Monday, January 29, 2007

Monday with McKenna: Making War on Health

Click the graphic to watch Jon Stewart reveal everything you need to know about Dick Cheney. Then look here to watch Ted Kennedy bring it to the GOP for their "filibuster by delay" approach to the minimum wage increase.

See no alternative, hear no alternative, speak no alternative: If we deny that there is an option in Iraq, then there is none (even if there is one). And just in case anyone does have an option, it's treasonous—called it.

So nothing new has come under the Bush sun since the November mandate was delivered. He is, once again, giving the finger to the American electorate, the new Congressional majority, 95% of military experts and his own generals, and his own party's Congressional leaders. Fuck you, everybody: I'm the decider.

So the SOTU has brought us continuing war in Iraq, along with an insidious new turn in the war on the American people. For more on that, here's Terry McKenna.

In Saturday’s New York Times, Gary Wills delivered a reminder that may resonate with many of us:

WE hear constantly now about “our commander in chief.” The word has become a synonym for “president.” It is said that we “elect a commander in chief.” It is asked whether this or that candidate is “worthy to be our commander in chief.”

But the president is not our commander in chief. He certainly is not mine. I am not in the Army.”

I agree. In just a few days, the president’s State of the Union address has begun to disappear from public notice. He offered no memorable phrases, so fortunately no Axis of Evil moment. Still, the president dropped a little bomb with his proposals on health care. His ideas will never make it into law, but they are dangerous all the same!

George Bush introduced the topic by what was meant to sound like an appealing sound byte. Thus he agreed with most of us that it is the responsibility of government to provide health care to those that can’t afford it. But his words were sneaky. Just look at how carefully he worded his sentences: “A future of hope and opportunity requires that all our citizens have affordable and available health care. When it comes to health care, government has an obligation to care for the ELDERLY, the DISABLED and POOR CHILDREN (my emphasis).” He said nothing about the adult poor, especially the hard pressed working poor. Wow! So compassionate conservatism does not waste its compassion on poor adults. Double wow!

What does he mean? Well, let’s look at the proposed solution first for a clue. Again, the words were carefully chosen: “For all OTHER Americans, private health insurance is the best way to meet their needs. But many Americans cannot afford a health insurance POLICY (again, my emphasis).”Wow again!

In today’s world, prevention of catastrophic illness is the key to sustained good health. Prevention includes lifestyle decisions (like diet and exercise – also whether to smoke or drink); it also includes regular doctor’s visits. Thus, for people like myself, I watch my weight, but I also see a doctor quarterly (to monitor blood pressure) – and thus prevent kidney disease, heart disease or stroke. Unfortunately, the unemployed poor and working poor rarely receive regular care, and often have nowhere to obtain guidance regarding lifestyle choices. For them, medical care amounts to a visit to a hospital emergency room during a crisis. Best practices would replace the dependence on emergency medicine with regular and competent care. But did the president suggest a way to do this? NO! Instead, he offered incentives to purchase private health insurance.

Will these policies help? Not really. The president wants us to purchase policies that are like the old major medical policies of the pre-HMO days. These policies cover events like childbirth, a broken leg or a heart attack, but not regular preventive health care. For a fuller discussion of what the political right wants, read this article by a Cato Institute scholar. It’s somewhat dense, but useful as a guide to the president’s real plans. Embedded in the article is an interesting fact – only 10% of Americans have health policies of the sort that the president wants all of us to have. The rest of us have plans that are considered "too generous" – most of these are provided through employer or union groups – and the president wants to tax them!

Why would the president turn to private health insurance as a solution? It turns out that people like George and Laura Bush are just the sort of folks who typically purchase old fashioned private health insurance policies (when they are not in government – and before they are old enough for Medicare). Private health insurance is a specialty product that mostly serves an elite customer base: professionals in private practice, successful business owners, and the well to do. These folks have sufficient disposable income to pay for regular doctors visits without needing help from a generous health insurance plan.

So, I ask again, what does the president really mean (or want)? This is just another stealth attack on the growth of entitlements. A legitimate concern, but it should be addressed honestly (as should the question of whether the government can take on the burden of providing health care for all of us). Entitlements like Social Security, Medicare and Medicaid already account for over 50% of the federal budget – and these will get larger as we age. Think tanks like the Brookings Institution have attempted to grapple with the problem – here is an excellent piece. It challenges all the sacred cows – offering something for everyone to compromise on. In contrast, the president’s ideas are dishonest. And while he’s failed to touch Social Security, his ideas have started to impact Medicaid. In the guise of allowing states to experiment with Medicaid reform, states such as Missouri and Tennessee have begun to remove hundreds of thousands from the rolls of eligible beneficiaries. And then there is welfare reform – turns out this too was a stealth attack against Medicaid. As people go off welfare, their wages push them off Medicaid, thus they earn the privilege of joining the ranks of the America’s uninsured working poor.

There you have it, the health proposal was in fact a Trojan Horse. Just another attack on the social safety net.

Before I sign off, I wanted to review a few details. Private health policies are tremendously expensive. I priced two plans on line (for New Jersey). HMO coverage for a family would cost $16,900 per year; traditional insurance would cost more than double that, at $34,900. The president’s tax deduction of approximately $4000 for a family earning $60,000 would do little to help them pay for health insurance. On the other hand, for the well to do who can already afford coverage, the deduction means just more income in their already bulging pockets. The graphic shows the results of my web search, just in case anyone thinks I’m exaggerating the cost.

Then there is the nature of the so-called standard deduction for health insurance. George Bush has slyly added PAYROLL taxes (under our current income tax system, only income taxes are impacted by deductions). Adding payroll taxes (Social Security taxes) would be an expensive drain against Social Security revenue. With a $15,000 deduction (x 7.625% - the payroll tax rate), Social Security would lose $1144 per family. Wow. Taking revenue away from Social Security at the very moment that benefits are rising. Diabolical! Thus are billions of dollars stripped away from a program already in trouble.

As usual, the president is playing to his base, and lying to us all the while. The well to do get a tax benefit and the poor (working and middle class citizens too) get squat.

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