Thursday, August 27, 2009

'Just stay home' when pigs fly -- Aug. 27, 2009 column


It sounds like the plot of a horror movie:

An insidious virus sweeps the nation, infecting half the population. Millions go to work sick, spreading disease. Hospitals and intensive care units are overloaded. Medicines are in short supply, and pharmacies run out. Within a few months, the dead number 90,000, with most of the victims under the age of 50.

It’s not a movie. The President’s Council of Advisors on Science and Technology offered this “plausible scenario” in a report about a possible surge of the swine flu, or 2009 H1N1, this fall and winter. The council emphasized that the scenario was not a prediction but a possibility that federal, state and local officials should use in planning.

There’s no need to panic, but the government wants people to be aware that swine flu could be worse than it was last spring. As for a vaccine to protect us -- don’t count on it. We’ll need to take steps ourselves and if we get sick, stay home, if we can.

The report said peak infection could come by mid-October. But it will be Thanksgiving before shots can protect most Americans from H1N1, Health and Human Services secretary Kathleen Sebelius told reporters.

Manufacturers started testing the vaccine’s safety only this month. The government’s vaccination campaign is supposed to start in mid-October, but it will require two doses three weeks apart and then take a couple of weeks to become effective.

And, there’s a logistical challenge. The government recommends that people also get inoculated against seasonal flu, which typically kills about 36,000 a year. That means three flu shots.

It’s possible that manufacturers will be able to produce and distribute the swine flu vaccine earlier or that the virus won’t surge next month after school and cooler, drier weather resume. Nobody knows.

When swine flu arrived last April, dire predictions caused turmoil – but the virus was not as devastating as feared. Unlike seasonal flu which tends to dissipate in warmer months, though, swine flu persisted through the summer, infecting some kids at camp. That worries health officials.

To combat the flu, the Centers for Disease Control and other health organizations advise plenty of hand-washing, coughing into tissues and sleeves (not hands) and just stay home when sick.

These precautions are sensible, but there’s a weak link. Millions of Americans can’t stay home because they lack paid sick days. They risk financial and even job loss if they don’t go to work. While 61 percent of private-sector workers have paid sick leave, the Bureau of Labor Statistics reported in March, only 26 percent of part-time workers do.

Paid sick days are standard for government and white-collar employees but not for those in food service, hotels and construction. Only about 15 percent of restaurant workers have paid sick days, according to the Institute for Women’s Policy Research.

The president’s council recommended flexible sick leave policies. A couple of cities have passed such measures, and about 15 states, including North Carolina, are considering them. But it will take a federal law to make paid sick days a widespread reality. This should be a priority when Congress returns from its August break.

To be sure, this is hardly the time to ask businesses to expand benefits, especially small businesses that are hurting, but public health may depend on it. Besides, some studies have shown that “presenteeism,” sick employees coming to work and infecting their co-workers, actually costs employers more than absenteeism. A 2007 study by the Society for Human Resources Management pegged presenteeism at $180 billion annually and absenteeism at $118 billion.

Passing paid sick days would be a tribute to the late Sen. Edward M. Kennedy, D- Mass. For years, Kennedy and Rep. Rosa DeLauro, D-Conn., have proposed the Healthy Families Act that would require employers with more than 15 workers to allow employees to accrue seven days of sick leave annually. The time could be used to care for a sick family member.

In Washington offices these days, you’re more likely to see a bottle of hand sanitizer or a bowl of moist towelettes on a reception desk than a bouquet of fresh flowers. Visitors to the National Building Museum are greeted by a poster that reads: “Wash Your Hands & Reduce the Spread of Germs.”

That’s good advice. Now, Congress needs to act to protect public health by making sure sick workers can just stay home.

© 2009 Marsha Mercer. All rights reserved.

Thursday, August 20, 2009

How to get health-care reform on track -- Aug. 20, 2009 column


Several smart journalists were on a public radio talk show the other day, calmly and dispassionately discussing health-care reform, when something surprising happened.

A man who had lost his insurance called, and he was angry. These panelists all have coverage, he said, and they can’t possibly understand how the issue affects people who don’t.

After the tiniest pause, the host invited the caller to tell his story. It was too late; he had already hung up. The host clucked that the man should have used his moment to enlighten the world, but I could understand his frustration.

In this cantankerous summer of shouting matches and gun-toting creeps at health-care town halls, it often seems that the uninsured, the people who will be most affected by health-care reform, either have been used as props or simply ignored. Even their numbers are in dispute. Is it 46 million or half that?

Furious speakers at congressional town hall meetings rage against losing their current benefits and raise the specter of Big Brother and “death panels.” Congressmen worry about next year’s elections. President Obama talks about curbing costs when he could be fostering a can-do, we’re-all-in-this-together attitude.

Change as big as health-care reform is about more than dollars and deficits and heartless bureaucrats and insurance companies. It’s about the kind of country we want.

It’s not too late for the president to use his bully pulpit to set a new tone and lead a discussion about our moral responsibilities to our fellow citizens. Oddly, it has taken until this week for the president to raise the moral imperative, which he did in calls with liberal religious leaders.

As Obama wrestles with congressional Democrats to pass reform in the fall, he and his advisers should remember what attracted voters. Candidate Obama said health care should be the right of every American.

During the second presidential debate last fall, NBC newsman Tom Brokaw asked candidates John McCain and Obama if health care is “a privilege, a right or a responsibility.”

McCain responded mushily that health care is an individual responsibility, sort of.

“I think it’s a responsibility, in this respect, in that we should have available and affordable health care to every American citizen, to every family member. … But government mandates I — I’m always a little nervous about. But it is certainly my responsibility,” McCain said.

Obama replied crisply, “Well, I think it should be a right for every American.”

He continued, “In a country as wealthy as ours, for us to have people who are going bankrupt because they can't pay their medical bills -- for my mother to die of cancer at the age of 53 and have to spend the last months of her life in the hospital room arguing with insurance companies because they're saying that this may be a pre-existing condition and they don't have to pay her treatment, there's something fundamentally wrong about that.”

Obama won with a vision of change that lifted up all Americans. Now is not time for the country to wallow in an every-man-for-himself mentality.

But this summer, health-care reform has been about self-interest. The people who complain loudest against a government takeover and socialized medicine already have health insurance. They don’t need a government option.

The White House may jettison the public option so that some sort of bipartisan reform can pass. That’s politics, but to win Democratic support, the final bill needs to include a way to ensure coverage for citizens who lack insurance. That’s more than a political reality. Without such a measure, we risk rising social insecurity and distrust in institutions.

I’ve been surprised by the level of cynicism in the mail I receive from readers, and I’ll write more about that soon. For now, let’s say that many people have lost their faith in politicians, government and the chattering class.

After all, the so-called government experts who tell us the economy is on the mend all have jobs and health insurance. The pundits and professors who say we should rethink the American dream of home ownership and be satisfied with renting? They own their own homes – and have jobs and health insurance.

Empathy got a bad name during the confirmation hearings for Supreme Court justice Sonia Sotomayor, but the angry radio caller was right to want a seat at the table for those who will be most affected by what happens in Washington.

©2009 Marsha Mercer. All rights reserved.

Thursday, August 13, 2009

Obama as LBJ? -- Aug. 13, 2009 column


President Lyndon Johnson, signing Medicare into law 44 years ago, triumphantly predicted better lives not only for the elderly but also for younger Americans.

“No longer will older Americans be denied the healing miracle of modern medicine,” Johnson said. “No longer will illness crush and destroy the savings that they have so carefully put away over a lifetime so that they might enjoy dignity in their later years. No longer will young families see their own incomes, and their own hopes, eaten away simply because they are carrying out their deep moral obligations to their parents, and to their uncles, and their aunts.”

The genius of LBJ was in offering something for everybody. Yes, seniors would benefit from Medicare, but so too would the younger generation. The new Medicaid program would begin to cover poor children and some of the disabled.

Johnson was right. Medicare transformed lives across generational lines, easing the burden of health-care costs for our aging population. Now ironically that success has become a problem for President Barack Obama as he tries to extend health-care security to other groups.

Polls show that the majority of people over 50 oppose Obama’s health-care reform ideas, while a majority of those under 50 support them. The face of the angry protester at congressional town hall meetings is the retiree who likes his or her Medicare just the way it is, thank you.

In Portsmouth, N.H., Obama tried to reassure seniors, saying, “We are not talking about cutting Medicare benefits.” But he’s also looking for significant savings from the popular program, which he says can be accomplished without hurting beneficiaries.

Obama talked about a letter from a woman who wrote, “I don’t want government-run health care. I don’t want you meddling in the private marketplace. And keep your hands off my Medicare.”

The crowd laughed, and he said, “True story.” He cited Medicare as an example of a government program run right and said seniors should have more confidence that “government
can have a role – not the dominant role, but a role – in making sure the people are treated fairly when it comes to insurance.”

You’d think everyone could agree to such a mild goal, but trust in government is in short supply.

Because no one bill is under consideration – several are kicking around in the House and Senate – nobody can say with certainty what provisions will be in the final package. That has opened the door to fear-mongering, including preposterous claims by Sarah Palin that government “death panels” could withhold care from her parents and baby with Down Syndrome and Rep. Virginia Foxx, R-N.C., who suggested the House Democratic health-reform bill would lead to the government putting elderly people to death.

Palin subsequently stepped back from her claim.

Obama has tried to tamp down fears of Big Brother and rationing, and he has shifted the emphasis from covering the millions who are uninsured to attacking the insurance industry. The idea is that most people do have insurance, but they’re unhappy with their coverage. This may turn out to be a miscalculation.

A new poll by CNN-Opinion Research Corp. found that 74 percent of people are satisfied with their insurance, and 83 percent are happy with their health care.

Obama wants to be the heir to Lyndon Johnson, and it still seems likely that some kind of health-care reform will pass, although it may be less than Obama wants.

As the “don’t-touch-Medicare” chorus grows louder, however, Obama risks becoming more like Bill Clinton, whose attempt to overhaul the entire health-care system died partly because of the opposition of seniors. Voters in the following midterm election punished Democrats and delivered control of the House and Senate to Republicans.

Clinton, chastened by the defeat of reform and the 1994 elections, said on the 30th anniversary of Medicare in 1995, “We had people all over America coming up to me or the first lady…saying, ‘Don’t let the government mess with my Medicare.’ People had actually forgotten where it came from, as if it sort of dropped out of the sky.”

In Johnson’s Great Society, government was a partner in fostering hope across generational lines. Clinton failed at bringing the generations together. We’re about to find out if Obama can cast the benefit net widely -- or whether opponents will be successful in depicting reform as a zero-sum game in which one group must lose.

© Copyright 2009 Marsha Mercer. All rights reserved.

Thursday, August 6, 2009

Taxing the middle class after all – Aug. 6, 2009 column


It’s hard to argue with raising other people’s taxes.

When President Barack Obama said the best way to pay for health-care reform may be for people like himself “who have been very lucky and are in the top – not just one percent but top half percent – of the income ladder to pay a little bit more,” many people thought he had an excellent idea.

The late Sen. Russell B. Long of Louisiana was onto something when he said raising taxes is a game of "don't tax you, don't tax me, tax that fellow behind the tree."

It’s pleasant to think that a lucky few can deliver health-care coverage with little pain to themselves or anyone else. So why stop there? Tax the rich to rein in the ballooning federal deficit and save Social Security and Medicare.

If only it were that easy.

It’s time to put aside the happy fiction that tapping the top 5 percent of tax filers can solve the nation’s financial troubles. It won’t happen.

Sad but true: The deep pockets aren’t deep enough. That’s not just a Republican line; liberal economists say taming the deficit beast will require help from the middle class too.

Candidate Obama promised everybody making less than $250,000 a year that they won’t pay a dime more in taxes. President Obama is sticking to that promise and is pledging to pay for health-care reform without adding a penny to the federal deficit.

Like every president, Obama also has taken aim at wasteful government spending, fraud and abuse, but those popular targets never yield much.

Something’s got to give.

Polls show most people favor paying for health reform through limiting tax deductions for high rollers and forcing smokers to pay more per pack.

Senate leaders have a list of revenue options. These include requiring well-off seniors to pay more for prescription drugs, taxing people who don’t buy health insurance and companies that provide especially generous insurance plans, new excise taxes and limits on health savings accounts. Meanwhile, committees are working to whittle down the price tag of a trillion dollars over 10 years.

Even if some form of paid-for reform becomes law, though, we’ll still face a stack of bills from the economic stimulus plan and other Obama spending projects. The conventional wisdom used to be that “deficits don’t count.” These days, people are worried about the country’s massive deficit.

Two of the president’s top economic advisers refused on Sunday talk shows to rule out raising taxes on the middle class. Nor are they saying yes to higher taxes just yet.

“It is never a good idea to absolutely rule things out no matter what,” Larry Summers, a former Treasury secretary, said on CBS’ “Face the Nation.” And Treasury Secretary Timothy Geithner said on ABC’s “This Week” that once the recovery is established, “We have to do what’s necessary” to bring down the deficit, and that will require “some very hard choices.”

White House press secretary Robert Gibbs said, “I don’t think any economist would believe that, in the environment that we’re in, that raising taxes on middle-class families would make any sense.”

Isabel V. Sawhill, an economist at the Brookings Institution who was on Clinton’s budget team, is among those saying higher taxes for the middle class are inevitable.

Sawhill told New York Times reporter Jackie Calmes, “There is no way we can pay for health care and the rest of the Obama agenda, plus get our long-term deficits under control, simply by raising taxes on the wealthy,” adding, “The middle class is going to have to contribute as well.”

All this explains why you’ll be hearing more about a value-added tax.

The VAT is a consumption tax used in scores of countries around the world. The tax on goods and services is assessed along the line, rather than at the end point of sale, like a sales tax. Since consumers don’t see it, the VAT is a way to raise taxes fairly painlessly.

Alan Greenspan, former chairman of the Federal Reserve, said Sunday that he thinks a VAT is likely – in time.

A growing group of academic and think-tank economists are pushing a VAT as part of an overhaul of the income tax code. Proponents say a VAT is fair because nobody can evade it, and tinkering can make it less regressive.

Still, the idea will take some getting used to. With a VAT, everybody is “that man behind the tree.”

© 2009 Marsha Mercer. All rights reserved.