Affordable Care Act

Affordable Care Act

Before the Affordable Care Act (ACA), the American health care system worked well for those who could financially afford it, but it left out large segments of our population.  The World Health Organization ranked the United States 38^th in health care and number one in dollars spent per capita on medical care.   Health care cost was the top reason for people filing for bankruptcy. Even if you had health care insurance, most plans had a lifetime cap, denied pre-existing conditions, and had high deductibles. And more than 20 per cent of the premiums went to administrative costs and CEO salaries.

We desperately needed health care reform and the ACA started the long process of change in our health care industry. The ACA (often called Obama Care), is not reserved for the top 1%; it serves everyone. The Congressional Budget Office says ACA will reduce the deficit. ACA will slow the cost of health care premium increases, eliminate lifetime caps and preexisting conditions, and cap administrative costs to 20 per cent. It provides free prevention screenings and health care for 50 million additional people. Although Congress failed to allow Medicare to negotiate with drug companies to lower prescription drug costs, the ACA closes the donut hole for seniors.

There is bipartisan consensus that Obama Care works much better for the middle class and lower income Americans than before ACA. No one should die because they cannot afford health care nor be forced into bankruptcy due to illness. Democrats are proud to be a part of this seminal step in health care reform. America must not revert back to the health care system in place prior to the Affordable Care Act.

America should look at Taiwan's health care system

When talking about health care, consider this, America should choose the best ideas from around the world. That is what Taiwan did. Why not start with Taiwan? I found this on
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/

Frontline - Sick Around the World - Transcript
http://www.pbs.org/wgbh/pages/frontline/sickaroundtheworld/etc/script.html

What if you could pick and choose the best ideas from around the world? Well, that's exactly what one small Asian nation did.
[on camera] Taiwan's an island nation of about 23 million that became rapidly industrialized and went from poor to rich in about 20 years. And when Taiwan got rich, the government said, "Wait a minute. We need a rich country's health care system." So you know what they did? They set up a committee and they looked all over the world at different health care systems, looking for good ideas, and then designed their own."
[voice-over] In the late 1980s, Taiwanese health care was even worse than the America's is today. About half the population had no coverage at all. Hongjen Chang was one of the officials charged with designing a new health care system from scratch.
HONGJEN CHANG, M.D., Fmr. Pres., Bureau of Natl. Health Ins.: Taiwan is a small island. We always look abroad internationally for ideas. Chinese saying, we say, "The track of the previous cart is the teacher of the following cart."
T.R. REID: [on camera] So if the other guy's oxcart has found a good route to universal health coverage, follow those tracks.
Dr. HONGJEN CHANG: Follow those tracks. If they were trapped in trouble, avoid that track. Find a new track.
T.R. REID: [voice-over] So they consulted experts from around the world, and asked William Hsiao, a Chinese-born Harvard health economist, to head a blue ribbon panel.
Prof. WILLIAM HSIAO, Harvard School of Public Health: Why do you want to repeat the mistakes other people make? You want to pick up what people have done well and then move beyond that.
T.R. REID: Another expert they consulted was Taiwanese-American health economist Tsung-mei Cheng.
[on camera] How many different countries did they look at, do you know?
TSUNG-MEI CHENG, L.L.B., Princeton University: Over 10. Maybe 10, 13, 15 countries they looked at. And so in the end, the program that they finally set up in 1995 really is like a car that was made of different parts imported from overseas, but manufactured domestically.
Dr. HONGJEN CHANG: We examine quite extensive the major systems of quite a dozen, Europe, British or France, Germany, the Nordic countries, Swiss or the Dutch--
T.R. REID: Well, did you look at--
Dr. HONGJEN CHANG: --America.
T.R. REID: --the richest country in the world, the United States?
Dr. HONGJEN CHANG: [laughs] Oh, yes, yes, yes. It was the best system in the world, we thought.
T.R. REID: Yeah, you thought. And when you studied it, what did you find?
Dr. HONGJEN CHANG: Well, American is not really a system that you can copy. It's a market. So if you let things happen, it will be like the United States. There are many supporters, but in the end we said, "No, this is not the way we want to go."
T.R. REID: [voice-over] They wanted a system that gave everybody equal access to health care, free choice of doctors, with no waiting time, and a system that encouraged lots of competition among medical providers. To finance the scheme, they chose a national insurance system that forced everybody to join in and pay.
But Professor Hsiao thought Taiwan could improve on other countries like Japan and Germany.
Prof. WILLIAM HSIAO: We try to correct their mistakes. Japan has many funds, and we unified it. Germany let the rich people opt out. We do not let the rich people opt out. So we're building on what they have done correctly, but trying to overcome their deficiencies.
T.R. REID: The solution: To have one government insurer collecting the money and no chance to opt out. The result: A system that works a bit like the U.S. Medicare system for the elderly, and in fact, a lot like Canada's.
TSUNG-MEI CHENG: It has drug benefits, vision care, traditional Chinese medicine, kidney dialysis, inpatient care, outpatient care, just about everything under the sun.
T.R. REID: And to satisfy the patients in Taiwan, there's no gatekeeper and no waiting time. Clinics are open on weekends. This street clinic was bustling at 5:30 on a Saturday afternoon.
[on camera] If I woke up in Taiwan some morning and my shoulder's really hurting, how long would it take me to see an orthopedic specialist?
Dr. HONGJEN CHANG: We go now. [laughter]
T.R. REID: This morning I could see one?
Dr. HONGJEN CHANG: Yeah.
T.R. REID: I don't have to go to a GP and get a recommendation?
HONGJEN CHANG: No, we-- our people don't like the idea of gatekeepers. [laughs] They want to keep-- keep themselves. They want to decide by themselves.
T.R. REID: [voice-over] High-tech Taiwan designed its new health system using state-of-the-art information technology. Everybody here has to have a smart card like this to go to the doctor. The doc puts it in a reader, and the patient's history, medications, et cetera, all show up on the screen. And then the bill goes directly to the government insurance office and is paid automatically.
So Taiwan has the lowest administrative costs in world, less than 2 percent. Compare that to the endless paperwork and all the denied claims we get with for-profit U.S. health insurance.
The smart card can also be used in other ways.
TSUNG-MEI CHENG: If a patient goes to see a doctor or hospital over 20 times a month, or 50 times in a three-month period, then the IT picks that person out and then gets a visit from the government, the Bureau of National Health Insurance, and they have a little chat. And this works very well.
T.R. REID: That may be too much like Big Brother to get by in the U.S., but surveys show the Taiwanese are highly satisfied with their health care.
[on camera] How many people in Taiwan every year go bankrupt because of medical bills?
Dr. HONGJEN CHANG: None.
T.R. REID: [voice-over] So the patients are safe from bankruptcy. But just like Japan, the system itself is under strain.
[on camera] How much of the Taiwan's GDP are you spending on health care?
Dr. HONGJEN CHANG: We spend some 6.23 percent.
T.R. REID: Do you know the number in America?
Dr. HONGJEN CHANG: Yes, it's about 16 percent.
T.R. REID: Sixteen percent. Yes, that's right.
[voice-over] So we spend too much on health care and don't even cover everybody. But the Taiwanese spend too little, less even than Japan. They just don't bring in enough money to pay for all the services they offer.
TSUNG-MEI CHENG: So actually, as we speak, the government is borrowing from banks to pay what there isn't enough to pay the providers.
T.R. REID: Taiwan's politicians are reluctant to increase premiums. They think voters will punish them. So that's their problem. They know the solution is fairly straightforward, increase the spending a little to maybe 8 percent of GDP. Now, there's a problem the U.S. would love to have.
Like the other countries we've seen, Taiwan is struggling to balance the hopes of patients and the expectations of doctors against the price people are willing to pay for health care.
Before leaving Taiwan, I tried some acupuncture for my bum shoulder. I hurt it years ago in the Navy. Of course, Chinese medicine is covered by Taiwan's plan, too.
Taiwan's achievement got me thinking about what it takes to carry out health care reform. But to create a universal health system in an emerging Asian nation is one thing. To get there in a mature free market economy is something else. So my final stop was in a country more like us that did take on health care reform.
[on camera] Some people say it's politically impossible to fix our health care system. And in fact, the last time we tried it in 1994, the result was disastrous failure. But that same year here in Switzerland, a country famous for huge insurance companies and drug companies, they did take on health care reform and changed the system. Today they have universal coverage with high quality.



According to Dr. HONGJEN CHANG, Taiwan spends some 6.23 percent of GDP on health care. America’s GDP is about $14 trillion and spends 16 percent on health care, about $2.24 trillion. If America adopted Taiwan’s Health Care System and spent 8 percent of GDP for universal health care, that is only $1 trillion, less than half. Universal health care is the key to America’s companies and employees staying competitive in the world market.
It is also note worthy that $1 trillion is less than 3 percent of the household net worth over $1 million for every taxpayer. In other words, people with a net worth under $1 million would not pay for universal health care if we taxed net worth over $1 million to pay for it.

Concentrated Wealth

I found this comment on www.lcurve.org regarding economic issues. I hope people find this as educational as I do!

Quoting from a recently-published book by political philosopher David Schweickart,
If we divided the income of the US into thirds, we find that the top ten percent of the population gets a third, the next thirty percent gets another third, and the bottom sixty percent get the last third. If we divide the wealth of the US into thirds, we find that the top one percent own a third, the next nine percent own another third, and the bottom ninety percent claim the rest. (Actually, these percentages, true a decade ago, are now out of date. The top one percent are now estimated to own between forty and fifty percent of the nation's wealth, more than the combined wealth of the bottom 95 %.)

There is a growing class of billionaires that collectively holds a substantial fraction of the wealth of the country. [In March 2006 Forbes reported 793 billionaires in the US with combined net worth of $2.6 trillion. In March 2007 Forbes reported 946 billionaires in the US with combined net worth of $3.5 trillion. That is a 1-year increase of 19% in the number of billionaires and an increase of $35% in their net worth during a time of increasing poverty. Severe poverty is at its highest point in three decades.]

I do not have any problem with successful, wealthy, and/or well educated people, nor do I envy them. In fact I have great respect for Mr. Gates Sr., Mr. Buffet, and Dr. Robert Reich.

What I have a problem with is the attitudes in this country about the poor and the wealthy. Since President Ronald Reagan, people seem to have lost respect for poor and unfortunate people and detest giving a helping hand and the wealthy and businesses can do no wrong. That “kick them while they are down” attitude degrades our morals, principles, and government policies. The biggest injustice is the tax system. Mr. Gates Sr. has talked about estate taxes. Mr. Buffet has talked about the percent of tax paid. Dr. Reich has talked about the widening inequality of income and wealth and other things.

While I have nothing against billionaires, I do wish Republicans would let them pay their own taxes. When a poor person is taxed on 50 % of his net worth and a wealthy person is taxed on much less than 1 % on his net worth and a business is not taxed, that is not fair! The supporters of the consumption tax are trying to convince you to vote for the well being of the wealthy and businesses.

Let’s level the playing field for business by taxing every business out there the same. The only fair way to do that is a net worth tax. Should a single mother of 3 making minimum wage be forced to pay for part of a company jet? What are your morals? What is fair to you?


What should taxes be based on? Would you call someone making $50,000 a millionaire? If he has a net worth of $10 million, would you call him a millionaire? If someone has a net worth of $1,000.00, should he be required to pay $1 million in taxes? Should taxes be based on what someone buys?

By definition the term millionaire is based on net worth, not income. Therefore, if someone has a net worth of $1 million or more, yet only has an income of $50,000 per annum he is still a millionaire.

Income is not a measure of being rich, net worth is. Taxes should be based on ones ability to pay, not what he makes or spends.

When a poor person is taxed on 50 % of his net worth and a wealthy person is taxed on much less than 1 % on his net worth and a business is not taxed, that is not fair! The supporters of the consumption tax are trying to convince you to vote for the well being of the wealthy and businesses.

Wealthy people can use their influence single-mindedly and very effectively. A single billionaire can get the undivided attention of any politician he wants, any time he wants. If he doesn't get what he wants he can, in fact, "fight city hall," the statehouse, and even the federal government. Poorer people must pool their limited individual power and organize to have any effect at all. This is a very difficult thing to manage, in practice.

There are two classes in this country. One class derives concentrated power from its concentrated wealth. The other class has power only in numbers. That power is effective only to the extent that it can be mobilized through organization.

We live in representative democratic society. That means that “we the people” vote for people to represent us to conduct the business of government for the people. Businesses can’t vote and the wealthy that control the businesses are too small in number to elect the representatives. So what do they do? They have money to influence government to their advantage legally. The tobacco companies spent billions to influence public opinion and therefore government regulations to make even more money and kill people. The oil companies spent billions to fight the fact that burning fossil fuels accelerates global warming. Why? Short term profits. Will they make money? Yes. Will they destroy the planet? Maybe. Will people die? Yes. The examples go on and on. Increasing copyright laws from the original 14 years to 70 +, chemical company clean-ups, strip mining, saving and loan, Enron, and so on.

The point is that wealthy people hire lobbyist, think tanks, government employees, and yes our representatives to persuade people that our representatives are voting in the best interest of people instead of allowing the wealthy to steal from society. The fair tax system is funded by millionaires and companies. The fair tax system benefits the wealthy and companies. Shouldn’t people take a critical look at their claims to see how the tax system will benefit them and society?

Until we come to terms with these issues, phrases such as, "We the people...," and, "of the people, by the people, and for the people," are hollow clichés. Every four years people get to exercise there power to vote for representatives. 2008 is one of those very important years. Please don’t make the same mistakes as the last years.

Reasons for a Net Worth Tax System

America should adopt a tax system based on net worth for the following reasons.

1. A tax on net worth has the largest tax base. The net worth of this country is larger than the income system, about $9 trillion, and the consumption system, less than the gross domestic product, (GDP) about $14 trillion. The individual assets of $55 trillion and business assets of about $60 trillion is over 8 times larger than the consumption system.
2. Income is not a measure of being rich, net worth is. George Will has said that the wealthiest 1-percent of households have more assets than the lowest 90%, $16 trillion. Since the total individual assets are $55 trillion. The wealthiest 10% own about 73% of the net worth in the USA. The biggest 1-percent of corporations own 80 % of the business net worth.
3. Taxes should be based on ones ability to pay. A tax on net worth is the fairest tax to all. Net Worth is the measure of ones ability to pay.
4. Taxes on net worth have the lowest percentage. America’s budget is about $3 trillion. A consumption system requires a sales tax of over 21%. A net worth tax would be less than 3%.
5. A tax on net worth is the most versatile. Besides a flat tax of 3% for individuals and businesses, there are other possibilities. Some people say we have double taxation. We could tax only people at 6% or only businesses at 6%. Since businesses can’t vote and they pass there cost on to their customers, that is the best way to go. Next is the progressive path. The first $1 million could be tax-free and increase by 0.1 % for each $1 million up to 5% after $50 million.
6. A tax on net worth is the simplest to file. Take what you own minus what you owe. Our present tax system is 63,000 pages of loopholes. Example: a person leases a car. The lessee does not own the car, so no tax. The leasing company owns the $25,000 car, but has a $10,000 loan. The company is taxed on $15,000. ($25,000 minus $10,000) The loan entity has $10,000 of assets so it pays tax on $10,000.
7. A tax on net worth is the easiest to enforce. Since this is a property rights country, all assets are traceable. Taxing only the most prosperous 10 % of businesses and people is the most efficient tax system.
8. Like the consumption tax, all of our present taxes could be replaced, Individual income tax, corporation income tax, employment taxes, gift tax, and estate tax. Plus the excise tax.
9. Guarantees funding for all budget items like social security and Medicare by eliminating use taxes. User fees or tolls are another way for the wealthy and businesses to avoid paying taxes. Budget items come out of general funds.
10. A tax on net worth promotes transparency. When a company shows an annual report with a book value of $1 billion and only $10 million in taxes, they aren’t paying their full taxes.
    A tax on net worth promotes free trade. Money, inventory, buildings, etc. are all assets so everyone can move assets around for the best effect.
11. Eliminate inflation. Dr. Milton Friedman said to end inflation, stop printing money. By increasing the tax rate 1%, the national debt of $9 trillion could be paid off in 10 years.
12. We start collecting 100 percent of our earnings in every paycheck. We all get virtual raises, since payroll taxes are no longer siphoned from our checks.
13. Reducing taxes on the poorest 90% will raise revenue. When people have more money to spend, they buy more goods, which means more profit for businesses and the wealthiest 10%. Money flows up, water trickles down.
14. A tax on net worth promotes jobs. Employees cost companies less since the employment taxes are repealed and therefore employees become more competitive in the global market.
15. A progressive tax on net worth levels the playing field. Small companies that create the most jobs become more competitive with large companies.
16. A tax on net worth removes some incentive to move plants overseas. Taxes are based on assets no matter where they are located. What you own minus what you owe.

"FairTax" Scorecard

FairTax.org has a presidential and congressional scorecard that shows 5 GOP and one democratic presidential candidate would sign a fair tax bill. On the congressional side, in the house 76 republican and 4 democrats and in the senate 9 republicans support the fair tax bill. These people that support the consumption tax have not shown good judgment for the greater good of all our citizens. The fair tax is a misguided attempt to benefit business and the wealthy. This just goes to show you that you can fool some of the people all of the time but you can’t fool all of the people all of the time.

The Fair Tax Act of 2007 – HR 25/S 1025

For FY 2006, the IRS reports collections of 44.7% of Individual Income tax and 13.8% of Corporation income tax for the budget of $2.76 trillion. When employment taxes are included, individuals contribute 60 % to the budget while corporations only pay 28.5%. Income is not a measure of being rich, net worth is. Taxes should be based on ones ability to pay. Individuals have assets of $55 trillion and corporations have over $60 trillion. If corporations were paying their fair share, we would not have a budget deficit of 9%.

The wealthiest 10 % own 80% of all stock and 73% of all individual assets. Shouldn’t the wealthiest 10 % be paying 73 % of the individual income taxes? The wealthiest 1-percent make 25% of all individual income and the wealthiest 0.5 % make more than the lowest 50%. Does anyone really think that the poorest 50 % of taxpayers should or could finance 50% of the income tax budget? Our present tax system is not doing a good job.

America should not adopt this tax system, HR 25/S 1025, that is based on all retail sales for personal consumption of new goods and services, for the following reasons.

1. The tax base is not much more than the present system. The base is less than the Gross Domestic Product, (GDP) $14 trillion. A tax on net worth is 8 times more, $115 trillion.
2. The consumption tax will increase the tax on people about 28.5 %. Instead of individuals paying 60 % of taxes, they will pay 100% of the budget. In FY 2006, corporation income tax was 13.8 % of the federal budget and corporate employment taxes were 14.7 %. Under the "Fairtax plan," businesses do not pay taxes. Corporations enjoy all of the privileges of persons except the vote. They benefit from infrastructure, employee public education, law enforcement and limited liability. If corporations do not pay taxes, their privileges should be revoked.
3. A sales tax is regressive. In a study of Texas sales tax, those who earn less than $22,000 a year pay 14.2 percent in state and local taxes, those who earn more than $60,000 wind up paying about 5 percent. Even with the rebate, wealthier people and older people that have already purchased most of their needs will pay less than 23% of their income.
4. Taxable property is what most of the people have. Intangible property which is not taxable is what the wealthiest people have the most of. Taxable property – any property (including a leasehold of any term or rents for such property), but excluding intangible property and used property. Intangible property – an asset that is not physical and not real property. It includes copyrights, trademarks, patents, goodwill, financial instruments, securities, commercial paper, debts, notes, and bonds. Taxable property or services purchased from a seller for a business purpose in an active trade or business, or for export from the United States for use or consumption outside the United States are not taxed. Purchases by consumers are taxed. Investments (property purchased exclusively for purposes of appreciation of income or the production of income) are not taxed. Used property – defined as property on which the federal sales tax has been collected already, and property that was held for other than a business purpose on December 31, 2008 (the day before the sales tax became effective). The term "used" relates to whether or not the sales tax has been paid previously, and not just to whether or not the item has been sold previously. It appears that almost everything will be taxed for the first few years.
5. Insurance will cost 23% more. All types of insurance: Life, health, property and casualty, liability, marine, fire, accident, disability, and long-term care will be taxed.
6. The consumption tax is not fair. When a company has a dispute with a customer, they may find themselves in a court that only the customer has funded and to add insult to injury, the customer has to pay his lawyer 23 % more than the company does.
7. Everyone will start their own business. If a business pays Fair Tax on items for business use, the owner can get that FairTax back. Investments (property purchased exclusively for purposes of appreciation of income or the production of income) are not taxed.
8. The FairTax Act will phase out appropriations for the Internal Revenue Service and then spend billions recreating bureaus to administer the Fair Tax. The IRS is uniquely qualified to administer the Fair Tax with people, computers, and facilities in every state and major city. The fair Tax Act will pay retailers to collect taxes and keep records for six years and pay states to collect from retailers. An administering state enters into a cooperative agreement with the U.S. Treasury Department governing the administration of the FairTax by such state. The Social Security Administration sends out the monthly rebates. The Secretary of the Treasury is given the authority to promulgate regulations, to provide guidelines, to assist states in administering the FairTax, to provide for uniformity in the administration of the tax, and to provide guidance to the general public. The Secretary of the Treasury is required to establish an Office of Revenue Allocation to arbitrate any disputes between states regarding the destination of sales for purposes of allocating sales tax revenue among the states. The Secretary of the Treasury and each state sales tax administering authority may employ persons as necessary for the administration of the FairTax and may delegate to employees the authority to conduct hearings, prescribe rules and regulations, and perform other such duties. Following due process of law, the tax administering authority can seize property, garnish wages, and file liens to collect FairTax amounts due. Each sales tax administering authority must establish, maintain, and adequately staff an effective, independent Problem Resolution Office to protect citizens from abusive administration. The sales tax administering authority must establish and maintain an appeals process that provides a full and fair hearing of any dispute regarding tax liability. The Treasury Department may use FairTax data in preparing economic or financial forecasts, projections, analyses, or estimates. The fair Tax Act establishes an Excise Tax Bureau within the Treasury Department to administer those excise taxes not administered by the Bureau of Alcohol, Tobacco and Firearms. It also establishes a Sales Tax Bureau to administer the national sales tax in those states where the federal government directly administers the tax and to discharge other federal duties and powers relating to the FairTax. Does a rose by any other name still smell as sweet?

More information on the fair tax act can be found at "Americans for Fair Taxation http://www.fairtax.org/."