I'll not dispute the impact on expansion and consolidation, but I will say in recent months I have seen a number of hit pieces on the 340B program, mostly bankrolled by pharma companies.
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.
Hi, I wrote this article and largely agree with you. 340B is important and without it many hospitals likely wouldn't survive. However, it's pretty evident at this point that 340B has expanded beyond its original intent.
For example, Northwestern University (in the middle of downtown Chicago) got itself reclassified as a rural hospital in order to participate in the program.
Moreover, it's grown extremely rapidly over the past ~5 years, and the gravity of the program is starting to create bizarre second-order effects like the one outlined.
My intent with this article is just to highlight some of those effects, not to advocate for eliminating 340B.
Also, not bankrolled by pharma, just a researcher for Turquoise Health (a healthtech startup). I get to dig around in their data and publish occasionally, but editorial control / opinions are my own.
Really seems to me that there should be no exemption for land tax for non profits or religious reasons. It is just far too subject to abuse, and it means that we have large churches in the middle of incredibly dense cities that pay almost nothing in taxes.
The idea is that we give up the land tax revenues in exchange for the services the non-profit provides. (And of course the government does not decide which services are useful or not, the people do.)
One thing I might agree with is land tax for non-profits that charge fees for services, as opposed to those who work off of donations. I think that would fix the issue without destroying non-profits.
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.
In my metro area it irks me to see the churches with large empty parking lots empty most of the week. We have a housing shortage and they seem to have no little incentive to convert their parking to more productive use.
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.
There are almost no places where a housing shortage is due to a lack of land. Housing shortages have all sorts of reasons, from constructions cost, to zoning, to restrictions on what can be built, but it's virtually never a lack of land.
And parking is a productive use - they have services once a week, and parking means people can come to the service. That's the definition of productive use. Something does not need to be used 24/7 to be productive.
Do you think a government should be able to seize property under eminent domain if they believe that selling it to a third party to commercially develop would lead to higher tax revenue?
The government already has and does do exactly this. Is this suppose to be a gotcha? If you have very valuable property, you should pay taxes on it. Claiming that you have ownership over land on this planet is odd, you didn't create the land and governments change overtime.
Property taxes are the most evil of taxes because they force you out onto the street if you're unable to pay them. Qualifying it with the words "very valuable" to solve the problem creates an arbitrary two-tier system that is inherently unfair.
>Claiming that you have ownership over land on this planet is odd, you didn't create the land and governments change overtime.
Historically speaking, I am not sure if humans argued that they have created the land and therefore they should be allowed to use it. Ownership of the land and its use is, rather, simply tied to one's ability to retain it ( possession being 9/10ths of the law and all that ).
Yes, you are correctly identifying that all land rights stem from one's ability to claim nature's productive power as his own and monopolize all output from it.
This was self-evident in the feudal era, when landlords (Lords) had to at least raise their own militaries to assert this monopoly right. But the modern State and the landlords reached a compromise: the State will provide security to protect the lords' monopoly on nature so long as the landlords don't raise armed forces.
Or property taxes should be eliminated because they are subject to abuse, and instead sales tax should be the primary source of income for all governments.
At least the early comments seem very focused on churches despite this article literally mentioning "religious" uses once and focusing nigh exclusively on hospitals.
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.
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.
Yes you should not be able to own something you had no hand in creating, such as the earth beneath your feet or the productivity of that earth created by your community.
TL;DR taking properties off the tax roll costs the remaining taxpayers more. Pretty basic stuff. I've been talking this up to local electeds for decades, with very little progress. The only success I've had is ending the local program that makes "historic" properties tax exempt, but the huge whale exemptions for hospitals and whatnot remain.
Universities are just as bad or worse on this front. They will buy up properties with no plan simply because they have the cash to throw around and don't have to pay tax.
People say that in Berkeley but usually the specifics of the deal they are taking about are incorrect, so I generally ignore such people. For example the properties owned by the U.C. wealth fund are taxed like any other.
Although they key thing here is that it's not just that effect, but emergent unintended consequences. In the article, it describes how non profit healthcare institutions have an incentive to buy for profit clinics, because (alongside the other incentives), when they do so, the real estate becomes tax exempt because now it's owned by a non profit, even if the work being performed stays the same.
That's not "unintended" that is the core of what they call the NPIC, the non-profit industrial complex. They do the same activity, with the same financial outcome, but they do it under a different corporate form and pay no taxes. The public does not benefit. Medical care is not the only player in this game. You also get it with "community land trusts" that take a property off the tax roll but don't lower rents.
Only if you keep the things those taxes were paying for. I have no public roads anywhere near me, ~no police, no fire service, no public utilities, basically no county services -- maybe it is not for everybody but once I experienced it I would never go back to having these public services. I basically pay a pittance for the local school and that is it. Once property taxes are eliminated the other voters can push to not have their taxes raised and just shitcan what property taxes were paying for.
Property tax is an emerging issue. There are movement to end property taxes or limit them across the US.
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.
> 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.
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.
I'm more convinced that the LVT is the least invasive than it being the least bad in economic action, although I can somewhat understand the argument for it. If you eliminated all the other taxes and only used LVT then a large part of the financial surveillance apparatus wouldn't have a leg to stand on. The part about bean counting every bit of income, profit, and gain and then being made to report it to the government under the auspices of just paying your tax is absolutely dystopic compared to LVT.
The biggest challenges of Georgism are that it is basically communism for land (George straight up admits this in one of his books) and creates some issues with efficiently allocating land resources, especially bad with the fact that it can wipe out land speculators which perform an important role in doing time-allocation of land. But it's probably worth the tradeoff if you can eliminate the other taxes.
Taxes going up for shittier and shittier return is unfortunately something we are seeing across the US. Regardless of ideological viewpoint, the relative advantages of just buying the services you need on your own rather than playing into a broken system will appeal to larger and larger subsets. I was in the majority "subset" until I was tired of being squeezed dry by a system that always squandered my tax money.
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.
reducing or removing property taxes for legitimate historic properties seems like a good thing to me. I don't want every community to look like a slightly randomized version of every other community. Historic stuff is interesting. If we can encourage it to stay interesting and not get torn down to build a TGI fridays that sounds like a good thing to me. How much did your crusade to tax local historic structures save the average taxpayer? How many of those places will be lost?
Strong disagree. If something has value, then the community should decide to preserve it as a group or the state should preserve it for us. I suspect that most of these schemes are some form of tax avoidance for wealthier people. The idea that some politically connected and likely wealthy group of people need some sort of help "preserving" historic buildings seems... dubious.
Then they should be owned by governments outright. Provided that the community consent to it and are aware of the cost.
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.
None of the covered properties in Berkeley are legitimate landmarks of genuine architectural merit or historical importance. Every one of them was established by flim-flam for the purpose of claiming the tax abatement. Over the years this lovely property claimed more tax breaks than any other. Judge for yourself whether the public interest was served.
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.
For example, Northwestern University (in the middle of downtown Chicago) got itself reclassified as a rural hospital in order to participate in the program.
Moreover, it's grown extremely rapidly over the past ~5 years, and the gravity of the program is starting to create bizarre second-order effects like the one outlined.
My intent with this article is just to highlight some of those effects, not to advocate for eliminating 340B.
Also, not bankrolled by pharma, just a researcher for Turquoise Health (a healthtech startup). I get to dig around in their data and publish occasionally, but editorial control / opinions are my own.
One thing I might agree with is land tax for non-profits that charge fees for services, as opposed to those who work off of donations. I think that would fix the issue without destroying non-profits.
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.
And parking is a productive use - they have services once a week, and parking means people can come to the service. That's the definition of productive use. Something does not need to be used 24/7 to be productive.
>Claiming that you have ownership over land on this planet is odd, you didn't create the land and governments change overtime.
The government didn't create the land either.
This was self-evident in the feudal era, when landlords (Lords) had to at least raise their own militaries to assert this monopoly right. But the modern State and the landlords reached a compromise: the State will provide security to protect the lords' monopoly on nature so long as the landlords don't raise armed forces.
Totally absurd arrangement.
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.
Totally absurd to think that you should!
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.
The biggest challenges of Georgism are that it is basically communism for land (George straight up admits this in one of his books) and creates some issues with efficiently allocating land resources, especially bad with the fact that it can wipe out land speculators which perform an important role in doing time-allocation of land. But it's probably worth the tradeoff if you can eliminate the other taxes.
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,...