Members' Day

Comments for the Record

Joint Select Committee on

Budget and Appropriations Process Reform

Members' Day

Wednesday, June 27, 2018, 9:00 AM

By Michael G. Bindner

Center for Fiscal Equity

Co-Chairs Womack and Lowey, thank you for the opportunity to submit these comments for the record on budget and appropriations process reform.  By now Members and Staff should be familiar with our proposals for both process and tax reform so, instead of offering them again, we will offer questions for Members testifying today. There are three:

First, how would the behavior of the Congress change if, pursuant to a Joint Budget Resolution or an amended Budget Control Act, automatic appropriations were made if Congress did not act by the start of the Fiscal Year?

Second, what fears do you have of President’s misusing the veto if automatic appropriations were passed?

Third, if you favor a FairTax or a Value Added Tax, how would this fit under a system with automatic appropriation? What about a regional consumption tax with a balance requirement?

Thank you for the opportunity to address the Joint Select Committee.  We are, of course, available for direct testimony or to answer questions by members and staff.

Prescription Drug Affordability and Innovation: Addressing Challenges in Today’s Market

As you may recall, we have in the past, written urging a combination of catastrophic insurance, health savings accounts (Archer) and medical lines of credit, which is a bit more liquid version of a flexible spending account, with all accessed by one card with costs allocated based on account balances and income levels. Poor people would have minimum or even no copays, but would always have credit access. As income rises, so would copays and available balances, as well as catastrophic deductibles.

This plan would offer little incentive for the poor to shop for cheaper drugs, however wealthier patients could be made to feel the pain of drug prices a bit more, but only if they were denied comprehensive insurance. Good Luck passing that, it may be what cost Senator McCain the White House in 2008. Additionally, the Archer accounts and lines of credit are designed to assure universal access to care and drugs with little pain. It only helps the well wo can redirect funds to asset accumulation (thus causing asset inflation, speaking of 2008).

Single Payer and negotiation by government payers, state or federal price controls or taxing away excess profits would all control prices, which are monopolistically high. Unless an economist is far out on the rightward fringe, there is no doubt about the equity of stopping monopoly prices. The only question is how.

While some favor restricting patent rights, I would argue in favor of having every drug approval disclose all government supported research used to develop the product, giving the sponsoring agency the right to both share in the profits and have a say in the pricing. This both keeps the research dollars flowing and limits cost.

The last possibility is through our proposed Net Business Receipts Tax/Subtraction Value Added Tax. It would replace corporate income taxes and proprietary and pass through taxes and treat all business income the same. It would provide for the health insurance exclusion or fund single payer insurance. Companies who hire their own doctors and pharmacists and buy their own drugs would get a tax exclusion from single payer (third party insurance would be discouraged), and would negotiate with drug makers for lower prices, although this would leave small firms at a distinct disadvantage and would discourage such practices as franchising and 1099 employment. Still, on the whole, it would decrease cost while not discouraging innovation.

Short of that, an NBRT subsidized Public Option would allow sicker, poorer and older people to enroll for lower rates, allowing some measure of exclusion to private insurers and therefore lower costs. Drug prices would als0 decrease if the Public Option is allowed to negotiate with drug companies. Of course, the profit motive will ultimately make the patient exclusion pool grow until private insurance would not be justified, leading-again to Single Payer if the race to cut customers leads to no one left in private insurance who is actually sick.

Status of the Social Security Trust Funds

Comments for the Record

United States House of Representatives

Committee on Ways and Means

Social Security Subcommittee

Hearing on Examining Social Security’s Solvency Challenge:

Status of the Social Security Trust Funds

Thursday, June 7, 2018, 11:00 AM

By Michael G. Bindner

Center for Fiscal Equity

Chairman Johnson and Ranking Member Larson, thank you for the opportunity to submit my comments on this topic. These comments are an update to those provided last July and the previous September, although truthfully not much has changed, except that the tired old meme that we are stealing from the Trust fund by loaning it to the General Fund is going around again. This is usually an indication that Wall Street wants to make a run at using it as a source of fee income again, thinking that this President will let them. I urge you to resist the urge to go along with such idiocy. Someone has to be the grownup in the debate. Of course, if any such plan is proffered before the election, the Democrats will certainly eat the GOP alive.

We will leave it to the invited witnesses to explain the difference between the future projections, except to say that both forecasts are required to be conservative.  As the Economic Policy Institute found many years ago when attempts were being made to justify personal accounts in Social Security, there is truly no solvency problem if more realistic estimates are used.  Of course, that relates to the system as a whole, not on how the Trust Fund is to be reimbursed, as we reiterate below. 

Lessons from the Great Recession

The 2008 Recession triggered by our continuing asset-based Depression has both temporary and permanent effects on the trust fund’s cash flow. The temporary effect was a decline in revenue caused by a slower economy and the temporary cut in payroll tax rates to provide stimulus that has since been repealed, although the amount was added to the Trust Fund for later withdrawal, regardless of contributions not made.

The permanent effect is the early retirement of many who had planned to work longer, but because of the recent recession and slow recovery, this cohort has decided to leave the labor force for good when their extended unemployment ran out. This cohort is the older 77ers and 99ers who needed some kind of income to survive. The combination of age discrimination and the ability to retire has led them to the decision to retire before they had planned to do so, which impacts the cash flow of the trust fund, but not the overall payout (as lower benefit levels offset the impact of the decision to retire early on their total retirement cost to the system).  In addition, it has been made easier for workers over 50 to retire on disability (as I have done), with many of us approved on the first try.

The Reagan-Pepper Compromise

When Social Security was saved in the early 1980s, payroll taxes were increased to build up a Trust Fund for the retirement of the Baby Boom generation. The building of this allowed the government to use these revenues to finance current operations, allowing the President and his allies in Congress to honor their commitment to preserving the last increment of his signature tax cut.

This trust fund is now coming due, so it is entirely appropriate to rely on increased income tax revenue to redeem them. It would be entirely inappropriate to renege on these promises by further extending the retirement age, cutting promised Medicare benefits or by enacting an across the board increase to the OASI payroll tax as a way to subsidize current spending or tax cuts.

The cash flow problem currently experienced by the trust fund is not the trust fund’s problem, but a problem for the Treasury to address, either through further borrowing – which will require continued comity on renewing the debt limit – or the preferable solution, which higher taxes for those who received the lion’s share of the benefit’s from the tax cuts of 1981, 1986, 2001, 2003 and 2010.  Many also complain that this recovery is anemic.  That is likely because too many upper-middle income taxpayers were given a permanent tax cut from 2001.  Less savings and more taxation would boost spending on both transfer payments and government purchases – especially transfers to the retired and disabled.

What most threatens the Trust fund is to do a tax cut under the guise of tax reform, especially at the upper income levels.  Upper income families were given preference in the 1980s when OASI taxes went up while the Reagan tax cuts were preserved.  That should not happen again.

The ultimate cause of the trust fund’s long term difficulties is not financial but demographic. Thus, the solution must also be demographic – both in terms of population size and income distribution. The largest demographic problem facing Social Security and the health care entitlements, Medicare and Medicaid, is the aging of the population. In the long term, the only solution for that aging is to provide a decent income for every family through more generous tax benefits.

The free market will not provide this support without such assistance, preferring instead to hire employees as cheaply as possible. Only an explicit subsidy for family size overcomes this market failure, leading to a reverse of the aging crisis.

We propose a $1000 per month refundable child tax credit payable with wages as part of our proposal for a Net Business Receipts Tax.  This will take away the disincentive to have kids a slow economy provides. Within twenty years, a larger number of children born translates into more workers, who in another decade will attain levels of productivity large enough to reverse the demographic time bomb faced by Social Security in the long term.

Such an approach is superior to proposals to enact personal savings accounts as an addition to Social Security, as such accounts implicitly rely on profits from overseas labor to fund the dividends required to fill the hole caused by the aging crisis. This approach cannot succeed, however, as newly industrialized workers always develop into consumers who demand more income, leaving less for dividends to finance American retirements. The answer must come from solving the demographic problem at home, rather than relying on development abroad.

This proposal will also reduce the need for poor families to resort to abortion services in the event of an unplanned pregnancy. Indeed, if state governments were to follow suit in increasing child tax benefits as part of coordinated tax reform, most family planning activities would be to increase, rather than prevent, pregnancy. It is my hope that this fact is not lost on the Pro-Life Community, who should score support for this plan as an essential vote in maintaining a perfect pro-life voter rating.

This is not to say that there is no room for reform in the Social Security program. As I wrote in the January 2003 issue of Labor and Corporate Governance, Congress should equalize the employer contribution based on average income rather than personal income. It should also increase or eliminate the cap on contributions. The higher the income cap is raised, the more likely it is that personal retirement accounts are necessary.

A major strength of Social Security is its income redistribution function. I suspect that much of the support for personal accounts is to subvert that function – so any proposal for such accounts must move redistribution to account accumulation by equalizing the employer contribution.

I propose directing personal account investments to employer voting stock, rather than an index funds or any fund managed by outside brokers. There are no Index Fund billionaires (except those who operate them). People become rich by owning and controlling their own companies. Additionally, keeping funds in-house is the cheapest option administratively. I suspect it is even cheaper than the Social Security system – which operates at a much lower administrative cost than any defined contribution plan in existence.

If employer voting stock is used, the Net Business Receipts Tax/Subtraction VAT would fund it. If there are no personal accounts, then the employer contribution would be VAT funded.

Safety is, of course, a concern with personal accounts. Rather than diversifying through investment, however, I propose diversifying through insurance. A portion of the employer stock purchased would be traded to an insurance fund holding shares from all such employers. Additionally, any personal retirement accounts shifted from employee payroll taxes or from payroll taxes from non-corporate employers would go to this fund.

The insurance fund will save as a safeguard against bad management. If a third of shares were held by the insurance fund than dissident employees holding 25.1% of the employee-held shares (16.7% of the total) could combine with the insurance fund held shares to fire management if the insurance fund agreed there was cause to do so. Such a fund would make sure no one loses money should their employer fail and would serve as a sword of Damocles’ to keep management in line. This is in contrast to the Cato/ PCSSS approach, which would continue the trend of management accountable to no one. The other part of my proposal that does so is representative voting by occupation on corporate boards, with either professional or union personnel providing such representation.

The suggestions made here are much less complicated than the current mix of proposals to change bend points and make OASI more of a needs based program. If the personal account provisions are adopted, there is no need to address the question of the retirement age. Workers will retire when their dividend income is adequate to meet their retirement income needs, with or even without a separate Social Security program.

No other proposal for personal retirement accounts is appropriate. Personal accounts should not be used to develop a new income stream for investment advisors and stock traders. It should certainly not result in more “trust fund socialism” with management that is accountable to no cause but short term gain. Such management often ignores the long-term interests of American workers and leaves CEOs both over-paid and unaccountable to anyone but themselves.

Progressives should not run away from proposals to enact personal accounts. If the proposals above are used as conditions for enactment, I suspect that they won’t have to. The investment sector will run away from them instead and will mobilize their constituency against them. Let us hope that by then workers become invested in the possibilities of reform.

All of the changes proposed here work more effectively if started sooner. The sooner that the income cap on contributions is increased or eliminated, the higher the stock accumulation for individuals at the higher end of the age cohort to be covered by these changes – although conceivably a firm could be allowed to opt out of FICA taxes altogether provided they made all former workers and retirees whole with the equity they would have otherwise received if they had started their careers under a reformed system. I suspect, though, that most will continue to pay contributions, with a slower phase in – especially if a slower phase in leaves current management in place.

One new wrinkle is that I would also put a floor in the employer contribution to OASI, ending the need for an EITC – the loss would be more than up by gains from an equalized employer contribution – as well as lowering the ceiling on benefits. Since there will be no cap on the employer contribution, we can put in a lower cap for the employee contribution so that benefit calculations can be lower for wealthier beneficiaries, again reducing the need for bend points.

Thank you for the opportunity to address the committee.  We are, of course, available for direct testimony or to answer questions by members and staff.

Lowering Costs and Expanding Access to Health Care through Consumer-Directed Health Plans

Comments for the Record

United States House of Representatives

Committee on Ways and Means

Health Subcommittee

Lowering Costs and Expanding Access to

Health Care through Consumer-Directed Health Plans

Wednesday, June 6, 2018, 11:00 AM

By Michael G. Bindner

Center for Fiscal Equity

Chairman Roskam and Ranking Member Levin, thank you for the opportunity to submit these comments for the record to the House Ways and Means Health Subcommittee.  They mirror our submission to the committee of  May 17, 2016.

Proposals along the lines proposed have long been a part of our standard package of health care reforms.  We have long advocated a conversion to catastrophic insurance with a medical savings account to pay for appointments and drugs, although we have always suggested a third element – a Medical Line of Credit to bridge the gap between the current MSA balance at the catastrophic deductible.  The MLC would also pay for services, including acupuncture and reproductive health that may not be covered or coverable under catastrophic insurance.  

Under our standard tax reform proposal, catastrophic policies would be purchased by all employers (and certain self-employed) as an offset to the Net Business Receipts Tax/Subtraction VAT.  The Net Business Receipts Tax (NBRT) includes tax expenditures for family support,  health care and the private delivery of governmental services. It will fund entitlement spending and replace income tax filing for most people (including people who file without paying), the corporate income tax, business tax filing through individual income taxes and the employer contribution to OASI, all payroll taxes for hospital insurance, disability insurance, unemployment insurance and survivors under age 60.

While this raises the tax rate, the lack of any tax subsidy would doom private insurance and deny most families medical care.  Likewise, the Health Savings Account would be provided by employers, but would be a deduction rather than a credit.  Medical Lines of Credit would be funded entirely by employees with no tax advantage – as under our plan most employees would not pay any income taxes.

Personal experience with cardiac care (luckily a succession of false alarms) showed that, while this approach makes economic sense, it does not jibe with how doctors operate.  There is no price schedule in the waiting or exam rooms to compare costs for proposed procedures or tests. Health care is not a normal good.  While it responds to market pressures, some care cannot be limited by them. 

I also came to the conclusion with the passage of health care reform – and the electoral rejection of the health care reform above which was not far from what Senator McCain proposed in his 2008 run (and which was not even mentioned as the Republican alternative in the Obamacare debate) – that Americans like their comprehensive insurance.  Most importantly, while the Medical Line of Credit is essential for complete health care, its inclusion essentially short circuits any decision to shop for care.

If the McCain approach cannot pass, will the Affordable Care Act survive the test of time (it has certainly survived all attempts to repeal it)?  Possibly.  The key concept, that people in marginal jobs deserve the same tax subsidies that corporate employees get is sound.  Those parts that fulfill that need, which originated in the Heritage Foundation (which even now clamors for repeal) are also worthy. 

What is less defensible are the higher non-wage income taxes used to fund it, although no bill which just repeals these will survive a Budget Act point of order in the Senate (regardless of House Rules) nor would the political optics look good.  Repeal would hurt too many Americans, so expansion of the tax (along with a rate cut) with some form of consumption or payroll tax– such as the one proposed by Senator Sanders in his single payer plan (or by Mrs. Clinton during her husband’s health care reform effort).  In our proposal, the consumption tax used would be the NBRT/Subtraction VAT.

The main danger to the Affordable Care Act is ease of entry and exit.  If it is too easy to get in, then people will wait until they are sick to sign up.  After they are well, any plan will stop coverage if you stop sending in your monthly premium check.  If enough people do that, rates go up and the cycle goes down.  This eventually leads to a collapse in the system that can be fixed in one of two ways – give everyone cheap and mandatory health care or place health insurers into bankruptcy, like General Motors and Chrysler, and reorganize them into a single-payer system (without any congressional action).  Had the leadership laid out this scenario, it might have stopped the Affordable Care Act – and insurance companies would have most assuredly stopped contributions to the GOP.

The low-cost system with catastrophic care would operate as above (and would hopefully include the Medical Lines of Credit).  Single-payer care would be funded by the NBRT/Subtraction VAT.  Such a tax is superior to the payroll tax proposed by Senator Sanders because it would hit profit.  The upper-income payroll taxes for non-wage income would repealed and incorporated into the NBRT.  

Under Single-Payer, we propose an additional option.  Firms that provide direct health care, such as automobile manufacturers, would not pay for third party coverage at all.  The cost of the coverage provided would be an offset to the NBRT.

We believe that our current insurance system adds no value to health care. Theoretically, insurance pools everyone’s costs and divides them up with everyone paying a monthly share, regardless of the risk they pose.

The profit motive has given us differential premiums based on risk and age. Indeed, the age based premiums in the last attempted health reform were so unaffordable to older Americans in individual plans that the bill could not pass the Senate. Single payer plans, funded through the NBRT, would not have this feature and insurance companies doing claim processing for the government would be paid an adequate profit with little risk.

Short of that, an NBRT subsidized Public Option would allow sicker, poorer and older people to enroll for lower rates, allowing some measure of exclusion to private insurers and therefore lower costs. Of course, the profit motive will ultimately make the exclusion pool grow until private insurance would no longer be justified, leading-again to Single Payer if the race to cut customers leads to no one left in private insurance who is actually sick.

The NBRT can provide an incentive for cost savings if we allow employers to offer services privately to both employees and retirees in exchange for a substantial tax benefit, either by providing insurance or hiring health care workers directly and building their own facilities. Employers who fund catastrophic care or operate nursing care facilities would get an even higher benefit, with the proviso that any care so provided be superior to the care available through Medicaid. Making employers responsible for most costs and for all cost savings allows them to use some market power to get lower rates, but no so much that the free market is destroyed.

This proposal is probably the most promising way to arrest health care costs from their current upward spiral – as employers who would be financially responsible for this care through taxes would have a real incentive to limit spending in a way that individual taxpayers simply do not have the means or incentive to exercise.

While not all employers would participate, those who do would dramatically alter the market. In addition, a kind of beneficiary exchange could be established so that participating employers might trade credits for the funding of former employees who retired elsewhere, so that no one must pay unduly for the medical costs of workers who spent the majority of their careers in the service of other employers.

Thank you for the opportunity to address the committee.  We are, of course, available for direct testimony or to answer questions by members and staff.