Funding Medicare For All with Tax Reform

An unprecedented lobbying effort led up to the failure to repeal and replace the Affordable Care Act. Insurance companies and Big Pharma spent heavily to protect their interests.

As reported in “Modern Healthcare,” 04/21/17, government lobbying disclosures revealed the five largest publicly traded insurance companies spent over $6 million total on lobbyists in first quarter 2017.  To be clear, this effort was not to find a way to protect the public interest. Among other provisions to the Affordable Care Act, insurers sought to eliminate the annual tax on health insurance companies that funds ACA subsidies for low-income enrollees.  

The insurance industry’s lobbying wave in the first quarter was dwarfed by the tsunami of the pharmaceutical industry.  According to “Kaiser Health News,” 04/21/17, 38 drug manufacturers and trade organizations spent $51 million in first quarter 2017, a 25% increase over first quarter 2016.  Big Pharma used 600 lobbyists in all. At stake are lower prices and increased competition.

America’s dependence on private insurance companies results in a large unproductive expense. While the administrative cost of Medicare is only 3%, private insurance companies have administrative expenses of 30%. Eliminating that unrewarding difference would go a long way towards covering more of the population at less cost. With fully 16% of the economy involved in healthcare, some regulation will be needed to curb abusive pricing practices and to put the breaks on runaway costs. Insurance companies and pharmaceutical manufacturers will spend heavily to sway Congress otherwise.

There are, of course, other crushing expenses of healthcare: preposterously high malpractice policy premiums that protect doctors and hospitals against unlimited “pain and suffering” judgments; the drag on hospitals created by ER’s which are open to the uninsured.

Citizens must pressure Congress to act for the common good. More funding will surely be needed, and the public needs to decide whether it is willing to pay for all the benefits wanted. Ultimately, it comes down to how — and how much — we would pay for healthcare. The public must make it possible for politicians to do the right thing.

As we have already experienced with the ACA, young people tend to postpone insurance expense, betting on their youthful vigor. And, many ultra-wealthy taxpayers would surely forego a contribution and tax deduction rather than support illegal aliens.

The secure approach would employ tax reform in a plan that would curtail lobbying for loopholes while it funded basic insurance for the nation — Medicare For All (MFA). Medicare works (3% administrative expense), and it is well liked. The Gallup Organization polled insured Americans for satisfaction with their health insurance, and the winner is Medicare (75%), well above employer paid insurance (66%).

The country could move to MFA and leave private insurers to compete for supplemental policies, much as they do now. According to Pew Research (01/13/17), 60% say the federal government should ensure healthcare for all Americans.

Paying for MFA could be accomplished with a dedicated sales tax replacing the Corporate Income Tax. The public would understand exactly what it is paying for healthcare, noting the percentage tax on all consumed goods and services. If this percent reaches a ceiling of acceptance, the public will come to understand the need to curtail covered expenses.

The ideal form of the sales tax would be a value added tax, since it would be applied equally to imported goods as to domestic production and would eliminate a competitive disadvantage for American companies and workers. (VAT would also be subtracted from exports making US goods more competitive abroad. VAT’s are already in use by every US trading partner, so this would be a reciprocal tax policy. VAT differs from a retail sales tax in that it is collected at each stage of production; the percentage and tax is the same.)

Implementing a VAT sales tax across the board without exceptions would assure the broadest base and the lowest needed percentage. Any one exception would produce a clamor from lobbyists for various clients’ desired tax loopholes, ergo no exceptions means no lobbying for loopholes and “draining the swamp”.

The VAT sales tax would collect from the illicit drug trade and from illegal aliens, too; those individuals would pay substantial taxes as they consume goods and services. Unlike the income tax, the VAT will affect them equally. The consumption tax would apply to hundreds of billions of dollars of transactions per year and would reduce the percentage tax for the rest of us.

The consumption tax burden for the lowest incomes would be relieved through the Earned Income Tax Credit, and funded by a more progressive tax code that affects the uppermost income segments. Note, it is consumers who (indirectly) pay the current corporate income tax when their purchases make corporations profitable. Also, when considering the burden of the corporate consumption tax, it is important to remember it would replace the cost of basic health insurance premiums.

The concept of a border-adjustable tax had been a keystone of the Republican tax reform plan (see the Trump campaign’s economic white paper written by Secretary of Commerce Wilbur Ross and economist Peter Navarro), but it was recently dropped from consideration due to lobbying pressure from the retail industry and importers. It would be smart for Democrats to seize the concept as their own (much as Gov. Jerry Brown did in 1992 when he ran for president). The idea of a VAT replacing other taxes has more recently been endorsed by President Clinton to level the playing field for American workers.

This healthcare solution is what we could have…if we could only break the stranglehold of corporate lobbyists on the Congress.


Trump Wants to Exempt US from Mexico’s VAT? The Real Antidote Is a VAT of Our Own.

For the first time in seven presidential election cycles, Value Added Tax has entered the arena of a presidential campaign.  Not since Gov. Jerry Brown focused his 1992 presidential campaign on sweeping tax reform including a VAT had a would-be president boldly suggested a VAT.  In this cycle, both Sen. Ted Cruz and Sen. Rand Paul brought forward tax plans with value-added consumption taxes.

During the first debate with Hillary Clinton, Donald Trump pointed to the trade advantage of Mexico’s 16% VAT, which is subtracted from exports.  Mr. Trump suggested he would negotiate an exemption for the US from Mexico’s VAT.

A more realistic solution to the existing price wedge of the VAT between the US and Mexico — and over 160 countries using VAT’s — would be for the US to adopt a VAT of its own in replacement for other taxes, i.e., the Corporate Income Tax (CIT).

Why does every US trading partner employ a VAT?  Because it eliminates the cost of government represented by the tax from the price/value relationship of goods crossing borders.  VAT is added to imports (to match the domestic VAT percentage), and subtracted from exports to permit the importing country to add its own VAT without doubling up on the exporting country’s tax.  That is, VAT is a border-adjustable, destination based tax perfectly suited to this era of globalization.

The usual argument made against the US using a VAT is that it would be used to raise tax revenues to fuel social programs and put the country on a path to socialism.  Opponents allude to the high percentage of tax revenues raised by VAT’s in France and Scandinavian countries.  But, there is nothing that prevents a VAT from being used as a revenue-neutral replacement for other taxes, or for that matter, within an overall revenue cut.  Fear of VAT extends mostly from the notion of using VAT as an “add-on” tax base which it need not be.

Nor is there any justification to assume that the revenues raised by a US VAT would increase as a matter of course.  Among the major US trading partners within the 35 OECD members, the percentage VAT revenue to GDP did not explode over the fifteen years from 2000 to 2014 (the last year reported):

VAT Revenue  % GDP 2000 2111 2014   VAT % Total Tax Revenue 2000 2011 2014
France 7.4 7.0 6.9     16.7 19.7 15.4
Italy 6.5 6.2 6.0     15.4 14.4 13.8
Germany 6.9 7.3 7.0     18.4 19.4 19.3
Japan 2.4 2.7 3.7     14.4 14.4 13.8
Spain 6.1 5.3 6.0     16.6 12.6 16.6
United Kingdom 6.6 7.4 6.9     18.1 20.5 21.2
Canada 3.2 4.1 4.1     9.2 13.3 13.1
Mexico 3.1 3.7 3.9     18.7 19.0 n/a

Source: OECD Consumption Tax Trends, 2014

The meaningful trend among our trading partners is to increase revenues from the consumption tax while reducing CIT revenues.  Japan, for example, raised its VAT rate from 5% in 2013 to 8%, and has planned to raise it to 10% in 2017.  Concurrently, however, Japan reduced the CIT rate from 39.5% to 32.11% in 2013 and will drop its rate further to 29.74% in its 2016 fiscal year.

If the US were to replace the CIT by a VAT, it would put the US on a more competitive footing by eliminating a trade disadvantage.  This change would be positive for economic growth.  With zero corporate income tax, profits parked abroad by multi-national corporations would flow to the US.  The incentive for inversions would disappear along with the corrupting process of lobbying for loopholes.  Trump’s economic advisor, Peter Navarro, has a handle on the VAT concept.  For a full explanation of the impact on US trade, VATinfo has posted a 9-minute video with an explanation and support of VAT from Bill Clinton.

Marco Rubio Attacks Ted Cruz on Tax Reform

Sen. Rubio’s attack on Sen. Cruz has taken an unfortunate turn. Sen. Rubio has called Sen. Cruz’s tax reform plan “sneaky” and a “liberal scheme” supported by President Obama and Nancy Pelosi. That’s laughable on the face, but may sadly prove effective.

Opponents of VAT fear that its simplicity would encourage more taxation and spending, but they focus on the VAT being an “add-on” tax and not a replacement for other taxes. As Larry Summers said, “Liberals think VAT is regressive and conservatives think it’s a money machine. We’ll get a VAT when they reverse their positions.” With proposals from Sen. Cruz and Sen. Paul replacing the Corporate Income Tax by a VAT, perhaps this is a sign that the time has come.

The VAT itself is not a tool to deliver more expensive social programs.  VAT should be seen for what it is…an efficient mechanism for raising revenue and partially leveling the playing field in trade.  How we use the funds raised and how much revenue we should raise are separate issues, and should be debated separately.

The U.S. is at a major competitive disadvantage without a VAT of its own. All our trading partners utilize a VAT, as do over 160 countries today.  Far from a “European-style” tax, VAT is the world class tax system for international trade.

Our trading partners tack on significant VAT percentages to our goods and services as they cross their borders, a de facto tariff. For example, China adds 17% VAT to their imports from the U.S. and Germany adds 19%, just below the European average. Were the U.S. to replace the CIT by a VAT, it would remove this competitive disadvantage; U.S. exports would be cheaper and our imports..which arrive with the exporting country’s VAT subtracted..would face the same taxes as domestically produced goods and services.

Eliminating the CIT would end the incentive for multi-national corporations to park profits in lower-taxed countries. Forget inversion mergers. With zero CIT, the U.S. would become the lowest income tax country and capital would flow back to our shores. Foreign multi-national companies, too, would seek to move profits retained elsewhere to the U.S. Gone would be the double-taxation of dividends; stock market values should soar.

VAT remains a hot potato. To date, no Democrat for the presidency since Jerry Brown in 1992 has dared to raise the issue of a consumption tax.  Hillary Clinton will probably not mention VAT, even though President Clinton has previously endorsed the concept of VAT replacing other taxes.

Value-Added Taxation in Canada: GST, HST, and QST (5th edition), Ryan global tax services, publ. by Wolters Kluwer, 12/2015

Value-Added Taxation in Canada is an in-depth analysis of the Goods and Services Tax (GST), its harmonized counterpart (HST) currently applicable in Nova Scotia, New Brunswick, Newfoundland and Labrador, Ontario, and Prince Edward Island, and the Quebec Sales Tax (QST). The book combines discussion on the theoretical and practical questions posed by Canada’s value-added taxes, with an emphasis on the implications for private and public sector taxpayers. The authors have integrated commentary on the impact of all three taxes (GST, HST, and QST) in each topical area. These taxes are referenced extensively throughout the book, providing insight into the legislation and administrative policy at both the federal and provincial level.

This fifth edition of this essential reference has been updated to reflect applicable legislation, regulations, government policies, and proposed amendments as of September 2015.

TPP – Competitive Disadvantage(s)

You might think Congress would look back at our prior “free” trade deals – pitting U.S. workers against lower wage countries – and have a more jaundiced view of the Trans-Pacific Partnership.  The most outspoken MOC critic of our trade deals is retired Sen. Fritz Hollings of South Carolina.  Hollings saw the industries in his state decimated and warned about the threat to higher paid manufacturing jobs by the trend to globalization.  Free Trade policy, he said, was just American corporations seeking a lower-cost labor supply.  (See, for example, Hollings on “Economists and Free Trade.”)  Sen. Hollings’ Op/Ed’s repeatedly cited the additional competitive disadvantage for the U.S. without a Value Added Tax, a handicap which compounds our labor cost disadvantage.  Let’s look at what the VAT tax disadvantage means for TPP.

According to the Congressional Research Service, in 2012 total U.S. exports to TPP countries amounted to $650 billion.  Total imports from TPP countries amounted to $800 billion.  Of that import total, 40% was from Canada, which operates with an average 13% GST (value added tax).  The VAT - being border adjustable - is subtracted from exports, which means the $316.5 billion in goods imported from Canada would cost $41 billion dollars more within Canada.

This is not a Canadian subsidy.  Rather, GATT rules (General Agreement on Tariffs and Trade of the World Trade Commission) respect the subtraction of VAT from exports to eliminate the burden of the cost of government from the price/value relationship of goods shipping to another country.  The importing country would add its own VAT (cost of government).  Therefore, the imported goods would be on an equal footing with goods produced in the importing country since the VAT is charged on domestic production.

All even, except in the case of the U.S., which does not employ its own VAT.  Imports to the U.S. from TPP countries arrive with a competitive price advantage to the exporting country…13% in the case of Canada.

The second largest TPP exporter to the U.S. is Mexico, which accounts for one-third of U.S. imports from TPP countries.  Mexico’s VAT is 16%, so these goods arrive 16% cheaper than they would be in Mexico itself.  The third largest TPP exporter to the U.S. is Japan, accounting for 16% of U.S. TPP imports; Japan’s VAT is 8%.  The VAT in the other TPP countries: Australia, 10%; Chile, 19%; Malaysia, 6%; New Zealand, 15%; Peru, 18%; Singapore, 7%; Vietnam, 10%.  Only Brunei and the U.S. do not use a VAT.

Because the U.S. does not employ a VAT, government costs are not subtracted from exports.  (GATT rules do not permit the subtraction of corporate income taxes.)  When U.S. exports arrive at a TPP country, that country’s VAT is levied on the total price of U.S. goods..including the implicit CIT.  That is a competitive disadvantage for U.S. exports.  All our trading partners utilize a VAT, as do over 150 countries today.  China’s VAT is 17% and Germany’s is 19%, just under the European average.  Were the U.S. to turn to a revenue-neutral VAT to replace the Corporate Income Tax and Social Security Insurance, the VAT would be in the range of 10%.

The U.S. Congress – in deference to our multi-national corporations – has expressed knee-jerk opposition to VAT.  There has been no outspoken support for VAT even with our presumed goal to retain and increase high-paying domestic manufacturing jobs.  The VAT itself is not a tool to deliver more expensive social programs, an expressed fear of many in Congress.  VAT should be seen for what it is…an efficient mechanism for raising revenue and partially leveling the playing field in trade.  How we use the funds raised and how much revenue we should raise are separate issues, and should be debated separately.

The debate over TPP should beg the question whether the U.S. should employ a VAT to replace other taxes and remove a competitive disadvantage in trade.

Would a VAT replacement of the CIT add a greater burden to consumers?  Taking the view that the consumer pays the CIT, a revenue neutral replacement of the CIT by a VAT should make no difference on balance.  However, there would be a shift of burden from smaller companies to multi-national corporations that are more dependent upon imports.

It is notable that economists are split on where the burden of the CIT falls.  Some argue that it is workers who suffer the burden because the amount of taxes paid could otherwise be used for increased wages.  Likewise some argue that the burden falls on the shareholders.  Others posit that..when a company prices its goods..a margin is added and an implicit tax obligation will inure; since the margin exists within the price of goods, it is the consumer that absorbs the burden of the CIT.

As to the argument that a VAT consumption tax would be regressive..this could readily be nullified via adjustments to the threshold and progressivity of the income tax and via the Earned Income Tax Credit for those at the bottom.

We are entering into the height of the presidential primary season, ripe for conceptual debates about tax policy.  But, so far, among the Republican candidates we see only talk of lowering taxes, and little to none on the impact of tax policy on trade.  Only one presidential candidate has offered a VAT (Rand Paul), and, while he perhaps wisely named it a BAT (business activity tax), no debate question covered Paul’s concept of replacing the CIT with his BAT consumption tax.  To date, no Democrat has raised the issue of a consumption tax.  Hillary Clinton will probably not mention VAT, even though President Clinton has previously endorsed the concept of VAT replacing other taxes.

VAT remains a hot potato.  Even though its clear advantage for trade should mean economic growth and domestic jobs.  There is tacit support among union leaders (Richard Trumka, AFL-CIO; Andy Stern, SEIU).  The elimination of double-taxation of dividends would be good for stock valuations (and Wall Street).  But, until there is a national political leader who champions this sweeping tax reform and rallies the public behind it, VAT is destined to remain unmentionable.

Sen. Rand Paul’s Plan…A Good Start for Tax Reform

Tax policy is a hot potato and controversial.  It can propel a presidential candidate into the headlines, but it can also make the candidate an easy target for opponents and pundits alike. Sen. Paul’s bold proposal is a fine beginning and merits productive discussion.  Hopefully it will not be dismissed by knee-jerk opposition.

The way we tax ourselves should be separated from the purposes to which we apply the revenue we need.  Ideally, on the personal income tax side this plan would have eliminated - purely - all deductions.  Sen. Paul, in sensible head off congressional opposition..has incorporated deductions for mortgages and charitable contributions.  The mortgage deduction will placate the real estate lobby, but it will also create the precedent for other industries to lobby for their gain.  The proverbial camel’s nose under the tent.

Critics are circling over the potential shortfall in total revenues.  Once revenue needs are clearly defined, if more revenue is needed the plan can be fixed by increasing the 14.5% rate in the Business Activity Tax, a value-added tax, and by adding one or two tax brackets on the personal income tax side.  The addition of another personal tax bracket or two will change the definition from a “flat” tax with a single percentage for both business and personal taxes, but would provide the necessary flexibility to ensure progressive distribution of the tax burden.  The tax base will be clean.

Importantly, Paul’s Business Activity Tax will finally harmonize the U.S. tax system with all of our trading partners; over 165 countries now use the border-adjustable VAT to our current competitive disadvantage in world trade.  With Paul’s BAT, the cost of government paid by the BAT will be subtracted from U.S. exports and added to imports, neutralizing that government burden in the price/value comparison of goods and services crossing borders. 

Bottom Line: Sen. Paul’s plan is an excellent beginning.  Let’s not let the pundits and political opponents kill it this time.  Let’s fix it.