Tuesday, December 23, 2008

The Health Care Cancer, Taxed to Death

As a medical imaging (x-ray) engineer for over 26 years, working and traveling the eastern seaboard & beyond, from Maryland to Miami to Mississippi, I've seen the gamut of America's healthcare system. It is in shambles. Not from the healthcare providers (doctors, nurses, technicians, etc.), but from the bureaucracy (administration, insurance, government, profiteers).
I've done the research, and it's little known fact that nearly 1000 hospitals have closed across America over the last 20 years, 16 in metro Atlanta alone. There are between 300-400 more on the verge as I write this. The need for healthcare hasn't diminished, it's exploded, but the means, availability & affordability have fallen through the floor.
I'm no proponent of socialized medicine as the world understands it, but we see healthcare, like insurance, is a necessary "evil"; a stopgap to protect us from ourselves and each other. Yet, not an "evil", but a necessary "good".
The problem is as long as the motive for its provision is greed & profit, it will not, cannot, succeed. Healthcare must always be deemed a public service, a charity, in our hearts & minds; the same way we provide food, medicine, clothing & shelter for the starving masses in Africa and elsewhere. It is a sacrifice we all must make willingly for ourselves & one another:
"When you cut down yours harvest in your field, and have forgot a sheaf in the field, you shall not go again to fetch it: it shall be for the stranger, for the fatherless, and for the widow: that the LORD your God may bless you in all the work of yours hands." Deut 24:19
"Learn to do well; seek judgment, relieve the oppressed, judge the fatherless, plead for the widow." Is 1:17
"Pure religion and undefiled before God and the Father is this, To visit the fatherless and widows in their affliction, and to keep himself unspotted from the world." James 1:27
"And great multitudes came unto him, having with them those that were lame, blind, dumb, physically disabled, and many others, and cast them down at Jesus' feet; and he healed them." Matt 15:30
"If I then, your Lord and Master, have washed your feet; you also ought to wash one another's feet. For I have given you an example, that you should do as I have done to you." Jn 13:14-15
"Whatsoever ye would that men should do to you; so also do ye to them: for this is the law and the prophets." Matt 7:12
I'm sure this includes all the sick, the ill, the infirm, the damaged & the broken. Much as we give our tithes & offerings for the Lord's service and ministries, we should also deem healthcare the same for one another. It does not, cannot, work any other way...
By the way, one more little known fact: Almost every hospital started in this nation began as a Christian service & outreach to its community.

______NEWS________

At House Party on Health Care, Diagnosis: It’s Broken

By Robert Pear, NYTimes
December 22, 2008

Brendan Smialowski, NY Times
Karima Hijane, flanked by her husband, Theodore A. Kolovos, and Li Yang, needed a year to get correct diagnoses of illnesses. “Instead of being able to focus on my health, I focused on insurance to cover the tests and treatments.

VIENNA, Va. — When a dozen consumers gathered over the weekend to discuss health care at the behest of President-elect Barack Obama, they quickly agreed on one point: they despise health insurance companies.
They also agreed that health care was a right; that insurance should cover “everything,” not just some services; and that coverage should be readily available from the government, as well as from employers.
Those were the conclusions of a house party held here in Northern Virginia at the home of Karima Hijane and Theodore A. Kolovos, information technology consultants who have been married for seven years. It was one of more than 4,200 such events being held around the country from Dec. 15 to 31, as part of an experiment in grass-roots politics and policy-making, to provide recommendations to the president-elect.
“We have to keep the momentum going,” said Ms. Hijane, 34, who was a volunteer in the Obama campaign and is active in women’s health advocacy. “We are not lobbyists. We are simple citizens. We want to make sure that our voices are heard and that health care is reformed.”
One of the people seated around Ms. Hijane’s dining room table, Bruce D. Chatman, worked for I.B.M. for 29 years. Corporations, he said, have too much influence in the legislative process and the health care system. He wants to counterbalance their power with the energy and passion of citizens lobbying for themselves.
Mr. Chatman, a Chicago native who lives in Fort Washington, Md., said he had been inspired by Mr. Obama’s book “The Audacity of Hope” and started working for his campaign as a volunteer in April 2007.
“I don’t believe health care should depend on people making money,” Mr. Chatman said. “The profit motive has to be tempered, especially on the administrative side of the health care business.”
Shiva S. Makki, an economist, complained that in many cases, insurers did not cover the costs of screening procedures and preventive care.
Dr. Lawrence M. Nelson, a scientist at the National Institute of Health who emphasized that he was speaking as a private citizen, said: “The incentives in the current health insurance system are upside down. The less care you provide, the bigger your profits.”
Dr. Nelson said he liked Mr. Obama’s proposal to create a new public plan, similar to Medicare, that would compete with private insurance companies.
Alex R. Lawson, a volunteer in the Obama campaign now trying to build public support for Mr. Obama’s agenda, said a public plan would give people a choice they do not have.
“A public insurance plan would not take anything away,” Mr. Lawson said. “It just adds another option.”
After one speaker expressed a mild concern about too much involvement by the government, Mr. Kolovos said: “Everyone is afraid of government bureaucracy. But what we have now, with the filing and adjudication of insurance claims, is also bureaucratic.”
Several people at the health care forum said they were frustrated by the current arrangement under which health insurance is tied closely to the workplace.
Hamudi Almasri, a 35-year-old information technology consultant at a small company that does work for the Labor Department, said that when he changed jobs, he had to change health plans and doctors.
“If I change employers, why should it be such a hassle?” Mr. Almasri asked.
His wife, Li Yang, said: “When I move from one doctor to another, my information is lost. In many cases, the doctors don’t talk to each other. In a country where information technology is so advanced, there’s no system linking all these doctors together. It’s a hindrance to treatment.”
Ms. Li said she and her husband “had a few surprises” when they started shopping for a better health insurance policy on their own.
“If we wanted a baby,” Ms. Li said, “insurers would not cover the maternity care if conception occurred within six months after we purchased the insurance. We were shocked.”
In many cases, the standard individual insurance policy does not cover maternity care, though such coverage can be bought for an additional premium. Even then, some insurers stipulate that maternity benefits will be available only if a woman waits for a certain amount of time before becoming pregnant.
The Obama transition team asked for “particularly poignant stories to highlight the need for health care reform,” and such stories were abundant at the round table here.
Mr. Almasri said that when his infant daughter had severe eczema, she had to wait several months to see a dermatologist in their H.M.O. network. By then, he said, “the symptoms were all cleared up.”
Ms. Hijane said she had gone from doctor to doctor for more than a year before she got correct diagnoses for premature ovarian failure and celiac disease, a digestive disorder.
“Instead of being able to focus on my health,” Ms. Hijane said, “I focused on insurance to cover the tests and treatments. Everything we did was designed to find a job with good health insurance.”
The Obama transition team did not ask people how a new health care system should be financed, but several people here said that individuals and businesses should have to pay a small health care tax — some preferred to call it a “contribution” — so that everyone could be covered.
Mr. Chatman said he expected insurance companies and others in the health care industry to resist many of Mr. Obama’s proposals.
"This is warfare for the health care of our country,” Mr. Chatman said. “The question is, Will money win, or will the people win? If we lose, we’ll be a second-class country.”

___________


The best and worst states for taxes
Where you live can make a big difference in how much you pay in taxes. So can whether you smoke and how you get to work in the morning.
By Scott McCredie

We pay Uncle Sam the same no matter where we live, but property, gasoline, tobacco, sales and state income taxes are all over the map.

The differences can be extreme. An Alaskan keeps 7 cents more of every dollar than a Vermonter, once cities and the state have grabbed their shares.

Factor in federal taxes and the gap grows even wider. Those who earn more money generally pay a greater percentage of it in federal taxes, so states with a greater percentage of highly paid workers end up paying more.

The state in which residents pay the most in combined state, local and federal taxes, per capita, is Connecticut (38.3%), followed by New York (37.1%), New Jersey (35.6%) and Nevada (35.2%). Oklahoma residents pay the least (27.8%), followed by those in Alabama (28.0%) and Alaska (28.1%).

We're all paying more, though. The U.S. average for state and local taxes in 2007 was 11%, up from 10.8% in 2006. The average combined state, local and federal tab for 2007 was 32.7%, up from 32.3% in 2006 and 30.7% in 1980.

On same income, taxes vary

Of course, even Ted Taxpayer and Debbie Deduction, two people making the same salary and living in the same neighborhood, pay different amounts in taxes. For example, Ted's house is worth more, so he pays higher property taxes; Debbie buys fewer goods and services, thus saving on sales taxes; Ted drives a gas hog and commutes farther to work, costing him more in gas taxes; Debbie doesn't drink or smoke, so she saves on so-called sin taxes. That's not to mention the countless other ways they can incur, avoid or defer taxes.

There are 50 states in the union and, it seems, 50 formulas for collecting taxes. Only seven states -- Alaska, Florida, Nevada, South Dakota, Texas, Washington and Wyoming -- don't assess income taxes, and New Hampshire and Tennessee have income taxes on just dividends and interest. These states balance the lack of income taxes with other taxes, notably sales taxes.

Five states have no sales tax -- Alaska, Montana, Delaware, New Hampshire and Oregon. For 2007, the state with the lowest sales tax rate is Colorado (2.9%); the highest is California (7.25%). Among the sales-tax majority, every state but one (Illinois) exempts prescription drugs, while 31 states exempt food. Counties and municipalities can add their own sales taxes, so comparisons are difficult between states. To find the sales tax in a specific ZIP code, click here.

Gasoline and diesel are taxed at different rates in most states. Besides the straight excise tax, which varies from a low of 4 cents a gallon in Florida to a high of 36 cents in Washington, most states add other gas taxes that increase the toll. The state with the greatest total state tax on gasoline is California (45.5 cents per gallon); the lowest is Alaska (8 cents). Those are levied on top of the federal tax on gasoline, unchanged from last year at 18.4 cents per gallon.

On average, the combined state and federal gasoline tax is 45.8 cents across the nation, making the United States one of the least expensive places in the Western world to buy fuel. In Europe, government taxes make up about 60% of the price of fuel, on average, according to The Christian Science Monitor. According to the American Petroleum Institute, motorists in the western U.S. pay the most in fuel excise taxes (53.9 cents), while those in the South pay the least (38.4 cents).

States lead way on tobacco taxes

The American Lung Association gives the federal government an "F" for its lack of political will to impose greater taxes on tobacco. Although there were rumblings in Congress last year to boost tobacco taxes by 61 cents per pack, no legislation was passed. For each 10% increase in the price of cigarettes, smoking drops by about 4%, experts say.

In 2007, the federal tobacco tax remained at 39 cents a pack, the same as it has been since 2000. State and local taxes on tobacco products, however, have been steadily rising. For example, Kentucky, one of the top tobacco growers in the nation, had the lowest cigarette tax in the country (3 cents a pack) until 2005, when it raised the tax to 30 cents, where it remains. New Jersey, for the third year in a row, collects the heftiest tax on cigarettes -- $2.58 per pack -- followed by Rhode Island ($2.46) and Washington ($2.03). South Carolina, among the 21 states that grow tobacco, collects 7 cents a pack, still the lowest tax in the nation.

And coming up on the outside . . .

Are there any new trends showing up in the way states apply taxes?

Bill Ahern, the Tax Foundation's director of communications, sees several patterns developing. One is that state legislatures are coming up with plans that shift taxes from state residents to those who live outside the state.

How can this sleight of hand occur? By raising taxes on commercial property and vacation homes, some of which are owned by "nonvoting, nonresidents," Ahern says. "On the same theme," he continued, "there are numerous plans to raise taxes on lodging, rental cars, restaurant meals and other tourism targets. They are pitched to voters as a way to extract revenue from out-of-staters."

Another trend Ahern notes is the larger percentage of state revenue being generated from what some call gaming revenue and others term gambling losses. "In the early 1960s," Ahern says, "lotteries were illegal or unconstitutional in every state. Now 42 states have done a 180 and promote lottery tickets as if they were mother's milk. Last year was the first year that any state got more than 10% of its revenue from the lottery. Rhode Island did that, but it will be joined by others soon."

Taxes by state


SalesGas/gal.Cig./packBeer/gal.State burdenRankState/Fed. burdenRank

Alabama

4.0%

$0.20

$0.43

$1.05

8.8%

46

28.0%

49

Alaska

none

$0.08

$2.00

$1.07

6.6%

50

28.1%

48

Arizona

5.6%*

$0.19

$2.00

$0.16

10.3%

31

31.3%

25

Arkansas

6.0%

$0.22

$0.59

$0.21

11.3%

13

30.7%

32

California

7.3%

$0.46

$0.87

$0.20

11.5%

12

34.3%

8

Colorado

2.9%

$0.22

$0.84

$0.08

10.4%

30

31.8%

23

Connecticut

6.0%

$0.44

$2.00

$0.20

12.2%

8

38.3%

1

Delaware

none*

$0.23

$1.15

$0.16

8.8%

47

31.2%

26

Florida

6.0%

$0.33

$0.34

$0.48

10.0%

38

33.6%

12

Georgia

4.0%

$0.26

$0.37

$0.48

10.3%

32

30.9%

28

Hawaii

4%*

$0.33

$1.80

$0.93

12.4%

6

33.0%

16

Idaho

6.0%

$0.25

$0.57

$0.15

10.1%

35

29.6%

42

Illinois

6.3%

$0.40

$0.98

$0.19

10.8%

22

33.2%

14

Indiana

6.0%

$0.32

$1.00

$0.12

10.7%

25

30.8%

30

Iowa

5.0%

$0.22

$1.36

$0.19

11.0%

18

30.6%

33

Kansas

5.3%

$0.25

$0.79

$0.18

11.2%

15

31.0%

27

Kentucky

6%*

$0.19

$0.30

$0.08

10.9%

20

30.4%

34

Louisiana

4.0%

$0.20

$0.36

$0.32

11.0%

17

29.1%

44

Maine

5.0%

$0.29

$2.00

$0.35

14.0%

2

33.9%

10

Maryland

6.0%

$0.24

$2.00

$0.09

10.8%

23

33.1%

15

Massachusetts

5.0%

$0.24

$1.51

$0.11

10.6%

28

34.4%

7

Michigan

6.0%

$0.36

$2.00

$0.20

11.2%

14

31.9%

21

Minnesota

6.5%

$0.22

$1.49

$0.15

11.5%

11

33.9%

11

Mississippi

7.0%

$0.19

$0.18

$0.43

10.5%

29

28.1%

47

Missouri

4.2%

$0.18

$0.17

$0.06

10.1%

34

30.2%

38

Montana

none

$0.28

$1.70

$0.14

9.7%

41

29.8%

39

Nebraska

5.5%

$0.24

$0.64

$0.31

11.9%

9

31.8%

22

Nevada

6.5%

$0.33

$0.80

$0.16

10.1%

36

35.2%

4

New Hampshire

none*

$0.20

$1.08

$0.30

8.0%

49

30.8%

29

New Jersey

7.0%

$0.15

$2.58

$0.12

11.6%

10

35.6%

3

New Mexico

5.0%

$0.18

$0.91

$0.41

9.8%

40

28.8%

45

New York

4.0%

$0.41

$1.50

$0.11

13.8%

3

37.1%

2

N. Carolina

4.3%

$0.30

$0.35

$0.53

11.0%

19

31.3%

24

N. Dakota

5.0%

$0.23

$0.44

$0.16

9.9%

39

30.2%

37

Ohio

5.5%*

$0.28

$1.25

$0.18

12.4%

5

32.4%

18

Oklahoma

4.5%

$0.17

$1.03

$0.40

9.0%

45

27.8%

50

Oregon

none

$0.25

$1.18

$0.08

10.0%

37

30.7%

31

Pennsylvania

6.0%

$0.32

$1.35

$0.08

10.8%

24

31.9%

20

Rhode Island

7.0%

$0.31

$2.46

$0.10

12.7%

4

35.1%

6

S. Carolina

6.0%

$0.17

$0.07

$0.77

10.7%

26

30.3%

35

S. Dakota

4.0%

$0.24

$1.53

$0.27

9.0%

44

29.3%

43

Tennessee

7.0%

$0.21

$0.62

$0.14

8.5%

48

28.8%

46

Texas

6.25%*

$0.20

$1.41

$0.19

9.3%

43

29.8%

41

Utah

4.7%

$0.25

$0.70

$0.41

10.7%

27

30.3%

36

Vermont

6.0%

$0.20

$1.79

$0.27

14.1%

1

35.1%

5

Virginia

5.0%

$0.20

$0.30

$0.26

10.2%

33

32.9%

17

Washington

6.5%*

$0.36

$2.03

$0.26

11.1%

16

34.0%

9

West Virginia

6.0%

$0.32

$0.55

$0.18

10.9%

21

29.8%

40

Wisconsin

5.0%

$0.33

$1.77

$0.06

12.3%

7

33.3%

13

Wyoming

4.0%

$0.14

$0.60

$0.02

9.5%

42

32.1%

19

*State collects a gross-receipts tax that is applied before the retail level.



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