July 12, 2009 - July 18, 2009 Archives

'Bad Policy Any Way You Look At It' - Health Care Rx Panelists

'Bad Policy Any Way You Look At It'

| 3 Comments

It was very disappointing to see House Democrats' health-care bill. Every American should be disappointed that House Speaker Nancy Pelosi (D-Calif.), Reps. Henry A. Waxman (D-Calif.) and Charles B. Rangel (D-N.Y.) chose a partisan political power-grab over solving real problems. They dismissed the deep concerns of conservative Democrats like my friend Rep. Jim Cooper (Tenn.). They ignored the protests of small business groups. They ignored the American people who have said they favor sound, rational ideas to pay for real reform rather than raising taxes, exploding the deficit even further and destroying private insurance.

I found myself agreeing with the Washington Post's lead editorial on July 15. Their point against raising taxes was exactly right. They said it was "bad policy any way you look at it." An open-ended tax increase with a specific provision that it could go even higher in the midst of a painful recession?

Saddling small business owners with surtaxes, more mandates from Washington and penalties if they do not comply is fundamentally wrong. A National Federation of Independent Business report in 2006 said there were 1 million small businesses that employed five to nine workers with an average payroll of $375,000. All of them would see a 6 percent tax increase if they do not provide health insurance. Employers with payrolls above $400,000 in payroll would face an 8 percent tax increase. Around that level of payroll, we're not talking about corporate America. That's a local physician office, a hardware store, a restaurant, a community pharmacy or a retail shop.

Once this idea is defeated, we will have an opportunity to pass real reform -- meaningful reform that actually improves the quality of care, lowers costs and expands access without raising taxes during a recession.

3 Comments

After the "contract with America" and 12 years of republican congressional control, 6 of those years under a republican president, healthcare was the forbidden topic. Why should the likes of the Newt even have a comment here since we know all he will say is NO. NO universal healthcare, NO taxes for healthcare, NO overhaul of healthcare, NO NO NO.

The Post needs to find people who at least have alternate ideas or can justify the current broken system. Why bring NOewt into this discussion? You might as well have asked a Hells Angel to comment on the laws of the road or speed cameras.

What needs to happen, and healthcare will be a mess until it does, is to decouple healthcare from employment. My employer allows a choice of 6 insurance plans. My wife's office allowed 3. The Feds have something like 9 to choose from. Many have none. The price of the same insurance in different companies varies based on the group risk and employer coverage. But what is worse is that if I lose my job I still have homeowner's insurance, car insurance and other insurance I obtain on my own and not coupled with my employer. Ony healthcare seems to require employment to be affordable.

Decouple healthcare from employment so all have to buy it individually with laws to protect those with existing conditions. Let each employee receive their company's current contribution. Allow 50% or more of what you pay individually for healthcare to be tax free to avoid that additional income being taxed. Let people shop for health insurance as we shop for home and car insurance. With everyone on a level playing field rates should go down since they will become more competitive. The government should come up with its own health plan or subsidize some health plans for the poor.

As long as we keep this silly employer-based model of distributing health insurance we will always have uninsured and always the fear and risk of losing health insurance for something as unrelated to health as losing a job. The system as it stands is stupid and leads to a high rate of uninsured. Anyone can see that, even a Newt. Fix it NOW!

One would be hard press to consider any suggestion coming from "THE NEWT." As I recall in 1994, he was the architect of the 'INFAMOUS' "Contract with America", more like the "CONTRACT ON AMERICA".

He and his Republican lead House of Representatives set the foundation for this Mortgage Meltdown, and the Collapse of the Financial Markets, in 2008.

Every Safeguard, and Regulation to protect the consumer, was "MUTILATED", thanks to the "NEWTSER", and Senator Phil Graham(R-TX).

It's a "Sad Commentary", when the Washington Post has to turn to people like "THE NEWT", for Advice. Their Budget must be Dried up.

If Newt, "Told me the SUN was Shining, I would go outside and See for Myself."

"GIVE IT UP NEWT.'

Is this really correct. Here a comment that describes what I thought was the way it went:

"If you own a small business and file as an individual, on your Schedule C you get to deduct your operating expenses. That is, the money you spend on salaries, supplies, rent/mortgage, advertising, licenses and fees, depreciation on equipment does not count in your income!

Only if Uncle Joe clears a profit of 300,000 and chooses to draw it out rather than invest in new equipment or whatever would he show an income of 300,000. That is, he's really making 300,000 for himself, same as a "fat cat" who gets 300,000 on a W2. If Joe gets 300,000 in receipts and spends 290,000 of it on operating expenses, then his 1040 shows a whopping 10,000 in income.

Please, let's stop this "small business owners who file as individuals" line -- it ignores how the tax laws really work."

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This page is an archive of entries from July 2009 listed from newest to oldest.

July 5, 2009 - July 11, 2009 is the previous archive.

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Where's My Safe Driver Discount? - Health Care Rx Panelists

Where's My Safe Driver Discount?

| No Comments

I support the individual health insurance mandate and here's why: by allowing some folks to opt out of participation in the overall risk pool, we perpetuate an unfair tax on those who do purchase insurance in the form of cost-shifting. It's no different than getting into an accident with an uninsured motorist. When the uninsured show up in the emergency department, they are not turned away. The rest of us who pay our fair share for health insurance get the privilege of picking up the tab.

The most recent Census Bureau data I could find (2007) indicates that 40 percent of the nation's approximately 47 million uninsured come from households earning $50,000 or more annually. So it's not merely an issue of poverty. There's a huge cohort of "invincibles" who, for whatever reason, choose to forgo purchasing health insurance. Perhaps they work in a small business and it's not offered. Or, maybe, they don't see the value in it. Illness is what happens to someone else. They're young and immortal.

Whatever the reasons, the current non-system of health-care allows the perpetuation of an injustice. Here's what we ought to do: mandate individual coverage and verify it via the tax roster. For individuals living in poverty, coverage would be government purchased. For those working to escape poverty, but not quite there yet -- say up to 400 percent of the poverty level -- coverage could be government-subsidized in a tiered fashion if it's not offered at work. For those who want to purchase the least amount of insurance necessary, we would need clear definitions of minimum acceptable health plan benefits, say catastrophic coverage and slam-dunk type primary care and prevention (such as immunizations for the kids). And while we're at it, how about taking another lesson from the automobile insurance industry and stratify premiums based upon healthy behaviors? I'd like to see discounts for not smoking and maintaining a healthy weight.

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How Do We Fund What We Are Committed To? - Health Care Rx Panelists

How Do We Fund What We Are Committed To?

| No Comments

There are many dramatic failures in our current health-care system and the most striking is the inexorable rise in the number of uninsured in our nation. Further, we know that this group is complex and, to some extent (meaning that some individuals -- and we can quibble with exactly who and how many they are), must receive some subsidy to afford health insurance. How do we pay for this? We can continue to transfer our liability to our children and grandchildren or we can pay for it as we go.

Since I refuse to continue to transfer our generation's obligations to future taxpayers, I am forced to believe we should pay for it now. I would hope the cost of this program can be held to the minimum possible. I believe, strongly, that there are enormous savings that can be reaped from true reform. But, to the extent that we can not get to these savings immediately, we need to be fiscally prudent and generate appropriate revenue to pay our bills.

How then to generate revenue in a manner that does not stifle our economy? Perhaps the most appealing (but apparently politically-challenging) proposal is to "tax" employer-purchased health benefits that exceed a certain level. We have no obligation to federally-subsidize expensive health benefits when we do not provide any direct subsidy to the uninsured. I do not see this as taxing the rich, but rather merely reducing their federal subsidy. And I include myself in this group: my employer (Yale University) provides me with access to a generous health benefit and flexible spending account. Combined, I am receiving a federal subsidy that exceeds $3000 per year.

As a side-effect to reducing this generous federal subsidy, we might even find our workforce becoming more sensitive to insurance costs and medical decision making. This would not be a bad thing. Together with provider payment reform and better information to assist medical decision making, we might even be on track to achieving better health, rather than merely more health care!

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Only If You Like Killing Jobs - Health Care Rx Panelists

Only If You Like Killing Jobs

| 7 Comments

Tax increases are a recipe for wrecking health-care reform and the economy simultaneously. They would increase unemployment, decrease incomes, push up short-term health-care spending and leave long-term spending unscathed. Plus, the whole contraption rests on a spurious definition of who is and is not wealthy, doing its inequitable worst to small business owners and employees.

Let's begin with the spurious "wealthiest Americans:" 75 percent of small business owners (S corps, partnerships, sole proprietors) report business earnings on their individual income taxes. Typically, they reinvest the after-tax portion back into their firms to expand markets, hire employees, build facilities and buy supplies. For many, these new taxes would sap their biggest funding source, choking business growth and job creation. Bad idea in good times; terrible idea in a deep recession.

This tax most severely damages those firms experiencing the greatest success and producing the most new jobs. One-third of small business owners employing 20 to 200 employees earn more than $250,000 (after taxes and expenses). This bill effectively tells them, "Slow down. Don't grow. Don't create so many jobs." Even if an owner takes home very little and plows the lion's share into new jobs, this bill treats him as if he's the guy on the Monopoly board with cash flying out of tuxedo pockets.

In the short-term, the House bill would drive health-care utilization and prices upward. In the long-term, the bill would do little or nothing to push expenditures downward. The House should examine how the 2006 Massachusetts reforms are unraveling. The Bay State sought universal coverage while giving consumers and providers no incentive to economize. This coverage-before-cost gambit now imperils the state's fiscal stability and the state is beginning to dismember health-care reform itself.

President Obama calls the rapid rise in health-care costs "a threat to our economy" and a "ticking time bomb for the federal budget." The House Bill's tax increases would mainly serve to speed up the ticking.

7 Comments

BTW, here's the answer to the question I posed on last week's blog (I changed the $300,000 to $250,000)

"In fact, only 8.9 percent of people with any small business income have incomes of over $250,000 and, thus, would even potentially be affected by these provisions."

CBPP - http://www.cbpp.org/cms/index.cfm?fa=view&id=2697

Come on, Bob, I'm not going to argue about these nit-picking special cases. Just answer the question, how many people who are really small business owners have take home pay of over $300,000 for any reason?

Lensch's argument might work for some businesses. It's dead wrong for any whose production process extends over multiple years. Lensch views frugal, patient risk-takers as "fat cats" and proposes seizing the assets they use to create goods, services and jobs.

EXAMPLE ONE: John's business has one mature product (called ABC) and a new product under development (DEF). DEF won't hit the market till 2016. John uses 25% of ABC profits to pay himself a modest salary and hire researchers to develop DEF. As Lensch says, these salaries are deductible business expenses.

But from 2009 till 2015, John puts 75% of ABC's profits in the bank because the really big DEF expenses won't come until 2015. In 2015, he withdraws the money he has saved for six years, builds a factory, hires a sales team, hires production workers and begins producing DEF. With skill and luck, DEF is the big success story of 2016. Or maybe not, and John loses everything. Entrepreneurs take risks.

John lived modestly and carefully saved the funds he knew would be needed in 2015. Lensch implies that John spent those 6 years sailing his yacht and driving his Lamberghini around the Riviera. If Congress makes the same mistake as Lensch, they declare John a "fat cat" and subject him to punitive tax rates that assure he can never accumulate sufficient funds to finance the 2015-2016 launch of DEF. John never bothers to hire the researchers, marketers, construction workers and production line personnel along the way.

EXAMPLE TWO: Jim has a factory that earns $400,000 in 2009. He pays himself a salary of $100,000 and uses the remaining $300,000 to refit his factory with non-polluting technologies. The tax law says he must depreciate that investment over 30 years. That means he can only deduct $10,000 in 2009, $10,000 in 2010, etc. until 2038. After deducting his salary and this year's depreciation, the company shows a profit of $290,000. Once again, Lensch thinks Jim is going on safaris, hiring servants, and eating caviar for three meals a day. Lensch wants Jim to get a huge tax bill, even though Jim has plowed every single cent of the paper profit back into the company.

EXAMPLE THREE: Joe's company earns a $400,000 profit, but this doesn't become obvious until the November data come in. Joe plans to put every cent back into the company, but there's no time to spend it in December. He plans to do the spending in January. But Lensch's logic would tax it all away on the 2009 return because he can't spend it until a month into 2010.

These are just three examples. There are lots more.

Lensch is EXACTLY right.

Trust me (a fellow business owner) -- you have to be really raking it in if your accountant says "sorry, I deducted everything I could think of, and you're still going to be paying taxes on income of $300K this year."

Graboyes is a paid lobbyist who does NOT represent small business. Small business wants health care reform because they know that they'll save more on reduced premiums than they'll pay in new taxes.

The last thing we need is Enron economics from a convicted supply sider.

I think LENSCH answered the concern. I say tax the rich to pay for health insurance; after all, every time a Repuganacant is President us middle-classers get taxed to pay the rich.

Is this really correct? Here a comment that describes what I thought was the way it went:
"If you own a small business and file as an individual, on your Schedule C you get to deduct your operating expenses. That is, the money you spend on salaries, supplies, rent/mortgage, advertising, licenses and fees, depreciation on equipment does not count in your income!
Only if Uncle Joe clears a profit of 300,000 and chooses to draw it out rather than invest in new equipment or whatever would he show an income of 300,000. That is, he's really making 300,000 for himself, same as a "fat cat" who gets 300,000 on a W2. If Joe gets 300,000 in receipts and spends 290,000 of it on operating expenses, then his 1040 shows a whopping 10,000 in income.
Please, let's stop this "small business owners who file as individuals" line -- it ignores how the tax laws really work."

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About this Archive

This page is an archive of entries from July 2009 listed from newest to oldest.

July 5, 2009 - July 11, 2009 is the previous archive.

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Sharing Growth - Health Care Rx Panelists

Sharing Growth

| 5 Comments

Sometimes a picture is worth a million words. Take a look at this graph from the Center on Budget and Policy Priorities to understand why it makes sense to tax the very rich to help finance health-care reform.

It shows how much the wealthiest 1 percent of all households benefited from income gains as the country grew wealthier from 1946 to 1976 --and the degree to which the very rich shared in the nation's prosperity from 1976 to 2006.

During the thirty years following World War II, the wealthiest 1 percent enjoyed 20 percent of the gains, which is to be expected. It takes money to make money. Wealthier Americans are in a position to pay for education that will help them leverage their talents and they have the deep pockets to take advantage of the best investment opportunities -- buying stocks, real estate, businesses and other assets when prices are low.

But the vast majority of all Americans -- the lower 90 percent on the income ladder -- also did very well, taking in 80 percent of the wage benefits that came with the nation's growth.

By contrast, in more recent years growth was no longer widely shared. From 1976 to 2006, the mega-rich enjoyed 232 percent of the gains while the bottom 90 percent saw only 10 percent of the benefits. And in the ten years ending in 2006, the trend accelerated.

The share of the nation's income flowing to the top 1 percent rose from 15.8 percent in 2002 to 20.0 percent in 2006. "Not since 1928, just before the Great Depression, has the top 1 percent held such a large share of the nation's income," the Center observes.

When growth is no longer widely shared, things are out of whack in a way that threatens both the economic stability and the social solidarity of a nation. Asking the very wealthy to help finance health care for all is a step in the right direction.

5 Comments

Why should those who work hard have to pay for those that don't? I just dont understand that. The more you take away from those who work hard, the less desire there is to work hard. What happens then? If we teach our country to expect handouts we are going to be in real trouble. Great idea Obama.

Andy - I don't if what follows is correct, but it does match up with figures I have seen.

In the first case, when she talks about the top 1% she means income while for the bottom 90% she means wages (not all income)

In the second blooper, I think 232% was supposed to be 23.2% and it doesn't have to add to 100% because she is comparing the top 1% with the bottom 90%.

Make sense?

This particular article is either poorly written or drastically misleading. The author's statistics don't add up, which would lead one to believe that they are made up or propaganda.

The obvious typo where 1 percent of Americans made 20 percent of the gains whereas 90 percent of Americans made 80 percent of the gains is forigiveable (where is the rest of the top 10 percent of earners), but the comment of 232 percent of the gains going to the rich and 10 percent going to the poor is not. The second statistic must have a sum of 100 percent.

If I understand the two statistics (the apples and the oranges) correctly, it is the same as me saying that I make 20,000 percent of what I made 10 years ago (when I was a camp counselor), but my gains are only .00001 percent of the gains that all Americans have made in that time.

It is a drastically unfair comparison to make and misleads readers.

Those who prosper and benefit most in our nation should be asked, and be willing, to bear a larger share of support for the public policies that keep the country healthy, growing and strong. That includes national defense and the basic social-services safety net of which health care is clearly a part.

It's ridiculous to assert that a modest increase in income-tax rates will discourage hard work or business initiatives. Americans did quite well after World War II when tax rates were much higher than now.

A small tax surcharge on high incomes is a perfectly acceptable way to help finance an expansion of basic health care for those who lack it now. An overhaul of the federal tax system to restore more progressivity would be even better but that's plainly not going to happen this year.

"Sharing" as part of the liberal mantra is unidirectional and revenue-based: take from people that earn and give to those that do not. What about sharing on the cost, i.e. tax, side of the equation? What about sharing on the personal responsibility side of the equation? What about sharing on the family planning side of the equation? You don't make others successful by trampling all over those that have success.

Another liberal favorite is this statistic about how middle class wages stagnated from 1976-2006. This coincides with the baby boomer generation's rise in the work force. It's simple supply and demand. The baby boomers have caused displacement all along...they're now causing massive unfunded liabilities in existing medical entitlement programs. How about a plan where each generation needs to pay its own bills, and not stick it to generations before and after?

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Throwing Good Money After Bad - Health Care Rx Panelists

Throwing Good Money After Bad

| 1 Comment

The administration's proposed tax on the wealthy could supposedly raise $550 billion over the next decade, which is only half the cost of health-care reforms estimated to cost $1 trillion. But, the new tax proposal will lack widespread support since it will impose an enormous burden on small business owners who are not wealthy and generally report business income on their personal tax returns.

In addition, does it make sense to impose this tax on the highest income-generating citizens? Raising taxes on the "wealthiest Americans," and even small business owners, has been found, over many years, to produce lower revenue to the Treasury, not higher revenue. Lower tax rates reduce the incentive to avoid or defer current taxation and lead to higher Treasury tax collections.

Before more taxes are imposed to pay for a broken non-system of health care, why aren't we talking about fixing the system (or lack thereof) first? We are planning to throw good money after bad. All the money in the world will not make our current, fragmented non-system more effective until we all agree that the right provider needs to provide the right care to the right patient in the right setting for the right cost at the right time for the right reason using the right tools. This means allowing non-physician members of the health care team to treat patients under appropriate, mutually-agreed upon protocols and to be reasonably reimbursed. It means solving the litigation problem where many extra tests are being ordered to protect a provider against malpractice suits. It means supporting palliative care where people can die humanely and in the arms of their family. And it means more of a focus on incentives for prevention, better chronic disease management, healthier life style choices, etc.

Corporations like Safeway have figured much of this out for their employees and are installing such incentives with good results.

People are predictable. We have a huge industry now of tax attorneys who help the "rich" avoid taxes -- does anyone seriously think they will go away if taxes are raised even more?

We need to fix and right-size and systematize our health-care delivery non-system before we arbitrarily tax the wealthiest. And, by the way, we do not have 50 million hard-core uninsured - we have half that number. Let's also use the right data on the uninsured to drive decisions.

1 Comment

"Raising taxes on the "wealthiest Americans," and even small business owners, has been found, over many years, to produce lower revenue to the Treasury, not higher revenue. Lower tax rates reduce the incentive to avoid or defer current taxation and lead to higher Treasury tax collections."

I am sure Ms Conway - Welch is a fine nurse, but she should leave economics to others. She says, "Raising taxes on the "wealthiest Americans," and even small business owners, has been found, over many years, to produce lower revenue to the Treasury, not higher revenue. Lower tax rates reduce the incentive to avoid or defer current taxation and lead to higher Treasury tax collections."

This idea has been discredited many, many times and is believed by no respectable economist. The CBO has determined that the Bush tax cuts REDUCED tax revenue by almost $2 Trillion dollars.

If you don't want to go into the nitty gritty, just compare the Clinton Administration with the Bush II Administration. Clinton, with higher taxes, created 20,569,00 new private sector jobs; Bush created 417,000.

You can also compare the period 1946 - 1973 when marginal rates were over 70% with the period 1973 to the present. Real median wages grew 3 times as fast during the first period. In many ways we were much better of (except for the Rich).

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A Chance to Bolster Healthy Behaviors - Health Care Rx Panelists

A Chance to Bolster Healthy Behaviors

| 1 Comment

If tax policy will be explicitly molded to focus on paying for health reform, then it should be shaped to impact taxpayers' health behaviors. We are beyond the point where we can call this approach a "Nanny State." The first focus should be on America's obesity epidemic, which is bolstered by a food industry supported, in turn, by public policy and fiscal incentives. The evidence of this is broadly available in the work of Michael Pollan, the film "Food, Inc.," and David Kessler's latest book, "The End of Overeating." Other areas that require a strategic look are zoning for green spaces that encourage walkability in communities. Or what about tax incentives for growing local food?

When it comes to taxation, we need a more global and strategic view than "tax the rich." That may be a short-term strategy, but in the longer term tax policy should firmly focus on moving the U.S. toward healthy lifestyles and a healthy economy.

1 Comment

I am agreement with Jane Sarashohn-Kahn. Although meaningful reform to our health care system will require a lot more than a strong initiative to promote healthy lifestyles, there will be no cost control without it. We can tax all we want; there will be no cost control until we get our countries obesity issue under control.

Congressional analyses show that more than $200 billion over 10 years could be collected from new or increased taxes on sugared soft drinks, tobacco products and alcoholic beverages which account for much of our countries obesity and cancer problem. The Joint Committee on Taxation determined that a 3 cent tax on each 12-ounce sugared soda would raise $51.6 billion over a decade. It was also calculated that the government could raise $61.5 billion with an additional alcoholic beverage tax by charging 40 cents more for a fifth of liquor, 48 cents for a six-pack of beer and 49 cents on a bottle of wine. Federal alcohol taxes were last raised in 1991. If you adjust for inflation, they are 37 percent lower today. Opponents of these taxes say that this will disproportionately affect lower-income people. Proponents say that the poor have the most to gain from universal health coverage.

I believe that this is responsible taxation; tax the problem and let the dollars raised be used directly to get the problem under control. If President Obama has a fight, it’s against all of the political interests that keep America among the worst when it comes to obesity and overweight.

There is not miracle fix, but there are reasonable immediate actions we can take. Probably the biggest issue is that there is too much emphasis on entitlement and hardly any focus on changing consumer behavior and individual accountability. Studies show the most significant factors leading to increased health care costs are: obesity & overweight, alcohol and smoking—all health choices that individuals largely have control over. With appropriate incentives for adopting healthy behaviors and penalties for not doing so, we can significantly reduce health care costs.

(1) Substantial tax increase on unhealthy activities such as alcohol & smoking
(2) Stringent rules, taxes and incentives for behavior modification to reduce alcohol consumption and smoking
(3) Tax incentives to heavily encourage physical activity and better lifestyle choices

Brian Jolles, Ellicott City, MD
President, Jolles Insurance & Financial


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Lets Tax Everyone Instead - Health Care Rx Panelists

Lets Tax Everyone Instead

| 4 Comments

I think everyone should be taxed to pay for health care. Each time my husband or I have had health insurance provided by an employer, a co-pay was deducted from our salary. These co-pays average over $500 a month. That is almost 10 percent right off the top! Each employee was charged the same co-pay, so this would mean almost 25 percent of an entry-level salary of $25,000 went to health care. A 1-2 percent tax would be far more affordable, more fair and quite practical. Increase that to a 3-5 percent tax for the wealthiest making over $250,000, and health care could be covered.

I am not a proponent of higher taxes. However, I am pragmatic and know that taxes are essential to pay for infrastructure, defense and other important services that contribute to the progress of this nation. It is my conviction that health care is as significant as these and warrants the same status. It is reasonable then that taxpayer money should be used to cover the cost of providing health care to all Americans.

Americans pay slightly lower taxes than nations such as Canada, France and Australia that have universal health care. People in these nations however enjoy a longer life expectancy. It seems that Americans are paying for a lower tax rate with their lives. If a slight increase in taxes can contribute to a healthier longer living nation, then it's worth it.

4 Comments

Assuming extra taxes are required for health-care reform to be budget neutral - which the proposals to date are not - I think all taxpayers should contribute on a pro rata/ percentage basis. Everyone treated equally and have a vested interest.
Don't know if all 47mm should be the target for coverage since 16mm make 50k/yr or more and elect not to have health insurance plus another 10mm are not USA citizens!!

"If you take lives lost to crime out of the equation, the United States ranking improves as we move from to the bottom to the top of the list in terms of longevity."

Does taking crime out improve our infant mortality? birth weight? life expectency after 60?

Look, there are 16 basic bottom line public health statistics and we are at or near the bottom in each. Do you have separate explanations for each?

How do you "take out" obesity from these statistics? Also the Australians are about as obese as we are and they have better outcomes than we do and they pay about half as much as we do.

At some point Friar Occam has to step in and point out that all the other countries have some form of government run health care system.

Kathy,

I have been hearing your statement below in a lot of arguments in the health care reform debate. You wrote:

"People in these nations however enjoy a longer life expectancy. It seems that Americans are paying for a lower tax rate with their lives. If a slight increase in taxes can contribute to a healthier longer living nation, then it's worth it."

These conclusions are completely out of context and I'm not sure why we are not hearing more from our experts to clean this up. Here are two things to think about the next time you hear that the US is among the bottom when it comes to life expectancy:

(1) If you take lives lost to crime out of the equation, the United States ranking improves as we move from to the bottom to the top of the list in terms of longevity.

(2) The United States ranks among the bottom when it comes to obesity and overweight. This is cultural. If we could find a way to take lives lost and health care costs associated with obesity out of the equation, once again, the United States goes right to the top of the list.

Having said this, I fully agree with you that the right tax strategies can go a long way to funding health care solutions. Unfortunately, whenever we raise taxes, the money raised doesn't seem to go to where it was intended. Sin taxes for smoking and drinking should go to improve health care and, more specifically, to deal with alchol, obesity and smoking. Taxes on highways should go to build infrastructure. Taxes on guns & ammunition should go to fight crime.

Hi Kathy - Ellen:

"Americans pay slightly lower taxes than nations such as Canada, France and Australia that have universal health care."

You did not mention that they don't pay any insurance premiums to private insurers. When you add up all the health care spending, we spend twice as much per person as these countries (and every other industrialized country).

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Taxing Isn't the Answer - Health Care Rx Panelists

Taxing Isn't the Answer

| 1 Comment

I am very hesitant to endorse paying for health-care reform by taxing the wealthiest income earners. An initial surcharge has been proposed, ranging from 1 to 3 percent with the probability that those percentages would increase in two years if the new programs prove to be very costly. Certainly health-care spending is increasing at unsustainable rates. Looking for more revenue to feed the current system is like trying to lose weight by eating more. It does not work that way. Instead we need to keep our focus on improving the system and identifying ways to reduce health-care spending.

As President Obama has pointed out, there are several examples of exemplary health-care systems throughout the country that are providing care at significantly lower rates than other systems. For example, the Progressive Policy Institute estimates that the Mayo Clinic costs the government 17 percent less than the national average for treating Medicare patients with major chronic diseases. Since health-care spending in the United States reached $2.4 trillion in 2008, duplicating the savings achieved by Mayo Clinic on a nationwide basis could help take care of at least part of the costs of reform.

No matter how you look at it, funding health-care reform will be a challenge. But a plan that proposes a tax increase to the wealthiest income earners instead of a focus on decreasing health-care spending is not the answer.

1 Comment

"But a plan that proposes a tax increase to the wealthiest income earners instead of a focus on decreasing health-care spending is not the answer."

I agree, but getting all physicians to join in a Mayo Clinic type practice will take years. Why not pass HR676 (Medicare for All) now. The $500 Billion we will save each year by the elimination of the high overhead and compliance costs of private insurers and high drug company marketing costs will pay for this expansion. AND we will be in a better position to push physicians into more efficient practice.

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Brother Can You Spare A Dime? - Health Care Rx Panelists

Brother Can You Spare A Dime?

| 4 Comments

"Come now and let us reason together." The text, taken from the book of Isaiah, resonated with me as I sat in my church's weekly leadership class. Our senior pastor and bishop, a former corporate professional, schooled us on coalition building, framing the argument and, ultimately, swaying critics. Though the intended topic was not health-care reform, the message was timely. As Congress has shown, winning consensus can be a heroic feat of high-wire acrobatics.

In maneuvering to overhaul the American health-care system, legislators could further jeopardize our fiscal health if we fixed health care on the backs of the "rich." Although we cannot afford to preclude tax hikes of any variety, we must prioritize sound choices, especially since personal revenues are shrinking and defining the wealthy has become somewhat arbitrary.

A counterpoint: Those who are more affluent can bear the cross of steeper income taxes because of the trade-off of lower insurance premiums. In addition, supporters argue that the rich game the system through loopholes and deductions, thereby avoiding their fair share of the tax burden. Though these claims are valid, they underscore another political hotbed: re-evaluating the current tax code. Instead of an added surcharge, however, other judicious alternatives could include capping itemized deductions, allowing the Bush era tax cuts to expire and levying fees on the pharmaceutical and insurance industries ---two stakeholders not to be allowed off the hook.

Difficult problems often require difficult positions. Still, we are obligated to wade through the tedious wrangling and arrive at the right solutions -- the best fit given the precarious economic climate. At a time when seemingly no family has been spared, there are better ways to fund the restructuring of the health-care system other than higher income tax rates. Although a clever blend of savings and new spending is warranted, bullying the haves with excessive taxes and pitting the have-nots as their proverbial foe is, frankly, dated and unimaginative.

The key to subsidizing health-care reform appears to be choosing the most appropriate tax without placing undue constraints on the have-nots, the haves and the have mores. Further, shouldn't health-care reform actually be reflected in some behavior which directly affects health? Legislators have passed over an excise on sugary drinks, sodas and alcoholic beverages, which would present a rather viable option. Mere cents on the dollar could turn into billions, make inroads in the obesity epidemic and prove pivotal in showcasing wellness efforts. In the past, smokers have been penalized, so why not imbibers? Particularly since the benefit would be felt both in the nation's pocketbook and the public's waistline.

The majority of Americans are primed for comprehensive health-care legislation. As such, financing must be creative and diverse, and not burdensome during a fragile economic recovery. It seems Congress could have benefited from leadership class that night.

4 Comments

Nice job summing up both sides objectively.

I sway towards doing things more socialistically when it comes to providing a basic necessity. I think to whom much is given, much should be expected.

"COME NOW LET US REASON TOGETHER."

Profound words of Logic, if only the Elected Representatives would join together and work out a "VALID HEALTH CARE PLAN".

The Republicans have labeled themselves the "INFAMOUS PARTY OF NO", and the so-called "BLUE DOG DEMOCRATS", are posed to throw a 'WRENCH', into the Health Care Plan.

In this "GOD FORSAKEN COUNTRY", 'MONEY MATTERS, I repeat "MONEY MATTERS."

The Health of this Nation, to those in POWER, is 'IRRELEVANT'. That's the main reason Health Care for all Americans has been put on the "BACK BURNER", for over 50 years.

The people and Corporations who make 'Billions of dollars each year, refuse to give it up.

If Children, Seniors Citizens, working Class people got to suffer and "DIE", "OH WELL!!!!"

The "PROFITS", are to high with the Health Care System that exist, and as long as the General Public, remains "HOODWINKED, and CONFUSED." The Insurance companies will continue to make out like 'BANDITS'.

This article accurately sums up both sides of the healthcare debate, but it seems that no one wants to compromise in order to overhaul the system.

Myth - "It will be very expensive to get good health to everyone."

Fact - Actually there's a way we can have better universal health care at no more than we are now paying (see 5. below). Here are the facts (cf. www.pnhp.org):

1. We waste $100 - $200 Billion a year on the high overhead of insurance companies.
2. We waste $200 - $300 Billion a year on doctors filling out forms for insurance companies.
3. I don't know the compliance cost of patients fighting with insurance companies, but it must also be in the 100's of Billions.
4. We pay the highest drug cost in the world to drug companies that spend twice as much on profit and three times as much on "marketing" as they spend on research. This is about another $100 Billion each year.
5. Because of the above, we could give Super Medicare (few limitations, no co-pays, no deductibles and complete drug, dental & mental coverage) to everyone at no more cost per person than we are now paying.

Other countries with single payer systems get better health care as measured by all the basic public health statistics and they do it at less than half the cost per person. If we build on our rotten system, we will get a health care system with rotten foundations.

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There Is No Easy Way to Greatness - Health Care Rx Panelists

There Is No Easy Way to Greatness

| 5 Comments

Taxing the rich to give to the poor: this is how the debate on financing health-care reform has been framed. This inevitably puts the "haves" against the "have-nots" and will create deeper divisions within our society with great consequence. And once this happens, we will no longer see our individual efforts in advancing society as mutually beneficial. Instead, there will be more credence given to harsh criticisms about who deserves what and who should foot the bill that compromise our professed values.

As difficult as this discussion is, the debate is forcing us to re-evaluate our collective and individual perceptions and value systems. For example, what does a wealthy American look like -- a Republican CEO of a Fortune 500 corporation or a social entrepreneur who happens to be a liberal Democrat? How about what an uninsured American looks like -- a small-business owner living with multiple chronic illnesses, the 10-year-old child whose parents can't afford insurance despite holding multiple jobs, or hard-working conservative family living in low-income housing? Does either group deserve to be less healthy than the other? Chances are they do not fit the neatly packaged stereotypical images used to defend or denounce proposals to fund health care. Reliance on them prevents us from focusing on the real issue--the health of our nation. Our nation's health does not solely rest on the status of the 50 million uninsured (though this is an important priority). It also relies on curbing health care costs, supporting efficient delivery of quality health care and investing in mechanisms that promote health. These will only be accomplished by all of us working together, doing our part. Focusing on these things will lead to substantial dividends.

So does taxing the wealthy Americans get the job done? It is part of the answer. I once heard it said that there is no easy way to greatness. By extension, there is no easy or unanimously comfortable way to finance our health-care system. Invariably, some concessions will have to be made. But, this is one time where all of us, rich or poor, sick or healthy must look in the mirror and ask what investment we can make to improve our (collective and individual) health. And how we frame the issue will necessarily dictate how we solve it. The "us vs. them" platform will hinder us from seeing that we all deserve to live healthy, productive lives with a health-care system that supports this and that we each play a significant role in making it happen. It may not dampen the angst that comes with the word "taxes," but it will help us align our values with our goal of having a healthier, more productive nation.

5 Comments

Insightful article addressing some very valid points about the complexity of health care issues

I dont believe that the burden of health care rests fully on the shoulder (or dollars) of hard working americans. The target should be improving the system by regulating those who are directly responsible for the delivery of health care. Contrary to what the... Read More Obama Administration thinks its not within the hands of doctors and nurses as we sold our professions to big business long ago and have yet to reclaim our professions and place as health care leaders/patient advocates. The major burden lies with the insurance and pharmaceutical companies who regulate what and how much we can provide as clinicians. Clean up the system 1st before creating an alternative plan that doesnt have the funding, and may/may not work. Easier said than done, but thats my take.

I dont believe that the burden of health care rests fully on the shoulder (or dollars) of hard working americans. The target should be improving the system by regulating those who are directly responsible for the delivery of health care. Contrary to what the... Read More Obama Administration thinks its not within the hands of doctors and nurses as we sold our professions to big business long ago and have yet to reclaim our professions and place as health care leaders/patient advocates. The major burden lies with the insurance and pharmaceutical companies who regulate what and how much we can provide as clinicians. Clean up the system 1st before creating an alternative plan that doesnt have the funding, and may/may not work. Easier said than done, but thats my take.

These ideas are very true and this nation must focus on prevention in regards to a lot of healthcare issues.

A reasoned approach to a serious issue. We should heed her words.

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A Simple Answer: Yes - Health Care Rx Panelists

A Simple Answer: Yes

| 2 Comments

Should wealthy Americans see their taxes stepped up by a modest 1 to 3 percent in order to help dramatically overhaul a health-care system that is torpedoing our economy and leaving tens of millions of our neighbors sick and scared?

The simple answer: yes. Yes. Yes. Yes.

Health reform must be one of the nation's top economic and social priorities. We have seen how all of us -- from our industries to our families -- have been hurt by fast-rising premiums and increasingly inadequate health care. But we must find a way to pay for the reform we desperately need.

A modest levy on the wealthiest 1 percent of Americans is the most fair, equitable and sensible way to cover the costs. As this chart from The Atlantic shows, the effective tax rate for the nation's top 1 percent of income earners has dropped dramatically since the late-1990s, even as real wages for working people have stagnated or even fallen. Other potential funding ideas -- such as cutting the charitable deduction rate or taxing employer-sponsored health-care benefits -- could cause direct or indirect harm to low-income people at a time when they can least afford it.

Rep. Charles Rangel's (D-N.Y.) proposal will not, as some critics suggest, levy an undue or onerous burden on the nation's wealthiest people or be a "job-killer." It will simply bring wealthy Americans' taxes back to Clintonian levels - a time of great and shared national prosperity. It is time for the nation's wealthiest to forgo their out-sized gains of the Bush years and return to a time of a more reasonable and progressive tax structure -- and save countless lives in the process.

2 Comments

I live a frugal life. I earned my way. At one point the plan was to tax those with household income over $250K. THAT IS NOT WEALTHY. Furthermore, if you take from me I must take elsewhere. Which charity do you not want me to contribute to? Should it be United Way, Habitat, my church, that I give less to becuase my goverment decided to choose my "charity" for me.

Lastly, this plan has nothing to do with how health care gets delivered. No homeless person gets more or better coverage because they have coverage under this plan. No single parent with three children gets to the doctor any easier during the normal work day because now they have coverage.

This ia bad plan. Ill-formed and ready for disaster.

Basically we'd be restoring the rates that the wealthy were paying before the Bush tax cuts. They were rich before Bush's cuts so what would keep them from still being rich after their tax rates were restored to pre-Bush levels?

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Who Pays for Whose Heath Care? - Health Care Rx Panelists

Who Pays for Whose Heath Care?

| 3 Comments

Fellow citizens, we're all already paying for health care whether we realize or not in the form of:

• Lower take-home wages so employers can pay the premium on health insurance
• Lower take-home pay via Medicare tax on wages
• Partial payment of premiums, co-pays and other out-of-pocket expenses
• Other taxes (income or real estate) so the States can fund their portions of health benefits for employees and for their entitlement programs
• Higher prices on goods and services from businesses so they can pay their taxes

As of the latest income tax data available, the top 5 percent already pay 60 percent of total income taxes. By definition, there is a limit to the number of services for all that can be subsidized by a few.

The political debate is often framed around covering the uninsured. At the heart of this is the supposition that health care is a moral obligation -- that everyone has a "right" to it. But it's difficult to separate the moral from the economic because there is no other "liberty" that requires payment. Simply put, health care has to be provided and paid for either directly or indirectly. The key question is who pays for whose health care.

The many behavioral choices an individual makes can dramatically alter the cost of health care over the course of his or her life. If health care were a right, does one have the right to all the health care one can consume and no accountability to society on how it is consumed? If not, who decides how much health care to deliver and who pays for it? As a taxpayer and citizen, in addition to being accountable for my family's health needs, for how many others should I be accountable? Such a society or social bargain cannot be sustained over time, as the Romans and others discovered.

The most important health reform problem we need to focus on now is not access, but rather how to create a framework to get more value from our current spending. If we were to improve the value delivered (health outcomes/economic inputs consumed), there would be more dollars available to cover the disadvantaged (social, economics, genetics). Without improving the former (value delivered) there is little chance of affording the latter (more coverage).

3 Comments

As with all health care issues, behavioral choices are crucial. We are living in a society were there are many addictions: smoking, alcohol, prescribed and unprescribed drugs,eating disorders, etc. Are we going to be able to force people to stop these addictions, without the ACLU coming after us? The choices we make and the liberties we enjoy in this country are wonderful. Are we willing to give up the right to our freedoms in order to pay for the healthcare of others? Are we willing to close all of the fast food eateries and soft drink companies, putting more people out of work?
At what point will I be able to take away someones Big Mac as they are about to eat. I should'nt be responsible to reimburse him/her for that meal, it's part of my tax dollars at work.
If we are going to some form of national healthcare it needs to be paid for. Remember what it says in the constitution. Promote the general welfare. where I grew up, promote does'nt mean right. We have no right to healthcare. It is a privilege! One of the "benefits" we look for when we are looking for employment is do they provide healthcare? I was never taught benefit or promote meant "right".

It's not a matter of who pays for whom. If we decide as a country we want something, like roads or military, we have to go to where the resources are to fund our needs. These resources should not be tapped discriminatorily. Everyone should pay their fair share, not to pay for their own service, but to fund the program overall. If the rich have to pay more, so be it.

"As of the latest income tax data available, the top 5 percent already pay 60 percent of total income taxes. By definition, there is a limit to the number of services for all that can be subsidized by a few."

This is a fake statisitc that is often quoted and is simply reflective of the fact the the richest 1% is taking more and more of the income of the country. Why just restrict to looking at income tax?

In any case the bottom line is that the rich are not suffering, but simply getting richer and richer at an ever increasing rate.

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Higher Taxes? For Whom and for What? - Health Care Rx Panelists

Higher Taxes? For Whom and for What?

| 4 Comments

It was inevitable that Congress would float a tax proposal once they recovered from the sticker shock of health reform. Taxing the wealthy seems appealing. Why shouldn't the well-to-do help less fortunate citizens afford health care coverage? After all, other countries like Great Britain and Canada have higher taxes to cover such benefits.

This simple approach is more complex than it seems.

1. If we increase taxes--who will actually pay?
Our tax code is designed around net income rather than gross income. The very rich routinely structure their income to avoid taxation. If we increase taxes for "the rich," I suspect very few of these folks will pay much more.

2. As we bail the government out of its stimulus debt, how much taxation will the public endure?
Our federal liabilities are substantial -- two expensive wars and the recession recovery with its stimulus and bailout packages. These are intimidating obligations, not to mention Medicare, our national health-care entitlement. Faced with these realities, will the average taxpayer tolerate even more taxation to cover the uninsured?

3. Without a national health system, will we be throwing tax money into a black hole?
Before taxpayers dig deeper, they will want to know what they are paying for. Unlike Canada and other western nations, we have no organized national health-care system. Given that vacuum, where will these tax dollars go? Are they to build a durable health system or just pay for more escalating health-care costs?

Before they raise taxes, Congress and the administration must have good answers to these questions. Otherwise, angry taxpayers will make their feelings known in the 2010 elections.


4 Comments

Everyone seems to be talking about how much this program is going to cost, yet, there is NO program. If everyone is covered by some sort of health plan, national or private, then why do we need Medicaid/Medicare?
After all, we are already being taxed for these programs, and this money could be used to help pay for whatever it is that Congress deems we need.

Thanks for the comments. Our effective tax rate is lower than some countries because our tax laws are based on net income. True universal health care requires a reliable, equitable payment system that charges higher premiums for those who can afford them. If based on taxes, this revenue stream would require Congress closing many tax loopholes for the wealthy.

Now that would be REAL reform !!

Excellent points about the net effect of taxation, Dr. Kelley.

It seems, however, that you are engaged in an argument two or three steps beyond our Congress...they're still fighting over whether the wealthiest people in the wealthiest nation on earth should deign to pay their fair share.

Your point about the need for a national health care system is well-taken...and I hope it gets more traction. Seeing Congress stuck in this twenty-five-year-old stale Reaganomics debate is incredibly frustrating.

I strongly agree with 3., but not with 1. and 2.

If 1. is correct, the right thing to do is to close the loopholes.

As for 2. the US whose overall tax rate is26.4% is among the lowest in the industrialized world. Sweden's tax rate is 50.2%, Spain's is 35.6%. BTW both of these countries have higher growth (per capita GDP) rates than the US.

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Uncle Sam Is No Robin Hood - Health Care Rx Panelists

Uncle Sam Is No Robin Hood

| 6 Comments

This is the United States of America, not jolly ol' England. The last time I saw a drawing of good old Uncle Sam he was not dressed as Robin Hood. Take from the rich to give to the poor? Since when is that the motto in America?

This is supposed to be the land of opportunity. You work, you earn the money, you must pay taxes and what is left is your profit. Making a profit, working hard to reap the rewards are an integral part of capitalism, are they not?

It's anathema to me to see this brilliant idea coming from the same administration who has run up our debt to such an alarming level as well as planning to give more bonuses, in the millions, to all of those executives at AIG, etc. with money from the "stimulus" measure. What is wrong with this picture?

This would be laughable if it weren't so tragic in it's destruction of the very opportunistic values that separate this great country from others. "Go west, young man and you'll lose your shirt, and don't bother to build a business 'cause you'll lose your pants, too."

6 Comments

Well, we all know that those who have do not pay as much tax as they should, they have good employees to make sure they don't. Just as we try to not pay as much as we have to. There are loopholes aplenty for those who seek them out. I can't say I blame them, do you ?
I do however think it is time to take back our government from this guy who is trying to turn us socialist. He would love to be a dictator. All hail Cesear !
What you earn should be yours. If I were making billions of dollars, I wouldn't want it taken from me just because I have it. Just as I don't want my pittance taken from me now.
My only tiff with the IRS and the wealthy is that if we owe them $200 they will stock pile interest and charge on it until we owe $1000 in a year, then freeze our accounts to get it. The wealthy owe for years, and nothing is done.
How can we live and pay taxes and taxes and taxes ? The line has to be drawn somewhere. And QUICKLY !

DOPS:

I wish people like you would look further into those statistics.

Of course over 50% of taxes comes form 5% of the population. This is unfair. What would be fair is if we had a more progressive tax structure so that if 90% of the wealth is held by only 5% of the population (as it is) they would then pay 90% of the taxes. That only seems fair.

No one is saying the rich and corporations don't pay taxes, but to think they pay their fair share is ludicrous. Not only does the tax system get less progressive as the income level increases, but there are so many easy loopholes that the average rich person only pays 18% in taxes. Warren Buffet challenged his fellow billionaires to show they paid a higher tax rate than their secretaries - so far no one has been able to.

I wish people who think that a releative few corporations and upper-income taxpayers don;t pay any taxes would check the statistics on this. Over half of the the Federal income taxes come from about 5% of the population. Nearly half of the population pay not income tax at all, after credits.

Tax "loopholes" were created by congress to provide for special circumstances, presumabley in the national interest. if these are abusinve, Congress should change them. if they are not abusive, Congress should defend them.

At what point in time does someone paying 40-50% of their income to stae and federal taxes constitute a "fair share?"

People should be allowed to succeed in this country. And if a few people take the risk, invest their future, and make it big, why should they be so severely penalized?

Chances are that a whole lot of people who make a lot of money, took a chance on losing it all. Chances are, they created a lot of jobs and contributed a lot through the consumer channels. Giving a little credit here would be good.

Posted by: DOps

-Would you mind quoting what the tax rate was for the richest individuals was before Reagan came along?

After doing that would you mind telling us how innovative and successful we were at the time?

At most we're talking 5.4%.........on incomes of over 1 million dollars. What is wrong with you?

Robin Hood was a man who lived in Jolly Ole England. There were Kings, and Queens, all royals, for sure. There were peasants, who did not own anything, who toiled, and tilled, and sewed, and watched over the King's land.

Painting a picture of Robin Hood as the U.S. Government is silly. While it is true that the West was won by hard working farmers and loggers, there were plenty of "rich folks" who ran railroads, shipping companies, and factories.

The pursuit of Life, Liberty and Happiness is not the exclusive dream of "rich folks" is it? Rich folks, typically in the West, earned their status, with the help of many hard working men and women.

But imagine how the first transcontinental railroad could not have been built without so many men and women working together for a common goal. Isn't it ironic, that once the railroad is built, when the last spike is driven, that spike become the "last nail in the coffin" for the sick and tired workers. Those workers were thrown off the train, and moved over to the "other side of the tracks" in shanty towns. Who needs those hard working folks, after they have finished a life of "workin, sweatin, and prayin?"

The argument of "I have earned my health benefits by my own hard work" doesn't hold any compassion for exploited immigrants, the poor, or any unskilled workers. After all, those guys are "lucky to get minimum wage."

The story of Cain and Abel teaches us that "we are our brother's keeper." Few of us live in isolation, behind a moat, where our every need is provided by peasants. Even fewer of us live in the Garden of Eden. How much longer can we ignore the "web of life". Taking care of the sick and poor may not be "profitable", but it is "ethical."

I wish people who think that a releative few corporations and upper-income taxpayers don;t pay any taxes would check the statistics on this. Over half of the the Federal income taxes come from about 5% of the population. Nearly half of the population pay not income tax at all, after credits.

Tax "loopholes" were created by congress to provide for special circumstances, presumabley in the national interest. if these are abusinve, Congress should change them. if they are not abusive, Congress should defend them.

At what point in time does someone paying 40-50% of their income to stae and federal taxes constitute a "fair share?"

People should be allowed to succeed in this country. And if a few people take the risk, invest their future, and make it big, why should they be so severely penalized?

Chances are that a whole lot of people who make a lot of money, took a chance on losing it all. Chances are, they created a lot of jobs and contributed a lot through the consumer channels. Giving a little credit here would be good.

Obama is hip to the reason why Robin Hood robbed from the rich. It is because the poor don't have any money. Obama did discuss his plans for the redistribution of wealth during his campaign. It was no empty campaign promise. Now he can put a feather in his cap like his English mentor.

Our Byzantine tax code and congressional meddling created massive loopholes for big corporations and wealthy individuals.

Rather than reform taxes, Obama chose to raid the treasury, print more money and soak the rich in a multitude of new ways. This has a tendency to stifle new investment and promote companies to move their manufacturing to other countries.

Now his economic advisors are suggesting a VAT (value added tax) like they have in Europe. This will wind up soaking everybody if it is implemented.

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Death and Taxes...or Taxed to Death? - Health Care Rx Panelists

Death and Taxes...or Taxed to Death?

| 3 Comments

Only two things we're certain of: death and taxes. Or being taxed to death...

The recent House Democrats' proposal to raise $550 billion over the next 10 years by increasing taxes disproportionately on the nation's wealthiest earners seems to be the approach gaining most traction -- for now. If it comes down to an either/or type of situation -- that is, to increase employers' payroll taxes in a "play or pay" scenario or to increase individuals' tax burden -- it's most likely that individuals will be paying more taxes in years to come, perhaps as high as 45 percent for the richest Americans.

The real kicker here is that this may not be an either/or deal. The $550 billion over 10 years is only expected to cover about half of the cost of health-care reform. So, employers and wealthy individuals may both be made to cover the cost. Which begs the real question: why would we be willing to add $1 trillion to the already over-bloated cost of buying health care in this country?

As I have stated before in these pages, we need to think in terms of health-care reform as distinct, but inseparable from, health-care transformation. Folks much smarter than I who have analyzed the state of U.S. health care have determined that about a third of what we are spending, or approximately $800 billion annually, is, in the aggregate, muda. Muda is a fantastic Japanese word, by the way, a favorite amongst the "lean transformation" crowd. It sounds like what it represents: waste. ("Oooh... Look there! Muda! Sure glad I didn't step in it!") So anyway, why would we want to raise taxes, whether payroll or individual, to perpetuate such inefficient health-care spending?

In a perfect world we'd penalize neither employers nor the wealthy but instead strive to emulate the best Lean practices from places like ThedaCare in Appleton, Wis. Instead of being forced to choose between the lesser of two evils it's time to begin focusing our energies on the lean transformation of health care: to take waste out of system.

3 Comments

"The subjects of every state ought to contribute towards the support of the government, as nearly as possible, in proportion to their respective abilities..."

Adam Smith, The Wealth of Nations.

When the Cheney/Bush Administration rallied the Nation to go to WAR, with IRAQ, was cost an "ISSUE"?

For 8 years the cost of the WAR, was not reflected in the "FISCAL BUDGET", and no one complained.

Now we know the real cost war over '1 TRILLION DOLLARS'. That could cover the cost of Health Care for all Americans, with no new 'TAXES.'

"Which begs the real question: why would we be willing to add $1 trillion to the already over-bloated cost of buying health care in this country?"

Absolutely correct, but the right plan is to have a more efficient health insurance system like Medicare for All which would save about $500 Billion each and every year from the high overhead and compliance costs of private insurance and the high cost of drug company marketing. This is low hanging fruit. Once we have a national health system we would be in a better situation to go after the more difficult improvements Mr. Zastrow wants.

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Tax Unhealthy Behaviors Instead - Health Care Rx Panelists

Tax Unhealthy Behaviors Instead

| 1 Comment

I think that we need to separate the two questions of how to pay for health-care reform and the right tax rate for upper-income Americans. We should pay for health care reform through taxation that encourages healthy behaviors, such as taxes on cigarettes, alcohol and soft drinks, which raise revenues, reduce consumption and improve health. More equitable agricultural subsidies would also help to reduce obesity. We also need to do a better job measuring the potential benefits of prevention, to help aggressive prevention efforts pay for health care reform.

Relative to taxation of upper-income Americans, that should stand on its own merits -- or lack of merit. As an upper-income American, I would want to know whether what I pay is being well-spent. If it is for health-care reform, I would want to know whether it is good reform or just an overly ambitious and misguided public plan. I would gladly pay for government services that improve the health, well-being and productivity of all Americans, but would not want to support increased taxes without a clear path toward these goals.

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"I would gladly pay for government services that improve the health, well-being and productivity of all Americans, but would not want to support increased taxes without a clear path toward these goals."

HR676 (Medicare for All) does exactly what you want. It provides a clear path towards your goals of improving the health, well-being and productivity of ALL Americans AND it does so in a cost effective way.

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To Care Or Not To Care - Health Care Rx Panelists

To Care Or Not To Care

| 2 Comments

A rich society can decide either to take a caring, inclusive attitude to providing for its people or a "devil-take-the-hindmost" approach. A system that provides universal care removes a large element of risk from the lives of the poorest elements of society and at relatively small cost to the richest. In the United Kingdom, such a system removes the poorest people's worries about lack of health care. Of course, it comes at a cost to everyone who can pay, but it provides baseline care that lessens sickness among the destitute. It also potentially makes public health accessible to all, thus preventing some diseases from spreading (potentially to the rich!).

It can be good for everyone to have a healthier nation as long as the message about taking personal responsibility is not forgotten. I believe the U.S. wants to be viewed as a caring nation, but we overseas hear far more about the lack of provision for the poorest than about the good care given to the richest. If you care about opinion, now is the chance to do something!

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In Britain, France, Switzerland and elsewhere, public health systems have become political punching bags for opposition parties, costs have skyrocketed and in some cases, patients have needlessly suffered and died.
...
Critics say the policies are often driven more by politics than science. Last week, Prime Minister Gordon Brown promised that patients unable to see cancer experts within two weeks would get cash to pay for private care. Brown had previously argued against paying for private providers and some say the reversal may be a gimmick to boost his sagging popularity.
*** Look out grandma, your old. Only the young get cancer treatments under government run programs.
"There is nothing inherently different about cancer in the U.S. and Britain to explain why more people are dying here," said Dr. Karol Sikora, of Cancer Partners UK.
...
A World Health Organization survey in 2000 found that France had the world's best health system. But that has come at a high price; health budgets have been in the red since 1988.
*** Again, typical government run program. Over budget and in the red.
Similar scenarios have been unfolding in the Netherlands and Switzerland, where everyone must buy health insurance.

"The minute you make health insurance mandatory, people start overusing it," said Dr. Alphonse Crespo, an orthopedic surgeon and research director at Switzerland's Institut Constant de Rebecque. "If I have a cold, I might go see a doctor because I am already paying a health insurance premium."

Cost-cutting has also hit Switzerland. The numbers of beds have dropped, hospitals have merged, and specialist care has become harder to find. A 2007 survey found that in some hospitals in Geneva and Lausanne, the rates of medical mistakes had jumped by up to 40 percent. Long ranked among the world's top four health systems, Switzerland dropped to 8th place in a Europe-wide survey last year


Eh, read it for yourself.
http://news.yahoo.com/s/ap/20090704/ap_on_bi_ge/eu_med_europe_health_lessons

yes,. we need health reform. NO, we do not need goverment run health care.

GOOD GOD PEOPLE, why the bloody hell don't we just cap the flippen costs. insurance/medical/prescription. Only allow the costs to increase at the rate of inflation.

Want to know why this health care package wont pass? President Oboma is letting congress draft it... COME ON PEOPLE, who put us here in the position we are in now. Oi, congress(both parties).

Tie health care costs to the inflation rate. Tort reform. Insurance rates should also be tied to the inflation rate. Whats that called? Hey, health care REFORM.

This is spot on. Dr. Dommett neglects to mention that not only does the UK do all the wonderful things he mentions, but they do it at 40% of what we pay per person. They just have a better, more efficient, more caring system.

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Time to Bear the Burden - Health Care Rx Panelists

Time to Bear the Burden

| 2 Comments

The proposal developed by House Ways and Means Committee Chairman Charlie Rangel, which would add a modest surtax for the wealthiest taxpayers, is part of a sensible approach to ensuring that health care reform is deficit-neutral during the next ten years. Since this group enjoyed a significant tax reduction windfall during the last decade -- and since this windfall played a big role in burgeoning federal deficits -- it makes sense that this group bears some burden as part of the effort to secure America's long-term economic future through health-care reform.

The proposed tax surcharge on wealthy taxpayers is very similar in intent, if not in form, from the original budget proposal developed by the Obama administration. The President's proposal would have reduced the value of tax deductions for the wealthy -- a proposal that also makes eminent sense. Given the opposition to that proposal from some quarters, Rangel's (D-N.Y.) approach offers a sensible alternative.

Of course, the modest surtax is not the only way health coverage improvements and stability are achieved under the House bill. The bill also creates significant efficiencies in our health-care system and those efficiencies will help to decelerate health-care costs as well as to ensure that virtually everyone has access to high-quality, affordable health care. As such, the House financing package offers an excellent starting point for the ultimate resolution of how health-care reform should be financed.

2 Comments

The idea of tax reduction as windfall presumes that personal wealth is a national resource to be allocated "fairly" among all Americans (and even some non-Americans, apparently). A windfall is a benefit that one receives through no effort of one's own, but lottery winners aside that isn't where personal wealth comes from. Somebody created something out of nothing through luck to some degree, but mostly through skill, personal deprivation and perseverance. Those who presume on the wealth of others because of some puerile fantasy that they were ill-gotten through oppression or some other crime have gallen into the most damaging of sins: coveting.

It never ceases to amaze me how the republican leadership and their media reps, continue to ignore what is clearly a fact of the last 8 years of the Bush era - the top 1% benefited greatly from an irresponsible $1.8 trillion tax break. For the sake of the union, it is time to make the necessary adjustments in health care through a modest tax increase of the wealthy.

There should be NO American whose finances are devestated by the medical cost of an illness of a child or adult family member, yet this is happenning daily primarily because of the profit motive that exist in the healthcare system in this country. This could be remedied by the baseline proposal that President Obama is seeking in the industry, including a government sponsored healthcare plan.

Let's stop playing politics with this issue, and past healthcare reform for the good of the nation.

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About this Archive

This page is an archive of entries from July 2009 listed from newest to oldest.

July 5, 2009 - July 11, 2009 is the previous archive.

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About this Archive

This page is an archive of entries from July 2009 listed from newest to oldest.

July 5, 2009 - July 11, 2009 is the previous archive.

July 19, 2009 - July 25, 2009 is the next archive.

Find recent content on the main index or look in the archives to find all content.