News Assuming Affordable Care Act Is Shot Down, Should There Be a Healthcare Hospital Tax?

[ParticleGrl]

We've gone so far beyond "even in principle" though, with now 47% of tax filers paying no federal income tax and thus not contributing to the cost of the associated federally provided services.

This is bad reasoning- there are more forms of federal taxation than income tax (payroll tax, for one, which is somewhat regressive).

That's not really true. Roads and a military are a good example of things that simply can't be done privately.

Thats not true- private military contractors (mercenaries) exist, and it is certainly possible for the federal government to hire a private sector military contracting company. This is being done to supplement forces in Iraq/Afghanistan, and we COULD if we wanted, disband our military and hire it out to private sector contractors. It is NOT true that it can't be done privately. Its not a good idea, but its not impossible.

Governments need to build and maintain roads because private companies wouldn't build roads where/how they are needed, they'd build them where/how they could make the most money. So people in rural areas would suffer, maintenance and quality would suffer, etc.

Here your argument is NOT that its impossible for the private sector to build roads. Your argument is that the government is BETTER at providing roads.

If the government were better at providing health insurance (I'm not saying they are, just postulating the IF), than why not have the government provide health insurance?

The same argument you are making for roads could be made for risk pools/insurance. Private companies would only take the least risky people, leaving people with genetic illness (or bad family histories of such illness) to suffer, the elderly would suffer, etc. There is no profit in insuring risky people, just like there isn't much profit in rural roads or electricity.

 

[Astronuc]

It most certainly is not. Yours was a tautology because you included the word "government" in it. You made yours logically impossible - you made it self-contradictory by its very wording. A privately-run state road/interstate system is functionally impossible. Meaning that people could try it, but it wouldn't work.

This isn't a word-game, Gokul. You haven't made any arguments yet! This is the first I've seen of a point from you! So: why do you believe that private roadways are possible? And please, don't make this about small-scale communities. I live in such a community and my 1/4 mile road is privately-owned and works fine. This isn't about that.

Governments need to build and maintain roads because private companies wouldn't build roads where/how they are needed, they'd build them where/how they could make the most money. So people in rural areas would suffer, maintenance and quality would suffer, etc. The need for government control of roads is exactly the same as the need for government control of the power grid. Even as private companies own the wires, they are essentially just government contractors at that. People in rural areas would still not have electricity today if the government didn't require it.

Private roads/highways would be difficult now at the scale that is required.

However, historically, private tolls roads did exist.
http://en.wikipedia.org/wiki/Philadelphia_and_Lancaster_Turnpike

It was the first turnpike of importance, and because the Commonwealth of Pennsylvania could not afford to pay for its construction, it was privately built by the Philadelphia and Lancaster Turnpike Road Company.

http://explorepahistory.com/hmarker.php?markerId=1-A-F3

http://en.wikipedia.org/wiki/First_Great_Western_Turnpike#Origins

http://eh.net/encyclopedia/article/klein.majewski.turnpikes

Private turnpikes were business corporations that built and maintained a road for the right to collect fees from travelers. Accounts of the nineteenth-century transportation revolution often treat turnpikes as merely a prelude to more important improvements such as canals and railroads. Turnpikes, however, left important social and political imprints on the communities that debated and supported them. Although turnpikes rarely paid dividends or other forms of direct profit, they nevertheless attracted enough capital to expand both the coverage and quality of the U. S. road system. Turnpikes demonstrated how nineteenth-century Americans integrated elements of the modern corporation – with its emphasis on profit-taking residual claimants – with non-pecuniary motivations such as use and esteem.

Private road building came and went in waves throughout the nineteenth century and across the country, with between 2,500 and 3,200 companies successfully financing, building, and operating their toll road. There were three especially important episodes of toll road construction: the turnpike era of the eastern states 1792 to 1845; the plank road boom 1847 to 1853; and the toll road of the far West 1850 to 1902.
. . . .

There were also privately chartered canal companies and railroads, and some toll roads could not compete with railroads and canals.

As for private armies - a more recent event.
http://www.nytimes.com/2011/05/15/world/middleeast/15prince.html

. . . . In fact, they were soldiers for a secret American-led mercenary army being built by Erik Prince, the billionaire founder of Blackwater Worldwide, with $529 million from the oil-soaked sheikdom.
. . .

Ostensibly, if one has the monetary resources, then a private military is feasible.

When the Santa Fe Railroad and the Denver and Rio Grande Western were competing over the Royal Gorge, both railroads hired private armies to battle it out. Federal intervention was required to end the fighting.

Labor conflicts in Pennsylvania’s coal mines and steel mills during the nineteenth and early-twentieth centuries were usually violent. In order to insure that they had the upper hand and to avoid relying on local police (who were sometimes sympathetic to strikers), mine and mill operators set up their own “Coal and Iron Police” as early as the 1870s. Public reaction against these private armies led the Pennsylvania legislature to create a Department of State Police as an ostensibly more neutral and highly-trained law enforcement body. But the cure turned out to be worse than the disease. In the 1910 strike at Bethlehem Steel, the state police proved to be as pro-management as the Coal and Iron Police and even more brutal. The following testimony from workers and labor leaders appearing before the U.S. Commission on Industrial Relations in 1915 underscored the anger and discontent of common laborers with the military mindset of the newly formed Pennsylvania State Police.

http://historymatters.gmu.edu/d/5661/

 

[Vanadium 50]

This is bad reasoning- there are more forms of federal taxation than income tax (payroll tax, for one, which is somewhat regressive).

Yes, but of majority of people who pay no income tax (according to the IRS, for 2009, it is now 51% of filers), a majority of them (60%) receive a refundable credit. For many of them, this will balance FICA.

 

[ParticleGrl]

Yes, but of majority of people who pay no income tax (according to the IRS, for 2009, it is now 51% of filers), a majority of them (60%) receive a refundable credit. For many of them, this will balance FICA.

I can't find a specific breakdown of credits vs. FICA (the best I can find includes state taxes and sales tax). If we include payroll and credits, roughly how many people pay no federal tax?

 

[Vanadium 50]

I don't think that information exists, as they are two separate taxes that go through two completely separate chains - i.e. you don't calculate FICA on your 1040. Someone in the IRS would have to get this by matching 1040's and W-2's. Not a small job.

What we do know is that 30% of tax filers have a refundable credit.

So here's the approximate breakdown:

• 30% pays negative income taxes.
• The next 20% pays no income tax.
• the next 40% pays half the income tax.
• The last 10% pays the other half.

 

[mege]

... Unfortunately, the big insurance companies are pricing regular people out of the market.

... but there may be some morons in our government who actually believe that keeping health-insurance companies fat is good for our economy.

Why are the insurance companies, pharm companies and other for profit medical industries for the ACA?

BCBS and a few other smaller NFP insurers have come out and said they don't think it's sustainable without major infrastructure changes.

What I don't ultimately get in the ACA is: if our current health insurance system is so bad and broken, why are we forcing the rest of the country to join in on it with little fundamental change? (except now the government is acting as the broker for everything - in a loose sense)

 

[WhoWee]

Why are the insurance companies, pharm companies and other for profit medical industries for the ACA?

BCBS and a few other smaller NFP insurers have come out and said they don't think it's sustainable without major infrastructure changes.

What I don't ultimately get in the ACA is: if our current health insurance system is so bad and broken, why are we forcing the rest of the country to join in on it with little fundamental change? (except now the government is acting as the broker for everything - in a loose sense)

Control/power?

 

[WhoWee]

Fox News just reported 20% of April Health Care Waivers went to Nancy Pelosi's Congressional District.
http://nation.foxnews.com/nancy-pelosi/2011/05/17/pelosi-caught-hand-obamacare-waiver-cookie-jar
"Pelosi Caught With Hand in Obamacare Waiver Cookie Jar "

 

[WhoWee]

Fox News just reported 20% of April Health Care Waivers went to Nancy Pelosi's Congressional District.
http://nation.foxnews.com/nancy-pelosi/2011/05/17/pelosi-caught-hand-obamacare-waiver-cookie-jar
"Pelosi Caught With Hand in Obamacare Waiver Cookie Jar "

I guess people in her District finally read the legislation - now they know what's in it?

 

[Ryumast3r]

Why are the insurance companies, pharm companies and other for profit medical industries for the ACA?

BCBS and a few other smaller NFP insurers have come out and said they don't think it's sustainable without major infrastructure changes.

What I don't ultimately get in the ACA is: if our current health insurance system is so bad and broken, why are we forcing the rest of the country to join in on it with little fundamental change? (except now the government is acting as the broker for everything - in a loose sense)

They tried to get those fundamental changes in, but didn't have the support (no I'm not talking about JUST the government option, which, honestly, I don't see as all that bad since France has only government options and they rate pretty high in healthcare, but that's a different debate), so they went with the "let's get everyone on to insurance and see what we're able to come up with down the road" plan.

 

[CAC1001]

On privatizing fire services, it would be stupid to privatize a fire house in the sense of having individual people pay for the fire service, and if they refuse, then if a fire starts, their house burns down (I don't know why any town would have tried it that way). The way to do that would be for private fire companies to compete for contracts to cover the fires in a certain area, being paid by the local government with taxpayer money. If a fire company doesn't do its job properly, then it loses the contract, and another company would take over. Maybe the fire houses could be publicly-provided for the fire companies (otherwise each company would need to build its own fire houses), but the firefighters and the trucks are provided by the company in this theoretical example.

Thats not true- private military contractors (mercenaries) exist, and it is certainly possible for the federal government to hire a private sector military contracting company.

Private military cotnractors aren't the same thing as mercenaries. Mercenaries are paid soldiers who will work for anybody, who have no loyalties. That is different than a soldier who goes to work for a private military company that is licensed by the U.S. government.

The same argument you are making for roads could be made for risk pools/insurance. Private companies would only take the least risky people, leaving people with genetic illness (or bad family histories of such illness) to suffer, the elderly would suffer, etc. There is no profit in insuring risky people, just like there isn't much profit in rural roads or electricity.

A government-run system might function the same though. The people who are the most likely to die may be given secondary consideration, as the system will have to ration care.

 

[mege]

Control/power?

This is my greater point - the ACA just entrenches the current system and subscribes millions more to it. Costs of health care are high in the United States because (some could argue) too many people have access to health care. The ACA will naturally disincentivize health care and force the government to subsidize the resources necessary for healthcare to be successful at even a basic level (and the setup costs dealing with building more facilities, training more staff etc).

What needs to be done is encouragements in efficiency in the health care world. Adding another elephant to the equation (ie: government hand-holding, the first elephant being medicare/aid) doesn't favor that approach. Limit the litigation, stop the micro-transactions, and stop the government involvement. I am of the mind that the health care system wouldn't be broke if we didn't have medicare/medicaid manipulating the administration practices and associative costs of most hospitals and doctor's offices. If medicare and medicaid functioned more like traditional insurance we wouldn't be in this problem. Instead medicare/aid's menu of services forces hospital's hands in the name of accountability.

 

[mege]

They tried to get those fundamental changes in, but didn't have the support (no I'm not talking about JUST the government option, which, honestly, I don't see as all that bad since France has only government options and they rate pretty high in healthcare, but that's a different debate), so they went with the "let's get everyone on to insurance and see what we're able to come up with down the road" plan.

My grandparents were dual citizens US-Canada. My grandfather worked for OHIP post-retirement as a consultant. They paid for US health insurance, and only used the government plan in Canada when they had a single emergency while they happened to be in London, ON. For emergency services - the costs were slightly higher because of the deductable in the US, but for anything else - cancer screenings, routine care, preventitive care, 'sick visits' their insurance from an American provider was superior. My grandmother could walk in for a mammogram in the US, but the wait was months in Ontario. My pessimism of a government run system comes from family experience. It sounds shiny when you're 25-40 and healthy because you're probably not getting your money's worth out of insurance currently (out of the 1500/yr I pay in premiums I have visited the doctor twice in 5 years (And 1500 more I am sure my employer provides)). But when you're in waning health and need to visit the doctor for more than a sinus infection, days and weeks waiting can matter.

Aside from the 'coverage' aspect of a government option, I fear for what it will do to medical developments. Can the US continue to operate teaching and research hospitals with a single payer option? Will places like the Mayo Clinic still exist? If it does, it will be requiring massive private donations to stay afloat like St. Judes or other charity-funded research hospitals.

In addition - when we have a government option for health care, and your body becomes an investment of the government, what else will start to be controlled? A second prohibition? A pop ban? A 'fat tax'? These all seem very big-brother-ish and remove any sense of responsibility from the individual to actually do something right (they are all ideas that have been seriously considered by congress in the last 5 years by the way...). Many of us have had a 'sugar sickness' as a kid that probably taught us to eat healthier and remind us that too many sweets are bad, if the government bans this type of behavior - we never learn and are doing things 'just because'. Seems very anti-intellectual to not allow for simple, innocent learning mechanisms in a youth's life. I often wonder if the nanny-state is part of why we are seeing a relative decline in the interest of science - too many youth are given truisms rather than allowed to discover basic, harmless things on their own.

 

[WhoWee]

My grandparents were dual citizens US-Canada. My grandfather worked for OHIP post-retirement as a consultant. They paid for US health insurance, and only used the government plan in Canada when they had a single emergency while they happened to be in London, ON. For emergency services - the costs were slightly higher because of the deductable in the US, but for anything else - cancer screenings, routine care, preventitive care, 'sick visits' their insurance from an American provider was superior. My grandmother could walk in for a mammogram in the US, but the wait was months in Ontario. My pessimism of a government run system comes from family experience. It sounds shiny when you're 25-40 and healthy because you're probably not getting your money's worth out of insurance currently (out of the 1500/yr I pay in premiums I have visited the doctor twice in 5 years (And 1500 more I am sure my employer provides)). But when you're in waning health and need to visit the doctor for more than a sinus infection, days and weeks waiting can matter.

Aside from the 'coverage' aspect of a government option, I fear for what it will do to medical developments. Can the US continue to operate teaching and research hospitals with a single payer option? Will places like the Mayo Clinic still exist? If it does, it will be requiring massive private donations to stay afloat like St. Judes or other charity-funded research hospitals.

In addition - when we have a government option for health care, and your body becomes an investment of the government, what else will start to be controlled? A second prohibition? A pop ban? A 'fat tax'? These all seem very big-brother-ish and remove any sense of responsibility from the individual to actually do something right (they are all ideas that have been seriously considered by congress in the last 5 years by the way...). Many of us have had a 'sugar sickness' as a kid that probably taught us to eat healthier and remind us that too many sweets are bad, if the government bans this type of behavior - we never learn and are doing things 'just because'. Seems very anti-intellectual to not allow for simple, innocent learning mechanisms in a youth's life. I often wonder if the nanny-state is part of why we are seeing a relative decline in the interest of science - too many youth are given truisms rather than allowed to discover basic, harmless things on their own.

I'd like to address the "Big Brother" factor. While I don't have direct information to support, I'll assume a number of people receiving food stamps are also on Medicaid - is that a fair assumption?

Perhaps the Government SHOULD control the types of food allowed for purchase with food stamps? Perhaps processed snacks and sugary sweets should be excluded - in favor of more raw fruit and fresh/canned vegetables, meat, poultry and fish, pasta and bread?

I see a lot of "fruit roll-ups" and gourmet ice cream in the carts of people paying with food cards.

 

[CAC1001]

I can't find a specific breakdown of credits vs. FICA (the best I can find includes state taxes and sales tax). If we include payroll and credits, roughly how many people pay no federal tax?

I know that a few of the ways lots of people can reduce or eliminate their federal income tax bill is through the Child Income Tax Credit (which doubled under President Bush from $500 to $1000), the Earned Income Tax Credit, there's the mortgage interest deduction, and probably a few others I am not thinking of.

 

[Vanadium 50]

Only a credit can make your income tax negative. If you deduct more than you made, the tax is pegged at zero.