The US has the best health care in the world?

[Evo]

Could you explain? Obama's repeatedly stated he will place no additional taxes whatsoever on the middle class. The 'rich' will pay it all - 5% surtax or so. What do you mean by 'the same rate'?

Just stating what Obama said in his speech the other night. I disagree that it is bad policy to adopt. The wealthy will continue to get wealthy, they will continue to invest. It's just not right that so much of the wealth they accumulate should be sheltered from being taxed. They get to keep so much more of their money than the average wage earner, and no, I don't think it's right. At one time I was making over $250k a year. I didn't feel entitled to tax shelters. Probably why I never got rich.

 

[mheslep]

Just stating what Obama said in his speech the other night. I disagree that it is bad policy to adopt. The wealthy will continue to get wealthy, they will continue to invest. ...

Well T* is out there somewhere, otherwise the government could just crank up the tax rate to 100% and collect all the revenue they need.
http://upload.wikimedia.org/wikipedia/commons/3/36/Laffer-Curve.svg

 

[j93]

And I've seen when the is competition the quality of service or product suffers - because people underbid, then cut costs, and provide less service, often at poorer quality. Competition also produces redundancy.

Quality is dependent on the integrity of the provider/produce/seller, and as we've seen in the meltdown of the economy, integrity is sorely lacking in many cases.

Thats a good point.

 

[mgb_phys]

And I've seen when the is competition the quality of service or product suffers - because people underbid, then cut costs, and provide less service, often at poorer quality. Competition also produces redundancy.

Thats become a problem outside health.
The rail services in the UK are franchised, the government own the track but companies bid to provide the services. The company that runs the main London to Edinburgh line decided it wasn't making a profit in the current climate and walked away. Leaving the government to either bailout, run the service themselves or have England and Scotland with no rail link.

 

[avant-garde]

The strongly individualistic perspective, which trades off your own wealth against the basic health of people less fortunate than yourself is not a simple equation, even if self-interest is your only motivation.

Self-interest is not the motivation here. It's about having the right to save what you have from bums taking it away. After health care, what's next?

 

[Al68]

It's just not right that so much of the wealth they accumulate should be sheltered from being taxed. They get to keep so much more of their money than the average wage earner, and no, I don't think it's right.

Any evidence for this claim?

 

[Evo]

Any evidence for this claim?

Yes, US tax laws.

The poorer you are, the less likey it is that you can take anything other than the standard deductions. The key is "adjusted gross income" this is the dollar amount that your taxes are paid on. The wealthy can, through tax shelters and exemptions, vastly reduce the amount of their income that can be taxed. So even looking at a tax % on the "taxable amount" of income left after deductions (adjusted gross income) isn't a true picture of the % of tax averaged over their total real income.

Tax Burden Shifts to the Middle

Since 2001, President Bush's tax cuts have shifted federal tax payments from the richest Americans to a wide swath of middle-class families, the Congressional Budget Office has found, a conclusion likely to roil the presidential election campaign.

The conclusions are stark. The effective federal tax rate of the top 1 percent of taxpayers has fallen from 33.4 percent to 26.7 percent, a 20 percent drop. In contrast, the middle 20 percent of taxpayers -- whose incomes averaged $51,500 in 2001 -- saw their tax rates drop 9.3 percent. The poorest taxpayers saw their taxes fall 16 percent.

http://www.washingtonpost.com/wp-dyn/articles/A61178-2004Aug12.html

 

[lisab]

Yes, US tax laws.

The poorer you are, the less likey it is that you can take anything other than the standard deductions. The key is "adjusted gross income" this is the dollar amount that your taxes are paid on. The wealthy can, through tax shelters and exemptions, vastly reduce the amount of their income that can be taxed. So even looking at a tax % on the "taxable amount" of income left after deductions (adjusted gross income) isn't a true picture of the % of tax averaged over their total real income.

True...I expect most people earing high incomes don't file using the 1040-EZ form.

 

[Vanadium 50]

So, I was intrigued by Evo's comment, and looked up the data. The IRS posts it http://www.irs.gov/pub/irs-soi/06in11si.xls", and the most recent year for which there is data is 2006.

It's fascinating - I won't even attempt to categorize all the interesting features. But some things that caught my eye are:

Just under 16,000 people made $10M or more per year. (That alone is amazing) This 0.0053% of the population makes 5.6% of the total income in the US, and pays 8.9% of the income tax.

Half of the total income tax is paid by 3% of the population.

The income tax rate on AGI behaves more or less as one expects - monotonically increasing until incomes of many millions (which is likely dominated by capital gains) when it dips slightly. If one instead uses total income, rather than taxable income, the picture is different: it pretty much grows monotonically until it hits 20% for people making $100-200K per year. Then it starts falling, rises again between $1M and $2M, and then starts falling again.

 

[Ivan Seeking]

More scare tactics from the Republicans.

Amid a debate about national health care, Rep. Virginia Foxx, R-5th, caused a stir yesterday with comments before the U.S. House.

Foxx said the Republican version of the health-care plan "is pro-life because it will not put seniors in a position of being put to death by their government."

http://www2.journalnow.com/content/2009/jul/29/foxx-causes-stir-comments-health-care/

 

[j93]

I am still confused why the health care program is being used as whipping post for tax code.

Tax code has become a joke but I am not sure what anyone could do about it because those with the most money also have the most resources to look for loopholes and means to lower taxes paid.

 

[drankin]

I am still confused why the health care program is being used as whipping post for tax code.

Tax code has become a joke but I am not sure what anyone could do about it because those with the most money also have the most resources to look for loopholes and means to lower taxes paid.

Can you give an example? I've heard this comment several times without a supported example at least. Of course the more money you have the more assets you have and with that you have the same write-offs that a middle-class individual would have owning a single such asset. The IRS doesn't just figure that if you make half a mil a year you don't have to pay taxes on your assets the same as a middle class individual that may have the same thing. People like yourself simply imply that there is an injustice in the tax code and lower income people do not get a fair shake. So far, I see this as an unsupported allegation with a bias against those who have become financially successful (small business owners, entrepreneurs, professionals in various fields that have put themselves in valuable positions).

 

[Evo]

Of course the more money you have the more assets you have and with that you have the same write-offs that a middle-class individual would have owning a single such asset..

Right, a middle class American gets to claim deductions on their $2 million dollar yacht, claiming that they use it for business. Same goes for the helicopter that's used for "business". My yacht actually has a helio pad on it to land my clients directly onboard for important business "meetings".

 

[Ivan Seeking]

Right, a middle class American gets to claim deductions on their $2 million dollar yacht, claiming that they use it for business. Same goes for the helicopter that's used for "business". My yacht actually has a helio pad on it to land my clients directly onboard for important business "meetings".

That is exactly how it works. Even for a small businessman like me, the write-offs are fantastic. The key is to blend lifestyle options with business needs.

My mother actually got angry when she discovered that I could deduct my BBQ. "That's just not right", she objected. Then I told her just how much I get to deduct for everything from coffee, to a new well system, to the guy that mows my pasture.

I ALWAYS go by the book, btw.

 

[drankin]

Right, a middle class American gets to claim deductions on their $2 million dollar yacht, claiming that they use it for business. Same goes for the helicopter that's used for "business". My yacht actually has a helio pad on it to land my clients directly onboard for important business "meetings".

Do you have an actual example? I suppose a yacht manufacturer would hold meetings on their yachts. This is a made up scenario in which you do not know the IRS code related to it.

"Business is generally not considered to be the main purpose when business and entertainment are combined on hunting or fishing trips, or on yachts or other pleasure boats. Even if you show that business was the main purpose, you generally cannot deduct the expenses for the use of an entertainment facility. See Entertainment facilities under What Entertainment Expenses Are Not Deductible? later in this chapter. " http://www.irs.gov/publications/p463/ch02.html"

 

[Ivan Seeking]

Do you have an actual example? I suppose a yacht manufacturer would hold meetings on their yachts. This is a made up scenario in which you do not know the IRS code related to it.

"Business is generally not considered to be the main purpose when business and entertainment are combined on hunting or fishing trips, or on yachts or other pleasure boats. Even if you show that business was the main purpose, you generally cannot deduct the expenses for the use of an entertainment facility. See Entertainment facilities under What Entertainment Expenses Are Not Deductible? later in this chapter. " http://www.irs.gov/publications/p463/ch02.html"

Then the key is to show that the yacht is not an entertainment facility. Perhaps all that is required is to have an office on the boat, or simply designate it an office, or use it for legitimate business travel.

 

[turbo]

All kinds of gifts and perks fly "under the radar" for people in positions of influence and expenses are charged off to "business meetings". On small scales, when I was selling and servicing expensive fabrics for paper machines, my employers often required me to set up get-away weekends at ski resorts at which all the food, accomodations, booze, lift tickets, and gifts (new parka and goggles, anyone?) were picked up by my expense account. I'd be asked (required) to set up out-of state junkets for golf, often at pretty pricey country-clubs. Generally, those junkets were stag and involved some chauffeured bar-hopping or private parties, though the ski weekends were usually all-family affairs and my employers expected me to get my wife to come along and help entertain the spouses and kids.

Higher brass like paper mill superintendents, production managers, mill managers, purchasing managers, etc, got nicer trips - maybe to Steamboat Springs for skiing, or to the keys for deep-sea fishing, or Alaska for salmon or big-game. The recipients don't claim all this on their taxes, and the people paying for the "entertainment" write it all off as "business expenses". Most ordinary folks have no idea how much of this stuff goes on nor how their tax burden is increased by having to make up for all the freebies sloshing around behind the scenes.

When Congressional members, their families, aides and staff, are invited to "informational" meetings in exotic locales, please keep in mind that money is "grease".

 

[drankin]

All kinds of gifts and perks fly "under the radar" for people in positions of influence and expenses are charged off to "business meetings". On small scales, when I was selling and servicing expensive fabrics for paper machines, my employers often required me to set up get-away weekends at ski resorts at which all the food, accomodations, booze, lift tickets, and gifts (new parka and goggles, anyone?) were picked up by my expense account. I'd be asked (required) to set up out-of state junkets for golf, often at pretty pricey country-clubs. Generally, those junkets were stag and involved some chauffeured bar-hopping or private parties, though the ski weekends were usually all-family affairs and my employers expected me to get my wife to come along and help entertain the spouses and kids.

Higher brass like paper mill superintendents, production managers, mill managers, purchasing managers, etc, got nicer trips - maybe to Steamboat Springs for skiing, or to the keys for deep-sea fishing, or Alaska for salmon or big-game. The recipients don't claim all this on their taxes, and the people paying for the "entertainment" write it all off as "business expenses". Most ordinary folks have no idea how much of this stuff goes on nor how their tax burden is increased by having to make up for all the freebies sloshing around behind the scenes.

When Congressional members, their families, aides and staff, are invited to "informational" meetings in exotic locales, please keep in mind that money is "grease".

Of course the system is abused by all income brackets but it is not a matter of the wealthy having special tax rights just because they are wealthy. The IRS doesn't discriminate tax law application concerning write-offs based on income. At least I've seen no evidence of this provided in this forum or IRS.gov.

 

[j93]

Of course the system is abused by all income brackets but it is not a matter of the wealthy having special tax rights just because they are wealthy. The IRS doesn't discriminate tax law application concerning write-offs based on income. At least I've seen no evidence of this provided in this forum or IRS.gov.

I think the implicit truth is that the wealthy have more opportunities to write off and abuse the system.
Example a middle class may abuse the system by writing off his Hummer

but someone in the top of the income distribution can write off a yacht , a helicopter, multiple cars, ...

given the greater amount of opportunities to abuse the system the only way you could say that the wealthy abuse the system at the same level as the middle and lower class is if they decide to decline these opportunities more often than middle/lower class individuals ie. the wealthy are much more likely to pay their taxes faithfully than middle/lower class individuals.

 

[turbo]

The wealthy, and business interests operate on a whole different level than folks earning in the low 6 figures. When I signed on as a technical consultant for a supplier to the pulp and paper industry, I expected to be paid well, and to be required to participate in professional conferences and other functions in order to improve my knowledge and my relations with industry contacts. I never expected to find myself with a "bottomless" expense account that rivaled or exceeded my salary and bonuses.

I found myself arranging get-aways for key customers and their families in 5-star American-plan resorts that were so expensive (with the extras) that my wife and I might have only contemplate booking a weekend there once every few years. Junkets to the White Mountains in NH are not cheap but they were close enough that we all could drive there and back and people in production positions would not be held up in distant airports due to weather problems. Spa-treatments and massages for the wives? Riding lessons for the kids? Golf for anyone who is so-inclined? Side trips to local attractions with all expenses paid? All covered. Every nickel of my expense-account was presented as a legitimate business expense, and due to the growth of sales in my territory for two consecutive employers, my managers encouraged me to spend even MORE money courting existing or potential clients who had purchasing power. I got out of that rat-race eventually, but it really opened up my eyes to the sub-current of undeclared compensation in this country. The middle-class and the poor (yes, even the poor pay unavoidable taxes such as sales taxes, property taxes, etc) are paying much more than they should because of the fraud that occurs in higher-income groups.

In my jobs in that industry, I wanted to sell you custom-engineered industrial textiles that would save your company money in reduced steam costs (the biggest fixed cost in the production of paper), reduced wear, and lower replacement rates. A big paper machine might have a couple of forming fabrics, 2-4 pressing fabrics, and maybe 10 dryer fabrics. They need regular replacement, and back then 20 years ago, replacing the two forming fabrics might have cost $200K plus downtime and lost production. Replacing all the press fabrics could easily have cost well over $150K, and the dryer fabrics were typically $35-50K each - much higher in demanding applications.

I know that I have blathered on and on about this, but please consider that this is accurate. Now, consider what goes on behind the scenes in the medical field when costs are astronomical, and the profit potential is commensurate? A reasonable person might expect that tax-avoidance techniques and tactics that work perfectly well in industry will work equally well in the medical field. In other words, the sellers will successfully write off the expenses incurred in the bribing of the people that ultimately buy their services.

Is there anybody here that has worked in health-care that does not have a life-time supply of pens and notepads emblazoned with the name of prescription drugs, and some tote-bags, drink cozies, insulated lunch bags, etc? These are not "free". They are produced and distributed at some cost by the vendors, and that cost is written off as "promotion" - a cost of doing business. I still have a golf umbrella with the name of a drug emblazoned on it that was given to me by one of the docs in the practice that didn't play golf. I would have preferred a Sage fly-rod, but you can't be picky. The example in this last paragraph are minuscule in value compared to the really huge abuses, but every cent contributes to the overhead of our health-care system.

 

[drankin]

I think the implicit truth is that the wealthy have more opportunities to write off and abuse the system.
Example a middle class may abuse the system by writing off his Hummer

but someone in the top of the income distribution can write off a yacht , a helicopter, multiple cars, ...

I agree with that. But as I've shown, writing off a yacht isn't so easy as it is considered an entertainment vehicle. A helicopter, maybe if it's part of a business. How many rich people commute via helicopter anyway? I live in Redmond, WA home of Microsoft and I don't see private helicopters flying around.

The IRS hassles businesses and higher income folks more than lower income folks simply because they are interested with the amount of money owed.

I just don't see a large injustice in the tax code worth the "tax sheltered rich" stereotype implied.

 

[Evo]

It's the fact that many middle to low income people cannot even itemize. They have to take the standard deductions. They don't even have the opportunity to exclude their income from taxes. Therefore, they pay the highest percentage of taxes when averaged across their real income than people that can write things off or find tax shelters. Pretending it doesn't happen is not just naive, it's disengenious.

 

[turbo]

It's the fact that many middle to low income people cannot even itemize. They have to take the standard deductions. They don't even have the opportunity to exclude their income from taxes. Therefore, they pay the highest percentage of taxes when averaged across their real income than people that can write things off or find tax shelters. Pretending it doesn't happen is not just naive, it's disengenious.

I have not been able to itemize for many years, even when I was at my highest-gross earnings. I had no mortgage, no "strategic" debt, and no way to work the system. I was fresh meat for the system that was designed to let inflating cost and wages and a stagnant alternative minimum tax start stripping lots of extra money from hard-working folks.

 

[turbo]

I should mention that our tax system rewards indebtedness, and punishes actual conservatives who pay their own way. It may take a radical overhaul and simplification of the US tax code before wealthy people are required to pay their fair share of the upkeep of the government that helped make them wealthy, and protects their privileged status.

A $64m yacht owned by a Scottish billionaire docked in Bangor a couple of days ago, with 5 huge decks and a helicopter (with the main blades currently stowed). It certainly has been an attraction in an area in which countless thousands in the region have no employment and no prospect of any. As my mother used to tell me as a child, "Even a cat can look at the Queen." I wish the "Queen" would look back in this case and offer a response.

 

[j93]

At least in the state level sales tax also matters
http://www.itepnet.org/whopays.htm

 

[aquitaine]

Jumping in a bit late, I admit I haven't read in everything in the thread, one of my parents works in an insurance company and appearently part of the reason why healthcare costs so much is the hospitals deliberatly overcharge patients in order to bilk as much as possible from the insurance company, and often times the insurance will only pay for half of that leaving the patience to hold the bag, and that does of course assumes that you are _not_ one of the 40+ million people without health insurance, and no doubt many millions more also have the so called "Utah Insurance" (insurance that doesn't actually pay for anything). What amazes me about our healthcare system is not just the fraud, but also the waste, inefficiency, and corruption in the entire system. Healthcare will be one of the last bubbles to pop, and frankly I can't say I would miss it.EDIT: And I'll also throw this in:

According to Reuters:

Medical bills are behind more than 60 percent of U.S. personal bankruptcies, U.S. researchers reported on Thursday in a report they said demonstrates that healthcare reform is on the wrong track.

More than 75 percent of these bankrupt families had health insurance but still were overwhelmed by their medical debts, the team at Harvard Law School, Harvard Medical School and Ohio University reported in the American Journal of Medicine.

Seriously, what is wrong with this picture?

EDIT2:

And I don't pay through the nose in taxes to pay for any of that. My employer pays for it, private medical insurance is a perk.

What happens when you lose your job and can't get another one with such good benefits? Ooops...

 

[Evo]

What happens when you lose your job and can't get another one with such good benefits? Ooops...

Unfortunately I won't have to lose my job to lose my insurance, if Obama's health plan is passed, my employer will stop providing health insurance when they are no longer able to get a tax break to do so.

I had a talk with my doctor today, he said that the proposed healthplan is dreaded by doctors, they are absolutely against it. If you believe the media, doctors love Obama's proposal, he said it couldn't be farther from the truth. He said he sees the ability of doctors to make the best decisions for their patients a thing of the past. Right now they have to fight with insurance companies to get the best procedures approved, the new health care plan won't even let them fight that battle.

 

[j93]

A doctor also stands to make less money by passing healthcare reform.

 

[mheslep]

It's the fact that many middle to low income people cannot even itemize. They have to take the standard deductions ...

True.

It is also a fact that many low income people pay no federal income tax at all. It's a fact that of the higher incomes (ranked by gross income - before deductions), the top 1% of earners pay 34% of all US federal income taxes, that the top 5% pay 54%, that the top 10% pay 66%, that the top 25% pay 84%.
http://www.irs.ustreas.gov/pub/irs-soi/03in05tr.xls

 

[Evo]

True.

It is also a fact that many low income people pay no federal income tax at all. It's a fact that of the higher incomes (ranked by gross income - before deductions), the top 1% of earners pay 34% of all US federal income taxes, that the top 5% pay 54%, that the top 10% pay 66%, that the top 25% pay 84%.
http://www.irs.ustreas.gov/pub/irs-soi/03in05tr.xls

Not sure what that link was supposed to be. No one pays 84% tax. I saw a similar tax site and I passed it by, th tax % made no sense.

 

[TheStatutoryApe]

I apologize for being insensitive about your injury but my point is that ultimately we are responsible for our own welfare. If a particular private doctor does not give you the service that you expect, FIRE him/her. I've done it myself. I'll walk out of the office if a doctor does not attend to me within 20min after an appointment time. If the gov't begins dictating who we go to then we can't FIRE them for poor service.

Some of us can afford that and some of us can not. Some of us can not even afford to look for another job if our employers are shafting us. That does not make these people any less deserving of medical attention. The whole point of the medical profession is to help others, including those that are unfortunate. I think we can all agree that every one should get proper medical treatment. The real question is whether or not we can give everyone proper medical treatment. My opinion simply is that our seeming inability to provide this for our citizens is not reason enough to abandon the idea of doing so. Changes need to be made towards such a goal and ideas for reaching that goal must be worked on.
As far as being able to or not being able to fire an incompetent doctor there is no reason why this could not be accomplished in a national health care system. This system does not yet exist, we can not say how it will or will not be. If we perceive certain problems in other countries implimentation of such programs then we can attempt to avoid them. If the problems crop up anyway they can be fixed. Merely decrying something as doomed to failure accomplishes nothing in preventing that failure. And many of the opponents of the idea will only be too happy to see it become a failure instead of trying to help fix it.

Where?

I lived in Orange County in Southern California at the time. Lots and lots of hospitals and MRI machines everywhere. This is why it stumped me that it took so long. Maybe it was really just because of where I went but I have not really had very different experiences even when I was growing up and covered by my parents insurance.

 

[CRGreathouse]

Not sure what that link was supposed to be. No one pays 84% tax. I saw a similar tax site and I passed it by, th tax % made no sense.

You seem to misunderstand. That's total tax burden -- the top 25% of earners provide 84% of the government's money, and the bottom 75% provide the other 16%. (That's gross, not net -- I imagine the top 25% provides more than 100% net.)

This is a drop from previous percentages. The wealthy have lost a larger percentage of their wealth than the non-wealthy in the last 10 years, so their aggregate tax share has dropped. But still, it makes you wonder. Being in that lower 75% myself, I'm very thankful that I *don't* have to pay a proportional share.

 

[TheStatutoryApe]

Not sure what that link was supposed to be. No one pays 84% tax. I saw a similar tax site and I passed it by, th tax % made no sense.

I believe the idea is that that is the percentage of the total revenue paid by these people.

 

[mheslep]

Not sure what that link was supposed to be. No one pays 84% tax. I saw a similar tax site and I passed it by, th tax % made no sense.

Sorry bad link. Here
http://www.irs.ustreas.gov/pub/irs-soi/03in05ty.xls
See line 186.

It is not an 84% tax rate, rather the top 1/4 of taxpayers pay 84% of all US federal income tax revenue. The top half of taxpayers pay essentially all of the income tax revenue (97%). And that is ranked by gross income.

No doubt the super wealthy get large tax breaks. Warren Buffet complained that he owed only 17.7%, probably because his 'income' is dividends and cap. gains. But the average top 1% earner ($1.28 million) in this country makes most of his/her money from working. The day of the leisure class capitalists is gone, replaced by the working rich. She, typically, is a successful neuro surgeon, with eight years of school and another eight in training. She has the big mortgage deduction and some smaller ones, but they're still paying 35% on a million or more, soon to increase. And lop off another 10% if you are in California.

 

[j93]

The wealth distribution would be relevant here
http://zfacts.com/p/728.html

Roughly it would seem like the bottom half should be paying about 2.5% considering the amount of wealth they hold, rightly this is a very rough calculation assuming a flat tax.