141–150 of 212 posts
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Where is the funnel? The for profit supplier pays taxes, and the expenses are deductible.
They can charge whatever they want, sort of like they already do for medicine.
This strikes at an issue we haven't really addressed enough in non-profits: how much community benefit do they need to offer? A 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 hospita…
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All corporations have this incentive. It's how the tax system is designed to operate.
This is silly and false. Corporations that inflate management expenses will generate less profit for shareholders. I don't think any shareholders would like that idea.
Trimming workforce costs and padding the executive and administrative pay is an old and successful playbook.
It’s also a short-term playbook and has become a national security issue.
I’d love to see retro-active clawbacks for the CEOs and their teams that have dumped the problem on the current generation.
Isn’t the distinction that non-profit hospitals have to plow surplus’s revenue back into the hospital versus distributing profit to investors / owners? If so, the tax exempt status seems aligned with how for profit businesses are taxed?
A guy a worked with once did some time as an IT contractor at one of the large hospitals here in town (they are almost all now owned by the same organization) and he was telling me how this works in practice. Since they have to spend all of them the money on "improvements" it ends up on things like the wall-sized $40k television his team of 5 put in a room in a conference room in a basement that no one ever uses.
Departments spending all their budget in the last month of the financial year, thereby justify the following year’s budget has been a thing forever.
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But. They can be paid as salaries. :)
Yes but the salaries have to be reasonable. You can’t setup a charitable organization and then pay yourself $10 million a year to run it. And the people getting paid are usually separate from the people in charge. Most of the time board members of non-profits are either unpaid or are paid a small token amount. When they are paid, it’s not going to be a meaningful chunk of the profits.
"The top three hospital administrators there made nearly $20 million in salaries."
Isn’t the distinction that non-profit hospitals have to plow surplus’s revenue back into the hospital versus distributing profit to investors / owners? If so, the tax exempt status seems aligned with how for profit businesses are taxed?
This strikes at an issue we haven't really addressed enough in non-profits: how much community benefit do they need to offer? A 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 hospita…
It doesn't really seem that hard. If somebody wants to build a new building to do medical research, and the medical research benefits the public, what does it harm if they also put their name on it?
If anything it's a well-aligned incentive. They'd want the thing with their name on it to be associated with public goods like curing diseases and not disreputable things like waste and corruption.
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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.
A lot of ideas aren't absurd until they meet reality. The arguments that defend an idea don't really matter in the long run, if we can later see that the outcomes they provide aren't good. I look at one of our local private universities: A non profit with a huge endowment. Their prices keep going up, and then discount enough to make sure the student's price is as heavy as they could possibly bear. They put that money…
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... I had it tough, therefore others should too? What if those others had it tougher than you? have you apologized to them for having it so much easier? Or, hear me out, maybe the goal should be for tomorrow to be better than today, or yesterday, and that definitionally means a lot of stuff gets easier. Complaining as you're doing here is the same as saying "this cancer treatment should be banned because I lost famil…
My original post suggests that costs should be attributed to risks. If you take an outsized portion of health care relative to the rest of society, there's a chance that may be linked to behavioral choice. If you smoke a pack every day, eat two McGriddles every morning, film parkour stunts for your YouTube channel, go to the STD clinic monthly, are an alcoholic, etc. Society should not be paying for this in the same…
And we can see that because you're complaining about, for example, parkour stunts, but not the much more common sports that cause significant injuries.
I get that it's a common desire to say "this person does not deserve to live because I don't like their choices", but like so many other things it turns out that the cost of trying to do this is always more significant than just not assigning value to people's lives, and those policies have a tendency to capture people you don't think it should apply to. Take the various conservative anti-women laws that suddenly became a problem when they interfered with IVF for middle aged white women, despite that being a completely consistent application of the claimed rationale for the law (if an embryo is a live human, then IVF requires murder, but everyone knows an embryo is not a person, the goal of these laws, much like your desire to restrict access to healthcare, is about punishing people for perceived slights).
I might have thought you could also see how the costs associated with many illnesses might contribute to the proportionally higher tax rates on things like alcohol and tobacco in countries with public health services.
But there's more to it than that, you're arguing against a Public Health Service as though your claimed concern about unreasonable costs from bad life choices does not apply to private healthcare+insurance, but that's simply not true. Your insurance premiums are priced to cover the YouTube stunters, the alcoholics, the people playing sports, the people driving, etc just like a Public Health Service. The only difference is that your insurance companies and hospitals are making a profit as well so definitionally cost more as applied to the total economy (a statistic that has been repeatedly shown is that the US spends more on healthcare than countries with PHS, but has lower coverage and worse outcomes). Because the metric for success in a public health service is treatment, the system is optimized to treat the most people. For private health care the metric is income, which means hospitals charge more, and optimize their billing to maximize the amount that can extract from insurance companies (that's why your anesthesia for a surgery is inexplicably billed as a separate procedure), and insurance companies optimize to deny or delay coverage as much as possible.
This strikes at an issue we haven't really addressed enough in non-profits: how much community benefit do they need to offer? A 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 hospita…