Let Lower Income "Pay Their Fair Share"!

[Anonymous]

I have to defend OP on the small co-pay on medical care for the poor. The point is not that the poor get ground down in many other ways by poor housing, substandard food, etc, or that they pay a bunch of local taxes like sales tax. Rather, it is an incentive question.

Those of us who pay for medical care make choices every time about whether something is worth going to the doctor or not. If medical care were free, we'd just go without evaluating the necessity. So you'd end up with a lot of unnecessary doctor's visits.

I was very familiar with a mother and child health clinic some nuns ran in a very poor area of an emerging market country. At first they offered free services. But the patients didn't self-regulate visits at all and they also became nastily demanding. In other words they felt entitled to get whatever care they wanted for free and were put out when the nuns didn't oblige.

The nuns then changed their policy to charge a small amount for each visit--mind you this was largely for pregnant women living in far more wretched conditions than 99% of our poor people. The bad attitudes among their patients vanished. They appreciated that for their financial sacrifice they could get dedicated and high quality care instead of abysmal care in a dirty government clinic. The lesson the head nun told me was that: "People don't value what they get for free."

[Anonymous]

Anonymous wrote:

Anonymous wrote:You neglected to state that the very top really don't pay their fair share via loopholes and tax deductions, which the lower/middle income folks never get to use. Sure, they pay a lot in taxes, but that's because they make a lot. But, if they only pay 10% in taxes, and middle/upper are paying 30%, then that's not fair is it?

But, I agree with you in that the middle and upper/middle are the only groups probably paying their "fair share".

If we got rid of all the loopholes, then I might agree with you.

Everyone complains about "loopholes" yet no one can cite one. A loophole is, by definition, an unintended benefit. Deductions? Which would you get rid of? Solid tax policy would say get rid of all deductions for no revenue producing expenses. Otherwise, it's just a give away in the form of a tax subsidy. But I hear the hew and cry when people are faced with losing a mortgage interest deduction or child care credit.

What specifically would you want to see eliminated that would have a broad impact on the wealthy/UMC and would bring in more than a token amount of revenue?

Trump is a perfect example. After bankruptcy he gets to pay no fed taxes for 18 years, despite being filthy rich.

I'm only middle class, so I wouldn't be able to enumerate all, but a simple Google search gets plenty of articles covering this topic.

http://www.bankrate.com/finance/taxes/tax-deductions-favor-rich-1.aspx

https://www.washingtonpost.com/news/wonk/wp/2015/04/09/the-rich-get-government-handouts-just-like-the-poor-here-are-10-of-them/

[Anonymous]

Anonymous wrote:I have to defend OP on the small co-pay on medical care for the poor. The point is not that the poor get ground down in many other ways by poor housing, substandard food, etc, or that they pay a bunch of local taxes like sales tax. Rather, it is an incentive question.

Those of us who pay for medical care make choices every time about whether something is worth going to the doctor or not. If medical care were free, we'd just go without evaluating the necessity. So you'd end up with a lot of unnecessary doctor's visits.

I was very familiar with a mother and child health clinic some nuns ran in a very poor area of an emerging market country. At first they offered free services. But the patients didn't self-regulate visits at all and they also became nastily demanding. In other words they felt entitled to get whatever care they wanted for free and were put out when the nuns didn't oblige.

The nuns then changed their policy to charge a small amount for each visit--mind you this was largely for pregnant women living in far more wretched conditions than 99% of our poor people. The bad attitudes among their patients vanished. They appreciated that for their financial sacrifice they could get dedicated and high quality care instead of abysmal care in a dirty government clinic. The lesson the head nun told me was that: "People don't value what they get for free."

All of this. You've gotta have some skin in the game.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:OP, why don't you ask for more help for the middle class rather than trying to take away the crumbs that the poor get? If you force a family living in poverty, a family that is living from penny to penny, to give up their grocery/electricity bill/rent money to pay your $8/month income tax, your $10/visit doctor fee and your $100/year health insurance is that going to alleviate your $20,000/year health care burden?

Or is it all about making you feel better knowing that others are suffering worse?

OP is one who somehow believes that if you play him in monopoly and he starts with all the properties except Mediterranean Ave and all the money and you lose it's not because OP started with so much it's because you're lazy and stupid.

Data from federalsafetynet.com (may be verified from public records, U.S. Census, federal spending breakdowns.). Spending on social benefits has not changed poverty, it has only made being poor more tolerable.

An small story: I had a similar experience where a crown on my tooth failed and I was advised to get an implant to replace it at a cost of about $15,000. I have to defer the work until I save (probably two years) because of the expense. Yet the next patient, who was Medicaid, was advised to get implants instead because it would all be paid for by his Medicaid plan which he immediately agreed to. If he had to pay out of pocket like me, maybe his decision would be different like the choice I was forced to make.

Yes, exactly....that's my point. (I'm the one who can't afford the twice weekly PT due to the expense, and have to shortchange my odds of recovery....and yet the Medicaid patient gets better care, paid for by taxpayers like me.) I can't understand how people cannot see the inequity in a system where taxpayers must come up with high monthly insurance premiums that do not provide coverage until a ridiculous deductible is met and must therefore sacrifice care - while at the same time a Medicaid patient enjoys a superior level of care that someone else's money can buy. Shouldn't a middle-class taxpayer get the same level of care as the poor person?

Someone upthread seemed sympathetic to the situation, but the solution was....why not ask for more help for the middle class? While well-intentioned, that is the liberal solution to everything - just give more help out. But I always come back to the same question: where is the money going to come from?

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:You neglected to state that the very top really don't pay their fair share via loopholes and tax deductions, which the lower/middle income folks never get to use. Sure, they pay a lot in taxes, but that's because they make a lot. But, if they only pay 10% in taxes, and middle/upper are paying 30%, then that's not fair is it?

But, I agree with you in that the middle and upper/middle are the only groups probably paying their "fair share".

If we got rid of all the loopholes, then I might agree with you.

Everyone complains about "loopholes" yet no one can cite one. A loophole is, by definition, an unintended benefit. Deductions? Which would you get rid of? Solid tax policy would say get rid of all deductions for no revenue producing expenses. Otherwise, it's just a give away in the form of a tax subsidy. But I hear the hew and cry when people are faced with losing a mortgage interest deduction or child care credit.

What specifically would you want to see eliminated that would have a broad impact on the wealthy/UMC and would bring in more than a token amount of revenue?

I had mentioned that we pay about 33% in tax, combined state+federal. If they got rid of most of the tax deductions, then *everyone* would end up paying their fair share, no? Personal exemptions and child credit is fine. These would actually help the lower/middle class. Yes, I'd be fine with getting rid of mortgage deductions as long as the very wealthy can't use any loopholes or other deductions either. That would actually be a much more fair system.

I'm the PP. To make this work broadly (and fairly) you would also have to eliminate the distinction between capital gain and ordinary income, except as "capital" relates to direct infusion of money into an income producing activity. So no capital gain on market transactions, houses, etc. IPOs if the stock purchased is treasury stock. Direct investment in a business could retain its "capital" nature.

No step up in basis at death.
There would be other modifications needed, but once the base is established rates could be adjusted much more easily.

PP here.. I would also say that if they got rid of the loopholes and majority of the deductions, then they should lower the tax rate for everyone by 5% or so. Even with the lower rate, we'd still have a lot more income coming from taxes since the very wealthy would be now truly paying their fair share - about 25% vs 10% or even sometimes lower.

[Anonymous]

Anonymous wrote:

Anonymous wrote:I have to defend OP on the small co-pay on medical care for the poor. The point is not that the poor get ground down in many other ways by poor housing, substandard food, etc, or that they pay a bunch of local taxes like sales tax. Rather, it is an incentive question.

Those of us who pay for medical care make choices every time about whether something is worth going to the doctor or not. If medical care were free, we'd just go without evaluating the necessity. So you'd end up with a lot of unnecessary doctor's visits.

I was very familiar with a mother and child health clinic some nuns ran in a very poor area of an emerging market country. At first they offered free services. But the patients didn't self-regulate visits at all and they also became nastily demanding. In other words they felt entitled to get whatever care they wanted for free and were put out when the nuns didn't oblige.

The nuns then changed their policy to charge a small amount for each visit--mind you this was largely for pregnant women living in far more wretched conditions than 99% of our poor people. The bad attitudes among their patients vanished. They appreciated that for their financial sacrifice they could get dedicated and high quality care instead of abysmal care in a dirty government clinic. The lesson the head nun told me was that: "People don't value what they get for free."

All of this. You've gotta have some skin in the game.

OP here, and I say "yay"! There are some people who get it: "What we obtain to cheaply, we esteem too lightly." (Thomas Paine.)

Psychologists have long reported that when a patient is required to kick in something toward his treatment (say Mom and Dad are paying, but he has to kick in $10 or $15 each time), he does better than people for whom it is entirely free. That's because they are INVESTED in the outcome.

I've also spoken to doctors who have said their Medicaid patients are the most unreliable. They don't show up for appointments, fail to call to cancel, neglect follow-up recommendations, that type of thing. That because it's all free, and taken for granted. Bet if the system required a $10 co-pay and $5 for canceling without notice (as most of have to do, but the charge is a lot more), you'd see more appreciation for the doctor's time and a drop-off in no-shows.

[Anonymous]

Anonymous wrote:I have to defend OP on the small co-pay on medical care for the poor. The point is not that the poor get ground down in many other ways by poor housing, substandard food, etc, or that they pay a bunch of local taxes like sales tax. Rather, it is an incentive question.

Those of us who pay for medical care make choices every time about whether something is worth going to the doctor or not. If medical care were free, we'd just go without evaluating the necessity. So you'd end up with a lot of unnecessary doctor's visits.

I was very familiar with a mother and child health clinic some nuns ran in a very poor area of an emerging market country. At first they offered free services. But the patients didn't self-regulate visits at all and they also became nastily demanding. In other words they felt entitled to get whatever care they wanted for free and were put out when the nuns didn't oblige.

The nuns then changed their policy to charge a small amount for each visit--mind you this was largely for pregnant women living in far more wretched conditions than 99% of our poor people. The bad attitudes among their patients vanished. They appreciated that for their financial sacrifice they could get dedicated and high quality care instead of abysmal care in a dirty government clinic. The lesson the head nun told me was that: "People don't value what they get for free."

I completely agree, and this was one of the problems of the UK's NHS. In France, where healthcare is inexpensive and universal, people pay for everything upfront. Just not the ridiculous and astronomical sums we are slammed with here. American patients are at the mercy of big "health" corporations - it's a scandal that they have such power.

But from that, to what OP is ignorantly advocating, there is a chasm as wide as the Grand Canyon.

[Anonymous]

So if the poor lady died because she couldn't have surgery, would that solve your problem or make you feel better?

[Anonymous]

You get plenty for your taxes. Just because you don't get a check or voucher doesn't mean you don't get plenty of benefits.

[Anonymous]

Anonymous wrote:So if the poor lady died because she couldn't have surgery, would that solve your problem or make you feel better?

And what if the middle-class person responsible for coming up with the money couldn't have the surgery, and she died? Why does the sympathy always go to the people on government aid, and insults go to lower-middle class people struggling to pay their own way?

[Anonymous]

Anonymous wrote:

Anonymous wrote:So if the poor lady died because she couldn't have surgery, would that solve your problem or make you feel better?

And what if the middle-class person responsible for coming up with the money couldn't have the surgery, and she died? Why does the sympathy always go to the people on government aid, and insults go to lower-middle class people struggling to pay their own way?

OP is lower-middle class? Like DCUM "lower-middle class," or for real?

[Anonymous]

It does seem the liberals always defend the underdog. I noticed at the debate the other night that Hillary was talking about the benefits to illegal immigrants if they are made citizens. Well, DUH. Of course it's to their benefit. But she didn't consider if it's to the benefit of current American citizens. With the system already overwhelmed with people, there are definitely some downsides to a huge influx of new citizens who rely to a greater degree (than native-born citizens) on government aid. That really needs to be considered before we convert all these illegals to citizens.

And since the thread has focused largely on health care, what about that? There's a real shortage of doctors, and we can't provide timely care as it is. If we add millions more to Medicaid or subsidized Obamacare, what then? I hear stories of people waiting for minths to see their doctor, and it will only get worse. I'm not saying no immigrants, but if we don't follow a reasonable pace, the system simply can't handle it.

[Anonymous]

Anonymous wrote:

Anonymous wrote:

Anonymous wrote:So if the poor lady died because she couldn't have surgery, would that solve your problem or make you feel better?

And what if the middle-class person responsible for coming up with the money couldn't have the surgery, and she died? Why does the sympathy always go to the people on government aid, and insults go to lower-middle class people struggling to pay their own way?

OP is lower-middle class? Like DCUM "lower-middle class," or for real?

Just curious. What's your definition of lower-middle class for real? And for DCUM lower-middle class (in this high COLA)?

[Anonymous]

Anonymous wrote:

Anonymous wrote:So if the poor lady died because she couldn't have surgery, would that solve your problem or make you feel better?

And what if the middle-class person responsible for coming up with the money couldn't have the surgery, and she died? Why does the sympathy always go to the people on government aid, and insults go to lower-middle class people struggling to pay their own way?

I got jobs that offered insurance and I paid the premiums like any middle class person should do.

[Anonymous]

Anonymous wrote:It does seem the liberals always defend the underdog. I noticed at the debate the other night that Hillary was talking about the benefits to illegal immigrants if they are made citizens. Well, DUH. Of course it's to their benefit. But she didn't consider if it's to the benefit of current American citizens. With the system already overwhelmed with people, there are definitely some downsides to a huge influx of new citizens who rely to a greater degree (than native-born citizens) on government aid. That really needs to be considered before we convert all these illegals to citizens.

And since the thread has focused largely on health care, what about that? There's a real shortage of doctors, and we can't provide timely care as it is. If we add millions more to Medicaid or subsidized Obamacare, what then? I hear stories of people waiting for minths to see their doctor, and it will only get worse. I'm not saying no immigrants, but if we don't follow a reasonable pace, the system simply can't handle it.

Oh, the irony...
More than a quarter of the doctors practicing in our county are foreign-born.