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3141. Unnecessary Relics: The Surgeon General and the Public Health Service Commissioned Corps

Author:
Jeffrey A. Singer, Akiva Malamet, Bautista Vivanco, and Michael F. Cannon
Publication Date:
07-2025
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
The US surgeon general has morphed from an apolitical supervisor of medical personnel to a divisive activist who undermines public health. Successive administrations have turned the Office of the Surgeon General into a highly political platform that opines on divisive non–public health issues ranging from gun control and social media to labor and housing policy. Such mission creep undermines the effectiveness of legitimate government public health activities. The surgeon general oversees the 6,000-member Public Health Service Commissioned Corps—a uniformed, noncombatant service that provides personnel for various federal agencies, including many non–public health roles. The Commissioned Corps takes longer to deploy than civilian alternatives, and many of its functions are redundant. A 2010 report from the Department of Health and Human Services estimated that employing Corps officers costs 15 percent more than hiring civilians. Replacing Corps officers with equivalent civilian employees could save $1.3 billion annually. Eliminating the surgeon general’s divisive political advocacy would be a step toward restoring trust in public health officials. Congress should dissolve the Office of the Surgeon General and the Commissioned Corps, eliminate their non–public health activities, and reassign any legitimate public health activities to other agencies.
Topic:
Government, Budget, Public Health, Public Spending, and Surgeon General
Political Geography:
North America and United States of America

3142. Immigrants Cut Victimization Rates, Boost Crime Reporting

Author:
David Bier and Julián Salazar
Publication Date:
08-2025
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
Americans are concerned about immigrants’ involvement in crime and their potential reluctance to cooperate with law enforcement. The National Crime Victimization Survey (NCVS) can help address these concerns. First, since criminals typically commit offenses near where they live and against people with similar demographics, the victimization rate can show whether immigrant communities are experiencing higher crime rates. Second, the NCVS can prove whether immigrants are less likely to report crimes to the police. The NCVS started recording citizenship status in 2017. From 2017 to 2023, immigrants were 44 percent less likely than US-born Americans to be victimized by violent criminals and were 64 percent less likely to be harmed by someone they knew. Immigrants also worked with police to solve violent crimes. Immigrant victims were 29 percent more likely than US-born victims to personally report violent crime to the police. Immigrants worked with police on 5.1 million crimes during that time. Victims’ cooperation with police led to nearly half a million criminal arrests and about 300,000 arrests of violent offenders. Because they commit fewer violent crimes, immigrants lower the violent-victimization rate in the United States. Furthermore, at least prior to the current mass deportation efforts, immigrants cooperated more with police to solve violent crimes when they occurred. Americans should trust that their immigrant neighbors help create safer communities.
Topic:
Crime, Immigration, Law Enforcement, and Victimization
Political Geography:
North America and United States of America

3143. Reforming Federal Laws on Private Sector Labor Unions

Author:
Charles W. Baird
Publication Date:
07-2025
Content Type:
Working Paper
Institution:
The Cato Institute
Abstract:
In America’s labor markets, interactions between employers and employees are generally based on voluntary exchange. Employers make offers of wages and benefits, while workers offer their services at terms that are suitable to them. In the absence of force and fraud, job providers and job applicants can bargain to reach agreement in a mutually beneficial manner. In the early 20th century, however, the idea that employers had too much bargaining power relative to employees began gaining favor. Congress responded by passing a series of laws allowing the formation of worker cartels called labor unions, which replaced individual employment agreements with collective bargaining. Congress imposed the Davis–Bacon Act of 1931, the Norris–LaGuardia Act of 1932, and the National Labor Relations Act (NLRA) of 1935 on the private sector workforce. The laws created rules for exclusive representation, mandatory union dues, and other labor force restrictions. These labor laws are still on the books, and they are deeply flawed. They damage the economy and violate individual rights, particularly the freedom of association. This study describes the 1930s labor laws and discusses why they should be repealed to allow greater freedom for workers and employers.
Topic:
Law, Reform, Private Sector, and Labor Market
Political Geography:
North America and United States of America

3144. Aimless Rivalry The Futility of US–China Competition in the Middle East

Author:
Jon Hoffman
Publication Date:
07-2025
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
Fear in Washington over China’s expanding regional presence is quickly becoming a new rationale for an expansive US foreign policy in the Middle East. But China remains an opportunistic actor in the Middle East, driven by practical needs, not by aspirations to dominate the region. Beijing lacks the ability and desire to assume a dominant position in the Middle East, and its ability to jeopardize US regional interests is limited. Centering US Middle East policy on competition with China is a recipe for disaster. It is an aimless rivalry divorced from concrete US interests. The United States has little to fear from China in the Middle East. By viewing every development in the Middle East through the framework of zero-sum competition with China, Washington is operating on faulty assumptions that will result in counterproductive policies. If navigated correctly, the return of multipolarity to the Middle East can be a net benefit for the United States, allowing Washington to disentangle itself from the region.
Topic:
Foreign Policy, Bilateral Relations, Strategic Competition, and Rivalry
Political Geography:
China, Middle East, Asia, North America, and United States of America

3145. Better Long-Term Care for Billions Less

Author:
Stephen A. Moses
Publication Date:
11-2025
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
Medicaid is a means-tested government health and long-term care program that states operate largely with funds from the federal government. In 2025, Medicaid will spend nearly $1 trillion on behalf of 84 million enrollees, or nearly $12,000 per enrollee. Medicaid is the largest purchaser of long-term care (LTC) in the United States, covering nursing home, memory, personal, and other forms of care for qualifying persons. In 2025, Medicaid will spend roughly $80,000 per enrollee receiving Medicaid LTC subsidies, which account for more than one-third of Medicaid spending and nearly half of total LTC spending. Yet, Medicaid subsidies reduce LTC quality, strain state budgets, and contribute to a federal debt that has surged past 100 percent of US gross domestic product. Counterintuitively, Medicaid subsidizes LTC for middle-class and affluent individuals, who do not need government assistance. Middle-class people easily qualify for Medicaid under the basic financial eligibility rules. Some individuals with significant assets artificially impoverish themselves to become eligible for and receive Medicaid LTC subsidies. Eliminating Medicaid LTC subsidies for individuals who could meet or could have planned to meet their own LTC needs would improve LTC quality and reduce the burdens Medicaid imposes on taxpayers. Middle-class and affluent seniors could draw on their assets and private LTC insurance, saving Medicaid as much as $100 billion per year without impairing its ability to serve those who truly need assistance.
Topic:
Economy, Medicaid, Subsidies, Public Spending, and Healthcare System
Political Geography:
North America and United States of America

3146. Protection for Whom? The Origins of Protective Labor Laws for Women

Author:
Matthias Doepke, Hanno Foerster, Anne Hannusch, and Michèle Tertilt
Publication Date:
09-2025
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
Over the past two centuries, the movement for women’s rights and gender equality in the United States has achieved remarkable milestones: Property and economic rights were granted to married women in the 1800s, women gained the right to vote in 1920, and sweeping civil rights reforms were implemented in the second half of the 20th century. Given these developments, progress has appeared to be steady. Yet, this process has not been a story of ever-expanding rights. We can gain insight into the complex political and economic forces that have shaped women’s labor rights by examining a striking historical reversal in the United States: the rise and fall of gender-specific, so-called protective labor laws between the late 19th and mid-20th centuries.
Topic:
Women, Employment, Economy, Protection, and Labor Law
Political Geography:
North America and United States of America

3147. Neoliberalism and Globalization Are Not Undermining Democracy

Author:
Stefani Branilović and Tibor Rutar
Publication Date:
09-2025
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
Neoliberalism and globalization are two distinct yet interrelated processes that began to spread across the world in the 1970s and 1980s. Neoliberalism mainly aims to limit the role of the government in the economy through corporate deregulation, cuts to social benefits, privatization of public assets, and tax cuts for corporations and the investing class. It promotes the free movement of goods, services, capital, and money within countries and throughout the world. Neoliberalism advocates a free-market economy in which governments exist only to maximize the efficiency of global markets, such as by securing property rights. Meanwhile, globalization is the process that promotes the integration of markets worldwide and intensifies economic, political, social, and cultural relations. In other words, globalization creates an interconnected world and removes barriers between countries.
Topic:
Globalization, Democracy, Economy, and Neoliberalism
Political Geography:
Global Focus

3148. What Are the Costs of Weakening Shareholder Primacy?

Author:
Benjamin Bennett, René M. Stulz, and Zexi Wang
Publication Date:
09-2025
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
The mainstream theory of corporate governance in the United States holds that the primary responsibility of the board of directors and management is to maximize the wealth of shareholders. This is the theory of shareholder primacy. If directors and officers stray from their duty, shareholders can constrain or remove them. An alternative theory is that directors and management should consider all stakeholders, including employees, customers, and communities. This theory offers limited guidance when decisions affect stakeholders differently, so it gives much more discretion to directors and officers than the shareholder primacy theory. As a result, the stakeholder theory enables insiders to pursue their own interests and find excuses for underperformance.
Topic:
Environment, Economy, Corporate Governance, and Shareholder Value
Political Geography:
North America, United States of America, and Nevada

3149. The Impacts of Grade Retention Policy with Minimal Retention

Author:
Jordan S. Berne, Brian A. Jacob, Christina Weiland, and Katharine O. Strunk
Publication Date:
10-2025
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
Strong early literacy skills are crucial for children’s school and life success. However, the latest results from the National Assessment of Educational Progress reveal that only about a third of American fourth graders read at a proficient level, with children from historically marginalized backgrounds trailing behind their peers. As educators work to improve reading outcomes, requiring students to repeat a grade—known as retention—has become a common, though controversial, component of state policy reforms, with mixed evidence on student outcomes.
Topic:
Education, Literacy, and Reading
Political Geography:
North America and United States of America

3150. The Impact of Deregulation on Long-Term Acute Care Hospitals

Author:
Markus Bjoerkheim and Ali Melad
Publication Date:
10-2025
Content Type:
Policy Brief
Institution:
The Cato Institute
Abstract:
Acentury ago, only 5 percent of Americans were 65 or older. Today, that figure is about 17 percent, and it is projected to reach 23 percent by 2050. This demographic shift poses a two-headed challenge: How can our society provide health care access to a rapidly growing population of seniors with extensive and increasingly specialized health care needs without further straining an already unsustainable federal budget? Regulations pose many barriers. For example, certificate-of-need (CON) laws restrict the entry and expansion of health care facilities in 35 states. Since the 1980s, 15 states have either completely or partially eliminated their CON laws. However, CON laws for long-term care services have largely been kept in place, making it difficult for researchers to estimate the effects of these laws on long-term health care services and access to care.
Topic:
Aging, Public Health, Hospitals, and Deregulation
Political Geography:
North America and United States of America