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The House: Tax the Wealthy to Keep Everyone Healthy
It's the most blatant form of Robin-Hood economics ever proposed. The universal health care bill reported by the House yesterday pays for the health insurance of the 20 percent of Americans who need help affording it with a surtax on the richest 1 percent.
I don't recall the last time Congress came up with such a direct redistribution. Occasionally Congress closes a few tax loopholes at the top and offers a refundable tax credit to workers at the bottom, or it creates a poor people's program like Medicaid, paid for out of general revenues from a progressive income tax. But to say out loud, as the House has just done, that those in our society who can most readily afford it should pay for the health insurance of those who cannot is, well, audacious. There's another word for it: fair. According to the most recent data (for 2007), the best-off 1 percent of American households take home about 20 percent of total income -- the highest percentage since 1928. Yes, I know: Critics will charge that these are the very people who invest, innovate, and hire, and thereby keep the economy going. So raising their taxes will burden the economy and thereby hurt everyone, including those who are supposed to be helped.
But there's no reason to suppose that taking a tiny sliver of the incomes of the top 1 percent will reduce all that much of their ardor to invest, innovate, and hire in the future. Yet if this tiny sliver means affordable health care for a far larger number of Americans, who will be able to get regular checkups and thereby stay healthy and productive, the positive effect on the American economy is likely to be far greater.
Don't believe critics who say the surtax will harm small business. According to the Center for Tax Justice, it would hit only five percent of small business owners -- realistically defined as taxpayers for whom small business income makes up at least half of their adjusted gross income (from schedule C businesses, partnerships, family farms, and Subchapter S corporations).
Besides, only the profits of a small business would be taxed. The owner of a small business deducts money paid to employees as compensation, as well as operating costs. So, for example, a couple whose income comes entirely from a small business would have to earn more than $350,000 in business profits -- after paying all their expenses, including salaries -- before the surcharge would affect them at all. And if they earned more, the surcharge wouldn't reduce their incentive to hire more employees because they pay employees with pre-tax income. And not even purchases of equipment to expand business operations would be affected because most small business owners can write off up to $250,000 of the costs of such equipment immediately.
A surtax is easy to administer. And the whole idea is easy to understand. Tax the wealthy to keep everyone healthy. Not even a bad bumper sticker.
I don't recall the last time Congress came up with such a direct redistribution. Occasionally Congress closes a few tax loopholes at the top and offers a refundable tax credit to workers at the bottom, or it creates a poor people's program like Medicaid, paid for out of general revenues from a progressive income tax. But to say out loud, as the House has just done, that those in our society who can most readily afford it should pay for the health insurance of those who cannot is, well, audacious. There's another word for it: fair. According to the most recent data (for 2007), the best-off 1 percent of American households take home about 20 percent of total income -- the highest percentage since 1928. Yes, I know: Critics will charge that these are the very people who invest, innovate, and hire, and thereby keep the economy going. So raising their taxes will burden the economy and thereby hurt everyone, including those who are supposed to be helped.
But there's no reason to suppose that taking a tiny sliver of the incomes of the top 1 percent will reduce all that much of their ardor to invest, innovate, and hire in the future. Yet if this tiny sliver means affordable health care for a far larger number of Americans, who will be able to get regular checkups and thereby stay healthy and productive, the positive effect on the American economy is likely to be far greater.
Don't believe critics who say the surtax will harm small business. According to the Center for Tax Justice, it would hit only five percent of small business owners -- realistically defined as taxpayers for whom small business income makes up at least half of their adjusted gross income (from schedule C businesses, partnerships, family farms, and Subchapter S corporations).
Besides, only the profits of a small business would be taxed. The owner of a small business deducts money paid to employees as compensation, as well as operating costs. So, for example, a couple whose income comes entirely from a small business would have to earn more than $350,000 in business profits -- after paying all their expenses, including salaries -- before the surcharge would affect them at all. And if they earned more, the surcharge wouldn't reduce their incentive to hire more employees because they pay employees with pre-tax income. And not even purchases of equipment to expand business operations would be affected because most small business owners can write off up to $250,000 of the costs of such equipment immediately.
A surtax is easy to administer. And the whole idea is easy to understand. Tax the wealthy to keep everyone healthy. Not even a bad bumper sticker.
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Except that it's not the full truth.
The healthcare plan will be paid for by a combination of new taxes AND a reduction in Medicare spending, as metioned by the CBO in its letter to Rangel.
It breaks down to this:
- anyone with income under 400% poverty gets subsidized (~$44,000 or so?)
- anyone else gets a mandate to buy insurance under threat of penalty. But no subsidy
To pay for this, only half of the money will come from the rich.
July 15, 2009 12:18 PM | Reply | Permalink
Okay, irony free questionm here. I'm not clear on whether you think it's a good thing or a bad thing that only half will come from taxing the rich. Which is it and why?
Or are you being neutral and just making an observation in the interest of adding precision to the discussion?
July 16, 2009 12:40 PM | Reply | Permalink
The surtax on the rich is simply another form investment for them and of innovation. The investment will return huge dividends in terms of healthier workers and the innovation is providing universal coverage. The critics, far from being upset that the biggest beneificiaries of our economic system should have to return something to those who produce their wealth, they should be pleased that the government is providing them with this avenue for fulfilling their role as investors in our economic future. And who will be the biggest winners as a result? As always, the richest will be the bigges winners because they will, in fact, have a healthier workforce that will continue to produce their wealth, fight their wars, etc...
July 15, 2009 12:43 PM | Reply | Permalink
All true and, as I'm sure you'd agree, all largely lost on the wealthy for whom the concept of "enlightened self-interest" has always been, and likely always will be, impossible to accept.
Paying the workers a decent percentage of the company's profits has always been in the capital-owning segments collective best interest because it gives them money to spend on the goods and services being produced. And yet, throughout history, individual owners have usually been incapable of seeing past the benefits they could obtain individually by beating down the wages of their own workers.
Even the ones who could see it and reaped fortunes from it were unable to sustain their belief in the principle. Exhibits A and B being Andrew Carnegie and Henry Ford.
So even though it is clearly in their best financial interest to have more universal health care, we can absolutely count on the top 1% to "cry 'havoc'" and loudly pronounce the imminence of an economic apocolypse as a result of having to cough up an extra couple of percent on income over 350K just as surely as the Roman Senators killed both of the Gracchi.
July 16, 2009 12:50 PM | Reply | Permalink
Here's how to sell it to the über-rich: Tell them it's preferable to the govt. going after their offshore tax havens and Swiss bank accts.
But we should do that anyway.
July 15, 2009 1:16 PM | Reply | Permalink
Wow ... Dave . . .
Funny you bring up the "offshore tax havens and Swiss bank accts" . . .
It's about the same thing I was saying back in the darker ages ... like circa September 4, 1966.
Silly as it Seems . . .
~OGD~
July 15, 2009 1:36 PM | Reply | Permalink
Nice alliteration at the end there, OGD;)
July 15, 2009 10:32 PM | Reply | Permalink
I 'get' tax policy (s) by way of numbers like the Bush tax cuts are worth $1000/week to the top 1% of us and about $1.50/week to the rest of us.
$52,000/year to the likes of a hedge-funder making $2 billion/year or even someone earning a lousy $100 million/year is as useless to either one of them as is $78 dollars/year to me.
There must be such a thing as utopian greed afterall.
July 15, 2009 1:42 PM | Reply | Permalink
Gee, who could have guessed that our sliver of wealthy folks have consituted a majority for the past decades.....amazing....Goodbye oligarchy and hello democracy. Fancy that.
July 15, 2009 1:48 PM | Reply | Permalink
"I don't recall the last time Congress came up with such a direct redistribution".
REALLY?
I tell you when...When Congress changed the tax code and made the wealthy, WEALTHY, to the detriment of all the rest of us, who now cannot afford HEALTHCARE!
July 15, 2009 3:18 PM | Reply | Permalink
Right on!
July 16, 2009 12:50 AM | Reply | Permalink
Actually, the rich should look at this deal as a cost of doing business at a reduced rate.
First, a sick worker is not productive. Second, a sick child causes absenteeism. Third, all of this just might reduce their cost of providing health care and reduce the costs of a worker's comp claim.
If they do not have these kinds of direct costs, then whoever is delivering the money to their profit and loss sheet probably will benefit, and consequently deliver even more money.
Bob Spencer
July 15, 2009 4:01 PM | Reply | Permalink
Why does everyone believe that they have a right to the money of the rich.........the rich made themselves rich and already pay the overwhelming majority of the taxes in the country........why should somebody making 350k have to pay for health insurance for somebody that is unwilling to buy it himself. Most of the folks without health insurance are rolling around with cell phones and cable TV............so really, this great idea from congress says that we are going to let the poor buy healthcare now and the rich will pick up the cable bill...............Reich has the biggest Napoleon complex I have ever seen..........somebody please get the man some lifts
July 15, 2009 4:39 PM | Reply | Permalink
What makes you believe that the top 1% actually earned their incomes?
Over the past year in particular, we have had flagrant examples of the very wealthy engaging in fraud and other dubious practices to accumulate large amounts of wealth. We have seen CEO's collect huge salaries while driving their companies into the ground. We have seen banksters collect huge bonuses by selling mortgages to crack-head hookers.
These guys not only have failed to make a positive contribution to society, but they have robbed millions of their pensions and life savings. Manipulating the economy is not something that should be protected.
Economic rewards are the product of the Great Government Rulebook, which allows some to prosper while others don't. But don't think for one moment that the vast majority of these guys actually earned the money they receive. The Rulebook which allows these guys to accumulate great wealth can also be written to take some of that wealth away.
July 15, 2009 8:52 PM | Reply | Permalink
Thank you.
July 15, 2009 9:25 PM | Reply | Permalink
Just because Reagan convinced the wealthy that they are only wealthy because they deserve to be, doesn't make it so. My money says that the majority of the wealthy became wealthy through inheritance or malfeasance. Even those who actually earned their wealth by working hard, could only do so as a result of government spending that benefitted their businesses. They most certainly do owe our society some payback as a result. And, progressive taxation is that payback.
July 16, 2009 11:07 AM | Reply | Permalink
The rich did not make themselves rich -- there are exceptions of course, Bill Gates seems to have done it on his own.
A few rich people just get lucky; they are in the right place at the right time.
But most rich people come from rich families who send them to the best universities. This is why, in the early United States, the government was much harsher on inherited wealth than it is today: because inherited wealth is anti-democratic, and gives an unfair advantage to the rich over poor people who don't have family wealth to give them a leg up.
July 16, 2009 12:59 PM | Reply | Permalink
"Bill Gates seems to have done it on his own."
I really hate having to post this over and over, but Bill Gates' father is (or was) the name partner in the largest law firm in Seattle. That puts Bill Jr. squarely in the uber-uber class at birth. Bill Jr. also went to a prep school along with a bunch of other rich elites, and then to Harvard.
Bill Gates is talented, smart, and he seems like a decent guy for a ruthless capitalist. But his is not exactly a Horation Alger fairy-tale come to life.
July 16, 2009 9:23 PM | Reply | Permalink
Has anyone noticed the sudden influx of brand new commenters, each of whom seem to be mixing oh so compelling personal stories regarding the glories of Randian economics in their life with a series of Luntz's talking points?
Sorry, "Steve," "Ellen K," "randgalt," "JoseyWales," and "John," but I smells the noxious odors of sock puppets and astroturf.
July 16, 2009 6:03 PM | Reply | Permalink
It is true that I am a new poster. But I don't know who "Luntz" is and think Ayn Rand is a bit of a nut.
What led me to this article from Mr. Reich was a link from another site...I hadn't actually visited TPM very often. The topic does hit close to home, and I thought I had something to add to the discussion. The reference to "sock puppets" and "astro turf" is a bit too obscure for me to understand, but I assume it isn't a compliment.
July 16, 2009 8:30 PM | Reply | Permalink
Yes.
July 16, 2009 10:37 PM | Reply | Permalink
Most of the folks without health insurance are rolling around with cell phones and cable TV.
Gee, Steve. It takes $12,7000** to insure an average family of four annually with employer based health insurance.
That average family of four without employer based insurance would have to give up something like 200 of their cell phones in order to afford health insurance. Maybe you're right ... they just have too damn many cell phones.
**The Henry J. Kaiser Family Foundation. Employee Health Benefits: 2008 Annual Survey. September 2008.
July 17, 2009 6:35 AM | Reply | Permalink
I am a stranger in a strange land at this posting site. Irrespective, the idea that anyone is entitled to someone else's money or assets always bothers me. Rich people include athletes, entertainers, and yes politicians. Someone paid for their personal skill set that sells tickets products or whatever else. The point being that a lot of rich people get that way through hard work and innovation, not by having it handed to them. This is not an investment for the rich, nor is it a cost of doing business. It is a tax, it is taking (re-distributing) their income to satisfy someone else's sense of fairness, of sense of entitlement. With all of the tax hikes being bandied about, it is quite likely that the so-called rich will be paying over half of their income to the government for taxes. Over half. No idea why some think they are entitled to the majority share of someone else's income. And nearly half of all do not pay any income tax at all. Nada. And yet, as this is a democracy, we let the majority who pays no tax decide how much the others should fork over in fairness. I have no problem going after the tax cheats, have at it. This will reduce the overall quality of healthcare for the majority. The innovation of new drugs, treatments and equipment will also slow way down. And though Doctors may make a lot to some, they also invested over $250,000 in education towards their profession. They are entitled to make above average pay. There will be fewer going into medicine after this "reform" is enacted.
July 15, 2009 4:52 PM | Reply | Permalink
to the stranger James in a strange land (LA?):
Complete and utter nonsense.
Fewer people will want to make a lot of money for fear of having to trim off 1% of it? (Will entertainers stop being entertaining? Give me a break..) You don't really believe that. That sounds like John Galt-ish logic - I'd rather make nothing if I have to share! boohoo.
The percentage of people you claim pay no taxes at all also have very little. And I don't believe, even for a minute, that half of our voters pay no taxes at all.(Unless you're also counting millionaires who are sheltering much of their income..)
Taxation rates used to be over 90% on the richest incomes in this country (and many others). And what it did was encourage business investment, instead of people buying trophy mansions to show off.
Stop with the hand-wringing and read some Civics.
July 15, 2009 9:37 PM | Reply | Permalink
I'm always confused why adding 50 million new customers to the medical establishment will 'slow innovation'. More customers = more revenue = more incentive to innovate.
How is it the most staunch free marketers seem to overlook the very basics?
July 16, 2009 12:44 PM | Reply | Permalink
(i am not even barely knowledgeable in economics, but...)
I think the idea in general is that taxes are levied to pay for essential services (however the people may determine those) [3].
Now, the next idea is that the tax burden should impact everyone as little as possible.
That is to say, there is some optimum way in which the tax burden can be shared so that everyone feels the pain equally (and as little as possible).
Finally, we add in the concept of marginal value[1]: The value of getting X more of something depends on how much of that something you already have. It is not constant and perhaps non-linear, often showing diminishing returns.
This means that the optimal tax rate to spread the burden is not flat. If i make $15k/yr i will have a tough time making ends meet no matter how low the tax rate is. At the same time at $60k/yr i can live pretty well with not too much effort as long as the tax rate is pretty reasonable (these are of course adjusted for cost of living).
At the very top end you could tax a very wealthy person a lot and they'd still be able to survive.
(You don't want to go overboard though, because bad things will happen socially, and socio-economically, but the point is that they can stand a higher rate before any impact is felt[2]).
So i guess this all ends up in that the marginal tax rates should reflect the marginal utility of money to some extent.
[1] I don't think this is the correct usage of the term
[2] Although if you keep repeating in the media how burdensome taxes are and how unfair it is, that point may change
[3] The essential-ness of healthcare can i think be justified in that the impacts of poor health are pervasive (consider herd immunity and vaccination similarly).
July 16, 2009 2:17 PM | Reply | Permalink
Here's what ya do James in LA. Move to a country where you'll pay less in income taxes, get citizenship there and don't come back. Somalia is a tax free Randian paradise perfectly suited to you.
July 16, 2009 6:17 PM | Reply | Permalink
I thought the slogan "love it or leave it" went out with the sixties.
July 16, 2009 9:00 PM | Reply | Permalink
If you're a lucky ducky in the top 1% you'll love Somalia John. There's no government taxes at all! If you don't care about your fellow Americans why should we care about you?
July 17, 2009 2:10 PM | Reply | Permalink
The growing inequality between the very wealthy and everyone else is a monster gnawing at the fabric of our society, or any society based on the notion of community and shared sacrifice. In that sense, the proposed surtax is a very small step in the right direction. Whether the Senate will go along remains to be seen.
When topics like these arise, one can expect some fanciful arguments suggesting that high income individuals earn more than low income individuals - e.g., that a CEO taking home $40 million has earned more than a coal miner bringing home $40,000. The CEO has indeed made more money, but one could argue that the miner actually earned more, in the core sense of the word "earned". In any case, almost every person with a sense of fairness instinctively understands the need for progressive taxation, even if not always able to articulate his or her thinking. It takes more in the way of philosophical contortions to rationalize the notion that high earners owe nothing to the remainder of the community they inhabit.
July 15, 2009 5:10 PM | Reply | Permalink
Let's just scrap the 'public option' and take the 'profit' out of healthcare. Single Payer is the best system.
Will you be at the rally on July 30th?
July 15, 2009 5:58 PM | Reply | Permalink
damn the lies.
http://www.counterpunch.org/lindorff07142009.html
Hello, Goodbye
The End of "Nice" Health Care Reform
By DAVE LINDORFF
Of course I could be wrong. Congress could turn around and pass some cockamamie scheme to kick the issue of health care reform down the road, offering some kind of minimal insurance coverage to a few million more people, and cracking down on this or that particularly egregious health provider rip-off, and then staging a “mission accomplished” photo op.
But real health care reform of the kind that Democratic candidates were promising during last year’s presidential campaign is dead, killed by the timidity of the promiser-in-chief, President Barack Obama (and by the massive corruption of the Democrats in Congress, who hav e accepted the tainted coin of the health care industry).
Obama could have come to the American people as a newly elected leader and addressed us as adults, saying: “Look, we know what needs to be done. Plenty of countries in Canada, Europe and elsewhere have figured it out already. They set up the government as the single payer to health providers—doctors and hospitals, etc.—and the government bargains and sets the prices those private providers of health care can charge. Of course that means you’ll all pay higher taxes to finance such a plan, but the record of all those countries shows that you’ll be saving money over all, because you won’t be paying for health insurance, your employer won’t be paying for health insurance, you won’t be paying co-pays and deductibles, and you won’t be getting gouged for drugs or hospital stays or doctors’ bills. You won’t be paying state taxes for Medicaid either, nor will your insurance and local property taxes have to subsidize the hospital care of indigents. On balance, you’ll all be saving money, and you’ll never have to worry about disease or injury bankrupting you. Nor will employers be able to hold you hostage any longer. The reality is that the countries that have a single-payer plan are spending half of what we spend per capita for health care, they have no uninsured citizens, and their health overall, as measured by such things as longevity, infant mortality, etc., is better than ours.”
The president could have said all this and rallied the tens of millions of Americans who desperately want a health care system modeled on the single-payer idea to his side, forcing Congress to go along or pay the price in 2010.
Instead, this president who, in years past as a senator, as a state representative and as an activist had praised the idea of single-payer, has taken to saying it’s important do keep the private health insurance industry in business. Instead of inviting Canadian administrators of that country’s successful system down to talk about how it works up there, he barred even American advocates of single payer from speaking at his talk-fests on health care reform at the White House. Instead of taking an axe to the US Medical-Industrial Complex, he has pretended he could reform the current profit-crazed system we have in the US without raising taxes. Instead of pointing out that we already have a well-functioning single-payer system for our elderly and disabled in the form of Medicare, he has spent his time badmouthing the single-payer idea, even claiming that it’s not part of our “American” tradition.
But let’s note that Obama’s sell-out on health care reform was aided and abetted by the progressives, the left groups and political organizations and the unions that failed to hold him to his earlier espousal of single-payer, that instead of calling him out on his cave-in, bought into his initial compromise of a so-called “public option” insurance alternative, and even into his subsequent backdown to an even more watered-down version of possibly state-run or “cooperative” plans.
Now his political cowardice and mendacity have caught up with him. His “plan,” if it can even be called that, of mandating employer health coverage and then adding a government-run alternative “public option” to existing private insurance, has understandably failed to excite the public, while still arousing the passionate opposition of conservative Republicans and conservative members of his own party, and meanwhile does nothing to limit soaring health costs, which already eat up a fifth of the entire gross domestic product of the nation, requires an increase in taxes and reductions in Medicare, will probably, if established, lead to more companies actually dropping their current benefit programs in favor of a cheaper, stripped-down government plan, and yet will still leave millions of people unable to get access to timely, quality, affordable medical care.
Furthermore, his apparent failure to deliver on this key initiative will deal a body blow to his political clout on other initiatives, such as tackling climate change and dealing with an acute economic crisis.
If I’m right that health reform is dead, so is Barack Obama’s presidency. President Bill Clinton’s new administration foundered early on following his shameless backdown on a pledge to guarantee the right of gays and lesbians to serve openly in the military. It never recovered. President Obama’s new administration is foundering on his equally shameless backdown on a promise to establish a system of quality affordable health care for all.
Dave Lindorff is a Philadelphia-based journalist and columnist. His latest book is “The Case for Impeachment” (St. Martin’s Press, 2006 and now available in paperback). He can be reached at dlindorff@mindspring.com
July 15, 2009 6:12 PM | Reply | Permalink
Countries that do not have single payer also spend half (per person or a share of GDP)of what we do. You should expand your understanding.
July 16, 2009 10:45 AM | Reply | Permalink
July 15, 2009 6:30 PM | Reply | Permalink
congratulations on your terrific wealth! shame about your terrific greed.
pardon me if i don't shed any tears for any portion of your $350,000+/year in taxable earnings.
btw: taxes are the price you pay for the luxury of living in a liberal democracy. and the thing is, living in a liberal democracy also means that the decision on how high or low your taxes ought to be is not, in fact, yours alone to make. rather, it is a decision that we all get to make. together.
but please keep taunting us with your wealth and greed. i'm sure the 99% of americans who make less than you do will find your tantrum persuasive.
July 15, 2009 7:37 PM | Reply | Permalink
Oooooo . . . A New Person . . .
Why is it I have the distinct impression that this whiner is handing everyone a big load of crap?
Come on ... If this person were to tell the truth you'd find out that they're barely making ends meet and have never produced anything more than a shitload of hot wind out of their piehole? Sounds like Rush... Eh?
Pull my finger. . .
~OGD~
July 15, 2009 9:06 PM | Reply | Permalink
Anyone called "RandGalt" is a bodice-ripper reading, delusional, self-centered, blowhard.
Just sayin.
July 15, 2009 9:17 PM | Reply | Permalink
Jesus what a lame conflation. Blowhard needs some bodice ripping in a bad way.
July 15, 2009 10:20 PM | Reply | Permalink
=D
July 15, 2009 10:33 PM | Reply | Permalink
By looting your houses?
July 15, 2009 10:36 PM | Reply | Permalink
John is that you? The omnipresent John Galt?
So the producers will maybe stop producing. So they'll cut off their noses to spite their face? If they can't get it all they'll settle for nothing? They'll grumble a bit just like anyone would and go back to making money hand over fist...just a little less of it.
Like miguelito said this is just reversing what was done in the 80's. Back before every thing got trickled up and the American workers were doing marginally better than they are now.
The rich are a lot of things but they didn't get that way by not wanting to make money...even out of spite.
July 16, 2009 2:34 AM | Reply | Permalink
Considering that the people doing the actual physical producing aren't the wealthy like yourself, I think we'll get along just fine when you finally 'go Galt.' The real question is how are you going to fare when there's no one to do the heavy lifting for you? We might miss you when you're gone. But, how can we miss you when you won't go away?
July 16, 2009 11:16 AM | Reply | Permalink
Listen, dipshit. Society created money. Society also decides how much money is worth and protects its value for you.
If you want to take society out of that equation, and think just because you have a bunch of zeros behind a crooked number in a bank ledger that you have the right to decide whether my child has food and medical care, then don't be surprised if,under the rules you espouse, I decide to change them right back on your sorry ass by any means necessary.
July 16, 2009 9:31 PM | Reply | Permalink
Time for a break, brewmn61. I think an ice cold adult beverage might make you feel a bit better.
July 16, 2009 9:46 PM | Reply | Permalink
In other words, you got nuthin', loser.
July 17, 2009 12:26 AM | Reply | Permalink
"....who will be able to get regular checkups and thereby stay healthy and productive, the positive effect on the American economy is likely to be far greater."
For all you oompa loompa's that believe this fairy tale there's always the spectre of government mandated "vertical disenrollment" to ponder between periods of egg sucking on demand from Jefe Obama.
July 15, 2009 6:51 PM | Reply | Permalink
You should add Roald Dahl and Dr. Seuss to your reading list on your user page. Sounds like your reading comprehension may be up to third grade level about now.
July 16, 2009 2:25 AM | Reply | Permalink
"There's another word for it: fair."
Fair is where you ride the Ferris wheel and eat cotton candy. Will it be “fair” when a government bureaucrat decides you are too old for that knee replacement and that the money would be better spent on breast implants for a 20 year old transgender female to help its psyche?
July 15, 2009 7:17 PM | Reply | Permalink
is it fair when an insurance company bureaucrat does it???
July 15, 2009 7:39 PM | Reply | Permalink
Oooh! I know the answer to this one... No. No it isn't fair when an insurance company decides you're not covered, delays approval for procedures, and even rescinds your coverage for trivial reasons. It's also not fair when they raise your premiums if you are unlucky enough to lose a job and have a pre-existing medical condition when you attempt to acquire private coverage.
July 16, 2009 2:20 AM | Reply | Permalink
The most recent example of a broadly-levied surtax in the United States was one imposed to help finance the Vietnam War during the Lyndon B. Johnson administration. It essentially consisted of calculating one's ordinary federal income tax liability and then adding another 10% to it -- the amount of the surtax.
http://en.wikipedia.org/wiki/Surtax
July 15, 2009 7:22 PM | Reply | Permalink
With the recent House action, it now appears that meaningful healthcare reform that includes a public option is likely to pass. It is hardly a sure thing, but with the example of what the House has done, combined with President Obama's daily campaigning on the issue and polling evidence of substantial support, I believe we have reasons for optimism.
It has required political courage on the part of many in Congress to advance this far, and while we must await the final result to bestow our gratitude on them, the one thing we should probably do in the meantime is support their efforts rather than engage in juvenile rants when not every item one might wish is proceeding as expected.
I would not have posted this comment except for the misguided and overlong screed by Lindorff above. I note that his biography includes publication of a book by St. Martin's Press, an outlet sought be would-be authors who can't get a legitimate publisher to market their work.
July 15, 2009 7:22 PM | Reply | Permalink
I would respectfully ask one thing: what is the definition of "rich?"
While lots of people see Paris Hilton and celebrities as the targets, the truth is farther down the food chain. I am a teacher. I make around 47K a year. I have nearly 30% of my income already taken out of my check for taxes. You can add the sales taxes, license tag taxes, gas taxes and every other piddling tax that is laid on us to where it's just about 40% of my income. If by definition, my husband and I have a combined income that is more than twice the poverty level, then by some definitions we would be considered "rich" even when we cannot afford a new car, repair our small home or heaven forbid, take a vacation-something we haven't been able to afford in years. Yet down the line when this bill puffs up like the toad that it is, I see more taxes trickling down to people like me. And this will benefit me precious little, but give services to people who are not legal residents, who do not pay into the system and who in fact make payroll deductions weaker because they take wages out of the system for which taxes are not paid. How in any scenario is this a win-win situation?
Face it, this is political payback to buy votes.
July 15, 2009 7:47 PM | Reply | Permalink
Ellen - If you look at the experience of all the other industrialized nations, you may come away convinced that the proposed healthcare reform legislation, including its public option, is a major step toward making your life both better and more affordable.
All those nations employ some form of public option - in some cases single-payer, but in other cases a variety of public/private partnerships. They all provide almost universal healthcare coverage, at about half the cost consumers pay for health care in the U.S., and they also provide better health, as measured by the well established indexes of life expectancy and infant mortality.
The proposed taxes would not touch you at your income level (only about 1.2% of the wealthiest Americans would be surtaxed), but they would dramatically lower your costs.
You'll even be able to take the vacation you've been yearning for all these years.
July 15, 2009 7:56 PM | Reply | Permalink
So it's okay for government to take my money and spend that in ways that I would never condone for programs and technologies that I would never support? You do understand that there is a huge bioethical gap between mainstream Americans and what the White House wants, don't you? When you have someone in government saying that this person may get a specific care and this one may not, it is not going to be humane nor will it be fair. I suggest you read up on bioethics and this presidency. It is a very slippery slope which may include support for euthanisia, late term abortion and many other questionable techniques. If the government was REALLY concerned about people using their money wisely for medical concerns they would do two things-tort reform, that would take trial lawyers like Edwards out of the business of ambulance chasing, and allow for medical savings accounts to be used for such things as medical insurance with a tax credit.
Seriously, when filing for college loans, none of my three kids (all in school at the same time) qualified for student aid because we were viewed as "rich" by the government. The government said that we could contribute the equivalent to my entire annual salary. And this is the same government that will assess who pays and who gets. Do you not wonder where those lines will be set? Do you have so much faith in government-the same one that has tangled VA and Medicare benefits-will do any better on a national scale with a program that in its pilot form has helped bankrupt California? It's a money pit. And no, I won't feel any better to see more money taken from my paycheck to be spent in ways that are far more politically motivated than medically expedient. And that sir, is reality.
July 15, 2009 10:16 PM | Reply | Permalink
Ellen K wrote: So it's okay for government to take my money and spend that in ways that I would never condone for programs and technologies that I would never support?
So I ask you Ellen, is it okay that the United States, outspends all other Nations. Spends it in ways I don’t condone?
For the 2009 fiscal year, the base budget rose to $515.4 billion. Adding emergency discretionary spending and supplemental spending brings the sum to $651.2 billion.[1] This does not include many military-related items that are outside of the Defense Department budget, such as nuclear weapons research, maintenance and production (about $9.3 billion, which is in the Department of Energy budget), Veterans Affairs (about $33.2 billion), interest on debt incurred in past wars, or the wars in Iraq and Afghanistan (which are largely funded through extra-budgetary supplements, about $170 billion in 2007). As of 2009, the United States government is spending about $1 trillion annually on defense-related purposes.
http://en.wikipedia.org/wiki/Military_budget_of_the_United_States
July 15, 2009 11:13 PM | Reply | Permalink
You had your referendum. Your guys are in. The president could have pulled the military in tomorrow if he desired because he has Congress backing him. Haven't you wondered why that hasn't happened yet? Is it not just possible that the vacuum of power hypothesized by the previous administration is a fact? Or could it be that faced with a double digit unemployment that a mustering out of millions of young men and women would push an already weak economy into a dead one? And if the economy is in such disarray, having been miscalculated according to the Vice President, then does it make sense to create an entitlement program that will only reduce services, not costs?
I have a right to dissent and I will exercise that, although it is becoming a social liability in some circles. I still contend that the lack of clarity in regards to the bioethical problems with a massive program such as this poses serious issues. And, if the government is in charge of picking and choosing who is served and how, then is it not possible that seniors who need heart valve replacements could be shuffled aside in order to provide the euphemistic "reproductive services" to young women? It is playing God. And there is nothing of heaven that I hear in anything coming from Congress.
July 16, 2009 2:10 AM | Reply | Permalink
As is witholding healthcare from those in need, through the lack of an ability to pay.July 16, 2009 11:10 AM | Reply | Permalink
ellen, meet democracy. democracy, ellen.
July 16, 2009 10:33 AM | Reply | Permalink
July 16, 2009 2:30 AM | Reply | Permalink
With all due respect, Mr. Reich...you are wrong...very, very, wrong.
This is not "fair." As one of the people who will be subject to this tax, let me describe why.
First, I agree with a progressive tax system. I know that my success at making money is at least somewhat a result of advantages that have nothing to do with my work or sacrifices. Luck, genetics and being born into a supporting family all have given me an advantage not enjoyed by all; a progressive tax system helps correct for these "luck" factors. However, I have made choices, taken risks and made investments during my life that have resulted in a higher income -- and it is absolutely NOT fair for the government to confiscate my earnings as a direct transfer to others.
Let me elaborate. My family and I have relocated for work opportunities 5 times, crossing the country and uprooting relationships. Each time was a risk, for which I expected a reward -- a higher salary. These moves followed the attainment of 2 college degrees. The second one was achieved after 3.5 years of twice-weekly evening classes -- putting a strain on my relationships, a sacrifice of leisure time and extraordinary expenses. I made these choices willingly, as an investment in my family's future and I hoped for a return on our investment in terms of a higher salary, which has proven to be the case.
I'm now with my 3rd company in a 25 year career. My last employer had a traditional, defined benefit pension plan. I voluntarily left this and joined a company with only a 401(k). In exchange, I have a higher salary. Again, a decision I made because I expect that I will be able to keep my income, save for my retirement and not have it confiscated so it can be "redistributed" to others.
I do not complain about my choices -- they were freely made and have (usually) worked out as hoped. I also do not complain about paying a higher tax rate than most other people; I am not so arrogant to think that my success is due solely to hard work and risk-taking.
However, for the government to so blatantly play "robin hood' as you describe will permanently change the risk-reward equation, not only for those of us who are already "wealthy" (your word, not mine), but also for those who might want to become wealthy. This is unfair to those of us with a high salary who have "invested" with the expectation of being able to keep our "rewards". It is also counter-productive. People younger than me will learn that the risks they take and sacrifices they make will not result in the same reward; and will therefore not make the same decisions. They won't invest in themselves or their businesses if they won't be able to keep their rewards. The result: fewer businesses; less value created; lower productivity; fewer jobs and lower growth in the future.
Fair? No. Smart? No. Another step toward a lower-growth economy? Yes.
July 15, 2009 8:57 PM | Reply | Permalink
People with your particular bent on the economy always perceive growth emanating from the top down. I think that a healthy middle and working class can have equal or greater beneficial effects on the economy, by freeing people up to innovate and start new small businesses that will grow into bigger businesses. A content and happy middle class will help prolong a robust and growing economy. It would behoove that top 1% of taxpayers to not kill the real goose that lays the golden eggs, America's workers. The tax code was lowered for the top tier of taxpayers under Reagan in order to fund trickle down economics which has cost the lower tiers their own relative standing in what has turned out to be a transfer of wealth to those upper tiers. Who is to say that that top rate can't be adjusted to pay for other programs with more specific and measurable public benefits?
July 16, 2009 2:45 AM | Reply | Permalink
There's extraordinary sense of deja vu about some of the arguments advanced here. The latest one is that individuals making more than $350,000 per year will be discouraged from entrepreneurship if a small additional tax is added to what they already pay, while still leaving them far wealthier than almost everyone else.
That argument is selfish in a nation that requires a sense of community and shared sacrifice, but equally important, it's contradicted by history. We've had much higher taxes in the past, before the Bush tax cuts, and the economy thrived far more then than in the past eight years. Even more important, every other industrialized nation has done better than we have in providing health care for more people, less expensively, and with better results. Given that growing health care costs are devouring our economy, the one thing we can't afford is to refrain from the proposed reforms that include a public option to reduce costs.
The threat of "don't tax us rich folks or we'll stop being productive" has been issued many times in the past, and probably will be in the future, but in a nation where the gap between the rich and everyone else has grown unconscionably, I believe the public is prepared to ignore it in favor of a reform package that will improve the lot of almost every American - even the rich ones.
Most people have an instinctive sense of how much each member of society owes to society as a whole. That sense has been violated in recent years, but I'm hopeful it will be vindicated in the near future.
Let me add a personal note in response to what John wrote. I too am well-educated, with I'm guessing more years of education, more years of study, and perhaps more educational expenses than John. I too have tried to apply my native talents and learned skills toward success. The main difference is that my version of success did not involve making large sums of money, but rather helping make this world a better place while earning myself a sense of accomplishment and some recognition by my peers. As a result, my income is nowhere near the surtax level. I'm truly glad I can say that, because talent devoted primarily to making money beyond merely a comfortable living is talent that is partially wasted. Even at my lower income level, however, I would be willing and able to afford the proposed surtax.
I am not opposed to capitalism as a component of a society that balances individual entrepreneurship with societal obligations. I certainly don't begrudge Bill Gates his billions, but he illustrates a principle I endorse. Dedicating one's skills to a valuable and productive purpose, and becoming wealthy in the process is to be congratulated. Devoting one's life to wealth is not. Some who do may incidentally perform a public good, but a society that emphasizes that motivation is destined to be cruel and selfish. In a previous century, American capitalism epitomized that selfishness, but it has mellowed since, although perhaps not enough to satisfy our nation's needs.
The surtax would be fair. Even greater sharing would be even fairer, but we must start with the present.
July 15, 2009 9:46 PM | Reply | Permalink
Fred,
A thoughtful post (and partial response), which is appreciated.
I neither admire nor look down upon your value decisions -- you have chosen to apply your talents and education toward something you value (peer recognition, sense of accomplishment, making world better); I have chosen to do the same thing. To say that my talent is "partially wasted" is incorrect (and a bit presumptuous) -- the investors, employees and bondholders of my company would disagree (strongly, I hope). If you grant that I have some talent in my field, and am able to provide my employer with added profit that can be used to employ people and provide a return to investors, why is that less noble or valuable than your choices?
Another way of framing the issue: Instead of requiring me to contribute more of my monetary earnings, how would you feel if you were required to contribute your non-monetary earnings? For example, if you were required by the government to work 4 hours per week at a position of their choice? And only those with extra education (or talent, or some other reason) were required to "volunteer" while others aren't required to do so at all? Would that be fair?
One last item. With the current tax structure, my marginal tax, including state taxes, is 41%. After the phase-out of the Bush tax cuts, I believe it will be 46% (perhaps 47%, depending on deduction phase-outs). Add in this new health care surtax, it could be over 50%. At what point do you think it might be "unfair?" 55%? 60%? 70%? Fair or not, I think it is bad public policy for 40% of the population should be able to benefit from government while paying NO income tax, but others should have to submit 50% or more of their earnings?
I would propose that at that level, I will likely make different choices about how I spend my time -- more with family and friends and leisure and less creating value for my company, its employees and stakeholders. And THAT choice, repeated by thousands of other people, will lead to lower growth and less employment.
July 15, 2009 10:22 PM | Reply | Permalink
John - You must be extremely wealthy if the proposed surtax would affect you at a rate of 4-5 percent. If so, you will remain wealthy after the tax, and after you recover from your indignation, I expect you will rediscover substantial incentive to continue doing whatever it is you do that provides valuable goods or services to our economy. If not you, I know many wealthy people who would not feel cheated by the extra tax and would be every bit as productive as before. The historical evidence here and abroad bears this out. In some very prosperous western democracies, a 50 percent overall tax rate is the policy of the low-tax political party, not the high-tax one.
I can make the rest of this fairly brief. Our healthcare costs are at about 16 percent of GDP, far higher than all the other industrialized nations, all of which have some sort of public or single payer plan. These costs are rising at an alarming rate. If they are not greatly reduced, they threaten to ruin our economy. However dramatic that statement may sound, it reflects the views of most mainstream economists.
All other societies have controlled these costs because their various types of public options have prevented private insurers and health care providers, in nations where they remain, from charging exorbitantly - a consequence of inefficiency, duplication, excessive profits, and unnecessary costs (e.g. for advertising). No-one with expertise believes these costs can be controlled without a public option, and so the reality is a choice between either a public option or economic disaster. The public option will probably require some additional revenue from taxation beyond that achievable by cost cutting. That taxation is therefore a burden any fair-minded individual who can afford it should accept willingly. Anything else would be egregiously unfair to our entire society.
This conversation has focused on what is "fair" or "unfair". I feel saddened that you don't share the concept of fairness that I find instinctive in many ordinary citizens. It's a combination of a sense of community, and a recognition of the need for shared sacrifice, so that no segment of society truly suffers, but each contributes enough to feel a bit of hardship when necessary. As I've mentioned elsewhere, it means equal pain so that no-one's pain is difficult to bear. I would gladly accept a need to provide extra money or extra hours if that hardship were no greater than the hardship imposed on others, but I already provide more hours than I would need just for the income, so it's a moot point.
It may be impossible for me to communicate to you what the concept of fairness means to me, and to so many others. Perhaps though, with the help of some empathy, you can rethink this issue, and see fairness less in terms of what is owed you, and more in terms of what you owe to others.
July 15, 2009 11:04 PM | Reply | Permalink
Well. I guess you are right. I will give more.
What a condescending post. I do note that you didn't address any of my points.
At what point do you think "fair" stops and "unfair" begins? 50% is apparently OK. How about 60%, 70%, more? How would you decide how much of my money to take?
You say you already provide more hours than needed...but that wasn't my point. What if regardless of how much you gave, the government required you to work 4 hours more at its choosing?
On to the real issue of health care costs being high...true and I agree. In fact, I agree with the 2008-era Mr. Orszag (link: http://budget.senate.gov/democratic/testimony/2008/Orszag013108HealthTestimony.pdf )
But...of course, we aren't talking about reducing our expenditures below the 16% of GDP level...but increasing our costs and having someone else pay for it. If the debate were really about how to reduce health care costs, this wouldn't be very fun, politically. It is simple -- pay for fewer procedures, encourage healthy choices (or penalize unhealthy ones, like obesity, smoking, drug use), reduce threat of lawsuits, reduce payments to doctors and require preventative care for all. All these options have been available for the current government-run systems (Medicare, Medicaid, S-Chip). However, those are hard choices that tell people "no" on occasion. So, we will instead increase costs and coverage and raise taxes to pay for it.
Please go back and see my first point...a progressive tax system is fair and just. To imply (actually, say) that I don't have empathy is not only wrong, but offensive.
July 15, 2009 11:29 PM | Reply | Permalink
Four more hours of work per week equates to a 10% tax increase on a 40 hour work week. To my knowledge no one has suggested such an increase. The top tax rates were lowered in the eighties in order to feed the top tier of earners in the poorly conceived 'trickle down' theory of economics. Who says they can't be readjusted upwards? Those affected by this tax increase are already earning over $388K/year. If an earner at this threshold cannot adjust their expenses to accomodate the small tax increase proposed, I would suggest they spend some of their cash on a financial consultant. Then go work as a greeter at Wal-Mart for a week and ponder how you might rearrange expenses in order to afford adequate health coverage for yourself and family.
July 16, 2009 1:25 AM | Reply | Permalink
John - Sorry for the offense. It was not intentional. I will take you at your word that you have empathy. I do ask you to apply it to the 50 million or more uninsured individuals, and the countless numbers of families devastated by a combination of illness and unaffordable costs, all of which can be alleviated if we follow the example of every other industrialized nation. That means one or another type of public option. It means paying for the public option, including modest additional taxes if necessary, while knowing that the ultimate savings will greatly outweigh the costs.
You asked if I would accept a requirement to spend 4 extra hours a week as my share of a societal arrangement. The answer is I would gladly do it, if society urgently needed to impose a similar level of imposition on everyone else. Four hours per week is not intolerable, but it would noticeably affect my life pattern. What would be a comparable imposition for a billionaire with six yachts, three villas, a private jet, and a private helicopter? My guess would be something of the order of giving up four of the yachts, two of the villas, and probably the helicopter. Even then, it might not be a comparable imposition despite its dollar value running into the hundreds of millions.
Asking anyone earning in excess of $350,000 to accept a small tax increase is almost no imposition at all - at least as encompassed by my concept of fairness. I understand that you disagree, but I still hope you'll consider my argument.
July 16, 2009 11:25 AM | Reply | Permalink
Fred,
Thanks for your response. However, you have created a strawman to argue against, rather than the points I have attempted to raise.
You reference "billionaires" with multiple yachts, houses, and helicopters. That is not me; nor is it most people who will be subject to this surtax. Regardless, my arguments remain the same.
From your post:
"You asked if I would accept a requirement to spend 4 extra hours a week as my share of a societal arrangement. The answer is I would gladly do it, if society urgently needed to impose a similar level of imposition on everyone else. Four hours per week is not intolerable, but it would noticeably affect my life pattern."
Please note that what is being proposed is not to "impose a similar level of imposition on everyone else," but is to only impose a surtax on the few so it can be re-distributed to the many. What is being proposed is the YOU (and 1% of the population) contribute extra work hours...and 99% of the people will not. Does that change your view at all?
We've beaten this issue of fairness quite effectively; I suspect we have both learned from the other and will continue to disagree. That is OK.
The real issue, though, remains. Health care costs are rising much, much faster than GDP and tax receipts. This will remain true even with the surtax. Until our representatives are willing to confront the basic problem of our health care system (both private and public), we, as a country, are fighting a losing battle. Our current system is a pay-for-procedures on the provider side...so more procedures mean more money for doctors, hospitals and nurses. (I know you aren't motivated by money, but the facts show that most people are). On the consumer side (you and I and others who need care), our choices around prevention, tests, healthy lifestyles, and interventions are disconnected from the costs of our choices and the people who pay (usually employers, sometimes the government). Until these two critical issues are addressed, costs will continue to grow at a higher rate than taxes...and the system will become unsustainable.
I repeat myself (sorry) -- these are hard issues that will result in difficult choices being made by a government unwilling to make hard choices (witness the current F-22 fiasco in Congress for a military example.) It is much easier to create a new entitlement, enact new taxes, and hope the next generation figures something out. Basically the same strategy as Medicare, Medicaid, Medicare Part D, Social Security, the state of California, etc.
July 16, 2009 8:52 PM | Reply | Permalink
I addressed some of these issues in my response to Risky693 below. I agree with you and him that we need more than a simple substitution of one payer for another, but that type of substitution has proved an essential component of cost-effrective health care as evidenced by a comparison between the U.S. and the other nations that offer less expensive, universal health care, with better results.
The question of fee-for-service vs capitation has been argued for decades, and there are advantages and disadvantages of both. Capitation discourages excessive services, while occasionally discouraging necessary ones as well. The imperfections of any single approach is why we are also seeing a move toward evidence-based medicine as an additional means of controlling excessive procedures and their attendant costs.
We need multiple approaches to allow U.S. healthcare to accomplish what other nations are accomplishing, and perhaps we can agree, therefore, not to be too dogmatic in claiming to know the exact answer to this complicated problem.
July 16, 2009 9:39 PM | Reply | Permalink
Agree completely.
July 16, 2009 9:43 PM | Reply | Permalink
Can you please show me research that suggests increasing taxes is beneficial to economic growth? I can point to research conducted by Christina Romer, White House Council of Economic Advisors that refutes your hypothesis. In addition, Lawrence Lindsey, former White House economist, has reached the same conclusion, although Lindsey is more granular as to the specific level of taxes that starts to negatively affect growth - anything greater than 40% on the federal level. Moreover, can you answer one question? Why have 9 US multinational companies relocated and redomiciled in Ireland and Switzerland in the past month?
And Mr. Reich is missing the point. The tax surcharge does not fall solely on the wealthy. These bills include an individual as well as an employer mandate. That unfortunately, is a tax for employers.
I like you, believe in the ideal of universal healthcare. But I'm an economist by trade, and I realize that this country has several unfunded liabilities, namely Medicare and Social Security. As such, by 2017, the Medicare Trust Fund's assets will be greater than its liabilities, and by 2034, the Fund will be bankrupt. With this in mind I must ask, don't you think we should fix the existing problems, and actually reform the current system (namely Medicare and Medicaid) before we embark on creating a new entitlement program?
Lastly, I suggest you study the healthcare system in more depth, and take a look at the following examples:
a. Initial Medicare expenditures, as envisioned by the House Ways and Means Committee. Just to give you a taste: in 1966, the HWMC projected Medicare costs of $12B (inflation adjusted) by 1990. Well, they were only off by 9X. Spending increased to $109B in 1990.
b. Massachusetts Universal Healthcare Experience: Costs were greater-than-expected in year one, which forced the legislature to assess "taxes" on hospitals and insurers. In year two, Massachusetts now finds itself reducing benefits ($130M) and reducing enrollment in order to deal with greater-than-expected expenditures.
Why do I mention this? You can not expand access and reduce costs at the same time. It defies economics and historical precedent. I, like you, share a lot of the same ideals, but I refuse to allow this government to bankrupt this country.
Expanding access, w/o true reform will not solve the 16-17% of GDP being spent on HC. There is very little in any of the proposals (HELP, Tri-Cmte) that actually lowers the cost curve.
There are better ways to deal with this problem, including not taxing individuals and employers.
July 16, 2009 12:26 AM | Reply | Permalink
Why do I mention this? You can not expand access and reduce costs at the same time. It defies economics and historical precedent. I, like you, share a lot of the same ideals, but I refuse to allow this government to bankrupt this country.
To me, that statement suggests that your familiarity with healthcare is less than your familiarity with economics. In fact, expanding access is vital to cost reduction, and underlies the critical need for a public option in healthcare reform. The reason is simple - the people without access are still getting sick, and still getting care, but who is paying for it? You and I are, because health providers, to stay solvent, must charge someone for unreimbursed costs, and they add that charge to our bills. The problem is that these extra charges are exorbitant, due to insurance system duplication, inefficiency, excessive profits, advertising, and other unnecessary expenses. A public option expanding coverage would still have us pay, in part via taxes, but in a more cost-effective way. That is a major reason why every other industrialized nation has much lower costs, nearly universal coverage, and better health. It would be the failure to implement this reform that threatens to bankrupt the country.
On a couple of other points - the debate over the relationship between tax changes and economic health will never end, but it's a minor point in the current debate in comparison with the train wreck of an economy we face if we don't dramatically reduce costs. In this case, the small increase in taxes is a small down payment on net cost reduction, which I hope you agree will be good for the economy.
Finally, regarding the SS Trust Fund's insolvency, it doesn't trouble me, mainly because the Trust Fund doesn't really exist.
July 16, 2009 11:10 AM | Reply | Permalink
Actually, I understand the economics of HC pretty well. And to a certain extent, you are correct in your hypothesis, although only to a certain extent.
1. DSH (Disproportionate Share Hospital Payments) totaled roughly $25B in 2009, $14B for Medicare and $11B for Medicaid. Total HC spending was $2.45T according to CBO. So on the surface, uncompensated care accounted for 1% of total HC costs. These are CBO and CMS numbers.
2. DSH payments are funded through general taxes. So hypothetically, our premiums should not be affected by uncompensated care.
3. However, as you suggest, that is not the case. But then again, that's not the whole story. Recent Senate Finance testimony suggests that private insurance subsidizes Medicare and Medicaid to the tune of $90B/yr. As I review the profit / loss statements of hospitals, dialysis providers, SNFs, etc, it is quite apparent that Medicare and Medicaid do not pay their fair share of the bill. On average, Medicare pays rougly 70 cents on the dollar, while Medicaid pays 60-65 cents on the dollar, which leaves the private sector footing the bill in order to make these providers whole.
4. Moreover, if you adjust for enrollment, Medicare spending has outpaced private health expenditures in 7 out of the last 10 years. So despite unilateral pricing power and a perceived lower administrative burden, Medicare inflation is outpacing that of private insurance. I suggest you review the work of Karen Davis at The Commonwealth Fund, entitled Bending the Cost Curve. Managed care has its drawbacks (and those can be fixed), but at the end of the day, managed care works.
5. The problem with the public plan is that it relies on an antiquated reimbursement mechanism that is not being fundamentally altered by HELP, Tri-Cmte or SFC (although I must say, I have not seen the SFC bill yet, so I should reserve judgement). Fee-for-service promotes cost inflation, as there is no incentive to rein in costs.
6. Lastly, let's think about the unintended consequences of the public plan. One, there is data, facts even that prove Medicare is not efficient (see above YOY cost inflation comparisons and cross-subsidy). Please explain to me just how a public plan is going to lower costs? Relying on pricing? Great, then the private sector just harbors a greater burden. I suggest you review the Sunday Boston Globe lead article. MA has two problems: one, access and two cost. Waiting times for PCP visits can last weeks. Specialists, forget about it. And two, and more pressing, is cost. BMC has sued the MA state government for reducing Medicaid funds 25% in F10. And even with this 25% reduction, MA is still over budget; as such, Gov. Patrick has issued a referendum to lower the benefits of certain MassHealth benefactors as well as disenroll some of those who were auto-enrolled. So what happens? Care suffers, b/c Medicare and Medicaid, and now the public option, underpay.
I know HC quite well. I see the numbers daily. I review the CMS numbers. I review the CBO numbers. I review the bills. I review the public filings for insurance companies, hospitals, dialysis providers.
What we have in front of us, is not HC reform; it is simply entitlement reform. Call it what it is.
Fundamentally, the only way to solve our issue is to put all the power of HC in the individual's hands. Take it away from the employers. Once we understand the ramifications of smoking, eating McDonalds, not exercising, being lazy, sedentary; once we understand the true cost of HC, only then will half of the cost curve bend. The other half is changing the incentive system for the physician. It is called capitation. It works well. People may not like it, but it restrains costs without jeopardizing care.
July 16, 2009 4:28 PM | Reply | Permalink
Risky693- Thank you for very thoughtful and provocative comments. Before responding to the core issue - universal healthcare at a net cost savings, let me first address some other points that arose.
I defer to your knowledge of Medicare statistics. There are some who would probably assert that Medicare is more efficient and equitable than you suggest, but I’m not qualified to argue that point. In any case, I wasn’t attempting to advocate Medicare For All - certainly not without changes.
Second, I have some familiarity with the pros and cons of capitation. In many circumstances, the advantages seem to prevail, and I’ve observed this personally with VA healthcare - a very successful public option system.
Third, I couldn’t agree more on the need for individual Americans to assume greater responsibility for their own health in terms of diet, smoking cessation, and the like. This can be incentivized by an appropriately designed health insurance system, public or private. - particularly one with greater emphasis on preventive medicine.
When it comes to the core issue - the cost of health care to the American economy, I would approach the topic with two separate questions. 1) Does a public option reduce costs? 2) If so, how?
The reason they are separate is that we already have a strong affirmative answer to the first question, and so uncertainties regarding question 2 are not a legitimate challenge to question 1. If we examine healthcare in the dozen or more industrialized nations beyond our borders, we find that they all provide nearly universal care at a cost not much more than half of ours, expressed as a percentage of GDP. Similarly, their health outcomes are better, as measured by the well established criteria of life expectancy and infant mortality. This uniform advantage over U.S. healthcare does not reflect uniformity in other regards such as demographics or the specifics of the individual system. Some are single-payer, whereas others involve various public/private combinations and/or employer-mandated insurance coverage. What is uniform, beyond their greater success rate, is the presence of a strong public option. In view of the consistency of this effect across multiple comparisons, I would argue that a substantial burden of proof lies on those who claim we cannot expand coverage, reduce costs, and provide better healthcare in the bargain.
How then, would a strong public option reduce costs? I can only skim the surface, but let me suggest some obvious mechanisms. The first involves savings related to economy of scale, elimination of excessive administrative costs and paperwork necessitated by a multitude of fragmented systems, and of great importance, the reduction or elimination of consumer costs that go to fund corporate profits, market research, advertising, and other expenditures that benefit investors but not the public at large. In the case at least of the pharmaceutical industry, profits are a major element in this excess. I’ve discussed in some detail elsewhere why industry attempts to rationalize their exorbitant profits are deceitful - Reducing Drug Costs. In any case, we know from the VA and elsewhere that broad public leverage can dramatically curtail excessive drug costs.
No politically viable public option will eliminate all the above costs, but it will almost certainly eliminate the worst excesses by rewarding the private providers who can compete with the public plan in terms of quality while still realizing a modest income.
A second mechanism relates to universal coverage, including an emphasis on preventive medicine as a means of minimizing later treatment costs. In my earlier comments, I had mentioned that consumers pay for unreimbursed expenses, but that is only a part of the story. Uninsured Americans still get sick, and while the rest of us may pick up some of the tab for those who can’t afford it, the other part of the bill is paid by the uninsured themselves - ie, it’s part of the cost of health care, except it’s often borne by families who are devastated by both the costs and the illness that brings them on. When a public plan pays for more of those costs, it simply substitutes a fairer, more humane, and more cost-efficient payment mechanism for payments that are made anyway.
Universal coverage probably also reduces the amount of illness that must be paid for. It is true that some uninsured Americans grit their teeth and endure an illness rather than visiting a doctor, and in some cases, that saves money. In many other cases, however, it allows an illness that begins at a stage where it is treatable easily and cheaply to progress to a far more severe and expensive stage. In the case of preventive care, the effort involved, depending on the illness in question, may yield either a net savings or net cost in terms of medical expenses. However, like treatment of early illness, it offers a multi-billion dollar savings in terms of workplace productivity, where illness reduces our GDP to the tune of hundreds of billions of dollars annually.
Finally, a broad public option, through its bargaining leverage, can work to reduce inefficiency and duplication within healthcare services themselves. There is no need for each of three hospitals in a small area to have its own MRI, heart surgery unit, or other expensive toy that is not only excessively costly, but medically harmful in that the dividing up of services prevents any one institution from acquiring the caseload needed for optimal experience. The leverage a public plan exerts can reward institutions that cooperate to eliminate unnecessary duplications.
We don’t know yet how well a proposed public option would emulate the success of the other nations who surpass us in both health and savings. We do know that the current system is unsustainable. In my view, we should start with an effort similar to those proposed in Congress, while being prepared to monitor it so as to adapt in ways that enhance its virtues and correct its failings. Almost anything proposed would be better than to continue on the present course.
July 16, 2009 8:40 PM | Reply | Permalink
I enjoy your perspective, but like so many today, there is really no substance or data behind your assertions. I will write later today as to why the OECD and WHO world health statistics are flawed. People take these numbers as gospel, but has anyone actually examined the criteria they used to determine their baselines? The numbers are so flawed it does not pass any rigorous scientific or statistical methodology.
Unfortunately, time is short this morning, but I'll give you some facts, some data that simply refutes your assertions. As an economist, similar to Mr. Elmendorf, I can only rely on facts, not what ifs.
1. Public Plan & Lowering Costs: One, according to the CBO score, the public plan will not save money, as stated yesterday by Mr. Elmendorf in front of the Senate Budget cmte. I've tried to explain why the public option won't save money, but I'll reiterate:
a. It is a cross-subsidy, therefore, simply moving money within different buckets does not engender savings.
b. Perceived administrative efficiency: Susan Fu at CMS, in conjunction with the Manhattan Institute actually found that administrative spending per member was actually higher in the government programs than in private insurance. Susan works at CMS, the government agency in charge of Medicare and Medicaid. In the Senate HELP mark-up hearing, Senator Tom Coburn actually used some of this information to inform Senator Dodd and Harkin. Neither Senator was able to refute the data. Moreover, Mr. Elmendorf, of the CBO, cited no overall savings for the public option as it stands today.
c. You can achieve administrative efficiency by mandating standard IC9 and HIPAA compliant coding. Develop a universal coding system that is phased in over 5-7 yrs, enabling the government as well as private insurance to adjust their back-end operations. Lastly, remember I talked about the law of unintended consequences? Let's just assume that the Levin model is correct, and 120M people move into the government's program. Simply adding the employee base of the 1,300 insurance companies (since they would be out of work) would number close to a million people. That's a million people out of work. The law of unintended consequences. We need to think before we act.
d. Fee-for-service lives on in this public option. There is no further need to discuss. It does not work. It does not encourage cost reductions.
I could go on and on, but at the end of the day, what he have in front of us with the HELP and Tri-Cmte bills are a farse. Is it any wonder that Senator Conrad, head of the Senate Budget cmte, told cmte members last night that he can not vote for either bill, as they stand today?
Lastly, I'm not claiming the status quo is adequate. But if we are going to embark on a discussion of reining in costs, and attempting to improve our HC system, it can't be done in the fashion our President is claiming (like many things).
July 17, 2009 7:32 AM | Reply | Permalink
but I'll give you some facts, some data that simply refutes your assertions. As an economist, similar to Mr. Elmendorf, I can only rely on facts, not what ifs.
1. Public Plan & Lowering Costs: One, according to the CBO score, the public plan will not save money, as stated yesterday by Mr. Elmendorf in front of the Senate Budget cmte.
If you are to rely on facts, you have an obligation to state them accurately. The CBO did not say that the public plan would fail to save money. Rather, it said that the plan would not save the government money - an observation that would probably be self evident even without the CBO testimony, given that the plan involves public expenditures.
Despite the additional federal costs, the plan can be expected to save substantial sums of money to the economy as a whole, because the savings to consumers will greatly outweigh the cost to the government. Estimates of net savings have been in the hundreds of billions or even trillions over ten years, but we really don't know the exact figures. All we know is that all the other industrialized nations utilize strong public options, provide nearly universal health care, and achieve better health for their citizens.
This error in your understanding of what the CBO stated renders most of your other commentary irrelevant in my view. However, I've already addressed most of the other assertions earlier so I won't reiterate. I agree with some, but they don't significantly alter the imperative to include a strong public option in healthcare reform. At this point, I see objections now as simply a form of obstructionism in the face of compelling evidence that our current system is a failure, and that by utilizing the same type of public component as every other industrialized nation does, we can begin to correct the circumstance that finds all of them doing a far better and less expensive job than we do.
July 17, 2009 12:05 PM | Reply | Permalink
Oh BTW Mr. Reich, both NPR stations in Fairfield area, CT cut your spot to the last 10 seconds on Marketplace tonight.
I was pissed, what's up with that? I guess I'll ask NPR.
July 15, 2009 10:33 PM | Reply | Permalink
I'm with Robert Reich on this one. As a matter of fact he doesn't go far enough. Bill Gates, Warren Buffet, Barabara Streisand, Oprah Winnfrey, Michael Dell, The Walton family, the Kennedy's, Gov Corzine, Al Gore, Ariana Huffington, these fat cats are worth multi-millions, hundreds of million, or tens of billions. And most if not all of them supported Obama and his promise to share the wealth. So Congress should just pass a law confiscating everything over $1 million. That money can be used to pay for Obama growing unemployment problem..9.5% and still shooting up, the trillions in debt he's created, his health care program, the money needed to pay off Democratic special interests. Take it all and share it. They've fattened themselves on the country for long enough! They'll still have $1 million and be richer than 99% of us. Fair is fair...they need to share!!!!
July 15, 2009 10:53 PM | Reply | Permalink
My goodness, if average people -who are in no danger of paying this surtax- are this upset NOW, after the failed stimulus, the earmarks, the massive budget, the Waxman-Markey electricity tax, can you imagine the rage AFTER this nonsense passes?
The 2010 elections will be studied for decades afterward, as a prime example of voter repudiation.
July 15, 2009 11:44 PM | Reply | Permalink
i don't think your sampling methods are sufficient.
perhaps you should consult the polling that has actually been done on these questions.
July 16, 2009 10:41 AM | Reply | Permalink
Who said those people are average? At least some admitted to being in the top 1% of taxpayers who will be affected by this. That puts their taxable income at a minimum of $388K/year. The median household income in the US is $50,233. I'd say these commenters are well above average.
July 16, 2009 11:20 AM | Reply | Permalink
Well the taxpayers just bailed them out to the tune of about $1T so I think it is about time time* they start paying us back our money...maybe with a bit of interest added on.
* please see: Goldman Sachs 2nd quarter profits.
July 16, 2009 12:39 AM | Reply | Permalink
I can't believe that people think it is okay to take someone elses money to pay for a deadbeat healths insurance! America use to be a country where you work hard to get ahead and if you choose not to work hard you lose out. Now it is a country that if you choose not to work hard then the government will give you what the others worked hard for. Any one who believes that is okay is a lazy idiot!
July 16, 2009 7:22 AM | Reply | Permalink
Tell it to the bankers.
What color is the sky in your world?
July 16, 2009 8:05 AM | Reply | Permalink
Why? Because the people who stole our money think it is unfair that we want it back? It is theirs now and possession is 9/10ths of the law? Criminals works hard at stealing stuff too...does that mean they've earned it? Go away Mr. Galt and your damned lies. The American Way is for the American worker needing to work harder for less. You're are right and it is a proven fact that the government makes sure lazy rich people get what others have worked hard for.
July 16, 2009 10:21 AM | Reply | Permalink
Was anyone else surprised by some of the numbers coming out about this funding?
I really thought more Americans made high wages. Apparently, just a tad over 2 million make 280K or better. That puts a person just this side of the top 1%.
Wealth concentration has gotten far worse, as everyone knows. Wealth is more and more consolidated in the hands of a few multi-billionaires and multi-nationals, and the middle class is shrinking. Even the upper middle class is shrinking.
It's no coincidence that this has happened under a decades' old conservative economic regime, that saw taxes slashed for the rich and for corporations. It also comes at the same time that deregulation has taken hold like wildfire.
Wages used to rise year after year for the middle class. But that hasn't happened since 1973, roughly. We've had nearly 40 years of stagnant or falling wages for more than 90% of Americans, while the wages for the top 1% have skyrocketed.
And what else do we have to show for voodoo economics? An eleven trillion dollar debt, record trade debt, crumbling infrastructure, a collapsing health care system and a collapsing economy overall.
Reaganomics. The biggest economic con-game in our history. It's time to reverse course.
July 16, 2009 11:09 AM | Reply | Permalink
"Tax the Wealthy to Keep Us Healthy" has a better rhythm.
Otherwise, quite good.
July 16, 2009 11:54 AM | Reply | Permalink
I would capitalize the US - to make ambiguous "U.S." from "us".
July 16, 2009 1:19 PM | Reply | Permalink
Good debate here. The sad thing is single payer would eliminate most of the problems defined in the debate. Both John and Fred make valid points. I can understand Johns reticence in having to pay more taxes since he personally will not benefit from it and Fred is correct that we are a community of citizens and should all pitch in for the common good. A decent single payer system such as Medicare paid for not just with employee/employer taxes, but with a value added tax (VAT) would go a long way to restore some semblance of equilibrium in regards to everyone's responsibility for paying for health care. In fact everyone who spends a dollar in this country would be contributing towards the cause.
But, unfortunately, single payer was not part of the national debate and we will be forced to decide which group will pay more and which groups get more or less health care. And the inequalities will remain.
July 16, 2009 12:53 PM | Reply | Permalink
Americans are all on the same lifeboat. So, let's say that there is a doctor on this lifeboat, and he won't provide medical treatment unless he is paid. And let's say that there is another guy on the lifeboat who has flu-like symptoms that turn out to be swine flu, then the choice is this: does everyone on the lifeboat chip in as much money as they can afford to pay the doctor, or does everyone on the lifeboat get swine flu?
July 16, 2009 1:03 PM | Reply | Permalink
Well, everyone else on the life boat knows how to fish, but the doctor does not. Maybe, if the doctor wants to eat, he'll cure the patient.
July 16, 2009 1:18 PM | Reply | Permalink
This country is governed by one principle: free contract.
What you earn, what you make, what you pay, what you take, is all based upon one thing: your bargaining power.
Tax the rich to feed the poor? Only if the poor have bargaining power.
July 16, 2009 1:16 PM | Reply | Permalink
It amazes me that, at a point when the discussion should be about how most efficiently to make affordable health care accessible to all, so many Americans are bogged down in a debate over the very principle of progressive taxation.
Folks, that's why you're all going to be stuck with a half-assed "public option" instead of a single-payer system.
Unfortunately, that's the most Obama could hope to get through Congress. But he's right: almost any change would be better than the piece-of-crap health-delivery system you have now.
July 16, 2009 3:03 PM | Reply | Permalink
To Ellen K
In reply to your address.
http://tpmcafe.talkingpointsmemo.com/talk/blogs/robert_reich/2009/07/the-house-tax-the-wealthy-to-k.php#comment-3528561
The Pursuit of Happiness.
You're absolutely correct. We had a referendum and the will of the majority will prevail.
No more of the selfish ideology that deprives individuals of life as in "Life, liberty, and the pursuit of happiness" one of the most famous phrases in the United States Declaration of Independence. These three aspects are listed among the "inalienable rights" of man.
No longer will life be deprived, because of ones station in life or whether they could afford healthcare.
After Obama gets this budget agenda done, then maybe we can focus on the military budget. Then I want to hear the Republicans talk about affordability or budget deficits.
REPUBLICAN Hypocrites
Time to bring the troops home and stop squandering our blood and treasure making the World safe for everyone, while depriving ourselves Healthcare and the other things our society finds it really wants to support.
Put the burden back on the Republicans to fund a 1 trillion dollar budget for the military.
If Republicans want a stronger military, then fund it. No more cuts to one side of the ledger.
July 16, 2009 6:26 PM | Reply | Permalink
Taxes. In reality, contrary to the propaganda put out by the rich, and given to useful idiots on the right for repeated dissemination, we are near historic lows as far as tax burdens go. Compared with our own past, and definitely compared with most of the rest of the world, we have very low taxes.
The percent of GDP going toward taxes in roughly 25%. I've seen conservative economists who say it's lower than that. Under 20%. They cite that number, ironically, in defense of their scare tactics about Obama's future taxation potential.
Sweden's is roughly 50% of its GDP, as a point of contrast.
America, from 1947-1964 had a top rate of 91%. From 1964 to 1973 it was 70%. There is a direct parallel, historically, between high taxes for individuals and corporations, and high economic performance, job growth and wage growth.
After 1973, wages for roughly 93% of Americans stagnated or fell, with only a brief blip during the Clinton years, when he raised taxes.
There is a direct parallel, historically, between low taxes for the rich and corporate America and poor job growth, poor wage growth, and a rapidly increasing gap between rich and poor, rich and the middle, and even rich and richer.
Some posters here have tried to say that low taxes are needed for a healthy economy. The facts, the evidence, the historical record says otherwise.
The most recent example is obvious. Under Bush, just 1.45 million new jobs were created, net. Tax receipts to the Treasury declined his first three years and his last. He doubled the debt. He set records for domestic and trade deficits. Wage growth for roughly 95% of the American workforce were flat or declined. Wage growth for the top 1% skyrocketed. It was even higher for the top .01%.
History tells us that lower taxes for the rich and for corporations do NOT help the vast majority of Americans. They help the rich. Period. And, since they have seen the vast majority of tax CUTS in the last few decades, it is only fair that they pay for health care reform. They can afford it. No one else can. It needs to be done.
That said, the two best health care bills are the ones being ignored. Conyers' and Sanders'. Both Single Payer. Single Payer would immediately save us at least 30% in overhead costs . . . which would translate into several hundreds of billions each year. It has the potential to save much more, as prices could be forced down with a Medicare for All system.
It's the cheapest, most efficient, best answer to our health care problems. And it would save the vast majority of Americans a fortune. No more out of pocket costs or premiums would help any family. It would also help businesses, for obvious reasons.
If not for the power of private insurance company lobbyists, we'd do the right thing, the smart thing, the least costly thing and go Single Payer.
July 17, 2009 12:16 AM | Reply | Permalink
For those of us who prefer a single-payer option, today is an important opportunity. This is copied from an e-mail sent out by democrats.com (please forgive the long cut-n-paste).
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Rep. Dennis Kucinich proposed a crucial amendment today for single-payer healthcare and we urgently need you to call one or more of the 26 Democrats on the House Education and Labor Committee. Our message is simple:
Please support Rep. Kucinich's Amendment today in the HELP Subcommittee to let states create single-payer healthcare systems. The federal government should give states the freedom to fix our health care crisis.
The Kucinich Amendment would let individual states create single-payer healthcare systems even if Congress fails to create a nationwide single-payer system.
That's exactly how Canada evolved towards single-payer: one province at a time. Given the corporate-funded resistance to single-payer in Congress, the U.S. may have to follow the Canadian path.
Progressive activists in California, Illinois and Pennsylvania are leading the way for single-payer systems and the Kucinich Amendment would remove the legal roadblocks they face.
The fate of the Kucinich Amendment rests in the hands of the 26 Democrats below. Please call as many as you can.
George Miller (CA-7) 202-225-2095
Dale Kildee (MI-5) 202-225-3611
Donald Payne (NJ-10) 202-225-3436
Robert Andrews (NJ-1) 202-225-6501
Bobby Scott (VA-3) 202-225-8351
Lynn Woolsey (CA-6) 202-225-5161
Ruben Hinojosa (TX-15) 202-225-2531
Carolyn McCarthy (NY-4) 202-225-5516
John Tierney (MA-6) 202-225-8020
David Wu (OR-1) 202-225-0855
Rush Holt (NJ-12) 202-225-5801
Susan Davis (CA-53) 202-225-2040
Raul Grijalva (AZ-7) 202-225-2435
Tim Bishop (NY-1) 202-225-3826
Joe Sestak (PA-7) 202-225-2011
David Loebsack (IA-2) 202-225-6576
Mazie Hirono (HI-2) 202-225-4906
Jason Altmire (PA-4) 202-225-2565
Phil Hare (IL-17) 202-225-5905
Yvette Clarke (NY-11) 202-225-6231
Joe Courtney (CT-2) 202-225-2076
Carol Shea-Porter (NH-1) 202-225-5456
Marcia Fudge (OH-11) 202-225-7032
Jared Polis (CO-2) 202-225-2161
Paul Tonko (NY-21) 202-225-5076
Dina Titus (NV-3) 202-225-3252
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-- ARG
July 17, 2009 9:45 AM | Reply | Permalink
But there's no reason to suppose that taking a tiny sliver of the incomes of the top 1 percent will reduce all that much of their ardor to invest, we have helped by transporting cars coast to coast by auto transport online quotes, they have also hired in the future. Yet if this tiny sliver means affordable health care for a far amount of Americans, who will be able to get checkups and thereby stay healthy and productive.
June 28, 2010 4:08 PM | Reply | Permalink