Saturday, May 12, 2007

Health Benefits, Equality, and the 2008 Presidential Election

Every campaign year many campaigns use accessible, affordable, and equitable health care as a campaign promise. If we can or are to make health coverage equitable and obtainable for everyone, the question is how? I am of the school of thought that this should be done without us dragging our efficient and advanced free market health care system to the depths of Canadian health care or as Pete Ashdown once erroneously said the efficient model of VA hospitals. (Do we really want Walter Reed Medical Center's infamous building 18 to become a norm of American Health Care?)

However, health care coverage in this country is no where near accessible, affordable, and equitable for all Americans. For instance small employers health coverage is extremely unaffordable due the way group plans are written -- the smaller the group the bigger the per employee premium is. In many cases it is worse than that, employers who can't afford the extremely expensive small group plans leave their employees purchasing health care as individuals. Here is where the income tax code currently falls short of providing the desired equity we Americans so desperately seek. From a taxation standpoint, if you are covered by an fairly large employer-sponsored plan you receive pretty solid benefits, otherwise you may are hosed one way or another. Here is a breakdown of Health care and taxation:

Employees Covered by Employer

-- No income tax on premiums paid from wages
-- No FICA and Medicare tax on premiums from wages
-- No State income tax on premiums from wages
-- Employees of a large employer receive coverage at very little cost
-- Employees of a small employer pay significantly larger premiums.

Self-Employed Coverage

-- Premiums are deducted from Adjusted Gross Income (AGI)
-- Nearly the same effect as employee's covered by an employer.

Employees who have to cover themselves

-- Premiums are not deducted from AGI
-- Taxes are paid for FICA and Medicare on wages used to pay premiums
-- Premiums can be deducted as a severely limited itemized deduction (A floor of 7.5% of AGI in most cases taxpayers do not have enough medical expenses to deduct)

In this regard President Bush's recent health care tax proposal in the 2007 State of the Union address, would be a step in the right direction. The proposal plans use the Internal Revenue Code to allow those taxpayers who self-fund their own health insurance would pay no FICA, Medicare, or Income tax on the wages used to purchase health insurance. The change would also require those who benefit from larger-employer plans to recognize some income on some of the premiums covered by their better large-employers health plans. The proposal would level the playing field between those who have large-employer health care coverage and those who have pricey small-group or self coverage. This is one of the most innovative ideas I have heard regarding health care. Due to the fact that the rabid anti-war movement has the Bush administration on the ropes regarding Iraq, a meaningful and innovative domestic policy change like this has little chance of passage.

I do hope to hear more innovative ideas like this from the current field of presidential candidates on both sides of the isle.

(P.S. I wrote an similarly titled earlier post that was inspired by a year-old OneUtah post, which I erroneously and unbelievably thought was current. I guess that's what happens when you live in a cave for the 1st four months out of the year.)

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