Nevertheless, Congress loves these nonproductive redistributions of tax burden among taxpayers. Tax preferences – properly called “tax expenditures” by economists – are the vehicles for these dubious favors. It is easy to see why Congress loves tax preferences:
Suppose the Pentagon wanted to buy a new fighter plane. But instead of writing a $10 billion check to the manufacturer, the government just issued a $10 billion “weapons supply tax credit.” The plane would still get made. The company would get its money through the tax credit. And politicians would get to brag that they had cut taxes and reduced the size of government!
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The virtue of the Milliman Index is that it includes out-of-pocket spending by families. The current debate on health reform typically focuses only on whether insurance premiums rise or fall, as if that were the proper metric for judging the affordability of health care. It is not. Total spending matters more.
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Given the often clinically and morally compelling nature of health care as a commodity, one can think of a nation’s health system as just another tax system, operating side by side with the government’s tax system.