| Subject: 2nd attempt at taxes |
Author:
krz
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Date Posted: 11/10/04 2:26:01pm
In reply to:
tjm
's message, "could you explain this again. slower? [the taxes as tool post]" on 11/ 9/04 9:29:10pm
Sorry - I can have great arguments with myself sometimes....
Here are some of the points that spoke to me in the original link. I'm cutting and pasting only parts, but presented in order by Balko. I'll put my 2 cents worth in after each...
(Balko)
But there's something else at work here, too. The nonchalance with which Frum assures readers that "almost all conservatives" accept the premise of Medicare and Medicaid -- or the very idea that some people should be forced to pay for other people's medical expenses -- speaks volumes about the state of 21st century conservatism. There was a time when such a position would have been abominable in conservative circles. Come to think of it, there was a time when David Frum and National Review would have been among those doing the abominating.
But we live in post-prescription-drug-benefit, post-W, post-compassionate-conservative America,
(krz)
We also live in an America where relatively 'simple' medical advances that include immunization (now carried on for 3 generations) has limited the impact of some diseases on the public consciousness. Polio was the example I used in the prior post. We also live in an America where pharmaceutical advances have found meaningful treatments for diseases that only 50 years ago resulted in great masses of the work force being disenfranchised (eg. the TB hospitals) or removed from the work force (think of pneumonia). There is an important and meaningful role for government sponsored health care. The obvious question is to what extent we should fund the health of others...
I understand that Balko is working towards a discussion of the role personal resonsibility plays in one's health - and I support a discussion on this - but I'm one who feels that the common good of providing a healthy work force, maintaining a minimum standard of preventive and restorative medicine is a social good and should be a role of government to provide.
(Balko)
...where the principles of personal responsibility and limited government have given way to the "principle" that assigning a government program to remedy society's every ill is just fine, so long as said government program is administered in an adequately conservative manner (which, from what I gather over the last four years, means first filtering it through a faith-based organization, or subjecting it to national testing).
So when it comes to health care, the new conservatism apparently means that instead of advocating reforms that would apply consumer-driven pressure to drive down medical costs,
(krz) -
Consumer driven pressure? This is often bantered about by people who really don't understand health care funding, and I may be generalizing too quick, but I suspect Balko is one of them. You can't take a consumer driven approach to a delivery system where someone else pays for the good delivered. It's an apples to oranges comparison.
At the heart of 'consumer driven pressure' are the assumptions that:
(1) the consumer can make an informed decision about the good he/she is purchasing - In all honesty, in health care this requires some skill. What outcomes are achieved with medical intervention - what are the outcomes/risks if medical intervention is not sought? Try getting question #2 answered by a medical professional. In purchasing a good one is weighing the risk/reward ratio - if you never know the risks (which in some cases are minimal), you only decide on the reward.
(2) the consumer can get information in advance of purchase on price of the good delievered (ever try that one???) in order to comparison shop
(3) the consumer can get information about competitors so that true comparisons can be made on quality - maybe I do want to pay more for the one I consider 'better'. But, what constiutes better? Is the therapist who treats highly motivated athletes to recover to their prior functional performance better than the therapist who treats overweight patients with stroke to return to a level of function lower than they were prior to their stroke?
(Balko)
But let's get to Frum's actual proposal -- a tax on soda. Principles aside, why is it a bad idea logistically?
Because it won't work. To add to the "fat" and "fit" figures above, overall average caloric intake among children is virtually unchanged over the last thirty years, and overall fat intake has actually decreased. Looking at soda specifically, there's simply no link between soda consumption and the rise in obesity. Non-diet soda consumption has remained stable for the last 15 years. One study from Frum's idealized Canada showed that poor Canadian kids are twice as likely to be obese as rich Canadian kids, even when they eat the same general diet, a pretty clear indicator that our kids today aren't fat because of evil soda and fast food companies, but because they're spending too much time in front of the computer/TV/video game screen.
(krz)
I agree with him here. A tax imposed for the purpose of changing personal behavior has to be large enough to encourage one to actually change. The 'negative reinforcment' has to be substantive - and targeted. A global tax to reduce obesity is not meaningful. The concept of applying a small tax on a good that all (the obese and non-obese) would pay in order to fund programs for the purpose of reducing obesity is not in my mind a meaningful way to address the issue.
I'm beginning some pilot work next semester on barriers to physical activity in people with stroke. Essentially, trying to figure out why those with stroke, who know changing diet and exercise will change abilities, don't make that change. Some really interesting background reading getting done on non-disabled populations as well. I'm hoping as a result of next semester's pilot to then be able to pilot a small scale intervention program.
Could be fodder for good discussion.
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