Government does not have patients. It has interest groups, a crucial distinction that yields important implications for the design and operation of such government benefit programs as Medicare and Medicaid.

In a recent article, I reported and discussed the lackluster - basically non-existent - results of the Utah Health Exchange. As a critic has pointed out, I used to be much more accomodating of the Utah exchange. However, Utah's experience demonstrates why unsubsidized exchanges are unlikely to attract significant numbers of beneficiaries from the small-group market.

The Utah Health Exchange is the model some conservatives believe can be used to push back against Obamacare.  Witness the Wall Street Journal (July 16) soundly rejecting regulatory guidance on what the Administration is now calling “Affordable Insurance Exchanges,” but encouraging governors to get on the exchange bandwagon, in the hope they can build free-market exchanges that will blunt Obamacare’s worst effects. 

In June, several California legislators complained about having their pay cut by state Controller John Chiang because the budget they submitted by the June 15 constitutional deadline - the only deadline they seem to care about - was unbalanced. This latest budget drama shows why California needs a part-time legislature.