5 x 8: You may be more government dependent than you think

1) THE SAFETY NET YOU DON’T KNOW YOU HAVE

Ask most people if they benefit from a government “safety net” program, and most will say “no,” but many of them do, according to Marketplace reporter Krissy Clark.  Interviewing Cornell University professor and “invisible government” expert Suzanne Mettler, Clark reports:

Let’s take the second category first— employer health care and retirement benefits, which have been tax-free for decades, as a policy that encourages employers to provide health insurance for their workers. “If our employers gave us the same amount of money they put in to these benefits in to our paychecks” instead, Mettler says, “we’d be paying income taxes on it.” Since we don’t have to pay those taxes, we’re effectively getting a little extra money in our pockets, and a little more economic stability.

The home mortgage interest deduction is a good illustration of a safety net program “hidden” in the tax code, Mettler says. “We could have a housing policy in the United States where everyone got a check every month to help them pay their mortgage,” she says. “But instead we channel it through the tax code and we simply allow people to pay less. From an accounting perspective, it’s the same thing.”

But from a political perspective, it’s a very different thing, argues Mettler. To create these sorts of “submerged” safety nets lawmakers don’t need to raise taxes. And people who use them rarely think of themselves as reliant on a government program. Of course, not everyone agrees with Mettler’s framing. “I receive emails from some people saying ‘How can you call these provisions in the tax code government social benefits? This is simply government taking less of my money,’” she says.

2) AFTER THE ATTENTION DISAPPEARS

The 19 “Hotshots” who died trying to save people’s homes in Arizona this summer were hailed as heroes.

Then it came time for the city of Prescott to live up to their promise to the people who risk their lives for people’s “stuff.”

It’s denying survivor benefits accorded city workers because they’re considered “seasonal workers,” CBS reports.

“I said to them, ‘My husband was a full-time employee, he went to work full-time for you,'” one widow said, “and their response to me was, ‘Perhaps there was a communication issue in your marriage.'”

Nice.

3) THE CANCER GAME

If doctors stopped using the word, “cancer,” would you be less likely to agree to more tests and treatments?

A recent Journal of the American Medical Association article claimed Americans are overdiagnosed and overtreated, chasing cancer treatments that likely won’t make much difference. You might live, but you probably would’ve lived anyway.

John Horgan, of Scientific American, says the significance of the article is it comes from the very industry that’s responsible: the medical community.

One policy change that the authors recommend would be to avoid using the term “cancer” to describe tumors or other abnormalities that are not life-threatening. When patients hear the word “cancer,” they often demand further tests and treatment, even when medically unjustified, and physicians are too often eager to comply.

The JAMA article, if anything, downplays the problems with cancer testing. For example, the authors state that “colon and cervical cancer are examples of effective screening programs in which early detection and removal of precancerous lesions have reduced incidence as well as late-stage disease.” As I stated in a column last year, “Why I Won’t Get a Colonoscopy,” the value of colonoscopies has not been clearly demonstrated.

In that same column, I quoted Gilbert Welch, a professor of medicine at the Dartmouth Institute for Health Policy and Clinical Practice Welch, writing in The New York Times that screening healthy people leads to “needless appointments, needless tests, needless drugs and needless operations (not to mention all the accompanying needless insurance forms).”

4) WRITING YOUR OWN OBIT

Jane Catherine Lotter and you probably didn’t know her, but the Seattle woman has become the latest “popular” obit because it’s not like every other obit you read — formulaic and focusing on our jobs rather than our lives.

Ms. Lotter wrote her own obit instead.

I was given the gift of life, and now I have to give it back. This is hard. But I was a lucky woman, who led a lucky existence, and for this I am grateful. I first got sick in January 2010. When the cancer recurred last year and was terminal, I decided to be joyful about having had a full life, rather than sad about having to die.

Amazingly, this outlook worked for me. (Well, you know, most of the time.) Meditation and the study of Buddhist philosophy also helped me accept what I could not change. At any rate, I am at peace. And on that upbeat note, I take my mortal leave of this rollicking, revolving world-this sun, that moon, that walk around Green Lake, that stroll through the Pike Place Market, the memory of a child’s hand in mine

According to the obit, she also took advantage of the fact it’s legal in Washington state to take one’s own life with a physician assisting.(h/t: Will Lager)

Related: Living with ALS: The right kind of bucket list (MPR)

2-year-old dies just days after being parents’ best man (NBC)

5) WHY HE CAN’T QUIT A-ROD

Baseball has suspended 13 ballplayers for violating the league’s policy on performance-enhancing drugs. The biggest name, you may have heard, is Alex Rodriguez. He’s remained blind to his actions, the Star Tribune’s Chip Scoggins writes today in the Star Tribune.

“If only the narcissistic phony in New York would have accepted his punishment, too, and faded into oblivion. Alas, Alex Rodriguez clings to his last shred of hope, a pariah even to his own team and fan base, defiant and smug to the end,” he writes.

But not everyone came to bury A-Rod. “It seems the media have gone overboard in their portrayals of A-Rod as a player uniquely deserving of flagellation,” writes Greg Simons of Hardball Times today. “Why don’t I have the same feelings of derision toward Rodriguez? I think it’s a combination of an admiration of the major league talent he demonstrated at such an early age and a reflex response to the overabundance of abuse he has received for more than a decade.”

Bonus I: 6 clever reuses for plastic bread tags.

Bonus II: NPR and Threadless launch T-shirt challenge (Current.org)

Bonus III: Wisconsin’s supper club culture.

Bonus IV: While we’re trying to follow his game Of checkers, Jeff Bezos is playing chess (TechCrunch)

TODAY’S QUESTION
Should CNN and NBC pull Clinton shows?

WHAT WE’RE DOING

Daily Circuit (9-12 p.m.) – First hour: Income inequality.

Second hour: Tom Weber speaks with MCTC officials why there’s such a large amount of homelessness among college students and what schools are doing to address it.

Third hour: NPR’s former “spy beat” reporter Mary Louise Kelly debuts her first thriller, Anonymous Sources, this summer. Kelly combines her reporting experience and knowledge in introducing us to Alexandra James, an intelligent young reporter who gets caught up in a murder and a terrorism investigation. She joins The Daily Circuit to talk about her first novel, spies and reporting, and how she hit the wall.

MPR News Presents (12-1 pm): From the Aspen Ideas Festival: Three doctors speak on a health care panel titled, “The Overtested American.”

The Takeaway (1-2 p.m.) – U.S. Extends Closure of Some Embassies & Diplomatic Posts | TVs Stay Dark Amid Time Warner, CBS Dispute | Messy Desks a Sign of Creativity

All Things Considered (3-6:30 p.m.) – The race for governor and U.S. Senate are overshadowing what could be another competitive statewide race: the campaign for Minnesota secretary of state. Democrat Mark Ritchie announced in June that he’s not running for reelection. A few Democrats have quickly announced that they’re running for the seat but no Republican has filed the official paperwork yet. MPR’s Tom Scheck will have the story.

  • MrE85

    #3) The U.S. Preventive Services Task Force recently issued draft lung cancer screening recommendations recommending annual low-dose CT screening for individuals at high risk for lung cancer. They define high risk individuals as “current and former smokers, ages 55-79 years, who have significant cumulative tobacco smoke exposure and have smoked within the last 15 years.”
    The American Lung Association (my employer) agrees. While not all doctors agree with the screenings, it does seem to offer some modest gains in survival. For a disease as deadly as lung cancer, any improvement is welcome. In spite of all the advances in fighting other types of cancer, lung cancer is still the deadliest. That’s why we focus so much on tobacco and radon exposure — it’s much easier to prevent lung cancer than to treat it.

  • John O.

    #3) Sorry MrE85, but have you priced a CT scan of late? My spouse of 26 years was diagnosed with stage IV lung cancer in January, courtesy of a couple of large “cysts” that had been removed during a hysterectomy nearly two years earlier that turned out to be malignancies. It took a team of five pathologists two weeks to identify what she exactly has and it had nothing to do with tobacco. NOTHING. She will now have that damn CT scan every 90 days for the rest of her life. It is a very rare form of cancer with very limited treatment options. And no, I am not mad at the docs for “missing” the diagnosis a couple years back. Neither is my wife.

    The tests they did at the time indicated the “cysts” were initially deemed to be “benign.” (FWIW, the odds of this particular form of uterine cancer are roughly 1 in every 100,000 to 250,000 women–depending on which statistician you believe. The costs for the lab work needed to get a diagnosis in this case: >$7,000.) They aren’t gods, but they are businesspeople. Medicine is one of the few places where the patient usually lacks enough knowledge to know what to ask for or want. The patient is told what to do, who they are going to see, etc. With the amount of money forked over for a CT or MRI unit (and the staffing that goes along with it), health care providers have a vested interest in keeping those machines as busy as possible. Everybody gets a payday.

    It’s always easy to recommend procedures without regard to cost if you aren’t the one paying for it. And most consumers aren’t wise enough to check ahead with their insurer to make sure they don’t get a whopper of a bill in the mail.

    • MrE85

      First, let me wish the best for your wife. I hope she beats this. No one EVER deserves lung cancer, smoker or nonsmoker. We know that about 10 percent of lung cancers have nothing to do environmental exposure to tobacco or anything else. But since 90% do, you can understand why we focus on prevention for that group. If we can’t prevent, earlier detection offers some “high risk” people a better chance we believe is worth taking.

      Yes, these low-level CT scans ARE expensive, and they are not usually covered by insurance, including Medicare and Medicaid. That’s exactly why this new recommendation is so important.

      Under the new Affordable Care Act (Obamacare), cancer screenings
      recommended by the task force are to be covered by the government plans with no co-payment. And private insurance companies almost always follow the government’s led in covering these tests.

      • John O.

        Thanks! Most appreciated.
        In no way, shape, or form am I anywhere near teabag territory, but I am smart enough to know that there ain’t no such thing as a free lunch. Sure, the folks doing the scans can bill the government and/or the private insurer, but there is *still* a pricetag attached to it. The out-of-pocket might be smaller, but you and I both know that the economics of health insurance are not for the squeamish. Let’s just say I have pored over my health care bills with a fine-tooth comb.

        • MrE85

          You’re a savvy consumer. Most people don’t, because someone else is paying most of the bills. I have worked in health care (including a big HMO) most of my career, and there is plenty I don’t understand about costs and billing.

          • John O.

            Oh, I can shed some light on this topic. As the father of a $1M baby (in 1992!), let’s just say that the experience of looking at the billing sent to TWO insurance companies was interesting. This could involve a cup of coffee.

  • jon

    @#1) As for health insurance, not being taxed, is this a security net, or is this a policy decision being influenced by the tax code? I think this is an important distinction.

    If we are not being taxed so that we are encouraged to have health insurance, because having health insurance is cheaper for the government then not, ultimately this isn’t a benefit to the taxpayer on the side of “getting free money!” so much as it is “here is some money, earmarked for something that will keep us from charging more in the future.”

    Even with the mortgage breaks, we are encouraging people to own houses, in exchange we are taking less money from them, homeownership has been tied to lower crime rates, and higher property values… now assuming we lump city, county, state, and federal government into one large entity, then we can say that home ownership ultimately drives down the expenses the city county and state pay for police, and that it drives up the revenue from property taxes, If encouraging good behavior through financial incentives leads to improved financial situations how is that a safety net?

    I’d liken these things to an automotive analogy of this is encouraging people to do regular maintenance on their car rather than having the car break down on the side of the road and block traffic, or worse having the brakes fail and having them destroy not only their own car, but also do further damage beyond that…

  • Kassie

    re #1) I think it is a lot more simple than trying to stretch the tax code into “safety net” to get people to see they have used it. Ask them if they ever have used Unemployment Insurance or used their financial aid to pay for housing or food. Ask if they or a loved one have used Medicaid or Medicare or taken Social Security. Those are all very common safety net programs that the majority of Americans (or close family) will use sometime in their lifetime. And even if YOU don’t use them, if a close family member does, it may be what is keeping you out of poverty.

  • Starquest

    Simple way to determine if someone is dependent on some government service: take it away and see who complains.

    • John O.

      Ever complain about the road in front of your residence? Or waiting for the snowplow to come through?

  • spaz06

    Regarding A-Rod, I am incredibly happy to see him drag this to arbitration. His suspension is 4 times the length of anyone else’s, on a first offense and without a positive screen. He should challenge it on those grounds alone. More importantly, for the game, someone needs to make sure the owners, agents, and the league are cross-examined for their role in the steroid mess, and taking this to arbitration may accomplish some of that. It is a disgrace of the sports media in general that the players have received nearly 100% of the brunt of criticism for steroids when we know that agents, team doctors, and almost certainly owners were complicit and tacitly encouraged their use. If a-rod can make them sweat a little in an arbitration hearing, all the better.

  • kevinfromminneapolis

    Letting people keep their money via taxes is not a “safety net” unless you, like Keith Ellison, apparently, believe money belongs first to the government.

    • http://blogs.mprnews.org/newscut/ Bob Collins

      It’s a “safety net’ for the economy more than anything else. As we’ve seen, the economy is basically built around homebuilding. So encouraging people to buy homes encourages them to buy STUFF that trickles through the economy.

      That said, people who rent buy STUFF too. There’s no real reason to have a mortgage interest deduction and not have a credit card interest deduction other than to prop up the economy.

      It doesn’t really have anything to do with a philosophy of letting people keep their own money.

      • kevinfromminneapolis

        The whole article is based on the bogus assumption that letting people keep their money constitutes a “safety net.” It’s just another way of trying to sound academic and enlightened when what they mean to say is, “See, conservatives, you depend on big government spending, too.”

        What they should be studying if they actually want to provide something useful is why an economy as large and supposedly diverse as ours is so vulnerable to the ups and downs of one industry. But that wouldn’t garner them very many web links, I imagine.