An objective look at the reality of today’s economy, our demographics and our income distribution suggests that the current tax debate is terribly misguided.
.. the increasing tendency of Republicans to engage in reverse Robin Hoodism — paying for huge breaks for the wealthy by raising taxes or cutting spending on the poor — in an economy that generates too much inequality before taxes kick in is unjust and terrible policy
.. For Democrats, it means abandoning the notion that we can have everything we want and send the bill to the top 1 percent, and accepting that the corporate tax system is a hot mess that needs repair.
.. But “get it from the rich” can’t be the extent of every Democratic tax plan.
.. private business will provide optimal levels of public goods and services such as education, transportation, health care and retirement security, global protection (both defense and climate), the justice system, labor and financial market oversight, and anti-poverty and countercyclical policies
.. Since 1970, the federal revenue share of the gross domestic product has averaged 17.4 percent, ranging from around 15 to 20 percent. It’s just under 18 percent today. Congressional Budget Office analysis reveals that meeting the promises of Social Security and Medicare would require about 2.5 percentage points more than that by 2027.
That takes us slightly past the upper bound of the historical record, but the extent of our aging demographics is historically unique.
.. Tax reform .. should be revenue positive.
Jim Geraghty: Healthcare Debate
If you want health-care reform to cost the U.S. government less than the status quo, that requires less money to go out the door to pay for other people’s health care and/or health insurance. This means someone else has to pay more, or someone else has to pay for their care or insurance entirely by themselves.
This is the core conflict of all health-care debates.
.. Everybody screaming “Medicaid for all!” basically means, “I don’t want to pay anything for my health care.” They think of themselves as being generous.
.. “found no evidence that Medicaid caused new enrollees to substitute office visits for [emergency room] visits; if anything, Medicaid made them more likely to use both.”
.. In 2010, when the Affordable Care Act was passed, CBO estimated that 21 million people would enroll in the ACA exchanges in 2016. The actual number was closer to 10 million. Even now, CBO believes that 18 to 19 million people will soon be enrolled in the exchanges, when in fact enrollment is degrading under current law, and will likely end up stabilizing at about 10 to 11 million.
The Quiet War on Medicaid
Progressives have already homed in on Republican efforts to privatize Medicare as one of the major domestic political battles of 2017.
.. Of the two battles, the Republican effort to dismantle Medicaid is more certain.
.. If Mr. Trump chooses to oppose his party’s Medicare proposals while pushing unprecedented cuts to older people and working families in other vital safety-net programs, it would play into what seems to be an emerging strategy of his: to publicly fight a few select or symbolic populist battles in order to mask an overall economic and fiscal strategy that showers benefits on the most well-off at the expense of tens of millions of Americans.
.. it will be too easy for Mr. Trump to market the false notion that Medicaid is a bloated, wasteful program and that such financing caps are means simply to give states more flexibility while “slowing growth.” Medicaid’s actual spending per beneficiary has, on average, grown about 3 percentage points less each year than it has for those with private health insurance
..Together, full repeal and block granting would cut Medicaid and the Children’s Health Insurance Program funding by about $2.1 trillion over the next 10 years — a 40 percent cut.
.. a similar Medicaid block grant proposed by Mr. Ryan in 2012 would lead to 14 million to 21 million Americans’ losing their Medicaid coverage by the 10th year, and that is on top of the 13 million who would lose Medicaid or children’s insurance program
.. Current Republican plans to eliminate the marketplace subsidies and A.C.A. Medicaid expansion in 2019 would create a health care cliff where all of the Medicaid funds and subsidies for the A.C.A. expansion would simply disappear and 30 million people would lose their health care.
.. In the face of such a manufactured crisis
.. About 60 percent of the costs of traditional Medicaid come from providing nursing home care and other types of care for the elderly and those with disabilities.
.. It would take only three Republican senators thinking twice about the wisdom of block grants and per capita caps to put a halt to the coming war on Medicaid.
The Surgeon Extracting Government From Medicine
Trump’s new secretary of health and human services intends to make life better for physicians.
.. The men often contorted their faces when speaking the word “Obamacare,” as if it produced an acrid taste—though they used the term effusively.
.. The New York Times editorial board described Price as “a man intent on systematically weakening, if not demolishing, the nation’s health-care safety net.”
As Price puts it, though, the goal is rather to improve patient-doctor interactions.. In an attempt to contain spending and ensure quality, Medicare and Medicaid come with guidelines that dictate reimbursement. Many doctors find the systems’ requirements tedious and cumbersome—a common and serious complaint among doctors, who tell me they feel the art and autonomy of medicine are lost amid tedious paperwork and other minutiae. .. Downsizing these programs would mean freeing doctors from dealing with patients insured by the cost-containing plans that many feel are too bureaucratic.
.. Trump has promised not to dial back the programs that have accounted for so many insured Americans, in no uncertain terms (“I’m not going to cut Social Security like every other Republican, and I’m not going to cut Medicare or Medicaid”). But the President-elect’s website has since changed its language on the issue, saying it will “modernize” Medicare.
.. If you have a gap in coverage—for example, if a sick person gets fired and doesn’t immediately find another job that provides coverage (or purchase individual coverage)—then the insurance companies can raise premiums.
.. the idea of saving a stack of tax-free cash to purchase your health care sounds in ways idyllic—but impractical when care costs as much as it does in the U.S. The average person incurs more than $10,000 in medical costs every year
.. The exorbitant system costs are the result of oligopolies: privatized insurance corporations, pharmaceutical and medical device corporations, and health-care systems. All of these things Obama attempted to moderate with the Affordable Care Act, and all stand to be repealed.
.. Were Price’s plan fully carried out, that could potentially do more to exacerbate the rift between rich and poor than any other cabinet member
.. Republicans like Lamar Alexander, chair of the Senate Health, Education, Labor and Pensions Committee, have said that realistically, any holistic replacement of the Affordable Care Act will take years.