John Amato explains how. See also Christy and Digby.
Category Archives: Health Care
Tots and Taxes
This morning President Bush vetoed the S-CHIP legislation, as promised. CNN reports:
Speaking in Pennsylvania, Bush said he vetoed the bill because it was a step toward “federalizing” medicine and inappropriately expanded the program beyond its focus on helping poor children.
“I believe in private medicine, not the federal government running the health care system. I do want Republicans and Democrats to come together to support a bill that focuses on the poorer children,” the president said, adding the government’s policy should be to help people find private insurance.
Harold Meyerson points out the obvious:
We have a massive, competitive private sector that has decided it cannot turn a buck on millions of Americans of modest means or uncertain health. If there were a private-sector solution to the problem of 9 million uninsured American children, the private sector would have found it.
In today’s press briefing at the White House, Dana Perino said,
What the President wants is for S-CHIP to revert back to what is the original intent of the law, which is that the neediest children should be taken care of first. That’s not what the law that they sent to the President does — well, we don’t have it yet, we’ll get it soon — but that’s not what that law does. I would also say that, in a time when Democrats are very concerned, supposedly, about people being worried about how they’re going to pay for their mortgage, that raising taxes on them doesn’t seem like the wisest fiscal policy. In a time when they think that they want to increase funding for children’s health care, they’re actually wanting to pay for it with a cigarette tax, which includes — people who smoke are usually — the majority are in the low-income bracket. And so they’re raising taxes on something to pay for a middle-class entitlement. It’s just completely irresponsible. Stop the madness on Capitol Hill.
I don’t know if it’s true that most smokers are in a lower income bracket, but if so, a lot of them probably don’t have health insurance. I’d advise them to stop smoking. Anyway, as I’ve written before, the states want to expand S-CHIP because so many “middle class” families are losing their health insurance.
Back to Harold Meyerson:
But the president and those Republican members of Congress who join him in opposing SCHIP’s expansion have a faith in laissez-faire ideology that cannot acknowledge the limits of what capitalism can, or even chooses to, do.
We hear a lot from Republicans these days, presidential candidates most especially, that they want to return their party to its roots, to make it once again the party of Ronald Reagan. Problem is, they’ve overshot Reagan and seem bent on reinventing the GOP as the party of Barry Goldwater.
Reagan’s conservatism had wind in its sails: The stagflation and drift of the Carter years provided an opening for Reagan’s limited rollback of government. What Goldwater personified, however, was the triumph of ideology over experience. He opposed Social Security and Medicare and voted against the Civil Rights Act of 1964 in the name of property and states rights. The needs of seniors, the claims of African Americans to equal rights, ran counter to Goldwater’s theology of markets over people.
Today’s Republicans seem determined to re-create that magical Goldwater self-marginalization. Opposing the provision of health care to children because it conflicts with one’s faith in an economic future (capitalism insures everyone) that capitalism itself does not really share (or it would insure everyone) is the same kind of theological nuttiness that led to the Goldwater debacle. In the name of attacking socialism, what Republicans are really doing is affronting the empiricism and the pragmatism, not to mention the decency, of the American people. At, one need hardly add, their own risk.
However, Jonathan Kaplan thinks it’s the Dems who screwed up:
Democrats had been reveling in their good fortune, believing they had a winning issue in legislation to expand the State Children’s Health Insurance Program (SCHIP), which Bush is expected to veto Wednesday.
But three senior Democrats floated a proposal to impose a surtax, a levy on a percentage of citizens’ tax bills, to fund the war in Iraq.
Republicans pounced to criticize the plan while Democratic leaders did their best to appear undeterred by the bump in the road.
Under the surtax proposal, taxpayers would pay extra taxes — ranging from 2% to 15% based on income — to raise $140 billion a year to pay for the war. And this takes us to the most brilliant comment by Michelle Malkin yet: “Nothing screams impotence louder than a desperate, last-ditch effort to tax the war on terror to death.” No, dear, they wouldn’t be taxing the war on terror, they’d be …. oh, never mind. It’ll never pass, anyway.
Awhile back I proposed a Civilian War Footing Act, which would provide for an automatic tax raise, gasoline rationing, and maybe even a draft in the event some damnfool in Washington took a notion to invade somebody. The idea is that if a war isn’t so essential to the survival of the nation that it’s worth raising taxes over, it isn’t worth fighting. I think some guys in Congress caught on to my idea.
My understanding is that taxes always go up in time of war, because wars are expensive. Awhile back Fred Kaplan wrote,
To fund World War II, the United States drastically expanded and raised taxes. (At the start of the war, just 4 million Americans had to pay income tax; by its end, 43 million did.) Beyond that, 85 million Americans—half the population at the time—answered the call to buy War Bonds, $185 billion worth. Food was rationed, scrap metal was donated, the entire country was on a war footing. By contrast, President Bush has asked the citizenry for no sacrifice, no campaigns of national purpose, to fight or fund the wars in Iraq or Afghanistan. In fact, he has proudly cut taxes, heaving the hundreds of billions of dollars in war costs on top of the already swelling national debt.
The posters in this post are from World War I, btw. Can you imagine what Little Lulu would say if the government told her what to feed her kids to support the war effort? If paying taxes are too onerous a sacrifice, telling little Chauncy he has to give up pop tarts in favor of corn meal mush must be unthinkable.
Back to Dana Perino and the press briefing:
Q And yet 70 percent of the public in the latest poll yesterday, an ABC/Washington Post poll, supports that increase in the S-CHIP, but opposes the $190 billion in war funding spending.
MS. PERINO: Well, you know, I don’t know how all those questions were asked in the poll, and you might want to take a look at that and be a little bit skeptical. But I think that people would agree that we — well, and also what I said yesterday: Republicans often taken on really unpopular positions because it does sound great to say that you’re going to spend a lot more on children’s health care, but when you start digging deeper and realize that they’ve got a funding cliff, that basically in 2011, there’s no money left for the S-CHIP program. They don’t fund it sustainably. And on this idea of raising taxes on the American people right now to fund a war, well, does that sunset? Do they wait for al Qaeda to wave a white flag and then those taxes are going to go away? Does anyone seriously believe that the Democrats are going to end these new taxes that they’re asking the American people to pay at a time when it’s not necessary to pay them? I just think it’s completely fiscally irresponsible, and the President won’t go along with it.
In other words, we don’t have money to provide children with health insurance because we have to pay for the war, and we can’t raise taxes to pay for the war because the war will go on forever and ever amen.
Well, just as long as we’re all clear on our priorities, right? Little Americans should be proud to give up health care for their country.
At MyDD, Tom Beeton says the fight is on to override the veto:
… a coalition made up of MoveOn.org Political Action, Americans United for Change, AFSCME, USAction, SEIU, and True Majority will be holding more than 200 “Rallies For Our Children’s Health” around the country to urge Congress to override the veto. You can find a rally near you HERE.
To find out if your congressman voted against healthcare for children, the roll call vote is HERE. Call them (switchboard: 202-225-3121) and demand that they vote to override the veto. I wrote about 8 of the Republicans the Democratic leadership is targeting HERE but there are plenty more where that came from — 151 Republicans voted against it after all. I expect every Democratic challenger of these Bush lapdogs to hit on this issue at every opportunity.
Like the poster says, do your bit.
Update: If anyone has the time and energy to respond to this stupid comment just left on an old S-CHIP post, be my guest. I’m not up to it today.
The SCHIP Hits the Fan
That’s Dan Froomkin’s headline, but it was too good not to steal.
I’ve written about S-CHIP before, so I’m going to skip the background and go right to the update. Yesterday the House approved S-CHIP legislation. Tony Pugh writes for McClatchy Newspapers:
In one of the biggest congressional health care votes since 2003, the House of Representatives voted 265 to 159 to reauthorize and expand the State Children’s Health Insurance Program by $35 billion over five years.
But the victory tally fell short of the tally needed to override a promised veto of the measure by President Bush.
Forty-five Republicans joined Democrats in supporting the bill that provides health coverage for 3.8 million uninsured children and has the support of most health industry organizations as well as most of the nation’s governors, religious leaders and patient advocacy groups.
But expanding government programs to cover more uninsured Americans has proven ideologically intolerable to President Bush and to many House Republicans, whose opposition left the legislation well short of a veto-proof, two-thirds majority despite an all-out push by hundreds of lobbyists.
I just learned that one of the handful of Dems who voted against it was Dennis Kucinich. Jerid at Buckeye State Blog writes that Kucinich won’t vote for any health care measure other than his own universal coverage bill. Rosemary Palmer, a Democrat who is challenging Kucinich in the primary next year, said,
On one hand, President Bush vows to veto the bill, and on the other, Dennis Kucinich votes against it because he doesn’t think it is perfect. This is a perfect example of what is presently wrong with Washington decision-making. Polarizing positions work against functional compromise resulting in a government that cannot serve in the nation’s best interest. While fringe politicians like President Bush and Congressman Kucinich rant like petulant children, the nation remains stagnant and desperately needing effective leadership. Unfortunately, children in Northeast Ohio and around the country will pay the price for their obstinate actions.
I believe Kucinich also had a problem because House Democrats agreed to drop language from the bill that would have allowed foreign-born children who are here legally to obtain coverage. Apparently this was a sop to right-wingers who feared SCHIP benefits might go to illegal aliens in spite of identification requirements. The provision for legal immigrants was being called ” a gaping loophole to allow states to give taxpayer benefits to illegal immigrants” by ring-wing congress critters like Rep. Marsha Blackburn (R-Tennessee).
You know the rightie principle — better to let American citizens do without than allow one thin dime of taxpayer money benefit illegals. Back in the day we called that attitude “cutting off your nose to spite your face.”
Back to Tony Pugh:
A vote on the measure is expected Thursday in the Senate where a two-thirds majority is likely. The bill will then go to President Bush who is expected to veto it. In the interim, Democrats will temporarily fund the program, possibly through mid-November, until a long-term funding agreement can be reached, according to a senior Democratic aide.
President Bush may be courting the ultimate presidential indignity — a Congressional override — with his threatened veto of a bill to expand poor children’s health care access, which many members of his own party enthusiastically support.
Bush is still able to bully Congressional Democrats when it comes to the war and national security. But, in the realm of domestic politics, he’s the archetypal lame duck. About the only power he has left is the veto — and then, only if he can maintain enough Republican backing to sustain it.
Yet, astonishingly enough, Bush not only remains dead-set on vetoing the popular child health-care initiative, he’s once again pushing a dead-on-arrival proposal to give tax breaks to people who buy private insurance. Even some leading Republicans are agog.
The House vote suggests that overriding the veto is a long shot. Karen Tumulty writes at Swampland:
We’ve discussed before why this is a fight President Bush is likely to regret having won–and why millions of uninsured children are likely to regret it even more. Now, with House passage of the children’s health insurance bill having fallen about two dozen votes short of a veto-proof majority, it appears the bill is indeed headed for doom because of what Bush’s HHS Secretary Mike Leavitt has called “the ideologic question.”
Democrats have been handed what could be a powerful issue going into an election year in which health care ranks at the top of voters’ domestic concerns. The bill got 45 Republican votes in the House–a sharp increase from the five who supported the original House version of the bill and more than some of its sponsors expected. That isn’t much consolation to all those children, though. Which is why Nancy Pelosi vows this won’t be the end of it.
An example of the nonsense going on surrounding this bill is provided by the Atlanta Journal Constitution. The Georgia congressional delegation split on the vote:
Republicans opposed it, Democrats supported it, and the only exception was Rep. Jim Marshall, a Macon Democrat, who voted against the expansion. Marshall is one of the most vulnerable congressmen in the country is once again facing a strong Republican challenge in next year’s congressional elections.
PeachCare, funded through SCHIP, has been successful and popular in Georgia so state Republicans were careful to praise PeachCare while denouncing SCHIP, which provides health insurance for poor kids, as a first step toward socialized medicine.
Is that slick, or what?
“Reauthorizing SCHIP is essential,†Rep. Tom Price, a Roswell Republican, said. But “I was forced to oppose the bill.â€
“The reality is this bill does not protect the most vulnerable amongst our citizens,†said Rep. Phil Gingrey, a Marietta Republican. “Rather it diverts precious resources from those who need it the most in order to cover adults and already privately insured children.â€
As explained by Jeanne Lambrew at the Center for American Progress, Gingrey’s charges are bogus. The bill does not expand coverage to adults, and the charge that the bill would divert money from poor children to less needy children comes from data promoted by Secretary Mike Leavitt of the Department of Health and Human Services that has been widely discredited, in particular by the Congressional Budget Office. See Lambrew for details.
The Senate bill is expected to pass tomorrow.
How Did It Come to This?
The AARP produced this video, which “tells the story of a real American family pushed to the brink of financial ruin by a personal health crisis.”
More on the Clinton Health Care Plan
Ian Welsh see pros and possible cons. Ezra Klein compares the Clinton and Edwards plans.
Clinton Health Care, v. 2
Ezra Klein evaluates Hillary Clinton’s new health care proposals.
Mind the Gap
Fascinating information from Eesha Pandit at Reproductive Health Reality Check:
The Alabama Department of Public Health released a report that shows a link between birth outcomes and health insurance, as reported by the Decatur Daily. The report, by the department’s Center for Health Statistics, examined birth certificates for 60,262 live births, and among other things:
â–ª Infants born in Alabama in 2005 were more than three times likely to die in the first year if their mothers paid for their deliveries out-of-pocket than those with private health insurance;
â–ª Infants in deliveries covered by Medicaid were 40% more likely to have low birth-weights and 60% more likely to die than infants with private insurance;
â–ª White women were more likely to have private health insurance than minority women;
â–ª Medicaid covered deliveries for nearly four out of every five births among teenage girls and 40% of births involving women ages 20 to 34;
â–ª Private insurance covered nearly 80% of births among women ages 35 and older; and
â–ª Nearly all women with private insurance received prenatal care within the first trimester, compared with 74.7% of women with Medicaid.
Now whether Medicaid has merely become a marker for things like education, age, race and economic status, is up to debate. What is clear, though, is the fact that these factors do indeed affect access to reproductive healthcare, and that Medicaid is not a sufficient solution for social inequities.
The simple-minded might read this as an endorsement of private health insurance over “government” health care. In April, Erik Eckholm wrote in the New York Times about a rise in the deaths of babies born to poor and mostly black mothers in southern states — Alabama, Louisiana, Mississippi, North Carolina, South Carolina, and Tennessee. Focusing mostly on Mississippi, Eckholm said Medicaid patients had a difficult time finding and getting to providers.
But social workers say that the motivation of poor women is not so simply described, and it can be affected by cuts in social programs and a dearth of transportation as well as low self esteem.
“If you didn’t have a car and had to go 60 miles to see a doctor, would you go very often?†said Ramona Beardain, director of Delta Health Partners. The group runs a federally financed program, Healthy Start, that sends social workers and nurses to counsel pregnant teenagers and new mothers in seven counties of the Delta. “If they’re in school they miss the day; if they’re working they don’t get paid,†Ms. Beardain said. …
…In 2004, Gov. Haley Barbour came to office promising not to raise taxes and to cut Medicaid. Face-to-face meetings were required for annual re-enrollment in Medicaid and CHIP, the children’s health insurance program; locations and hours for enrollment changed, and documentation requirements became more stringent.
As a result, the number of non-elderly people, mainly children, covered by the Medicaid and CHIP programs declined by 54,000 in the 2005 and 2006 fiscal years. According to the Mississippi Health Advocacy Program in Jackson, some eligible pregnant women were deterred by the new procedures from enrolling.
One former Medicaid official, Maria Morris, who resigned last year as head of an office that informed the public about eligibility, said that under the Barbour administration, her program was severely curtailed.
“The philosophy was to reduce the rolls and our activities were contrary to that policy,†she said.
The outcomes described by Eesha Pandit at Reproductive Health Reality Check speak loudly and clearly — babies born to women who are cut off from decent health care are at greater risk. Eckhold continues,
Whether the rises continue or not, federal officials say, rates have stagnated in the Deep South at levels well above the national average.
Most striking, here and throughout the country, is the large racial disparity. In Mississippi, infant deaths among blacks rose to 17 per thousand births in 2005 from 14.2 per thousand in 2004, while those among whites rose to 6.6 per thousand from 6.1. (The national average in 2003 was 5.7 for whites and 14.0 for blacks.)
That racial discrepancy has a lot to do with why the overall infant mortality rate in the United States is high compared to other industrial first-world nations. Eesha Pandit writes,
In a report from Save the Children released this May, entitled State of the World’s Children, 125 nations were ranked according to 10 gauges of well-being — six for mothers and four for children — including objective measures such as lifetime mortality risk for mothers and infant mortality rate and subjective measures such as the political status of women. Among industrialized nations, the US was second to last (ranked only above Latvia).
See also: “Haley Barbour, Baby Killer,” “At Least We Beat Latvia.”
Infant mortality in the U.S. has been relatively high for many years. Yet most Americans either don’t know this or dismiss the statistics as fake. We do have The Best Health Care System in the Worldâ„¢, after all.
It’s true that some of the problem with our infant mortality rates can be attributed to different standards in what’s considered a live birth. In a small percentage of births, a birth that would count as a live birth by U.S. medical standards would be considered a stillbirth in other countries, and thus would not count as an infant mortality. But my understanding is that when these births are taken into account, the U.S. doesn’t move up much. What’s really cranking up the death rates of U.S. babies is the high infant mortality rate among the poor, especially the poor and black, in the United States.
There are also significant differences in infant mortality rates among the states. According to a recent release from the Center for Disease Control:
Three years of data (2002-2004) were combined to get specific estimates of infant mortality rates by state, race and Hispanic origin. For the three-year period there were significant differences in infant mortality rates by state, ranging from a rate of 10.32 [per 1,000 births] in Mississippi to 4.68 in Vermont. For infants of non-Hispanic black mothers, rates ranged from 17.57 in Wisconsin to 8.75 in Minnesota. For infants of non-Hispanic white mothers, the infant mortality rate ranged from 7.67 in West Virginia to 3.80 in New Jersey.
As I wrote here, American hospitals generally provide excellent care for newborns. But too many American babies are born prematurely, or with low birth weight or other preventable problems. And many of these problems can be traced to a lack of basic prenatal care.
Today UNICEF declared that the rate of child mortality worldwide has dropped considerably. Happy news. A table showing rates by country 1960-2005 shows a slight drop in deaths of children under 5 in the U.S. also. But all of the western European nations on the list have lower rates, as do Australia, Canada, Cyprus, the Czech Republic, Japan, South Korea, New Zealand, Singapore, and Slovenia. Shit, people, we don’t even beat Slovenia.
Adventures in Health Care
The Mahadaughter, whose benefits from a new job haven’t kicked in yet, visits ER Land.
Not Owning Up to the Ownership Society
Tony Snow is, by all accounts, a likable guy who is gravely ill, and I have no personal animosity toward him. But what Daniel Gross writes about him in Slate is aggravating.
Snow has also been a chief spokesman for the Bush administration’s domestic agenda, forced to argue continually that the typical American is doing just fine, and bravely pushing the unpopular elements of Bush’s vaunted “ownership society”: privatizing social security, eliminating defined-benefit pensions in favor of 401(k)s; and replacing insurance with health savings accounts, high-deductible policies, and other consumer-driven health-care initiatives.
And yet Snow’s own life in many ways symbolizes the downside of the ownership society—and suggests how much a government role in health and retirement benefits is necessary.
For one thing, Snow never bothered to establish a 401k account, and he gets no pension from Fox News. He’ll get a pension through AFTRA (a union) and Social Security, and whatever he might have squirreled away to live on after retirement. And the “squirreled away” part can’t be much.
Snow admitted to feeling pinched on his salary of $168,000, which is about 3.5 times the median U.S. income. “We took out a loan when I came to the White House, and that loan is now gone,” he said. “So I’m going to have to pay the bills.”
And then there’s his cancer treatment. He’s getting regular CAT scans and MRIs and chemotherapy. Daniel Gross writes,
But such treatment is enormously expensive and only available to people who have good insurance—like the kind taxpayers fund for public employees such as Snow. If Snow had owned his own benefits, or approached health care as a consumer, as the administration wants people to do, he’d certainly be singing a different tune. Had Snow stashed a few thousand dollars in a health savings account, which is one of the administration’s chief proposals to reduce the rising number of the uninsured, he likely wouldn’t have enough cash to afford chemotherapy. According to the Census Bureau, there were 47 million Americans without insurance in 2006, up from 41.2 million in 2001, when Bush entered office. Were any of them to be afflicted with cancer as Snow has been, they’d be largely out of luck—unable to pay the bills for all those scans and chemo doses, and unable to find an insurer willing to cover such a pre-existing condition.
One wonders if this ever flickers through Tony Snow’s mind.
Of course, when it comes to health care, Republicans generally seem a tad out of the loop. Today’s Wall Street Journal has an editorial that begins this way (emphasis added):
As Congress returns, so does the health-care debate, including an important intramural squabble among Republicans. To wit, what is the better way to move to an individual based insurance system — via a tax credit, or a tax deduction?
That’s the extent of the Republican debate?
We think the tax deduction has the better argument, especially as a matter of tax policy. Tax credit proponents tout their reform as “budget neutral,” meaning that it neither raises nor lowers overall federal revenues. But that masks the enormous shift in the tax burden that it would require, including a big tax increase on large portions of the middle class.
Congress’s Joint Tax Committee has estimated that, among families earning adjusted gross income of $75,000 a year, more would lose more tax benefits than they’d gain under the tax credit by 2009. By 2018, some 60.7 million filers — or two-thirds of today’s taxpayers — would face a net tax increase. Most of those happen to be Republican voters.
Meanwhile, the “refundable” tax credit would require some $800 billion over 10 years in new health-care spending for those who don’t pay any income taxes. In other words, a “universal” tax credit would mean a major redistribution of wealth from middle- and upper-middle-income families to subsidize health care for lower earners. Once embedded in the tax code, this would become a new “entitlement” that would be nearly impossible to repeal.
The horror.
WSJ doesn’t like the tax credit idea because, as it’s currently being proposed, the credit would go even to people who pay no income taxes at all. And this would amoun to “a government handout to buy individual insurance.”
The real argument for the tax credit idea is political — namely, that it can be called “universal” and thus claim to cover all Americans the way a government-run system would. Senators DeMint and Coburn believe this is a better strategy to counter HillaryCare and its variations. But we think they’re selling short the appeal of the deduction to most tax-paying voters.
HillaryCare = all non-rightie health care reform proposals, whether they even remotely resemble the former First Lady’s 1993 plan or not.
The Treasury Department estimates the Bush proposal would add at least five million Americans to the ranks of the insured, and that’s before the tax change led to a far more robust and affordable individual insurance market than we have currently.
Ooo, five million. That only leaves us, what? 42 million to go? And will the “more robust” individual insurance market sell insurance to people who can’t get it now because they have pre-existing conditions?
Here’s another article about “innovative” health care proposals, from Forbes, which include such breakthrough ideas as “greater transparency.” It’s all band-aids, in other words. Here’s the best part:
Duke Law School professor Clark C. Havighurst, believes that consumers are given the choice “between a Lexus, Mercedes or BMW” in health coverage. “You don’t have the choice of buying coverage that isn’t outlandishly expensive,” giving people an incentive to find lower cost health plans. “The old managed competition idea from the Clinton years is still a pretty good one,” he says.
Do these people live on the same planet we do, I wonder?
The Road to Serfdom
Today’s Paul Krugman column is a must read. Shorter version: We are all New Orleans now.
Today, much of the Gulf Coast remains in ruins. Less than half the federal money set aside for rebuilding, as opposed to emergency relief, has actually been spent, in part because the Bush administration refused to waive the requirement that local governments put up matching funds for recovery projects — an impossible burden for communities whose tax bases have literally been washed away.
On the other hand, generous investment tax breaks, supposedly designed to spur recovery in the disaster area, have been used to build luxury condominiums near the University of Alabama’s football stadium in Tuscaloosa, 200 miles inland.
But why should we be surprised by any of this? The Bush administration’s response to Hurricane Katrina — the mixture of neglect of those in need, obliviousness to their plight, and self-congratulation in the face of abject failure — has become standard operating procedure. These days, it’s Katrina all the time.
If you want to be worked into blubbering outrage, read Tim Shorrock’s “Hurricane Recovery, Republican Style” in Salon. Although tight-fisted with Louisiana, the Bushies have been more than generous to Mississippi and its Republican governor, former RNC chairman Haley Barbour. But distribution of the funds in Mississippi has favored the wealthy, and a large part of it is being used to build casinos and luxury condominiums while poor, devastated communities wait for help. And notice there’s little about this outrage in the mainstream media.
Krugman continues,
Consider the White House reaction to new Census data on income, poverty and health insurance. By any normal standard, this week’s report was a devastating indictment of the administration’s policies. After all, last year the administration insisted that the economy was booming — and whined that it wasn’t getting enough credit. What the data show, however, is that 2006, while a good year for the wealthy, brought only a slight decline in the poverty rate and a modest rise in median income, with most Americans still considerably worse off than they were before President Bush took office.
Most disturbing of all, the number of Americans without health insurance jumped. At this point, there are 47 million uninsured people in this country, 8.5 million more than there were in 2000. Mr. Bush may think that being uninsured is no big deal — “you just go to an emergency room” — but the reality is that if you’re uninsured every illness is a catastrophe, your own private Katrina.
Yet the White House press release on the report declared that President Bush was “pleased” with the new numbers. Heckuva job, economy!
Today E.J. Dionne wonders why the rising number of uninsured Americans isn’t getting more news coverage. “Why is it that the poor — and, for that matter, the struggling middle class, too — disappear in the media, barricaded behind our fixation on celebrity, our titillation with personal sin and public shame, our fascination with every detail of every divorce and affair of every movie star, rock idol and sports phenom?” he asks.
Poll after poll puts health care near the top of citizens’ concerns. But I’ve yet to see anything remotely resembling an intelligent discussion about the health care crisis in mass media. If the issue is addressed at all, it’s given a six-minute segment in which some well-paid partisans mouth talking points and demonstrate they are utterly out of touch with Americans’ real opinions and concerns.
Back to Professor Krugman:
The question is whether any of this will change when Mr. Bush leaves office.
There’s a powerful political faction in this country that’s determined to draw exactly the wrong lesson from the Katrina debacle — namely, that the government always fails when it attempts to help people in need, so it shouldn’t even try. “I don’t want the people who ran the Katrina cleanup to manage our health care system,” says Mitt Romney, as if the Bush administration’s practice of appointing incompetent cronies to key positions and refusing to hold them accountable no matter how badly they perform — did I mention that Mr. Chertoff still has his job? — were the way government always works.
And I’m not sure that faction is losing the argument. The thing about conservative governance is that it can succeed by failing: when conservative politicians mess up, they foster a cynicism about government that may actually help their cause.
This worries me, also. Younger people in particular (i.e., anyone born after 1970) can’t remember a time before the “government doesn’t work” meme took hold. My parents’ generation, whose ideas about government’s capabilities were shaped by FDR’s Hundred Days and World War II, generally trusted government. It was us Boomers who became cynical about government, and not without reason. But now that cynicism is paralyzing us.
Even as the health care crisis touches nearly everyone in the middle class, directly or indirectly, government and media continue to treat it as some little inconvenience for “the poor.” Being cut off from all but emergency care is considered a personal problem no doubt resulting from an individual’s bad choices. Just about every voice in Washington and mass media tells citizens that it’s wrong to expect government to make it possible to get decent health care. They should just suck it up and cut out trans fats. (See also “Let Them Eat Gold-Plated Cake.”)
But while ordinary Americans have bought the idea that government solutions are not for them, for the wealthy and well-connected government works just fine.
Of course, the Right cannot abide the thought of citizens using their own government to solve problems. Even though they mostly support the Republican Party, the Right doesn’t seem to grasp republican government. They think like 19th century imperialists who saw the “underclasses” as an intractable burden, and their “let it rot” attitude toward New Orleans is reminiscent of Britain’s treatment of Ireland during the Hunger.
Lurking behind much rhetoric about “big government” is Friedrich Hayek’s The Road to Serfdom, first published in 1944. Full disclosure: I haven’t read Hayek, although I’d be willing to bet not many of today’s wingnuts have read him, either. But I understand that his ideas had an enormous impact on people like Milton Friedman, Ronald Reagan and Margaret Thatcher. “Hayek’s central thesis is that all forms of collectivism lead logically and inevitably to tyranny,” says Wikipedia. For a synopsis I’m told is accurate, see the cartoon version.
Hayek’s first step, “war forces national planning” of the economy, was no doubt a swipe at Franklin Roosevelt’s War Production Board, which I notice did not lead to serfdom. But generally, says Hayek, planned economies lead to planned everything else, and pretty soon you’ve got a totalitarian government. Certainly the Soviet-style planned economy was accompanied by political oppression, and bread lines to boot. But I have never in my life met a fellow American who seriously proposed establishing a planned economy, in which government controls all production and distribution of income. And there’s a huge difference between a planned economy and citizens choosing, through their elected representatives, to establish a universal health care system.
And the biggest laugh of all is that righties, fleeing in hysteria from serfdom threatened by communist government, run headlong into the waiting arms of serfdom imposed by a corporatist government.
Professor Krugman concludes:
Future historians will, without doubt, see Katrina as a turning point. The question is whether it will be seen as the moment when America remembered the importance of good government, or the moment when neglect and obliviousness to the needs of others became the new American way.
I think it can be argued that America has been at this crossroads for a long time. Certainly “neglect and obliviousness to the needs of others” was the rule through all the years when white America was able to shut racial minorities out of equal opportunity, for example. But the truth is that as long as America had a big, strong and upwardly mobile middle class, the nation also grew stronger and, in fits and starts, wealthier. But now the rot has reached into the middle class, and if we don’t turn this trend around, America can look forward to long years of diminishment and decline.