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April 29, 2005

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Appalled Moderate

TM:

Once upon a time, when HMOs were seen as a needed reform of our healthcare system, rather than a cabal of evildoers out to deny expensive medical care, the argument for covering routine medical care was to get people to go to the doctor and get checkups, because this is the way folks would avoid more expensive health problems down the road. I don't know if it has truly worked out that way (anyone know of any studies?), but that was the argument.

But, this time, I think you have the right take, thoug it might be getting lost in the ritual earnest prof bashing. Insurance that covers everything (as opposed to insurance with a high deductible) is far more expensive. From the insurance point of view, that makes sense. A program that covers doctor's visits is, by any actuarial table you can dig up, going to cost them more.

So. the solution? Sorry, when it comes to health care, almost anything you do has unintended consequences that are often pretty ugly. So I don't have a cure. Really, the whole problem is that insurance is tied to employment, so that the consumer is not the purchaser. Bush I's idea of trying to shift the responsibility of insurance away from employers and to individuals probably makes the most sense, if you can force insurers to community rate, and you make health insurance something like auto insurance -- something you are required to get. (I do not want to bore anyone with a lecture on adverse selection right now. Just take my word that an entirely voluntary system will not work.)

Oyster

Employers don't give their employees any real choice on insurance plans. You either take a complete plan that covers everything from bandaids to heart surgery or you get nothing. I'd love to be offered a plan that covers the heart surgery and allow me to simply pay for my own damn flu shot. I'm willing to bet that those who have an HMO are no more inclined to get regular checkups than who don't. There are many who abuse their insurance and run to the doctor everytime they get a twinge and the rest of us have to pay for it because the only choice we have is the "comprehensive group plan".

In the past 8 years I've shelled out enough money for health insurance to pay cash for a triple by-pass. What have I gotten in return? Two prescriptions for antibiotics. And I paid my co-pay so it wasn't "free". I should have a choice for a "cheaper" group plan through my employer that only covers catastrophies.

Joe Mealyus


Krugman's whole approach in his series of health-care columns so far seems to be "it's a free free free free market." Starting there frees him from the burden of giving us his view of how the actual market structure - regulated, incentived, rent-seeked, psychedelic and funkadelic - is failing - let alone why it must fail. I.e. instead of elaborating on the wasting-resources topic of paragraphs 5-7, he turns instead to a discussion of the foibles of his ideological opponents. Which maybe bears some fruit, but it's the kind that I would argue that NYT readers eat too much of already....

Creech

Oyster; I'm with you, except many -if not most - states have laws that mandate certain procedures and
coverages and the employer can't do anything about it except offer no health insurance. For example, in PA insurance must cover so many days maternity care even though a tiny percentage actually need the extra days.
It is illegal for, say, Blue Cross, to insure two days and permit you to pick up extra days if the doctor and
patient want extra days.

As for the statistics cited, I doubt very much that even half the uninsured even sought out a doctor in a one year time period. Most, in my experience, don't go to the doctor unless they are seriously ill. In that instance, they run to the emergency room where the must be treated regardless of their ability to pay.

HMOs encourage "wellness" checkups, etc. but can't force
participants to go. Does anyone know if employers, as a condition of continued employment, can force employees to have annual physicals and take action before a disease or condition becomes expensive?

Appalled Moderate

Creech:

You are not usually permitted discriminate against someone on the basis of their health status. I have feeling what you suggest would require something that woul run afould of that rule.

Foobarista

I'm one of those who went without health insurance by choice for several years: I was self-employed, young, healthy, and a tad overweight, so I figured that the $250/month or so to cover the one or two visits to the doctor per year didn't seem worth it. Even though everyone said that I'd be financially destroyed, I managed to get through it by going to doctors for the occasional flu or hangnail and actually paying cash.

Shockingly, I somehow lived to tell the tale...

Jeff

I will not quibble about your quibble with Krugman over semantics. Krugman, who's been pissed off for four years, has a hard time composing a simple declarative sentence that does not include a tweak to the nose of the conservatives who enrage him. You, tweaked, tend to parse the offending language, not the argument. I'll grant you that he's snotty. You gotta grant me that he's outnumbered 100-1 by snotty righties.

To the argument. While not copping to the title "acolyte," I will muster a defense of the article. Keep in mind that it's not a stand-alone; he combines it with Monday's as part of a series. Krugman's essential argument is expressed in paragraph one: "[American health care]uniquely inefficient. We spend far more per person on health care than any other country, yet many Americans lack health insurance and don't receive essential care." He adds that the GOP's effort to privatize the system further address not these problems, but the wealth of their K Street buddies, which has not yet allowed them, Midas-like, to gild their mansions.

That this should be a matter of dispute is inconceivable to me.

janine

The survey actually tells you nothing about the other 59%, actually. We can only figure that out by knowing what the other options were on the survey/questionnaire/study. There could be anywhere from 1-27 subgroups falling into the 59%. Also, we'd need to find how how much of the 56% is "young and healthy." It's a good inference you make, but can't be definitive. This is why I hate the bandying about of partial statistics. It's a good thing for you your whole argument doesn't rest on it...

SaveFarris

"You gotta grant me that he's outnumbered 100-1 by snotty righties."

At the NYT? NOW we're in Bizzaro World.

Pouncer

I'm old enough to remember -- and I'm not all that old, either -- when health care providers and health insurance companies (who were not then indistinguishable each from the other either to policy makers or the general public) included not only "private" for-profit market-driven agencies and municipal, state, and various federal organizations, but faith-based and charitable agencies as well.

The Shriners' Children's Hospital. Catholic Sisters of Mercy. Danny Thomas's Saint Jude's Children's hospital. Blue Cross health insurance didn't use the "cross" because they were Nazis, either. Mount Sinai Hospital in New York City. Lutheran Brotherhood health insurance and United Commercial Travelers fraternal and benevolent accident insurance. World class top of the line services and facilities shaped by forces apart from either the market or legislative processes.

Even now here in Dallas we have Harris METHODIST hospitals and Baylor (Baptist) hospitals and Presbyterian hospitals ...

You know, if a pundit wanted to be consistant he might charge that conservatives have persistant faith in faith as an answer where gov't and markets have failed.

TM

It's a good thing for you your whole argument doesn't rest on it...

My argument is needs to rest - it is weary, probably from shadow-boxing.

Anyway, it is a fair point that we don't know what else was on the survey (yet), but somehow, that strikes me as Krugman's job to provide the supporting evidence for his case.

And Jeff, my quibble was quite minor - I was just noting that his survey hardly matches his assertion.

Well. Here is a link to the survey. Let's see.


Jeff

At the NYT? NOW we're in Bizzaro World.

I meant in the universe: Limbaugh, Hannity, Savage, everyone at the National Review, O'Reilly, everyone else at FOX, etc.

Jim English

Krugman
Brad Delong
Mike Moore
Al Frankin
The Remaining Staff of Air America
Kos

Ok Jeff. Ramble off 590 snotty righties while think for a few minutes.

Jim English

Barbara Boxer
John Kerry
Peter Jennings
France (est pop. 60,000,000)
The Baldwin Family (est pop. 25)
Madonna

That should keep you busy for a while Jeff. I'll check back Monday afternoon to see how you are doing.

Forbes

Well, I’m glad to see Jeff unquestioningly accepts Krugman’s argument, “we spend more per person on health care than any other country, yet many Americans lack health insurance and don’t receive essential care”—which frankly, is no argument, but the assertion of a connection between expenditures, the financial responsibility for such (insured, or lack thereof), and a subjective measure of care. At best, Krugman's merely confused.

Better yet, that Jeff accepts Krugman’s conclusion that “[American health care] [is] uniquely inefficient,” is not only subjective, but not proved.

Let’s quickly debunk Krugman’s conclusion with the recollection of former President Clinton’s cardiac episode last year—he saw a specialist the next day, and under went by-pass surgery within days. (That the hardware store owner in Salinas, KS may experience less speedy treatment is due to geographic proximity to a cardiac clinic, rather than an argument over subjective efficiency.)

Now if Bubba Bill were a Canadian citizen with similar resources, he would’ve done the same—except he would have had to traveled to New York—by going to Columbia Presbyterian Hospital and receiving treatment within the week. While the Canadian citizen might have died during the 5.6 week waiting list for a cardiac specialist and surgery. Some efficiency, that. (See Fraser Institute report, “Waiting Your Turn, Hospital Waiting List in Canada, 14th edition, http://www.fraserinstitute.ca/shared/readmore.asp?sNav=pb&id=705.)

As to Krugman’s “we spend more, but many lack insurance” assertion, so what? The spending incorporates all—whether you’re insured or not. Lack of insurance does not result in a lack of health care, despite Krugman’s linking of such unconnected concepts. What’s the implication—if more were insured, we’d spend less on health care? Absurd. That the insured always, and only, receive “essential” health care? Equally absurd.

And as to the “we spend more” observation—well, what is known is that as a country’s standard of living rises (per capita GDP), more is spent on healthcare. Spending also rises on the environment, and leisure—I’ll let others what is being measured, and whether it's good or bad.

So what’s the problem with health care? Nobody "pays" for it.

As an “economist,” you’d think that Krugman would understand incentives, but apparently, he doesn’t.

Current arrangements rely on a World War II era accommodation around wage and price controls which allowed employers to increase employee compensation by providing healthcare benefits. The resultant treatment of this benefit—a tax-deductible expense for the employer, and non-taxable compensation for the employee—is a double tax subsidy in favor of healthcare spending (employer-provided as compared to individually purchased). Such favorable treatment is an incentive for employees to take compensation in the form of non-taxable, and gold-plated, healthcare benefits. These gold-plated benefits include not just insurance for surgical and hospital care, bur pre-paid medical expenses for regular and customary treatments such as office visits, annual physicals, dental hygiene, eye glasses, talk therapy with a “shrink,” et. al. The outcome of significantly subsidized healthcare benefits, in concert with a third-party payer system—where consumers spend from bottomless wallets—is overspending on healthcare, and spiraling healthcare costs. Consumers do not make prudent decisions when spending someone else’s money.

Such a dysfunctional system means that if you’re not covered under an employer-provided benefit plan, Medicare, or Medicaid, you’re probably one of 44 million Americans without health insurance. Now, the reason the “uninsured” isn’t a catastrophe is because the uninsured are not without medical care—they cannot be denied on account of an inability to pay. But the uninsured contribute to rising healthcare costs because the current system requires they access the healthcare system through the most expensive settings—hospital emergency rooms.

The primary reason those 44 million forgo healthcare coverage is simple economics. They’re relatively healthy (60% are age 35 or younger), so their healthcare utilization, hence cost, is low, yet they’re subject to paying the full (unsubsidized) price for healthcare. Other covered individuals, whether employer-paid or through Medicaid/Medicare, receive substantial and hidden subsidies. Additionally, the uninsured pay taxes funding the very subsidies for which they are ineligible due their employment situation. The existing system is so perversely dysfunctional it encourages people to go without healthcare insurance.

The fastest way to fix the health care “spending” problem is to make compensation received in the form of healthcare benefits taxable—as other forms of compensation are. Think about it, there are few, if any other, forms of consumption where the consumer (but not all consumers) receives such a direct tax shield subsidy.

Additionally, we should require hospital/surgical/rehabilitation insurance coverage—actual insurable events—as opposed to the balance of a typical benefit package--pre-paid regular and customary care--should be subject to the vicissitudes of consumer choice and the free market (such as cosmetic and laser eye surgery) . This would immediately reduce the explicit tax subsidy on healthcare spending, and break the pernicious consequence that results from tying healthcare to employment.

That the Medicare regulations at HHS are even longer (a multiple, actually) of the 17,000 pages in the IRS tax code might suggest that less government, and more market, is the better route to a solution to this issue.

Forbes

errata
****************
--I'll let others**decide**what is being measured...
****************
Additionally, we should require hospital/surgical/rehabilitation insurance coverage—actual insurable events—**while**the balance of a typical benefit package--pre-paid regular and customary care--should be subject to the vicissitudes of consumer choice and the free market (such as cosmetic and laser eye surgery).

(If your posts were shorter, Preview would actually help catch those mistakes--ed.)

Joe Mealyus

Krugman: "We spend far more per person on health care than any other country, yet many Americans lack health insurance and don't receive essential care."

Forbes: "...no argument, but the assertion of a connection...."

Krugman (the rest of paragraph one): "American health care is unique among advanced countries in its heavy reliance on the private sector. It's also uniquely inefficient."

No argument, but the assertion of a connection?

(I guess you are supposed to establish your theme in your opening paragraph).

Forbes

JoeM: Sorry, I'm dense on your point. If you could elaborate, I'd be happy to repond.

TM

My guess - if and when Krugman proposes something, it will be based on seeral principles that I infer to be widely held by liberals:

1. Access to health care is a right

2. Access to health care should *not* be rationed by price (perhaps I am remembering the caricature, but IIRC, Dems were very proud that under "Hillarycare" we were all provided the same health care plan, and "the rich" would not be able to wriggle out and buy better care for their kids or parents.)

Krugman will also insist that those principles are based on simple social justice, or international best practices, or common sense, or public opinion polls, or anything except ideology. In his world, the only ideologues in the health care debate are on the right.

richard mcenroe

Jeff... ALL lefties are snotty. They're just not very good at it. That's why they usually start screaming about Hitler and Halliburton by the third, fourth sentence.

Patrick R. Sullivan

Poor Krugman just got hammered by a Bush punch from the left on Social Security reform: Restore solvency by cutting benefits for the well-off and increasing them for the poor. He'll probably soon do something similar about health insurance.

Thomas

One word not yet mentioned: immigration.

For it, against it, whatever, it needs to be mentioned. There's a reason Texas is the state mentioned.

Jeff

Hmm, I see if I am to be comprehensive, I have several responses to make. Ah well, comprehensiveness is overrated. I select Tom's final comment. (As to the snotty righties, I meant folks from the chattering class; obviously pols are snotty--but again, with our pathetic gibes, we cannot hope to reach the level of vitriol that righty pols achieve when they threaten judges, call lefties satanic, and so on.)

Tom, as to what this lefty would offer, try my home state's (now gutted, thanks to righties) Oregon Health Plan. The main attempt was to shore up the uninsured and it accomplished this by capping the kinds of precedures offered, but offering the program universally to anyone who met the financial threshold. Some tough procedures were cut--like keeping 4-month-old premies alive and liver transplants. Oregon also had a rigorous negotiating policy with big pharma--something that we could never expect the K Street crowd to embrace.

For lefties there are two central issues that are repugnant about the current system: it means millions suffer and die needlessly, and the benefits flow disproportionately to big pharma and insurance companies. It's our country and we can do whatever we want. Hate to say it, but the righties would prefer that pharma and insurers get rich and the poor suffer and die. It's not exactly the culture of life, but that's what it is.

So while you're right that the liberal commitment to social justice remains intact, you're sorely mistaken to imagine that we prefer punitive ideological solutions to actual good public policy. Honestly, I think that's another conservative value.

Paul Zrimsek

Ever since I saw Jor's new attitude on display down in the Sojourners thread, I've been wondering who he left his old attitude to. Now I know.

TM

So while you're right that the liberal commitment to social justice remains intact, you're sorely mistaken to imagine that we prefer punitive ideological solutions to actual good public policy.

I am not opposed to good outcomes!

However, I notice that, for example, in Europe, there is tremendous under-investment in new pharma research - not surprising, since everyone wants to control costs, and no one wants to pay for a drug after someone else has put in the R&D. Consequently, Europe is free-riding on the US consumer on pharma (sort of like with defense.)

Let's see, Imocked Kerry's drug vision here, and had a modest reform plan here (reform the drug industry to produce drugs under contract,like Big Defense, another darling of the Left.) Europe here.

TM

That said, the idea of looking at Oregon (and the experience with TennCare in TN) is a good one. Federalism in action.

Jeff

That said, the idea of looking at Oregon (and the experience with TennCare in TN) is a good one.

That's a sore subject, too. During the first term, our poor system was assaulted not just by Tommy Thompson but John Ashcroft, for reasons that appeared--just to harp on in defanged pique--punitively ideological. The system was actually a modest success: it didn't cost too much and the uninsured were brought a measure of safety. (There was even a notion that it saved the state money because the poor didn't end up in hospitals with burst appendices and so on--the expense of which, of course, the taxpayers end up footing.)

But it meant that certain procedures that the Reverend Ashcroft disdained were performed on the public nickel (not his, but hey, Federalism's got it's limitations, right?), and it also meant that a percentage of lucre was diverted from pharma's pockets.

So now it's mostly gutted and we're picking up the tab for those burst appendices on the back end, not to mention that we're also subjecting our fellow citizens to them in the first place. I get bitter because the "ownership society" looks pretty harsh if what you get to own is a burst appendix and not, say, a new yacht.

Joe Mealyus


"JoeM: Sorry, I'm dense on your point. If you could elaborate, I'd be happy to repond."

I thought your "no argument, but the assertion of a connection" was the perfect summary/critique of Krugman's paragraph-one summary of spending and results in American health care. My comment was (an attempt) to add that the exact same summary/critique applied equally well to Krugman's paragraph-one summary of industry structure and performance in American health care.

I probably couldn't have been less clear - sorry.

Krugman seems to be saying that the cause of our inefficient and bureaucratic health care system is our "heavy reliance on the private sector." And it seems that this is basically his starting argument, not something that he's going to be arguing - his emphasis (in this column, at least) is entirely on the big companies, not on the regulatory and incentive environment in which they operate (and which is partly the focus of your comment, and other comments).

At the same time, I wonder if Krugman won't be able to make some pretty effective arguments that a single-payer system won't be better than what we have now. I would much rather see the Bush administration tackle inefficiency in our health care system before they tackle Social Security.

Finally, since I don't believe any other commenter has explicitly done so, let me second JOM's evident bemusement with Krugman's "America is ruled by conservatives, and they have a private obsession..." bit. I am something of a fan of Krugman (still!), but he is certainly not the least unintentionally-funny-prone person in our Big Media.

Robert

Insurance is based on the idea that risk is spread out among many. Allowing the young, or anyone for that matter, to forego health insurance is a major problem.

Harry Arthur

"Hate to say it, but the righties would prefer that pharma and insurers get rich and the poor suffer and die. It's not exactly the culture of life, but that's what it is."

Honestly, Jeff, your ad hominem assertion that you know what we "righties" prefer is unfortunately fairly typical of a "lefty" unsubstantiated assertion that, quite frankly, does nothing to advance anyone's understanding of the problem or of potential solutions.

To suggest that any of us prefer that those less fortunate than ourselves "suffer and die" is insultingly ridiculous at best. You do yourself and any sensible portion of your argument a disservice by such nonsense.

Jeff

To suggest that any of us prefer that those less fortunate than ourselves "suffer and die" is insultingly ridiculous at best. You do yourself and any sensible portion of your argument a disservice by such nonsense.

I wondered if anyone would call me on the rhetoric, Harry. Truth is, I'm happy to cop to overripe, provocative language. But I'm stickin' to the point. In the past five years, W has made an art of transfering federal dollars from the middle class and poor to the wealthy through program and tax cuts. This year alone he's offered a bonanza to his K Street buddies and wealthy patrons, gutting the bankruptcy law, trying to ram through the estate tax cut, while meanwhile cutting Medicaid.

I'm willing to hear arguments that this is compassion of another stripe, but when your party is busy pulling money from the threadbare polyester pockets of the poor and putting into fur-lined aristocratic pockets, the burden of proof is on the GOP. I only have to reference the actions. Motivational gymnasticas are up to you.

Jim English

"I'm willing to hear arguments that this is compassion of another stripe, but when your party is busy pulling money from the threadbare polyester pockets of the poor and putting into fur-lined aristocratic pockets, the burden of proof is on the GOP. I only have to reference the actions."

No, Jeff, the burden of proof is on you to demonstrate that the poor are worse off. All your assertions aside, I have seen nothing to demonstrate that.

While you're at it, how about that enumerated list of snotty righties or a retraction.

Paul Zrimsek

The poor had BETTER be worse off! When I remember how much of our valuable kitten-strangling time we had to give up in order to install Bush as our puppet, it would be a crime if we were deprived of the sight of even one poor person suffering. [Twirls long black mustache.]

Harry Arthur

Jeff, having asserted that you are privy to the motivation of the GOP, you then suggest that "the burden of proof is on the GOP" to essentially prove a negative. Nice debating touch but it doesn't contribute to the discussion in any meaningful way.

You also said "I only have to reference the actions. Motivational gymnasticas are up to you." It's no more possible for me to speak to the motivations of the GOP than it is for you to do so, all your circular reasoning and unsubstantiated allegations aside. Essentially you asserted that all you have to do is make accusations of greed and avarice and that makes the point. Nope.

I think you'll find that progams haven't been cut and that the "rich" bear a larger share of the tax burden than prior to the tax cuts. But how great a percentage would you think is appropriate? The top 5% now pay something on the order of 90% of the tax burden. Not enough? The bottom 50% pay no federal taxes at all. Too much? If you really want to stand up for the poor, how about supporting the privatization of Social Security so they can become owners of wealth themselves.

By the way, I'm in the top 5% and don't have a single fur lined pocket in my vast wardrobe, nor does my wife. We both drive American made compact cars that are going on 10 years old and the majority of our neighbors and friends are similar. I guess I'm a bad person for saying it but I certainly don't feel under taxed or that I've stolen anything from those less fortunate than I. Sorry.

Jeff

I'm not sure why I keep flogging myself by coming back to debate the point, but maybe if Tom would post a new story, we could argue about Tom DeLay or Harry Reid instead. Meantime, I wade into the fray.

Harry, let's go with your post, because I think it most clearly describes why I use harsh rhetoric (ie, to shake the scales of FOX news from your eyes):

I think you'll find that progams haven't been cut...

You probably honestly believe this, and it's exactly why George W. Bush got re-elected. I'll find the programs haven't been cut? Oh really? Then what do you call the 154 items on Bush's http://msnbc.msn.com/id/7013465/>cut list? What did Congress just do to http://www.washingtonpost.com/wp-dyn/content/article/2005/04/28/AR2005042800446.html>Medicaid?

Congress passed a five-year, $14 trillion budget last night that will pave the way for oil drilling in parts of an Alaskan wildlife refuge, a new round of tax cuts and the first curbs on entitlements for the poor in nearly a decade. The House approved the plan by a vote of 214 to 211, and the Senate voted 52 to 47.

Moving on:

... and that the "rich" bear a larger share of the tax burden than prior to the tax cuts. But how great a percentage would you think is appropriate? The top 5% now pay something on the order of 90% of the tax burden.

Again: poppycock and Fox propaganda. http://www.washingtonpost.com/wp-dyn/articles/A61178-2004Aug12.html> To wit:

Since 2001, President Bush's tax cuts have shifted federal tax payments from the richest Americans to a wide swath of middle-class families, the Congressional Budget Office has found, a conclusion likely to roil the presidential election campaign.

The CBO study, due to be released today, found that the wealthiest 20 percent, whose incomes averaged $182,700 in 2001, saw their share of federal taxes drop from 64.4 percent of total tax payments in 2001 to 63.5 percent this year. The top 1 percent, earning $1.1 million, saw their share fall to 20.1 percent of the total, from 22.2 percent.

It didn't roil the campaign because the Democrats and the media failed to point this out. If you were duped, Harry--you, who are presumably a wonk who follows politics closely--is it any wonder the Dems got mopped up once again? This is my swan song, so once more: the GOP is transfering money from programs that help the poor and giving it to oil barons. There's just no way to spin it otherwise.

Harry Arthur

Jeff, fair enough, lose a bit of the condescension and you might actually add something useful to the debate. Thank you, though, for your concern with my vision.

Yes, you're correct that Bush has actually requested cuts in a number of programs. From the same article:

“Federal programs have staying power

Last year, Bush persuaded Congress to limit non-security spending to about a 1 percent increase — the smallest in years. But of the 65 programs he then proposed eliminating to save $4.9 billion, lawmakers killed four, saving just $270 million.”

In another measure of the staying power of most federal programs, of the 154 programs Bush wants to kill or cut this year, he has targeted 86 in the past — including 41 he has tried erasing or trimming every year since becoming president in 2001.”

Administration officials say every program on their list has shown little evidence of effectiveness.”

Unfortunately, it is generally the case in Washington that when we discuss “cuts” in any particular program we are most often really talking about decreasing the rate of increase. Thus, my statement and my preference that when “cuts” are alleged I’d like to see the numbers: what was the number in this budget and what will the number be in the next budget? By and large the number always gets larger somehow, even with “cuts.” In this particular case, if Bush is totally successful with his long list of draconian "cuts" the best we can hope for is a three year entitlement "freeze" at $404 billion per year. If you think this is draconian, wait until 2017 when the Social Security surplus disappears and the true size of the deficit is no longer hidden.

Now we can argue whether $404 billion per year is adequate to address the needs of the poor and the elderly. Perhaps it is and perhaps it isn't. Further, to be entirely fair we ought to look at the growth in these programs since Bush's first budget proposal. I would submit that the aggregate growth has far exceeded inflation and any reasonable demographic increases.

If I have any beef with Bush it's that he's been too much of a big spender on far too many programs that probably should have been "cut" but never seem to be. Adding roughly $500 billion over ten years to Medicare for prescription drugs was hardly a cut, even in the Washington sense of the word. In terms of proving one's compassion by spending other people's money, Bush is far ahead of Clinton with respect to virtually every discretionary budget category. Now, THAT fact does make me wonder why I would support a republican candidate.

You cite the CBO study of the results of the tax cuts. Fair enough. However, to be truly "fair and balanced" you should have included the following that even the Washington Post article didn't miss:

“They [republicans] point to a http://www.washingtonpost.com/wp-dyn/articles/A61178-2004Aug12_2.html”>different set of numbers within the CBO study that show that the rich are actually paying more in individual federal income taxes. If Social Security, Medicare and other federal levies are excluded, the rich are paying a higher share of income taxes this year than they would have paid with no tax changes, the CBO found. If none of the tax cuts had passed, the top 20 percent would pay 78.4 percent of income taxes this year. Instead, they will pay 82.1 percent. In contrast, the middle-class share of income taxes dropped to 5.4 percent, from 6.4 percent if no tax cuts had passed.”

You do have to read the articles you cited carefully for the "Paul Harvey" version but if you do you'll eventually find the "cuts in the rate of increase" terminology carefully tucked away here and there. You'll also find some of the interesting assumptions behind the numbers that generate the percentages you quote.

What the CBO study that you cite revealed was that those who pay all the taxes actually had the largest tax cuts in terms of actual dollars cut but that their share of the tax burden actually increased when comparing apples with apples. Not too surprising really.

And we haven't even begun to discuss whether the tax cuts had any positive effect on reducing the effects of the burst stock market bubble, the ensuing recession and the effects of 9/11.

As for "oil barons" receiving the largess of this budget, that's great rhetoric but the government will be receiving revenue from leasing tracts in Anwar - presumably offsetting some level of necessary "cuts." Not to mention that we as a nation might actually reduce, however slightly, our dependence on foreign sources of energy.

No spin - we just disagree on what the facts mean.

dsquared

[Yet health insurance is in crisis if folks don't have coverage for routine visits to the doctor?]

If it was possible for my house to catch my neighbour's paint, this analogy might hold up. As it is, all those young, healthy people who don't think a visit to the doctor is worth the expense for a little case of 'flu, are incubating bugs for the rest of us to catch.

By the way, I'm not sure that the factoid about "Europe" not investing in pharmaceutical R&D necessarily bears up under scrutiny, or to the extent that it does, that it matches up all that well to socialised medicine. The UK spends about 20% of the amount spent in the USA on pharmas R&D and we have the NHS. AFAICT, the location of R&D depends more on the strength of local intellectual property law than anything else, as you'd expect. (There is also the issue that a lot of the "D" in "R&D" is the cost of getting new drugs through the FDA testing regime; if you guys doubled the bureaucracy in this one I suspect that you could really kick our ass).

Jeff

If Social Security, Medicare and other federal levies are excluded, the rich are paying a higher share of income taxes this year than they would have paid with no tax changes

And if you remove payroll taxes from the calculation, hell, I'm damn near paying nothin'! What the hell does that have to do with anything? The thing that's ultimately useless about this discussion isn't that we disagree only on the spin--you won't acknowledge the facts. Either the rich are paying less or they're not. It's not an interpretive calculation. You are among a diminishing group of faith-based voters who are willing to eliminate unsavory facts from the argument so that the numbers line up.

Harry Arthur

Jeff, congratulations on "damn near paying nothin'". That has EVERYTHING to do with this discussion. As I recall, payroll "taxes" (really a tax in name only because that's how it's collected) pay for Social Security and Medicare for current retirees and the surplus goes into a "trust fund" to pay for your retirement needs. Are you suggesting now that these are not retirement and medical care programs? If they are, then how do they belong in the equation relative to who pays federal taxes. Are you suggesting that we cut "payroll taxes" so you pay nothing at all? OK. And we can privatize SS while we're at it. Thanks.

It seems that you're frustrated that I disagree with you. Get over it. I'm very well aware of the "facts" and the "spin" and to suggest that somehow we "rich" are somehow under taxed is just ridiculous.

You said "You are among a diminishing group of faith-based voters who are willing to eliminate unsavory facts from the argument so that the numbers line up." And I would offer the same criticism of your argument from the other side of the coin. You prefer to mix apples and oranges so that your numbers add up to suggest, imply, accuse the right of abusing the "little guy." Sorry, doesn't wash.

Not sure I can agree on the characterization of "faith based voters" as "diminishing." Certainly was not the case in the last election. We'll see what the future holds. If I am, as you say, in a diminishing group then, as a member of the majority you'll have your way at some point. No problem. That's how our system works. Perhaps you can then work on increasing your tax load to the higher levels you seem to prefer.

Harry Arthur

Or do you prefer that I also pay for your retirement and medical needs?

I'll ask again: What rate of taxation do you feel is "fair" for the "rich" to pay? At what income level does someone enter the "rich" category?

I think you have to decide on some basics before you assign labels and attack people for their heartlessness.

comehe

http://wsyc.org/wwwboard/messages/323.html enduredprincessteenage

thirties

http://www.goldworksusa.com/wwwboard/messages/12410.html currentmontgomerypause

Blue Cross of California

Krugman has a great discussion on health care. He also goes over the major health care crisis going on makes many good points of what we lack in our health coverage. I think health insurance is a major aspect to many and everyone deserves to be covered.

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Wilson/Plame