America’s Tax Problem Isn’t That Taxes Are Too High, It’s That We Don’t Think We GET Anything For Them…

Americans have always hated paying taxes. “No taxation without representation” was one of our first great marketing triumphs as a young nation. Wanna know who WE are? We’re the “We ain’t paying no stinking taxes” guys.

The colonists saw their tax dollars going out and nothing coming back in return.

What made it worse — the things they could point to that their tax dollars were funding included the British soldiers who, the Americans increasingly believed, were oppressing them. Americans, it turns out, HATE paying to be oppressed.

We resisted any sort of federal income tax for 140 years (caveat — the federal govt briefly imposed an income tax during the Civil War) until the 16th amendment was ratified in 1913 — that’s the one that made a federal income tax legal. Just for information’s sake, the first federally imposed tax was an inheritance tax. We knew even back then that the rich were hoarding cash.

When someone holds out their hand to you — expecting YOU to put cash in it — you kinda want to know what you’re getting for it. Even if all you’re responding to a threat with a bribe or a payoff, you KNOW what you’re getting — a few moments of relative peace until the next time they come with their hand out. You may not like what you’re getting, but at least you can identify it. Most Americans couldn’t tell you what they get for their tax dollars — other than the military and “the federal government” in all its polymorphous splendor. The problem is, aside from the military (which is mostly other people doing what they do far, far away), Americans see their tax dollars as paying for nothing.

Taxes are a black hole that mocks us relentlessly. Only a sucker pays taxes. Isn’t that what we’re taught?

We laugh at Europeans because they pay such high taxes — Just above 60% in Denmark, for instance. The sub headline from this article (from US News & World Report, 2016) says it all: “People in the European country see taxes as an investment in their quality of life”. They’re laughing at us a lot harder than we ever laughed at them. By virtually every metric — other than self-delusion — Northern Europeans like the Danes (the ones paying the highest taxes) are far, far, FAR happier than we are.

They’re far healthier than we are. As is said — they work to live. Americans, OTOH, live to work. Yeah — the ones paying the higher taxes are far happier than the ones begrudging every tax dollar spent.

But then, Europeans like the Danes can point to things they GET for their tax dollars. They GET health CARE from cradle to grave.

That’s especially foreign to Americans because we think in terms of health INSURANCE, not health CARE. That’s because our system evolved out of an historical anomaly that arose during WW II. The first employersponsored hospitalization plan was created by teachers in Dallas, Texas in 1929. These were small, very localized health plans that were meant to deal with catastrophic situations. Hospitalization. In the absence of any sort of “national health system”, every locality did what it did in its own way.

During WW II, the federal government directed every possible tax dollar its way. It was illegal, during the war, to give employees raises (or to raise a salary so as to attract talent to a job). But fringe benefits like, say, “health insurance” didn’t count as salary. Big companies (they could afford to) offered “health plans” instead.

Then the war ended — and these health plans should have ended right along with it. From Wikipedia: In his November 19, 1945 address to the nation, President Harry Truman proposed “…a national system that would be open to all Americans, but would remain optional. Participants would pay monthly fees into the plan, which would cover the cost of any and all medical expenses that arose in a time of need. The government would pay for the cost of services rendered by any doctor who chose to join the program. In addition, the insurance plan would give cash to the policy holder to replace wages lost because of illness or injury.”

Americans liked the idea — a lot. But the AMA hated it. So did the Chamber of Commerce and The American Hospital Association. They denounced it as “socialism”.

And that is where America’s shot at Universal Single Payer Health CARE died.

The people who opposed it did not oppose it on medical grounds, they opposed it for monetary reasons. Greed mattered more than medicine. FACT.

If Truman had done what Obama did — muscled his way past the greed as best he could — we wouldn’t be laughing AT the Danes and the Swedes and the British and the Germans and the French and the Canadians. We’d be laughing with them.

These systems aren’t perfect. Not by a long shot. Nothing is — can we please accept that fact? But — the data’s pretty conclusive — if you want to measure a health care system by its successful health care outcomes? We’ve got it all wrong. We pay far more and get far less.

Ah, but — what if we payed less (our individual piles of money are the same pile whether we pay taxes with it or out-of-pocket health care costs like deductibles & co-pays) and got a whole lot more for those very same dollars? What if — in addition to cradle to grave health CARE — we got the knowledge that we could NEVER go broke or lose our houses because we or someone we love got sick?

What if Americans — instead of merely seeing a deduction already taken from their paycheck or a check written to the US Treasury in blood — got an itemized bill that showed 1) what they themselves owed but (more importantly), 2) also gave them a detailed breakdown of where every single penny went. And what if some of those things their every tax dollar funded was good health care with the doctors they like?

Caveat — it’s not just the tax system that needs overhauling. It’s the whole nature of the health CARE system. In a universal single-payer system, every physician who wants to have a license to practice medicine will have to take part. Part of our “you know what you’re paying for system” would now include your education. Want to be a doctor? We’ll pay for it — you’ll pay for it (via your taxes). But then you won’t leave college/university hundreds of thousands of dollars in debt. You will have to spend your early years as a doctor inside the National Health CARE System. You’ll learn a ton. You’ll be well compensated — but you won’t be overly compensated.

Health care cannot be a wild, wild west of greed. It simply can’t be run that way — otherwise you get what WE have where people get billed $3200 cos they caught coronavirus. That should be a joke that we all laugh at because it’s so incomprehensible.

That’s our reality. It’s why people like the Danes laugh their asses off at us.

There’s no such thing as a “rugged individual”. That’s a bullshit myth “rugged individuals” (men — almost exclusively men) tell themselves to justify their greed.

They’re the ones benefiting from our tax system.

You CANNOT Have Profit Incentive At The Core Of A Health CARE System

Some ideas are so stupid, you have to marvel how they don’t die at their inception. Example — having profit incentive inside a health care system.

Of course we want people to “make money” doing their jobs in a health care system. That’s not the same thing however as having corporations step in as gatekeepers between Americans and their health CARE. Our system is screwed up foundationally. We’ve let the inmates run the asylum — literally.

The reason America’s system is so different than everyone else’s goes back to World War Two. Once America entered the war, every available dollar in the economy was directed toward sustaining America’s war effort. Large companies weren’t allowed to offer employees raises. If a competitor could offer skilled workers more money (because they paid more to start with), the competitor was going to get all the talent.

To counter this freeze on wages, American companies offered to pay for employees’ health care. More precisely, they offered to pay for their health insurance (not the same thing). Most major American companies did this. And then the war ended. But this practice did not.

In the abstract perhaps keeping this idea going wasn’t a terrible idea. But it was a terrible idea. Example — a big, big company like Boeing pays for the health insurance (not care) of a huge number of people (Boeing employed about 161,000 people in 2015). Airbus Group — Boeing’s largest (and main) competitor (though it employs around 136,600 (as in 2014) — by comparison paid ZERO for their employees’ health insurance.

That’s because all the countries that help build Airbus products have socialized medicine systems where tax dollars pay for everyone’s health CARE. Everyone can walk in the door at a universal single payer system. We know already who’s paying for it — we are. As we should.

In a universal single payer system? No one loses their house or goes broke (for a generation or so) because you or someone in your family got sick. Where Airbus is concerned, unlike Boeing, they DON’T have to add the cost of all that health insurance to the bottom line cost of each and every Boeing aircraft.

Consequently Boeing enters every competition with one hand tied behind its back. Our insurance driven system makes that a fact of life. It makes America less competitive. It hurts us — and then makes it hard to get healthy again.

Oh, the irony…

Insurance companies — being publicly traded — have a fiduciary responsibility not to any “patients” (those are cogs in a much larger wheel from an insurance company’s perspective) but to their shareholders. And not to the common class of stock shareholders either (yes, there’s a theoretical fiduciary responsibility) but to the PREFERRED CLASS of shareholder.

Ya know how Facebook users mistakenly think they’re Mark Zuckerberg’s customers? They’re not (of course), they’re the thing Zuckerberg’s SELLING — to the people who advertise on Facebook (aka ACTUAL customers). Same deal. Americans have it in their heads that they’d be screwed without their private insurance.

No, your insurance company is just a gatekeeper actually. Different insurance companies try to carve off different doctors as part of their “network”. Go outside their “network” & pay lots more. The people in the network have agreed to whatever fees the insurance company has decided to pay. The insurance company, if you notice, is ALWAYS in the driver’s seat.

Keep in mind — from the insurance company’s point of view (and fiduciary responsibility), they are OBLIGATED to deny and refuse as much coverage as the can get away with because that makes the company more profitable and being more profitable makes their shareholders happy and the company more financially healthy. Money — not health CARE — runs everything.

It’s not just money, remember — it’s PROFITABLE money. It’s profit INCENTIVE.

It’s completely antithetical to what a health care system is supposed to do — if anyone inside it has ever taken a Hippocratic Oath.

You can’t “But first do no harm” by asking “How’re ya gonna pay for this, Sparky?” These two things are mutually exclusive propositions.

Dear America – We Have A Health INSURANCE System, Not A Health CARE System; They’re NOT The Same Thing

Until we get the framing right, we’ll never fix the problem: our health CARE system is broken because it’s NOT a health CARE system. It’s a health INSURANCE system.

The first question anyone gets asked when they walk into any facility for health CARE isn’t “How can we fix you?”, it’s “How ya gonna pay for this?” Right off the bat, that’s ass backwards. The inmates are in full control of the asylum.

No other industrialized nation has a system like ours — where most Americans get their health INSURANCE (not care) through their employer. There’s a reason — and it’s not because we’re so clever and exceptional. It’s a historical anomaly that we’ve simply never dealt with, addressed or even admitted to.

Back during World War II, every available dollar was put toward the war effort. Rules prohibited companies from giving employees raises or raising salaries for new hires. Big companies, wanting to compete for the best employees, needed another incentive so they began offering free health care — well, they’d pay the insurance premiums.

Note — big companies were able to do it because they could afford (at first) to handle the additional admin and cost of running a health insurance program. As the war went on, more big companies offered the same health insurance benefit. Then the war ended… but the health insurance benefit didn’t — even though it should have.

After the war, all those big companies looked to get out of the health insurance business. They subcontracted out the work to the burgeoning health insurance industry to serve as the “gatekeepers” between workers and their health CARE. To keep costs down, the insurance companies eventually cut deals with doctors to get better rates. All very reasonable except that the insurance companies had now created EXCLUSIVITY where there wasn’t any.

Suddenly insurance companies could control which patients a doctor could see. And then they made their gatekeeping integral to the whole health CARE system itself.

Corporations — like health insurance companies — have a fiduciary responsibility to their shareholders (the preferred class, not the regular class of shareholders) first and foremost. They have NO actual responsibility to “patients”. The insurance company doesn’t actually care what happens to any patient. It’s in their interest to spend the least they can get away with on each patient while collecting the maximum amount of income from him/her.

Is universal single payer perfect? FFS, there’s no such thing as “perfect”. But at least it takes the FOR PROFIT gatekeepers out of the health CARE equation. There will still be gatekeepers for sure — government gatekeepers. But We The People can control how they keep the health care gates for us. We can’t do the same with a corporation.

It is even more absurd to run around all Chicken Little-like about Elizabeth Warren says she’d pay for her Medicare For All plan — without comparing it to either 1) what our current health INSURANCE system costs each & every one of us in cold, hard cash terms or 2) ever asking a Republican EVER what their “health care plans” cost or how THEY might get around to paying for it.

FFS – the Republicans pulled off a massively destructive (to the middle class) tax cut to the rich that they had no intention of every paying for — except by gutting social security and welfare.

America keeps getting tripped up by greed. Greed is what allows Big Pharma to charge extortionist prices for insulin when it’s inside America’s borders and reasonable prices everywhere else.

Greed never makes anyone smarter. It ain’t gonna cure anyone’s ills either.

Get Used To A Gig Economy. It’s The Future For Most of Us

Back when I was growing up, there still existed this ‘notion’ that one’s goal was to educate oneself just enough to score a job with a Big Employer who would then be ‘Your Daddy’ till the day you retired.  And, as your Employer was the source of your pension, too — they were going to take care of you till the day you died (and, if there was employee-provided life insurance, they’d ‘take care of you’ after you were dead and buried too).

Most people don’t know the story how & why America is the only place where one’s health care is left up to one’s employer instead of, say, the government (like every OTHER civilized country).  It started during WWII.

Because the war effort demanded all available cash, employers were prohibited from giving raises to employees or offering a new employee higher pay for a job than it paid previously.  To compete for good, new employees though, companies had to do something.  A few came up with what was, at the time, a clever idea:  “Free Health Care”.  That wasn’t prohibited.

Soon, lots of companies were offering it.  Then the War stopped.  But the practice never did.  It continued though it no longer actually made economic sense for anyone — especially while Europe was re-building and instituting socialized  systems for health care and education and old age pensions that were paid for via taxes not as some perk offered by employers). What Europe was doing made far better sense — both as economic policy and as social policy.

The citizens of Europe are far healthier, better educated AND MORE COMPETITIVE than most Americans.  And now the rest of the shit pie comes out of the oven.

The old Employer-Provided Health Care System is crumbling under its own unsupportable weight.  It makes business expensive.  Makes goods and services more expensive.  Example — an Airbus doesn’t have to build in the cost of its makers’ health care and old age pensions.  Boeing, for instance, DOES.

There ARE Real World impacts.

And people don’t work for anyone for Life any more.  And companies are scaling back their health care & pensions to MOST employees (not the ones at the very top of course, NEVER the ones at the VERY top…) because they’re too expensive.

America’s business are already gearing up in every way they can to shed ’employees’ and hire ‘contractors’.  Gig Economy people.

When that happens, the other vital benefits that Americans came to rely on will go unattended to — with dire consequences.  It ain’t rocket science to make that call.  It’s so obvious it hurts.

Makes me wish I had a job — so I could go to a doctor about it…