Time for a Health Care Tax Revolt
Consider the following analogy. Imagine you are stranded on a remote island with a group of fellow survivors of a shipwreck. After a few weeks of lying around eating coconuts, you decide to do something. You organize a simple government. It starts democratically. Everyone shares the tasks as well as the benefits of various civic projects: a sanitation pit, a garden, a cooking fire, and so on.
At some point, the island government decides by popular vote to build a ship. Everyone is assessed taxes in the form of labor. Each individual contributes the skills he or she has to offer– cutting trees, carpentry, nautical design, or miscellaneous manual labor. The government of your island, like the government of the United States, has evolved from providing basic necessities to funding big public works.
Now imagine that the island council decrees that only those with a certain minimum amount of wealth in bank accounts back home will be allowed on board the ship when it sails for civilization. Furthermore, there will be little hope of rescue for those who remain behind.
Those left behind on the island are analogous to those Americans who work and pay taxes but cannot afford health insurance. These working poor (and those who are denied coverage because of pre-existing medical conditions) are being denied the benefits of biomedical research, even though a significant portion of their taxes is used to fund biomedical research. The National Institute of Health (NIH) is benefiting from a generous Congress– even the Republicans want to give it more money. The NIH budget has increased from just under $11 billion in 1993 to almost $16 billion in 1999. Meanwhile 44 million Americans lack health insurance. This means that about half the nation’s low-wage workers are without coverage. Just like the poor castaways on our socially stratified island, a large number of Americans are paying for something that benefits a group from which they are excluded.
The uninsured should encourage health care reform by resorting to a time-honored American tradition and starting a tax revolt, refusing to pay for biomedical research that does not benefit them. Deducting money from their income taxes, they could form a nonprofit organization that would lobby for health care reform. They could deduct from their taxes an amount that is equivalent to the percentage of the tax revenues spent by the federal government on biomedical research, and put this money in escrow. The IRS would object, but this would only give the campaign more publicity.
My own mother, who lives in northern Minnesota (a state known for its generous health benefits), is one of the potential tax rebels (despite her placid temperament). In 1980 she contracted hepatitis-c from a blood transfusion during an operation. The government did not yet screen the blood supply for the virus, and thousands of people were infected. She survived the infection, but the virus still resides in her liver. Nobody will insure her for anything less than an exorbitant premium. She is a small-business owner and contributes a fair amount of tax money to the federal government. Even though the NIH spends increasing amounts of her tax money on research projects– some of them are directly related to hepatitis-c– my mother cannot afford treatments that might help ward off a life-threatening illness. But if she stopped paying her share of the NIH pie and put that money in a high-yield money market account, she’d have a form of self-insurance when she needs it.
To state it simply, uninsured poor are dying because they can’t afford medical care. One must question the ethical principles of a wealthy society that does not care for the health of a whole class of its people. The society becomes even more unethical by forcing the uninsured class to fund the research leading to the next round of cures for the insured class.
Yes, everyone pays for things they don’t benefit from. That’s how taxes work (and in fact a major conservative complaint is that the tax system redistributes wealth). But our current system of medical insurance redistributes wealth from those who cannot afford a visit to the doctor to those who already can. This is a regressive redistribution; it goes against the American ideal of fairness.
Think about it this way. Even if I don’t drive a car, I’m forced to fund the building and maintenance of roads and highways- but at least I benefit from the distribution of goods that this infrastructure allows. The uninsured cannot choose to become insured by a simple act of will. They’re tied to their unmarketable bodies and are thus cut off from the potential benefits of biomedical research. If you have a pre-existing condition, you can be fairly sure that the insurance companies are sharing your medical records and effectively forming a cartel of non-access. Thus, taxing the uninsured to further medical research takes from their already limited ability to pursue life, liberty, and happiness.
Henry David Thoreau once went on a six-year tax revolt, in protest of the war against Mexico, which he believed to be unjust. His arrest and one-night stay in jail led to the writing of the essay “Civil Disobedience.” It may be that our war on disease in research labs at every major university is also an unjust war; not unjust because of who the victims are (germs and microbes), but because of who does not benefit– mainly children and women living in poverty who lack basic medical care. The working poor need state-subsidized insurance, not the small solace of reading about the latest genetic manipulations of sheep funded by their tax dollars. Nor will the health of the poor be improved by new treatments for the diseases of those who, because of lives lived with continual access to medical care, are fortunate enough to live so long.
Of course, forcing health insurance companies and HMOs to disregard a person’s medical history, however well-intentioned, may not always be an unmitigated good; it amounts to a redistribution of wealth from the healthy to the sick. We should therefore be forthright about our desire to care for the sick and the poor by instituting a system of subsidized health insurance for those who need it. The ship’s hull needs to be enlarged so that all the inhabitants of the republic can set sail toward good health. Then the debate over the details can begin.
