PNHP

Reconciliation Act includes wealth transfer

Reconciliation Act includes wealth transfer

Health Care and Education Reconciliation Act of 2010

H.R.4872
The Library of Congress
SEC. 1402. UNEARNED INCOME MEDICARE CONTRIBUTION.
(a) Investment Income-
(1) IN GENERAL- Subtitle A of the Internal Revenue Code of 1986 is amended by inserting after chapter 2 the following new chapter:
CHAPTER 2A–UNEARNED INCOME MEDICARE CONTRIBUTION
Sec. 1411. Imposition of tax.
(a) In General- Except as provided in subsection (e)–
(1) APPLICATION TO INDIVIDUALS- In the case of an individual, there is hereby imposed (in addition to any other tax imposed by this subtitle) for each taxable year a tax equal to 3.8 percent of the lesser of–
(A) net investment income for such taxable year, or
(B) the excess (if any) of–
(i) the modified adjusted gross income for such taxable year, over
(ii) the threshold amount.
(2) APPLICATION TO ESTATES AND TRUSTS- In the case of an estate or trust, there is hereby imposed (in addition to any other tax imposed by this subtitle) for each taxable year a tax of 3.8 percent of the lesser of–
(A) the undistributed net investment income for such taxable year, or
(B) the excess (if any) of–
(i) the adjusted gross income (as defined in section 67(e)) for such taxable year, over
(ii) the dollar amount at which the highest tax bracket in section 1(e) begins for such taxable year.
(b) Threshold Amount- For purposes of this chapter, the term `threshold amount’ means–
(1) in the case of a taxpayer making a joint return under section 6013 or a surviving spouse (as defined in section 2(a)), $250,000,
(2) in the case of a married taxpayer (as defined in section 7703) filing a separate return, 1/2 of the dollar amount determined under paragraph (1), and
(3) in any other case, $200,000.
—-
SEC. 1409. CODIFICATION OF ECONOMIC SUBSTANCE DOCTRINE AND PENALTIES.
(a) In General- Section 7701 of the Internal Revenue Code of 1986 is amended by redesignating subsection (o) as subsection (p) and by inserting after subsection (n) the following new subsection:
(o) Clarification of Economic Substance Doctrine-
(1) APPLICATION OF DOCTRINE- In the case of any transaction to which the economic substance doctrine is relevant, such transaction shall be treated as having economic substance only if–
(A) the transaction changes in a meaningful way (apart from Federal income tax effects) the taxpayer’s economic position, and
(B) the taxpayer has a substantial purpose (apart from Federal income tax effects) for entering into such transaction.
http://thomas.gov

And…

Is Single-Payer Health Care The Best Option?

By Don McCanne
The New Republic
July 16, 2008
Because of our very high costs, we must accept the fact that the insurance function is no longer simply a transfer from the many who are healthy to the fewer with health care needs, but it now must also include a partial transfer from the wealthy to middle- and lower-income individuals with needs. There is no alternative to this wealth transfer.
https://pnhp.org/news/2008/july/response-to-tnrs-jonathan-cohn

The traditional role of health insurance has been to transfer funds from the many who are healthy to the few who are sick. But now health care costs in the United States are so high that if we expect everyone to have the health care that they need, a transfer of funds from the wealthy down would be absolutely mandatory if we are to be able to finance that care.
The easiest way to accomplish that transfer would be to establish a single national risk pool that covered everyone, and fund that pool through progressive taxes. Unfortunately, Congress and the President selected a much more complex financing scheme for their health reform program. Nevertheless, there was no way that they could escape the necessity of including a wealth transfer mechanism. So what did they do?
The most obvious transfers are contained in the bill signed yesterday that is now law. Individuals purchasing their health plans from the state exchanges will receive federal subsidies in an amount inversely related to their incomes. Individuals with very low incomes will be enrolled in Medicaid and will not have to contribute any premium. Since the taxes collected to support these programs are progressive, the wealth transfer is automatic.
The Reconciliation Act that is still under consideration in the Senate provides additional measures that acknowledge the need for a wealth transfer, including the unearned income Medicare contribution, and the codification of the economic substance doctrine.
Our current tax policies extract both income taxes and payroll taxes from hard-earned wages, but passive unearned income such as interest, dividends and capital gains may receive favorable treatment for income taxes, and totally escape payroll taxes. It seems unfair to tax individuals who are contributing to society by their personal work effort at a higher level than wealthy individuals who contribute little more than conversation at the nineteenth hole of the golf course. The common argument that those funds shouldn’t be taxed so that they can be invested in the economy holds little water when you consider that increased productivity comes from the workforce and not from passive investors.
In recognition of this imperative of wealth transfer, the Reconciliation Act includes a Medicare tax of 3.8 percent on passive income over $200,000 for individuals or $250,000 for couples. Although that is a relatively modest tax for wealthy individuals, it is a giant step forward in solidifying the principle of wealth transfer.
The codification of the economic substance doctrine is simply locking into law the principle that wealthy individuals can no longer establish sham transactions that have the sole function of reducing income tax liability. Although this is not a wealth transfer in the same sense as the Medicare tax on passive income, it does ensure that the rightful transfer can no longer be avoided by these devious transactions, subject to an extra 40 percent penalty if attempted.
Although the decision of Congress and the President to continue to use private health insurers to finance health care was a terrible decision that we will continue to attempt to upend by pushing for a single payer system, nevertheless we can celebrate some of the beneficial features of the legislation such as the expansion of community health centers and the reinforcement of primary care.
One of the most important beneficial features of all is the firm establishment of the principle that the transfer will not come only from the healthy but must also come from the wealthy. That is a policy bridge that we will have already crossed on our march to an improved Medicare for all.

Ernestine: Blind? Read the fine print!

Campaign for SB 810 - Single Payer Universal Health Care

California OneCare

Lily Tomlin as Ernestine

30 second video:

http://californiaonecare.org/365-ad-campaign/365-ad-archive/365-ad-35-2/

Comment:

By Don McCanne, MD

We have been saturated with commentary since the passage and signing of the trillion dollar Private Insurance Industry Stimulus legislation. Lily Tomlin provides us with a much needed break as she reminds us, in her own incomparable style, of the industry that Congress and the President have so richly rewarded.

Politicians didn’t get it right

Seattle Times (print edition only)
March 22, 2010

Editor, The Times:

Regarding the insurance albatross the politicians just hung around our neck [“Historic health-care overhaul passes,” Seattle Times, page one, March 22]:

An estimated 23,000 unnecessary deaths annually will result from 23 million still uninsured nine years out;

Millions of middle-income people will be pressured to buy commercial policies that cost up to 9.5 percent of income but cover an average of only 70 percent of medical expenses;

Insurance firms [which give no care to anyone] will get at least $447 billion in taxpayer money in subsidies;

The bill will drain about $40 billion from Medicare payments to safety-net hospitals;

People with employer-based coverage will be locked into their plan’s limited network of providers;

Health-care costs will continue to skyrocket, like they did in Massachusetts;

There are loopholes in the pre-existing conditions regulations;

Women’s reproductive rights will be further eroded.

We needed and still need a single-payer, equal-access-for-all plan. Physicians for A National Health Program and United for Single Payer locally will continue to work on this until we get it right.

— Linda Jansen, Seattle

Louisville doctors, Humana react to healthcare bill

By Janelle MacDonald
WAVE NBC 3
Mar 22, 2010

LOUISVILLE, KY (WAVE) – The sweeping reform of the nation’s health care system has passed the House of Representatives and is ready for President Obama to sign into law. In Kentuckiana, reaction from doctors is mixed. Supporters showed a long list of healthcare professional organizations that backed the bill, but some doctors fear what it will do to their business and profession. Others say this bill didn’t go far enough to address the problems.

Dr. Adewale Troutman, director of Louisville Metro Health & Wellness, said there were obvious problems with the healthcare system as it stood.

“People are dying at unacceptably high rates due to the fact they don’t have health insurance,” said Troutman.

With coverage to 30 million more Americans, Troutman sees a lot of things to like in the newly passed healthcare reform bill.

“Removing a cap for a lifetime cap on what insurance money you spend, the preexisting condition piece is extremely important, not being able to drop somebody from coverage because now they’ve got something that costs money,” Troutman said.

But to call it comprehensive healthcare reform, Troutman said, “I think that the bill that was passed is a step in the right direction but we have a long, long, long way to go to turn this ship around so that we have equity, health equity for all populations.”

His former colleague, now retired Dr. Garrett Adams, puts it even more bluntly. According to Adams, it’s, “aspirin for cancer.”

Adams says the healthcare reform bill as passed won’t do anything to control costs.

“The bills will continue to go up,” said Adams. “The premiums will have to go up, there’s no way they won’t go up.”

As for the mandates for insurance coverage, Adams said, “people will buy the least expensive coverage that they can get and it’s not going to be enough. It’s skimpy coverage.”

In addition, Adams agrees with critics who say the new bill takes some healthcare decisions out of the hands of doctors and places it in the hands of the government.

“There are so many controls,” Adams said. “It’s very unfriendly, I think to physicians … It’s awkward, it’s complicated.”

Adams is a member of Physicians for a National Healthcare Program, which advocates for getting rid of the private, for-profit, insurance company system all together. Troutman says he is also in favor of a not-for-profit system. However, here in Louisville, a lot of jobs depend on the insurance industry.

Jim Turner, a spokesperson for Louisville-based Humana, said the bill could be good for the company because requiring everyone to get health insurance will add customers to the market and that could help Humana.

Turner also said the company is worried because the bill doesn’t do much to reduce healthcare costs and the cost of not having insurance – a government imposed penalty – isn’t strict enough.

“People could just say, ‘I’m not going to pay my fair share of premium,'” Turner said. “They could say, ‘I’m going to wait until I get sick, pay an extremely modest penalty, and then I’ll sign up,’ and if that does come to pass, that will actually destroy the whole basis of insurance.”

Turner also told us the bill will hurt the young and old more than others by putting new taxes on the young, and reducing Medicare advantage payouts for the elderly.

Information for this story also provided by Ryan Nash.

Copyright 2010 WAVE News. All rights reserved.

http://www.wave3.com/Global/story.asp?S=12185064

Research by Physicians for a National Health Program

Over the past two decades, PNHP research has influenced health policy and focused debate on the need for fundamental health care reform.

  • Administrative costs consume 31 percent of US health spending, most of it unnecessary. The US could save enough on administrative expenses (nearly $400 billion annually) with a single payer to cover all the uninsured.
  • Medical bills contribute to more than 60 percent of all bankruptcies. Three-fourths of those bankrupted had health insurance at the time they got sick.
  • Taxes already pay for over 60 percent of US health spending. Americans pay the highest health care taxes in the world. We pay for national health insurance, but don’t get it.
  • Despite spending far less per capita for health care, Canadians and residents of other developed countries are healthier and have better measures of access to health care than Americans.
  • Alternative health proposals for “universal coverage” do not work. State health reforms containing the key elements of the Obama health plan have failed to reduce the number of uninsured.
  • Computerized medical records and chronic disease management do not save money. The only way to slash administrative overhead and improve quality is with a single payer system.
  • Business pays less than 20 percent of our nation’s health bill. It is a misnomer that our health system is “privately financed” (60 percent is paid by taxes and the remaining 20 percent is out-of-pocket payments).
  • For-profit, investor-owned hospitals, HMOs and nursing homes have higher costs and score lower on most measures of quality than their non-profit counterparts.
  • Immigrants and emergency department visits by the uninsured are not the cause of high and rising health care costs.
  • Nearly 45,000 Americans die each year for lack of health insurance. The uninsured do not receive all the medical care they need – they live sicker and die younger. Those most in need of preventive services are least likely to receive them.
  • The US could save enough on administrative costs (over $400 billion annually) with a single payer to cover all the uninsured.

Full text and citations for each finding are available on our web site at www.pnhp.org/research.

Campaign for SB 810 – Single Payer Universal Health Care

California OneCare
Lily Tomlin as Ernestine
30 second video:

http://californiaonecare.org/365-ad-campaign/365-ad-archive/365-ad-35-2/

We have been saturated with commentary since the passage and signing of the trillion dollar Private Insurance Industry Stimulus legislation. Lily Tomlin provides us with a much needed break as she reminds us, in her own incomparable style, of the industry that Congress and the President have so richly rewarded.

US healthcare law 'poses long-term threats'

Al Jazeera English

Al Jazeera interviewed Matt Hendrickson, a doctor from California and PNHP member, who said the recently signed healthcare law is good for the short-term, but in the long run it could prove disastrous.

US healthcare law ‘poses long-term threats’

Al Jazeera English

Al Jazeera interviewed Matt Hendrickson, a doctor from California and PNHP member, who said the recently signed healthcare law is good for the short-term, but in the long run it could prove disastrous.

Pro-single-payer doctors: Health bill leaves 23 million uninsured

A false promise of reform

For Immediate Release     
March 22, 2010

Contact:
Oliver Fein, M.D.
Steffie Woolhandler, M.D., M.P.H.
David Himmelstein, M.D.
Margaret Flowers, M.D.
Mark Almberg, PNHP, (312) 782-6006, mark@pnhp.org

The following statement was released today by leaders of Physicians for a National Health Program, www.pnhp.org. Their signatures appear below.

As much as we would like to join the celebration of the House’s passage of the health bill last night, in good conscience we cannot. We take no comfort in seeing aspirin dispensed for the treatment of cancer.

Instead of eliminating the root of the problem – the profit-driven, private health insurance industry – this costly new legislation will enrich and further entrench these firms. The bill would require millions of Americans to buy private insurers’ defective products, and turn over to them vast amounts of public money.

The hype surrounding the new health bill is belied by the facts:

  • About 23 million people will remain uninsured nine years out. That figure translates into an estimated 23,000 unnecessary deaths annually and an incalculable toll of suffering.
  • Millions of middle-income people will be pressured to buy commercial health insurance policies costing up to 9.5 percent of their income but covering an average of only 70 percent of their medical expenses, potentially leaving them vulnerable to financial ruin if they become seriously ill. Many will find such policies too expensive to afford or, if they do buy them, too expensive to use because of the high co-pays and deductibles.
  • Insurance firms will be handed at least $447 billion in taxpayer money to subsidize the purchase of their shoddy products. This money will enhance their financial and political power, and with it their ability to block future reform.
  • The bill will drain about $40 billion from Medicare payments to safety-net hospitals, threatening the care of the tens of millions who will remain uninsured.
  • People with employer-based coverage will be locked into their plan’s limited network of providers, face ever-rising costs and erosion of their health benefits. Many, even most, will eventually face steep taxes on their benefits as the cost of insurance grows.
  • Health care costs will continue to skyrocket, as the experience with the Massachusetts plan (after which this bill is patterned) amply demonstrates.
  • The much-vaunted insurance regulations – e.g. ending denials on the basis of pre-existing conditions – are riddled with loopholes, thanks to the central role that insurers played in crafting the legislation. Older people can be charged up to three times more than their younger counterparts, and large companies with a predominantly female workforce can be charged higher gender-based rates at least until 2017.
  • Women’s reproductive rights will be further eroded, thanks to the burdensome segregation of insurance funds for abortion and for all other medical services.

It didn’t have to be like this. Whatever salutary measures are contained in this bill, e.g. additional funding for community health centers, could have been enacted on a stand-alone basis.

Similarly, the expansion of Medicaid – a woefully underfunded program that provides substandard care for the poor – could have been done separately, along with an increase in federal appropriations to upgrade its quality.

But instead the Congress and the Obama administration have saddled Americans with an expensive package of onerous individual mandates, new taxes on workers’ health plans, countless sweetheart deals with the insurers and Big Pharma, and a perpetuation of the fragmented, dysfunctional, and unsustainable system that is taking such a heavy toll on our health and economy today.

This bill’s passage reflects political considerations, not sound health policy. As physicians, we cannot accept this inversion of priorities. We seek evidence-based remedies that will truly help our patients, not placebos.

A genuine remedy is in plain sight. Sooner rather than later, our nation will have to adopt a single-payer national health insurance program, an improved Medicare for all. Only a single-payer plan can assure truly universal, comprehensive and affordable care to all.

By replacing the private insurers with a streamlined system of public financing, our nation could save $400 billion annually in unnecessary, wasteful administrative costs. That’s enough to cover all the uninsured and to upgrade everyone else’s coverage without having to increase overall U.S. health spending by one penny.

Moreover, only a single-payer system offers effective tools for cost control like bulk purchasing, negotiated fees, global hospital budgeting and capital planning.

Polls show nearly two-thirds of the public supports such an approach, and a recent survey shows 59 percent of U.S. physicians support government action to establish national health insurance. All that is required to achieve it is the political will.

The major provisions of the present bill do not go into effect until 2014. Although we will be counseled to “wait and see” how this reform plays out, we cannot wait, nor can our patients. The stakes are too high.

We pledge to continue our work for the only equitable, financially responsible and humane remedy for our health care mess: single-payer national health insurance, an expanded and improved Medicare for All.

Oliver Fein, M.D.
President    

Garrett Adams, M.D.
President-elect    

Claudia Fegan, M.D.
Past President
            
Margaret Flowers, M.D.
Congressional Fellow    

David Himmelstein, M.D.
Co-founder    

Steffie Woolhandler, M.D.
Co-founder
            
Quentin Young, M.D.
National Coordinator
   
Don McCanne, M.D.
Senior Health Policy Fellow

******

Physicians for a National Health Program (www.pnhp.org) is an organization of 17,000 doctors who support single-payer national health insurance. To speak with a physician/spokesperson in your area, visit www.pnhp.org/stateactions or call (312) 782-6006.

Private insurer nightmare

Effects of health overhaul will take time to become clear

By Duke Helfand
Los Angeles Times
March 22, 2010

(The industry’s Washington lobbying arm, America’s Health Insurance Plans) ran ads in national newspapers last week criticizing the overhaul for failing to adequately contain costs. Without bolder action, it warned in its “Open Letter to the American People,” the country could face a healthcare cost “crisis similar to the financial crisis that has rocked our economy.”

“Virtually everyone believes that we have a huge number of issues that remain to be addressed,” said Jay Gellert, chief executive of Woodland Hills-based Health Net Inc. “If anyone thinks that just by passing this we’re going to solve the problems, they are seriously mistaken.”

http://www.latimes.com/business/la-fi-insure22-2010mar22,0,3396267.story

Comment: 

By Don McCanne, MD

I had a nightmare last night. I dreamed that we reformed the financing of health care in America, but that we left the private insurance industry in charge. Oh, wait… Oh, no!

Private insurer nightmare

Effects of health overhaul will take time to become clear

By Duke Helfand
Los Angeles Times
March 22, 2010
(The industry’s Washington lobbying arm, America’s Health Insurance Plans) ran ads in national newspapers last week criticizing the overhaul for failing to adequately contain costs. Without bolder action, it warned in its “Open Letter to the American People,” the country could face a healthcare cost “crisis similar to the financial crisis that has rocked our economy.”
“Virtually everyone believes that we have a huge number of issues that remain to be addressed,” said Jay Gellert, chief executive of Woodland Hills-based Health Net Inc. “If anyone thinks that just by passing this we’re going to solve the problems, they are seriously mistaken.”
http://www.latimes.com/business/la-fi-insure22-2010mar22,0,3396267.story

I had a nightmare last night. I dreamed that we reformed the financing of health care in America, but that we left the private insurance industry in charge. Oh, wait… Oh, no!

Arizona shuts down CHIP, slashes Medicaid

Governor signs Ariz. budget-balancing bills

By Casey Newton
The Arizona Republic
March 18, 2010

Gov. Jan Brewer signed the fiscal 2011 budget on Thursday, enacting $1.1 billion in spending cuts and program eliminations.

The budget, passed last week by the Republican-led Legislature on largely party-line votes, drew criticism from opponents for what they called a disproportionate impact on the poor.

“I’m not sure how cutting three-quarters of a billion dollars from public education and kicking 300,000 people off of health care puts our state on the back on the road to recovery,” said Rep. Kyrsten Sinema, D-Phoenix. “In fact, it dismantles what we have been working for years to build in Arizona — a vibrant, healthy state where people want to live and work.”

One aspect of the budget expected to be challenged is a cut of $385 million to the state’s Medicaid program, the Arizona Health Care Cost Containment System.

The budget bills also eliminate KidsCare, which provided health care to 38,599 children of low-income parents.

Hours after she signed the budget, Brewer appeared at a news conference to urge opposition to federal health-care reform. Asked by reporters what the hundreds of thousands of Arizonans set to lose coverage this year should do, Brewer said they should use community health clinics and emergency rooms.

http://www.azcentral.com/news/election/azelections/articles/2010/03/18/20100318brewer-signs-budget-bills-arizona.html

Comment: 

By Don McCanne, MD

Programs benefiting low income individuals and families, such as Medicaid and CHIP, are politically vulnerable to the whims of conservatives wielding budget cleavers. Gov. Jan Brewer of Arizona has just provided us with a prime example of that.  Yet popular programs benefiting everyone, such as Medicare, are relatively impenetrable to the weapons of the conservatives.

The reform proposal likely to be enacted by Congress is heavily dependent on the expansion of Medicaid. Since it is a federal/state program, it requires the support of the government on both levels. In spite of the proposed increases in federal support, Gov. Brewer continues to urge opposition to the reform proposal. Low income families will remain vulnerable in her state as long as she and her Republican colleagues remain in charge.

Suppose Congress had included single payer in their deliberations and eventually decided that the benefits were too great to pass up ,and so enacted an improved Medicare program that covered everyone. Gov. Brewer and her ilk on the state level would be powerless to stop it. It would be so popular that conservatives who managed to take over the federal government would never be able to shut the program down.

Whether or not the current bill passes, we need to make every effort to replace our expensive, fragmented, often cruel, and relatively ineffectual system of health care financing with one that works for all of us – a single payer national health program – an improved Medicare for everyone.

Or failing that, as Gov. Brewer says, we could all just go to the emergency room when we can’t get into the clinic.