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Large franchised businesses and well-connected firms have hoovered up much of the capital of the Paycheck Protection Program (PPP) under the CARES Act. Despite its intention as a lifeline to small business, large firms have once again run roughshod over their smaller competitors. Once again, a complicated thicket of rules stood in the way for small business while large firms, armed with highly paid legal and accounting departments, slipped easily through. It’s a continuation of the misunderstanding of the relationship between regulation and power of large entities. Incumbents get what is in effect a moat in the form of paperwork that will easily overwhelm a lean start-up while their size means the costs of the regulation are often little more than a rounding error.

To illustrate, I’d like to talk about my friend Ray. He owns a small gym in Chicago which has been closed due to the stay-at-home order here. As soon as the PPP loans went live, he was trying to apply for one. He submitted his application as soon as he was able, but heard nothing from his bank initially beyond an automated email. He waited a day, then more, then a week. Finally, he went to the branch of his bank where his banker worked and knocked on the window to the man’s office. Since he knew the man personally, he was able to have a conversation outside (6 feet apart). He has not yet heard back on the status of his application, but he was at least able to (finally) get something in. Do you think Shake Shack or the Harvard Endowment had to knock on their banker’s window to get service?

Of course they didn’t. Banks are desperate for customers like that. They have enormous amounts of money to work with. Every minute spent with a Harvard Endowment likely nets as much profit as tens or hundreds of hours with small businesses like Ray’s. Why would a bank jeopardize the relationship they have with a large entity to make sure the application process was ‘fair’ for those applying for the PPP loans? Short answer: they wouldn’t.

It would have been difficult to foresee the obstacles to effectively deploying the money allocated to small business loans under the CARES Act, but that’s precisely the standard to which we need to hold our elected officials. Governing is not about posturing, it’s about creating an environment for your citizens to reach their potential and live relatively secure lives. These times are far from secure, but the federal government is uniquely positioned to cushion the fall that everyone in this country is currently experiencing.

Instead of rolling out a program targeted towards those in industries hardest hit by the pandemic, we over-complicated the response by trying to keep people on the payrolls. We spent more money on big business bailouts than small business lifelines and then big business even managed to finagle its way into the meager scraps left over for the small businesses that form the backbone of our economy.

The worst part is not the death of some businesses, but rather the uneven playing field. ‘Creative destruction,’ or the process by which inefficient or insufficiently productive enterprises are destroyed when they are out-competed by younger, hungrier ones is an essential part of capitalism. If we had bailed out carriage producers when automobiles replaced them, we would have had to wait decades longer before cars became ubiquitous. Small and young firms are often better equipped to handle a rapidly changing landscape because they are lean and able to quickly change direction; instead of providing the opening for a hungrier firm to dart into the openings left by a large business that was caught off-guard after, perhaps, spending effectively all of their cash flow on share buybacks, we have rained money down upon the incumbents while the challengers scrabble for crumbs dropping from the table. What broke capitalism in America? Corporate socialism and rent-seeking.

After the fall of the Roman empire, China became the unquestioned leader in economic and military might. In the 1400s, however, just before Columbus sailed across the Atlantic, the emperor ordered their fleet – about 3,500 oceangoing naval ships – burned. The ‘treasure fleet’ was too powerful and the emperor feared usurpation. Prior to that, they had likely colonized Madagascar and there’s even some evidence that they may have landed in South America. It was not until the 19th century that the West finally surpassed China economically. This happened because China stagnated as Europe and the US grew. Why? China, after it united, was isolated by mountains, desert, and ocean. Europe, however, was filled with nations protected by nothing but their own military might, technology, and intelligence. Europe continued to be forged in the fires of competition.

If a European leader decided that technology, ships, guns, or scientific discovery was not for them, they would be killed (quite literally in some cases) by their neighbors. China, which had established itself as the world’s greatest country and collected tribute from countries flung across the Pacific until the burning of the treasure fleet, was able to isolate itself with no immediately obvious consequences. It’s competition that creates processes, technologies, and discoveries. With competition comes pain, but from that pain comes progress.

Why, you may ask, am I talking about this right now? Competition is falling out of fashion and, with that, we are losing something essential. With respect to the current pandemic, people are asking one treatment to be ramped up before it is established as effective (Trump is calling for chloroquine treatments even as they cause heart failure and brain damage). The beauty of competition is that we have enormous sums of money being poured into research and thousands of brilliant scientists are fighting to become the ones that figure out an effective treatment. This is the power of our pharmaceutical and biotech industries (although sometimes they could use a bit more competition and less FDA prevention of generics, but that’s for another day). We should celebrate competition, not complain that someone is looking at different solutions to the same problem. Their solution may turn out to be correct!

Covid 19 has brought to the fore this conversation, but it’s by no means limited to treatment research. Many have deplored the ruthlessness of global capitalism as old manufacturing plants closed or asked outright whether the government would be better suited to running our real estate and healthcare industries (and more!). Things can always be improved, but when we remove competition from the equation, progress ends. We don’t have the luxury of isolation; if America steps aside, countries like China and Russia will take our place. The world will be much worse off for it.

Here I talk about some of the good parts of the covid 19 stimulus plan and some of the parts that could have been put together better.

There’s really only one thing on everyone’s mind right now, but the only thing we have been told we can do to help is stay home unless you are a healthcare professional. For the rest of us, it is almost sure to elicit a sense of powerlessness and loss. Human beings, after all, are social creatures who derive contentment – the longer lasting, deeper kind – from feeling valued. Two of our most significant emotional needs are not being met.

If you are one of a very select group of people, you can help shape the policy action to try to minimize Covid 19 infection rates and economic damage. Otherwise, we have to work within the rules that are set for us (i.e. avoiding others like this is The Purge). Still, we can do little things to make life better for other people. They’ll appreciate it and you won’t have to resort to unhealthy coping mechanisms to avoid falling into a pit of frustration and despair. While by no means a comprehensive list, I have a few ideas.

1. Volunteer at a food pantry. Much of the volunteer staff at food pantries across the countries consists of retired people. Obviously, they are no longer able to do so because of the high vulnerability of the elderly to Covid 19. Meanwhile, with 10 million people claiming unemployment over the past 2 weeks, the need has never been greater.
2. Adopt a grandparent! The elderly of our communities are particularly isolated and scared (with good reason). Even before the outbreak, many long-term care residents and other elderly people were lacking the personal contact they need. Now, they are intolerably alone. Many nursing homes have established new policies that allow people to contact their residents or “Adopt-a-Grandparent.” It’s not just your friends who need to talk. Give them a call!
3. Learn a new language to become closer to that friend or family member who is just more comfortable in a different one. Duolingo is a free language-learning software that gamifies the whole process. Alternatively, if you want to make your own way into a crash course, this article gives you the tools to become conversational in record time.
4. Foster an animal. Strays aren’t social distancing and springtime is when the stork brings all the new puppies and kittens. Animal shelters are not able to bring in the stream of volunteers and potential adopters as before, so the animals will need to be taken care of in a more distributed fashion. You can save the life of an animal and keep yourself busy at the same time.
5. Create an instructional video. Mayor Lori Lightfoot has done a humorous one on staying home. Perhaps you have some sort of skill that you’d like to show off; I’d love to see what everyone is doing. Shoot me an email or a message on social media to share yours!

We are in a crisis the likes of which will almost certainly end the lives of stolid businesses, so obviously it’s a great time to talk about the benefits of that. In the short run, job losses are, of course, terrible. In the long run, creative destruction plays an important role in the evolution of the economy and society as a whole. When unproductive firms continue to shamble along, the capital available to innovators is wasted on life support for laggards.

Economic data point to a close relationship between declining productivity and a rising portion of capital being allocated to what are colloquially referred to as ‘zombie’ firms. It’s consistent across time and countries. It’s estimated that employment is 1% lower per standard deviation of the zombie share of capital and that the productivity of zombie firms is more than 10% lower than the average non-zombie firm. The problem was exacerbated by near-zero interest rates, which made it easier for banks to continue rolling over questionable debt, and more stringent capital requirements, disincentivizing poorly capitalized banks from taking losses on bad debt. In other words, banks will often refinance bad loans to low-productivity firms using cheap money rather than take losses on the loans and face the accompanying decline on paper assets. This cocktail of cheap capital for inefficient incumbent firms helped zombie firms nearly double in capital share from 2009 to 2013.

The endgame: zombies are eating our brains! That is to say, low productivity firms are crowding out younger and more innovative firms, thereby stifling productivity growth and expanded employment rates. The difficulties, both in firm productivity and jobs, have expanded as the share of the economy taken up by zombies has increased. Think of it as a garden; if we do not prune the unhealthy bits, growth will be stunted for young, healthy plants. Sickly firms are sucking up too much of the available nutrients and preventing sunlight from reaching newly emerged sprouts.

The problem, of course, is that we are talking about people’s livelihoods. In theory, the end of old firms can help propel new ones forward. Practically, many will be out of work as an immediate result. This is why politicians’ first instinct is to throw a lifeline. However, rather than keeping a firm afloat, we should be thinking of the governed. Expanded unemployment benefits could ease the pain while not interfering with the market; providing people with income also helps keep demand steady in communities relying on a single industry or company.

Typically, downturns in business cycles result in the cleansing of weak firms. The last downturn, however, was combatted with unprecedented monetary support. Actions taken by the Federal Reserve likely averted another long spell of 20% or higher unemployment. They also may have set the stage for the anemic productivity growth we have faced over the past decade. In a world awash in capital, low-performing firms are having little difficulty refinancing or rolling over debt. We now face an entirely different kind of crisis; a pandemic is damming the river of economic activity. Zombie firms will once again struggle to find the cheap money they need to survive. As our lawmakers continue to work on fiscal stimulus, I would urge more focus on individuals and less on highly leveraged legacy firms.

Read more of the series here.

People all over the world are dealing with sudden and unprecedented (in modern times) hardship. A virus that was first discovered in December has caused thousands of deaths and will likely cause millions before all is said and done with many more caused by knock-on effects and poor responses by global governments. The hardest hit will be the poor who cannot afford to miss work and service-industry folks who suddenly find themselves without a paycheck. Social safety nets can help stem the bleeding, but some countries (such as the US) lack a sufficiently robust system to cope with a situation such as this without taking new and drastic action. As a result, we are seeing competing stimulus packages getting rammed through both houses of Congress. Some measures are good ideas while others are wasteful or miss the mark. Ideally, we would look at who needs help to get by (and when I say who, I mean human people, not corporations), and then we would find ways to most efficiently help them.

The essential first step is making sure that everyone is able to weather the storm. Most importantly, that means giving everyone the security to take off if they are sick. This is why the bulk of the plans making their way through Congress include some form of extended paid sick leave guaranteed for everyone. It also means giving people a helping hand that suddenly lost work because we are closing or reducing capacity for public spaces including bars and restaurants. Waitstaff, chefs, bartenders, and all other service-oriented professions are feeling the squeeze more than any other. They are not the only ones, though. A poll completed a week ago (a lifetime ago in terms of this virus) found that one in five American households had lost work due to the coronavirus; they either lost hours or lost their jobs. This is why Congress is talking about simply cutting checks to every American. We can deal with the ramifications later by clawing some back via income taxes for those who did not need it, but we do not have the time to waffle around on who doesn’t deserve it and why. The speed of this crisis does not allow it.

After we have secured help for people who are immediately impacted, the next step is securing the future. We will get past this whether it is 6 months from now or 18 months from now. When we do, the economy will need to be rebooted. If businesses are all left in ruins, we might not like what sprouts up from the ashes. Small business is the backbone of our economy and we need to treat it as such; our diverse restaurants, bars, and cultural sites may become extinct if we do not help them. Nascent businesses building our future may die off before they ever get a chance to show us what they have to offer. Large corporations forming the backbone of our economy may struggle to bring people back to work. If we want to avoid these scenarios, we need to determine where the government needs to step in to prevent the utter devastation that would otherwise come about. Nevertheless, corporate policy should be more subtle than that impacting individuals.

Restaurants, bars, cultural venues, museums, and other businesses relying on customers to come into their establishments will be the hardest hit. They would not be experiencing this difficulty in the absence of this particular form of crisis or government responses to it and, as such, could reasonably be expected to be prepared for it. Offering long-term 0 percent interest loans to such businesses or grants that help them stay in their leases or mortgages could prevent closures negatively impacting communities. This cannot be open-ended, but keeping them afloat will give people a place in which they can return to work when this is all over and it maintains cultural sites for happier days.

Meanwhile, new businesses just getting off the ground will not be able to find new customers and will struggle to find funding with the inevitable cash crunch that will come as financial institutions batten down the hatches. There is no productivity growth without innovation and innovation cannot take place without the help of entrepreneurs. This does not mean that every business that has recently been founded deserves funding, but proposals such as that of Amy Klobuchar would allow the government to invest side-by-side venture capital in places such as the Midwest, which have historically struggled to find funding. If private money feels comfortable investing, public money can come in alongside it.

Finally, we can turn our attention to large corporations. They have the funds to wait it out a bit longer, so approaching that last allows us to better assess what is happening. If they are not able to withstand the hit after just a few weeks, they were probably overleveraged and the virus likely only accelerated the inevitable. Industries likely to be hardest hit by this crisis include travel and durable goods. Some, such as the automotive industry, can retool their production lines to temporarily create things we need more of right now including ventilators and other life-preserving medical technology. Others, such as airlines, will not be able to do much beyond waiting it out, so some form of assistance will be necessary (although it should probably come with some strings attached as they have spent the vast majority of their free cash flow on share buybacks during the good times).

A broad-strokes policy is inappropriate and we do not have space for me to discuss all of them here, but I will say that, in the case of large corporations, staying within our means is better than overdoing it. We are still dealing with ramifications of extensive low-cost financing today in the form of shambolic firms that continuously roll over their finances without creating any positive cash flow. In an ideal world, such firms would cease to exist and we could restart productivity growth. Open-handed financing of these ‘zombie’ firms can only contribute to an extension of the era of low productivity growth.

Further, there are many policies being put forward with which I believe we should immediately dispense. Proposals of funding payrolls to keep people working that would not otherwise be is a gross mismanagement of government funds. It is regressive in that it gives more money to people who are already better off. Payroll tax breaks do nothing to help the millions of Americans who are about to be out of work; those breaks are essentially turning a sprinkler onto a field that is filled with water. Cancellation of student debt is not in any way related to this current situation and even talking about it wastes valuable time that should be spent on more productive ideas. Corporate tax breaks are ineffectual when most economic activity is suspended by design.

Relief required also depends on the scale of restrictions placed upon normal economic activity. Extreme positions such as full lock-downs are especially onerous on wage workers and, as such, more focus for relief needs to go towards them. Here I should mention that I believe lockdowns to be unsustainable given the timeline we are looking at for this crisis, but, after our local leaders hit the panic switch, the federal government needs to step in to alleviate some of the damage such policies have wrought. That aside, this will all change as the situation develops. There is simply too much we do not know. The speed of this economic onslaught has been faster than anything else in history (including the Great Depression). To wit, the stock market has gone from peak to bear market faster than at any time in history. Responsible leadership has never been more important.

With about 2.3 million languishing in prison, the US makes up about a quarter of the world’s prison population. It isn’t as if we can claim that it makes us safer to imprison so many, either. We suffer from a worse homicide rate than Sudan; every other rich country has but a tiny fraction of our homicide rates. Lengthening average sentences has sent our population skyrocketing from 100,000 in the 70s to more than 20 times that now. Meanwhile, the abhorrent conditions inside prisons have done terrible damage to institutional trust and lead to a recidivism rate of nearly 40% within 2 years. A broad overhaul could improve the lives of both criminals and everyone else while saving us money.

Lengthy prison sentences are, after all, expensive. Tough on crime rhetoric has been followed by lengthening average sentences for all manner of crimes. Just as an example, the US sentences those convicted of robbery to prison 2.5 times as long as the UK, a country similar in culture, and 4 times as long for assault. We also rely on incarceration much more heavily than other countries; 70% of crimes result in imprisonment here while only 33% do in Canada and in other OECD countries fines are used a majority of the time. All of this costs enormous amounts of money and causes years of lost productivity for millions of Americans. For many, it closes the door on any chance for becoming a contributing member of society.

The arguments in favor of longer prison sentences are that they prevent people from committing crimes in the first place, they prevent people from committing new crimes when they finally get out, and they keep dangerous people off the streets. Long sentences as a method of crime prevention have so clearly not been borne out in the data as to not be worthy of a deeper discussion; there is absolutely no evidence that they are effective deterrents and there are heaps of it showing it to be useless. Additionally, above-average recidivism rates in the US proves conclusively that the method is worthless at preventing new crimes from those convicted of prior crimes. Keeping dangerous people from returning to society as long as possible is a bit more complicated; the odds that someone getting out of prison will be a good neighbor drop as the sentence length increases, but it does remove the possibility of them committing any crimes.

Addressing that specific point, we can take Norway as an example. Two-year recidivism rates are lower there than anywhere else in the world, but they were not always that way. In the 1980s, their recidivism rates were similar to those of the US, but over time they have been able to reduce that rate to 20% over 2 years and 25% over 5 years. The concept is simple: by treating people well and helping them become better versions of themselves, Norway turns criminals into good neighbors. They provide educational and wellness programs for prisoners and they allow them some freedom of choice. Even the high-security prisons are more open buildings that are meant to feel less oppressive. By improving the emotional states of prisoners, they are able to reduce violent incidents between the prisoners and incidents that require intervention by the guards. The cost, unsurprisingly, is significantly higher than that of American prisons (or those of most other countries, for that matter). Norway spends more than twice as much prisoner per year, but the cost of those prisons is proportionally much lower because of lower rates of incarceration, shorter sentences, and, tellingly, much lower rates of recidivism.

I am not suggesting an immediate conversion of all prisons to the exact same programs as Norway, but there is space between our model and theirs to experiment. If investing a little bit more money into our prisoners can radically reduce the recidivism rates, we can save money while improving trust in the system and the lives of millions of our citizens. Humaneness is not the only reason to do this. We face shortages of skilled workers, particularly those in trades. If, after we have convinced a prisoner to buy in, we educate them in a trade or allow them to train under an employer, they will provide vital services when they get out. The obvious statement is that employed people commit crimes at a fraction of the rates of those who are not. A recent Norwegian study found that prisoners who found jobs within 2 years of being released had recidivism rates of less than a quarter of those that did not.

Skills-building does not have to be prohibitively expensive. Online coursework has become increasingly common and we can enroll prisoners in those owned by public universities. The cost of such a program will be minimal while the benefits will include a safer and more prosperous society. The most expensive part will likely be that of mental health professionals, but there will be savings in reduced violent incidents in prisons. Increasing freedom of choice worked for Norway as a method for increasing responsibility, so perhaps we could also experiment with increasing openness in prisons as capital projects.

Meanwhile, modest changes to the incentive structure of our private prisons could potentially provide for massive benefits. Long-time readers will recall that when Great Britain was shipping prisoners to Australia, changing the payment structure so that transport companies were paid based on healthy arrivals rather than departing prisoners, the survival rate went from approximately 50% to over 90%. By the same token, we could pay private prison companies a bonus if a released prisoner does not commit a crime after 1 year, 2 years, and more. The profit motive will surely induce human ingenuity to work at a solution. Instead of overcrowding and horrid conditions, we might see the companies provide for the personal growth of their charges.

As an added benefit, we are creating trust in our institutions among a group that has close to none. For some communities, law enforcement is the only exposure they have to American institutions. If we want them to work within the system to improve their lives and, by extension, our society, the first step is going to be building up trust. If they see that, even if they make a mistake, we are going to help them lift themselves up, they will be much more willing to believe that the institutions we rely on are there for everyone’s benefit. If poverty-stricken people do better, we all do better, because we have to live together whether they are prosperous or destitute.

Criminals and people who live outside of our mainstream society are often cynical or broken in some way. If we can heal the damage or implant more optimism in them, we can restore them to our system. They can become contributing taxpayers instead of marginalized or violent outsiders. I would certainly prefer a neighbor who was rehabilitated than one who has had to survive the horror show that is our current prison system. Wouldn’t you?

The presidential election receives all the attention, but nothing will likely have as large of an impact on Chicago residents as the primary for Cook County State’s Attorney. Taking the office away from a person who has refused to use it to administer justice will make the city a safer, fairer place to live. The candidate best positioned to do that is Bill Conway. Mr. Conway previously held a position in the State’s Attorney’s office where he worked in the Public Corruption and Financial Crimes unit.

The incumbent is Kim Foxx, who you have doubtless heard of centering on the Jussie Smollett scandal. That scandal, though, is merely a red herring when placed up against the scale of the issues surrounding her tenure. The intentions, as is so often the case, are good. She wanted to reduce the prison population and raise accountability in law enforcement. If she had any success on those measures, she would doubtlessly have been broadly popular. The reality of her policies is, however, much different. Her efforts to keep people out of jail have included letting violent criminals go free and the supposed accountability does not, apparently, include herself. A few of the problems she has created include failing to retry old cases with new evidence, failing to prosecute theft, and releasing violent felons without bail.

Let’s briefly review some of the consequences of those errors. When you decide not to retry a case, the defendant gets something called a certificate of innocence, which effectively exonerates them from all wrongdoing and, as such, they are entitled to compensation. This is a drain that we simply cannot afford given the sorry state of our finances. On the other end, failing to prosecute retail theft (shoplifting) unless offenders have already been caught 10 (!) times, encourages lawlessness and punishes law-abiding citizens. Businesses must recoup those losses somewhere and it shows up in higher prices or stores closing. This disaster is particularly acutely felt on the south and west sides among our most vulnerable residents. Food deserts are losing their few oases. Probably the most obviously flawed policy, though, is releasing violent criminals without bail. Twenty-one felons who were released from custody while awaiting trial for violent crime have gone on to commit murders (that we know of). To me, the most damning thing about this is her response to criticism; she considers all of it fearmongering. The people most impacted, as always, are the vulnerable, and they deserve better.

This election is about restoring rule-of-law. It’s about reminding ourselves that we can only live in our crowded cities when everyone follows the rules. It’s about the safety of everyone, especially our most vulnerable residents. Fortunately, there is a candidate on the ballot who promises to restore rule-of-law while enforcing the laws and keeping our streets safe.

Bill Conway is a return to actually administering justice, but his campaign is about more than that. He wants to take nonviolent offenders out of the bail system and work to reduce the 40% of State’s Attorney resources that go towards drug crime. His time as a prosecutor was spent rooting out corruption and financial crime and he wants to use that experience to expand prosecution of dirty politics. Most importantly, he has vowed to keep violent criminals in jail. For those reasons, I am encouraging all my friends here in Chicago to vote for him and against Kim Foxx.

The American healthcare system has deviated so far from any form of competitive market that it lost any claim to the moniker ‘capitalist,’ but it has received a steady stream of denigration as an example of capitalism run amok nonetheless. Today, I’d like to go over some of the obstacles to a fair market and what can be done to improve it.

There are, of course, things that cannot be properly serviced by a market. We’d like everyone to have access to good healthcare and that is only possible if we help our disadvantaged citizens out a little bit. Humans discount low-probability but high-impact scenarios too much, so we need to be encouraged to purchase insurance and participate in preventative care more frequently. Still, there are aspects of healthcare that would be significantly worse if the invisible hand of the market didn’t encourage investments of time and money into high-quality treatments.

Perhaps both the best example of an ideal application of a competitive market and the most egregious example of corporate lobbying and legalese erecting barriers to competition is that of the pharmaceutical industry. Large pharmaceutical companies spend enormous amounts of money on R&D, but perhaps even more impressive is their legal and lobbying budget. No industry spends more on lobbyists than Big Pharma, and it isn’t even close. They make money on a few blockbuster drugs, so when they find one, they set their rabid pack of lawyers to work on preventing any new entrants to the market (like generics). They don’t need to win, they only need to delay to make those lawyers worth nearly any cost. I wrote about the issue in a bit more detail here, so I will not go too deeply into it, but the crux of the issue is anti-competitive behavior allowing pharmaceutical companies from charging exorbitant prices. Medicare is not even allowed to negotiate in the same way as private insurance companies; the whole situation is a cash grab into the pockets of the taxpayer.

Hospitals make an even larger percentage of the total healthcare spend in the US than pharmaceuticals, but they have run rampant with bureaucratic costs, monopolistic behavior, and opaque pricing. There is no menu of prices for various procedures. They hide behind deceptive labeling when they create your bill. They charge absurd prices for simple things. The same procedure can cost an order of magnitude more in one hospital than another across town. Price discrimination, while illegal in all other industries, is commonplace in hospitals. The simple truth of the matter is that there is nothing you can do as a consumer of healthcare because hospitals are almost never close to each other. They are given regional monopolies and they abuse that monopoly power with impunity while insurance companies struggle to negotiate with them because of nearly unparalleled market power.

Meanwhile, the American Medical Association (AMA), an organization made up entirely of doctors, is allowed to determine licensure for various procedures. I doubt someone who completes college, medical school, internships, and residency has anything but the best interests of their patients at heart, but they do naturally assume that anyone without their extensive training is able to give competent care. While, in an ideal scenario, everyone would have fast and cheap access to a physician, the truth of the matter is that we do not have nearly enough doctors to do everything they are meant to do for everyone. Trained nurses can perform many of the more basic tasks that are assigned to doctors competently enough and their labor comes at a fraction of the cost. Labor shortages mean that we have to pay healthcare professionals much more money per hour and care suffers as a result. Preventing people who would be able to perform those tasks from doing so only exacerbates the problem.

Despite all of that and more problems we will not be discussing today, the American healthcare system does an admirable job of providing care. Controlling for accidental deaths, gun violence, and drug overdoses, we have one of the best systems in the world. The problem lies with price. We spend more per capita than any other nation for a similar result. Fixing it should, in theory, be simple. We need to make markets more transparent and lower barriers to entry for drugs and labor. In practice, there are powerful special interests that are able to prevent those things from coming to pass. Shining a light on the dirtiness of the issue can go a long way towards pressuring elected officials to get these things done.