Health Care Payment Reform

From 25 years ago: My Proposal for Health Care Payment reform.

Still, I think, more rational than anything else I’ve heard. Agree with me or convince me I’m wrong — either is a good outcome if it means we end up with something that actually works without destroying either health care or our culture of liberty or both.

The original cover letter to the Concord Coalition and to various Senators and Congressmen

The original cover letter to then-Governor Howard Dean, of Vermont

The proposal

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Yes, raising taxes affects people!

Taking money out of someone’s pocket by taxing them has exactly the same effect as cutting their salary or raising their mortgage payment or increasing the cost of their groceries. It makes them poorer. It means there is less money for them to pump back into the economy by spending it at the hardware store or at the movies or at the gas station or on someone to cut the grass….

I am not in the camp of, “No new revenue ever”. I sympathize with the Republicans who look at the history of budget debates and conclude that raising revenue before cutting spending leads, inevitably, to spending never being cut because it makes the problem seem not so bad. But I expect, and would support, paying more in taxes if I thought that it was really going to be spent to dig us out of the hole we are in, rather than being a down payment on digging the hole deeper.

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Politicians “making decisions about your birth control”

As a consumer of resources, I love the idea of someone else paying to support my lifestyle choices. But, as a producer of resources — and as a liberty-minded citizen of the American republic — I abhor the notion that the government should oblige me to provide for the lifestyle choices of others.

Perhaps the availability of contraception transcends mere “lifestyle choice” and comprises a public good worthy of government compulsion. Perhaps it doesn’t. That is worth a debate and I won’t pass judgement on it here.

But I must insist that those debating the issue do so honestly. No one is threatening to take away your birth control. All they are asking is that they not be forced to pay for it.

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Rational spending: it’s a matter of (dis)trust

What assurance can you offer me that, if I go along with a robust governmental stimulus financed by debt and inflation now, then the Congress and the President will follow through with austerity programs to resolve that debt and inflation later?

Because, unless you (or someone) can provide such assurances, can convince me that our politicians and government bureaucrats will suddenly change their approach to fiscal policy and behave in the rational way that economists would advise them to do, I and many like me cannot support such stimulative policies.

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Citizens United

“No taxation without representation” was the rallying cry of the American revolution, an explicit acknowledgement that the role of taxpayer — the role of providing financial support to government — is an overtly political one. If corporations are not individuals for political purposes, then they should not be taxed as individual entities. If corporations are really no more than aggregates of their stakeholders, and have no right to political participation other than through those stakeholders, then political duties, including the paying of taxes, should also apply strictly and purely through those stakeholders.

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Estate taxes and other tax oddities

I actually think the Estate Tax has a beneficial consequence in preventing the establishment of multi-generational economic dynasties. Apart from the potential detrimental effects of such dynasties on society and the economy, they do spiritual damage to those who inherit them: handing someone “success” without any need for effort or sacrifice is almost always a recipe for intellectual, psychological, and moral dissipation.

My objections to the estate tax — and to other tax policies — are based more on basic ideas of economic fairness and on the cultural ideals of “family”.

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Breaking News: People want to get things and make other people pay for them!

Suppose you want me to pay for your health care — or for your mortgage, or for your car, or for your iPod, or for anything else you feel you really need but can’t afford — and I don’t want to do so. If you point a gun at me and tell me to give you the money, it would be armed robbery. Everyone knows you don’t take what isn’t yours by force just because you want it. That would be wrong.

So, instead, you convince your Congressman to take the money from me, as a “tax”, and to give it to you. Why does that suddenly make it right?

What if I still don’t want to pay? What if I refuse — what do you think is going to happen? Federal agents will point guns at me and tell me to give them the money. Is taking my money by force suddenly righteous, rather than outrageous, because you outsourced the job? Is that what democracy is supposed to be about — lending moral authority to what would otherwise be morally reprehensible?

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Beating a Dead Horse: Social Security Edition

So yes, if you want to be pedantic about it, Social Security is not in trouble at all. It is covered by the trust fund. The managers of the Social Security Administration can sleep well at night knowing they’ve served us well in securing the benefits they’ve promised.

But, unless we do something clever, and fairly soon, the federal government as a whole will be in trouble because of Social Security. To me that is a distinction without a difference.

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Addicted to earmarks

On an individual basis, if we refuse the earmarks targeted at us but other people don’t refuse the ones targeted at them, then we end up paying for their earmarks without benefiting from our own. So, on an individual basis, we end up worse off by refusing earmarks unless we can count on everyone else doing likewise.

Hence, the system is perpetuated: if/when individuals stand up to it, they end up losers while everyone else takes advantage of them. Only a universal agreement from the top to change the system can work; insurrection from the bottom is suppressed by self-interest.

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