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Why would they be dumb enough to voluntarily accept that outcome? A market system would force those providers out of business. One bright spot, of sorts, is the Medicare Advantage program.

In the Medicare Advantage program, the government pays insurance companies to play that role. Medicare enrollees may choose among competing Medicare Advantage plans, which often offer more coverage than traditional Medicare. Some 30 percent of enrollees opt for Medicare Advantage plans, a share the Congressional Budget Office projects will grow to 40 percent by Medicare Advantage creates more competition in the delivery of medicine by extending government subsidies to different ways of financing and organizing health care.

Some Medicare Advantage plans are fully integrated and capitated plans, such as Kaiser Permanente. Other plans fall somewhere in between. Medicare Advantage mitigates some of the problems traditional Medicare creates. One review of the literature found that Medicare Advantage plans score higher on some quality measures, including use of preventive care.

One study estimated that Medicare Advantage plans reduce hospitalizations by a third without any negative impact on mortality. Medicare Advantage appears to have spillover effects that reduce unnecessary spending in traditional Medicare. There is nothing inherently superior about the government writing checks to insurance companies instead of health care providers, however. There is evidence Medicare pays more to cover enrollees through Medicare Advantage than it would cost to cover them through traditional Medicare.

The projected growth in Medicare Advantage enrollment suggests this may be the case. This may be because participating insurers tend to market themselves to Medicare enrollees who will cost them less and to avoid patients who would cost them more than the government is paying.

Traditional Medicare receives higher marks from enrollees with expensive illnesses, likely because it provides relatively — albeit dangerously — easy access to care. To build on the meager progress of Medicare Advantage, Congress should take three steps to liberalize health care for the elderly and disabled. At present, people who are eligible for Medicare but do not enroll forfeit all Social Security benefits — past and future.

Conditions on government subsidies become problematic when they require recipients to accept a second government subsidy. The main problem with this condition, however, is that it has no basis in statute.

Federal bureaucrats just made it up. It is fairly clear why they did. Withholding Social Security benefits makes it harder for seniors to leave Medicare, which has the effect of both quashing the market for alternative forms of health insurance and making more Americans dependent on Medicare.

Congress should allow seniors to opt out of Medicare without losing Social Security benefits. Removing this condition would curb executive overreach, expand the market for alternatives to Medicare, and create a political constituency of seniors that is more open to fundamental Medicare reform. The rules Medicare attaches to these subsidies stifle innovation, while keeping quality low and costs high.

One bipartisan proposal would create a more level playing field between traditional Medicare and private plans. Many multinational corporations and banks are wary of conducting business with Iranian entities, since transactions that pass through American banks or involve American citizens working for foreign companies technically remain subject to sanctions.

The United States will likely be unable to broker mutually acceptable resolutions to the conflicts in Syria, or to defeat the Islamic State, without Iranian cooperation. Securing that cooperation would be much more difficult if Washington imposed a series of new sanctions.

Since Iranian leaders would surely interpret new sanctions as a violation of the spirit, if not the letter, of the JCPOA, they would grow even more skeptical that the United States can be trusted to abide by negotiated compromises. Launching a political warfare campaign would be even more counterproductive, effectively confirming the suspicion espoused by Iranian hardliners that the United States is intent upon catalyzing regime change in Iran.

By attempting to subvert the Iranian regime, the United States could thus undermine the very reformers it seeks to empower. Since getting tough with Iran is unlikely to yield positive results, the United States should instead pursue a policy of engagement. Perhaps the simplest way to do that is to issue clear guidance detailing how foreign firms can invest in Iran without running afoul of remaining U. The United States should also attempt to build on the JCPOA by continuing to actively engage Tehran in negotiations over ongoing and future regional crises — most notably the wars in Syria and Yemen.

The idea of building diplomatic ties with Iran is no longer taboo. Indeed, an open letter to the president on the first anniversary of the JCPOA, advocating increased engagement between the two countries, was signed by 75 national security leaders from both parties, including 23 former ambassadors, 14 former members of Congress, and 3 Nobel laureates. For instance, although Supreme Leader Ayatollah Khamenei issued a dictum in October asserting that further negotiations with the United States were forbidden, Iran accepted an invitation later that month to join the United States in multinational negotiations on Syria.

The time is ripe to explore additional areas of common interest. Negotiations are unlikely to yield immediate benefits. Yet Russia, with million people, has less than 60 percent of the population of the old Soviet Union — and it is an aging population with a declining average lifespan.

In short, Russia is simply too weak to pose a conventional challenge to much of Europe. Nevertheless, U. A more plausible interpretation is that those moves were an effort by Vladimir Putin's government to strengthen security along Russia's western border against what Russian leaders see as a dangerous eastward expansion of NATO.

Instead of responding as the United States and its NATO allies have done with military exercises and new military deployments in Eastern Europe, they should move more cautiously and be mindful of Russia's longstanding security concerns in that region.

It also would be the height of bitter irony if, having escaped a direct military clash with the Soviet Union a truly dangerous adversary during the Cold War, NATO stumbled into conflict with a mundane Russia because of a needlessly inflexible and confrontational approach.

Yet that is now a real danger unless U. Some candidates are not necessarily in Russia's security zone. The newest alliance member, for example, Montenegro, is in the Balkans.

The most discussed potential members, though, such as Georgia and Ukraine, would trigger a crisis with Moscow. Only the most reckless policymakers should wish to go down that path. Moreover, adding an assortment of small, militarily insignificant "allies" does nothing to benefit America's security and well-being. Indeed, when those small security dependents are on bad terms with a great power neighbor, they can greatly endanger America's security by triggering an unnecessary armed conflict.

We already have that risk with the three Baltic republics, given their fraught relations with Moscow. Adding Georgia or Ukraine to the alliance would greatly compound the danger. Although the United States should push NATO to adopt a more conciliatory policy toward Russia, Washington also needs to make clear to the other alliance members that the days of free riding on America's security exertions have ended.

There is an especially annoying gap between the rhetoric of those European members who cite a rising Russian security threat and their commitment to fulfilling the pledge made at the summit to devote at least 2 percent of annual gross domestic product GDP to defense. Some still fall short — often far short — of that amount. Only 4 of the 28 members other than the United States fulfill the 2 percent pledge, and 2 of them Estonia and Poland have done so just recently see Figure If NATO's European members want to present a credible deterrent to Russia, they need to do more — unless, of course, they are simply relying on the United States to handle their security needs.

Washington has complained about the lack of burden sharing for decades and gained little satisfaction. When the European allies have not ignored U. The United States needs to move beyond burden sharing to burden shifting.

Another problem is that Congress and the USDA distribute disaster payments in a careless manner, with payments going to farmers who do not need them. EWG found that billions of dollars over the years have been paid to farmers who would not normally have planted the areas included in their USDA claims.

Subsidies undermine U. Global stability and U. America can help by encouraging poor nations to adopt free markets and expand their international trade. However, U. Federal sugar protections block freer trade within the Americas, for example, while enriching sugar growers and harming U. Subsidies harm the environment. Federal farm policies damage the natural environment in numerous ways. As a result, areas that might otherwise have been used for parks, forests, grasslands, and wetlands get locked into less efficient agricultural use.

Subsidies are also thought to induce excessive use of fertilizers and pesticides. Producers on marginal lands that have poorer soils and climates tend to use more fertilizers and pesticides, which can cause water contamination problems. Sugar cane production has expanded in Florida because of the federal sugar program, for example, and the phosphorous in fertilizers used by the growers causes damage to the Everglades.

Agriculture would thrive without subsidies. Different crops would be planted, land usage would change, and some farm businesses would contract while others would expand. But a stronger and more innovative industry would emerge with greater resilience to market fluctuations. Private insurance, other financial tools, and diversification would help cover risks, as they do in other industries.

An interesting example of farmers prospering without subsidies is New Zealand. In , New Zealand ended its farm subsidies, which was a bold stroke because the country is four times more dependent on farming than is the United States. The changes were initially met with resistance, but New Zealand farm productivity, profitability, and output have soared since the reforms.

New Zealand farmers cut costs, diversified land use, sought nonfarm income, and developed niche markets such as kiwi fruit. Babcock, Bruce A. Washington: Environmental Working Group, February