Aside from choosing politicians for office this election, many voters will decide on important policy issues, such as whether their state and local governments should issue more debt. This year, four states have bond issues on the ballot and there are usually hundreds of local ones. Voters in Arlington County, Virginia, for example, will decide on six bonds for schools, transit, parks, and other items.

When higher state and local taxes are on the ballot, voters usually reject them. But, inconsistently, voters usually support bonds by large margins—often around 75–25—as in Arlington in recent years. Voters may not realize that general obligation bonds are equivalent to taxes. When they are issued, it results in higher taxes down the road than otherwise to pay the principal and interest.

Bond issues are particularly unjustified this year because most states have large budget surpluses. State and local tax revenues soared 10 percent in 2021 and may grow another 7 percent in 2022. In addition, the federal government showered the states with $1 trillion in pandemic-related aid followed by hundreds of billions more aid in the 2021 infrastructure bill. Governments should be paying down debt right now, rather than issuing more debt.

In general, state and local governments should minimize or eliminate debt, as I argue here. Governments can fund their infrastructure on a pay‐​as‐​you‐​go basis, meaning with ongoing taxes, fees, and charges. Some of the most frugal states in the nation issue very little debt.

Financing infrastructure with general obligation debt incurs interest costs and creates unneeded budget risks. This year, interest rates are rising, so it is a particularly bad time for governments to increase borrowing. State and local debt issuance also generates billions of dollars of fees for Wall Street middlemen, which is pure waste for the overall economy because pay-as-you-go funding would avoid it.

New Mexico is asking voters to approve $19 million in debt for libraries and $215 million for schools and colleges. If the spending is really needed, couldn’t the state have included it in its $25 billion regular budget? After all, the state currently has a budget surplus of $2.5 billion. Similarly, Rhode Island is asking voters to approve $50 million in debt for environmental and recreational projects, yet the state has a $900 million budget surplus.

It is imprudent for states to impose costs on future residents when the costs can be paid now. Debt provides no free lunch. Rather than borrowing, policymakers should sequence their major projects and allocate a portion of ongoing tax revenues for construction and renovation.

I benefit from state and local parks and schools, but I always vote “no” on bond questions.

This post is adapted from Processing Backlogs in the U.S. Immigration System: Describing the Scale of the Problem

The Department of Homeland Security’s U.S. Citizenship and Immigration Services (DHS-USCIS) is the gatekeeper for the broadest array of immigration benefits, including employment authorization and applications for green cards by immigrants already in the United States (see Table below). This broad jurisdiction makes the DHS-USCIS backlog the most important among the four departments with immigration processing authority. The DHS-USCIS backlog of pending cases has grown more than fourfold from fiscal year 2010 to FY 22—from 2 million in the second quarter of 2010 to 8.8 million in the third quarter of 2022. This 6.8 million increase represents growth from about the number of cases received in a quarter at the end of FY 10 to the number of cases received in a year in FY 22 (Figure 1).

Figure 2 breaks down the DHS-USCIS backlog by broad type of benefit being sought from 2010 to 2022 (quarter 2 in each year only). Every category of immigration benefits has seen significant increases in the number of pending cases. At 2 million cases, the largest component of the backlog is family‐​based petitions—a backlog that has increased by 1.3 million since 2010. Employment authorization documents (EADs, or work permits) are second at 1.5 million pending cases, with asylum applicants and immigrants with pending green card applications the most common EAD applicants.

About 1.2 million applicants await humanitarian statuses, with asylum, temporary protected status, and nonimmigrant status for crime victims leading this category. Nearly 900,000 legal permanent residents are trying to replace or renew a green card. Naturalization and citizenship applications are the fifth‐​largest group, with over 850,000 pending cases. New green card applications (or adjustments of status to permanent residence) comprise nearly 800,000 cases. Travel authorization exceeds 530,000 applications. There are almost 179,000 employer petitions. Other types of benefit petitions (mainly waivers of grounds of inadmissibility and changes or extensions of nonimmigrant status) number almost 560,000.

The table shows the growth in backlogs from 2010 to 2022 by detailed form type. By far, the biggest change has been in the number of pending EADs, which increased more than tenfold from fewer than 150,000 in 2010 to over 1.5 million in 2022. This category alone accounts for 21 percent of the backlog increase. This makes sense because employment authorization is often triggered when other applications are delayed. Delayed applications for green cards (443,159) and asylum (397,650) are the most backlogged categories for employment authorization, making this a backlog within a backlog.

Over one million of those cases have been added to the backlog since 2016. A similarly startling increase has occurred for legal permanent residents applying to replace or renew a green card. Regulations require that green cards be renewed every 10 years, and the 888,550-person backlog represents nearly an entire year’s worth of applicants receiving legal permanent residence in the United States.

The backlog is causing wait times for benefits to increase dramatically. DHS-USCIS’s reporting on wait times is often difficult to parse because it focuses primarily on the median for completed cases. By not disclosing the average, the agency can keep the longest‐​delayed cases from influencing the measure of processing delays. Moreover, the agency can carry over a huge number of extremely long‐​pending cases without affecting its performance measure. Recently, however, DHS-USCIS has started to publish more‐​detailed processing data, which reveal the wide variance in outcomes even for a single application type in a single year.

Figure 3 shows the median processing times for 2012 to 2022 and the 80th and 93rd percentiles at the most‐​delayed filing locations for August 2022 for selected form types. Figure A beneath it shows an even more complete picture of processing times. By themselves, the increases in the medians would be staggering. The average of the median processing times across all forms for which DHS-USCIS reports data increased threefold—from less than 4 months in 2012 to over a year in 2022. However, the 80th percentile at the most‐​delayed locations was more than double the average at 27 months, and 20 percent of applicants at those locations waited even longer. The I‑90 form to replace or renew a green card shows how slippery the DHS-USCIS’s focus on the median processing time is (second row of Figure 3). The I‑90 median wait is just 1 month, the 80th percentile is 15 months, and the 93rd over 20 months—15 to 20 times as long.

Figure A shows how wait times have increased in numerous categories. 

The Washington Post recently reported on the critical shortage of mental health providers. While there was a great demand for mental health services even before the COVID pandemic, the pandemic and the public health responses to the pandemic exacerbated the situation by increasing stress, isolation, loneliness, and despair and, at the same time, reducing access to mental health services.

According to The Post, Jeffery Huffman, clinical director of Massachusetts General Hospital’s department of psychiatry, said, “the demand for mental health care has been ‘so unprecedented’ that the hospital doesn’t have enough staff to keep up.” In fact, this past summer, over 880 people were on MGH’s wait list for psychiatric services. The article then describes various ways mental health practitioners are trying to cope with the demand, including recruiting clergy, school guidance counselors, and even soccer coaches to the mental health team.

The “American Rescue Plan,” passed by Congress in 2021, provides $5 billion to help states expand the mental health workforce. But one step state lawmakers can take now to help improve access to mental health services doesn’t need federal taxpayer dollars. State lawmakers can expand the scope of practice of clinical psychologists who have clinical psychopharmacology training to allow them to prescribe mental health medications.

In the 1990s, the Department of Defense embarked on a program to train doctorate-level clinical psychologists in clinical pharmacology to prescribe medications to their patients without referring them to psychiatrists. The program was so successful that the U.S. Public Health Service and the Indian Health Service adopted the idea. So-called “prescribing psychologists” or “RxPs” provide mental health services in those federal agencies today. Today, five states plus the territory of Guam allow prescribing psychologists to practice in their jurisdictions.

Allowing RxPs to provide mental health services will not completely solve the shortage of mental health providers. But it would help reduce the backlog of psychiatry appointments and expand the range of services that clinical psychologists can offer mental health patients, particularly in areas where psychiatrists are scarce.

For more information, you can read my Cato briefing paper on the topic. And a few weeks ago, I moderated an online forum on the issue that you can view here.

In the Wall Street Journal last week, I had a letter to the editor published regarding Bittner v. United States. As Travis Nix and Tyler Martinez explained in the article I had responded to:

Alexandru Bittner, a Romanian-American dual citizen, [mistakenly] failed to file five foreign bank account reports, or FBARs, with the IRS while living in Romania between 2007 and 2011. Taxpayers fill out annual FBAR forms if they have “foreign financial accounts exceeding $10,000.” When Mr. Bittner moved back to the U.S., he discovered this responsibility and had his certified public accountant file these forms to the IRS. The IRS responded by imposing a $2.72 million penalty even though there were no allegations of tax fraud or any additional taxes owed.

What the Supreme Court decides to do is yet to be seen, but Congress should also be taking notice. Americans across the country, and across the world, are recognizing now more than ever how the Bank Secrecy Act regime (the regime responsible for FBARs, suspicious activity reports (SARs), and currency transaction reports (CTRs)) treats citizens as suspicious until proven innocent. More so, Americans are recognizing just how dismal financial privacy is in the United States.

It’s time for a change.

For those interested in learning more, here are a few resources regarding the Bank Secrecy Act and how Americans have their financial activity surveilled:

• Revising the Bank Secrecy Act to Protect Privacy and Deter Criminals
• Treasury and DOJ Seek Greater Financial Surveillance around Cryptocurrency
• How Inflation Erodes Financial Privacy

Ever since the first nurse practitioner (NP) was created in 1965, a debate has raged between the medical profession and the advanced practice nursing profession (APRNs) over whether NPs can provide primary care services comparable in quality to physicians. Organizations representing APRNs argue that nurse practitioners receive training that fully qualifies them to provide primary care services. Organizations such as the American Medical Association maintain that “care from nonphysicians is dangerously being promoted as ‘just as good’ as that provided by doctors—despite the huge differences in education and training requirements.”

Both opponents and proponents of expanding nurse practitioners’ scope of practice can cite literature comparing care by NPs to care by physicians. Opponents point to the differences in education and training: physicians must complete 10,000 to 16,000 hours of clinical education and training, while NPs only have 500 to 720 hours. Proponents cite research that NPs provide safe, comparable care to their physician counterparts. Proponents and opponents make these arguments to state lawmakers considering legislation to expand NP scope of practice in their states.

Some physicians claim that NPs make up for their lack of knowledge and experience by ordering too many tests or consulting too many medical specialists, which adds to health care costs. If so, that also makes the argument that, rather than getting in over their heads and risking medical errors, NPs know their limitations and get help when they need it.

It is challenging to study and compare patient outcomes with NPs versus physicians as primary care providers. For example, there’s the matter of self-selection bias, where certain patients may prefer physicians. It is difficult to adjust the data based on the complexity of patients’ conditions. For example, patients who have comorbidities often see specialists. Studies should also consider cost—NPs cost less compared to managed care systems—and access to primary care (in many states, NPs and physician assistants tend to practice in rural and underserved areas).

A recent study by researchers at the University of Washington, the VA Puget Sound Health Care System, and the University of Michigan was designed to minimize confounding factors and offer the best comparison of NP to physician-provided care.

The study used a quasi-experimental approach to examine differences in clinical outcomes, service utilization, and health care costs between NP-assigned and physician-assigned patients. It used administrative data from the Veterans Health Administration (VHA), one of the largest integrated care systems in the U.S..

The VHA reassigned patients whose primary care physician had left the VHA to either another physician or an NP, independent of the patients’ health, introducing a pseudo-random feature to the study. The final sample included 806,434 patients in 530 VHA facilities across the U.S.. After comparing patient conditions pre- and post-reassignment and between primary care providers, the study found NP-assigned patients had similar total costs and clinical outcomes to physician-assigned patients and were less likely to require hospitalization.

The pseudo-random element of the study addresses the confounding variable of sampling bias. The integrated model of the VHA removed the exogenous variables of patient preference and complexity of health status at the time of reassignment. In addition, the study’s large sample size accomplishes a degree of generalizability that other studies have not. This minimizes the effect of independent variables seen in other studies, enabling researchers to better estimate the association between NP-assigned and physician-assigned patient outcomes.

In some states, NPs have full practice authority and independently evaluate, diagnose, and treat patients. Other states restrict their scope of practice, requiring them to work for physicians or have physicians oversee their practice. This new research strengthens the case for expanding NP’s scope of practice to allow them to provide primary care services fully and independently.

Spencer Pratt is a Research Associate in the Department of Health Policy Studies

Earlier this year, I had the pleasure of speaking with Deirdre Nansen McCloskey. Deirdre is a Distinguished Scholar and Isaiah Berlin Chair in Liberal Thought at the Cato Institute, as well as Distinguished Professor Emerita of Economics and of History, and Professor Emerita of English and of Communication, at the University of Illinois at Chicago. She is a highly regarded economic historian and, in her own words, a “literary, quantitative, postmodern, free-market, progressive-Episcopalian, ex-marxoid, Midwestern woman from Boston who was once a man.”

Deirdre is the author of many academic articles and books. The latter include her most recent work, Why Liberalism Works: How True Liberal Values Produce a Freer, More Equal, Prosperous World for All (2019), and the famed trilogy of books on the Bourgeois Era: The Bourgeois Virtues: Ethics for an Age of Commerce (2006), Bourgeois Dignity: Why Economics Can’t Explain the Modern World (2010), and Bourgeois Equality: How Ideas, Not Capital or Institutions, Enriched the World (2016).

Over the course of two hours, we discussed the spread of classical liberalism as a chief cause of the Great Enrichment, the renewed interest of the clerisy in the discredited idea of industrial policy, the workings of spontaneous order, bureaucratic meddling in the economy and public choice theory, F. A. Hayek’s distinction between the macro and micro worlds, the importance of innovation for economic growth, the difference between Smithian and Schumpeterian growth, hierarchy and equality, progress and utopia, the differences between conservatism, classical liberalism, and progressivism, revolution versus evolution, the importance of studying history, the rise of liberalism in the 18^th century, Francis Fukuyama, interjurisdictional competition, and ancient China.

We end our conversation on a personal note, with Deirdre reflecting on her life’s journey and her message to young people today.

The U.S. Department of Commerce (Commerce) recently announced a new set of sweeping export controls—focused on semiconductors and advanced computing—with the goal of stunting the growth of China’s technology industry and protecting U.S. national security and foreign policy interests. The announcement comes on the heels of a major speech made by National Security Advisor Jake Sullivan at the Special Competitive Studies Project Global Emerging Technologies Summit in mid-September, in which he laid out, in part, the Biden administration’s approach to U.S. export controls. Though couched in terms of national security, the Commerce announcement is the most significant economic policy development in the bilateral relationship between Washington and Beijing since the ill-advised trade war that roiled markets between 2018 and 2020.

A battle for technological supremacy in the 21^st century lies at the heart of the competition between Washington and Beijing. In theory, export controls can be powerful tools to protect U.S. national security and technological considerations. For example, it makes sense to prohibit the export of materials necessary to make nuclear weapons. Yet it is a much more challenging calculus where the product in question has both civilian and military applications, as is the case with semiconductors and their component parts. Commentators have provided excellent technical analysis about the new export controls, the economic and geopolitical effects of which are still unclear. Nevertheless, some initial words of caution—if not outright concern—are appropriate.

First, the export controls apply to both military as well as commercial technology and artificial intelligence and bleeding edge products. This is a significant departure from the status quo, in which the United States tried a bifurcated approach to leading technology exports to China: a ban on military sales but permitted commercial sales. As Gregory C. Allen of the Center for Strategic & International Studies noted, “High-end AI chips can no longer be sold to any entity operating in China, whether that is the Chinese military, a Chinese tech company, or even a U.S. company operating a data center in China.” Indeed, as Alan Beattie recently observed in his terrific Financial Times column on the export controls, “[T]he prohibitions on US citizens and green card holders working in China’s semiconductor industry meant hundreds of employees, including from the world-leading Dutch manufacturer ASML, stopped work within days.” Perhaps these changes are necessary given China’s military/​civilian fusion, but—based on public information, at least—the scope seems too broad at this point. A scalpel is almost always better than a hatchet.

Second, the new export controls were unilaterally imposed pursuant to the Export Control Reform Act of 2018 (ECRA) and its corresponding regulations. Yet when Congress passed ECRA, it wisely stated in Section 102 (4), “Export controls should be fully coordinated with the multilateral export control regimes. Export controls that are multilateral are most effective…” That is exactly right. As former China director on the National Security Council and current Brookings Senior Fellow Ryan Hass noted on Twitter, “Multilateral controls tend to be more effective than unilateral controls. The US seems to have decided that it needed to move first and accept costs for doing so to signal to others the seriousness of its concerns.” It remains to be seen whether other countries will join the U.S. or whether the move will antagonize the very allies the U.S. should be partnering with to pressure Beijing to raise its commercial standards.

As I’ve previously explained, unilateral export controls raise major concerns regarding both efficacy and effect. Evasion of unilateral sanctions is common. If China can eventually source these products either domestically or from third party countries (home to U.S. firms’ competitors), the United States has not enhanced its own national security while at the same time simply denied sales to domestic companies. Needlessly denying U.S. tech companies revenue is no way to ensure that those same companies remain atop the global tech food chain. Indeed, as Eric Hirschhorn, under secretary of commerce and industry during most of the Obama administration noted in the China Business Review, “when we unilaterally control any technology too tightly, there’s a good chance we will drive research and development, and ultimately production, offshore.” An increasingly stringent export control ecosystem might also dissuade new firms from setting up operations in the United States—or incentivize offshoring of existing firms.

Third, the timing of the export control announcement raises numerous questions. Did it need to occur close to the recently concluded 20^th National Congress of the Chinese Communist Party, potentially embarrassing (and thus antagonizing) Beijing? Did the painful controls need to be implemented right now, just as the global economy, and China’s economy in particular, is faltering? Coming right before the U.S. midterm elections, was this more about U.S. political urgency, rather than about sound policy? Or was it really intended to amplify U.S. industrial policy—namely, the just-passed Chips and Science Act of 2022—by further encouraging the “re-shoring” of semiconductor resources? (Cato scholars have expressed skepticism of new semiconductor subsidies). Maybe there are good, classified reasons for why the sanctions were urgently needed today, but so far we haven’t heard them.

Fourth, the objectives of the new export controls are risky. Overnight, the policy hobbled China’s semiconductor industry and significantly damaged its technology industry. Meanwhile, Taiwan is a leading producer of semiconductors. Now that China is being cut out of the semiconductor supply chain and its own production has been kneecapped, the new policy could arguably hasten Beijing’s attempts to take control of Taiwan in order to secure the technological prowess it wants and needs to fuel its rise. At the very least, the policy—which Biden administration officials have expressly acknowledged is intended to thwart China’s technological progress—will further convince leadership in the Chinese Communist Party of the necessity of its quest for technological self-reliance as stated in its Made in China 2025 industrial policy. This sort of foreign discrimination and isolationism is a major irritant to firms in the United States and other market-oriented democracies around the world, and it could foster even more isolation and belligerence among the Chinese people (as past U.S. protectionism has done).

Too often Washington has treated sanctions as costless to the United States, but that is clearly not always the case. Aside from prioritizing multilateral over unilateral controls, policymakers should consider some simple steps to ensure a proper calibration between national security and economic considerations. For example, a tighter definition of “national security” is needed. The Trump administration’s bogus invocation of national security to restrict imported steel and aluminum is a perfect example of disguised protectionism. Though semiconductors are clearly a component of a country’s national security given their importance to weapons systems, the government should still explain how the controlled products in question are undermining U.S. national security (within reason; obviously certain intelligence must remain classified).

Likewise, policymakers should ensure that export controls are not unduly burdensome over the long term. A simple sunset with judicial scrutiny would be appropriate for export controls, particularly for products in which the technology is rapidly evolving. A high-end semiconductor needed for surveillance or a weapons system today may not be fit for that purpose tomorrow, yet such product could still be useful in commercial and civilian contexts. The government should be required to periodically show that the control is still necessary to protect national security or other vital U.S. interests. Finally, Commerce should be required to consult closely with affected businesses to determine if there are ways to mitigate potential national security risks without damaging commercial considerations.

There’s little doubt that China represents a major economic and geopolitical challenge for the United States and the rest of the world’s market-oriented democracies. Beijing is increasingly illiberal and repressive at home and bellicose abroad. Its brand military-civilian fusion is a unique challenge, particularly with respect to technology. Perhaps the Biden administration’s export controls will prove wise, but more caution—and official justification—are needed.