The hike idea of a “nonprofit” is dumb and ripe with abuse. Nonprofits still have to pay payroll, the phone bill etc. Why have someone deciding that they don’t have to pay taxes? They can certainly just show a loss for year after year.
The idea is that we want more of what nonprofits do. No taxes is an incentive. A nonprofit that turns a profit is presumably putting it to work eventually, such as adding a new wing. It's not as if they can do stock buybacks because there isn't any. There are many ways this structure is abused but the idea isn't absurd.
Hospitals that make profits should pay taxes
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Re: Hospitals that make profits should pay taxes
#72Re: Hospitals that make profits should pay taxes
#73Earlier quoted context omitted.
Why? To give terrible service and managed by bureaucrats? Or being a leech of the state medical system?
How are the current for-profit hospitals not the same in addition to being hilariously unaffordable?
Re: Hospitals that make profits should pay taxes
#74Earlier quoted context omitted.
Random things like cancer and genetic diseases happen, but an awful lot of disease is caused by personal choice. Drinking, smoking, unhealthy lifestyle, etc. Personal behaviors are the cause of a huge portion of our healthcare costs. I feel the same way about the recent auto insurance increases being caused by the shopping behaviors of others. Expensive EVs get completely totaled in accidents, and now everyone has to…
It’s really amusing when tech people who have a full understanding of singletons and basic statistics always refer to themselves when making a broader statement about society. I always wonder why people seemingly can’t apply their experiences beyond themselves when they already do that day to day at work. A lot of “personal decisions” are consequences of society. Depending on where you are in society, you’re going to…
I grew up lower middle class, and I didn't have it easy. I have no idea who my birth parents were. I had an abusive father. I was bullied and beaten relentlessly by the other children that didn't like on-the-spectrum kids. I didn't party like those that abused me, I withdrew into myself and turned that into hard work.
So when I see people [1] wanting me to pay for their choices, I feel used. When I see people demanding way more than I take for myself. It's as if the people that caused my problems are now trying to ride on my back.
Does that help lend perspective for how some people feel about calls to increase taxes to pay for this?
This doesn't mean that I'm unkind, uncaring, or unsympathetic. I just don't think US healthcare or how it is utilized is efficient, and I don't think armchair posturing or giving money to bureaucrats, administrators, or anyone without skin in the game will make it better.
edit: I removed the analogy and replaced it with a personal anecdote.
[1] The comments and downvotes here are probably from wealthy / well-off people on HN
Re: Hospitals that make profits should pay taxes
#75And virtually every other non-profit org should also pay taxes, including churches. This is not just a federal income tax thing. The variety of local property tax abatements for supposed community benefit organizations is incredible.
There's a huge golf course in my neighbourhood that doesn't pay property taxes, but they can't build on the land. If they had to pay property taxes, the land would probably be parceled and built upon. I don't like it that rich people don't have to pay taxes on their little game, but I think the neighbourhood is better off with this green area.
Re: Hospitals that make profits should pay taxes
#76Earlier quoted context omitted.
They can just create their own medical equipment supplier and funnel money that way. Bottom line is that when you let privat businesses decide they will always choose profit over people.
Where is the funnel? The for profit supplier pays taxes, and the expenses are deductible.
Re: Hospitals that make profits should pay taxes
#77A non-profit simply means that there are no investors who can profit from the business. However, I think we haven't really thought enough about how much community benefit they need to offer to justify being tax exempt - and it's a hard problem.
For example, let's say I run a non-profit hospital. We start getting a lot more revenue than costs. At a for-profit company, that's profits, but we don't have any investors. I decide "No, we shouldn't lower prices or forgive medical debt. I want to use that excess money to create a fancy new medical building with my name on it and to create a medical research unit that will bring prestige to the hospital (and hopefully useful medical research that will help people in the future)." Right now, that's an allowable non-profit use of that money. Universities do things like this all the time: a fancy new student center takes precedence over lower tuition.
How do we deal with this? It's hard. New buildings aren't simply unjustified costs. My city wants to build a new elementary school because the current one is crumbling. A hospital or university will likewise need to invest in its facilities, but at some point it potentially crosses a threshold from necessary and useful spending toward vanity and serving the institution more than it serves the mission. Universities spend money on research-only professors who don't teach and things like that drive up tuition costs, but is that a reasonable expense for a university? It can depend on who you ask because different people will have different opinions on the purpose of a university.
It's also hard because a successful non-profit will want to reinvest in itself and keep enough excess on hand in case something bad happens. Let's say I'm running a hospital and our costs are $1B in 2022 and we took in $1.2B. I use the excess $200M to rebate some of the fees to patients and forgive some medical debt. In 2023, our costs are again $1B and we took in $0.9B. Now I'm in a tough position. Do I lay off staff? Pay cuts? Take out a loan for $0.1B? What if 2024 is also a lean year?
Likewise, let's say that I'm trying to run a patient-friendly facility. We take people without insurance and don't make them worry about the cost. Even if I'm able to successfully run my facility, other non-profit facilities that aren't as friendly are taking in more money. They start to pay their doctors better. Their facilities are newer and better kept. Nurses complain that I'm being stingy with their contract. The other hospitals are publishing fancy papers and their doctors are giving conference talks that attract donors away from my hospital.
I think there's a survivorship thing happening here. If you have too little runway, you don't survive lean times. You run out of money and one of the less friendly hospitals "buys" your hospital (which often isn't a cash purpose since they're non-profits, but some sort of promise of keeping the mission of being a hospital alive).
Should the government bail out non-profits who are serving the community better? Maybe, but it's hard to define that. The fancy non-profit hospitals will argue that they're serving the community even better. The rich and connected probably see the fancy hospitals as better and are likely their donors. The general public probably doesn't understand that one hospital might be more forgiving than another. So the general political consensus will likely be "why should the taxpayer bail out a place that's 'poorly run' when the 'well run and better' hospital is willing to bail them out with no cost to the taxpayer?"
So, in order to keep my hospital, I can't run it too friendly. Plus, for my ego, I'd rather people think well of my hospital. I'd like to brag about the fancy new facility and have people think I'm doing something amazing. We give a lot more esteem to the president of Harvard than to the president of a school that's educating and helping way more people, but isn't as fancy.
Re: Hospitals that make profits should pay taxes
#78They should be a well funded public service that don't make a profit in the first place.
> well funded public service There is. The US spends more per capita on socialized medicine than any of the countries that actually have socialized medicine.[0] [0] https://data.oecd.org/healthres/health-spending.htm A P.S. for the "but the wait times!" crowd, look at the first chart then check out hospital beds, again per capita[1] [1] https://data.oecd.org/healtheqt/hospital-beds.htm
Re: Hospitals that make profits should pay taxes
#79so should religions that make profits pay taxes, something tells me neither will happen