FIGURE
I remember the first time I heard a nurse politician claim that patient care was more influenced at the policy table than the exam table. As an NP for a mere 5 years, I was astounded. Surely how I interact with my patients, the diagnoses I might miss, and the treatments I recommend play the most important role in the health of patients. This Washington politician insisted that this was not the case.
Over the subsequent years, I became embroiled in state politics and the Board of Nursing (to help open practice barriers). These experiences widened my appreciation of the speaker's views. Today, as I watch the current tax cut crusaders in Washington, I am convinced that health care providers must understand how today's political actions will impact their practice.
Taxes and Spending
Think of our government as a gigantic insurance company with subsidiary interests in military defense. Just seven programs make up about 75% of all federal spending: Social Security, Medicare, Medicaid, military pensions, civil service pensions, defense, and interest on our national debt. All other federal spending falls in the other 25 percent including NASA, homeland security, student loans, and the National Institutes of Health. America doesn't collect enough in taxes to cover all the programs that we want. Recent large tax cuts have caused a fundamental mismatch between what Americans want their federal government to spend, and the revenues the government collects. This mismatch is causing a crisis at the state level, and will soon have profound consequences at the national level.
Politicians who favor tax cuts want citizens to believe that Americans pay too much in taxes. The truth is that Americans pay fewer taxes than in almost every other industrialized country. Most taxpayers haven't seen much change in their overall tax rate in 30 years, and wealthy Americans have experienced a sharp drop in tax rates.
Effect on Health Care
Why do so many people support tax cuts? Some people who favor tax cuts accept the supply-side economists' claims that cutting marginal rates leads to such a large increase in the gross domestic product that everyone benefits. However, a hard analysis of President Reagan's economy convinces me that the Reagan tax cuts didn't produce any visible supply-side gains, but instead led to huge budget deficits that were corrected when President Clinton raised the marginal rate on high-income taxpayers.
Other tax cut supporters favor current huge deficits because they know this will force program cuts, which they want. Instead of honestly describing the consequences of huge deficits, the current administration implies that raising taxes is unpatriotic. This message comes even as our nation incurs massive war expenses. Many wealthy campaign contributors who support high-income tax cuts are not likely to ever depend on Medicare, Social Security, or Medicaid. Many of these supporters anticipate a 40% cut in these programs.
Our budget crisis will have a profound effect on all health care providers. Imagine a nation where Social Security, Medicare, and Medicaid are cut by 40%. Imagine seeing an elderly patient in your exam room and knowing that this patient can follow your recommendations because he has money, while millions of other elderly persons cannot afford to pay for visits, tests, or treatments. Imagine being a care provider in a class-based society where upper-middle and upper class children, adults, and elderly receive boutique care while millions lack access to a comparable level of health care. Given the current voter tax cut frenzy, a class-based society could become reality in the near future.
I'd say all health care providers ought to get involved in national politics as a way to help our patients. What do you think?