Excerpts from recent editorials in the United States and abroad:
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April 18
The Washington Post says corporate welfare for hospitals is raising health care costs
Hospitals are not as unpopular as other health care sectors, such as drug manufacturers and insurance companies. But like other businesses, they are prone to rent-seeking and fiercely defensive of special breaks.
Case in point: The 340B drug discount program.
The federal program was created in 1992 to help hospitals and clinics in poor communities. In recent weeks, it has become over complaints that wealthy health systems are abusing the benefits and driving up costs for everyone else.
The program requires pharmaceutical companies to sell drugs at a discounted rate 鈥� usually 25 to 50 percent off the wholesale price 鈥� to hospitals or clinics that primarily serve low-income or rural patients. Health systems love this because insurance companies and government programs such as Medicare still reimburse them for those drugs at standard, non-discounted rates. Providers then get to pocket the difference.
Over time, large health institutions have come to . Costs skyrocketed after the Affordable Care Act dramatically expanded eligibility. In 2010, about $6.6 billion in drugs were purchased through the program. By 2023, that number multiplied tenfold.
The system creates nasty distortionary effects. For example, participating providers have an incentive to use more expensive, brand-name products, since doing so increases their profit margin from reimbursements. That explains why branded drugs of 340B sales in 2023, compared to about 78 percent of sales outside the program.
This drives up overall costs, including for government health programs, which must pony up more for 340B patients, as the Congressional Budget Office .
Meanwhile, the program has fueled consolidation within the health care industry, as hospital systems seek to gobble up as many 340B-eligible patients as possible. Since Obamacare went into effect, big businesses have furiously acquired independent physician practices that administer expensive drugs, such as cancer treatments and other costly infusions. That reduces competition and, again, drives up costs.
Hospitals have also dramatically expanded their use of off-site 鈥渃ontract鈥� pharmacies to dispense the discounted drugs. Originally, each provider could only do so on-site or contract with one outside pharmacy. That changed under the ACA, allowing networks to work with dozens of them, greatly expanding the use of the program.
Instead of serving as a safety net for hospitals in vulnerable communities, the program has become a profit-making venture for big businesses. A Pioneer Institute analysis found that 340B hospitals actually on average than those not participating in the program.
Unsurprisingly, the health systems that have become addicted to these taxpayer-subsidized profit streams warn that paring back 340B would prove disastrous for hospitals. They spend heavily to protect their corporate welfare.
Once a business gets accustomed to handouts, it becomes extremely difficult to take them away. But it鈥檚 a fight worth having.
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April 17
The New York Times wonders if new Federal Reserve chair Kevin Warsh will serve the public or the POTUS
Kevin Warsh looks great on paper. President Trump鈥檚 pick to serve as the next chair of the Federal Reserve is a former Fed governor with extensive experience in the financial industry. He has many admirers both on Wall Street and in Washington.
But Mr. Warsh has a credibility problem. Central to the Fed鈥檚 mission of managing the American economy is the institution鈥檚 independence. The Fed鈥檚 board, like the Supreme Court, is composed of a group of experts who are chosen by presidents but who do not take directions from the White House. That operational freedom allows the central bank to make policy decisions that are in the nation鈥檚 economic interest, even when those decisions are politically unpopular.
Mr. Trump has trampled on the Fed鈥檚 independence. He has tried to bully its leaders into cutting interest rates to , even at the expense of inflation later. He has repeatedly said that he would nominate a Fed chair who agreed to comply with his demands. 鈥淚f I think somebody鈥檚 going to keep the rates where they are or whatever, I鈥檓 not going to put them in,鈥� the president . 鈥淚鈥檓 going to put somebody that wants to cut rates.鈥�
This vow meant that any subsequent choice of Mr. Trump鈥檚 would be suspect. When senators question Mr. Warsh at a confirmation hearing scheduled to start Tuesday, they must assess whether he would perform his duties as a public servant or serve the interests of the president. Hanging over the hearing is of the current Fed chair, Jerome Powell. The investigation was an attempt to intimidate Mr. Powell into cutting rates and to punish him for not having done so. Senator Thom Tillis, the North Carolina Republican who will preside over the hearing, has promised to block Mr. Warsh鈥檚 confirmation until the investigation ends. Mr. Tillis should keep his promise.
In the meantime, we believe that three questions for Mr. Warsh require particular attention from the Senate.
1. Is Mr. Warsh committed to Fed independence and to fighting inflation?
As a Fed governor from 2006 to 2011, Mr. Warsh built a reputation as a determined inflation fighter. He argued against interest rate cuts in 2008 even as the economy tipped into crisis. He continued to warn that the Fed was overstimulating the economy for years after the crisis, even as the persistence of high unemployment made clear that, if anything, the Fed had failed to do enough to increase growth.
But in recent years, Mr. Warsh has sounded less worried about inflation and more worried about pleasing Mr. Trump.
In 2018, during Mr. Trump鈥檚 first term, Mr. Warsh went to bat for the president, arguing that the central bank should extend the stimulus campaign he had once opposed. Since Mr. Trump鈥檚 return to office last year, Mr. Warsh has resumed his advocacy for easy money. Last summer, he criticized the Fed for keeping interest rates too high. 鈥淓conomic growth in the U.S. is poised to boom, but it鈥檚 being held down by bad economic policies coming from the central bank,鈥� Mr. Warsh said on . 鈥淚nterest rates should be lower.鈥�
Mr. Warsh has offered a rationale for his newfound enthusiasm for lower rates. He argues that productivity gains fueled by the rise of artificial intelligence will allow the Fed to keep rates low without fueling inflation, as it did .
That would be a gamble. Mr. Warsh himself acknowledges those productivity gains are not yet visible in the economic data, and inflation has remained above the Fed鈥檚 preferred 2 percent annual pace since 2021. The war with Iran to 3.3 percent in March, the highest since Mr. Trump returned to office. To keep prices under control, the nation needs a Fed chair who is willing to defy the wishes of the president.
When central bankers instead try to please presidents, everyone suffers. The outstanding example in American history is the case of Arthur Burns, the Fed chair whose deference to President Richard Nixon unleashed the Great Inflation of the 1970s. Mr. Warsh needs to demonstrate a willingness to make decisions that Mr. Trump does not support.
2. Does Mr. Warsh plan to hand over the Fed鈥檚 keys?
In a worrying sign for the Fed鈥檚 independence, Mr. Warsh has proposed to involve the Treasury Department in decisions about the central bank鈥檚 balance sheet.
The Fed makes investments to manage interest rates, raising or lowering borrowing costs for businesses and consumers. It currently holds $6.7 trillion, mainly in bonds issued by the federal government and in mortgage-backed securities.
Mr. Warsh wants a smaller balance sheet, and he wants to sell mortgage bonds. He argues that investing in mortgage bonds encroaches on the role of fiscal policymakers, because it targets interest rates in a specific sector of the economy.
There are reasonable arguments on both sides of that issue. But Mr. Warsh goes further. He says thathe wants the Treasury to participate in the decision making. 鈥淭he Treasury secretary would need to find the proposed change in Fed holdings acceptable, given that it is partially fiscal policy in disguise,鈥� he told in October.
The proposal is narrow and technical, but the precedent is dangerous. It would give Treasury officials, who answer to the president, a formal role in shaping the Fed鈥檚 monetary policy.
3. Does Mr. Warsh have too much faith in financial markets?
In addition to setting interest rates, the Fed is charged with keeping the financial system in good health. Republican presidents, and their Fed appointees, have tended to discount this responsibility. A key cause of the 2008 crisis was the almost religious conviction of the Fed鈥檚 longtime chair, Alan Greenspan, that regulation was often unnecessary because market discipline would keep financial firms in line.
Mr. Warsh has acknowledged that he was among those who failed to understand the weakness of the financial system before the 2008 crisis. So did many experts. We are more concerned that he does not seem to have grasped a central lesson of that crisis 鈥� that vigorous government oversight is necessary for markets to remain healthy and to function properly.
In the aftermath of the crisis, the Fed embraced its regulatory role with the conviction of the newly converted, and with the aid of new powers granted by Congress. Mr. Warsh, however, has described some of the key safeguards the Fed put in place as unnecessary or unduly burdensome to the financial industry. For example, he has argued that annual stress tests for large banks like JPMorgan and Citigroup have become ineffective, which is not the case. He also has suggested that those banks should be allowed to rely more heavily on borrowed money to fund their operations, reversing another of the Fed鈥檚 post-crisis stringencies. Both moves would leave the financial system more vulnerable to crisis.
His distaste for regulation is particularly concerning because financial innovation is straining the current system. and are moving a growing share of financial activity beyond the reach of existing rules and regulators. The rise of new, unregulated forms of finance is a longstanding pattern. The moment requires a Fed chair who understands the need for new rules to prevent meltdowns.
The modern financial history of the United States is divided between periods of strict regulation, during which tranquillity has been the rule, and periods of lax regulation punctuated by destabilizing crises. By catering to the financial industry, Mr. Warsh would increase risks to the health of the broader economy.
These are not the only issues that deserve the Senate鈥檚 attention. The Senate should also ensure that Mr. Warsh has a plan to avoid financial conflicts of interest. He owns , which can lead to many potential conflicts. Avoiding them is feasible, but he needs to offer a more credible strategy than senior members of the Trump administration, including the president, have for their own holdings.
The next Fed chair will shape not just the institution but also the nation鈥檚 economic path for years to come. The importance of reserving that role for someone who is both independent and principled has long been a matter of bipartisan consensus. Senators must press Mr. Warsh so they can decide whether he meets that standard.
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April 15
The Philadelphia Inquirer asks if Donald Trump will follow Viktor Orb谩n in defeat
Hungarian Prime Minister Viktor Orb谩n, whose illiberal right-wing policies have served as a template for 鈥檚 second term, was . His electoral loss, after 16 years in power, offers a lesson for those seeking to safeguard the American experiment from the president鈥檚 autocratic bent.
Perhaps the biggest takeaway from challenger P茅ter Magyar鈥檚 victory is that if the will of the voters is strong enough, even a hollowed-out democracy can still speak for the people. This bodes ill for in upcoming elections, as the United States is nowhere near the level of institutional degradation achieved by Orb谩n and his party.
It has not been for lack of trying, though.
Guided by the 鈥� a plan during his campaign but which he has followed since his return to the White House 鈥� the president has attempted to dismantle constitutional , , and bully and dominate and .
Trump adviser Steve Bannon once called Orb谩n 鈥� 鈥� and Hungary under his leadership offered a grim preview of what a successfully MAGA-fied America would look like: Government control of universities and the media, courts and federal jobs occupied by loyalists, extreme gerrymandering limiting political opposition, and curbed press freedoms.
But just as Trump and his enablers moved in trying to undercut democratic institutions and than their Eastern European counterparts, the cracks in the foundation that ultimately led to Orb谩n鈥檚 overwhelming loss are already visible in Washington.
Magyar and his Tisza party were expected to hold a on the strength of focusing on corruption and a poor economy. While Trump has been busy , his family, and his cronies to the tune of billions of dollars, everyday Americans are struggling.
Although the U.S. is not Hungary, still looking to find a winning message can鈥檛 do much better than what Magyar , a country 鈥渨here citizens can count on their government, where everyone is entitled to proper healthcare, a carefree childhood, and a dignified old age.鈥�
Contrast that with a president who claims that citizens of the richest nation in the world who want a better life, . 鈥淚t鈥檚 not possible for us to take care of daycare, Medicaid, Medicare, all these individual things,鈥� Trump said at an April 2 Easter luncheon. 鈥淭hey can do it on a state basis. You can鈥檛 do it on a federal. We have to take care of one thing: military protection.鈥�
Yes, having a strong military is important, but even more so is the responsible stewardship of America鈥檚 armed forces. By some estimates, Trump鈥檚 war of choice in Iran costs taxpayers $2 billion a day, with a long term price tag coming in at on military-related spending alone. That doesn鈥檛 even consider the pain at the pump and the checkout lane as the still unresolved conflict hikes up prices on everything from gas to groceries.
Trump鈥檚 blinkered priorities are not limited to the economy.
While the president and his secretary of state watched in Miami Saturday, were falling apart. On Sunday, Trump on social media, claiming the U.S.-born pontiff should 鈥渟top catering to the radical left鈥� and 鈥済et his act together as pope鈥� before posting an AI-generated image of himself as .
As far as we know, Viktor Orb谩n never publicly compared himself to Christ, but other parallels with Trump remain strong, including the use of the autocratic playbook, and the graft and incompetence of their administrations.
After Sunday, supporters of democracy can hope the similarities don鈥檛 end there.
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April 16
The Guardian says Trump promised a ceasefire, civilians in Lebanon need real peace
The 10-day ceasefire in Lebanon that Donald Trump on Thursday is desperately needed. It must also be regarded with immense caution. Iran and mediator Pakistan believed that Lebanon was covered by last week鈥檚 US-Israel-Iran ceasefire, before Israel unleashed 100 strikes in 10 minutes 鈥� killing hundreds and wounding many more on 鈥淏lack Wednesday鈥�. Lebanon was pulled into this crisis by Mr Trump鈥檚 illegal war on Tehran, and should not have been excluded from his truce. The US president, desperately seeking an exit to the broader conflict, is now reining in Mr Netanyahu. But only up to a point.
Israeli forces on Thursday destroyed the last bridge linking Lebanon鈥檚 south to the rest of the country and struck a school. The previous day they killed at least four paramedics 鈥� the latest of scores to have died. More than 2,100 people have reportedly been killed, including at least 172 children. Thousands have been injured. One in five of the population are displaced, some permanently: having occupied a vast swathe of land, Israel is from the map. Its own defence minister described that as modelled on its actions in Gaza.
Tuesday鈥檚 direct talks between Lebanon and Israel were a departure. But Lebanon is not fighting this war, and it does not control Hezbollah, which is. The government has seen new opportunities to assert itself. But it announced the expulsion of Iran鈥檚 ambassador a month ago. He remains in place. Hezbollah did not obstruct this week鈥檚 talks; Iran also wants to end the wider conflict. But the Lebanese president, Joseph Aoun, rejected a US request to speak to Mr Netanyahu. There are limits to this process.
Its prospects are irrevocably tied to US-Iranian discussions, and the gulf between sides is similarly vast. Israel鈥檚 starting point is the disarmament of Hezbollah 鈥� in the midst of war. Hezbollah demands Israeli withdrawal. Mr Netanyahu, who paid a surprise visit to Lebanon鈥檚 south this weekend, said that Israel would expand what it calls a 鈥渂uffer zone鈥� to protect its citizens. Permanent war suits the Israeli prime minister, and his far-right coalition partners are determined to expand Israel鈥檚 borders.
There is in Lebanon at Hezbollah: its rocket attacks upon Israel, in retaliation for the killing of Iran鈥檚 supreme leader, triggered this war. But Israel鈥檚 devastating attacks have also made the Lebanese government and army look impotent, and left citizens desperate for help which the state cannot provide 鈥� driving them towards the militant group. The disruption caused by the displacement of over a million people is magnified by fear that those fleeing Israel鈥檚 attacks will be targeted by Israel 鈥� . The spectre of sharpened social and communal divisions in a country which endured years of civil war could hardly be grimmer.
There is increasing disquiet in countries which have long supported Israel, at its actions. That must translate into real pressure. Lebanon has been presented with a dismal choice . Any pause in the war is welcome. But it must be sustained, and it must truly stop bloodshed. The Israeli military has killed hundreds of Palestinians since Gaza鈥檚 ceasefire was declared. Israel was carrying out strikes in Lebanon , despite a previous ceasefire. This one could hardly be more fragile when those seeking it put their own interests before the protection of civilians.
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April 17
The Wall Street Journal says keep pressure on Iran, hold off on the victory parade
President Trump all but declared Friday as V-I Day, for Victory over Iran, but hold off on the parade. 鈥淚RAN HAS JUST ANNOUNCED THAT THE STRAIT OF IRAN IS FULLY OPEN,鈥� he wrote Friday on Truth Social. That鈥檚 also what the April 8 U.S. cease-fire was supposed to allow.
Re-opening the Strait is good news, if it happens this time, and financial markets behaved as if they think it will. Equities rose and the price of oil dropped sharply on the news, which gives the U.S. policy breathing room.
Then again, calling Hormuz the 鈥淪trait of Iran鈥� reflects Tehran鈥檚 view. Iran鈥檚 Foreign Minister said Friday the Strait is open 鈥渋n line with the (10-day) ceasefire in Lebanon鈥� and only 鈥渙n the coordinated route鈥� through Iranian waters. That would leave Iran in control. The test is whether tankers begin moving in numbers through the normal route without fear of Iranian attack.
The good news is that Mr. Trump said the U.S. blockade of Iranian ports will persist until a deal is reached. This is critical to the success of negotiations, and it no doubt had something to do with Iran鈥檚 concession on the Strait. The blockade is serious U.S. leverage鈥攁s was Israel鈥檚 war on Hezbollah before Mr. Trump insisted this week that Israel stop it.
鈥淚srael will not be bombing Lebanon any longer. They are PROHIBITED from doing so by the U.S.A. Enough is enough,鈥� Mr. Trump wrote Friday. To ward off the implication he had traded Israeli freedom of action in Lebanon to Iran, Mr. Trump soon had to reiterate: 鈥淎gain! This deal is not tied, in any way, to Lebanon.鈥�
Mr. Trump was disturbed by photos he saw of Israel鈥檚 bombing earlier this week in Beirut. Most victims were Hezbollah fighters, but there were some civilian casualties. That鈥檚 what happens when Hezbollah hides its fighters and leaders among civilians.
Point three in this week鈥檚 Lebanon-Israel cease-fire document is clear that Israel 鈥渟hall preserve its right to take all necessary measures in self-defense, at any time, against planned, imminent, or ongoing attacks. This shall not be impeded by the cessation of hostilities.鈥�
Prohibiting Israel鈥檚 defensive war on terrorists is what U.S. negotiators demanded before Mr. Trump. 鈥淚 hope Hezbollah acts nicely,鈥� the President also wrote Thursday. But hope has never been a successful strategy with Hezbollah. Prime Minister Benjamin Netanyahu had wanted to finish clearing Iran鈥檚 proxy from southern Lebanon, but Mr. Trump forced his hand at Iran鈥檚 request.
Will Lebanon now defang Hezbollah? History suggests not, so Israel will need the freedom and U.S. support to defend itself proactively. The alternative is to allow a return to the days when Hezbollah functioned as an Iranian sword of Damocles over Israel.
Mr. Trump also announced Friday a stream of what he said were other Iranian concessions. He said 鈥渢he U.S.A. will get all Nuclear 鈥楧ust,鈥欌�� by which he means Iran鈥檚 enriched uranium.
鈥淣o money will exchange hands,鈥� Mr. Trump added, but this isn鈥檛 a denial that a release of $20 billion in frozen Iranians funds has been discussed in negotiations. That sum is roughly equal to Iran鈥檚 oil revenue frozen in Qatar, plus what Iran is owed by Iraq for electricity.
Mr. Trump also said Iran has agreed to remove all mines from the Strait and never to close it again, as well as stop backing proxies like Hamas and Hezbollah. These would be a U.S. victory, if you can trust the regime.
Media for the Islamic Revolutionary Guard Corps are already criticizing Iran鈥檚 Foreign Minister and threatening to keep the Strait closed. Some officials said Iran will still charge tolls to transit the Strait.
There鈥檚 also a lively debate inside the Administration about what to do as the cease-fire with Iran expires next Wednesday. Some would extend it by as long as 60 days, but that idea seems to have been dropped. The better idea is no extension, or a very short one, so the regime can鈥檛 drag out talks as it always prefers. A long cease-fire helps Iran, which Adm. Brad Cooper says is already digging out missiles and launchers that have been trapped but not destroyed.
The imperative now is to keep the pressure on. The U.S. blockade, which expanded on Thursday to interdict sanctioned vessels, is critical. The economic cost to Iran is mounting, and, if it is sustained, Tehran will soon have to shut-in wells that it will be costly to restart. The regime also needs to know the U.S. will strike again if it won鈥檛 come to terms.
Mr. Trump is right to insist Iran turn over its enriched uranium, and the regime shouldn鈥檛 be allowed to keep some in reserve or give it to an unreliable third-party. This applies to Iran鈥檚 20% enriched uranium in addition to the 60% enriched, as the one can become the other.
Mr. Trump has the right instincts about Iran, and we will be the first to give him credit if the Iranian concessions turn out to be real. But his frequent assertions that a deal is imminent also tell the regime he is desperate to end the war. This makes the regime less likely to make the concessions Mr. Trump needs to claim a legitimate and lasting victory.
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