Thursday, December 23, 2004

Bush's health insurance reform is about protecting wealth, not health.

I think there's an important point to be made about George Bush's healthcare agenda and I haven't seen anyone else make it yet. Basically, George Bush is trying to turn health insurance from a health protection plan into an asset protection plan--move insurance from securing health to securing wealth.

George Bush's key initiative for the uninsured are Health Savings Accounts. The way these work is that basically, you buy a catastrophic health plan in case you get really sick and you put some money aside in a tax-free investment account for your smaller primary-care health expenses, like doctor's visits and prescription drugs.

There is some great rhetoric about how this will let people "take control of their health spending" and be more "personally responsible," but nobody's real clear on how this is supposed to make healthcare more affordable for working people. If you're really sick your insurance company will still pay for everything, so there's no money saved there. All we can really expect is that people using HSAs will be more "personally responsible" by saving their money instead of going to the doctor for checkups, taking prescription medications and other preventive and primary care stuff.

But most experts agree that we need to make low-cost primary care more, not less, accessible. You know, the whole "an ounce of prevention is worth a pound of cure." Even Bush believes this, so it's quite bizarre that he's pushing plans which make it more expensive for people to get primary care. Furthermore, the way the healthcare system works, we can expect the price of healthcare to actually go up (PDF) if healthy people switch to catastrophic policies. So we're not making healthcare more affordable, we're not making people act more responsibly--what's going on here?

What's going on here is a massive disconnect between the Bush administration and the reality of most people's lives. Most people could get catastrophic insurance today but choose not to. They choose not to becuase in most cases catastrophic insurance doesn't protect health, it protects wealth.

Most people believe that if they become sick, hospitals and doctors will still provide necessary care. This is wrong, but most people believe it. Therefore, most low-income working people won't buy catastrophic insurance. They recognize they may have to declare bankruptcy if they get sick, but heck, they may have to do that anyway. Why waste money on insurance?

However, better-off people will buy catastrophic insurance because their concern isn't whether or not they'll receive care, it's whether or not they'll have to sell their house (or their yacht) in order to pay for it. They're not willing to take the risk that a health crisis may bankrupt them.

And that's the key point here. The people who need a "traditional" health care plan are working people who need it to help them pay for doctors' visits, prescription drugs, and their kids' asthma medication. They need health insurance not to protect their assets, but to access healthcare. And as stated above, as more people move into a HSA-type plan it will get harder and harder for working-class families to afford traditional health care plans, and fewer employers will provide them. So it will be harder for working people to access health care. But, of course, wealthier people's assets will still be protected, and at a far cheaper price than before.

When you turn a health insurance plan into a tax shelter, you undermine the health care system and you make it harder for working people to afford the care they and their families need. The point of health insurance should be to protect health, not wealth. George Bush and the Republicans don't get that. And that's a problem.

Wednesday, December 22, 2004

Social Security--A fifty-cent problem.

So, according to George Bush, in the very worst-case scenario, we have a $3.7 trillion shortfall over the next 75 years in Social Security. That sounds ghastly. Trillion is a VERY big number. Huge, even.

But if we look at it another way, it's pretty clear that George Bush is just a big fat drama queen.

3.7 trillion dollars over 75 years, spread out over 300 million people works out to--WAIT, $0.45 dollars a day? Less than fifty cents??

So, fifty cents a day is the size of this problem. If you want the future equivalent of $925 a month in guaranteed retirement, it’s gonna cost you all of fifty cents. Drop 50 cents in the “social security” bucket on your way to work ($1.50 on Fridays!), and you’re sure to get your Social Security check when you’re an old fart, even in the worst case scenario in which there’s no population growth, there’s no scientific or technological innovations leading to higher productivity, and the economy is in the crapper. You're 100% certain to get this part of your nest egg, even if your 401k totally collapses, your house burns down, and your rich Aunt Millie leaves everything to her cat.

Or alternatively, you can give up your guaranteed retirement. And in exchange, George Bush will give you a shiny quarter today to invest in the stock market for your retirement! Because the stock market always does great, and it does especially great when the economy is in the crapper. And lord knows, it’s not like you’ve already got money in the stock market and would really prefer to have something you can count on if the market goes sour.

Speaking only for myself, I’d happily gamble my social security if I really thought I was screwed. But even in the president’s highly exaggerated doomsday scenario, we’re not looking at a huge problem. If you don't believe me, look at what economists are saying with real math. They're saying sure, there's a problem we've got to deal with, but it's just not a crisis.

It’s immoral to force people to give up a guarantee and gamble their retirement just because the President thinks the stock market is nifty and he wants to throw his friends on Wall Street a bone. And it’s irresponsible for the President to propose wasting money on some half-baked privatization scheme when we have real problems in Medicare and Iraq that need his attention and our tax dollars.

You don’t throw away your car just because it has a flat tire. We can fix social security when and if it becomes a problem.

And am I crazy, but haven't we heard this whole "we must take drastic action now or we're doomed," song and dance from this guy before? This time, I'd like to see some evidence of crisis before we all start freaking out and making hasty decisions we regret later.

George Bush says: "This Christmas, if you're hungry you should just eat your babies!"

By now we're all aware of the Bush Administration's habit of releasing bad news when it's likely to be overlooked. With Christmas coming up, not only is the public's attention distracted from real news (apparently focusing all their attention on Bill O'Reilly's disingenous lie that Jews and Atheists are trying to ruin Christmas), but also, experienced editors and writers are on vacation, so news organizations are less likely to pick up on a significant story.

I get it from a PR perspective. But it's more than a little disgusting that Bush is taking advantage of the Christmas lull to announce he's cutting off the food aid America promised to starving people. Because if you call yourself a Christian and a Compassionate Conservative often enough, then you don't have to actually feed the hungry. Especially not at Christmastime.

So, Kristof, when they start actually following through on their press releases about feeding the hungry by actually feeding the hungry, then we'll work with them. But I really don't think there's any need to strive for bipartisanship when all we're really doing is adding some (D)'s to the caption below their photo-op.

Friday, December 17, 2004

Ah, but you'll only be mostly dead...

In a follow-up to my previous post, Celebrex now linked to heart attacks. Ironically, those who paid the least attention to the news in the weeks leading up to this revelation probably have a better understanding of this issue than those who followed it closely. Rock on, media.

Thursday, December 16, 2004

Cocktail Party Ammunition: Social Security

(In Understandable English, with jokes and pictures of naked women!)

Okay, I’m lying about the naked women. And probably about the understandable. Now on to business:

Lately we’re hearing a lot about the “crisis” in Social Security. Since this is probably going to be a big topic of political conversation at your better cocktail parties, I figured a primer may be helpful for the many of us who have better things to do with our time than research social insurance programs. Well, the many of you.

Social Security was started by FDR during the Depression, when basically everybody lost their life savings. Losing everything is awful when you’re 25 and can work for food, but it’s downright lethal when you’re 70 and can’t. Republicans strongly opposed Social Security for a lot of reasons. None of their reasons was that they wanted to help starving old people--basically, all their arguments were about communism and why letting old people starve was somehow an integral part of making America strong and prosperous.

In the roughly 70 years since Social Security was started, people have been ranting that it’s going to be the death of America, either by going bankrupt or through some other insidious trick. And it’s pretty much not been doing either of those things. And also, it’s widely agreed, even among those interested in reforming the program, that it’s been fantastically successful in achieving its goals of reducing poverty and creating a safety net.

Financing (This is the hard part. A cold beer aids comprehension.)
Most government programs are funded by general revenues. This is like the money you get from your job, which you use to pay all the bills that come in. Social Security, on the other hand, is funded by a special dedicated tax, the payroll tax. This is like deciding you want to pay for your kids’ private school, so you take a second job and you put all the money you make in your second job towards your kids’ school.

All About the Payroll Tax
The payroll tax is a totally evil tax. While general revenue includes taxes on all kinds of stuff, like investment income and corporate profits, the payroll tax only taxes work, and it only really taxes the work done by the middle class. If you’re Paris Hilton, making a million dollars from your trust fund, you/re not on anyone’s payroll, so you don’t pay the payroll tax. Nice life, Paris. But if you actually earn money by doing real work (even if you’re self-employed), then you pay the payroll tax. It’s no joke—6.2% of your pay if you work for someone else, and 12.2% if you own your own business (it’s that “FICA” thing on your paycheck).

And another evil thing about the payroll tax? It only taxes the first $88,000 you earn. So, a CEO making fifteen million dollars a year pays a payroll tax of about $5,500, and his secretary making 90 grand pays the exact same $5,500. So while trust fund babies don’t pay this tax and rich CEOs barely notice it, it takes a huge chunk out of the paychecks of people who actually work for a living. This is why it’s evil.

What’s all this about trust funds and crises? I remember a lockbox…
Right now, the payroll tax is like a really great second job—it’s paying more money than you need to send the kids to school. So, the question is what should you do with the extra money? Some people would think, “Hey, the kids are going to college eventually, so let’s put this money in the bank (or a lockbox!).” Other people would think, “Hey, let’s lend the money to my shiftless ex-husband who swears he’ll pay me back.” The Social Security Trust Fund gave the money to the ex-husband. It’s not their fault--Congress made ‘em do it.

For decades, the Trust Fund has been giving its extra cash (its surplus) to the federal government in exchange for IOUs in the form of Treasury Bonds. These are just like the Treasury Bonds your grandmother used to give you at Christmas. The Social Security trust fund is jam-packed with these Treasury Bonds. They’re tripping over ‘em on their way to the tree. It’s pandemonium!

Screw trees, what about this crisis? Well, here’s the crisis: in 10 years or so, the number of elderly is increasing—in other words, the kids are going to college. The second job (ie, the payroll tax) will still pay most of the tuition, but it won’t pay the whole thing with money left over anymore. This really isn’t a crisis, though, because we’ve got all those Treasury bonds from our shiftless ex-husband, right?

Ah, there’s the crisis. That deficit they keep talking about? That’s all the money your ex-husband is running up on his credit cards to buy stuff for his rich friends. All the money you lent him, he spent. He spent it on stuff like Iraq and a Medicare drug benefit and tax cuts for the rich.

So the crisis isn’t Social Security. It’s that the Federal Government is acting like a deadbeat ex-husband, and the Bush Administration is saying that since the payroll tax (your second job) doesn’t cover the full cost of Social Security benefits (your kids’ entire tuition), then you’ve got a problem. But wait, it’s not your problem, it’s HIS problem! You both knew this day was coming, and when you lent him the money, he promised he’d give it back starting around now! You’ve got the Treasury Bonds to prove it!

So what should you do?

Possible Solutions
The best solution is to tell your shiftless ex to repeal his stupid tax cuts for his rich friends and pay you back the money he owes you! This isn’t just an analogy-- Bush financed his tax cuts for the wealthy by borrowing the Social Security surplus. If he doesn’t pay it back, that means rich people just partied with money that was earned by people who work for a living! So, this is the most obvious solution, it’s the most moral one, it’s the most fiscally responsible one. Still, how likely do you think Bush is to repeal tax cuts for the wealthy to pay back the money he borrowed from working folks? Yeah, not very. So, the best solution now is to table discussion until we get a fiscally responsible person back in office. Remember the Clinton surplus? We’ll do it again, and this time we'll use it to pay our debts.

There are some other solutions which all boil down to cutting benefits, either financially or by raising the retirement age. These are mostly crappy solutions. Okay, that’s an exaggeration—cutting benefits for rich elderly people is not entirely crappy, as they’re not going to be stuck eating dog food. But across the board cuts that affect poor people are just immoral. You wouldn’t think it was OK for your kids to go to a worse school so your husband could throw a party for his rich friends, so why is it OK for Bush to cut benefits for retirees so he can keep his tax cuts for the wealthy?

Another possible solution to the projected future shortfall to raise the payroll tax. I think we can all agree that’s a bad idea. The last thing we need is a higher tax on work, to increase taxes on work so we can keep tax cuts for the wealthy? Wow, that's just sick and wrong.

And then there are the solutions that are really stupid if you’re trying to stabilize social security, but are really clever if you’re trying to dismantle it without admitting that’s what you’re doing. Private accounts tops this list.

Bush wants to borrow a trillion dollars and force people to privately invest it in the stock market with no guarantees on return. If they hit the jackpot, great; if not, then no Social Security for them! This forced gambling of Social Security in the stock market is deeply ironic, considering the program’s roots in the greatest stock market crash of all time. One can be opposed to this “borrow and privatize” scheme or support it on ideological grounds, arguing about who hates markets and whether or not benefits should be privatized or should be shared. But that argument just boils down to calling people communists and doesn’t really address the real issues.

First of all, their arguments don't make sense. Bush’s folks say stocks will give people way better returns than the current social security system. But when it comes down to crunching numbers, they use best case economic scenarios when they look at stocks, and worst case economic scenarios when they look at the current system. That’s just crazy. When the economy sucks, stocks tend to suck too, and vice versa. So you can’t simultaneously project that 2042 will be the worst economic year ever when it comes to calculating returns under the current system and predict it’s going to be the best year ever when it comes to calculating stock returns! It’s like saying that next week, the temperature will be 90 degrees and it will also be snowing. It’s just nutty, and they’re hoping you’re not paying attention.

The more important thing is, we’ve got a system that’s worked for more than 60 years, and the entire time its opponents have claimed that it is going to fail and take America down with it. But even now in this time of supposedly terrible crisis, the worst case scenario is that between Treasury notes and payroll taxes, this program is fully funded through 2042! Given that we’ve already got a huge problem with the deficit because of Bush’s tax cuts, does the minor problem we think we’re going to face in 2042 justify taking on a trillion dollars in additional debt to finance an incredibly risky “Hail Mary” venture that, golly gee, might not even work?

Wait, are we suggesting that Social Security is perfect? Hell, no! Women, because they live longer and are in the workforce shorter than men, aren’t well supported by Social Security. Also, sometime near 2042 we might either have to slightly cut benefits (preferably for rich retirees) or slightly increase taxes (preferably not the evil payroll tax). But frankly, that’s a trifling concern for another day, a problem we may never have to face because things may be better than the worst-case scenario (as they often are).

Finally, this debate comes down to a question of credibility. Honest people know that there are far bigger problems than Social Security looming on the horizon. And there are far bigger problems today. Do we really believe that the people who have opposed Social Security from its inception are now so worried about its future that they’re putting everything else on the back burner to fix it? Perhaps it is more credible to believe that “fixing” Social Security is really not what private funds are all about—perhaps they are about in the short-term rewarding Wall Street and in the long-term making Social Security less something that people can count on (an entitlement) and more something they receive if they’re lucky enough to afford a good stockbroker (an investment).

Here endeth the lesson.

Thursday, December 09, 2004

Alternative Energy is a GOP issue, apparently...

Today, in two unrelated stories, we learn of two fabulous innovations in alternative energy.

This would be just another cool science story except for the fact that one of the articles says, "[the inventor] is not assuming that the United States will shift from fossil fuels to the hydrogen economy by 2020, as touted by the Bush administration, California Gov. Arnold Schwarzenegger and many scientists."

It's not media bias--Wired magazine isn't exactly Fox News. What we see is yet another area in which Democrats have utterly failed to seize the initiative, and this neglect has allowed Republicans to define the terms of the debate to their advantage.

George Bush has a lousy energy policy, and it goes far beyond favoritism towards polluters. Of far greater consequence is the fact that he's failed to demonstrate real leadership by instituting policies that put us on the road to energy independence. Heck, he's failed to even use the power of his bully pulpit to call for energy independence.

Democrats, however, have not stepped in to fill the vaccuum. We aren't hitting hard on the fact that our dependence on oil forces us to support undemocratic regimes throughout the Gulf States. We're not pointing out that Osama bin Laden is a goddam oil prince, and he would never have come to power if the Middle East weren't awash in oil profits. We're not pointing out that our complete and total dependence on foreign oil undermines every single one of our strategic initiatives in the war on terror.

And we aren't giving people an alternative plan. We aren't calling for a billion dollar Manhattan project for alternative energy. We aren't demanding zero emission energy production by 2015. We aren't even promoting projects like the Apollo Alliance. Instead, we're allowing the debate to be "Arnold and George like hydrogen energy, Democrats like solar." That's a losing proposition for Democrats.

We don't want to be in a position where the argument over energy policy is characterized as each side placing bets on which energy source is going to prove to be the best one. We want to be in a position where we're the party that's demanding progress and they're the party that's beholden to special interests and standing in the way of security and progress! And if we let ourselves be dragged into a debate on the merits of hydrogen vs. solar debates, then we're allowing George Bush to get away with doing nothing--nothing to protect our security and nothing to find the fuel of tomorrow's economy. That's not just bad for Democrats--that's bad for America.

I'll talk about this more in the future, but it's time for Democrats to start behaving like an opposition party. Compromise is over--it's time to make the differences stark and clear, and present a real choice to Americans. Because we'll win once they know what we stand for.

Tuesday, December 07, 2004

Reason #2,312 why I love New York

Minimum wage increase. Granted, a 40 hour work week will now bring home a whopping $14, 872 (compared to the prior $10,712), but it's still better than before.

Blue Staters should focus on initiatives like these during the next 4 years -- locked out at the federal level, we need to build ourselves up in the states and locally. Initiatives like these serve three purposes: first, they show we're the folks who are going to improve people's lives; second, they promote cooperation between progressive groups and strengthen new groups; and third, they allow us to test different approaches to framing our issues.

The minimum wage campaign in NY did all three. Obviously, regardless of what Cato would have you believe, lots of hardworking people are going to do better as a result of the increase. Fighting for the increase strengthened local coalitions -- the Working Families Party, a political party supported by labor and community organizations, was the driving force behind this initiative. With an accomplishment like this under their belt, they are undeniably a political force to be reckoned with. Finally, progressives have been all over the news this week, dropping great lines like "It's a pretty good day for about a million people in the state who will have better food, be able to pay their rent, spend a little time with their children. These are family values."

So get local!

**Incidentally, the WFP is well worth checking out. (Full disclosure: I've got friends working there. But I used to vote WFP back in my political virginhood before I knew any of 'em, so I figure this isn't true pimping) It's a very effective third party, and has been able to take advantage of its ballot line to not only support progressive candidates, but also to pressure incumbents to take certain positions.

This has been possible because NY State has fusion, allowing candidates to be endorsed by multiple parties with votes from all parties counted toward their total. The upshot is that people don't have to throw away their votes to make a statement. For example, in NY State, the WFP can run Kerry on its line and progressives can vote their conscience by pulling for Kerry on the WFP line. The WFP thereby gains power not by acting as a spoiler, but by acting as an enabler -- it's a much better situation for all progressives to have Kerry win New York by a tight margin with WFP's votes making the difference, rather than by losing New York by a tight margin with WFP's votes making the difference. It's about the only way I've seen for a third party to actually be useful and relevant, as opposed to creating petulance and division among natural allies. Like, ahem, the Green Party's misadventures with Mr. Nader.**

Monday, December 06, 2004

Yes, but with our product, you'll be less dead...

So, news reports indicate that Celebrex is three times safer than Vioxx! Yay!

Well, Russian roulette is three times safer with one bullet instead of three. That doesn't make it a good idea.

I'm not trying to beat up on Celebrex here. For all I know, it's a miracle drug that'll cure your gout and make your wife love you more. But I am picking on Celebrex because this article is an example of the poor health reporting we see all the time.

Both journalists and researchers share a common bias -- they want to find something new. Both professions thrive on a "publish or perish" mentality, and the best way to get published is to report new things first.

As a result of this pernicious bias, we end up with articles full of misleads like this one. We read along, blissfully thinking there's scientific evidence that Celebrex is safer than Vioxx, and it's not until the 6th paragraph that we get our first indication this finding might not live up to its banner headline. A full third of the way into the article we learn, "But the researchers also found that patients using either drug were not at a significantly greater risk of having a heart attack than those who did not use either drug."

Huh? I thought the FDA pulled Vioxx because it caused heart attacks. But this study didn't find Vioxx caused heart attacks. So what can I learn here? Why should I care how safe this study tells me Celebrex is when it's also telling me Vioxx is safe? I mean, if a guy is telling me grenades are safe for children, should I listen to him when he tells me that land mines are three times safer?

I'm not suggesting that anyone was cooking the data or falsifying their sources. Check out the original journal article -- it's telling the same story as the article, albeit with more exciting math. What I'm saying is that journalists and scientists really wanted this study to have something newsworthy in it. So they found something.

It's bad science and it's bad journalism. Waiting until the end of the article to quote another expert as saying "
these types of studies are not conclusive," isn't enough. I mean, it was important enough to get that headline and a full article! Can you blame a reader for thinking there's some news of importance here? A little "he said, he said" isn't going to meaningfully challenge that assumption. When a headline should actually read, "Jury Still Out on Celebrex's Health Risks," a few last minute hedges aren't really going to undo the false impression created in paragraph one.

So what's the answer? Scientists have to stop inflating the significance of their findings, and reporters need to be less credulous about the integrity of scientists when it comes to the significance of their findings. Since neither of those things seems likely to happen, I suggest we read every health article from the bottom up -- start where the facts are, and end with a good laugh at the overblown headline.

Sunday, December 05, 2004

True Blue Liberal Quote of the Day

"My center has collapsed. My right flank is weakening. Situation excellent. I am attacking.”

When Idiots Attack…

“George Bush got more votes than any president in American History!”
“And George Bush had more votes cast against him than any president in American History. It’s called population growth, you nitwit.”

“George Bush is the first president to win a majority since Reagan!”
“I’m so shocked more voters didn’t choose Ralph Nader over Kerry or Bush.”

“Look at all the red on that map. Clearly, it’s a mandate.”
“Because we all know that in a democracy, the opinion of the wheat fields of Kansas should matter more than the 8 million people living in New York.”

“It’s a broad, nationwide victory!”
“George Bush didn’t win a single state in the Northeast or on the West Coast. Last I heard, ‘coast to coast’ didn’t mean ‘from Virginia to Texas’.”

“Kerry supporters were limited to the liberal holdouts of the East Coast”
“Liberal holdouts like New Hampshire. And since when is Wisconsin on the East Coast?”