| by Paul Craig Roberts
(
November 14, 2012, Washington DC, Sri Lanka Guardian) In the article below, Dr.
Dotson provides more information about Obamacare. The program is not what its
supporters or its critics imagine. In my opinion, with Republicans blocking a
single-payer national health system, the Obama White House went to the
insurance lobby and said, “give us a health care bill that you can get Congress
to pass.” The result is a complex system of taxes, penalties, and government
subsidized private health insurance policies with a layer of profits added to
the costs of new levels of bureaucracy.
Nomi Prins reports that the claim is
laughable that Obamacare will lower costs by creating competitive insurance
premiums, because of consolidations and mergers of insurance companies in
preparation for the “insurance exchanges.” Wall Street is already making money
off the mergers. What Obamacare really does is to allow concentration and
control of health care by large corporations that will sacrifice health care to
private profits.
http://nomiprins.squarespace.com/thoughts/2012/11/10/real-danger-of-obamacare-insurance-company-takeover-of-healt.html
Dr. Dotson believes that Obamacare will
result in Medicare being blended into some type of corporatist insurance
product bringing higher costs and fewer benefits to patients. It will be a
“health system” that funnels federal revenues into insurance company profits
instead of into health care.
The unexpected consequences of Obamacare
are likely to require endless amendments to the legislation. The complexity
will result in mistakes by doctors and hospitals that will be prosecuted as
crimes. Health care for patients and adequate payment to health care providers
will become back burner concerns.
Once Obamacare is up and running, the
private and bureaucratic interests that benefit from the monstrosity will
protect it regardless of its failure. It would have been so much better, so
much cheaper, and so much simpler to have created a single-payer national
health service like every other developed country. Instead, “superpower
americans” are to be deprived of good and inexpensive health care for the sole
sake of corporate profits.
Obamacare – The Tax Man Cometh ~ Robert
S. Dotson, M.D.
“I think you should send us the biggest
transport plane you have, and take this thing to the Arctic or somewhere and
drop it where it will never thaw.”
- Lieutenant Dave in the Sci-Fi Classic,
“The Blob”
With the confusion accompanying the
passage of the Patient Protection and Affordable Care Act (PPACA, aka
Obamacare) and its on-going implementation, it has not been easy to discern its
real meaning for those covered by it. Presidential and Vice-Presidential
candidates alike have kicked the disinformation machines into high gear. In
what follows I will try to identify some of its ramifications.
The Congressional Budget Office (CBO)
and Joint Committee on Taxation (JCT) have continued to periodically release estimates
of the costs of PPACA. Their most recent cost estimates for current provisions
in the legislation (July 2012) indicate that the insurance coverage provisions
of Obamacare will have a net cost of $1.168 trillion from 2012-2022. Government
projections usually underestimate costs. We were told that the war in Iraq
would be essentially self-financing and that the banks only needed a few
hundred billion to protect them from collapse. Many thousands of billions of
dollars have been shoveled at both to date and the end is not in sight.
The CBO says that the new health care
law raises taxes by more than $1 trillion. The individual mandate (which the
CBO refers to as a “penalty tax”) will produce $55 billion in “penalty payments
for uninsured individuals”. The “additional hospital insurance tax” is the
largest tax increase in Obamacare and is projected to bring in $318 billion in
new revenues. Supposedly, this tax mainly hits “high-income taxpayers”
(individuals making over $125,000/year and households over $250,000/year).
Other money comes from: “associated effects of coverage provisions on tax
revenues” ($216 billion); “reinsurance and risk adjustment collections” ($184
billion); fees on certain manufacturers and insurers ($165 billion); “penalty
payments by employers” ($106 billion); “other revenue provisions” ($87
billion); and, an excise tax (40%!) on high-premium insurance plans ($111
billion).
Americans are holding on to the fairy
tale that someone else will be paying these taxes – those rich pharmaceutical
and insurance companies, for instance. In fact, all costs will be passed along
to consumers/patients in the form of higher premiums and higher costs for drugs
and medical devices. According to the Cato Institute, the top 1% of income
earners can expect tax hikes of up to $52,000/year, but the bottom 99% will
also feel the pain – and lack the discretionary income to absorb the taxes.
There are at least twenty new taxes
included in PPACA. Seven of them will directly impact the people whose taxes
Obama promised not to raise: those making less than $250,000 per household.
Below is a summary of the new taxes on the middle class:
1. The Individual Mandate Tax – In 2014
this penalty will hit all Americans who are not covered by a private health
insurance policy, Medicaid, Medicare, of other public insurance program. The
penalty requires a couple to pay the higher of a base tax of $1,360/year, or
2.5% of adjusted growth income (AGI). In 2016 the cost of not being part of
Obamacare is $695 for individuals and $2,085 for families.
2. The Medicine Cabinet Tax – This tax
(begun in 2011) prohibits reimbursement of expenses for over-the-counter (OTC)
medicines, with the exception of insulin, from an employee’s Health Saving
Account (HSA), Flexible Spending Account (FSA), or Health Reimbursement Account
(HRA). This impacts the shrinking middle class hard, since they earn enough to
actually pay federal taxes, but not enough to make this a negligible
restriction. This is also another backdoor attempt to block access to
alternative medicines (vitamins and nutritional supplements).
3. The FSA Cap – This tax scheduled to
begin in 2013 is potentially one of the most harmful to middle class people, as
it imposes a cap of $2,500/year (it’s now unlimited) on the amount of pre-tax
dollars that can be deposited in these accounts. Why so harmful? It is because
funds in these accounts can be used for special needs education for special
needs children. Tuition rates for such special education can readily exceed
$14,000/year and the use of pre-tax dollars has helped many families over the
years.
4. The Medical Itemized Deduction Hurdle
– Presently, one must have medical itemized deductions of greater than 7.5% to
deduct them on federal income taxes. Obamacare raises the bar to 10% of AGI
beginning in 2013.
5. The HSA Withdrawal Tax – This tax
increases the additional tax on early non-medical withdrawals from these types
of accounts from 10% to 20% in 2013.
6. The Indoor Tanning Services Tax –
Begun in 2010, this provision added a 10% excise tax on people using tanning
salons. Some may consider this minor, but it is another attempt by the Ruling
Elite to control the behavior of the peasants and, I believe, to put a road
block to accessing beneficial light therapy for many people. Space does not
permit exploring this much further here, but suffice it to say that there are
many potential health benefits from the use of tanning beds when properly used.
A variety of conditions, from depression (Seasonal Affective Disorder or SAD)
and related mood disorders to psoriasis, are improved by the judicious use of
tanning type beds. I can hear my Dermatology colleagues groaning now, but the
over-reaction to increases in skin cancers by banning tanning beds and
slathering often-toxic sunscreen on everyone has led to an even worse epidemic
of Vitamin D deficiency, in my opinion. The latter problem, of course, can be
directly linked to explosions in the numbers of Type II diabetics, cancers of
many types, and respiratory infections (such as, influenza).
7. The Excise Tax on Comprehensive
Health Insurance Plans or the “Cadillac” Health Insurance Plan Tax – So-called
Cadillac plans are generally fully paid for by employers. This tax, delayed
until 2018 to protect Obama’s union supporters, will impose a 40% excise tax on
the recipients when fully enacted.
There are at least 13 other significant
taxes imposed on all businesses, employers, and “high income” individuals
(>$125,000/year) and families (>$250,000/year) within PPACA. A summary of
these other taxes and the history behind Obamneycare can be found at Wikipedia:
http://en.wikipedia.org/wiki/Patient_Protection_and_Affordable_Care_Act It is
worth taking time to review this entry, so that one can understand how invasive
and costly this legislation really is.
For “low income” individuals and
families, subsidies for insurance obtained from “insurance exchanges” will be
provided for those between 100% and 400% of the Federal Poverty Level (FPL).
For example, the 2016 FPL is projected to be $11,800/year for an individual and
$24,000/year for a family of four. DHHS and CBO estimate that the average
annual premium cost for a family of four without PPACA would be $11,328/year.
With PPACA in place as presently enacted, the same family at 200% of FPL would
be paying $2,778/year out of pocket and at 400% of FPL, $8,379/year. In
participating states, Medicaid eligibility will be expanded to all individuals
and families earning up to 133% of the FPL. The Wikipedia entry referenced
above contains several tables that explain this in more detail.
The Internal Revenue Service will be the
implementer and enforcer of PPACA (up to 16,000 new agents). The Act will be
partially paid for by taking $716 billion from Medicare and Medicaid; AARP
claims that the money is taken from doctors and hospitals, but the lower
payments to health care providers will reduce the services that Medicare
patients receive.
The Congressional Budget Office reports
that costs will rise for all Americans; and, more than 30 million will remain
uninsured when Obamneycare is fully implemented. The CBO further predicts that
the average family’s insurance premiums will rise at least $2500/year, in spite
of candidate Obama’s repeated promises that they would go down that same
amount. Be of good cheer, however, as all illegal immigrants will be exempt
from the health insurance mandate and, yet, will remain eligible for emergency
services under the 1986 Emergency Medical Treatment and Active Labor Act
(EMTALA).
As a kid (and, I confess, as an adult) I
always loved the 1950’s science fiction thrillers. One of the classics from
that era is “The Blob” (1958). Though silly in many ways, it remains
metaphorically appropriate today. Starring a young Steve McQueen, the story
revolves around an extraterrestrial bit of alien protoplasm that arrives on
Earth via a meteorite. This goo proceeds to engulf every living thing that
comes in contact with it until it fills the town’s cinema and engulfs the local
diner. In this thriller, the Blob is finally defeated by freezing it with CO2
bottles and the U.S Air force airlifts the blob to the arctic. Problem solved –
at least, until global warming kicks in.
In reflecting on Obamneycare over the
past few months, I have been unable to discover any such easy solution for
eliminating PPACA.
