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This week, many Americans will participate in the time-honored tradition of filing their personal income taxes, due April 17th this year since the 15th falls on a Sunday, and the 16th is Emancipation Day, a holiday observed in DC.
It’s not pleasant for many: paying federal and state income taxes is a bit like regular doctor and dental visits—you really have no choice but it’s not something you get excited to do.
This year, the federal government will take in about $2.4 trillion and spend about $3.6 trillion—the fourth year in a row of the deficit exceeding $1 trillion. And spending for health care programs—Medicare, Medicaid, Children’s Health Insurance Program (CHIP), military health, federal employee coverage—will be almost one-fourth of the government’s outlays and a third of all government revenues from taxes paid by individuals and companies.
Health care is the biggest single category in government spending. And its growth will continue as 10,000 Baby Boomers become Medicare eligible each day, and the cost of medical technology (medical inflation index) exceeds the average consumer price index by more than a third each year.
Most Americans do not view the health system’s performance favorably: in our consumer surveys since 2008, the majority rate it B- or worse, and only those in Medicare and military health programs give it higher scores. It is viewed as wasteful and inefficient; high tech, low touch. And it’s expensive, consuming 19 percent of discretionary spending in the average household… and that’s before taxes.
I do not know where all the tax dollars go. I know defense expenditures at more than $800 billion keep us safe, but I have no concept of whether that’s too much or too little. The same can be said of health care: I know it’s a big number getting bigger every day, but I can’t say for sure that it’s the right number. Countries that spend 30 percent less get comparable outcomes, even better in some instances. But in each of these, aging and economic downturns are pressing their leaders to improve the efficiency and effectiveness of their health systems.
So as I and others pay our taxes this week, I suspect we’ll not pause to reflect on the direct relationship between those taxes and the health system we enjoy. After all, it serves many who don’t pay those taxes, and it funds 70 percent of the research and development for drugs and devices that benefit taxpayers in other countries of the world.
We all pay for the health system, but some dramatically more than others, especially individuals and companies that pay federal and state income taxes. What comes to the public coffers goes out to everyone—bridges, roads, police and fire protection, schools, and health care.
I hope this week as taxes are paid, a few pundits observe that the health system, though imperfect and dramatically needing transformation, is increasingly dependent on taxpayers in addition to those with private insurance to keep it afloat. And taxpayers have a right to know their dollars in health care are appropriately invested and used wisely by the government.
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