Trade the Rich Their Taxes for Healthcare

Given the amount of control the wealthy have over the state and federal governments, this might be the best market-driven solution to healthcare. The basic outline is that the rich will pay less in taxes (limited to the portion paying for health-related services) as healthcare costs decrease and coverage levels increase. Since they care enough about taxes to make the Republican Party try to pass these bloodthirsty bills (AHCA and BCRA), we should let the rich take control over their own tax destiny.

Now, it’s a little more complicated than described, because there are more rich people in blue states that already make a bigger effort to increase coverage and decrease costs than many red states do. So the mechanism can’t be “if you live in a state that does better, you pay less tax.” That would also not work due to venue shopping, where the rich would just establish residency in states where they would pay less federal tax (some may already do this, if they can deduct state tax from federal and federal from state; but that depends on whether they can control which state their income comes from).

But the basic outline is there. And it could very well be bipartisan if the lever moves both ways. That is, if failure to diminish costs and increase coverage means they pay more tax, the Democrats might be able to deal with a bit of deregulation and help pass it.

Other sticking points would be that there would have to be a fairly rigid definition of coverage (something the Republicans seek to undo with their evil pair of bills), and there would have to be other broad strokes about existing conditions and bans on lifetime and annual maxima. But if the rich hate paying tax that much, they should be drooling at the chance.

Given we pay much more per capita and we don’t even have universal coverage, there should be a lot of cost savings available that the rich can tap to reduce their tax burden. They can buy all the hospitals and streamline them. They can focus on prevention and interventions for patients with high-cost conditions. They can buy the pharmaceutical companies and slash back the price hikes we’ve seen in recent years. Invest heavily in automation.

But one way or another, this country needs affordable care for everybody. If the rich want to get lower taxes in the bargain, I suggest that Congress lets them pull all of us up by their bootstraps.