It may, of course, be the economist’s bias to consider financing issues as of great importance. If that is the case, however, I should like to think that it is a bias that all of us will come to share. For, though it may be true that death and taxes are inevitable, it is certainly not true that the kind of death or type of taxation are not amenable to change.
The need for a rational discussion of financing issues and for the development of criteria, important as it is in every government expenditure or tax program, is perhaps even more important in the case of NHI. National health insurance calls for the substitution of a government program for the purchase of services that many persons are now financing themselves. Political realism suggests that if the tax plan chosen raises funds that are explicitly labeled as going for national health insurance, the public’s view of the benefits of the program may, in some measure, be based upon the comparison of their tax costs for NHI with their present expenditures for the same services.
As with many tax matters, the amount of detail ( as contrasted with general principles ) that can enter discussion is limited. The quantitative analysis of the burden and of tax incidence, by income group, is difficult to undertake. In part this is the case because there already exist various government programs for payment of health services. Also, the preparation of detailed tables of incidence would require adjustment for the elimination of some, if not all, of these programs as well as a full comparison with the rest of the tax structure at the city, state, and national levels. The comparison is necessary because existing programs that might be eliminated involve taxes at all levels, and it is the change in the distributional equity of the total tax structure that should be our concern. Even if such tables could be created, we would then have to project additional possible changes in taxes in future years ( and impose the same requirement for detailed taxes analysis on any possible future tax changes. ) The fact that stringent detailed analysis requirements are not likely to be imposed on other programs, and the fact that the debate cannot get down to the fine degree of detail, only emphasize the need for general criteria concerning the implications of alternative methods of financing the government revenues. The fact as we shall see later that we lack the data to create pages of computer runs’ of health cost burdens ( including tax burdens for the purchase of health care ) by family size and income simply means the general criteria are that much more important.
