House v. Senate: Who Should We Tax for Health Care?

By Derek Thompson
I'm interested in how the Senate health care bill raises taxes to pay for health care differently from the House version. The ever-useful Howard Gleckman at TaxVox has a good breakdown:

Reid proposes $370 billion in new tax revenues over the next decade. $150 billion would come from a 40 percent excise tax on high-cost employer-sponsored insurance. Fees on makers of branded drugs and medical devices and on insurance companies would raise another $100 billion. Boosting the Medicare payroll tax by 0.5 percent on wages in excess of $200,000 ($250,000 for couples) would bring in another $55 billion. Among the cats and dogs: $15 billion from an increase in the floor on deductible medical expenses from 7.5 percent to 10 percent, and $6 billion from an excise tax on cosmetic surgery (the tummy tuck tax).

Reid picked very different revenue sources than the House. It would raise far more in taxes--about $540 billion through 2019. And 85 percent--$460 billion-- would come from a 5.4 percent surtax on incomes in excess of $500,000 ($1 million for couples).

When we see the House/Senate blend in a few weeks, we're going to get a blend of revenue raisers. I'm with Gleckman here in preferring the Senate's approach. It's not merely that Reid expands the burden of paying for reform beyond the $500K crowd, and I feel uncomfortable merely soaking the rich to pay for our reforms. It's also that his main tax is a policy. The excise tax, as I've written, is a clever way to encourage employers to switch to less expensive plans and put the savings into their workers' compensation as taxable income. As for the other taxes, I suppose the Medicare payroll tax increase for the rich is a step toward the inevitable compromise to include some kind of surtax in the final bill. Also, I like me some sin taxes, but a cosmetic surgery tax? Meh.

This article available online at:

http://www.theatlantic.com/business/archive/2009/11/house-v-senate-who-should-we-tax-for-health-care/30512/