Seizing the moment with universal health insurance
As Derek wrote a few days ago, a New York Times/CBS poll reveals that a majority of Americans believe that the government should guarantee health insurance for all. This poll also found a solid majority willing to pay higher taxes for universal health insurance. A story in today’s NYT links middle class insecurity to the rising tide of working families finding themselves without health insurance.
The number of middle class families that get squeezed out of health insurance coverage is shocking. Today’s NYT story finds:
Today, more than one-third of the uninsured — 17 million of the nearly 47 million — have family incomes of $40,000 or more, according to the Employee Benefit Research Institute, a nonpartisan organization. More than two-thirds of the uninsured are in households with at least one full-time worker.
Americans pay twice as much for health care per capita as the average citizen of an advanced industrial nation while nearly 47 million remain uninsured. This disparity between price and coverage is driving the public towards a consensus on the need for universal health insurance, and as the poll shows, may put previously dead-on-arrival approaches back on the table:
One question offered a choice between the current system and a national health insurance program covering everyone, administered by the government and financed by taxpayers. Thirty-eight percent said they preferred the current system, while 47 percent preferred a government-run approach.
This makes worthwhile a brief review of a few examples of the universal coverage approaches floating around out there.
Individual Mandates
The Massachusetts individual mandate approach has garnered the most attention recently (for one helpful take, go here). This program requires that all citizens purchase health insurance, with subsidies provided to those that cannot afford coverage on their own. Small businesses and individuals without access to employer-based insurance are offered policies through the statutory “Connector.” Governor Schwarzenegger recently proposed a similar plan for California. Individual mandates expand insurance coverage and grow risk pools, reducing dependence upon emergency rooms for primary care and increasing access to care for low income and high risk segments of the population.
At the same time, however, mandates won’t reduce the administrative overhead costs of our multi-payer health insurance system. If the Connecter or an equivalent agency moves to standardize and streamline records and paperwork via health information technology and takes upon the
Expanding MedicareOthers have proposed opening up Medicare to non-senior citizens, encouraged by its administrative efficiency and potential for broad, cross-subsidization across populations. Yale political scientist Jacob Hacker outlines such an expansion coupled with individual and employer mandates in his “Medicare Plus” proposal (go here and here). This approach moves the country closer to a single payer system while preserving individual and employer choice, encouraging competition between private insurers to match the efficiency and accessibility of Medicare. At the same time, this program is susceptible to the same big government charges that helped kill the Clinton health care proposal at the beginning of his first term.
Empower Federalism
Another approach, outlined by Henry Aaron and Stuart Butler, is the creation of a structured national program of state experimentation with approaches towards expanding insurance coverage. This program could be enacted through federal-state “covenants” that condition federal funds upon the adoption of congressionally-specific policy constraints and approaches aimed at a set of defined goals. The “policy toolbox” of presumptively approved insurance solutions would enable advocates of different approaches, typically divided by partisanship or ideology, to buy into the program in hopes of building a broader consensus in favor of their views. The toolbox may also have the virtue of expanding coverage while simultaneously shifting the political playing field to the states, as advocates lobby state governments to adopt one approach or another. This approach may require preemption of state benefit mandates by federal regulation to permit. Like the individual mandate, this approach could expand health insurance coverage across the country while leaving costs rooted in administrative overhead and quality and efficiency of care unattended.
The Individual Mandates like MA are going to take some time to see how well they work. Given the difference in population, I suspect CA is going to have a much more difficult time making it work. Other states have also had plans for a few years now with mixed results, but none of them have put the brakes on rising costs, which is the central issue.
Medicare is a program already going broke. At present rates of growth the program will consume 100% of the federal budget in about 35 years. I don't see how expanding Medicare can even be an option.
Federalism is a system similar to Canada where provinces get huge federal grants and administer themselves. Canada spends around $ 3000 Federal dollars per person on health care. This doesn't include provincial taxes or premiums paid by citizens. Some quick math on a program like that here would add up to about a $ 5000 price-tag in federal dollars per taxpayer (assuming 60% or so pay taxes), which is more than middle-class taxpayers are paying now for private coverage.
Assuming Iraq will be fading as an issue in 08, health care may move into the top spot. We should be looking for concrete plans with real numbers to back them up from the candidates. Speeches and feel-good soundbytes aren't going to cut it.
March 5, 2007 12:08 PM | Reply | Permalink
which is more than middle-class taxpayers are paying now for private coverage....
every study I've seen suggests that the US spends up to twice per capita on health care than any other contry in the world and we are in 21st place, the last time I looked, for life expectancy.
I recently read an article about a women with breast cancer and her premiums shot up to around $25,000 a year-- something she couldn't afford and she didn't want to get married because of the burden.
In general, I think "national policy" should be "single payer" since administrators don't deliver care and I firmly believe that "do nothing labor" should be retrained to provide services.
Finally, all federally funded school lunch programs should follow "best practices" in the menus they plan, like paying attention to "glycemic index" rules and serving more vegtibles. The dairy and cattle associations have certainly lobbied against the health interests of our children, and we need to take a stand.
March 5, 2007 1:44 PM | Reply | Permalink
I am for a modified H.R.676 (Single Payer-"Medicare for all"- Conyers/Kucinich et. al.) with much more emphasis on prevention at the individual and instituional levels
Sorry folks- a high tech treatment oriented "disease care" system is simply NOT economically sustainable
Dr. Rick Lippin
http://medicalcrises.blogspot.com
March 5, 2007 2:27 PM | Reply | Permalink
Re: Some quick math on a program like that here would add up to about a $ 5000 price-tag in federal dollars per taxpayer (assuming 60% or so pay taxes), which is more than middle-class taxpayers are paying now for private coverage.
I assume you are talking about what people pay out of pocket, not counting premiums paid on their behalf by employers.
Otherwise it makes no sense to suggest that people would pay even more under any sort of single payor system since there would be no reason for the outgo to be any higher (people aren't going to get sicker orhave more acidents just because they have health insurance) while some level of adminsitrative savinsg would reduce expenditures. I'm skeptical that you would get massive savings, but there would be some.
March 5, 2007 4:37 PM | Reply | Permalink
Re: Sorry folks- a high tech treatment oriented "disease care" system is simply NOT economically sustainable
And why not? Unless your reply has something to do with global warming and/or peak oil driving us back to the Stone Age I fail to see why high tech medicine should be economically impossible while high tech everything else is.
March 5, 2007 4:38 PM | Reply | Permalink
More than this:
In general, I think "national policy" should be "single payer" since administrators don't deliver care and I firmly believe that "do nothing labor" should be retrained to provide services.
Administrators not only don't deliver care, their profit depends on denying as much as they possibly can. One way is by saying that care can only be delivered by one or two providers; another is demanding "preauthorizations" --- a maze that normal people fall all over themselves trying to get their medical needs met, but they are denied (gleefully) when someone has missed one hoop to jump through.
Then there is always the "referral." If you get referred, as I did for a broken clavicle, and 7 months later if it still clicks and hurts when you move, and so you go back to the orthopedist you saw in the first place --> Guess what? The referral expires after 6 months, and so it doesn't get paid. The patient, who was after all, NOT unreasonable -- loses. Who wins? The bottom line of the insurance industry. It is just one (of many) examples of what is wrong with our system.
The insurance company has one goal, and it is not good health care for its unlucky members. The industry profits only at the expense of preventive and reasonable health care. How else can one explain why screening mammograms are a covered expense, but a diagnostic mammogram is not covered for someone with a history of breast cancer? If a screening colonoscopy (a covered expense) shows a polyp, it is RETROACTIVELY redescribed as DIAGNOSTIC so that it will go against the patient's deductible, and NOT be fully covered.
We don't have to reinvent the wheel; we also don't have to do it the way that Canada, England, France, or any number of countries handle their health care. WE CAN CHERRY PICK! WE CAN TAKE THE GOOD AND LEAVE OUT THE BAD!
But one bad thing that we MUST leave behind is the idea that health care needs to have a middle-man, or "industry" to scrape profits away from the job of preventive and excellent health care from cradle to grave.
PS--That does not mean sustaining the Terri Shiavos for 20 years of non-life. Medical care should always be delivered within the context of being able to benefit from it.
Jan Knaus
March 5, 2007 4:40 PM | Reply | Permalink
First, seems to me the experiments have already produced data, and the American system stinks. Second, a mandate to experiment has to come from the feds, so it doesn't make it more politically palatable to the right. Suppose we just put forward a plan we like.
John
http://www.haberarts.com/
March 5, 2007 6:42 PM | Reply | Permalink
Instead of looking at a poll that asks theoretical questions like should the government provide healthcare funding for all Americans, why not look at the headlines and leading newsstories of the day to see how efficient the Federal government actually does provide healthcare funding for some of its citizens--our military Veterans!
If a Federally funded health care program for even a small segment of our population causes us to writhe in horror, does ANYBODY seriously believe this same Federal government can possibly provide hundreds of millions of Americans with minimal basic health care let alone fairly adequate services?
And what will happen to the majority of Americans who are now privately covered and regularly recieve some of the best health care on earth? Will these families eventually also face rat infested, mold laced, sh*t-hole hospital rooms after our Federal government takes over the universal funding of health care for all Americans--not just for our War Heros?
March 5, 2007 8:39 PM | Reply | Permalink
Individual plans for a 40-year-old run around $ 200 a month with a co-pay, prescription drug benefit, and $ 1000 deductible. If you're single with employer paid -- you pay much less than that or nothing at all. Families will pay around $ 400 for the same level of coverage -- much less at work, of course.
If we switch to a national plan -- the employers will shift what they pay to the taxpayers... ie me. Why would I want to pay twice as much in taxes for health care I can get for much less at work? From union workers to white-collar attorney's, a national plan paid for by a tax increase represents a lot more money out of their individual pocket, because employers will shift all the costs. Who is going to vote for that in a democracy?
You have to work the numbers on these ideas, folks. Let's get beyond speculation and talk about reality.
March 5, 2007 8:50 PM | Reply | Permalink
Re; If we switch to a national plan -- the employers will shift what they pay to the taxpayers... ie me.
Um, they already did that. It's not like they're printing their own cash to pay those premiums. No, the money comes from their customers (AKA, the taxpayers in another role) via the price you pay for goods and services. And also, if you have insurance through your employer, your take-home pay is reduced by the amount the employer is paying for your benefits, although most people don't think of it that way since they do not ever actually see that money. I think that's what you're not putting into the equation.
Re: Why would I want to pay twice as much in taxes for health care I can get for much less at work?
Huh? How would you be paying twice as much? Your wages would go up since your employer is no longer paying healthcare (that money is now yours) or else the price of things would go down as the cost of labor decreases (if the employer thinks to pocket the difference instead.)
Also, your estimates of how much people pay for individual plans are on the low side (but may be realistic depending where you live). Where I live (S Florida) I could get an individual policy (I am 39) for $240, a bit more than you suggest; but in other areas one might cost as much as $500-- or more if one has some pre-existing issues.
March 6, 2007 3:51 AM | Reply | Permalink
Re: If a Federally funded health care program for even a small segment of our population causes us to writhe in horror, does ANYBODY seriously believe this same Federal government can possibly provide hundreds of millions of Americans with minimal basic health care let alone fairly adequate services?
One word: Medicare. Do people "writhe in horror" at that? The problems at the VA are the result of the Bush incompetents screwing it up. It was working rather well during the Clinton administration, in fact it was being pointed to as a model of what government could do right in healthcare. I almost think this is why the Bushies decided to destroy it. But anyway, no one, I repeat no one, is proposing a national VA where the government provides healthcare directly. The most anyone is proposing is a national Medicare where the government pays for some major fraction of healthcare services but the services are still provided privately.
March 6, 2007 3:52 AM | Reply | Permalink
"Your wages would go up since your employer is no longer paying healthcare (that money is now yours) or else the price of things would go down as the cost of labor decreases (if the employer thinks to pocket the difference instead"
Give me some concrete examples to back this up. Comparing wages with other countries doesn't support this argument. White collar professionals don't earn that much more in Canada, for example, than they do here or European countries. In many cases they earn less. The cost of living in Europe is higher as well. Basic items like food are much more expensive. I had a friend from Ireland come over and took him to a pizza buffet -- all you can eat pizza/salad for $6 with a drink. He was amazed at how low food prices were.
You're making the same promises politicians make. Forgive me for being skeptical. This is too huge of a paradigm shift for me to just trust somebody. I want numbers and details.
March 6, 2007 5:13 AM | Reply | Permalink
The burden of proof is on you, not me, as you are the one making an extraordinary claim (one that runs counter to the normally understood laws of economics).
Now just try to understand this: the money your employer pays for your insurance is NOT his money-- it's really yours. It's part of YOUR overall compensation. If your employer no longer has to pay that money to some insurer why wouldn't you end up with it in your check? The demand for labor will not change as a result. Neither will its supply. Ever hear of "supply and demand"?
Or let's assume you work for the firm of Scrooge and Legree, and they pocket the windfall instead and, being unaccountably loyal to the shysters, you don't go work elsewhere for more ethical employers. Well Scrooge and Legree are going to find themselves at a disadvantage in the marketplace cause their prices are higher, reflecting the old healthcare system. Something has to give here. It's the way the real world works.
How strange that I have to give Capitalism 101 lessons to a rightinger!
March 6, 2007 9:19 AM | Reply | Permalink
Medicaid's overhead costs are 2%. Private insurers are 25%. Libertarians say private industry is so much more efficient than government that we should privatize all government functions and eliminate as much government as possible in order to save money. However, Medicaid proves that Libertarian truism dead wrong.
As a society, we would actually save money by moving everyone to Medicaid from private insurers. Even covering the uninsured would only raise the additional costs for everyone by less than 1%. Then, people would have that leftover 22% of their current medical dollars to put in their pockets. That additional money for the everyday American would boost the economy.
Yes, moving everyone to Medicaid would not only be the right thing to do, but also the economically sound thing to do.
March 6, 2007 10:06 AM | Reply | Permalink
no labeling, JP -- that's rude. You'll have to point out the extraordinary claim I made. All i did was hold up real world examples of people doing my job in other countries making less -- with a UHC plan. It's a valid point.
But let's go with your math. You do realize there will still be a monthly premium for a nat'l plan -- just like Medicare. In Canada it's about $ 150 for single coverage (depending on the province). So, I would expect my employer to pay that, of course, which means in my case a whopping $ 50 a month in savings they could fork over to me. (You'll get $ 100) Now for a $ 50 savings, I'm going to get hit with at least a 5% tax increase and maybe as high as 10%.
You're also underestimating the wisdom of politicians who will conclude that since they are saving employers so much on health insurance, they can stick them with higher taxes to give back some of their windfall.
I'm making this point not to argue against making a change -- we do need serious reform. I'm saying your approach is a huge shift, will be a huge battle to win and may end up doing little for most working Americans, perhaps even costing them more than they are already paying.
March 6, 2007 11:23 AM | Reply | Permalink
I agree with much of what you say here. But I don't believe it will sell nationally. Even in the most liberal states (e.g., California, Oregon, Massachusetts), single-payer health care has never been enacted. The most progressive current schemes still involve the insurance industry, and I just don't see that changing. Regardless of what might work best, there's a huge anti-governmen-bureaucracy movement that is tough to fight. It's an type of thought endemic in the U.S.
This is why I think the mandated-insurance plans that are in the works right now have the best chance of doing something tangible - actually decreasing the number of uninsured. A perfect solution, no, but one that I think the American people can stomach. I also think that getting more people some basic coverage will have ripple effects throughout our medical system (like helping failing emergency rooms that serve as primary care facilities for the uninsured), possibly making it work better for us all.
In general, I'm encouraged that we may actually be able to make some real progress on health care. Certainly moreso than since 1994.
March 6, 2007 3:16 PM | Reply | Permalink
Re: All i did was hold up real world examples of people doing my job in other countries making less -- with a UHC plan. It's a valid point.
No it's not. It's the post hoc propter hoc fallacy. The reason they make less may be due to a myriad of factors. To even begin to buttress your claim you would have to show (as a start only) that they ended up making less (than they had been, without referrence to US wages) in the time immediately after their national health plans were implemented.
March 6, 2007 4:30 PM | Reply | Permalink
JP, at it again I see. First of all, Walter Reed is NOT a VA hospital. It's an Army hospital.
Given the fact that Medicare is going broke sometime this century, I'm interested in your ideas as to how to fix it.
March 6, 2007 7:45 PM | Reply | Permalink
Re: First of all, Walter Reed is NOT a VA hospital. It's an Army hospital.
Yep, I;m aware of that. But the VA is also being cited here as an example of "government runm" healthcare. And what I said about the VA applise to Walter Reed as well. What we have is an example of the stunning incompetence and awful cronyism of the Bush adminsitration, not a systemic failure of government in general.
Re: Given the fact that Medicare is going broke sometime this century, I'm interested in your ideas as to how to fix it.
We need across the board healthcare reform, creating one integrated and unified system for healthcare for everyone. That need not be single-payor; I'm open to leaving it in the hands of the insurance industry, with major reforms thereof so that they would function more like public utilities. Medicare by itself cannot survive, I agree. A universal system can.
Do you really think America has become such a third world basketcase that it cannot afford its own healthcare bill? Every other advanced country on earth does this. It isn't hard.
March 7, 2007 3:33 AM | Reply | Permalink
What you're describing seems a lot like the current Medicare plan which is not run by the government. Various insurers offer medicare coverage -- but their plans have to conform to the standard guidelines. So, I'm assuming that's what you're saying would work on a national basis. If it's going broke now, it's hard to figure how adding more people will help, but if you can calculate the numbers, figure up how much it's going to cost and make it work -- then you'll get plenty of support.
March 7, 2007 6:41 AM | Reply | Permalink
The reason that the status quo remained for so long is because the most vocal people managed okay. As more middle-class people lose their coverage or can't pay their medical bills there will be more of a demand for change.
Even with that, as you say the single-payer concept is not popular now, but that is because there is still so much $$ out there.
I am afraid we will be going into a recession, if not a depression, and when we really start having to economize, the single-payer system will be so obvious that it will be impossible to keep it at bay.
Jan Knaus
March 7, 2007 6:51 AM | Reply | Permalink
In Canada we do not pay $150 dollars per month for health coverage in any province. If you are a citizen, you get a health insurance card, period. This has always been absolutely at no cost to the citizen. In Ontario, we very recently instituted a health premium that lasted three years. The average cost was $300 per year to a person earning $48,000. If you made less, you paid less, if you made under $20,000 you paid nothing. The plan is being reviewed every five years.
http://www.health.gov.on.ca/healthpremium/factsheet.pdf
You should also note that we pay less income tax that Americans do - it is a graduated system:
* 15.5% on the first $37,178 of taxable income, + * 22% on the next $37,179 of taxable income (on the portion of taxable income between $37,178 and $74,357),
+ * 26% on the next $46,530 of taxable income (on the portion of taxable income between $74,357 and $120,887),
+ * 29% of taxable income over $120,887.
http://www.cra-arc.gc.ca/tax/individuals/faq/taxrates-e.html
In the United States, your tax rate is:
$0 -$7,825 10% of the amount over $0
$7,825 - $31,850 $782.50 plus 15% of the amount over 7,825
$31,850 - $77,100 $4,386.25 plus 25% of the amount over 31,850
$77,100 - $160,850 $15,698.75 plus 28% of the amount over 77,100
$160,850 - $349,700 $39,148.75 plus 33% of the amount over 160,850
$349,700 - no limit $101,469.25 plus 35% of the amount over 349,700
http://www.irs.gov/formspubs/article/0,,id=164272,00.html
National Health Care is Good for The Economy TOO!
Joint Letter on Publicly Funded Healthcare
Alain Batty - President and CEO, Ford Motor Company of Canada
Basil Hargrove - National President, CAW-Canada
September 10, 2002
(Entered into the Congressional Record by Congressman McDermott)
Canada's publicly funded health care system provides essential and affordable health care services for all Canadians, regardless of their income. Publicly funded health care also enhances Canada's economic performance in several important ways.
The auto industry is Canada's most important export industry; it directly employs over 150,000 Canadians in high-wage jobs, supports hundreds of thousands of other spin-off jobs, produces $90 billion worth of shipments per year, and generates billions of dollars in tax revenues for all levels of government in Canada. The success of this industry has been crucial to Canada's economic progress over the past decade. Canada's health care system has been an important ingredient in the auto industry's performance.
Workers in the auto industry, and in the many manufacturing and service industries which supply automakers, benefit directly from access to public health care services. Thanks to this system, they are healthier and more productive. Employers in the auto industry, meanwhile, enjoy significant total labour cost savings because most health care services are supplied through public programs (rather than through private insurance plans).
The public health care system significantly reduces total labour costs for automobile manufacturing firms, compared to the cost of equivalent private insurance services purchased by U.S.-based automakers; these health insurance savings can amount to several dollars per hour of labour worked. Publicly funded health care thus accounts for a significant portion of Canada's overall labour cost advantage in auto assembly, versus the U.S., which in turn has been a significant factor in maintaining and attracting new auto investment to Canada.
Canada's publicly funded health care system is now facing demographic, technological, and fiscal pressures. The erosion of publicly funded health care through measures such as the delisting of currently-covered services, the imposition of user fees, the failure of the public system to keep up with the changing nature of health care, and new costs such as prescription drugs and home-care, will impose significant costs on automotive employers and undermine the attractiveness of Canada as a site for new automotive investment.
For both employers and workers in the auto industry, it is vitally important that the publicly funded health care system be preserved and renewed, on the existing principles of universality, accessibility, portability, comprehensiveness, and public administration. The system needs a secure multi-year funding base from government, and must be expanded to cover an updated range of services (including prescription drugs and home care services) that reflects both the evolving nature of medical science and the emerging needs of our population.
To this end, Ford Motor Company and CAW-Canada jointly urge the federal and provincial governments to take appropriate actions to preserve the public health care system, secure its funding base, and modernize the range of services which it covers. In addition to reinforcing the quality and accessibility of health care for Canadians, these measures would also help to ensure the long-run success of Canada's auto industry.
Alain Batty
President and Chief Executive Officer, Ford Motor Company of Canada, Limited.
Basil "Buzz" Hargrove
National President, CAW-Canada.
http://www.house.gov/mcdermott/sp051215a.shtml
March 7, 2007 7:24 AM | Reply | Permalink
I tend to agree with you that there a number of trends (housing, gov't deficits, weakness in foreign markets) that give me some concern about where the economy is going in the near(-ish) future, and that a major economic upheaval that really affected the middle to upper-middle classes would put pressure on the system to move to a nationalized solution. Though this would be a rough ride that would be awful for just about everybody.
March 7, 2007 7:56 AM | Reply | Permalink
Agree. I'm not looking forward to it.
Jan Knaus
March 7, 2007 8:10 AM | Reply | Permalink
Re: This has always been absolutely at no cost to the citizen.
Um, you do pay taxes for your coverage. That Canadian healthcare is "free" is simply not true. I'm am NOT criticizing canada's system, but the citizens of Canada do have to pay for it.
You are also incorrect about our tax rates, as you are leaving out the exemptions and deductions and the EITC which pretty much ensure that one does not pay any net income tax until one's income reaches a certain level (which varies by family size)
March 7, 2007 9:44 AM | Reply | Permalink
The only reason anything in the federal, state, and local governments are going broke is contained in David Cay Johnston's book "Perfectly Legal: The Covert Campaign to Rig Our Tax System to Benefit the Super Rich - and Cheat Everybody Else."
********
- We do not act rightly because we have virture, we have virtue because we act rightly.
Sign the Petition at stopIranWar.com
March 7, 2007 4:56 PM | Reply | Permalink
This administration is the singularly most heartless and morally bankrupt America has ever had. That does NOT mean that the institution of government or any of its services is an automatic failure. If we had a different president with a different administration, one that would actually serve the people and country, we'd be dealing with a whole different ballgame and none of this would be an issue.
That the elected are failing to uphold their duties as specified in the Preamble of the Constitution is the fault of the pathetically uninformed and AWOL public, most of whom don't vote at all.
As for America having "the best healthcare on earth", what is it about our rating of 21 don't you get? America is not actually best at anything with one exception: killing people.
********
- We do not act rightly because we have virture, we have virtue because we act rightly.
Sign the Petition at stopIranWar.com
March 7, 2007 5:18 PM | Reply | Permalink
Moon, i'm a 1099 employee who my employer reimburses for health insurance premiums. It's my understanding that self-employed do have to pay some type of premium for health care or tax (i'm not sure which). This information comes from a friend of mine who is a Canadian doctor. Am I wrong here?
March 7, 2007 6:57 PM | Reply | Permalink
Neo, we have a tax code larger than most large metro yellow pages. A skilled tax attorney can find enough in there to help just about anyone avoid some taxation -- if you can afford his $400 an hour fee. This is why we need a flat tax and dispense with all the deductions and loopholes. However, I don't think it's rigged on purpose -- it's just the way government works (or doesn't work). You can point to the same tangled complexity in just about any federal program that's been around a while.
March 7, 2007 7:04 PM | Reply | Permalink
You that can "think" anything you like. Your comment however is a non sequitur in relation to Johnston's book. You would be appalled at the way the system is weighted against wage earners and yet give partnership LLCs a free pass.
And yes, the tax system is in fact rigged on purpose. For a different source, read Eric Schlosser's "Fast Food Nation" where he talks about how meat packers in one state managed to get out of paying any taxes at all.
No, the flat tax is not a good idea due to proportionality. There has already been much written on this and I won't reiterate it here.
None of this information is an article of faith. I say again you can think anything you like but until you've read Johnston's book and can refute his data your comment is not relevant.
********
- We do not act rightly because we have virture, we have virtue because we act rightly.
Sign the Petition at stopIranWar.com
March 7, 2007 10:41 PM | Reply | Permalink
[1] There's a difference between the government providing health care and the government providing health insurance. With the government providing insurance, all they're doing is paying the bills. The actual care is provided by the same people who do so now.
[2] Walter Reed is an Army hospital, not VA. During the Clinton administration, the VA system was the finest medical system in the world, though Bush and his cronies have done whatever they can to destroy it. This is because Republicans have a religious belief that government is bad, and try their best to fulfill it whenever they get into office.
[3] America does not have "some of the best health care on earth." It has about the worst outcomes of any First World nation. It's a disgrace.
[4] The government already provides health insurance to one major segment of our population: the elderly. And, by and large, satisfaction with that insurance system is quite high. Thus, if universal health care is implemented, it would make sense to do so on the Medicare model.
March 8, 2007 1:07 AM | Reply | Permalink
I haven't read the book, but i hope he skewers the Trial Lawyers, who are one of the most powerful lobbies in DC. They squelch any meaningful consensus on tax reform, and they are the enemy of every American taxpayer. It's in their interest to keep the tax code complex -- it keeps the billable hours rolling in.
To be fair, Neo, couples making $ 35K or less in this country don't pay any federal taxes either, when you add up their deductions. I live in a state with no income tax (only a sales tax) and that's the only way to make it fair. Everyone pays into the system.
March 8, 2007 9:02 AM | Reply | Permalink
For some background on what has happened to the middle-class, take a look a Paul Krugman's piece: A History America's Disappearing Middle Class.
As for where the real problems lie, I attribute it to a fatal lack of moral clarity in America generally and in congress specifically, and the almost complete muddying of the political landscape so that people treat abstractions if they were concrete objects and fail to understand that reality doesn't care about ideology.
********
- We do not act rightly because we have virture, we have virtue because we act rightly.
Sign the Petition at stopIranWar.com
March 9, 2007 8:02 AM | Reply | Permalink