Two studies were announced last week, both bringing bad news for ordinary Americans. The insights from those studies was confirmed in the rough and tumble dysfunction of the new Medicare drug program for the neediest recipients. There may well be something to learn from all of this, as Congress looks to the new year.
The Congressional Budget Office announced Thursday that red ink will flow into the next decade if the Bush tax cuts are made permanent at a cost of $2.6 trillion for the decade. Its study, Budget and Economic Outlook: Fiscal Years 2007 - 2016, summarized here, projects a budget of $336 billion for 2006, or 2.6% of GDP. When projected needs for the military occupation of Iraq and Afghanistan are added in, as well as additional flood insurance payments related to the last fall's hurricane season, the CBO projects a deficit for 2006 in the range of $360 billion. That means that government borrowing --already over $8 trillion (including funds borrowed from the Social Security trust fund--will have to increase even more to finance the deficit and any additional tax cuts the Congress may ultimately enact this year, adding to the debt burden of future generations. Kent Conrad, a member of the Senate Budget Committee, told the Wall Street Journal that this Congress has been "the most fiscally irresponsible in our nation's history."
The Center on Budget and Policy Priorities, in a study entitled "Pulling Apart", available here, looked at the state by state income gap between the wealthiest families and those at the bottom. It found a steady widening of the gap from the early 1980s to the early 2000s. Although there was some decline in inequality at the turn of the century, by 2003 the wealthy were again rapidly leaving the poor behind. Those at the top, who generally are the primary owners of capital wealth, generally benefited from the rebounding stock market. Those at the bottom, who generally work for wages in jobs that are particularly vulnerable to slowdowns in the economy, suffered most in the recent recession and have continued to be affected by the slow recovery to the jobs sector. In thirty-eight states that showed a widening gap, the income of the richest grew by an average $45,800 or 62% while the income of those at the bottom grew by an average of only $3000 or 21%. Even within the top quintile of well-to-do Americans, the top 5% saw their income grow much more rapidly than the remaining members of the quintile. A significant cause for the decline, according to the report, is the law wages earned by the 70% of workers without a college education, outsourcing, low-wage service jobs, and the weakening of unions. Workers at the bottom are struggling against a decline in the real minimum wage, while capital owners at the top are enjoying extraordinary growth in wealth from increased productivity of workers that remain.
These data are particularly telling when individual states or districts are considered. In the District of Columbia, the average income of the poorest groups increased in two decades by only $382, from $12,321 to $12,703. At the same time, the best off saw their incomes increased by a whopping $70,362, or about $3,350 a year. See the statistical sheet for DC. Similar figures are available for other areas at this link. And see the analysis by Citizens for Tax Justice at this link. As noted by Ed Lazere at the D.C. Fiscal Policy Institute in a report on the study by the Washington Post, "It seems pretty clear that there's a large group of disadvantaged residents in the city who aren't getting the help they need to move up the economic ladder, whether it be education or training or other supports." D'Vera Cohn, Separation Between Rich, Poor Widening in DC, Jan. 27, 2006 Wash. Post. Lazere points out the need to increase skills for the city's residents, since most are working but simply cannot earn enough at their jobs to move ahead. Id.
These income distribution statistics are confirmed by an IRS study that looks at income and tax rate trends. See, e.g., Michael Strudler & Tom Petska, Further Analysis of the Distribution of Income and Taxes, November 2004 (revised 2005). The authors examine trends in the distribution of incomes and tax burdens based on a "retrospective income concept" that attempts to make the income measure both comprehensive and consistent over time by including the same income and deduction items for the years studied. The income measure includes capital gains, unemployment compensation, pensions and annuities, but does not include social security benefits because they were not reported when the system was first developed. The study predictably finds that "[w]hile all of the income thresholds have increased over time, the largest increases in absolute terms, and on a percentage basis, were with the highest income-size classes." Id. An American would have had to earn more than $233,000 to be in the top 0.1% bracket in 1979, but more than $1,278,000 in 2002--a 400% increase. The increase at the bottom was only 130%. Thus, the fact that those at the top pay higher average tax burdens is not surprising--"an increasing proportion of income has shifted to the upper levels of the distribution where it is taxed at higher rates." Id. The Strudler & Petska study also demonstrates just how much the highest-income Americans have been benefited by the Bush tax cuts.
The highest income group winds up paying an average tax that is less than all of the groups above the 20-to-40 percent class. Under the new laws, the 0.1-percent group would pay average taxes that are 3.19 percentage points less than the 1-to-5 percent income group, 2.91 percentage points less than the 5-to-10 percent income group, and 1.24 percentage points less than the 10-to-20 percent group. In fact, under the provisions of EGTRRA/JGTRRA [the 2001 and 2003 tax cut bills], individuals in the 0.1-percent group wind up paying less than one percentage point (0.99) more than the 20-to-40 percent income group. In contrast, the highest income group paid average combined taxes that were 12.03 percentage points higher than the 20-to-40 percent income group in 1979 and 4.29 percentage points higher than this group underexisting 1999 laws. Id. (emphasis added).
Couple these disturbing trends with two other pieces of information. First, with the new drug program in Medicare coming on line, millions of needy Americans were simply assigned to drug plans. Although they had been receiving their medications directly through government programs, they are now expected to navigate the complex, confusing and ultimately unsatisfactory system of private providers that is causing this nation's elderly such anguish as it gets off the ground. Regretably, it turns out that nearly one-third of impoverished Americans were enrolled by the government in Medicare plans that refuse to cover 15% of commonly used drugs. The agency insists that they will be covered since a therapeutically equivalent alternative of medically necessary treatments must be covered, but many of those having problems are the most vulnerable who may have trouble navigating well-understood situations, much less the labyrinth of the new prescription drug program. They may simply not know where to turn, and lack of coverage of their 'brand" may require another visit to a physician to get a prescription for a covered equivalent. See the story in the Jan. 28 Chicago Tribune. At any rate, the prescription drug plan experience in the "comparison shopping" of Bush's ideal health care market is so far a very unsatisfactory one. It just may be that finding the right doctor to treat you when you are sick or even chronically ill doesn't work the same way finding the right supplier of the tile for your bathroom floor, in spite of Bush's view that health care competition is the "cure" for the lack of accessible health care for millions of Americans.
Meanwhile, the veterans' health care system has worked to improve its care since the 1980s and has emerged as a leader in high quality care, according to an annual survey conducted by the National Quality Research Center mentioned by Paul Krugman in his Jan. 27 New York Times Op-Ed. As Krugman notes, the VHA's success story suggests that a "government agency can deliver better care at lower cost than the private sector." Id. Maybe it is time we really looked at the places that privatization works and does not work. Universal health care, funded by tax revenues and provided through a government system of hospitals and clinics, may be the answer we have avoided for far too long.
Can we really watch the poor get poorer and the rich get richer (and pay less taxes to boot) and still justify our failure to provide universal health care for those who need it? I think not. We should act now to create a single-provider health care system that puts medicine to the service of the people.
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