implementation until 2014 to hide the legislation’s true cost shouldn’t absolve President Obama for failing to deliver on his promise one whit.

The administration also now claims that Obamacare is working, because premiums are “only” rising by 6 or 8 percent per year.  But that’s not what then-candidate Obama himself promised in 2008; he spoke frequently of “cutting,” “reducing,” and “lowering” premium costs.  Whether premiums go up by 1 percent or 101 percent, any increase represents a promise broken.

In August 2012, Politifact nicely summed up Obamacare’s discredited premium pledge: “An author of the $2,500 figure has disavowed its use as it relates to premiums alone.  An independent health care analyst projects that premiums will go up for the typical family.  The federal agency implementing [Obamacare] did not provide evidence that premiums will go down for the typical family.  We rate this a Promise Broken.”

Even as Obamacare has failed to deliver, there is a better way.  The America Next health plan can provide the relief from rising costs that Americans need and deserve.  Rather than focusing on a massive expansion and restructuring of the health care system, the America Next plan focuses like a laser beam on reducing health costs. The plan creates incentives for states to reform their insurance markets, thereby reducing plan premiums. It also includes other reforms with a proven track record of lowering costs, including tax equity between employer-based and individually-purchased insurance plans, lawsuit reforms, and new incentives for Health Savings Accounts.

Analysis by independent, non-partisan experts confirm the plan’s effectiveness.  When considering proposals similar to those in the America Next plan, the Congressional Budget Office concluded in 2009 that they would lower small business health insurance premiums by 7 to 10 percent, and reduce individual health insurance premiums by 5 to 8 percent.  Compared to the premium increases projected under Obamacare, the reforms in the America Next plan could provide thousands of dollars in real relief for families struggling from high insurance premiums.

The America Next report confirms that the average American family has paid a price equal to the sum of many new cars because Obamacare has failed to meet the president’s commitments. And, as with any balky automobile, it’s time for the American people to trade in this Obamacare lemon, and replace it with something that works. Coupled with Obamacare’s full repeal, the America Next health plan can provide what the American people need—real relief from skyrocketing health costs.

This post was originally published at Fox News.

Why States Are Hesitating to Expand Medicaid

Just before the July 4 holiday the White House Council of Economic Advisers released a report titled “Missed Opportunities: The Consequences of State Decisions Not to Expand Medicaid.” The Pew Trusts also released a data compilation last week. But that one showed why many states, which had large and growing Medicaid programs even before Obamacare, have not rushed to embrace greater expansion.

Pew examined data from 2000 to 2012 and found large increases in state Medicaid spending even after adjusting for inflation. Nationally, Medicaid spending grew an average of 4% more than inflation every year during this period. All but two state Medicaid programs grew at real (inflation-adjusted) rates greater than 2% annually. In addition, programs in eight states and the District of Columbia grew at rates exceeding 5.9% per year–meaning that spending doubled during the 12-year period, even after accounting for inflation.

Some might argue that robust economic growth, which leads to an expanding revenue base, could allow states to absorb sustained increases in Medicaid spending greater than the level of inflation. But the Commerce Department’s Bureau of Economic Analysis found that inflation-adjusted gross domestic product grew 23.1% from 2000 through 2012. Meanwhile, Medicaid spending grew nearly three times as fast in inflation-adjusted terms: an average of 63% nationally. Only one state, New Hampshire, increased its Medicaid spending at a rate slower than the national economy grew from 2000 through 2012.

So during the decade before Obamacare took effect, states had dramatically increased their Medicaid expenditures—spending well above inflation and exceeding the economic growth their revenue forecasts are based on. Greater Medicaid expenditures have an opportunity cost: Many states have had to divert funds from education or other priorities to cover increased spending on health. Little wonder that many states have decided not to expand Medicaid further. In some respects, it may be smarter to ask why so many decided to embrace expansion.

This post was originally published at the Wall Street Journal Think Tank blog.

How Proposals for Obamacare Subsidies in 2015 Could Cost Taxpayers

In a Think Tank post last week, I explained why the number of unresolved inconsistencies in applications on the federal insurance exchanges probably exceeds the 2.9 million cited in two recent Department of Health and Human Services reports. Recent HHS proposals could allow many income-related inconsistencies to persist in 2015–potentially risking taxpayer funds.

In its proposed rule and related guidance for the 2015 open-enrollment season, the administration made two key decisions about determining re-eligibility for insurance subsidies. First, the guidance indicates that the exchanges would request updated tax return information solely from the IRS to determine eligibility for 2015 subsidies. Currently, the exchanges determine eligibility using information from the Social Security Administration and other income data sources, as well as tax information.

Second, most individuals who do not respond to requests to update their information would remain eligible for subsidies in 2015 at the same amount they received this year. (Their subsidies would not increase because of higher age or any premium changes.) Only individuals whose incomes appear to vastly exceed the thresholds for subsidies—what’s likely to be a “very small” group, HHS said in its guidance–or those who did not authorize the exchanges to review tax return data would not automatically receive subsidies in 2015.

The administration is seeking to streamline the process to determine eligibility, but the HHS inspector general’s investigations found the existing processes to be largely ineffective. An HHS report last week noted nearly 1 million inconsistencies relating to income reporting on applications. Because that includes only the federally run exchanges and only cases handled through Feb. 23, the number of inconsistencies is probably significantly understated. The inspector general’s office also found that HHS had resolved only about 1% of inconsistencies that occurred on the federal exchange between Oct. 1, 2013, and Feb. 23, though the health-reform law requires the department to resolve issues within 90 days.

With 1 million—and probably many more—applications containing inconsistencies over income, further liberalizing the subsidy eligibility criteria could create more problems. At best, individuals with inconsistencies that persist could eventually be forced to repay excess subsidies for 2014 and 2015. At worst, taxpayers could be on the hook for significant amounts of improperly paid subsidies.

This post was originally published at the Wall Street Journal Think Tank blog.

What the HHS Reports on the Health Exchanges Didn’t Cover

Recent media reports have highlighted unresolved inconsistencies in applications on the new insurance exchanges, including applications for federal premium and cost-sharing subsidies. Two reports released this week by the inspector general of the Department of Health and Human Services paint a troubling picture—and things could be worse than the reports suggest.

One HHS report examined data from federally run exchanges through Feb. 23 and from state exchanges through last December. Put another way, federal auditors tallied data from the months when the exchanges experienced middling to sluggish enrollment—not the periods when the greatest number of applications were completed.

The inspector general’s report indicates that federally run exchanges had 2.9 million data inconsistencies, of which only 1% had been resolved by late February. But those figures underestimate the number of inconsistencies from the 2014 open-enrollment period—and, unless data resolution has dramatically improved in recent weeks, probably also underestimate the number of inconsistencies still pending.

A separate inspector general’s report also released on Monday found that federally run exchanges, and state-run exchanges in California and Connecticut, in many cases lacked proper procedures for verifying applicant information. As a result, applications that should have been flagged for additional inconsistencies were not. Again, the scope of the verification problem is most likely understated.

When troubles became clear with the exchanges last fall, the focus on fixing immediate technical issues led to deferred work on verification systems. Overall, the reports expose another facet of the failures of Healthcare.gov—and the after-effects of last fall’s rollout could persist for some time.

This post was originally published at the Wall Street Journal Think Tank blog.