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THREAD: What does the House tax bill mean for America's health?
1/ This is really long but I've read what we know so far and have 4 major points, plus some "smaller" findings that are also really bad.
2/ First major point: the tax cuts will gut Medicaid and Medicare
3/ It is estimated that there will be $1.5-2 TRILLION cut from Medicaid and Medicare over the next decade.
4/ This will likely will mean a mix of A) some individuals losing ALL coverage, and B) a LOT of individuals becoming 'underinsured.'
5/ 'Underinsured' means you still have health insurance in name, but at the end of the day you end up not getting necessary care because ...
6/ with less funding, coverage with either pay for less, charge you more, or add frustrating layers of bureaucracy for you and/or doctors.
7/ For simplicity's sake, let's pretend it's all or nothing loss of coverage:
8/ $1.5-2T in Medicaid/Medicare cuts will take away hundreds of millions of years of health coverage.
9/ Taking away coverage kills. The House tax bill, taking away that much coverage, will kill *hundreds of thousands* of people.
10/ Millions more will lose necessary care, miss their critical window of prevention and cure, and live with the consequences.
11/ Preventable strokes. Cancers found too late. Totally unnecessary tragedies affecting ourselves, our families, and our communities.
12/ They will all be made more tragic, because the medicine and the moment existed, but were taken away by greed and apathy.
13/ Though the magnitude is shocking, the millions missing care and 100,000s dead will each be real, individual people, not just numbers...
14/ Second major point: "Tax cuts + spending cuts -> deficits" is a cycle instrumental for further cuts to health programs down the road.
15/ This bill doesn't cut in a way that balances anything, where we arrive at some sustainable budgetary equilibrium.
16/ And that's the point. Having giant deficits is a major goal for the GOP, despite their prior rhetoric.
17/ You might ask, "Why would the anti-deficit GOP want deficits?!?!" ... because of the long game.
18/ If policies now cause deficits later, future deficits can be used to justify MORE program cuts. Constructed justification for austerity.
19/ So if you believe in public research investment, this deficit strategy should scare you.
20/ If you believe in the FDA making sure drugs are safe/proven, this deficit strategy should scare you.
21/ If you believe in the CDC detecting and addressing epidemics, this deficit strategy should scare you.
22/ If you believe in gov role in education, env protection, fighting poverty ... solving problems, this deficit strategy should scare you.
23/ Third major point: This will worsen economic inequality, which will worsen health inequality and overall health.
24/ First, what will this bill do to economic inequality?
25/ Directly: Corporate tax cuts, wealthy tax cuts, little on balance for the rest. Indirectly: Don't believe the GOP.
26/ LIE: "Corporate tax cuts help everyone!" cbpp.org/research/feder…
27/ LIE: "This bill adds little to the deficit!" crfb.org/papers/five-gi…
28/ So for sure, corporate tax cuts + tax cuts for wealthiest + public spending cuts = worsened economic inequality
29/ (and we are already facing a large, increasing degree of economic inequality)
30/ So beyond the direct health program impacts, will the tax legislation's economic inequality affect health?
31/ Yes. Health justice and economic justice are deeply entwined.
32/ FACT: Economic inequality is worsen health outcomes. ahrq.gov/professionals/…
33/ We need tax legislation that remedies economic inequality, not worsens it...
34/ Final major point. "Tax legislation" is brackets, rates, exemptions. It's abstract, math-y. It evokes yawning, not rage and action.
35/ But this obfuscation is the perfect cloak for massive health and wealth theft.
36/ We must push past the cloak of stats, indirectness, and boredom. Help others realize this will horribly hurt America's health.
37/ Please make a month-long personal commitment to join those who oppose this bill, call your legislators regularly, and fight fight fight.
38/ This is just the current House bill. Activism now can change it and the upcoming Senate bill (their goal is passage before end of year).
39/ This is a bill for CEOs, Wall Street, heirs and heiresses. As a doctor I want a tax bill that helps my patients. This is not it.
40/ Ok, you stayed this long. Here are some final miscellaneous points, each of which is a big deal, too.
41/ The bill attempts to get in law that life begins at conception politico.com/story/2017/11/…
42/ This might bankrupt some states, which would have subsequent effects on Medicaid and other state health programs beyond what I mentioned
43/ Medical expenses deduction will be taken away ...
44/ ... Currently if your medical expenses are more than 10% of income, they can be deducted ...
45/ ... so those with low incomes and any medical expenses (seniors and poor will now have to pay more for care...
46/ ... those with ANY income and a medical catastrophe like cancer, trauma, a stroke (anybody) will now have to pay more for care.
47/ Student loan deduction will be taken away, further driving clinicians away from purpose- and impact-driven work, toward debt repayment.
48/ Orphan drug tax credit will be taken away, further dis-incentivizing finding new treatments for rare diseases.
49/ Repeals tax credit for small business to provide accessibility for the disabled. @TopherSpiro
50/ Other looming awful idea: repeal of the ACA mandate (which would destroy health insurance exchanges)
51/ Keep following this legislation and its health effects. I recommend @TopherSpiro @ASlavitt @crulge @benwikler @awgaffney @voxdotcom
Thank you @RepJerryNadler for points (when we spoke at tax protest 10/28) on deficit now, more cuts later.
