Tuesday, January 30, 2007

MS prevalence up?

A number of media outlets (e.g., CBS News) are reporting on a study published today that indicates MS prevalence is up 50% since 1982 to .9 cases per thousand. Are more people getting sick or are more people getting diagnosed? Don't know, but it's starting to seem like there really ought to be at least one charismatic, young A-list celebrity with MS who can do for this disease what Michael J. Fox has done for Parkinson's. Annette Funicello's too old; Squiggy's too old and kinda obscure; Teri Garr's too old and kinda flaky; Montel Williams is close, but still a bit too old (sorry guys, it's strictly business).

What we need is someone who, like Michael J. Fox, has been in the mainstream public eye so pervasively that he or she feels like somebody we all know and grew up with. What are we doing wrong?

Wednesday, January 24, 2007

Doing some math on the Bush tax plan

Here's how the Bush tax plan for health insurance works out for me, I think: The total premium for my employer-provided family HMO coverage is $1050 per month (of which I pay $68 per month). If the value of my coverage is computed based on what my employer pays, $982 per month or $11,784 per year, that yields a deduction of $3,216 ($15,000 - $11,784). At our marginal tax rate of 15% (last year, anyway), that means we'll pay about $482 less in taxes than I would have without the deduction.

So that's nice, I guess. But the question I have is, what's the government getting in terms of its stated goal of expanding health coverage for that outlay? Well, I guess it's discouraging the kind of Cadillac plan for which people are going to end up losing some tax deductions. And I guess the argument is that by penalizing the Cadillac plan, we're somehow discouraging the rising cost of health care in the country. So, OK. But as I understand it, the deduction for people like me with Hyundai plans won't be totally offset by the deductions lost by Cadillac people for a number of years. In fact, the only reason the Cadillacs will eventually zero out the Hyundais is because the $15,000 figure won't go up as fast as my Hyundai policy goes up. So eventually, even the Hyundais will end up losing the goodies they'd get early on, and end up being contributors to the tax subsidy (sorta the way families with moderate incomes have been swept up by the alternative minimum tax).

And what about that subsidy? In the beginning, I get a nice little piece of that action, even though it's going to cost the government in the beginning. But eventually, me and fellow Hyundais are going to be kicking in money to subsidize somebody else's tax deduction. The thinking is that the tax subsidy is going to make it possible for somebody who isn't presently covered to get coverage.

I don't think it's a bad idea to quit using the tax code to subsidize Cadillac health coverage, and I don't think it's a bad idea to use the tax code to subsidize Hyundai coverage for people who don't have any. I just think it's another example of too little, too late. There are millions of people without coverage, and many of them aren't going to benefit in a meaningful way from a tax deduction.

For a different take on the Bush plan, check out Ruth Marcus's piece in today's WaPo. And for an interesting peek into Bush's SOTUs, check out NYT's interactive feature that lets you search the text of Bush's SOTUs for keywords. Search for "health" and watch the 6-year evolution of the Bush health policy agenda.

Tuesday, January 23, 2007

Bread: It takes a village

For the last six weeks or so, I've been baking two or three loaves of bread a week. It's Mark Bittman's No-Knead Bread recipe, and it's sweeping the nation, or at least the bread-loving segment of the nation. Most of my loaves have come out lovely, with the exception of the loaf I tried to make with the bran-speckled organic stuff my wife brought home. My standard loaf is now Bittman's recipe with the addition of a generous handful of sesame seeds on top. For those of you keeping score at home, I put them on the towel before setting the shaped dough on the towel for the last couple hours.

A few loaves have, however, tended to look a little flat, spreading out to maybe 10" wide. I did a little poking on the Internets for a solution, and you really would not believe how many people are talking about and baking this very recipe. It looks like I'm just making a wetter dough by spooning flour into the measuring cup (you get less flour smooshed into the cup) rather than just dipping the measuring cup into the flour bag (squashing a larger quantity of flour into the cup). The solution, of course, is to measure by weight, but I'm not sure I have an accurate scale.

The really cool find, though, is the gazillion-odd pictures you get from Flickr when you search for "No-knead bread". Seriously, every shape and color and defect of bread you could imagine, from mouth-watering perfection to some blobby, vaguely bread-like objects. Is it possible that we're all reading the same recipe? But how totally great that so many people are making time for the ultimate slow food!

Cheers, my bakin' homies.

Monday, January 22, 2007

Universal health care: maybe later?

Today, WaPo's got a piece on the state of the health care debate. To sum up, Washington is starting to figure out what the states already know: somebody's gotta do something to expand coverage, preferably to everybody. But the feds don't have the money or the political will, so until the next election all the action will happen at the state level. And it's completely unnecessary to point out that we're currently investing trillions in Iraq, where the return on our investment is dubious at best. (A couple days ago, NYT offered a helpful graphic that compared the estimated cost of the war to the estimated cost of some crazy social-programmy things like universal health care, which was incredibly depressing, but I can't seem to find the link right now. Good.)

For the last couple days, I've been reading about a plan the president will announce in the SOTU Address tomorrow night. Yesterday's story in WaPo indicates that the plan will be to impose a tax on plans a tax on the value of employer-provided health plans that exceed more than $15,000. The tax would be used to subsidize health plans for those who buy coverage out-of-pocket:
Under the president's proposal, workers who receive employer-provided health insurance would have to pay a tax on the cost of their benefit above $15,000, the threshold proposed by Bush for the tax break. For instance, if a person's health insurance costs $16,000, he would pay a tax on the $1,000 difference.

People with families who buy low-cost policies, meanwhile, would have their taxable income reduced by $15,000, regardless of the cost of the plans and whether they itemize deductions on their tax returns. The deduction would be $7,500 for single individuals. The deduction, to be indexed to account for inflation, would also be extended to those with employer-provided plans, to be offset by the cost of their coverage.

"This is a huge incentive for the uninsured to get coverage, but, also, the vast majority of people with employer-provided coverage will benefit as well," a senior administration official said. "This is essentially a standard deduction for health care, and the size of the deduction will be significantly higher than the cost of an average policy."

The Bush administration estimates that 80 percent of people with employer-provided plans would see their tax liability fall because the deduction would be larger than the value of their insurance plans.

It sounds like a good idea. But it sounds less like a first step to solving the nation's health care problem and more like a first step to doing away with the enormous regressive subsidies in the tax code. Why not do both?

There's no way around it: fixing health care isn't just a matter of redistributing some money, we're going to have to spend more. Trimming all the waste out of the system--the corporate profits, the expensive emergency care that could have been prevented by cheap preventive care, whatever saving you might realize from tort reform--won't be enough to pay for quality care for everybody. One good way to pay for it would be to gradually cap the enormously regressive tax deduction for home mortgage interest.

The house behind ours just happens to be an enormous mansion with lake frontage. It has a garage that's bigger than our house. What public policy is served by allowing my neighbor to deduct every cent of the interest he pays on the mortgage for his mansion?

Sunday, January 21, 2007

Snowing again

We waited, and last weekend, it finally came: snow, 6" or so. It felt, at least for a little while, as though our little blue and green planet was not in fact spinning out of control. Gas prices dropped down to $1.99 per gallon. Two lost boys were found, apparently unharmed. Things got busy at the office, and it made me feel useful and productive to leave a week's worth of crossword puzzles empty, untouched. On Friday, when I left the office, there was still a little purplish-orange glow in the sky.

But here it is again, Sunday morning. It snowed again last night, and it's beautiful to look at. But it's so quiet, just me and the dogs and the hum of the refrigerator and a couple of dusky little juncos at the bird feeder.

Tuesday, January 02, 2007

New year, old problems

In the early morning hours of New Year's Day, I was staying at my dad's house, laying awake, watching the sun rise, and composing a short speech. Here's the gist of the speech, which I delivered to my dad over coffee:

This morning, I laid awake, watching the sun rise and composing a short speech, and here goes: In our live, all of us must learn a very painful lesson, namely that there is no occurrence, no sequence of events, that is so awful that God does not let it happen. If we are fortunate, God allows these things to happen to us while we are with people whom we love. It is in this spirit that I report the following:

Last night, I knocked over my urinal and spilled a generous quantity of urine on the carpeted floor of the room where your 13-year-old daughter usually sleeps.

Other than that, my Xmas vacation was okay.