Posted by larsiusprime 2 hours ago
The exact implementation might be flawed, but if 340b is eliminated it will kill many hospitals in underserved communities.
So any plan to change 340B should really also explain how to find these critical hospitals.
In the way that surgeries used to be the "money maker" to subsidize other expensive service lines like an ED, pharmacy has filled that gap in recent years.
It is less hospitals getting rich off overcharging insurance for drugs and more hospitals overcharging insurers for drugs since everything else they do is a drain on finances.
The issue is that, most of the time, "incredibly dense cities" are not the places where this is hitting the hardest. It's the smaller towns where the impact of hospital rollups hits hardest on the property tax rolls.
Problem is, of course, that if we don't get one of the hospitals in, say, Houston, to put a facility in, say, Nacogdoches, on its books; then that facility may go away entirely. In which case you'd have issues in the market with inequity of access for the very populations who may need that access most. (Elderly and poor.) But if you do allow it, well, you have issues with property tax rises.
So local leaders are put in a position of having to weigh the value of having a hospital or clinic be available locally, against any potential decrease in property tax revenues. Now you hope they get that cost-benefit analysis correct, but there's no guarantee.
But churches? Yeah. Not so much.
I agree, the whole ruse that these 501s meaningfully does charitable work for our communities is laughable and their tax exemption should be revoked, at least with regard to land taxes.
https://drive.google.com/file/d/1wzGqzWHDQA4m8DIo174yqx-eYDk...
Universities and hospitals are some of the worst offenders in situations like this, especially in urban cores, likely empowered by their clear transformation into state-sanctioned "non-profit" businesses that provide a good we are compelled to consume if we are a normie who wants a reasonable guarantee of a comfortable, healthy economic existence.
I've consulted with two large health systems that begin with A and they use 340B to subsidize all sorts of treatment.
Unfortunately American healthcare naturally seeks to socialize treatment, but instead of it being direct its in the most round about ways.
Call it what it is, a perpetual rent.
There's nothing funnier than a lot of people taking some absurd principles for granted when they make no sense at all, property taxes being one of them. So imagine you grind at least 30 years of your life working extra hours or two jobs to pay for an already inflated asset based on speculated prices rather than the actual cost, only to end up with that asset in a perpetual rent agreement where if you stopped paying it you basically don't own it anymore, a rent that also isn't controlled, so you can get screwed in the future like how a lot of people ended up selling their house because their retirement isn't enough to cover such rent.
Make it make sense, the only real winners here are the banks after they collect all that compound interest throughout all these years, and the government taking all these taxes.
There is some opposite momentum toward the land value tax, which is a good thing, but these are less visible and likely weaker than a tax revolt by landowners.
Eventually, if the current trend continue for property taxes, we will see a disruption in government funding for basic service, and the contraction of the economy through increased taxation of economic activity to compensate for lost revenue from property taxes. It will be a disaster.
This is the endgame of the expansion of land ownership in the post WW2 era. Exemption from property taxes worsen this crisis.
You're breaking my heart here. A land value tax is embraced by anti-tax advocates like Milton Friedman as the "least bad tax" as well as by actual Marxists. However, it does seem like in the current moment a land-owner tax revolt is the likeliest end game.
And if there is a big push towards eliminating property tax, those states will rush towards California-like real estate disasters.
I just wish that all the people who had a hard time purchasing a home or paying rent would act on their own self-interest in reducing the share of our economy that flows to the rentierism of the land owner. Rentierism is bad in all economies, yet we have enabled an overclass to exploit young people and the poor. We live in an asset economy, where there's a big class divide between those who must work to survive, and those who own real estate (especially if it's their own home) and those who own financial assets like stocks. Making capitalism work better requires more class mobility and less inequality than we currently have.
Maybe the government can be fixed, or even "must" be fixed for the sake of the poors that we always pretend we're thinking about (no doubt some are, but most are just using them as a prop for political persuasion), but in the meanwhile contingency plans must be made.
Government provides crucial services that increases land value, offsetting any losses in tax revenue through public utility. Perhaps the same thing can happen with historical buildings.
However, let us note that cities are for living in. It is not a museum.
Ultimately, only the public can determine the balance of concerns to be struck.
https://www.google.com/maps/@37.8567746,-122.2550107,3a,60y,...