This fall, I plan to start writing an article called Taxing Tiering: From Binary to Subtlety in the Regulation of Inequality of Access to Health Care. My basic points will be:

1) There are a number of new innovations in health care finance and delivery that both offer superior health care to those who can afford them and promise to generate innovative methods that will diffuse more generally. (My focus will be on specialty hospitals, concierge medicine, and perhaps cosmetic surgery.)

2) These innovations threaten the intricate system of cross-subsidies that have funded health care generally. For example, a specialty heart hospital siphons away well-compensated surgery away from general hospitals, which used those funds (in part) to fund things like charity care and medical education.

3) Entrenched players who benefit from the cross-subsidies (such as community hospitals, non-concierge physicians, and advocates for uninsured or poorly insured patients) are using a variety of laws and regulations to stop these innovations entirely (such as CON laws, Medicare fraud and abuse statutes, etc.).

4) A better approach would be to tax care at the new, innovative, high-end entities, and to direct that tax to care for the uninsured or poorly insured. Some states have already taken this approach; I’ll be applying to present a paper at a conference at Hamline this Spring to develop the idea generally.

There have been many comments invoking theories of taxation, efficiency, etc. I would like the chance to develop the article in dialogue with a critic who, say, believes that this sort of tax policy would not achieve its intended affect.

http://www.mirrorofjustice.com/mirrorofjustice/2006/07/growing_income_.html

some quotes:

“[G]reat disparity seems likely to make it harder for people to practice the value of solidarity, that is, ‘see[ing] the other-whether a person, people or nation-not just as some kind of instrument, . . . as our ‘neighbor,’ . . . to be made a sharer on a par with ourselves in the banquet of life to which all are equally invited by God.’” Berg, quoting Solicitudo Rei Socialis, para. 39.

I explore this idea a bit in the comments on my post on ventilators embedded in the original postt.

All I’m trying to assure is that these transactions generate some funds aimed at helping those currently left out of the system. There is nothing radical here. The radical idea is a pervasive, dogmatic skepticism about tailored taxation’s ability to help the least-well-off take a fairer share of the benefits created by a transition to a more market based approach.

Likewise, Lifesharers barter is better than the outright ban, but is substantially worse than the market. Another form of barter would be to actually donate today in exchange for a priority tomorrow; the biggest problem here is that the priority is not assignable to the third party. So, if I donate my kidney today, and my child will need one in twenty years, I can’t put him to the top of the list by handing him over my priority slip. Which means I won’t donate today. And, of course, if we allow transferable priority slips, we are de facto allowing markets. In which case we could just as well allow real markets unpolluted by bizarre distortions that the trading of priority slips would create.

This isn’t to say I wouldn’t take the transferable-priority system or tradable-cadaver-organs system over the current system. I’d take almost anything over the current system. Lifesharers is certainly a great undertaking, and we all should be grateful for it.

Just as we don’t expect the ban on doctors’ compensation to improve poor people’s access to surgeries, we can’t expect the ban on donor services to improve poor people’s access to organs. In both cases, the costs of the collapsed supply far outweigh dubious benefits of redistribution. Again, the identity of the payor is an issue completely separate from whether the market transaction should ever take place. And again, just as we can come to some sort of consensus on state subsidy to poor people’s health care, we can come to consensus on state subsidy to poor people’s cost of transplants.

Finally, your comment that Americans won’t like to pay cash to subsidize poor people’s kidney transplants, so we should devise a clandestine regulation, which would force Americans pay for the same thing a substantially larger sum in-kind, smacks of the sort of self-congratulatory cynical elitism that should be truly shameful for a person yakking about morality, spirituality, and the Pope.