Skin in the game

George Will’s column today concerns Representative David Camp of Michigan, incoming Republican chairman of Ways and Means. Camp says:

Many conservatives, including Camp, believe that although most Americans should be paying lower taxes, more Americans should be paying taxes. The fact that 46.7 million earners pay no income tax creates moral hazard — incentives for perverse behavior: Free-riding people have scant incentive to restrain the growth of government they are not paying for with income taxes.

“I believe,” Camp says, “you’ve got to have some responsibility for the government you have.” People have co-payments under Medicare, and everyone should similarly have some “skin in the game” under the income tax system.

It’s hard to know what to make of such arguments. It includes the standard Republican move of noting progressive federal income taxes without noting that low-income people pay significant payroll taxes to the federal government, not to mention the state and local sales taxes these lucky free-riders pay every time they buy a toothbrush or a stick of gum. This “skin in the game” argument is also applied rather selectively. These days, anyway, few conservatives argue that everyone who might get hit by a car should have skin in the game by remaining insured. Maybe more people should pay estate taxes, for that matter. Very few us have skin in that game, which abets continued persecution of the dynastically wealthy.

Snark aside, though, Camp has a real point. Only he should apply it more broadly. Two hundred million Americans with decent health coverage have no skin in the game when they consider the millions of poor people who need to wait 12 hours in a cruddy public hospital emergency room or some overcrowded safety-net clinic. Most Americans have no skin in the game when Arizona Medicaid recipients find out that their heart, lung, or liver transplants will no longer be covered, when South Carolinians find out that Medicaid will not cover hospice care and will cut its weekly meals on wheels deliveries from fourteen to ten, when California Medicaid no longer cover routine dental care but at least still covers the eventual tooth extractions. Few of us rely on AIDS drug assistance programs, which are turning people away or placing them on waiting lists. To take an example at random, most Americans do not have to sit in a south Chicago welfare office with a disabled brother, waiting for hours under happy-talk posters say: “Work makes sense!”

Most of us lament from a distance the failing schools and unsafe streets of our inner-cities. Few of us are gay, or are college students who lack proper immigrant papers. We have no personal stake when Congress debates whether to extend benefits to the chronically unemployed. Few of us are uninsured people with preexisting conditions. Few of us depend on Food Stamps or TANF. Few of us are frightened young women dealing with unplanned pregnancies. (Few of us, for that matter, are National Guardsmen doing repeat tours in Afghanistan or Iraq.)

Will rightly notes: “Serious arguments about taxes are never just about taxes. They are about government’s proper size and purposes.” That’s for sure. Republicans assume the House majority with the general promise of austerity and retrenchment during a deep economic crisis. When influential constituencies have direct stakes in the resulting fight—as in the case of Medicare—we have a good idea how these arguments will be resolved.

I’m more worried about other matters, which affect the most politically and economically vulnerable people who depend on federal and state government. If more of us who politically matter had real skin in that game, we would see better and different public policies.