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By Clayton A. Mitchell, Sr., Esquire

In the grand sweep of American history, we have often been tempted to defer the difficult decisions of governance in favor of expediency or political convenience. Yet, there are moments when reality compels us to confront the unavoidable truths of our collective predicament. Such a moment is now upon us, and it concerns the solvency of our national budget. To speak plainly, the federal budget cannot be rendered solvent without the reformation of entitlement programs—Social Security, Medicare, and Medicaid. Without such reform, we are hurtling toward what can only be described as a fiscal death spiral, an inexorable trajectory toward insolvency.

Consider, if you will, the data furnished by the nonpartisan Congressional Budget Office (CBO). It projects that the national debt held by the public will surpass 106 percent of Gross Domestic Product (GDP) by 2027. To place this in perspective, the historical average over the past half-century has been a far more modest 48 percent of GDP. This vertiginous ascent is fueled by perennial federal budget deficits, forecasted this year to exceed $1.9 trillion. Such deficits are the arithmetic byproduct of expenditures chronically outstripping revenues, a phenomenon exacerbated by the ravenous appetites of entitlement programs.

Social Security, Medicare, and Medicaid—the so-called “sacred cows” of American politics—consume an ever-expanding share of our national resources. Left unchecked, they threaten to engulf the entire federal budget, crowding out other vital priorities and rendering the government incapable of responding to unforeseen crises. Indeed, the very premise of their sustainability has been rendered dubious by demographic realities: an aging population, declining birth rates, and a shrinking ratio of workers to beneficiaries.

Compounding this fiscal challenge is the reality that the United States has funded wars in Afghanistan and Iraq, the bailouts during the Great Recession, and the programs to alleviate the effects of the COVID pandemic by borrowing money and not paying for them. The invoice for these endeavors is now due, and we cannot continue this pattern of fiscal irresponsibility without grave consequences.

Let us dispense with the fallacy that the national debt is a mere abstraction, a bogeyman conjured by fiscal scolds. The consequences of our mounting indebtedness are as tangible as they are dire. High and rising debt suppresses economic growth by diverting capital from productive investment to service interest payments. It erodes our standard of living, renders us less competitive on the global stage, and constrains our capacity for fiscal maneuvering in times of national emergency. Worst of all, it imposes a staggering burden on future generations, who will inherit the debts of our profligacy without enjoying the benefits of our largesse.

As Maya MacGuineas, president of the Committee for a Responsible Federal Budget, aptly observes, “Borrowing is not free; it comes with costs that will fall hardest on the next generation. Without changes, we risk leaving our children a legacy of debt, slower growth, and reduced opportunities.” Her warning underscores the urgency of addressing our fiscal challenges before they spiral further out of control.

Yet, these outcomes are not inevitable. As the CBO notes, policymakers retain the capacity to chart a more sustainable fiscal course. This requires both a reduction in the rate of spending growth and an enhancement of revenue streams. Among the options are measures to curb overpayments in Medicare Advantage, equalize Medicare payments for similar treatments, and raise the retirement ages for Social Security and Medicare eligibility. These are not draconian measures; they are prudent adjustments to programs whose underlying structures are misaligned with contemporary demographic and economic realities.

Moreover, we must not shy away from politically unpalatable but necessary revenue measures, such imposing a FICA payroll surtax on high incomes, and enhancing the efficiency of tax collection through better funding of the Internal Revenue Service. Such measures can be calibrated to preserve economic competitiveness while contributing meaningfully to deficit reduction.

The opponents of entitlement reform argue that such programs are the bedrock of social stability and economic security. This is true. But to preserve these programs for future generations, they must be reformed to reflect the fiscal and demographic realities of our time. Failure to act is not a neutral option; it is a decision to allow these programs to collapse under their own weight, taking the federal budget—and perhaps the American economy—down with them.

In closing, let us invoke a principle articulated by the late Edmund Burke, who observed that society is a partnership between those who are living, those who are dead, and those who are yet to be born. If we are to honor this intergenerational compact, we must act decisively to place our fiscal house in order. Reforming entitlement programs is not merely a matter of arithmetic; it is a moral imperative. Let us rise to the occasion.

The author is an attorney who resides on the Eastern Shore and is co-host of the Gonzales/Mitchell Show podcast.

By Brian Hose

Independent pharmacies across Maryland are singularly focused on one urgent priority: pharmacy benefit manager (PBM) reform. As Congress considers the future of healthcare policy, the opportunity to take meaningful action on PBMs is here—and it must not be missed. For too long, these corporate middlemen have driven up drug costs, squeezed local pharmacies to the point where many have gone out of business, and limited patient access to affordable medications. As an independent pharmacy owner in Maryland and the CEO of EPIC Rx, I have seen first-hand the detrimental effect on our communities.

Maryland’s congressional delegation, and every member of Congress, has a critical chance to act now, building on the body’s prior success in lowering prescription drug costs. We need PBM reform, and we need it now.

PBMs wield enormous power in our healthcare system. Originally intended to manage drug plans and negotiate discounts on behalf of patients, these entities have evolved into profit-driven intermediaries forcing higher costs on patients. Today, three PBMs control nearly 80% of the market, giving them significant leverage over drug pricing, pharmacy reimbursements, and patient access to medications. This consolidation allows PBMs to determine which drugs are covered, how much patients pay out of pocket, and even which pharmacies survive.

Independent pharmacies, in Maryland and across the country, have felt the brunt of PBM practices. These small businesses—many of them family-owned and deeply rooted in their communities—are struggling to stay afloat due to below-cost reimbursements and retroactive fees imposed by PBMs. Every time a local pharmacy closes, patients lose a vital point of care, especially in rural and underserved areas where these pharmacies often serve as the primary healthcare providers.

Our communities have already seen the negative impact of unchecked PBMs, with increasing closures of community pharmacies and patients forced to travel farther to get their medications. In some cases, PBM-owned mail-order services are the only option, leaving patients with fewer choices and less personalized care. This trend is unsustainable—and it’s harming the people who can least afford it.

The push for PBM reform is not just about supporting small, independent pharmacies like mine and the communities we service—it’s about putting patients first. Reform will inject transparency into a system that has operated in the shadows for too long. It will ensure that the savings negotiated between PBMs and drug manufacturers are passed along to patients rather than being pocketed by intermediaries. PBM reform will protect small pharmacies from predatory practices, giving them a fair chance to serve their communities and compete on a level playing field.

We have worked diligently with the Maryland General Assembly to help pass some small relief, but we can’t compete with companies listed near the top of the Fortune 25 biggest companies. Every time we close one loophole, they just find another way to gouge patients and their pharmacists.

Now, Maryland’s congressional delegation can and must play a leading role in this effort. Congress has already laid the groundwork with historic efforts to lower prescription drug prices, such as the Inflation Reduction Act’s Medicare reforms. But PBM reform is the crucial next step in this journey. Without it, patients will continue to pay more for medications, and local pharmacies will continue to close their doors.

The opportunity to pass PBM reform is here, and the time to act is now. Maryland’s members of Congress have a chance to build on the progress already made by embracing this reform, ensuring that the savings and benefits of drug price reductions reach patients—not just corporate middlemen. Delay is not an option.

Independent pharmacies are ready to do their part, but they need the support of Congress to succeed. Maryland’s lawmakers have a responsibility to act decisively—reform PBMs, reduce the cost of prescriptions, and preserve access to care for patients everywhere. They have their chance over the next couple of days to start helping independent pharmacies by voting “yes” on the spending package before them. Let’s put patients first, protect our local pharmacies, and make sure that the healthcare system works for everyone. The time for PBM reform is now.

Brian Hose is an independent pharmacy owner in Sharpsburg, Maryland and the CEO of EPIC Rx, a national leader of pharmacy services support for independent pharmacies.

By Clayton A. Mitchell, Esquire

Maryland, as presently governed, finds itself on the precipice of fiscal calamity, a condition made manifest by a burgeoning structural deficit that threatens to become one of the most severe financial crises the state has faced in decades. With a staggering $5.9 billion shortfall projected by fiscal 2030, it is not merely advisable but imperative that Governor Wes Moore assume the mantle of reformer, lest Maryland sink further into the quicksand of fiscal irresponsibility.

The solution, however, does not lie in simply raising taxes or relying on ephemeral “one-time fixes.” It demands a fundamental reorganization of the state’s unwieldy and antiquated government structure, the likes of which has not been seen since Governor Marvin Mandel’s sweeping reforms over half a century ago.

Let us first cast our minds back to the era of Marvin Mandel, whose tenure as Maryland’s governor from 1969 to 1979 was marked by a transformative overhaul of the state’s executive branch. Confronted with an astonishing 240 separate agencies—each a little duchy of inefficiency and redundancy—Mandel took a scalpel to this leviathan. His bold consolidation into a dozen cabinet-level departments was nothing short of revolutionary, a testament to the notion that the government can, indeed, be made leaner and more effective.

In contrast, today’s Maryland government has metastasized into a lumbering behemoth, with 20 executive departments and over 60 independent agencies and offices. It is a marvel of bureaucratic inefficiency, and like a forest left untended, it has grown wild and unmanageable.

The last substantial attempt at reorganization was a relic of the 1970s—a bygone era when “artificial intelligence” might have been mistaken for the latest Orwellian jargon rather than a tool capable of revolutionizing government operations.

If the purpose of government is, as the Founders suggested, to serve the public good, then Maryland’s fiscal projections are an abomination of that principle. As reported by Bryan Sears in a November 12, 2024 Maryland Matters article, David Romans, a budget analyst with the Department of Legislative Services, offered a stark diagnosis: by fiscal 2030, Maryland will be able to cover only 84% of its projected expenses.

The current year’s budget gap alone exceeds $1 billion, with this figure ballooning to $2.7 billion by 2026 and $5.9 billion by 2030. This trajectory rivals the economic straits of the Great Recession, but unlike that period, Maryland’s current woes are self-inflicted, driven not by external shocks but by profligate spending and a stagnant economy.

To be sure, Maryland faces an array of fiscal pressures, including the ambitious “Blueprint for Maryland’s Future” education reforms, surging Medicaid enrollments, and ballooning childcare subsidies. Yet, these are challenges that demand a long-term strategic solution, not the usual Annapolis short-term parlor trick of raiding the “Rainy Day Fund” or shifting funds to cover deficits.

What then is to be done? The answer, though politically perilous, is clear: Governor Moore must summon the courage to reform Maryland’s bloated government. The current structure, with its 20 departments and 60-plus agencies, is not merely inefficient; it is an affront to the very notion of accountable governance. By consolidating agencies, streamlining decision-making processes, and leveraging modern technology—artificial intelligence chief among them—Maryland can create a government that is smaller, more agile, and, dare we say it, less costly.

The automation of ministerial acts, for example, could transform the way Maryland handles everything from tax collection to permit issuance, freeing up human resources for tasks that truly require the nuance of human judgment. Consider the potential cost savings of automating routine functions that currently consume countless man-hours and taxpayer dollars. The private sector has long embraced such efficiencies; it is high time that the government follows suit.

To be sure, the forces arrayed against such reforms are formidable. The special interests that thrive in the murky waters of government largesse will resist any effort to disrupt the status quo. Already, we hear the predictable bleats of those who see every government program as sacrosanct, every budget line item as inviolate. Yet, if Governor Moore truly aspires to a legacy beyond mere incumbency, he must gird himself for a battle against the entrenched interests of his own party, as well as the forces of inertia that dominate the corridors of power in Annapolis.

A skeptic might argue that the political climate is not conducive to such radical reforms. But history teaches us that crises are often the midwives of change. Just as Marvin Mandel used the fiscal challenges of his day to justify his sweeping reorganization, so too can Governor Moore leverage the current budgetary crisis to usher in a new era of efficient, streamlined government. As budget analysts like Mr. Romans have implicitly indicated, the alternative—a grim cycle of tax hikes and service cuts—is no alternative at all, but rather a recipe for economic stagnation and public disillusionment.

At the heart of this debate lies the question of moral stewardship. The taxpayers of Maryland—ordinary men and women who go to work each day, who balance their own budgets with care—deserve a government that respects their hard-earned dollars. It is not merely a question of fiscal prudence; it is a question of justice. To allow government spending to spiral unchecked, to permit a bloated bureaucracy to siphon off resources that could be better spent on truly vital services, is to abdicate the sacred trust that public officials owe to their constituents.

Governor Moore, thus, stands at a crossroads. He can either continue down the well-worn path of temporary fixes and fiscal gimmicks, or he can choose to be a statesman in the mold of Governor Mandel, by taking the hard but necessary steps to reform a government that has grown too large, too inefficient, and too costly. The choice is his, but the consequences will be felt by every Marylander.

In this time of fiscal peril, we look to Governor Moore to lead—not with timidity, but with the boldness that the moment demands. Let him seize this opportunity to craft a leaner, smarter, more responsive government. For if not now, when? And if not him, who?

Let us not squander this moment. The people of Maryland deserve better. The time for reform is now. I have every confidence that Governor Moore has the political capital, the business experience, and the acumen to do this.

The author is an attorney who resides on the Eastern Shore and is co-host of the Gonzales/Mitchell podcast.

By Becky Wimmer

America’s seniors are getting a new tool in the war on cancer: a new blood test to detect colorectal cancer received full Medicare coverage the same week as its FDA approval. It is a boon to patients, and a validation of the work that U.S. Sen. Ben Cardin (D-MD) continues to champion after almost 30 years.

In 1997, Sen. Cardin sponsored legislation that allowed Medicare to cover FDA-approved colon cancer screening technologies. Passage of the legislation ensured that as medical science advanced in the following decades, future colorectal screening technologies not even scientifically contemplated in 1997 could be eligible for coverage once the FDA confirmed their safety and effectiveness. This legislation has driven significant innovations in colorectal cancer screening, including blood-based tests.

Fast forward to today, and the policy that empowered innovation then, is now the model for legislation that puts us on the cusp of another major breakthrough in cancer care. And, fortunately for all of us, our own Sen. Cardin is right in the middle of it.

The Medicare Multi-Cancer Early Detection (MCED) Screening Coverage Act has generated support from hundreds of bipartisan members of Congress – 317 in the House of Representatives and 62 in the Senate – who recognize the importance of preventative cancer screenings.

MCED is a revolutionary advancement in science. With a single blood draw, these new screenings can detect dozens of different types of cancers – identifying the presence and location with remarkable accuracy. This is exactly what Americans need in the collective fight against this awful disease.Currently, there are only five recommended cancer screenings including mammograms and colonoscopies. MCED screenings would expand the types of cancer we can catch in the earlier stages, opening the door to earlier diagnosis and treatment for many more of the deadliest cancers.

Seventy percent of cancer deaths occur in patients whose cancer did not have available screening options before receiving their diagnoses in later, harder-to-treat stages. When caught earlier, treatment is often less invasive and less expensive. That’s a win-win for all, especially older adults who face the highest and most serious risks for the disease.

Sen. Cardin’s latest bill would create a pathway to Medicare coverage for MCED tests, just like the pathway established in 1997 for colon cancer screenings. Once the FDA gives final approval, the Centers for Medicare & Medicaid Services (CMS) could evaluate the evidence and cover the screenings for millions of American seniors who are at elevated risk.

Throughout his decades of public service, Sen. Cardin has  made a difference on critical healthcare issues even when the political climate made doing so seem impossible. Establishing a pathway for Medicare to cover MCED tests would encourage innovation as a central pillar of public health and solidify his legacy as a champion for cancer patients. Congress has acted before to ensure all beneficiaries receive immediate access to new screenings and should do so again for tools that can transform cancer care and survival.

Becky Wimmer is the Executive Director of the Maryland Academy of Family Physicians