America’s elections are administered locally by tens of thousands of government employees and citizen-volunteers. This decentralized process sometimes makes people worry about the possibility of fraud. If there is so much leeway for state and local election boards to select people, and administer rules and procedures, to what degree can Americans trust the process?

An enormous sum of money is spent on America’s healthcare system: 4.5 trillion dollars in 2023 (nearly 14 thousand dollars per person). This per-capita cost is almost double the average in other industrialized nations. At first glance, these costs suggest that healthcare in America is beset by waste and inefficiency. However, it is also possible that these higher costs reflect decisions about the kinds of care that will be made available, both to people with private health insurance and those who receive care through a government program. This brief begins to address these complex questions. We focus on the Medicaid program, a partnership between the federal and state governments that provides health care to over 70 million Americans. Medicaid has an annual budget of over 800 billion dollars in 2024 (1 out of every 6 dollars spent on healthcare in America). We ask two questions: what is this money spent on, and are the program’s per-recipient costs in line with private-sector health insurance providers?