Death and Taxes

Two major issues bedeviling the Trump administration are health care and tax reform.  The key to resolving both is remembering that President Trump was elected a populist, not a Republican.  So far, what the Republican Party has offered on both issues has been its usual disinterest in the problems of people who are not from the .1%.  That includes most people who voted for President Trump.  Kicking your base in the butt is usually not smart politically.

What might the White House propose if it sought to offer populist solutions?  The key to health care is attacking the root of the problem:  vastly excessive prices.  Just as with the word “military”, if you can label something “medical” you can move the decimal point: everything costs ten times as much as it should.  I have a hospital bill sent to my grandfather, Bill Sturgiss, in 1952, his last year.  Everything except medications (which he got at half price as a druggist) came to $10 per day.  Accounting for inflation, that would equal about $200 a day now.  But a hospital room is not $200.  It is many thousands. 

I know of only one way to rein in costs:  Medicare for everyone, including prescription drugs.  I have been on Medicare for five years, and it works well.  It does not cover everything;  I also have supplemental private insurance.  But it covers the basics, which is what people most need.  That is what populist policies seek to do. 

How does Medicare control the cost? Simply. The provider bills x amount, but medicare says, “We only pay x-y.”  The provider cannot charge more.  Medicare for all would extend this pricing power to prescriptions.  If some profiteering scumbag buys a patent on an old, inexpensive medicine and raises the price by a factor of 500, Medicare would say, “Sorry, you will take the old price and like it.”  Any provider who now takes Medicare would have to accept the new, expanded Medicare.  Of course, people could pay from their own pocket for treatments beyond what Medicare considered justified.  But, again, for the people who voted for President Trump, the basics would be covered.  He would have delivered for his base.

Medicare also has the clout to take on a big and expensive problem into today’s health care: keeping people alive who have reached the end of their natural lifespan.  Often, the treatment is pure torture for the people involved.  They know it is time to go.  But the hospital will not let them.  And after torturing them uselessly for weeks or months, when the release comes, the provider sends an enormous bill to Medicare.  Who benefits?  Certainly not the patient.

One step in the right direction would be to allow people to choose hospice care over life-prolonging treatments when they want to.  Now, a doctor has to certify that further treatment is hopeless.  The decision should belong to the patient, not an entity that makes a great deal of money from prolonging treatment.  This is not assisted suicide.  It is just letting nature take its course while providing relief from pain.

On taxes, the White House could propose a populist tax bill with two basic elements.  The first is a series of reforms to the tax code, including large cuts in corporate taxes, that stimulate investment and create good-paying jobs.  There are policy institutes in Washington that specialize in determining how tax cuts should be structured to foster economic growth.  Not all tax cuts do so.  And some taxes, such as the federal gas tax, should be raised.  Our highways are falling apart and we need money to fix them.

What would make this tax bill populist is that it would raise, not lower taxes on the rich.  It should include a tax rate of at least 75% on all earned incomes over $1,000,000 a year.  Who needs more than $1,000,000 a year to live on?  Are they feeding the cat caviar?  The tax should not cover unearned income because that would discourage investment.  But the President’s populist base would get it that he is not just proposing tax cuts for the rich.

By adopting a populist rather than a Republican agenda, President Trump could potentially remake politics for a generation.  The next big political realignment will be uniting the anti-establishment elements in both parties, .i.e., the Trump voters and the Sanders voters.  A populist agenda can do that.  It is going to happen, from the left if not from the right.  It is in President Trump’s interest, and ours, that it be done from the right.

11 thoughts on “Death and Taxes”

  1. Getting rid of 40 – 60 million illegal alien felons and building
    a wall to keep them out would almost solve the medical crisis.
    The hundreds of billions they cost society would be released
    as a tax break. If rich people use their wealth to influence
    politics, they will be hung and their ill-gotten gain used to pay
    down the national debt. A rich person who doesn’t try to run
    my life through the force of government is not a threat. Their
    wealth produces a better life for all of us, unless it goes to
    influence the govt.

    By the way, how much in taxes do large corps pay? About zero
    in many cases. What do they pay for lawyers and lobbyists?

  2. Your policy here doesn’t make any sense at all. Medical prices are what they are now because of endless government tinkering that has eliminated all but the last vestiges of the free market in medicine. There are cash only clinics where you can get an MRI for $300 or have an entire operation for 1/5 of the cost of a traditional hospital that takes Medicare and other insurance. These clinics and hospitals only take cash. They don’t have a huge staff to deal with insurance paper work. They have list prices for procedures and everything is complete. THAT is how the free market is supposed to operate. Your plan is, frankly, stupid.

  3. “Who needs more than $1,000,000 a year to live on?” – Why one million? Where did that number come from? (hint: check your drawers)

  4. Okay, after thinking about it, if I compare this Medicare plan for all, to the Swiss healthcare system, it is somewhat similar. It would need tinkering to mix in a little more free market. The Swiss have price controls too. However, I believe those are done at the local level.

    Tie the dang WALL and immigration to it and it’s a deal.

  5. $300 MRI would be nice. However, cash clinics hundreds of miles away aren’t options when urgent care is needed. Or the expense to travel to one negates the savings.

  6. I’m generally a pretty hard core libertarian, but as a short term measure for a generation or so Medicare for everyone does make sense. It would force the dissolution of the big vertically integrated insurance/pharmaceutical/medical monopolies created by statist meddling. It could even pass Constitutional muster in assuring the health and fitness of the general militia.

  7. “the provider sends an enormous bill to Medicare. Who benefits? Certainly not the patient.”

    Yes, the patient who no longer has to face that big bill.

  8. YouTube has videos on the Swiss healthcare system. It’s very interesting. The Swiss have price controls on medications, 40% cheaper than meds in the US. And no one calls Switzerland at socialist country. Well, except for the looney Asperger libertarians. The Heritage Foundation ranks Switzerland as number 4 in economic freedom.

  9. All of the world has price controls on medicine, except the United States.

    How much lower might prices be worldwide without the artificial price ceilings?

  10. No, tax unearned income. The “investment” canard has allowed .01% to accumulate unassailable wealth that drives asset bubbles and economic destruction. Leave earned income alone except for very high levels (say anything over 5 million), but destroy the power that unearned income has. This applies to capital gains as well. Set the exclusions high enough and only the power elite will be affected; ignore the bleating about small businesses and farms. Tax planning and transfer planning removes the risk for those entities.

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