The health care reformation is to depend upon both savings and on higher taxes for upper income earners. That makes me wonder why the higher taxes are needed. Why don’t those with a lot of money just give it to the government?

The federal government and at least some states accept gifts. My state solicits right on the income tax forms. You can just fill in the extra amount you want to donate to the state.

Year after year only trivial amounts are received.

That is very puzzling considering the great wealth possessed by millions in the US.

I cannot explain why the government gets so few gifts. We know there are millions upon millions of prosperous liberals who insist taxes should be higher. In fact they insist that higher taxes are absolutely required for better government and for health care reform. Higher taxes are morally desirable.

Well, let me qualify that. Some higher taxes are morally desirable. Other higher taxes are not. Liberals understand the difference and know who should be taxed more.

There also are millions of prosperous conservatives who consider any taxes at least somewhat bad. Perhaps necessary but still bad.

But what has this to do with the negligible voluntary donations? Are gifts to government somehow morally repugnant to both wealthy liberals and conservatives? Why do groups that differ about almost everything agree about gifts to government?

Not too hard to figure out. Taxes are forced upon the payer. Gifts are not. A tax, especially one earmarked tax such as a surtax, forces the social wants of some to be paid for by others.

This can be seen clearly when we look at the high taxes on tobacco. They certainly weren’t imposed by smokers. Most revenues are earmarked for specific causes. Those may be health care, anti-smoking advertising, etc.

Politically, people who disliked smoking outnumbered the smokers and made them to pay up.

At least tobacco taxes are avoidable. You quit smoking. That is really social mobility; you resign from a class heavily taxed and enroll in one more lightly burdened.

While I’m not Dr. T but I do know people that got sick and then could not work, they went on disability. A Co-worker developed a problem that stopped him from working, he first was on short term disability then long term kicked in and also with that SSI kicked in. He is surviving and didn’t loose everything, just his health. That’s what disability insurance is for.

My sister became disable and unable to work. She went on SSI and has medical coverage through it. She is somewhat poor now, but she lives with my mother in a house I own.

Fay, we already have programs in place, both private and public, to cover the problem you addressed. Plus the health care plan in congress would make this worse, not better. They want to reduce the money spent on people not more.

You are relying on people like me to pay for this plan with a surcharge. I laugh. I’ve had a long and successful career and I can comfortably never ever work again. I simply won’t accept the 10 percentage point hike in my taxes and I won’t produce the income you’re looking to tax. My employees will be out of a job, so they won’t be producing much either (we’re losing, not creating jobs in my field). If taxes or inflation continue to increase here, I’ll simply buy citizenship elsewhere and my money will be out of reach of the IRS. Meanwhile, I’ll happily pay cash to avoid Dr.’s wait lists and I’ll still get much better care than you will. You do, of course, realize that these are not just my incentives but the incentives of everyone in my position – the very people you’re relying on to provide you all this “free health care”?

The young folks not yet earning above $350K will have very little incentive to get above that mark since they can afford out of pocket healthcare at that income level and they won’t be hit up for a health care tax surcharge either. So, they won’t work as hard, won’t produce as much income for you to tax and won’t take the risk of starting their own business (a high tax rate reduces the reward, but not the risk), thus won’t create new jobs. So, eventually, that tax surcharge is going to increase and creep down two the middle class. It’ll have to increase because 5.4% of $1MM is $54k and 5.4% of $100K is only $5,400. You’ll pay the surcharge (which, I bet is more than you pay now for healthcare) and you’ll wait on long wait lists to actually receive rationed care (which in some cases is like not getting care at all).

Good luck. You’re going to need it.

Fay….

I think you need to face a cold hard reality – eventually, you’re going to die and it might be disease that kills you. If these people died of their disease despite draining their entire life savings, that means that no amount of modern medicine could have saved them. So, what you’re proposing is that these people not only drain their bank accounts but yours as well so that they can continue to get ineffective treatment until their final gasp. Does that not strike you as stupid? No, you want them to drain MY bank account, not yours, since you obviously don’t want to reach into your own pocket to help these people out. Your feelings are only strong if it’s someone else who is forced to pay for it. Very compassionate.

No medical system can offer limitless medicine to hopeless cases. So, these people will still be cut off and die at some point – probably at an earlier point. That’s if they can get in to see their physician to get a timely diagnosis. Otherwise, they die much sooner. In exchange for this, you rob everyone of their liberty.

The reality is that most of “the rich” in this country are not employees, but rather employers and the first thing to go when taxes are raised on them are jobs. It just gets better.

How many anecdotes do there have to be?

Enough to be significant. Where are these scary stats, Fay?

And as for people dying for lack of treatment: I am not talking about walking into an emergency room. I’m talking about longer-term illnesses that first bleed the patient dry (often even WITH insurance), then ultimately kill him/her when all the money and benefits run out. I can think of four examples of this off the top of my head, just in my own daily (comfortable, middle-class) life. Yes, it’s anecdotal. How many anecdotes do there have to be? Do you really think people are just making this stuff up?

Dr. T, have you never encountered anyone who first got sick, then could not work, then lost their job, then lost their insurance, then lost all their assets, and then died from the combination of the illness and the stress of it all? No? Well like I said… nice world you live in.

If I were a conspiracy theorist, I’d be claiming that this is suspiciously timed so as to not affect Obama’s 2012 reelection campaign.

ALso, note the comment in the NY Post that a lot of the funding is directed to setting up community organizations and review boards, etc. This is the establishment of a low-level nanny-state monitoring infrastructure that can be expanded to cover all sorts of behavior besides health care. It can be expanded to include the sort of “anti-social” behavior that the Brits have been trying to stamp out for about 10 years. It is control over your life, if you do not live the way the nanny-state wants you to “live”.

More and more, I am coming around to the Jimmy Buffet philosophy: “I want to die while I’m living, not live while I’m dead”. I think I may try to post this somewhere on the NY Times, and see what reaction it triggers.

I’ve been a physician for 20 years in urban areas. Please show me all these people dying from lack of care. ERs, by law, must treat every significant illness or injury regardless of whether the patient can pay. Most cities and many rural areas have free medical clinics. Some even have free mobile clinics that drive to underserved neighborhoods. Poor people get Medicaid and can seek care from nearly all clinicians.

The only lack of care deaths I’ve seen were non-institutionalized mentally ill people who would not go to a doctor, a clinic, or an ER. I have not seen or heard of deaths among persons who were denied care because they were poor, though I did hear of one case where a hospital ER told an ambulance to go to another hospital and the patient died en route. But, that was a logistics problem rather than a financial problem.

People like Fay take a few exceptional news stories and turn them into common patterns. Then they use those ‘patterns’ as justifications for federalizing health care. They engage in magical thinking and believe that NannyState will kiss the boo-boo and make it feel better. In reality, NannyState is an impersonal, control-freak. You don’t want to make her bigger.

Because you’re not spending your own money on a less well-off stranger who wants to get good health care on your dime.

This massive bill will not improve health care or make it more cost effective. Its two purposes are to increase government power and to transfer wealth from the well-off to the middle class. Obama craves the first purpose and is buying off the voters with the second.