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The overwhelming need for a Travis County hospital district should be obvious

By Louis Black, Fri., May 7, 2004

The choice to vote on May 15 for the creation of a countywide hospital district should be as easy a "yes" vote as there is in politics. Even in these anti-any-tax times, for Austinites this is simply asking county residents to pay the same amount for area hospitals that the rest of us are already paying. But it is about more than equity, which is why even county voters should support it. A reliable, steady funding source for area health care will benefit all of us over the long run. One of the myths of some taxes is that by voting them down, individual taxpayers save money. When it comes to health care, trust me, you are paying at some point or another. By creating a hospital district, you are not only limiting rather than expanding what you are going to pay, but in addition you guarantee a level of quality and comprehensive care that will benefit all of us (including you personally).

In the middle of what I'm afraid is evolving into a series of pieces on taxes, I might well be my own enemy. Even those not rabidly and foolishly anti-tax are bound to disagree with some of my assumptions.

But the hospital district is removed from that discussion. If you live in the city, you are already paying for the hospital. So why not get top value for your money? County residents should be willing to pay their fair share and should also appreciate the superior services additional funding will support.

The only organized opposition to this is the perpetually anti-tax crowd. Some of you are part of that; others agree. Long-embedded ostriches are far more prescient in their outlook.

It should be obvious that American health care is headed toward some kind of significant crisis. I say this as a partner in two companies where we pay 100% of our employees' health insurance and see annual rate increases in excess of 10% (averaged over a couple of years), while the services offered are continually trimmed. There's plenty of blame to go around, but we should at least start by considering the level of health care we've come to expect. The insurance companies moan about liability judgments, but their costs are driven by profit targets (hammered in recent years by weakened stock market performances), and despite granting the industry endless tax breaks, legislators have shown a serious inability to regulate them. There are also the staff costs for all the forms doctors' offices must complete as well as the banks of unnecessary tests as a consequence of malpractice suits.

(As an aside: Sen. John Edwards, fair-haired favorite of so many, got rich by suing over a debatable health procedure. Toward the end, he would cherry-pick the clients whose cases offered the most potentially rich awards. Earning millions, he was able to retire at 40. Not only do none of the doctors I know cherry-pick patients, but suggesting to any of them that they might have been well-off enough at 40 to retire would just lead to weary grins, as such a statement ignores their incomes as well as their sense of mission and responsibility.)

But without going too far down that road, if we acknowledge that health care and how it is paid for is in such a state of flux, supporting the stability of a Travis County hospital district seems even more obvious. On this one, for your and your family's own best health interests, vote yes.


MORE ON TAXES: There is a lot that might be said about our state and taxes (the situation getting even more surreal with the special legislative session's Peter Pan determination to "never grow up"), but for now the local spotlight should be on only the hospital district.

To continue on last week's theme, supporting taxes and the need for socially responsible government is not a blanket endorsement of all or any government spending. Certainly, it is always important to monitor expenditures, but contrary to anecdotal wisdom, the greatest waste in federal spending is not for social programs but for special-interest, lobbyist-protected projects.

Given they won by campaigning against "tax and spend" Democrats, Republican "tax-cut and spend" budgeting is almost black comedy. Although they have and will continue to cut spending on health, education, and social services, they're spending on military, homeland defense, personal pet projects, and pork as though the bills will never come due.

Instead of outrage at the spending, many of their richest allies continue to focus solely on tax cutting. I truly don't understand those among the very, very rich who are so loath to pay taxes even when they make absolutely no material difference in theirs or their descendents' lives. For the moment, let's even disregard the recent multimillionaires who, having sold a company for tens of millions, are willing to pay accountants and lawyers a couple of million for phony tax shelters rather than pay their fair share in taxes. The category here is only those of such vast wealth that the steepest tax payments wouldn't impact the ability to buy another house or a new jet or even touch the core fortune.

Consider that those who benefit the most from Bush's dividend tax cuts have stock worth tens of millions of dollars. One can own a substantial amount of stock – hundreds of thousands of dollars' worth – and earn relatively meager dividends (in most cases annual stock dividends, if any are even paid, work out to some percentage of a cent on each dollar of investment).

The Bush administration's ambition is to eliminate taxes on everything but income. If you are in a two-income family, both of you will be paying taxes; if your neighbors inherit millions in stock, they'll be paying none. Certainly, the very wealthiest Americans pay the greatest percentage of taxes collected. But we're not exactly talking a communist, utopian vision here of "from each according to his ability, to each according to his need." Even in the most extreme cases, there's a lot of money left after taxes. It's far less a redistribution of the wealth than a reasonable assessment on shared social costs. (I would argue that the rich, for a variety of reasons and in any number of ways, benefit from government far more than other citizens, but that is another discussion.)

Yet there are organizations funded by the very richest Americans whose main purpose is eliminating taxes. They do this by targeting legislators who've voted, at any time, against tax cuts. Sen. Arlen Specter was just challenged in Pennsylvania by a congressman whose campaign, though supported by a bevy of Republican true believers (who believe that there should be no diversity of opinion in the party), was heavily funded by one of the wealthiest, most narrowly focused anti-tax groups. Why do those who have so benefited from this great country of ours and mostly pay so little in taxes already want to pay even less? If they become tax-free, will the world really be a better place? Will their country actually be better served?

The goal is to eliminate taxes. In order to send a chilling message, the political targets are legislators who vote against tax cuts, regardless of their overall record.

The Alaskan congressman who bragged of getting $2 billion to build two bridges to nowhere is safe. The representatives and senators who pressure the government to keep funding extravagant military projects that the Pentagon no longer needs (or, in some cases, no longer trusts) won't be challenged. The pork-barrel champions of federal subsidies for mega-agribusinesses aren't even considered.

In a nearly unprecedented agreement a week ago, both The New York Times and The Wall Street Journal supported the World Trade Organization on the need to abolish U.S. cotton subsidies. Cotton is but one of the crops immorally subsidized (consider the despicable tax supports for sugar), a practice which not only creates an unnecessary financial burden for taxpayers but devastates Third World countries' indigenous economies, undermining their attempts at self-sufficiency. But don't expect the megarich to support campaigns to unseat these federal spendthrifts. They're too busy going after those who voted against tax cuts and, besides, in whose pockets do you think this federal largesse ends up? As far as they're concerned, far better to wipe out welfare fraud by destroying the social safety net than address internationally destructive, absolutely unneeded government spending.


(Although my column of two weeks ago was mostly a joke, it's time to get serious about marijuana. Its illegality a social/political perversion, it should be legal for all sorts of reasons. But the cost of enforcing the unnecessary pot laws, of prosecuting and jailing otherwise decent citizens, and the loss of potentially extraordinary tax revenue, especially in times of tightening government budgets occasioned by tax shortfalls, goes beyond immoral into the outrageously stupid. As funding is being cut for health and human services – denying aid to the sick, the poor, the mentally ill, and children – we're still paying to prosecute and imprison civilians. These priorities are so inhuman, anti-social, and twisted that I just sputter ...!)


The passing of any present or former Chronicle staffer is hard enough, but two losses within days of each other found our hearts heavy with grief. Sid Moody was a novelist and playwright who wrote on any number of subjects for us over the years. Don Palmer was on our production staff as a part-time typesetter for many years. Both passed away late last week. They were our friends and will be missed. end story

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