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Commentary: Force is the Left Hand of Entitlement

Jane Orient, MD, for HealthLeaders Media, May 12, 2011

Politicians love to boast of the benefits they shower on favored constituents with their right hand. But as with the amazing feats performed by magicians, the unwary audience is watching the wrong hand.

It may seem that in government the right hand often doesn't know what the left is doing. However, it is surely obvious that the goodies in the right hand did not materialize out of thin air. They had to be taken from somewhere.

Usually that somewhere is taxes. Even doctors know that. For example, while bemoaning the coming cuts in their pay from Medicaid, some doctors ventured to say out loud, at a medical society meeting, that there is an answer to the problem: we just need to raise taxes.

The very same left-leaning doctors had just finished agreeing that many Medicaid patients come to the doctor only because they are lonely or bored. They add that this is all right with them because they get paid even though the visit was unnecessary.

With healthcare reform ("ObamaCare") there are some frank tax increases. But even the Democrats in the 2008 Congress probably wouldn't have passed a recognizable tax increase large enough to fund the enormously expensive bill. Instead, they gave us an insurance mandate. They insisted this wasn't a tax, although the Obama Administration insists that it is a tax after all—if that's what it takes to get a court to find it constitutional.

In 2014, assuming this law survives, we'll have a clever sleight of hand that casts the redistributionist, now-you-see-it-now-you-don't tax/nontax, as a subsidy.

If you, by their criteria, can't afford the high premiums on the comprehensive policy that is required, you get a subsidy to buy it—a negative tax. Otherwise, you have to pay the full cost yourself. So, is the absence of a subsidy a tax, or the functional equivalent of a tax? Aren't subsidies and taxes mirror images, like left and right hands?

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