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Property taxes going up? The 340B Program might be partly responsible

pricepoints.health

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Re: Property taxes going up? The 340B Program might be partly responsible

#41

Post by ars »

stephen_cagle wrote: post #17

Really seems to me that there should be no exemption for land tax for non profits or religious reasons. It is just far too subject to abuse, and it means that we have large churches in the middle of incredibly dense cities that pay almost nothing in taxes.

The idea is that we give up the land tax revenues in exchange for the services the non-profit provides. (And of course the government does not decide which services are useful or not, the people do.)

One thing I might agree with is land tax for non-profits that charge fees for services, as opposed to those who work off of donations. I think that would fix the issue without destroying non-profits.

Re: Property taxes going up? The 340B Program might be partly responsible

#42

Post by dfsnow »

shigawire wrote: post #26

I'll not dispute the impact on expansion and consolidation, but I will say in recent months I have seen a number of hit pieces on the 340B program, mostly bankrolled by pharma companies (not this one just calling out the trend). The exact implementation might be flawed, but if 340b is eliminated it will kill many hospitals in underserved communities. So any plan to change 340B should really also explain how to fund t…

Hi, I wrote this article and largely agree with you. 340B is important and without it many hospitals likely wouldn't survive. However, it's pretty evident at this point that 340B has expanded beyond its original intent.

For example, Northwestern University (in the middle of downtown Chicago) got itself reclassified as a rural hospital in order to participate in the program.

Moreover, it's grown extremely rapidly over the past ~5 years, and the gravity of the program is starting to create bizarre second-order effects like the one outlined.

My intent with this article is just to highlight some of those effects, not to advocate for eliminating 340B.

Also, not bankrolled by pharma, just a researcher for Turquoise Health (a healthtech startup). I get to dig around in their data and publish occasionally, but editorial control / opinions are my own.

Re: Property taxes going up? The 340B Program might be partly responsible

#43

Post by concinds »

tamimio wrote: post #34

>property taxes Call it what it is, a perpetual rent. There's nothing funnier than a lot of people taking some absurd principles for granted when they make no sense at all, property taxes being one of them. So imagine you grind at least 30 years of your life working extra hours or two jobs to pay for an already inflated asset based on speculated prices rather than the actual cost, only to end up with that asset in a…

Where's the money for local services supposed to come from?

Why should you be allowed to monopolize a piece of finite and scarce resource, land, for free?

Since you think it's a scam, surely you support 100% capital gains taxes on homes? Since old people getting rich off of an unproductive asset, blocking supply to "preserve neighborhood character", and inflating the price of their artificially-scarce goods would be more of a scam?

There's nothing wrong with retirees being forced to sell and downsize. You don't need a family-sized home when you live alone. Property tax is the least unfair tax of them all.

Re: Property taxes going up? The 340B Program might be partly responsible

#44

Post by xnx »

ars wrote: post #37
xnx wrote: post #19

Earlier quoted context omitted.

Yes. And then after many years, the appreciated land is sold for a profit.

A profit for who? It's a non-profit. If the sale netted extra money it goes back to the people who donated, or to another non-profit.

Non profits pay salaries.

Re: Property taxes going up? The 340B Program might be partly responsible

#45

Post by shigawire »

dfsnow wrote: post #42
shigawire wrote: post #26

I'll not dispute the impact on expansion and consolidation, but I will say in recent months I have seen a number of hit pieces on the 340B program, mostly bankrolled by pharma companies (not this one just calling out the trend). The exact implementation might be flawed, but if 340b is eliminated it will kill many hospitals in underserved communities. So any plan to change 340B should really also explain how to fund t…

Hi, I wrote this article and largely agree with you. 340B is important and without it many hospitals likely wouldn't survive. However, it's pretty evident at this point that 340B has expanded beyond its original intent. For example, Northwestern University (in the middle of downtown Chicago) got itself reclassified as a rural hospital in order to participate in the program. Moreover, it's grown extremely rapidly over…

Thanks for the response, I'll update my post to be clear I was not calling this post an astroturfing attempt.

Re: Property taxes going up? The 340B Program might be partly responsible

#46

Post by dfsnow »

shigawire wrote: post #45
dfsnow wrote: post #42

Earlier quoted context omitted.

Hi, I wrote this article and largely agree with you. 340B is important and without it many hospitals likely wouldn't survive. However, it's pretty evident at this point that 340B has expanded beyond its original intent. For example, Northwestern University (in the middle of downtown Chicago) got itself reclassified as a rural hospital in order to participate in the program. Moreover, it's grown extremely rapidly over…

Thanks for the response, I'll update my post to be clear I was not calling this post an astroturfing attempt.

Thanks! Good to see other health policy wonks on HN

Re: Property taxes going up? The 340B Program might be partly responsible

#47

Post by epistasis »

mothballed wrote: post #38
epistasis wrote: post #18

Earlier quoted context omitted.

> There is some opposite momentum toward the land value tax, which is a good thing, but these are less visible and likely weaker than a tax revolt by landowners. You're breaking my heart here. A land value tax is embraced by anti-tax advocates like Milton Friedman as the "least bad tax" as well as by actual Marxists. However, it does seem like in the current moment a land-owner tax revolt is the likeliest end game. A…

I'm more convinced that the LVT is the least invasive than it being the least bad in economic action, although I can somewhat understand the argument for it. If you eliminated all the other taxes and only used LVT then a large part of the financial surveillance apparatus wouldn't have a leg to stand on. The part about bean counting every bit of income, profit, and gain and then being made to report it to the governme…

> creates some issues with efficiently allocating land resources, especially bad with the fact that it can wipe out land speculators which perform an important role in doing time-allocation of land

Interesting, I have always thought the opposite. My undertsanding/reasoning: It's extremely difficult to find land for good purposes because speculators maintain land banks, preventing better uses of it. The speculator causes a ton of market friction, and the tendency for people to hold onto land because of limited supply are a fundamental hindrance to so much economic activity.

If there's a high carrying cost to land, a lot more of it will be on the market and available for people to use when they need it. Especially as land values rise, which is the most important time to reallocate land. Rising land values are exactly the time that the land speculator holds tightest, because they want to sell at the peak, not on the way up.

Re: Property taxes going up? The 340B Program might be partly responsible

#48

Post by concinds »

mothballed wrote: post #7
etrautmann wrote: post #4

Earlier quoted context omitted.

You seem clearly aware that this is relevant to a small subset of the population.

Taxes going up for shittier and shittier return is unfortunately something we are seeing across the US. Regardless of ideological viewpoint, the relative advantages of just buying the services you need on your own rather than playing into a broken system will appeal to larger and larger subsets. I was in the majority "subset" until I was tired of being squeezed dry by a system that always squandered my tax money. May…

It'll get worse. The US has lived above its means for a while, and it would need a big tax increase to only maintain the current level of service, no fancy extras.

Re: Property taxes going up? The 340B Program might be partly responsible

#49

Post by tamimio »

concinds wrote: post #43
tamimio wrote: post #34

>property taxes Call it what it is, a perpetual rent. There's nothing funnier than a lot of people taking some absurd principles for granted when they make no sense at all, property taxes being one of them. So imagine you grind at least 30 years of your life working extra hours or two jobs to pay for an already inflated asset based on speculated prices rather than the actual cost, only to end up with that asset in a…

Where's the money for local services supposed to come from? Why should you be allowed to monopolize a piece of finite and scarce resource, land, for free? Since you think it's a scam, surely you support 100% capital gains taxes on homes? Since old people getting rich off of an unproductive asset, blocking supply to "preserve neighborhood character", and inflating the price of their artificially-scarce goods would be…

The government already takes enough taxes. I am sure they can figure it out. In fact, you are already double taxed: once on income tax (which was temporary and only paid on corporate profits, not yours, but that's another story) and then taxed again on what was already taxed through GST, sales tax, VAT, you name it.

>finite

You think land is finite? You do realize you can fit the entire human race - both the ~8 billion people currently alive and the estimated ~100 to 117 billion people who have ever lived- inside the Grand Canyon? We have enough land that every single person could have an entire farm of their own, not to mention the "land isn't enough" argument makes no sense in a country with giant parking lots, and no exceptions are made for people living in apartment blocks.

The solution is simple for what you mentioned at the end: make houses a depreciated asset, not an investment. Investment by concept must always go up, scale, and grow, making it inevitably unsustainable. Japan did it and fixed the entire housing issue for the next generations to come. I am sure we are smart enough to do the same. Housing and land are made to live in, not to invest in, and keeping them empty to gauge prices up.

Re: Property taxes going up? The 340B Program might be partly responsible

#50

Post by kiba »

mothballed wrote: post #38
epistasis wrote: post #18

Earlier quoted context omitted.

> There is some opposite momentum toward the land value tax, which is a good thing, but these are less visible and likely weaker than a tax revolt by landowners. You're breaking my heart here. A land value tax is embraced by anti-tax advocates like Milton Friedman as the "least bad tax" as well as by actual Marxists. However, it does seem like in the current moment a land-owner tax revolt is the likeliest end game. A…

I'm more convinced that the LVT is the least invasive than it being the least bad in economic action, although I can somewhat understand the argument for it. If you eliminated all the other taxes and only used LVT then a large part of the financial surveillance apparatus wouldn't have a leg to stand on. The part about bean counting every bit of income, profit, and gain and then being made to report it to the governme…

It is the only tax without deadweight loss. Speculators are detrimental in this case because they make land more expensive without increasing supply and are loathe to make efficient use of the land.
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