Re: Family Values

1

Who doesn't?


Posted by: SomeCallMeTim | Link to this comment | 08-21-07 9:03 AM
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It's easier to lie to brain-damaged idiots, so Rove says: Maximize the supply!


Posted by: BigHank53 | Link to this comment | 08-21-07 9:29 AM
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Read the NYT headline online this morning, and cursed George Bush so loudly that my Polish neighbors heard me (through adjacent, open kitchen windows) and started laughing.


Posted by: Blume | Link to this comment | 08-21-07 9:29 AM
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Why is it wrong to prevent a program *for the poor* from becoming (yet another) middle- and upper-middle-class entitlement? Shouldn't we want Federal anti-poverty policy to actually focus on poverty?

If states can identify Kids in Need(tm) in households at 4x of the poverty level, then by all means, expand coverage. Given that 4x the poverty level is $82,000/year and median household income in NY state is, per the US census, 45K, it does not seem unreasonable to me to try and find some way of defining "need."


Posted by: baa | Link to this comment | 08-21-07 10:07 AM
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I think we've reached the point where the Bush administration is intentionally doing horrible and insanely unpopular things for the long-term good of the Republican party, so that both Democrats and Republicans can act like they're running against the incumbent in the next election. Just you wait until Giuliani's campaign slogan is "End The Tax-And-Spend Bureaucracy Of Bush And Clinton".

The upside of this is that probably it won't lead to an invasion of Iran.


Posted by: Cryptic Ned | Link to this comment | 08-21-07 10:08 AM
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And the best bit is that now if you think your child has lead poisoning from a goddamn baby bib, you'll have to pay to take him to the doctor!


Posted by: Cala | Link to this comment | 08-21-07 10:08 AM
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4 sort of gets it right. This seems to be a separate issue from Bush's insistence on vetoing any bill that would enable SCHIP to cover all children who are supposed to be covered under the current rules but are not covered because the state programs don't have enough money.

However, most of us here think that this sort of program should be expanded to both children and adults at infinity percent of the poverty level, so your point is moot in the larger scheme of things.


Posted by: Cryptic Ned | Link to this comment | 08-21-07 10:14 AM
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4,7---I had to skim the article quickly, but I think the point is that "the poor" is defined by a number that is established as a national average, and it is far too low to catch all the actual poor (as in, people who are having a hard time living and whowould not be able to pay for medical emergencies if their children got in trouble) in high cost of living states like CA or NY.


Posted by: Saheli | Link to this comment | 08-21-07 10:19 AM
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Three times the poverty level unfortunately doesn't mean you can afford health care for your children. The fact that that's true isn't an indictment of Pennsylvania's rules as it is of the affordability of health care.


Posted by: Cala | Link to this comment | 08-21-07 10:22 AM
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4: The article says that recipients must be uninsured for a certain number of months, depending on the state, before they are eligible. It's pretty doubtful that a family would drop their coverage for a few months unless they needed to. (If you don't believe me, listen to the New Jersey official who says "we have no evidence of a decline in employer-sponsored coverage resulting from the Children's Health Insurance Program.")


Posted by: destroyer | Link to this comment | 08-21-07 10:22 AM
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In NYS, I think CHIP is supposed to help out, specifically, with low- and middle-income families that might not get health insurance for their kids through work. There are plenty of middle class workers now whose kids are not guaranteed health insurance, and who can't even necessarily buy into insurance for their kids at a humane rate. And it's not like CHIP is so fabulous that paying customers everywhere are dropping their chosen plan to hop on the free ride---it's a stopgap measure against having no insurance at all.


Posted by: A White Bear | Link to this comment | 08-21-07 10:22 AM
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Given that 4x the poverty level is $82,000/year and median household income in NY state is, per the US census, 45K, it does not seem unreasonable to me to try and find some way of defining "need."

Well, NYS did define need -- the administration just doesn't like the definition. I will note that 'median household income' in NYS isn't all that meaningful, given the differences in cost of living between NYC and, say, Steuben County. $82,000 for a family of four sounds difficult to get by on to me, in NYC.


Posted by: LizardBreath | Link to this comment | 08-21-07 10:25 AM
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I understand what you meant, Ned, but I don't think "infinity percent" is a mathematically meaningful concept.


Posted by: Brock Landers | Link to this comment | 08-21-07 10:25 AM
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Median household income is also useless b/c the households for whom the median is calculate are not normalized by size. More and more singles are constituting their own household, based on the 2000 census. $82,000 for a family of four is not a lot in the city.


Posted by: Saheli | Link to this comment | 08-21-07 10:29 AM
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6: Just take them to the emergency room.


Posted by: Armsmasher | Link to this comment | 08-21-07 10:31 AM
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old Slate article on why the poverty guidelines are not very useful as is.


Posted by: Saheli | Link to this comment | 08-21-07 10:32 AM
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sorry, link here: http://www.slate.com/id/2108134/


Posted by: Saheli | Link to this comment | 08-21-07 10:33 AM
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The emergency room is getting crazy expensive. I accidentally dislocated a dude's shoulder last summer at softball, and he kept screaming at us not to call an ambulance because he couldn't afford it. After a two-block ambulance ride ($600) and a 10-minute ER examination ($300), he got a bill he was paying off for the entire next year.


Posted by: A White Bear | Link to this comment | 08-21-07 10:34 AM
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The dude should have known: you don't mess with white bears. he got off easy.


Posted by: John Emerson | Link to this comment | 08-21-07 10:36 AM
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Simple solution, AWB. Just declare bankruptcy! Why, lots of my friends and companies I've been on the board of have done it as a tax dodge.


Posted by: Every member of the Senate | Link to this comment | 08-21-07 10:37 AM
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Somewhat off topic, but how did you dislocate someones shoulder at softball? Last I checked that isn't a full contact sport.


Posted by: CJB | Link to this comment | 08-21-07 10:37 AM
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$82,000 may not be enough for a family of four in the city if you want to wear designers clothes and drink expensive wines and buy your kids all sorts of middle class garbage and give them violin lessons and nutritious foods and adequate health care, but it's definitely enough to get by.


Posted by: Brock Landers | Link to this comment | 08-21-07 10:38 AM
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If you declare bankruptcy, the new allows them to repossess your boobs and re-dislocate your shoulder.


Posted by: John Emerson | Link to this comment | 08-21-07 10:39 AM
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"new law"


Posted by: John Emerson | Link to this comment | 08-21-07 10:39 AM
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21: Softball is a euphemism, duh.


Posted by: apostropher | Link to this comment | 08-21-07 10:40 AM
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21: We have a lot of accidents because sometimes people try to be fancy, to make people laugh. In that particular instance, it wasn't really my fault; I hit a pop-up and the guy thought it would be funny to do a little shazam with his body while jumping in the air to catch it. His shazam threw the arm out.

We've had a lot of injuries that should have gone to the hospital since then, but everyone's too afraid of the cost.


Posted by: A White Bear | Link to this comment | 08-21-07 10:40 AM
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nutritious foods and adequate health care

Government should not be subsidizing these luxury items, I say !


Posted by: politicalfootball | Link to this comment | 08-21-07 10:42 AM
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Softball is a euphemism.

Oh my yes.


Posted by: William McKinley | Link to this comment | 08-21-07 10:44 AM
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I admit that I am struggling to understand how a program for poor children ends up applying to families making $75,000 year. It seems to me like classic entitlement creep. A problem, which, I should add, ends up diminishing the amount of money we have to spend on people who are actually in need. But stipulating that there are indeed cases we would recognize as "true need" among households making $75,000 a year, then sure, I'm a bleeding heart, let's help them out.

If ever a case called for narrow targeting, however, I would argue it would be this one. Defining need as "anywhere in in the bottom 80% of US households" does not seem very narrow.


Posted by: baa | Link to this comment | 08-21-07 10:45 AM
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Reading, the NYT article, I'm struck by:

1) The bizarre assertion that this is a zero-sum activity -- that expansion of CHIP to middle-income kids means that low-income kids are somehow going to not become the "focus." Wha? They can't possibly mean that states will be so excited about recruiting middle-class kids that they will try insufficiently hard to recruit low-income kids, right? What on earth is this? It's not even as coherent as baa's argument above.

2) Sometimes reporters do have the right name in the Rolodexes. I can't think of anyone in the country better qualified to comment on this issue than Cindy Mann.

3) In the letter sent to state health officials about 7:30 p.m. on Friday

I know Clinton did this too, but I thought it was sleazy then too. SLEAZY.


Posted by: Witt | Link to this comment | 08-21-07 10:46 AM
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26: That makes more sense. I was imagining you hit him with a bat or something.


Posted by: CJB | Link to this comment | 08-21-07 10:46 AM
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I admit that I am struggling to understand how a program for poor children ends up applying to families making $75,000 year. It seems to me like classic entitlement creep. A problem, which, I should add, ends up diminishing the amount of money we have to spend on people who are actually in need.

Perhaps the families making $75,000 a year are not poor, but are in need of this program.


Posted by: Cryptic Ned | Link to this comment | 08-21-07 10:47 AM
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Just to clarify, I was referring to baa's argument in the first paragraph of 4:

Why is it wrong to prevent a program *for the poor* from becoming (yet another) middle- and upper-middle-class entitlement? Shouldn't we want Federal anti-poverty policy to actually focus on poverty?


Posted by: Witt | Link to this comment | 08-21-07 10:48 AM
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A problem, which, I should add, ends up diminishing the amount of money we have to spend on people who are actually in need.

Sure, if the amount of money in the budget for health care for children is absolutely fixed, and no other tradeoffs (reducing other spending? raising taxes) can possibly be made. In the alternative universe where such other tradeoffs are possible, providing coverage to children in middle income families doesn't necessarily reduce spending on poor children.


Posted by: LizardBreath | Link to this comment | 08-21-07 10:48 AM
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29: But you're misunderstanding the law. It defines need as "anywhere in the bottom 80% of US households" which have not been providing health care to their children for X-number of months.

Yes, as the target income gets up this high, there will be some people who don't "need" health care but who still, for whatever economically irrational reason, lack it; it's both in their and our interest to buy them health care, even if, in a perfect world, they would stop drinking expensive wines and buy it for themselves.


Posted by: destroyer | Link to this comment | 08-21-07 10:50 AM
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I skimmed the article but it seems that if you're in the upper income brackets of eligibility you have to demonstrate that you've been unable to get insurance for your kids. $45,000 a year with no insurance likely means mom and dad are both individually making $20-25,000 (not the range of jobs that usually comes with bennies.)

Have you ever tried to buy insurance on your own for a family of four? Especially if anyone in the family has ever used their insurance? The states are just recognizing that 'in need of insurance' doesn't mean 'below poverty level.'


Posted by: Cala | Link to this comment | 08-21-07 10:56 AM
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Have you ever tried to buy insurance on your own for a family of four?

My mom tried this once. Not recommended.


Posted by: teofilo | Link to this comment | 08-21-07 10:57 AM
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Christ, it's not because people are spending too much on fancy wines. It's because it's really damn pricey just to get the kind of insurance that means you won't have to turn off the life support right away if you get in a car crash. That's the kind without regular doctor's visits and checkups.


Posted by: Cala | Link to this comment | 08-21-07 11:07 AM
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Wittt, LB,

You are surely correct that there is no logical implication that extending the CHIPS program to middle class families will reduce the total amount spent in the budget on poor children. It is likewise true that extending CHIPS to the children of the very rich would not logically imply such a reduction. I do not think, however, one needs be in a zero-sum alternative universe to be concerned about programs for the poor turning into programs for the middle- and upper-middle-classes.

Let me ask three questions:

1. Do you believe, generally, that spending on middle-class entitlements reduces funds available for other government spending?
2. Do you think it is advisable as a matter of political tactics that programs targeted to the poor and needy frequently turn into middle- and upper-middle class entitlements?
3. Do you believe that it is possible or desirable to provide the same amount of aid to the poor as to the middle class?


Posted by: baa | Link to this comment | 08-21-07 11:16 AM
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1: No, if you include the fact that middle-class entitlements are often popular enough that taxpayers are happy to fund them.

2: Pretty much the same answer. "A program for the poor is a poor program."

3: It would be nice if we did provide at least as much aid to the poor as to the middle class. I'm not clear that we do now.


Posted by: LizardBreath | Link to this comment | 08-21-07 11:19 AM
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The emergency room is getting crazy expensive.

Jesus fuck, yes. Last year I had a seizure at work, and found myself semi-conscious on the bathroom floor surrounded by medical people because some idiot called the ambulance, and got hauled off to an emergency room while telling the paramedics that I really, really wasn't supposed to go. The total cost of taking me to the hospital, keeping me in the ER for two hours, and giving me my own medicine was $3800. Thank god I make less than poverty level, or I'd never have qualified for the fucking patient assistance program.


Posted by: strasmangelo jones | Link to this comment | 08-21-07 11:20 AM
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My mom tried this once. Not recommended.

Seriously.


Posted by: redfoxtailshrub | Link to this comment | 08-21-07 11:21 AM
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because some idiot called the ambulance

This is so churlish it's making me laugh.


Posted by: ogged | Link to this comment | 08-21-07 11:23 AM
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The total cost of taking me to the hospital, keeping me in the ER for two hours, and giving me my own medicine was $3800.

I need to get a hotkey setup that just inserts:

"Man, your country is fucking insane".


Posted by: nattarGcM ttaM | Link to this comment | 08-21-07 11:24 AM
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39: You know, it's funny, every time we do have programs specifically targeted for the poor - Medicaid, welfare, heating oil assistance, S-CHIP, etc. - they're the first ones on the chopping block whenever anyone starts talking budget cuts. And the people who are making those cuts are invariably the same conservatives who are oh-so-concerned about making sure those programs stay targeted at the poor. If I didn't know better, I might think conservatives didn't actually care about the well-being of poor people after all!


Posted by: strasmangelo jones | Link to this comment | 08-21-07 11:25 AM
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You could color code it so we knew if you were referring to our foreign policy, our domestic policy, or our gender relations.


Posted by: LizardBreath | Link to this comment | 08-21-07 11:25 AM
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18, 36, 41: I'd like to reiterate that when the revolution comes, the insurance industry execs and lobbyists will be the first ones swinging from the lampposts.


Posted by: apostropher | Link to this comment | 08-21-07 11:25 AM
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Leave it to a foreigner to not understand how the free market snaps into action when we call 911.


Posted by: Cryptic Ned | Link to this comment | 08-21-07 11:25 AM
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43: I meant to edit that before posting to make it "some well-meaning, kind-hearted idiot." Nevertheless, everyone in my department at least knew that they weren't supposed to call an ambulance unless I'd been injured in the process of the seizure, and I hadn't been, but no one ever listens; they see me and freak and they call 911.


Posted by: strasmangelo jones | Link to this comment | 08-21-07 11:28 AM
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they see me and freak and they call 911.

I get this a lot.


Posted by: apostropher | Link to this comment | 08-21-07 11:29 AM
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45: Moreover, the easiest way to save a program is to get the middle class involved with it. I've never heard an argument, at least, about welfare queens being irresponsible when it comes to FAFSA.


Posted by: Cala | Link to this comment | 08-21-07 11:30 AM
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God, there's woman I work with who has two children with cystic fibrosis. Sometimes, medically, the shit hits the fan, and $85,000/year won't cover the insurance.


Posted by: heebie-geebie | Link to this comment | 08-21-07 11:31 AM
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52 should include a disclaimer that said woman would probably not be able to get insurance if she made $8,500,000 per year, either. Except as part of a group plan.


Posted by: Cryptic Ned | Link to this comment | 08-21-07 11:33 AM
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52: Oh, man. And there's something where emergency room treatment just won't cut it -- with CF you need to be on top of it all the time.


Posted by: LizardBreath | Link to this comment | 08-21-07 11:34 AM
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re: 52 and 53

I am pressing that hotkey again.


Posted by: nattarGcM ttaM | Link to this comment | 08-21-07 11:36 AM
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got hauled off to an emergency room while telling the paramedics that I really, really wasn't supposed to go.

I'm wondering about the legality of charging you under these circumstances -- how hard do you have to resist before you're not responsible for the medical bill? (This isn't an important policy question, just a funny situation.)


Posted by: LizardBreath | Link to this comment | 08-21-07 11:42 AM
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52: Dear god.

I'm in the middle of Jon Cohn's "Sick," by the way, and it's full of all sorts of horror stories, and, more interestingly, the history of the insurance industry in America and how it evolved to become this dysfunctional and insane. Cohn pulls off the trick of being wonkish yet simultaneously very readable, and I recommend it very highly.


Posted by: strasmangelo jones | Link to this comment | 08-21-07 11:44 AM
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4: Shouldn't we want Federal anti-poverty policy to actually focus on poverty?

Would it help you to think of this as federal healthcare policy?



Posted by: politicalfootball | Link to this comment | 08-21-07 11:45 AM
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Do you believe, generally, that spending on middle-class entitlements reduces funds available for other government spending?

Depends on many things -- such as whether the program is funded through existing or new revenue. Also, "other government spending"? Sure. I'd love to be spending less on debt and more on human services.

2. Do you think it is advisable as a matter of political tactics that programs targeted to the poor and needy frequently turn into middle- and upper-middle class entitlements?

Depends on the program. I haven't noticed millions of middle-class families flocking to LIHEAP or Head Start, much less lobbying their Congresspeople to widen the eligibility for those programs. For health insurance -- it's a different environment. Looking at Social Security and Medicare, my amateur opinion is that poor folks are either better off or neutrally affected by the fact that these programs serve middle and upper-middle class folks too.

Do you believe that it is possible or desirable to provide the same amount of aid to the poor as to the middle class?

This is a bizarre question to me. The middle class benefit from such a gigantic array of institutions, infrastructure, regulations, and laws that are intentionally or unintentionally providing "aid" to them that...ah...what was the question again? No. No, I don't think we're ever going to provide as much aid to poor folks as we do to the middle class.

Bonus extra point: For a clear and comprehensive summary of the High Cost of Being Poor, see the 2006 Brookings report of the same name (not linked because I don't have the full PDF handy, but it's on their website www.brookings.edu)


Posted by: Witt | Link to this comment | 08-21-07 11:46 AM
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And, to top it off, the woman in 52 is wonderful. Lighthearted, thoughtful, easy-going, jokey. One of my favorite people anywhere. (For the record, we have a group plan here, and I don't know what her husband does for a living.)


Posted by: heebie-geebie | Link to this comment | 08-21-07 11:47 AM
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I think that there might be an ambulance racket working the legal system to require ambulances in certain circumstances.


Posted by: John Emerson | Link to this comment | 08-21-07 11:47 AM
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I guess I am now confused, LB, about your basic model for thinking about government social spending. Per your answer to 3, you worry that more government money is spent on the middle class than the poor. Yet this leads you to conclude that here, in a specific case of a program targeting the poor, we should extend it to the middle class. Perhaps the postulate doing the work here is that "a program for the poor is a poor program" -- but there seems to be no evidence here that funds directed to the poor under CHIP were declining or threatened. No one appears to be making the claim that unless we extend CHIP to families making 400% of the poverty line, support for the poor will evaporate. If you were to become convinced that CHIP was in *no way* threatened for poor families, would you still back extension to non-poor families?

Likewise, I am a bit surprised that you seem to believe *as a general matter* that increasing middle class entitlements have no adverse effect on funds available for other government activities. Is the unfunded liability of Medicare and Social Security not an issue, in your estimation? I believe that the Medicare prescription drug benefit is highly popular among seniors, and among taxpayers generally. I am not aware, however, that we have seen any measurable increase in general positive attitudes towards increased taxation that would suggest a populace "happy to fund" this program through higher taxes.


Posted by: baa | Link to this comment | 08-21-07 11:48 AM
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45: Is Medicaid really the first one on the chopping block? At first I was very skeptical, but then realize I was confusing aid for poor people ('caid) with aid for old people ('care), which is untouchable.


Posted by: Wrongshore | Link to this comment | 08-21-07 11:50 AM
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Found the Brookings link.

I'm off, but will be back in a couple of hours.


Posted by: Witt | Link to this comment | 08-21-07 11:51 AM
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56: I really don't know, either. I don't know the law, so I don't know if there's some threshhold of consent they have to pass, and if so, how different levels of consciousness/self-control affect that. In the past, paramedics have just sternly lectured me into submission until I've agreed to be taken to the hospital, because I was exhausted and half-conscious and felt like crap, and I'm sure that's enough to cover any legal issues.


Posted by: strasmangelo jones | Link to this comment | 08-21-07 11:51 AM
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Is Medicaid really the first one on the chopping block?

Medicaid has suffered a number of cuts over the last few years, unless I'm greatly mistaken.


Posted by: strasmangelo jones | Link to this comment | 08-21-07 11:55 AM
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Per your answer to 3, you worry that more government money is spent on the middle class than the poor. Yet this leads you to conclude that here, in a specific case of a program targeting the poor, we should extend it to the middle class.

Huh. It's almost as if the specifics (tax benefits valuable only to those with significant income to shelter, versus the provision of health insurance) were important.

Is the unfunded liability of Medicare and Social Security not an issue, in your estimation?

Passing over what it means to describe Social Security as an 'unfunded' liability (I know, I know, only an idiot would think of debt backed by the US Government as real money) Medicare is a problem because health costs are skyrocketing. As a society, we're going to pay a lot more on health care over the next decades whether we do it through a public or private program, or we're going to actively decide not to spend the money. This is an issue that arises out of current trends in health care costs, not one related to government-provided health insurance generally.


Posted by: LizardBreath | Link to this comment | 08-21-07 12:00 PM
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Medicare is a problem because health costs are skyrocketing. As a society, we're going to pay a lot more on health care over the next decades whether we do it through a public or private program, or we're going to actively decide not to spend the money. This is an issue that arises out of current trends in health care costs, not one related to government-provided health insurance generally.

As Ezra Klein is always pointing out, the cost of Medicare is rising at a slower rate than health care costs outside of Medicare. And yet another reason to switch to government-provided health insurance is to reduce costs, which the private system has been unable to control.


Posted by: strasmangelo jones | Link to this comment | 08-21-07 12:07 PM
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My parents have been somehow indoctrinated against universal health care and we fight about it all the time. Their big ace in the hole is that "People will just go to the doctor about any little thing if it's free and use up all the money." This coming from my mother who, in the past year, has suffered from numerous possibly-life-threatening symptoms of something really fucking ominous and has refused to go to the doctor because of a deep-level and ancient phobia about doctors. The other one I hear is, "People have got to learn to eat right and take care of their bodies. You can't just treat your body poorly and expect me to pay for all your health care." This, again, coming from two obese Americans who eat fried food and spend hours a day watching television. I think it's a weird self-flagellation thing, this hatred for health care. "I deserve to die" or something.


Posted by: A White Bear | Link to this comment | 08-21-07 12:14 PM
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I am not aware, however, that we have seen any measurable increase in general positive attitudes towards increased taxation that would suggest a populace "happy to fund" this program through higher taxes.

How do you think it's going to get funded? You really expect program cuts? Seriously?


Posted by: politicalfootball | Link to this comment | 08-21-07 12:18 PM
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Is the unfunded liability of Medicare and Social Security not an issue, in your estimation?

I wonder how much of a tax increase on the top ten percent of incomes in this country it would take to solve this problem.


Posted by: mcmc | Link to this comment | 08-21-07 12:21 PM
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It's almost as if the specifics (tax benefits valuable only to those with significant income to shelter, versus the provision of health insurance) were important.

Glib, but non-responsive. And indeed, I begin to think the glibness correlates with non-responsiveness. There's a proposal on offer to take a program for the poor and extend it to cover the basically prosperous. I can understand doing this if a) those people aren't really prosperous, but are in fact, needy; b) extending it to the prosperous is required to keep giving it to the needy; c) even though it's a subsidy parental cheapness is denying kids medical care and we want to addreess that, d) it's very difficult impossible for prosperous people to buy health care efficiently, and including them in CHIP is a better way to enable efficient buying than some direct policy meant to increase efficient. These are all possible reasons to support expanding CHIP -- although there's no evidence in the article linked to believe any of them are operative here.

None of these reasons, however, means that as a general matter we should think expanding middle-class entitlements doesn't reduce funds available for other budget items. I wonder what you would think if someone made the same argument you have made about defense spending: it will be *so popular* that people will be happy to pay extra taxes! So we can increase it with no sacrifice! Frankly this is magical thinking on par with the worst of supply side. I don't know why you feel the need to go this route.


Posted by: baa | Link to this comment | 08-21-07 12:22 PM
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It's not fucking parental cheapness!! Christ on a cracker.


Posted by: Cala | Link to this comment | 08-21-07 12:26 PM
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None of these reasons, however, means that as a general matter we should think expanding middle-class entitlements doesn't reduce funds available for other budget items.

Yes...it would in fact be logically impossible to believe that.

As for your points on this specific matter, B and D are true.


Posted by: Cryptic Ned | Link to this comment | 08-21-07 12:28 PM
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Glib, but non-responsive. And indeed, I begin to think the glibness correlates with non-responsiveness.

Make vague, flippant attacks on other people's positions, and the answers you'll get will be glib. Ask better questions, and you're likely to get better answers.

I wonder what you would think if someone made the same argument you have made about defense spending: it will be *so popular* that people will be happy to pay extra taxes! So we can increase it with no sacrifice! Frankly this is magical thinking on par with the worst of supply side.

An important difference between defense and health care is that a suggestion that defense spending be cut, is a suggestion that less 'defense' -- armaments, servicemembers' salaries, etc. -- be purchased; that money be moved from buying 'defense' to buying something else. With health care, on the other hand, most people agree that having people die because they can't purchase health care is a bad thing -- while we talk about controlling the costs, a common goal is that everyone should have reasonable access to health care. The question is just how best to pay for that; through government provided health insurance; employer provided health insurance; indivdually provided health insurance; no health insurance, just write checks? Changing the mode of payment doesn't, by itself, change the total amount Americans spend on health care in the same way that changing the defense budget changes the total amount Americans spend on armaments.


Posted by: LizardBreath | Link to this comment | 08-21-07 12:33 PM
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75 is smart. All of you with guns strapped to the insides of your closets "for when They come for me" should be outraged that so much of your taxes go to national defense.


Posted by: A White Bear | Link to this comment | 08-21-07 12:35 PM
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All of you with guns strapped to the insides of your closets "for when They come for me" should be outraged that so much of your taxes go to national defense

I am more outraged about how much goes for national offense.


Posted by: CJB | Link to this comment | 08-21-07 12:42 PM
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Changing the mode of payment doesn't, by itself, change the total amount Americans spend on health care in the same way that changing the defense budget changes the total amount Americans spend on armaments.

I half agree and half disagree. It isn't like defense spending, but the amount Americans spend isn't immune from being affected by the method of payment. If you don't have health insurance, you don't get preventive care and checkups because you have a better use for that couple hundred dollars. But that isn't to say that because people use health care more often that they're spending more. (e.g., you catch the skin cancer when it's treated by half an hour in the dermatologist's office rather than after it's spread.)

And yes, if you increase the number of people permitted to use the CHIPS program, it will probably cost more. How much depends on how many are actually eligible. Here's where it gets interesting though. It's perfectly plausible for CHIPS to cost slightly more while overall health care costs diminish. And I do think, per ogged's post, that it's easier to get people to pony up for a small tax increase, especially if it reduces their overall health care costs, when they see it as something that helps their Responsible Neighbor who has a Good Job rather than as something that helps Lazy Poor People Who Should Be Encouraged To Get A Better Job.


Posted by: Cala | Link to this comment | 08-21-07 12:54 PM
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78: That's true, and I meant to cover it with the words 'doesn't, by itself, change'. The only point I was making is that if the gov't cuts spending on health care, individuals are going to replace that funding privately to a significant extent; if the gov't cuts spending on missiles, that's money that just doesn't get spent.

But you're right that changing methods of payment can end up either increasing or decreasing the total amount spent on health care, and it's not all that easy to tell which.


Posted by: LizardBreath | Link to this comment | 08-21-07 12:57 PM
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Yeah, I figured that's the work that 'by itself' was doing. I'm just allergic generally to arguments that assume that health care is the only thing where someone else picking up the tab doesn't influence your decisions at all.

If you have to pay for it all out of pocket, you DO go to the doctor less often. And sometimes, in the case of my family, you get really lucky and none of your kids even suffers a broken bone. And sometimes that cough you thought would get better on its own turns into pneumonia or the tooth develops an abscess.


Posted by: Cala | Link to this comment | 08-21-07 1:04 PM
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A big flaw in baa's arguments here is that uninsured has no direct correlation with poverty. There are 45 million uninsured Americans - almost 1 in 6. Does baa think that 1 in 6 Americans live in poverty? Some small portion of those 45 million are skipping it because it's not a great investment for them (I was uninsured through my 20s, and it would've taken a pretty cheap premium to get me on board), but most are unable to afford it, even if otherwise doing OK.

For a family with children, we're talking well over $1000 a month for any meaningful insurance - does baa think that someone earning $82,000 a year (take-home somewhere south of $60,000) has an extra $12-20,000 lying around? My household earns right in that range, but neither of us will get insured through work this fall. The free market doesn't work for us - it does not make it feasible for us to be insured. Fortunately, the gov't created COBRA, and we'll be able to pay a mere 5% of our pre-tax income to make sure that we can maintain our health care through the end of the year. But it would be trivial for us to be in a situation where no free market plan would be affordable to us.


Posted by: JRoth | Link to this comment | 08-21-07 1:24 PM
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vague, flippant attacks .... Ask better questions

I guess I don't see what vague, flippant attacks I've been making. This seems more like a generic "nyah-nyah" then anything directly occasioned by what I've written. Of course, I realize it's easy in this setting to write something that unintentionally sets someone's teeth on edge,* so maybe I did that.

Or maybe the claim that making poverty programs middle class subsidies increases our budget obligations, and thus in general diminishes our ability to fund other programs counts as vague or flippant. If so, it's going to be hard to be specific and serious. I didn't even realize this point was at issue until you and Witt seized on it. You said, and I hope I am correctly characterizing your position, that as a general matter we needn't worry about the effect middle-class entitlements have on the budget because they will increase willingness to pay taxes. This could be true in some cases, but as a general rule it's basically inverse supply side, and preposterous. I simply don't understand why you won't walk away from this silly position.

I understand Cryptic Ned's reasons in 74. I could even come to support expansion of CHIP if I were convinced they were correct. That's why I asked if you would still be inclined to support CHIP expansion if you became convinced that it was not necessary to ensure political legitimacy for the program. Is that the sole reason and you're just being ornery, or what?

*incidentally, Cala, I see I did that in my listing of reasons in 72. I didn't mean to suggest that the main reason someone would not by health insurance for their child was "cheapness," but rather to note that even in that "limit" case of parental misconduct, it might be reasonable to provide a subsidy if that's the only way to get the kid covered.


Posted by: baa | Link to this comment | 08-21-07 1:33 PM
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I guess I don't see what vague, flippant attacks I've been making.

It's vague and flippant to attack as inconsistent a position that we underprovide services to those in need, and that providing services to the middle class may be necessary to effectively help those in need. You're reasonably sophisticated in talking about this stuff -- you know that part of the reason that universal health care was so strongly opposed in the 90s was the Republican belief that it would be too popular to ever get rid of. I'd be stunned if you've never heard the 'a program for the poor is a poor program' argument laid out.

Given that assumed base of knowledge, a comment like your 62 is not something that's worth answering in depth. If the words 'vague and flippant' hurt your feelings, my apologies -- I do realize that unnecessary characterizations of the quality and good faith of the arguments one is addressing can sound very unpleasant.


Posted by: LizardBreath | Link to this comment | 08-21-07 1:40 PM
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"People will just go to the doctor about any little thing if it's free and use up all the money."

I get this all the time from my wingnut father (whose sister, it must be said, is a raving hypochondriac). This is one of those examples of argument-counter-to-all-experience that makes me despair of arguing the issues with people. You don't need a peer-reviewed study to make this case: out of a hypothetical population of Americans covered by a single-payer system, what portion of them are likely to be a) true hypochondriacs and b) not hypochondriacs, but overanxious people who feel their time is well spent sitting around in doctors' offices? Surely our personal experience suggests this number would be low? How many people have you met who won't even take a goddam aspirin when they have a headache?


Posted by: cerebrocrat | Link to this comment | 08-21-07 1:42 PM
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That's why I asked if you would still be inclined to support CHIP expansion if you became convinced that it was not necessary to ensure political legitimacy for the program. Is that the sole reason and you're just being ornery, or what?

There's JRoth's point about health insurance, specifically, being very difficult to buy for many people who genuinely aren't poor. I don't see any reason that a program like CHIP shouldn't cover people in such situations. And of course I find the hypothetical incredible -- a program that only serves the poor will always have less political legitimacy than one that serves the middle class. Accepting the hypothetical, or the reasonably equivalent hypothetical that health care could also be provided cheaply by flying pigs, if health care providing flying pigs were located, and ignoring JRoth's very important point, sure, there'd be no need to expand SCHIP.

But I don't think the hypo advances the conversation much.


Posted by: LizardBreath | Link to this comment | 08-21-07 1:46 PM
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LB, in 62 I specifically referenced that "poor program" argument and asked if that was the primary basis of your support for the expansion of CHIP. And then I referenced it again in 72. Either time you could gave just said "yes, that is my main reason." So it will not do to suggest that somehow I was playing dumb on that point.

I must say that discussion with you would be easier without the snideness. In particular, your "apology" is passive-aggressive in the extreme. I think, frankly, you responded that way because you know you have been caught out. Whatever.


Posted by: baa | Link to this comment | 08-21-07 2:06 PM
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No, I responded that way because I thought it was fucking rich of you to get supercilious about 'vague and flippant' after you'd called my arguments 'glib', asshole.

Better?


Posted by: LizardBreath | Link to this comment | 08-21-07 2:08 PM
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Fucking northeasterners.


Posted by: ogged | Link to this comment | 08-21-07 2:09 PM
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88 gets it exactly right.


Posted by: teofilo | Link to this comment | 08-21-07 2:24 PM
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It is better, actually. Because you *were* being glib in 67, and I thought that was intentional, and so I never imagined my saying so would be offensive to you. That's the truth.

On "vague and flippant", you probably won't believe this either, but I called it out less because I found it offensive than because I really didn't know what you were talking about ("how is talking about the budgetary effects of entitlements flippant?" I was asking myself), and was trying to figure out if you were serious or dodging the question.


Posted by: baa | Link to this comment | 08-21-07 2:32 PM
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Maybe we can vote them off the island and take their health care.


Posted by: Cala | Link to this comment | 08-21-07 2:35 PM
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I was serious -- your accusation of inconsistency (paraphrased as "Wait: you're saying that we don't do enough for the poor generally, so we should expand a program for the poor to include the middle class?") was flippant and thoughtless. First, the argument that people that the states want to cover under CHIP aren't really in need is very weak, for JRoth's reasons. But more fundamentally, the 'program for the poor is a poor program' argument isn't limited to political legitimacy, but to problems like edge cases (someone who's genuinely in need but not quite eligible), proof of eligibility (which can turn out to be terribly burdensome), shaming (making participation in a program a mark of abject poverty is going to drive people away from it.)

Further, your characterization of my assertion that the successful provision of social services can increase satisfaction with government and willingness to pay taxes as 'magical thinking' is snide, unpleasant, and poorly founded. A natural experiment has been done in this regard, and it turns out that citizens of countries that provide a well-funded welfare state are comparatively happier with their tax burden than Americans are. (I'm not going to find the cite for you, but a study to this effect has been done fairly recently.)

Generally, baa, I don't mind arguing with you. I do mind being lectured on my manners by you, given that yours are far from impeccable.


Posted by: LizardBreath | Link to this comment | 08-21-07 2:47 PM
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And I'll take glib, but 67 was absolutely responsive to your inquiry -- the inconsistency you purported to identify is nonexistent, because the specifics of the programs in which we provide aid to the middle class and not to the poor are important.


Posted by: LizardBreath | Link to this comment | 08-21-07 2:50 PM
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I didn't even realize this point was at issue until you and Witt seized on it. You said, and I hope I am correctly characterizing your position, that as a general matter we needn't worry about the effect middle-class entitlements have on the budget because they will increase willingness to pay taxes.

Time for a little forensic troll dissection:

First, Witt's comments are explicitly different from what you describe here. You can't find a Witt quote that can be mistaken for this sentiment.

LB, likewise, explicitly contradicts the idea that you attribute to her - except in 40, where she says something that kinda (but not really) looks like this as long as you squint at it the right way and are careful to remove it from context. Read 40 again in the context of 34, and you can see that her opinion is clear.

Money spent on one thing can't be spent on another. Duh. Read the first sentence of 34 again if you think LB is confused about this. And if that's too much, read the first word.


Posted by: politicalfootball | Link to this comment | 08-21-07 3:00 PM
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94: Not to agree or disagree with your comment generally (that is, that specific quote of baa's is distorted, but comprehensible to me), but I do kind of like saving the word 'troll' for contexts where it's clear that there's no good faith argument going on at all. And baa's been commenting here for quite awhile -- longer than I have, certainly -- and presumably isn't just fucking with us.


Posted by: LizardBreath | Link to this comment | 08-21-07 3:07 PM
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Let's introduce some data. This is a pie chart of federal spending in FY 01. It's at a very abstract level, so I'm going to assume it hasn't changed vastly since then, although I could be wrong.

(I'm linking this one since it's from the GPO, an arguably nonpartisan source. I am sure that organizations like the Center on Budget and Policy Priorities have FY08 charts, but I don't want to get derailed into arguments over partisanship.)

A few observations:
- 16% goes to discretionary spending on the military
- 11% goes to interest on our debt

I am not an economist or a statistician. However, I'm quite willing to suggest that CHIP could be expanded without raising taxes if some of that money we are spending on interest or missile defense was redirected. (We can have a side discussion about the wisdom of raising tobacco taxes to cover it, which is the proposal in at least one state.)

(Also: Thanks, PF.)


Posted by: Witt | Link to this comment | 08-21-07 3:23 PM
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95: I retract the word "troll". It's a loaded word that shouldn't be used to describe anyone here except for mcmanus - and only used in regard to mcmanus if we keep in mind that he's one of the cute little shiny-frizz-haired trolls, perhaps with a gem in the belly button.


Posted by: politicalfootball | Link to this comment | 08-21-07 3:24 PM
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95, 97: Good; I wouldn't call it trolling either.


Posted by: Witt | Link to this comment | 08-21-07 3:37 PM
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one of the cute little shiny-frizz-haired trolls, perhaps with a gem in the belly button.

I will forevermore treasure imagining Bob this way whenever I see his comments.


Posted by: cerebrocrat | Link to this comment | 08-21-07 3:48 PM
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However, I'm quite willing to suggest that CHIP could be expanded without raising taxes if some of that money we are spending on interest [...] was redirected.

How, exactly, would one go about doing that?

(We can have a side discussion about the wisdom of raising tobacco taxes to cover it, which is the proposal in at least one state.)

Horrible, horrible, idea. Partly because it's horribly regressive, but mostly because it gives the state a vested interest in keeping people smoking and lets them be easily captured by the tobacco companies.


Posted by: Jake | Link to this comment | 08-21-07 3:55 PM
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Horrible, horrible, idea. Partly because it's horribly regressive, but mostly because it gives the state a vested interest in keeping people smoking and lets them be easily captured by the tobacco companies.

The problem with sin taxes is that they really do cut down on sin.


Posted by: politicalfootball | Link to this comment | 08-21-07 3:56 PM
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101: Well, not a problem if cutting down on sin is your wholehearted intent. When you want to cut down on sin and raise money at the same time, then you have a problem.

100: How, exactly, would one go about doing that?

In one year's budget, admittedly, not possible. Over time, the idea is to spend less money on stupid shit coughIraqcough, requiring less borrowing and lower interest payments.


Posted by: LizardBreath | Link to this comment | 08-21-07 4:00 PM
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How, exactly, would one go about doing that?

Well, not to be simplistic, but one way to do it is to not run up the deficit such that one is paying that amount of interest. And one way to do that is by not spending money we don't have to spend. And one way to do that is to not start wars.

With regard to the tobacco taxes, I really do think they are a dance with the devil. The research I've seen says they cut down substantially on teen smoking, but not much otherwise. And as noted they're generally regressive.

Also, they arguably create quite a black market. The winners of that market are usually cigarette companies (and to a much lesser extent, Indian reservations). There were a couple of high-profile cases 8-10 years ago in which subsidiaries of subsidiaries of big companies (I think RJR was one) pled guilty to masterminding the smuggling.


Posted by: Witt | Link to this comment | 08-21-07 4:04 PM
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But the amount paid in interest depends much more on the national debt than on the deficit, reducing interest payments by one dollar next year means paying down fifteen dollars of debt this year. It's not a way to increase funding for anything within the next ten years.

Not spending lots of money building trucks to get blown up in Iraq would help a lot, for sure.


Posted by: Jake | Link to this comment | 08-21-07 4:21 PM
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Sure, it's not fast, but over time bringing tax revenues closer to being in line with spending would decrease the amount of interest being paid. But you're absolutely right that that's not one, or ten, years' budgeting decision.


Posted by: LizardBreath | Link to this comment | 08-21-07 4:24 PM
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Or we could pull a Weimar and just print shitloads of money.


Posted by: foolishmortal | Link to this comment | 08-21-07 4:29 PM
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Or we could pull a Weimar and just print shitloads of money.

And look how well that turned out for them.


Posted by: teofilo | Link to this comment | 08-21-07 4:32 PM
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Or we could pull a Weiner and just print shitloads of trenchant blog comments.


Posted by: Cryptic Ned | Link to this comment | 08-21-07 4:35 PM
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Then disappear.


Posted by: teofilo | Link to this comment | 08-21-07 4:43 PM
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Then disappear

Only from here.


Posted by: I don't pay | Link to this comment | 08-21-07 4:48 PM
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Simply repealing Bush's tax cuts or letting the sunset clauses on them would go a long way towards funding healthcare.

Taxing hedge fund managers on their income the way everybody else in the country is taxed, instead of giving them bizarrely low tax rates on income (I believe they pay roughly half of what other people in their tax bracket pay, because they can call it capital gains), would also go a very long way, given the typical salaries.

or, gasoline tax. yay!


Posted by: mrmf | Link to this comment | 08-21-07 9:01 PM
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Then disappear
Only from here.
Did I overhear
Or was I unclear?
There's nothing to fear
This calendar year.


Posted by: redfoxtailshrub | Link to this comment | 08-21-07 9:04 PM
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I need some beer.


Posted by: Sifu Tweety | Link to this comment | 08-21-07 9:07 PM
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I'm still here
at work, I fear.
And could also use a beer.


Posted by: LizardBreath | Link to this comment | 08-21-07 9:16 PM
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My shoe is off;
My foot is cold.
I have a bird I like to hold.


Posted by: Cala | Link to this comment | 08-21-07 9:19 PM
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My hat is off,
My teeth are gold.
And now my story is all told.


Posted by: LizardBreath | Link to this comment | 08-21-07 9:22 PM
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My pants are off,
My dick is cold,
I fear this trope will soon get old.


Posted by: Sifu Tweety | Link to this comment | 08-21-07 9:23 PM
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I had to cough,
but his move was bold.
It seems Tweet's dick is made of mold.


Posted by: Stanley | Link to this comment | 08-21-07 9:24 PM
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Sure you scoff
I had you sold
But now, confused, I have to fold.


Posted by: Sifu Tweety | Link to this comment | 08-21-07 9:26 PM
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My rhyme is off
My lines don't scan
I'm really a terrible poet


Posted by: M/tch M/lls | Link to this comment | 08-21-07 10:07 PM
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Can somebody tell me how much it actually costs to stay in a US hospital w/o insurance? (My father's cancer has recurred, his doc doesn't want to operate and we're in the process of getting second opinions including from the US. But if he survives any op he could be in hospital for weeks before he's stable enough to travel back.)


Posted by: emir | Link to this comment | 08-22-07 4:07 AM
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re: 122

This is unhelpful, but I spent the last 10 - 15 minutes googling and couldn't find a price list or cost breakdown anywhere. Sorry. I did find an article noting that per-day costs in many hospitals exceeded $5000 but I have no idea how representative that is.


Posted by: nattarGcM ttaM | Link to this comment | 08-22-07 4:23 AM
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Thanks, ttaM - I had the same problem trying to find out from searches.


Posted by: emir | Link to this comment | 08-22-07 4:56 AM
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I don't understand exactly why, but a big feature of the US health care system is total lack of transparency about pricing. Any hospital care is going to result in a flurry of bills from people you haven't heard of, that you had no simple way of finding out about before you incurred the charges.


Posted by: LizardBreath | Link to this comment | 08-22-07 6:19 AM
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I don't understand exactly why, but a big feature of the US health care system is total lack of transparency about pricing

I think most of this is the way the billing works. For the insured the bill goes directly to the insurance company or medicare/medicade. Each company then negotiates prices for their customers with the different hospital systems. So their is a base price that the hospital is going to charge for services, but they expect to have it negotiated down by the insurance company or medicaid/medicare. Unfortunately without insurance you pretty much get screwed since you are going to be paying full price.


Posted by: CJB | Link to this comment | 08-22-07 6:30 AM
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124: There's a doctor here who does mostly uninsured patients (Amish and Mexican) on a cash basis. One of her quirks is that she doesn't mark up her lab tests, so that if the lab charges $40 she charges $40 (instead of $99.99). Other doctors complained and the lab threatened to quit doing tests for her.

Her secret is that she came from a very rich family and came out of med school without debt. Even for undergrads, student debt is increasingly forcing people int prctical careers. Economists think this is wonderful, becuase it minimizes free riding and moral hazard. You don't want to let nobody get nothing for nothing.


Posted by: John Emerson | Link to this comment | 08-22-07 6:40 AM
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I don't understand exactly why, but a big feature of the US health care system is total lack of transparency about pricing

The most parsimonious explanation is that they are evil gouging bastards intent on ripping you off.


Posted by: nattarGcM ttaM | Link to this comment | 08-22-07 6:40 AM
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See, we (most of us) dream of a world in which anyone willing and able to do the work can become an MD and earn a nice living, and in which any patient who needs medical care can get it. Obviously that dream will never be completely attainable, but to us it's a sort of benchmark of an ideal society.

But to an economist, that's a free-riding world full of parasites. Giving expensive health care to penniless sick people is just wrong, exactly comparable to letting them eat free at five star restaurants -- everything is fungible. And by making sure that medical students go deeply into debt while allowing them to pull down enormous salaries after they graduate, moral hazard is avoided.


Posted by: John Emerson | Link to this comment | 08-22-07 7:41 AM
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I don't understand exactly why, but a big feature of the US health care system is total lack of transparency about pricing. Any hospital care is going to result in a flurry of bills from people you haven't heard of, that you had no simple way of finding out about before you incurred the charges.

If you have to ask, you can't afford it. Just go to the emergency room and use a fake name, like our president recommends.


Posted by: Cryptic Ned | Link to this comment | 08-22-07 7:41 AM
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The most parsimonious explanation is that they are evil gouging bastards intent on ripping you off.

I'm sitting here looking at the Blue Cross EOB for some blood tests. Apparently the fair and reasonable value of this work - the amount Tricore Labs charges to regular folks - is $133.22. However, because I'm insured with BCBS, the amount they charge me for that same exact work is $23.28. BCBS isn't paying a penny (I'm still meeting my deductible) but simply because I'm insured I get 80% off the cost of blood tests. It only costs me about $5,000 a year to be part of the buying cooperative that entitles me to this special price.

The discount rate for other services (doctor visits, hospital charges, etc.) varies from 10% to 90%

The uninsured who can pay are subsidizing the uninsured who can't pay and erhaps the insured. It's a mad game of cost shifting, and (as usual) the weak undoubtedly end up holding the bill they can neither pay nor (often) bankrupt against.


Posted by: Michael H Schneider | Link to this comment | 08-22-07 7:43 AM
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Hey, let's talk about medical billing for awhile.


Posted by: John Emerson | Link to this comment | 08-22-07 1:48 PM
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