A Healthy Blog

Massachusetts health care — wonky, with a healthy dose of reality

Progressive Financing -- Reader Comments

Progressive Financing -- Reader Comments

May 7, 2005

Had a response to an earlier posting from Bart Laws of the Latin American Health Institute who has his own blog, Healthy Medicine (click here):

"We need to think not only about out-of-pocket costs for low income people and families, but also about how subsidies for the system are financed. Progressive financing is absolutely essential if any plan to expand coverage -- and preferably, provide universal coverage -- is to represent real social progress. That is a major problem with employer mandate strategies. Most of the cost will come out of wages, in the real world, and cutting low-income workers wage income in order to provide them with health care is just going to mean that they can see a doctor after their bad housing, bad diet, emotional stress and bad community conditions have made them sick. From a public health standpoint, we always need to remember that 90% of medical care is a last resort."

No doubt figuring out how to pay has been the major impediment to all coverage expansions, incremental or universal. And no argument that progressive financing is the fairest and most ethical way. Question: What should we do when progressive financing options are blocked? For example, the fairest income tax is graduated -- higher income folks pay a higher rate than lower income folks. Yet five times between 1962 and 1994, Massachusetts voters rejected Constitutional Amendment proposals to eliminate our flat tax in favor of a grad tax, never giving it more than 28 percent of the vote. Do we stop pushing for funded-health access reform until the public changes its fickle mind on progressive taxation? Food for thought. And thanks, Bart.