Peter Neupert
Health Technology Executive

Peter Neupert

Peter Neupert is Microsoft’s corporate vice president for the Health Solutions Group. He led from 1998 to 2001.

Who Pays for Whose Heath Care?

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).

By Peter Neupert  |  July 14, 2009; 1:34 AM ET  | Category:  Health Care Reform , Taxes Save & Share:  Send E-mail   Facebook   Twitter   Digg   Yahoo Buzz   StumbleUpon   Technorati  
Previous: Higher Taxes? For Whom and for What? | Next: A Simple Answer: Yes


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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".

Posted by: rcpatocc | July 21, 2009 5:18 AM
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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.

Posted by: kengelhart | July 20, 2009 4:28 PM
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"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.

Posted by: lensch | July 14, 2009 11:07 AM
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