Government Thanksgiving

Corporate taxes are due on March 15th and partnership tax filings are due April 15th, but both can be extended to September 15^th. As a tax accountant, September 15^th was a big work deadline for me, and I’m glad it’s passed! I even got to have a bit of drama to celebrate the end of “busy season” – I had to hand deliver a tax return to a client in order to meet the filing deadline. Since that meant battling area traffic, I got to jam out on the radio in my car. I lucked out and heard some really good songs – “Lean on Me” and “Here comes the Sun” (which, I’ve decided, is my favorite Beatles song). The point is, all that good music got me thinking and so I sort of composed this post in my head.

I’m grateful for government.

I’m grateful for the tax system (even if it’s complex) and the fact that the vast majority of American citizens and corporations pay taxes, thus contributing to building our society. I’m grateful to live in a relatively corruption free society, where businesses can thrive without having to pay bribes to government officials. I’m grateful for a car that’s safe because government mandates certain safety features. I’m grateful for a government that restricts monopolies from crushing ordinary people. I’m grateful for a government that allows us to protest against it, and even provides police officers to protect such rights. I’m grateful to work in a building that won’t collapse, due to building codes. I’m grateful for workplace safety regulations and government protection from discrimination. I’m grateful for all 12 years of my public school education, paid for by our government. I’m grateful to eat safe food that’s inspected by the government. I’m grateful to be able to vote for my representatives, governor, senators, and president (and grateful for the confidence that the votes will be fairly counted). I’m grateful for a government that stays out of my religion and guarantees my right to worship as I please. In fact, I’m grateful for the whole bill of rights and all constitutional amendments (especially the 19^th!). I’m grateful for a government that provides a social safety net to the poor, the elderly, and the unlucky. I’m grateful for the sacrifice of brave men and women in serving in our armed forces, protecting me from horrors I will probably never fully comprehend. And yes, I’m grateful for the bureaucrats – those who work in public service jobs in government.

There are notable exceptions and limits to government’s abilities. Sometimes government doesn’t work. Government is imperfect, but I believe it reflects our own imperfections. When failures of government come to light, they should be exposed, rooted out, and reformed. After all, in America we believe in government “by the people, for the people, and of the people.”

Ronald Reagan once famously said that “Government is not the solution, government is the problem.” That simplistic statement overlooks the vast good that government can and does do in our society. Sure, it’s annoying to wait in line at the DMV, it’s frustrating to pay taxes, and we may not like our current representative, governor, senator and/or president. But on the whole, government is a good thing, and I’m grateful it protects my rights, provides so many services, and regulates things that should be regulated.

"Socialized" Medicine? Sign me up!

Call me a socialist, but I am so pro-health care reform, it's not even funny (After a my post on likeable things about President Bush, I had to make up for it by getting back to my liberal roots). I'll illustrate my health care views with a simple example from my time in Russia as a missionary.

I served for seven and a half months in a the town of Barnaul, which is in Siberia. As you might imagine, there was a lot of ice. On one cold winter night, my companion slipped and fell on some ice, twisting her ankle. Luckily, we were only three blocks from home and 1 1/2 blocks from a local clinic. We entered, and she was seen immediately by a doctor, given an x-ray within 15 minutes, and it was determined that nothing was broken (though she was in a lot of pain, poor girl). As we were leaving, I asked the nurse/receptionist where we should pay. I'll never forget the look on her face, or on my (Ukrainian) companion's face. They looked at me like I was completely insane. Why would we have to pay for basic medical services? Then it dawned on me that this was all paid for by the government!

Now, I will not pretend that all my interactions with the Russian health care system were that positive (some of them were downright scary), but on that visit at least, my companion was cared for more quickly and effectively than she would have been at the typical U.S. emergency room. I am not suggesting that socialized medicine is perfect (or that we should model our system on Russia's!), but I am saying that every civilized country in the world recognizes that health care is a national responsibility. Every country, that is, except America.

Depending on which poll you cite, about 8 in 10 Americans who have insurance are happy with it. Of course, citing those numbers doesn't include more than 40 million Americans without health insurance (Tangent: WSJ article about estimating the number of uninsured). It also glosses over the fact that 85% of Americans are concerned about rising health care costs. Others are "uninsurable" because of pre-existing conditions. For all too many people the American health care system is a nightmare of inefficiency and insufficiency.

For all the scare tactics about some "government bureaucrat" standing between you and your doctor, right now you have company bureaucrats standing between you and health care - we have a system with some very scary incentives. I am lucky to have a job with health insurance, through a large HMO. Think about that: this company literally makes more money if I don't go to a doctor. They have a profit incentive to deny me health care. On the other hand, doctors in our current system have an incentive, under fee-for-service plans, to push more expensive options. I have an incentive to consume more health care than I need because I'm not (directly) paying for it. These incentives often don't lead to the best treatment. A friend emailed me recently a story (not verified) of a doctor who treated children on Medicaid and was denied access to a badly-needed medication to prevent blindness. Horror stories like this may well occur (if they do, we need to change that), however my private health insurance plan does the same thing - I just received a three page list in very tiny print of all the drugs my health insurance doesn't cover (including such drugs as Prozac).

One of the best articles I've read on the bad incentives currently in place for doctors, patients, and all participants in our health care system was written by a man whose father died of an infection he picked up in a hospital. David Goldhill writes about what he learned in his search for answers in "How American Health Care Killed My Father" in Atlantic Monthly. I don't necessarily agree with his solutions, but he does a really good job of fleshing out the problem of how messed up our current American system is.

Here's a news flash: often the best run parts of the American health care system are (gasp!) the government run parts. People who are on "government plans" actually like it. Medicare recipients rate their health care higher than those on private insurance (see this article). The Veterans Administration is generally better at providing care, according to a study by the RAND corporation.

There are so many people saying "we can't" do health care reform. "We can't" afford it. "We can't" make a system that preserves the positive aspects of choice and competition. "We can't" have a public option because it would hurt those poor big health insurance companies. Congress "can't" possibly understand an issue as complex as health care reform.

I believe in the problem solving abilities of America. I believe that we can find a way to preserve competition and choice while also providing a basic safety net for everyone. My main problem with current proposals is that it doesn't take reform far enough - we need to be doing more to change the way health care is funded (again, see Goldhill's article cited above). We are going to have to make some tough choices, and yes I may have to pay slightly higher taxes because of it. Who says that because something is a difficult and complex issue that "we can't" tackle it with American ingenuity? How about some "can-do" American optimism? Yes we CAN!