We found out Christine was pregnant in the emergency room.
We wanted to have a baby. But our enthusiasm was dampened by the circumstances that brought us there. Christine had been experiencing severe, crippling abdominal pain for days. We were saddened but not surprised by the doctor's news. They thought it was an ectopic pregnancy. The fertilized egg was growing in one of Christine's fallopian tube instead of her uterus. If allowed to continue, the condition was guaranteed to be fatal to both Christine and the embryo.
The doctors recommended an operation to terminate the pregnancy. Immediately. We agreed.
After the operation we learned that the original diagnosis had been incorrect. It was not an ectopic pregnancy. The pain was caused by a substantial ovarian cyst. Christine was still pregnant.
Six months later we were back in the ER. Once again Christine had been experiencing severe pain. At this point she was 27 weeks pregnant - visibly bulging, but a very long way from the ingested-watermelon-look of a full term pregnancy. Once again we got the news that the pregnancy was killing her. She had HELLP syndrome and was hours away from a coma and death. The cure was to end the pregnancy. Immediately. Again.
Our local hospital was not equipped to handle the situation. We both grew up in Lebanon, New Hampshire and our parents were still living there. We asked that Christine be taken Dartmouth Hospital. The doctors were very concerned about her health deteriorating during the two hour ambulance ride. Ultimately, that's where they took her. Shortly after she arrived, our daughter Mattea was born, and Christine recovered.
Mattea weighted 1 lbs. 12 oz. at birth. Initially, she did very well and had no major health issues other than her low birth-weight. At six weeks, in yet another emergency setting, a new set of doctors informed us that Mattea had necrotizing enterocolitis. Her intestines died. Once again we were thrust into decisions involving the life and death of our child. And once again we really had no choice at all. Five days later Mattea died. She was our first-born child and the only daughter we will ever have. We were able to spend only a short amount of time with her. But we fell in love with her with an intensity that I had not anticipated and that the years without her have not diminished.
Following the murder of late-term abortion provider George Tiller, the blogger, Andrew Sullivan published a series of posts telling the stories of Tillers patients and of other women and families that have faced similar situations. I read through the stories of loving families thrust into impossible situations, of pregnancies gone horribly wrong, of children who could never be. What happened to us was tragic but not unique. The ectopic pregnancy was a false alarm. When Christine's HELLP appeared, the way to save Christine was to deliver Mattea. I have no illusions that another outcome was impossible. If the conversation had taken place a few weeks earlier, the baby could not have survived. A few hours later and Christine might not have.
Bringing life into this world is complicated and often dangerous. We don't often discuss it with anyone but our closest confidantes. But for so many families, pregnancy does not go smoothly. Many couples, many women experience infertility, miscarriages, complicated pregnancies, ectopic pregnancies, premature births, pregnancies where the life of the mother is threatened, pregnancies that will not result in a child that can thrive, pregnancies that are the result of rape, incest, coercion, or abuse. It's complicated.
When we talk about pregnancies being terminated, we usually only talk about the unwanted pregnancies. We act as if the inconvenient pregnancies are the whole story. They are not. Biology does not care if you are married or unmarried. It does not care if your baby is wanted or unwanted. Especially in the case of late-term abortions, if you are wondering how anyone could make such a terrible choice, you must remember that sometimes people have no choice.
When these issues are debated in our public spheres and in our august legislatures we need to recognize our limitations. Congress does not have to power to abolish tragedy. It can not legislate right or wrong. It can not save us from biology. They can create laws that compound tragedy with criminal trials and incarceration. It seems inconceivable that legislators would be willing to take tragic circumstances, like we experienced, and call them crimes. But the laws they propose would do precisely that. We have to see life as it really is and not just how we wish it to be.
Wednesday, August 29, 2012
Saturday, August 18, 2012
Romney's $716 Billion Medicare Ad Campaign
Romney and Ryan have a new ad up explaining that they won't keep the cost controls Obama added to Medicare:
The ad complains that changes made in the ACA cut $716 billion dollars from Medicare spending over the next 10 years. This is true. Most of the cost reductions come from two changes to Medicare:
- Medicare Advantage: Medicare Advantage is an option that allows Medicare recipients to purchase private plans instead. The program will continue, but previously we paid 14% for the private plans than we pay for traditional Medicare plans. Under the ACA the playing field is leveled. We pay the same amount for the private and public plans, and save many billions of dollars.
- IPAB: The Independent Payment Advisory board is a an independent body with the mandate of controlling Medicare costs. They are charged with insuring that Medicaid costs don't grow faster than GDP + 1%. Previously, Medicare didn't really have a budget and so health care costs have been growing out of control. The IPAB is there to find inefficiencies and set policies to insure Medicare stays within its budget.
These changes, along with anti-fraud initiatives and other pilot programs, are on track to reduce Medicare spending by $716 billion over the next decade without a reduction in benefits.
Mitt Romney and Paul Ryan have pledged to get rid of these changes. They promise to spend an extra $716 billion on Medicare.
The Romney and Ryan plans call for a similar mix of private and public plans competing on price. Cost growth is subject the same caps on rates. But their plan doesn't go into effect until 2023 at the earliest. That would mean pissing away the 716 billion dollars with another decade of runaway health care costs. And even then, they don't actually do anything to control health costs. The limited growth rate just applies to the voucher you'll get. The cost of the health plans can continue to rise, unconstrained. Patients will have to make up the difference with their own money.
They plan to convert Medicare to a voucher program. They waste a ton of money in the next decade. Over the long term, costs to taxpayers and consumers continue to rise. And even when it's fully implemented, their plan still costs the government and taxpayers more than the laws they seek to repeal.
Under Romney and Ryan that $716 billion doesn't get us a reformed Medicare system. It doesn't reduce the deficit. It doesn't provide affordable health care to all Americans.
It just allows them to run that ad.
They plan to convert Medicare to a voucher program. They waste a ton of money in the next decade. Over the long term, costs to taxpayers and consumers continue to rise. And even when it's fully implemented, their plan still costs the government and taxpayers more than the laws they seek to repeal.
Under Romney and Ryan that $716 billion doesn't get us a reformed Medicare system. It doesn't reduce the deficit. It doesn't provide affordable health care to all Americans.
It just allows them to run that ad.
Sunday, August 12, 2012
Romney - Ryan
The more I think about it, the more I think Ryan was a smart pick for Romney.
The Ryan pick is not show of strength. Romney's plan seems to have been to to stay vague, complain about Obama and the economy, and coast to victory by keeping himself and his part out of the spotlight. The Ryan pick is an acknowledgement that the plan wasn't going so well.
Ryan brings a lot to the ticket. He's the movement conservatives hero and the favorite wonk of GOP elite. This helps Mitt with a still-suspicious base. Ryan is good looking, good-natured, is not a known culture-warrior, articulate, a loyal partisan, and has a particular talent for presenting radical policies with soothing manner and a straight-face.
Paul Ryan does bring substantial baggage in the form of his sweeping, transformative budget blueprints. There's concern that his extreme positions will scare off moderates and elderly. But, until yesterday, anyone who knew how Paul Ryan was also knew how they were going to vote. The low-information middle has never heard of this guy. This gives both parties to the chance to try and define him.
The big question is will the Ryan Budget become the Romney (or the Ryan-Romney) Budget? Democrats will push for it. They would love to run a choice campaign, know a big target when the see it, are sure to mention Ryan's-plan-to-end-Medicare at every opportunity. Republicans will push for it as well. They've already voted for it twice. Ryan's policy initiatives are what catapulted him to prominence and led the GOP powers that be push for him to be on the ticket.
The person least interested in seeing the Romney-Ryan ticket run on the Ryan plan is probably Mitt Romney. Ultimately, I expect him to (semi-successfully) move away from the Ryan plan. If Romney wanted to run on the details for the Ryan plan (such as they are), Ryan would be an obvious assent. But if Romney wants to run away from the plan, then neutralizing Ryan by drawing him close, is also a smart plan. Ryan won't be an independent voice calling the shots from Congress and nobody will push the plan without him.
The Romney campaign has been maddeningly vague up until now. Every policy issue has been answered with a mish-mash of contradictory talking points and devoid of substance. The Ryan pick might mark a move toward and honest policy discussion. But since both Ryan and Romney have reputations as policy wonks there's a serious risk that they will simply try to ride their repudiations and continue to avoid policy specifics. They can wave in the general direction of their various "plans" while declining to offer anything that could actually be evaluated.
Both liberals and conservatives are clamoring for battle over their policies and visions for the country. The Ryan pick offers the promise of a campaign with renewed focus on policy and legislative proposals. We should all hope, and strive to insure, the rest of the campaign lives up to that promise.
The Ryan pick is not show of strength. Romney's plan seems to have been to to stay vague, complain about Obama and the economy, and coast to victory by keeping himself and his part out of the spotlight. The Ryan pick is an acknowledgement that the plan wasn't going so well.
Ryan brings a lot to the ticket. He's the movement conservatives hero and the favorite wonk of GOP elite. This helps Mitt with a still-suspicious base. Ryan is good looking, good-natured, is not a known culture-warrior, articulate, a loyal partisan, and has a particular talent for presenting radical policies with soothing manner and a straight-face.
Paul Ryan does bring substantial baggage in the form of his sweeping, transformative budget blueprints. There's concern that his extreme positions will scare off moderates and elderly. But, until yesterday, anyone who knew how Paul Ryan was also knew how they were going to vote. The low-information middle has never heard of this guy. This gives both parties to the chance to try and define him.
The big question is will the Ryan Budget become the Romney (or the Ryan-Romney) Budget? Democrats will push for it. They would love to run a choice campaign, know a big target when the see it, are sure to mention Ryan's-plan-to-end-Medicare at every opportunity. Republicans will push for it as well. They've already voted for it twice. Ryan's policy initiatives are what catapulted him to prominence and led the GOP powers that be push for him to be on the ticket.
The person least interested in seeing the Romney-Ryan ticket run on the Ryan plan is probably Mitt Romney. Ultimately, I expect him to (semi-successfully) move away from the Ryan plan. If Romney wanted to run on the details for the Ryan plan (such as they are), Ryan would be an obvious assent. But if Romney wants to run away from the plan, then neutralizing Ryan by drawing him close, is also a smart plan. Ryan won't be an independent voice calling the shots from Congress and nobody will push the plan without him.
The Romney campaign has been maddeningly vague up until now. Every policy issue has been answered with a mish-mash of contradictory talking points and devoid of substance. The Ryan pick might mark a move toward and honest policy discussion. But since both Ryan and Romney have reputations as policy wonks there's a serious risk that they will simply try to ride their repudiations and continue to avoid policy specifics. They can wave in the general direction of their various "plans" while declining to offer anything that could actually be evaluated.
Both liberals and conservatives are clamoring for battle over their policies and visions for the country. The Ryan pick offers the promise of a campaign with renewed focus on policy and legislative proposals. We should all hope, and strive to insure, the rest of the campaign lives up to that promise.
Monday, June 11, 2012
Taking Republicans Seriously: The Ryan Plan
Wisconsin Congressman Paul Ryan is the GOP’s favorite policy wonk. Ryan’s budget blueprint, The Path to Prosperity lays out a comprehensive vision of the future of the federal government.The wide-ranging document addresses everything from tax policy, defense and domestic spending, to entitlement reform.
Most politicians are known for their vacuous rhetoric. Ryan’s plan lays out the GOP agenda in stark numbers and explains how his party intends to govern, how they will balance the budget and their plan for the future. This plan has been put before US House of Representatives and approved, with near-unanimous acclaim, by the Republican majority.
Mitt Romney has joined the chorus of approval calling Ryan’s plan “marvelous”. And so this document represents, not just the guiding vision for the modern Republican Party, but a detailed plan of action.
The plan is not without its detractors. Commenters outside the GOP have suggested that the plan is a sham and that Ryan is a fraud. But given that is budget resolution has been put before and approved by the US Congress, it deserves serious consideration. Is it possible that all these pundits, politicians, and would-be presidents have heaped so much praise on this plan without considering its implications? Would the Republican majority vote to enact this plan into law if it didn’t reflect their values? Of course not.
So, it is worthwhile to examine this document and see what it says about the priorities and governing vision of the Republican party.
The GOP wants to raise your taxes. A lot.
Broaden the tax base to maintain revenue growth at a level consistent with current tax policy and at a share of the economy consistent with historical norms of 18 to 19 percent in the following decades.
Currently, federal revenue comes in at a little under 16% of GDP. Republicans want to increase that to 18% of within the next two years and to 19% over the next decade. These increases would generate an additional $13 trillion over the next decade.
The GOP does not plan to increase taxes across the board. The Ryan plan calls for the AMT to be eliminated and the top tax rate to be reduced to 25%. That means tax cuts for the rich. The increased revenue comes from the elimination of deductions. Regardless of the deductions eliminated, anyone currently paying more than 25% is going to get a substantial tax cut. In order to meet the revenue targets, a large number of Americans are going to be taxed at the 25% rate. Deductions are going to take a big hit. The home mortgage deduction, employer-sponsored health care, child care, earned income tax credits will all be on the block.
In order to meet aggressive revenue goals, and still offer generous tax cuts for the rich, the plan calls for steep tax increases for the poorest and middle-class Americans.
That means you get a big tax increase.
Republicans aren’t interested in controlling the cost of Medicare and Social Security.
the per capita cost of this reformed program for seniors reaching eligibility after 2023 could not exceed nominal GDP growth plus 0.5 percent.
The initial version of the Ryan budget contained a controversial plan to end conventional Medicare and replace it with a voucher program. The 2012 version of the plan modifies that idea, leaving the private plans as an optional addition. It sets the cap in Medicare cost growth at GDP growth + 0.5%. This is the exact same rate of increase President Obama has proposed.
The Ryan plan would not save the government any money relative to the Democratic alternative. It does eliminate Medicare cost controls that are part of current law, raising the likelihood that medical costs for seniors will rise faster than the Medicare payments. This will result in worse coverage and increased cost to patients and seniors.
The plan calls for a study of Social Security, proposes no specific reforms.
The Ryan plan eventually eliminates the entire federal government.
Entitlement and domestic programs outside Medicare, Medicaid and Social Security would shrivel from the 12.5 percent of G.D.P. it reached in 2011 to 5.75 percent in 2030 to 3.75 percent in 2050, according to the Congressional Budget Office.
The GOP budget cuts funds for Medicaid and turns it over to the states to do more with less. It increases spending on defense and doesn’t cut Medicare or Social Security. The tax increases in the plan are not sufficient to achieve major debt reduction. The debt reduction comes from unspecified cuts in non-entitlement government spending.
These cuts are quite severe. They are so severe that by 2050 the plan calls for non-entitlement spending to be only 3.75% of GDP. That number includes defense spending. Republicans have stated that defense spending must not fall below 4% of GDP. So, under this plan, there won’t be enough money for all the proposed defense spending. And there won’t be any money at all left for anything else. At all.
Implementing and sticking with this plan would turn the federal government into an insurance company with an army. Everything else (FBI, veterans benefits, border patrols, federal prisons, education funding, housing, R&D, every federal department and agency, food inspection, homeland security, parks, energy... etc..) would be rapidly squeezed and, ultimately, eliminated.
The Republicans have been very clear that the Ryan Plan is their plan. If they win the presidency and the majority, this is their agenda. Tax cuts for the wealthy. Big tax increases for everyone else. Medical costs continue to rise. Everything else gets slashed or eliminated.
Will they actually follow through with it? I don’t know.
But, that’s the plan.
Most politicians are known for their vacuous rhetoric. Ryan’s plan lays out the GOP agenda in stark numbers and explains how his party intends to govern, how they will balance the budget and their plan for the future. This plan has been put before US House of Representatives and approved, with near-unanimous acclaim, by the Republican majority.
Mitt Romney has joined the chorus of approval calling Ryan’s plan “marvelous”. And so this document represents, not just the guiding vision for the modern Republican Party, but a detailed plan of action.
The plan is not without its detractors. Commenters outside the GOP have suggested that the plan is a sham and that Ryan is a fraud. But given that is budget resolution has been put before and approved by the US Congress, it deserves serious consideration. Is it possible that all these pundits, politicians, and would-be presidents have heaped so much praise on this plan without considering its implications? Would the Republican majority vote to enact this plan into law if it didn’t reflect their values? Of course not.
So, it is worthwhile to examine this document and see what it says about the priorities and governing vision of the Republican party.
The GOP wants to raise your taxes. A lot.
Broaden the tax base to maintain revenue growth at a level consistent with current tax policy and at a share of the economy consistent with historical norms of 18 to 19 percent in the following decades.
Currently, federal revenue comes in at a little under 16% of GDP. Republicans want to increase that to 18% of within the next two years and to 19% over the next decade. These increases would generate an additional $13 trillion over the next decade.
The GOP does not plan to increase taxes across the board. The Ryan plan calls for the AMT to be eliminated and the top tax rate to be reduced to 25%. That means tax cuts for the rich. The increased revenue comes from the elimination of deductions. Regardless of the deductions eliminated, anyone currently paying more than 25% is going to get a substantial tax cut. In order to meet the revenue targets, a large number of Americans are going to be taxed at the 25% rate. Deductions are going to take a big hit. The home mortgage deduction, employer-sponsored health care, child care, earned income tax credits will all be on the block.
In order to meet aggressive revenue goals, and still offer generous tax cuts for the rich, the plan calls for steep tax increases for the poorest and middle-class Americans.
That means you get a big tax increase.
Republicans aren’t interested in controlling the cost of Medicare and Social Security.
the per capita cost of this reformed program for seniors reaching eligibility after 2023 could not exceed nominal GDP growth plus 0.5 percent.
The initial version of the Ryan budget contained a controversial plan to end conventional Medicare and replace it with a voucher program. The 2012 version of the plan modifies that idea, leaving the private plans as an optional addition. It sets the cap in Medicare cost growth at GDP growth + 0.5%. This is the exact same rate of increase President Obama has proposed.
The Ryan plan would not save the government any money relative to the Democratic alternative. It does eliminate Medicare cost controls that are part of current law, raising the likelihood that medical costs for seniors will rise faster than the Medicare payments. This will result in worse coverage and increased cost to patients and seniors.
The plan calls for a study of Social Security, proposes no specific reforms.
The Ryan plan eventually eliminates the entire federal government.
Entitlement and domestic programs outside Medicare, Medicaid and Social Security would shrivel from the 12.5 percent of G.D.P. it reached in 2011 to 5.75 percent in 2030 to 3.75 percent in 2050, according to the Congressional Budget Office.
The GOP budget cuts funds for Medicaid and turns it over to the states to do more with less. It increases spending on defense and doesn’t cut Medicare or Social Security. The tax increases in the plan are not sufficient to achieve major debt reduction. The debt reduction comes from unspecified cuts in non-entitlement government spending.
These cuts are quite severe. They are so severe that by 2050 the plan calls for non-entitlement spending to be only 3.75% of GDP. That number includes defense spending. Republicans have stated that defense spending must not fall below 4% of GDP. So, under this plan, there won’t be enough money for all the proposed defense spending. And there won’t be any money at all left for anything else. At all.
Implementing and sticking with this plan would turn the federal government into an insurance company with an army. Everything else (FBI, veterans benefits, border patrols, federal prisons, education funding, housing, R&D, every federal department and agency, food inspection, homeland security, parks, energy... etc..) would be rapidly squeezed and, ultimately, eliminated.
The Republicans have been very clear that the Ryan Plan is their plan. If they win the presidency and the majority, this is their agenda. Tax cuts for the wealthy. Big tax increases for everyone else. Medical costs continue to rise. Everything else gets slashed or eliminated.
Will they actually follow through with it? I don’t know.
But, that’s the plan.
Tuesday, May 22, 2012
Law, Morality, and Terror
President Obama began the year by signing the 2012 Defense Authorization Act. This law may, or may not, depending who you ask, authorize the government to detain US Citizens indefinitely, without trial. The President has approved, via drone missile strike, the execution of US Citizens.
The nature of modern conflicts force us to enter a multitude of grey areas and force us to confront a number of questions. What authority should the government have to engage enemies abroad or detain adversaries at home? What’s the proper line between law enforcement and war? How do we strike a balance between security and the rights citizens and humanity?
What do we want? What should we want?
It’s a question we all should grapple with. That’s what I’m trying to do here. My goal is to present a basic moral, practical, and legal framework within which policies and actions can be evaluated. In deciding the proper treatment for accused terrorists, suspected militants, or other enemies of the state, I divide them into three basic categories. These categories are differentiated largely by the circumstances under which the targets are operating or process by which they came to be in US custody.
Criminals
Anyone operating or apprehended on US soil, or in a friendly nation where our law enforcement officials can operate with relative freedom should be treated as a criminal. Regardless of the severity of the accusation, the detainee captured by law enforcement officials should be arrested and tried in criminal court. These individuals should be entitled to all of the rights, privileges, court systems and standards of evidence as anyone else arrested in the United States.
Prisoners of War
An individual, operating outside the US, captured, detained or handed over to the US military, who is thought be engaged of acts of war against the United States or its allies may rightfully be detained as a prisoner of war.
These persons should be treated in accordance with international norms and in a way consistent with our own expectations of how captured US service members are to be treated by other nations.
Only people actively engaged in acts of war, or planning such actions can be rightfully held under this authority. Attempts to kill American soldiers or civilians and similar acts of destruction are adequate qualification. But no amount of preaching, writing, speaking or other non-military act is sufficient.
Prisoners of war should have the opportunity to challenge the circumstances of their detention and to demonstrate that they should not be rightfully held as prisoners of war. They may be held until such time as the relevant conflict has ceased, or they are not longer considered a threat. This may result in an indefinite period of detention.
Prisoners of war may also be charged with crimes, subject to military courts, and thus incarcerated for longer periods of time.
Enemies on the Battlefield
Individuals engaged in acts of war against the US, and not subject to apprehension by military or civilian authorities, may be properly regarded as battlefield enemies. They are legitimate targets and may be targeted and killed by our armed forces.
The above represents relatively straightforward framework. That may or may not be controversial. It does carry several implications that should be called out.
Citizenship
None of these categorizations are dependant upon citizenship. An accused terrorist arrested at Logan airport with a Yemeni passport gets the same access to the courts as an American citizen. Similarly, holding an American passport affords you no protection if you are holding a rifle on a rooftop in Kandahar or organizing militants in a village in Waziristan.
Transparency and Authority
Much of the controversy around military and terror policies stem from questions of transparency and authority. Even if we grant the powers to detain or kill, who gets to decide when they are applied? What level of transparency do we require? Should our government be required to inform us if they’ve decided they are entitled to kill someone?
I’m taking the basic position that the framework outlined here is a moral framework. Issues of transparency and accountability don’t change the morality of the underlying actions. Torture or an extra-legal assassination doesn’t become moral because it is covered up successfully or rationalized to someone’s satisfaction. The acts are moral or immoral, legal or illegal, whether we find out about them or not.
The flip side of that is that, in a democracy, authority is granted by the people. But it is granted. We should not require military commanders or their civilian leaders to publish a list their targets or their protocols. Ultimately, we have to recognize that, with our elections, we are entrusting imperfect people with tremendous power.
We have to elect people we can trust. We have to trust the people we’ve elected. We have observe and evaluate the outcomes and see if that trust has been violated.
The nature of modern conflicts force us to enter a multitude of grey areas and force us to confront a number of questions. What authority should the government have to engage enemies abroad or detain adversaries at home? What’s the proper line between law enforcement and war? How do we strike a balance between security and the rights citizens and humanity?
What do we want? What should we want?
It’s a question we all should grapple with. That’s what I’m trying to do here. My goal is to present a basic moral, practical, and legal framework within which policies and actions can be evaluated. In deciding the proper treatment for accused terrorists, suspected militants, or other enemies of the state, I divide them into three basic categories. These categories are differentiated largely by the circumstances under which the targets are operating or process by which they came to be in US custody.
Categories
Criminals
Anyone operating or apprehended on US soil, or in a friendly nation where our law enforcement officials can operate with relative freedom should be treated as a criminal. Regardless of the severity of the accusation, the detainee captured by law enforcement officials should be arrested and tried in criminal court. These individuals should be entitled to all of the rights, privileges, court systems and standards of evidence as anyone else arrested in the United States.
Prisoners of War
An individual, operating outside the US, captured, detained or handed over to the US military, who is thought be engaged of acts of war against the United States or its allies may rightfully be detained as a prisoner of war.
These persons should be treated in accordance with international norms and in a way consistent with our own expectations of how captured US service members are to be treated by other nations.
Only people actively engaged in acts of war, or planning such actions can be rightfully held under this authority. Attempts to kill American soldiers or civilians and similar acts of destruction are adequate qualification. But no amount of preaching, writing, speaking or other non-military act is sufficient.
Prisoners of war should have the opportunity to challenge the circumstances of their detention and to demonstrate that they should not be rightfully held as prisoners of war. They may be held until such time as the relevant conflict has ceased, or they are not longer considered a threat. This may result in an indefinite period of detention.
Prisoners of war may also be charged with crimes, subject to military courts, and thus incarcerated for longer periods of time.
Enemies on the Battlefield
Individuals engaged in acts of war against the US, and not subject to apprehension by military or civilian authorities, may be properly regarded as battlefield enemies. They are legitimate targets and may be targeted and killed by our armed forces.
Implications
The above represents relatively straightforward framework. That may or may not be controversial. It does carry several implications that should be called out.
Citizenship
None of these categorizations are dependant upon citizenship. An accused terrorist arrested at Logan airport with a Yemeni passport gets the same access to the courts as an American citizen. Similarly, holding an American passport affords you no protection if you are holding a rifle on a rooftop in Kandahar or organizing militants in a village in Waziristan.
Transparency and Authority
Much of the controversy around military and terror policies stem from questions of transparency and authority. Even if we grant the powers to detain or kill, who gets to decide when they are applied? What level of transparency do we require? Should our government be required to inform us if they’ve decided they are entitled to kill someone?
I’m taking the basic position that the framework outlined here is a moral framework. Issues of transparency and accountability don’t change the morality of the underlying actions. Torture or an extra-legal assassination doesn’t become moral because it is covered up successfully or rationalized to someone’s satisfaction. The acts are moral or immoral, legal or illegal, whether we find out about them or not.
The flip side of that is that, in a democracy, authority is granted by the people. But it is granted. We should not require military commanders or their civilian leaders to publish a list their targets or their protocols. Ultimately, we have to recognize that, with our elections, we are entrusting imperfect people with tremendous power.
We have to elect people we can trust. We have to trust the people we’ve elected. We have observe and evaluate the outcomes and see if that trust has been violated.
Tuesday, March 27, 2012
Of Course the Individual Mandate is Constitutional
There’s lots hand-wringing going on today about the ongoing health care reform case before the Supreme Court. I don’t get it.
The question before the court is whether congress has the power to assess a tax penalty against people who can afford to purchase health insurance but decline to do so. It’s clear (to me anyhow) that congress does have that authority. It has it under both the commerce clause and under their taxation authority.
Health care costs have obvious implications regarding interstate commerce and interstate economic activity. Health care is a multi-trillion dollar industry. Every state, every municipality, every company, every family in this country has been pummeled by rising health care costs in recent years. The national deficit derives in no small part from rising health care costs. There are vast implications of escalating health care costs and with dealing with the uninsured. These implications transcend state borders.
If you travel to another state and get into a car accident, you will wind up in a hospital in that state. Whether or not you have insurance, whether or not you can pay your bill, whether or not the other people in that state will have to cover the cost of your care -- these are issues of interstate commerce.
The individual mandate is specifically designed to encourage people, who might otherwise take their chances on foregoing health insurance, to purchase policies from the upcoming health care exchanges. These exchanges will include national and inter-state plans. The entire point of the mandate is that it is essential in controlling costs in the plans offered in the health care exchanges, which will be available across state lines.
The counter argument is typified by the broccoli conundrum. If congress can assess a penalty for going without health insurance, where does does this slippery slope lead? Where does it end? If the tax us for not having health insurance can they tax us for not eating broccoli?
This is the flimsiest of straw men. The commerce clause ends when the activity being regulated is no longer relevant to interstate commerce. Since there is no economic necessity that compels the consumption of broccoli congress could not do so under the commerce clause.
But if congress can’t compel us to eat our vegetables using the commerce clause, they probably could do so using the tax code. The tax code is already riddled with exemptions, rebates, and penalties for all kinds of activities. That’s what the tax code is. You already pay a penalty for not owning a home, for not being married, for not having kids, for not being blind and for working for a living instead of cashing a dividend check. On the corporate side it’s even worse. No doubt there is someone somewhere facing tax implications for the manner and extent to which they do or do not produce broccoli.
A tax penalty for choosing to forgo health insurance is not extraordinary. And the punishment for ignoring the individual mandate is a tax penalty. You can’t be arrested. It’s not a crime. There’s no fine. When it comes time to pay your income tax, your health care decisions will contribute to the amount you owe the IRS when you file your taxes. And if you decide you aren’t going to pay this tax penalty - if you say screw health insurance and screw the tax penalty too -- that’s ok! There’s no penalty for that either. If you decide not to pay what you owe due to the individual mandate, the laws specifies that there’s nothing they can do about it.
The individual mandate is important to controlling health care costs across the nation and across state lines. That’s why it exists. That’s why it’s in the law. And that’s why we’re arguing over it. The enforcement mechanism is a tax penalty and a limply enforced one as well. Laws along these lines are well within the authority of congress.
The question before the court is whether congress has the power to assess a tax penalty against people who can afford to purchase health insurance but decline to do so. It’s clear (to me anyhow) that congress does have that authority. It has it under both the commerce clause and under their taxation authority.
Health care costs have obvious implications regarding interstate commerce and interstate economic activity. Health care is a multi-trillion dollar industry. Every state, every municipality, every company, every family in this country has been pummeled by rising health care costs in recent years. The national deficit derives in no small part from rising health care costs. There are vast implications of escalating health care costs and with dealing with the uninsured. These implications transcend state borders.
If you travel to another state and get into a car accident, you will wind up in a hospital in that state. Whether or not you have insurance, whether or not you can pay your bill, whether or not the other people in that state will have to cover the cost of your care -- these are issues of interstate commerce.
The individual mandate is specifically designed to encourage people, who might otherwise take their chances on foregoing health insurance, to purchase policies from the upcoming health care exchanges. These exchanges will include national and inter-state plans. The entire point of the mandate is that it is essential in controlling costs in the plans offered in the health care exchanges, which will be available across state lines.
The counter argument is typified by the broccoli conundrum. If congress can assess a penalty for going without health insurance, where does does this slippery slope lead? Where does it end? If the tax us for not having health insurance can they tax us for not eating broccoli?
This is the flimsiest of straw men. The commerce clause ends when the activity being regulated is no longer relevant to interstate commerce. Since there is no economic necessity that compels the consumption of broccoli congress could not do so under the commerce clause.
But if congress can’t compel us to eat our vegetables using the commerce clause, they probably could do so using the tax code. The tax code is already riddled with exemptions, rebates, and penalties for all kinds of activities. That’s what the tax code is. You already pay a penalty for not owning a home, for not being married, for not having kids, for not being blind and for working for a living instead of cashing a dividend check. On the corporate side it’s even worse. No doubt there is someone somewhere facing tax implications for the manner and extent to which they do or do not produce broccoli.
A tax penalty for choosing to forgo health insurance is not extraordinary. And the punishment for ignoring the individual mandate is a tax penalty. You can’t be arrested. It’s not a crime. There’s no fine. When it comes time to pay your income tax, your health care decisions will contribute to the amount you owe the IRS when you file your taxes. And if you decide you aren’t going to pay this tax penalty - if you say screw health insurance and screw the tax penalty too -- that’s ok! There’s no penalty for that either. If you decide not to pay what you owe due to the individual mandate, the laws specifies that there’s nothing they can do about it.
The individual mandate is important to controlling health care costs across the nation and across state lines. That’s why it exists. That’s why it’s in the law. And that’s why we’re arguing over it. The enforcement mechanism is a tax penalty and a limply enforced one as well. Laws along these lines are well within the authority of congress.
Saturday, February 11, 2012
Answers to the Fairness Quiz
The concept of “fairness” has been coming up a lot in my house. Generally, my son Isaac is complaining that “it’s not fair” that he has to eat the same dinner as the rest of the family. I’ve suggested that he appears to have a distorted concept what the word “fair” means.
A recent Wall Street Journal editorial had a “Fairness Quiz”, intended for President Obama. Reading the quiz it seemed to me that confusion about what constitutes fairness may be more widespread.
I decided to take the “quiz” (in bold) and included my answers below.
President Obama has frequently justified his policies—and judged their outcomes—in terms of equity, justice and fairness. That raises an obvious question: How does our existing system—and his own policy record—stack up according to those criteria?
Is it fair that the richest 1% of Americans pay nearly 40% of all federal income taxes, and the richest 10% pay two-thirds of the tax?
Yes. The top 10% possess 80% of all financial assets. Since they have 80% of the money it doesn’t seem unfair that they would pay 66% of the taxes.
Is it fair that the richest 10% of Americans shoulder a higher share of their country's income-tax burden than do the richest 10% in every other industrialized nation, including socialist Sweden?
Sure. There there is more income inequality in the US than “socialist” Sweden. Maybe the income inequality isn’t fair, but obviously it’s not unfair to the people that benefit from it.
Is it fair that American corporations pay the highest statutory corporate tax rate of all other industrialized nations but Japan, which cuts its rate on April 1?
No. It is widely acknowledge that the US corporate tax code is riddled with loopholes and special deals. If the code was streamlined then more revenue could be raised at a lower rate. Of course, the corporates that benefit from these loopholes want to make sure they are maintained. And they hire lobbyists.
Is it fair that President Obama sends his two daughters to elite private schools that are safer, better-run, and produce higher test scores than public schools in Washington, D.C.—but millions of other families across America are denied that free choice and forced to send their kids to rotten schools?
Yes. American kids are entitled to decent schools and we should endeavor to provide them. But wealthy people are going to want something better for their kids than we have the means to provide for everyone. People should be free to send their kids to private schools. And we shouldn’t be surprised that that expensive private schools are better than those paid for by taxpayers.
Is it fair that Americans who build a family business, hire workers, reinvest and save their money—paying a lifetime of federal, state and local taxes often climbing into the millions of dollars—must then pay an additional estate tax of 35% (and as much as 55% when the law changes next year) when they die, rather than passing that money onto their loved ones?
Taxes need to come from someone. Taxing dead millionaires doesn’t seem significantly less fair than taxing non-dead, non-millionaires. 55% does seem too high. 35% seems fair.
Is it fair that Treasury Secretary Tim Geithner, former Democratic Senate Majority Leader Tom Daschle, former Ways and Means Chairman Charlie Rangel and other leading Democrats who preach tax fairness underpaid their own taxes?
No. Everyone should pay the taxes they are required to pay under the law.
Is it fair that after the first three years of Obamanomics, the poor are poorer, the poverty rate is rising, the middle class is losing income, and some 5.5 million fewer Americans have jobs today than in 2007?
Is rising poverty fair? To whom? I don’t understand the question.
Is it fair that roughly 88% of political contributions from supposedly impartial network television reporters, producers and other employees in 2008 went to Democrats?
Yes. Working in television doesn’t mean you aren’t entitled to have an opinion about politics or mean that you should not be permitted to give money to whomever you choose.
Is it fair that the three counties with America's highest median family income just happen to be located in the Washington, D.C., metro area?
Once again I don’t understand the question. Is it fair to whom? Other counties?
Is it fair that wind, solar and ethanol producers get billions of dollars of subsidies each year and pay virtually no taxes, while the oil and gas industry—which provides at least 10 times as much energy—pays tens of billions of dollars of taxes while the president complains that it is "subsidized"?
Burning oil and gas come with a massive externality in that it is causing dangerous global climate change. The cost of dealing with this will be borne by it’s victims and is not factored into the cost of the commodities themselves. It is perfectly fair for a government to strive towards a tax and subsidy policy that seeks the maximum benefit (and tries to mitigate disaster) for it’s citizens.
Is it fair that those who work full-time jobs (and sometimes more) to make ends meet have to pay taxes to support up to 99 weeks of unemployment benefits for those who don't work?
The extended unemployment benefits were necessitated by chronic long-term unemployment caused by a massive financial crisis. The nation certainly benefited from the extra protections offered the unemployed as the economy recovered. Since taxes for the employed were not increased during this time (and they were, in fact, reduced) it seems perfectly fair all around.
Is it fair that those who took out responsible mortgages and pay them each month have to see their tax dollars used to subsidize those who acted recklessly, greedily and sometimes deceitfully in taking out mortgages they now can't afford to repay?
If that were occurring, it wouldn’t be fair. The actual fate for people who haven’t been able to pay their mortgages is that they’ve faced foreclosure and eviction. The system does not seem to be unfair to those people who have been fortunate enough to be able to keep their homes.
Is it fair that thousands of workers won't have jobs because the president sided with environmentalists and blocked the shovel-ready Keystone XL oil pipeline?
It’s certainly fair for the government to consider the environmental impact of an oil pipeline before approving it. And it would certainly be unfair, to the citizens within the pipeline’s path, for the project to be approved if the environmental assessment was not permitted to take place.
Is it fair that some of Mr. Obama's largest campaign contributors received federal loan guarantees on their investments in renewable energy projects that went bust?
If the reason for the loans is solely or primarily the donations, then that is not fair. If the actual criteria for approval of a project is some other, more fair system... well, then that would be more fair.
Is it fair that federal employees receive benefits that are nearly 50% higher than those of private-sector workers whose taxes pay their salaries, according to the Congressional Budget Office?
The real number is that total compensation is about 16% higher for federal employees than in the private sector. Much of that difference is due to better benefits packages for non-college graduates in government jobs.
Is it fair that a government job is one of the few ways for a high-school graduate to get health insurance? I guess that depends on your definition of fair.
Is it fair that soon almost half the federal budget will take income from young working people and redistribute it to old non-working people, even though those over age 65 are already among the wealthiest Americans?
Current beneficiaries payed into these programs for the entirely of their working lives. So long as the workers paying in now receive comparable benefits, the system is fair.
Is it fair that in 27 states workers can be compelled to join a union in order to keep their jobs?
If the salary, benefits, and other terms of the employment that make the job desirable were established due to the efforts of the union then it’s fair to ask that the people who receive those benefits to contribute to the union.
Is it fair that nearly four out of 10 American households now pay no federal income tax at all—a number that has risen every year under Mr. Obama?
It’s not true. Most every working American pays federal income taxes for Social Security and Medicare. Many households don’t earn enough to have to pay additional income taxes. But there’s nothing unfair about poor households paying any and all taxes the laws requires them to pay.
Is it fair that Boeing, a private company, was threatened by a federal agency when it sought to add jobs in a right-to-work state rather than in a forced-union state?
In 2010 Boeing received $19.4 billion in government contracts. The American taxpayers have been been more than “fair” to the Boeing corporation.
Is it fair that our kids and grandkids and great-grandkids—who never voted for Mr. Obama—will have to pay off the $5 trillion of debt accumulated over the past four years, without any benefits to them?
My kids benefit from the low tax rates we pay now. We will all benefit from an economic recovery. We do owe it to them to restore some fiscal sanity over the long term. Is it fair that they will will inherit the cost of substantial borrowing to deal with massive financial crisis caused by reckless millionaires? It is not.
But who ever said life was fair...
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