Tax Reform – what to watch for
#1 – Does it remove / reduce the Estate Tax?
If it does, it is a bad deal. The purpose of the Estate Tax is to prevent the wealthy from sheltering their wealth, passing it on from generation to generation free from taxes. Free market best practices approve of this type of tax because the ability of the powerful to produce generations of family wealth thwarts competition.
#2 – Does it reduce taxes on ‘small businesses’ that either have only 1 employee or that by their nature will never create more jobs?
The vast majority of small businesses are set up for professionals to avoid taxes. If their taxes are reduced, no jobs will ever be created. If this deal reduces the taxes on this type of business, that break largely goes to the wealthy and won’t create one single new job.
#3 – Does it remove the additional Medicare tax that was part of the ACA?
If it does, passing the bill will cripple Medicare. Part of the ACA had those that earned income outside of payroll or self-employed income pay into Medicare often for the 1st time. This loophole being closed not only strengthened Medicare it removed the entitlement that the top 1% received by getting Medicare benefits without paying a % of their income as the rest of us do.
#4 – Does it mess with the deductions for Health Care Insurance, claiming this is a major ‘loophole’?
If it does, it will dramatically increase the cost of employer-supplied health care insurance – impacting the bottom 99% the most. It increases the cost of providing health care because it subjects the money used to pay health premiums to social security and
Medicare taxes. This means you will have to spend more to get the SAME health insurance you have now.
#5 – Does it lower / reduce the tax rate on the top income level?
If it does, it will reduce the ability of our government to fund government services and pay its bills – including any current debt. It also will NOT create jobs or increase consumer demand in any way that will produce jobs. Once you earn a certain level of income, you are already buying each year what you need. If you get more money, you are not likely to spend it.
#6 – Does it leave the lowest tax rate unchanged?
IF it does, it misses the largest opportunity to stimulate economic growth. Any tax applied to people who make below the poverty level reduces their capacity to fund their survival. If there is no tax relief for those at the bottom of the tax rates, then the opportunity to really impact economic growth is lost. So is the opportunity to reduce demand for government programs.
Profit and Health Care don’t mix
“For-profit” – means you maximize profits and stakeholder value. It means it is about the money.
You charge the most you can. And you keep profits high.
Less regulation – you don’t lower costs, you make more profits.
More customers – you don’t lower costs, you make more profits.
Competition – well, what or who are you really competing with?
Doctors – supply is limited. Why should the good ones reduce their costs? They don’t have to. You would only lower your prices if you had excess capacity. But you don’t. So you won’t.
Hospitals – A lot of fixed overhead required. So it costs a certain amount to run a hospital. If fewer people can afford to pay, and you have to write off bad debt, you need to make it up somewhere – so you might raise prices. But there is no reason to lower prices.
Insurance companies – you would only lower costs if you can keep a decent profit margin and gain more profitable business. CBO said the premiums would be lower BECAUSE MORE SICK PEOPLE WILL HAVE TO GO WITHOUT COVERAGE. Since people who buy coverage will use less of it, you could charge less. But with the ACA repealed, you don’t have to. There is no motivation for insurance companies to lower prices when the risk mix if healthier. Why should they? If people are paying the rates they charge now, and profit margins are thin, why not keep the profits if the costs of those that you insure go down? That is what insurance companies did BEFORE ACA.
A plausible example – A drug company makes good profits on a patented drug that, once prescribed, is taken for the rest of the person’s life. They can charge whatever the market will tolerate – and if the alternative is death or suffering, people will pay. The company is working on an enhancement and will get it nearly ready for approval. They will delay release until the patent on their current drug is ready to expire. That way, they can keep a monopoly on the drug and closeout competition. They notice a medical device start up has a device that would cure the condition and eliminate the need for their drug. While the device is being approved, the drug company buys the start-up. They continue until the patent is in place. Then the drug company puts release on hold. The ‘forever’ drugs are remain profitable. The device never makes it to market.
The Opioid challenge is fueled by routine prescribing of Opioid’s for pain despite the risk of addiction. Alternatives are available. But drug companies have created a protocol of Opoids being routinely provided for possible pain – not just real pain. What motivation is there to stop this practice in a for-profit model? Opioid addiction is bad for people – but not for the companies that profit from it.
THAT is for-profit health care.
What if the focus was on caring for everyone? What if the incentives shifted from profit to quality of care and quality of life?
You could run research centers that focus on finding cures.
You could run rural health centers focused on providing care.
You could build out mobile health care models for handling the homeless.
You could ensure that the focus was on prevention and invest in public school health education on lifestyle choices that impact health.
You could develop support systems for people who require care assistance on a prolonged basis.
And the profit margins can be used to expand the capacity to care for people.
This could all be possible…..
If you believed in providing health care for all.
If you understand that no one wants the cheapest care if it isn’t the best care.
If you cared about people instead of profits or corporations.