The Impact of Price Transparency in Outpatient Provider Markets

By Kayleigh Barnes, Sherry A. Glied, Benjamin R. Handel & Grace Kim.

"Medical provider price transparency is often touted as a way to lower health care spending. But the impact of price transparency is theoretically ambiguous: it could lower health care spending via increased consumer price shopping or improved insurer bargaining but could also raise health care prices via improved provider bargaining or provider collusion. We conduct a randomized-controlled trial to examine the impact of a state-wide medical charge transparency tool in outpatient provider markets in New York State. In the experiment, individual providers’ billed charges (list prices) were released randomly at the level of the procedure and three-digit zipcode. We use a comprehensive commercial claims database to assess the impact of this intervention and find that it leads to a small increase in overall billed charges (+0.75%). This effect is concentrated among low-priced providers in markets with low out-of-network spending, suggesting that the transparency tool improves provider pricing information. We find no evidence of quantity effects. Results do not vary consistently across specialty groups, market concentration, frequency of service use, or frequency of website use. These results are consistent with price transparency having a minimal effect on consumer shopping while slightly improving provider information about competitors’ charges."

More Than 100 Years After its Creation, Officials Seem to Finally Realize That Overly Restrictive Zoning is Problematic

By Matthew Prensky of Institute Justice. 

"Late last month a Tennessee state commission found zoning, particularly single-family zoning, was one of the driving factors behind the state’s affordable housing crisis. The findings mirror a growing trend across the country: officials have finally realized that overly restrictive zoning is problematic.  

For more than 100 years municipalities have enacted increasingly strict and arbitrary rules to control where homes are built. Zoning was supposedly meant to help protect residents by restricting what could be built next to them, particularly in residential areas. But as officials are starting to learn, zoning has helped create a severe housing shortage, causing home prices to skyrocket. It has also been weaponized by local officials to punish critics or hurt well-meaning Americans who were trying to use their land to solve public problems. Now, jurisdictions are rolling back zoning regulations. 

Today, as much as 75% of land that is zoned for housing in American cities is set aside for single-family zoning, one of the most restrictive types of zoning. While only 40 of the 95 counties in Tennessee had zoning in 2020, the Tennessee state commission said that among the six counties it studied, larger multi-family housing like triplexes isn’t allowed on more than 94% of the land. In fact, in one of the counties, 82% of the land is zoned for single-family homes only. 

When comparing counties with zoning to those without it, the commission found the presence of zoning was associated with a lower rate of available housing, thereby exacerbating housing affordability dilemma. And that finding is consistent with a broader national trend: the more restrictive the zoning, the greater the cost of housing. To combat this problem, the commission looked to other U.S. locales that have already started to tackle the affordable housing shortage wrought by their own overly restrictive zoning laws. Based on those findings, it recommended lawmakers enact legislation that incentivizes local governments to adopt zoning reforms—a strategy the commission said other states such as Montana have adopted in the past. 

Local, state, and even federal lawmakers have started loosening or ending restrictive zoning practices altogether in recent years. Montana, Oregon, California, Washington, and Maine have ended single-family zoning. Most recently, Arizona enacted two laws—one that gives homeowners in certain cities the right to build multiple accessory dwelling units on their properties and another that requires cities of 75,000 or more to allow builders to build duplexes, triplexes, and townhomes in portions of new single-family zoning. 

Housing has become unaffordable for too many Americans. Reforming zoning, particularly single-family zoning, will not only help address housing affordability; it will also restore Americans’ right to use their properties as they see fit. Nationwide, arbitrary zoning requirements have stopped Americans from finding private solutions to local affordable housing crises, opening and operating home businesses, or using their land to help others or their community. Prohibiting all these uses simply because the government doesn’t believe they belong in a certain area is both counterproductive and illogical. 

Zoning has wreaked havoc on housing in America. Its deprived people of their right to use their land as they see fit, punished well-meaning individuals, and driven a core part of the American Dream—owning a home—out of reach for far too many. Everyone wants to live somewhere safe, convenient, and affordable; overly restrictive zoning shouldn’t get in the way of that. At IJ, we’re working to fix that through our new Zoning Justice Project, and luckily, it seems some local, state, and federal leaders are finally joining in on that fight."

Pennsylvania Vouchers From Milton Friedman to Jay-Z

The coalition for school choice expands in the Keystone State. Will Gov. Shapiro fight for poor families this time?

WSJ editorial. 

"As the Pennsylvania Legislature hurries to wrap up its budget before a June 30 deadline, the battle for school choice has resumed. But this is not your father’s voucher fight. Those lining up behind the push for choice include several dozen black pastors along with the famous rappers Jay-Z and Meek Mill.

This month Jay-Z’s entertainment company Roc Nation announced it is supporting the campaign for school choice in the Keystone State. Roc Nation says “we are supporters of the public school system,” but that opposing vouchers is in effect “telling Pennsylvania’s most vulnerable students that they must remain captive to a system that is not working for them.”

Milton Friedman couldn’t have put it better when he proposed vouchers more than a half century ago. Roc Nation then spells out the ugly educational results in Pennsylvania:

“According to the 2023 Pennsylvania System of School Assessment (PSSA), roughly 75 percent of eighth-grade students in the Pennsylvania public school system aren’t proficient in math while 47 percent aren’t proficient in language arts. Furthermore, in the bottom 15 percent of the state’s public schools, the data reveals that less than 10 percent of students are proficient in math, and only 25 percent are proficient in English. In 40 schools across the state, there were no students—absolutely none—that met the grade-level proficiency criteria in math.”

Those numbers should be shocking to anyone who cares about those students, as well as the fate of America. They should also demand a change from the status quo

Yet last year Democratic Gov. Josh Shapiro reneged on the support for vouchers he expressed in his 2022 campaign for Governor, bowing without a fight to opposition from teachers unions and the Democratic-controlled Pennsylvania House. He said he’d line-item veto the education scholarships—from $2,500 to $10,000 with up to $15,000 for special needs—if they were in the final package.

This year the forces for choice are back with a broader coalition. The measure Mr. Shapiro killed last summer would have provided $100 million in scholarships. Though there’s no specific estimate so far, this time proponents are pushing for $300 million to start the program.

Corey DeAngelis of the American Federation for Children acknowledges that only students in the worst 15% of schools would be eligible for a scholarship. That’s well short of the universal choice measures that have passed in about a dozen states.

But children in the worst schools need the most urgent help, and the bill would be a big step in a state with a Democratic Governor and House. In progressive states like New York, Illinois and New Jersey, the unions own the Legislature and the Governors.

Gov. Shapiro is often touted as having White House potential. But by wimping out on school choice last summer, he missed a moment to side with parents over unions. Maybe Jay-Z could set him straight."

Is Business Really ‘Part of the Problem’?

Montana Sen. Jon Tester thinks the success of his Republican opponent Tim Sheehy is disqualifying

WSJ editorial. 

"When President Obama told business owners “you didn’t build that” during his 2012 campaign, Democrats scrambled to cover for his gaffe. Today’s left says you built that, and you’re to blame.

That’s how Montana Democratic Sen. Jon Tester described his opponent, Tim Sheehy, at their first debate this month. “We’ve had a lot of folks move into this state, a lot of folks with thick wallets,” Mr. Tester said. “Tim Sheehy is not part of the solution; he’s part of the problem.”

The goal is to paint Mr. Sheehy as a mustache-twirling tycoon foreign to the rural West, but it’s an odd description of his career. He founded Bridger Aerospace in Montana a decade ago and took it public last year. “Creating jobs in this state was an honor for me to do,” Mr. Sheehy shot back.

The company outfits planes to survey and suppress wildfires, inspired by air-support methods Mr. Sheehy learned as a Navy SEAL. Last year the Interior Department hired him to map fire-prone lands, and the company brought $67 million in revenue to Big Sky country. This is what Sen. Tester calls part of the problem.

He also tarred Mr. Sheehy as one of the “folks that drive up the cost of housing.” He’s playing on Montanans’ frustration with newcomers, as high earners from California and elsewhere have driven up demand for Montana homes.

It’s a rich line from Mr. Tester, who has helped push up the cost of living by voting for trillions of dollars in Biden Administration spending. Like most of the left, he’s determined to shift blame to the wealthy and businesses.

Attacking Mr. Sheehy’s career is plan B for Democrats, after they tried and failed to boost a less popular challenger in the GOP primary. Voters aren’t likely to agree that a successful local business is a big problem, but the episode is another revealing look at how progressives view the economy."

Look Who the EPA Is Funding Now

WSJ editorial.

"The Inflation Reduction Act is the political gift that keeps on giving—especially if you’re a lobby for progressive causes. We recently told you that the Environmental Protection Agency handed IRA money to an outfit backing anti-Israel protests. Turns out EPA is also funding groups that oppose immigration enforcement.

That’s the latest discovery by West Virginia Sen. Shelley Moore Capito’s office, which is probing IRA spending. The law appropriated $3 billion for Environmental and Climate Justice block grants. EPA is supposed to select “grantmakers” and “partner” organizations to spread around the largesse.

EPA tapped Fordham University as a grantmaker to distribute $50 million, in collaboration with the New York Immigration Coalition (NYIC) and the New Jersey Alliance for Immigrant Justice (NJAIJ). What does immigration have to do with climate? Nothing, though progressives say the issues “intersect” in the oppression of minority groups.

According to the EPA, Fordham and its partners will take “an intersectional approach to place frontline communities in positions of power” to advance climate justice “in disadvantaged and hard-to-reach communities and communities disproportionately impacted by climate change, pollution, and other environmental stressors.” What does that even mean?

Perhaps abolishing Immigration and Customs Enforcement (ICE), which is what NYIC advocates. NYIC condemned ICE as “racist and abusive” at a “Member Congress” in January. The group this month rallied with Democrats in Albany for a bill to prohibit local law enforcement from working with ICE.

After President Biden’s election, the New Jersey Alliance for Immigrant Justice called for ending “all ICE transfers” and “all forms of incarceration in NY and NJ.” Does that count migrant criminals, including Venezuelan gang members, who prey on the innocent? NJAIJ boasts that its New Jersey policy victories include state cash assistance for undocumented immigrants and a ban on local government contract renewals with ICE.

As Mr. Biden talks tough on border security, his EPA is funding groups that are seeking to undermine immigration enforcement. It’s no surprise that IRA money is being misspent. But we can’t help wondering whether the Administration is trying to fund the resistance to a future Trump Administration."

Soaring U.S. Debt Is a Spending Problem

Revenue is stable, but outlays are reaching new heights as a share of GDP.

WSJ editorial. Excerpts:

"this year’s budget deficit will clock in at roughly $2 trillion, some $400 billion more than it forecast in February and $300 billion larger than last year’s deficit. This is unprecedented when the economy is growing and defense spending is nearly flat. The deficit this fiscal year will be 7% of GDP, which is more than during some recessions."

"says deficits will stay nearly this high for years"

"Debt held by the public will grow to 122.4% of GDP in 2034 from 97.3% last year."

"Revenue is expected to total 17.2% of GDP this year—roughly the 50-year average before the pandemic"

"Outlays are now expected to hit 24.2% of GDP this year and average 24% over the next decade."

"spending before the pandemic exceeded 24% only once since World War II—in 2009 amid the financial panic and the Obama-Pelosi “stimulus” binge."

"overall defense spending is still falling as a share of the economy and is expected to hit a postwar low of 2.8% of GDP in 2034."

"Biden’s latest plans for student-loan debt transfer to taxpayers, which CBO estimates could cost $211 billion this year above what it estimated in February. This is on top of the hundreds of billions of dollars in student debt that Mr. Biden has already written down"

"CBO increased its ACA spending estimate by $22 billion for this year and $244 billion over the next decade. It also raised its ACA enrollment projection by four million for this year and an average of three million over the next 10 years."

"the Inflation Reduction Act’s sweetened subsidies and a Biden Administration regulatory change increased eligibility for subsidies."

"The end of the pandemic emergency was expected to cause Medicaid enrollment to plunge."

"Democratic-run states have been slow to remove able-bodied adults who are no longer eligible. CBO has thus increased its forecast for Medicaid spending by $50 billion in 2024 and $314 billion over the next decade."

"Spending on interest is now expected to be $1.02 trillion next year, exceeding $964 billion for defense."

"If spending as a share of GDP remained at the pre-pandemic average, the deficit would be roughly $890 billion this year and $13.4 trillion smaller than CBO’s 10-year projection."

Ignoring Tech’s Past to Spite AI’s Future

It isn’t only the companies everyone loves to hate that are leading the way with this budding technology

Letter to WSJ.

"I was disappointed to see William Barr’s op-ed “Big Tech’s Budding AI Monopoly” (May 28) continue his attack on some of America’s most innovative companies. Mr. Barr’s fear that a few large companies will stifle competition reveals a fundamental misunderstanding of the dynamic, evolving ecosystem of generative artificial intelligence.

The U.S. tech giants everyone loves to hate are certainly major players but hardly the only ones. They aren’t even the only large companies leading the way—look to Nvidia and IBM, among others. Additionally, Meta’s Llama large language model is open source, a space teeming with new innovative firms and startups. The budding AI market isn’t in danger of monopoly.

The idea that Big Tech can easily dominate adjacent markets such as generative AI ignores the many examples of failure that litter the road to innovation, from Google+ and Amazon’s Fire Phone to past would-be giants AOL, Nokia, Palm (maker of the PalmPilot) and a host of others. Success in one area doesn’t guarantee it in another, even for large companies.

The U.S. dominates the global tech market today precisely because policy makers chose at the internet’s advent to take a light touch. The market is a discovery process that feeds on the dispersed knowledge of entrepreneurs, risk-takers and innovators. Suggesting that a beefed-up Federal Trade Commission with European-style regulations will yield better outcomes ignores the past to spite the future.

Wayne T. Brough

R Street Institute

Washington"