From David Williams <[email protected]>
Subject Private Investment is Closing Digital Divide and Cutting Medicare Waste: TPA Weekly Update - December 20, 2024
Date December 20, 2024 6:46 PM
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This is the last Weekly Update of 2024. I want to thank everybody who has supported the Taxpayers Protection Alliance (TPA) in 2024 and over the past 13 (almost 14) years. With your help and support we’ve been able to hold government officials accountable and be a true nonpartisan taxpayer watchdog. With the expiration of the 2017 tax cuts and a growing national debt, we have a lot of work to do in 2025. Thank you and everybody at TPA wishes you and your loved ones a very happy holiday season.


Private Investment, Not Government Spending, Is Closing the Digital Divide

The U.S. broadband industry continues to invest record amounts of money into infrastructure to close the digital divide. USTelecom recently reported that providers spent $94.7 billion in 2023, the second highest industry capex in 22 years and more than 23 percent above the historic annual average. Overall, broadband providers have put more than $2.2 trillion into network capital investment since 1996. The spending comes at a time when there are also record taxpayer funds allocated toward broadband expansion across the United States. The Broadband, Equity, Access, and Deployment (BEAD) Program will dole out $42.5 billion for infrastructure growth, with more than 100 other federal programs handing out tens of billions of dollars more. That doesn’t even account for state and local grant programs that allocate yet more taxpayer money. This $42 billion will be spent over the course of a number of years.

If history is any guide, the BEAD money will be slowly spent and wasted, as evidenced by past wasteful spending on government broadband. The $94 billion shows that the private sector is taking the lead on deploying broadband while the federal government lags. The year 2023 trails only 2022 for provider infrastructure spending over the past two decades. Providers invested $102.4 billion in 2022.
“Investment this past year reflects a range of activities, including expansion of fiber deployments, integration of fiber and mobile networks, increased rural broadband construction, and network capacity additions to keep pace with advances in artificial intelligence and other applications that are fueling rising bandwidth demands among consumers and across the economy,” USTelecom noted. As investment increases, prices go down and speeds get faster. USTelecom’s 2023 Broadband Pricing Index showed an 18 percent drop year-over-year in the price of providers’ most popular broadband speed tier and a 6.5 percent drop in the price of providers’ fastest speed tier. Meanwhile, the cost of overall goods and services were up 5 percent during the same period. When accounting for inflation, prices for both the most popular tier and the fastest tier are down about 55 percent since 2015. The USTelecom report shows that private broadband providers continue to push investment and innovation in the
marketplace, and that taxpayer funds should supplement and not be the main driver of the efforts to connect all Americans to high-speed internet.

Cutting Medicare Waste

Following a whirlwind presidential election, it’s easy to get caught up in sensational and scandalous headlines. For example, pundits and politicians have zeroed in on Department of Health and Human Services (HHS) Secretary nominee Robert F. Kennedy Jr.’s vaccine skepticism and criticism of water fluoridation. Similarly, Centers for Medicare and Medicaid Services (CMS) administrator nominee Dr. Mehmet Oz has been scrutinized for pushing dubious medical treatments. But, this focus shouldn’t distract the public or Congress from the less flashy (but no less important) policy positions. According to a report by the Financial Times, Kennedy and Oz are considering reevaluating Medicare’s billing codes and cutting fees paid to physicians. The Medicare payment system is in dire need of reform, but any billing shifts need to be carefully considered. With a steady and balanced approach, RFK Jr. and Oz can save taxpayers and consumers from a costly Medicare bailout. The incoming Trump administration
is eager to keep physician trade groups away from the levers of power. The truth is that doctors have already been losing their clout at the CMS. The agency’s recently finalized Medicare Physician Fee Schedule rule trims Medicare physician payments by 2.9% for 2025. Similarly, the agency lowered physician payments by 3.4% in 2024. According to an analysis by the American Medical Association, Medicare payments to physicians have decreased by 29% since 2001 after adjusting for inflation. Further reductions in reimbursements could result in doctors shifting Medicare patient expenses onto patients paying with private insurance, and potentially even hospital closures.

Fortunately, there are other ways to reform Medicare billing codes without further slashing doctor reimbursements. For example, CMS has started allowing reimbursement for digital therapeutics used as part of behavioral health treatments. While this is an important step in the right direction, Medicare reimbursement policies remain far too limited for patients to benefit from digital treatments currently in the marketplace. As Stat News reported, “While the FDA has cleared over 20 software-based medical treatments [i.e., digital therapeutics], only a handful of them would fall under the new regulation.” Given that digital treatments can improve patient well-being at a fraction of the cost of traditional treatments, CMS should consider expanding coverage to all FDA-cleared digital therapeutics.

The HHS and CMS should also work with lawmakers to implement site-neutrality in Medicare payments. Medicare creates considerable waste by reimbursing different amounts of money for the same services rendered at different types of health care facilities. It makes little sense that taxpayers pay 141% more for the first hour of chemotherapy in a hospital than that same hour at a doctor’s office. Hospital outpatient departments can bill Medicare more than $1,000 for an echocardiogram, a service that costs taxpayers just $350 at a doctor’s office. In a 2022 report to Congress, the Medicare Payment Advisory Commission stated the obvious: “Medicare should base payment rates on the resources needed to treat patients in the most efficient setting. If the same service can be safely provided in different settings, a prudent purchaser should not pay more for that service in one setting than in another.” Even though successive presidential administrations have advocated for reform, change remains
elusive. Sens. Bill Cassidy of Louisiana and Maggie Hassan of New Hampshire have been leading the charge in Congress for site-neutral Medicare payments, and allies in the new administration could get the proposal across the finish line. There’s more than one way to cut Medicare spending and save taxpayers from a fiscal calamity. RFK Jr., Oz and lawmakers must work together to reform Medicare’s unwieldy billing system and bring some much-needed sanity to the struggling program.


BLOGS:

Monday: TPA Submits Comments to Office of Management and Budget on Commercially Available Information ([link removed])

Tuesday: European Google Search’s Second Redesign Shows the Pitfalls of Bureaucrat Micromanagement ([link removed])

Thursday: Why We Need Free Trade: An Interview with AAFA’s Steve Lamar ([link removed])

Friday: CFPB Putting the “Lame” in “Lame-Duck” ([link removed])
Media:

December 5, 2024: The Herald-Review (Sierra Vista, Ariz,.) ran TPA’s op-ed, “The Postal Service is beyond the president’s help.”

December 5, 2024: WBFF Fox45 (Baltimore, Md.) quoted me for their story on Baltimore Mayor Brandon Scott.

December 5, 2024: WBFF Fox45 (Baltimore, Md.) interviewed me for their story on the future of funding in Baltimore.

December 6, 2024: Prescott eNews (Prescott, AZ) quoted me in their article, “With DOGE, Musk, Ramaswamy Confront the ‘Immovable Object’.”

December 6, 2024: WBFF Fox45 (Baltimore, Md.) interviewed me for their story on the Baltimore Children and Youth Fund trip billed to taxpayers.

December 8, 2024: WBFF Fox45 (Baltimore, Md.) interviewed me for their story on the future of funding in Baltimore.

December 9, 2024: WBFF Fox45 (Baltimore, Md.) interviewed me for their story on breaking down Maryland and Baltimore City’s new legislative session.

December 9, 2024: NewsMax ran TPA’s op-ed, “America's Tech-Driven Economic Future Tied to Energy Abundance.”

December 9, 2024: Our Community Now quoted TPA in their article, “Maryland legislature prepares to address fiscal challenges in upcoming session.”

December 10, 2024: Money 105.5FM (California) quoted TPA in their article, “Conservative groups praise Rocket's suit against HUD.”

December 10, 2024: The Hazard-Herald (Hazard, Ky.) quoted TPA in their article, “Conservative groups praise Rocket's suit against HUD.”

December 10, 2024: KTBS ABC3 (Shreveport, La.) quoted TPA in their article, “Conservative groups praise Rocket's suit against HUD.”

December 10, 2024: The Indiana Statesman (Terre Haute, Ind.) quoted TPA in their article, “Conservative groups praise Rocket's suit against HUD.”

December 10, 2024: The Appalachian News Express (Pikeville, Ky.) quoted TPA in their article, “Conservative groups praise Rocket's suit against HUD.”

December 10, 2024: The Albia Newspapers (Albia, Iowa) quoted TPA in their article, “Conservative groups praise Rocket's suit against HUD.”

December 10, 2024: The Iosco County News-Herald (East Tawas, Mich.) quoted TPA in their article, “Conservative groups praise Rocket's suit against HUD.”

December 10, 2024: The Atlantic News Telegraph (Atlantic, Iowa) quoted TPA in their article, “Conservative groups praise Rocket's suit against HUD.”

December 10, 2024: The Breeze (Harrisonburg, Va.) quoted TPA in their article, “Conservative groups praise Rocket's suit against HUD.”

December 10, 2024: The Livermore Independent (Oakland, Calif.) quoted TPA in their article, “Conservative groups praise Rocket's suit against HUD.”

December 10, 2024: The Wellsboro Gazette (Wellsboro, Pa.) quoted TPA in their article, “Conservative groups praise Rocket's suit against HUD.”

December 10, 2024: The Newsbug (Watseka, IL) quoted TPA in their article, “Conservative groups praise Rocket's suit against HUD.”

December 10, 2024: AOL quoted TPA in their article, “Conservative groups praise Rocket's suit against HUD.”

December 10, 2024: The Black Chronicle (Oklahoma City, OK) quoted TPA in their article, “Conservative groups praise Rocket's suit against HUD.”

December 12, 2024: The Baltimore Sun (Baltimore, Md.) quoted TPA in their article, “Meet the liberal megadonors funding Baltimore nonprofits.”

December 12, 2024: WBFF Fox45 (Baltimore, Md.) quoted me for their story on electric buses.

December 13, 2024: WBFF Fox45 (Baltimore, Md.) quoted me for their story on Baltimore’s aging infrastructure and its impact on the taxpayer.

December 13, 2024: WBFF Fox45 (Baltimore, Md.) quoted me for their story on Baltimore’s aging infrastructure and its impact on the taxpayer.

December 15, 2024: WBFF Fox45 (Baltimore, Md.) interviewed me for their story on Baltimore’s aging infrastructure and its impact on the taxpayer.

December 15, 2024: The Baltimore Sun (Baltimore, Md.) ran TPA’s op-ed, “How RFK Jr. and Dr. Oz can cut Medicare waste.”

December 16, 2024: WBFF Fox45 (Baltimore, Md.) interviewed me for their story on the Parksville Armory redevelopment.

December 16, 2024: The Baltimore Sun (Baltimore, Md.) ran TPA’s op-ed, “How RFK Jr. and Dr. Oz can cut Medicare waste.”

December 16, 2024: WBFF Fox45 (Baltimore, Md.) quoted TPA for their story on the Baltimore Children and Youth Fund trip billed to taxpayers.

December 17, 2024: WBFF Fox45 (Baltimore, Md.) quoted TPA for their story on the Baltimore Children and Youth Fund trip billed to taxpayers.

December 17, 2024: The Baltimore Sun (Baltimore, Md.) quoted TPA in their article, “Tourism boost: Baltimore nonprofit has a $4 million pitch focused on Harborplace, Preakness and CIAA basketball.”

December 17, 2024: The Maryland Gazette (Annapolis, Md.) quoted TPA in their article, “Tourism boost: Baltimore nonprofit has a $4 million pitch focused on Harborplace, Preakness and CIAA basketball.”

December 17, 2024: Yahoo! News quoted TPA in their article, “Tourism boost: Baltimore nonprofit has a $4 million pitch focused on Harborplace, Preakness and CIAA basketball.”

December 17, 2024: WBFF Fox45 (Baltimore, Md.) quoted TPA for their story on the Baltimore Children and Youth Fund trip billed to taxpayers.

December 17, 2024: The Baltimore Post (Baltimore, Md.) quoted TPA in their article, “Tourism boost: Baltimore nonprofit has a $4 million pitch focused on Harborplace, Preakness and CIAA basketball.”

December 17, 2024: WBFF Fox45 (Baltimore, Md.) quoted TPA for their story on the Baltimore Children and Youth Fund trip billed to taxpayers.

December 17, 2024: The Baltimore Sun (Baltimore, Md) quoted TPA for their article, “Tourism nonprofit asks city to give $4M to attract visitors.”

December 17, 2024: The Baltimore Sun (Baltimore, Md.) quoted TPA for their article, “Baltimore's youth fund defends using taxpayer money for adult travel.”

December 17, 2024: The Baltimore Sun (Baltimore, Md.) quoted me for their article, “Trimming health care costs? Start with insurance CEO pay.”

December 19, 2024: I appeared on WBOB 600 AM (Jacksonville, Fla.) to talk about Congress’ spending bill.

December 19, 2024: WBFF Fox45 (Baltimore, Md.) interviewed me for their story on Congress’ spending bill.


Have a great weekend!

Best,

David Williams
President
Taxpayers Protection Alliance
1101 14th Street, NW
Suite 500
Washington, D.C. xxxxxx

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