Friday, November 19, 2004

Tax Shifts

Much has already been said in the lefty blogosphere about Bush's new plan to pay for deep cuts in taxes on investment income by eliminating deductions for state and local taxes, plus business tax deductions for employer-provided health insurance. Dan Froomkin (writing in the Washington Post) has a pithy summary of the commentary:
As far as trial balloons go, however, this one has some diabolically clever politics to it. Consider who would be the big losers if state and local tax deductions were eliminated: People living in high-tax, high-services cities, counties and states. Most of those, I'm willing to bet, are blue-voter territory.

As for reducing the incentive for employers to provide health insurance, I guess that the ensuing loss of health coverage would -- among other things -- increase demand for tax-free health savings accounts?
45 million Americans lack health insurance, and the percentage of Americans under age 65 with employer-provided coverage is declining. Most people would probably look at that situation and conclude that the last thing the country needs is to take away incentives to provide employees with health coverage, but then, most people don't have the profound analytic capabilities of "America's first CEO president."

The Bush Administration champions "Health Savings Accounts," in which people are allowed to place money into tax-free accounts to pay for health care deductibles and uncovered expenses. The idea is supposed to be that health care magically becomes cheaper because patients don't waste money on unnecessary medical visits and procedures.
The idea of getting consumers to bear the upfront costs of medical care is that they will spend more responsibly because the money is coming from their own pocket. Maginnis said early figures with the high-deductible plans show a 20 percent drop in spending. "People are being more careful," he said.

But it is unclear whether policyholders are trimming back on frivolous procedures or on medical care they may need.
No, in fact, it isn't unclear at all.

If you have employer-sponsored health insurance, cast your memory over the things they have recently paid for. Did any of it involve "frivolous procedures?" Did you have medical procedures just for the fun of it, or take prescribed-and-covered medications recreationally? Are your insurance company's rules so loose and easy that they'll cover any damn thing, regardless of its medical necessity? Me neither.

The AMA knows what people cut when they have no insurance, or incredibly high deductibles: ongoing care and monitoring for chronic diseases, diagnostic tests, checkups, well-child visits, preventive care. Frivolous expenses like that. Patients "ration out" their blood-pressure medicine, taking half the dosage to make it last twice as long. (Yes, I have seen this many times.) They don't want to pay for ongoing Pap smears, so they wind up with carcinoma in situ . And they wind up in the ER with complications from untreated chronic problems, requiring care that is considerably more expensive than the ongoing management they thriftily refused.

This is not news to anyone who works in health care, or, for that matter, anyone who has been uninsured or underinsured. It is only news to the high-minded industry lobbyists who say things like, “The theme will be individual empowerment. We will see a shift to more responsibility on individuals to provide for their own health and retirement security.”"

But in any case, Health Savings Accounts will not help you if your employer decides to respond to the proposed tax code changes by dropping employee health benefits altogether. Even assuming - and it's a big assumption - that you have the disposable income to set aside savings at the maximum allowable rate ($2,600 for an individual, $5,100 for a family), a single emergency visit could easily wipe out your HSA savings. It's unlikely to be enough money to purchase an individual insurance policy. In short, it's no substitution for traditional medical insurance or HMO policies.

"Individual empowerment." When you hear that phrase coming from the Bush Administration, put one hand securely on your wallet and use the other hand to ward off the baseball bat.

Wednesday, November 17, 2004

The Military Draft Begins

They're too smart, too media-savvy, to go after nineteen-year-old college boys. But never mistake this for anything but a draft:
David M. Miyasato enlisted in the U.S. Army Reserve in 1987, served three years of active duty during the first Gulf War and received an honorable discharge in 1991. He remained on inactive status for five more years, until 1996. Since then, the Kaua'i resident has married, started an auto window tinting business and this year, he and his wife had their first child.

But in September, Miyasato received a letter from the Army recalling him to active duty and directing him to report to a military facility in South Carolina on Tuesday.
Or this:
Pistorius was honorably discharged from the Army in July 20, 2001. His certificate of release attests to his accomplishments: Army Achievement Medal, National Defense Service Medal, Sharpshooter qualification. The upper corner is the spot in which the military lists a departing member's reserve obligation, the amount of time discharged soldiers, sailors and Marines remain subject to recall. For Pistorius, the boxes contain a succession of zeroes.

Because he was discharged well after his prior reserve obligation had passed, the Army laid no further claim to him, until someone in St. Louis ignored those zeroes and went hunting for a fresh body to fill a manpower shortage that grows more painful with every Iraqi sunset.

"They basically told me that my Marine Corps time doesn't count as military service," Pistorius said. Faced with a threat of AWOL charges, and worried that a spotless military record was about to be stained, Pistorius headed last month to Camp McGrady in South Carolina.
This New York Times article has more context, although it confuses matters by mixing together the stories of former soldiers who (understandably) never thought their Individual Ready Reserves obligations would be called in, and those who have legitimately discharged all military obligations. The NY Times article also makes it clear that veterans with the wherewithal to sue are generally able to extricate themselves from the draft - leaving the less informed and those with fewer resources bound for Iraq.

I've long argued that a military draft is unlikely because the military themselves don't want it. The modern U.S. armed forces are not looking for untrained cannon fodder. But this backdoor draft removes the military objection to the draft; while Pistorius and Miyasato may be rusty and out-of-shape, they have the skills, training, and experience needed to be soldiers. And calling them up for active duty doesn't sound like a draft to the average reporter or citizen on the street. They're soldiers being called back to active duty. Surely that's different from Joe College getting a letter from his draft board, right?


Pistorius and Miyasato are civilians. They owe the military no further service. The military has precisely as much right to call them up for active duty as it has the right to call up pregnant, disabled, thoroughly civilian me. These stories are not about a "recall to active duty," they are about a draft.

A Colonel Hart, in the NY Times story, responds to the successful lawsuits by declaring them proof that "the system works." But Pistorius' story makes it clear that even those veterans who eventually manage to avoid the draft have suffered harm from the attempt to deprive them of their liberty:
Suddenly, on Nov. 5, Pistorius was ordered to pack up. He was driven to the airport and told he was going home. At the last minute, he was handed a letter declaring: "You are released from active duty, by reason of physical disability." He had already packed up the pre-deployment assessment that said precisely the opposite. The letter also says he's subject to reserve obligation until Feb. 26, 2006.

The Pistorius family, with its three children, ages 6, 5 and 2, is now trying to figure out what to do without a month's wages. "I just put everything off," Wendy Pistorius said. "I paid only the bills I absolutely had to."

The Army took back the family separation allowance he was given when called to Camp McGrady. Frederick Pistorius is working a swing shift at the local tube plant and trying to figure out if the Army still considers him a reservist and if he's going to get another letter from St. Louis.

"I don't want to get arrested in front of my kids," he said.

Wednesday, November 03, 2004


If it ain't over 'til it's over, then why do I feel so awful?

The Bush camp, of course, is pushing the "victory is inevitable" line. On the one hand, I think it's irresponsible of CNN to treat that as if it's, you know, news. (The banner headline at right now says "Bush camp certain of win.") On the other hand, for Kerry to pull out a win in Ohio, he'd have to damn near sweep the provisional ballots and the remaining absentee ballots. I don't think that will happen.

Right now I am fighting despair, and losing badly. It comes down to this: if we can't beat this guy, then who could we beat? If we can't make gains in this Senate, if we can't beat Bunning and Coburn, then what do we have left to hope for?