July, 2012

Taxing Our Patients

By Michael J. Katin, MD

What a difference a day makes! As of June 28, 2012, Chief Justice John Roberts was the darling of the conservative establishment, with his nomination having been considered one of the few sterling accomplishments of the administration of George W. Bush. On June 29, predications that the Apocalypse would occur this year were proven accurate when Mr. Roberts cast the deciding vote to allow the Affordable Care Act to proceed as though it were constitutional. In fact, the Chief Justice gave the opinion that the argument to support the individual mandate as a penalty allowable under the commerce clause was inappropriate, but then gave the instruction to count it as a tax and therefore make it legitimate. I’m not a constitutional law professor and I don’t want to try to comment on the validity of the Chief Justice’s decision but it seems to be this would be like taking the oral radiation oncology board examination and having the person questioning you say that the answer you gave was incorrect for the question asked about treating prostate cancer, but if you changed the question to treating bladder cancer, it would be acceptable . . .and then getting a passing score. I don’t think that happens too often.

There could be some confusion about the purpose of taxing people who do not go to the expense and trouble of acquiring health insurance. If the goal is to expand access to everyone, then why is it an option to pay the tax and still not have coverage? Why not just take that money and to buy an insurance plan for that person? Didn’t anybody come up with that idea, or is it too radical ?

News of the future, 2014: The United States Department of Culture has ruled that the Best Picture award for the 46th Academy Awards will be revoked from The Sting and given to The Exorcist. In a message to William Friedkin and William Peter Blatty, Secretary of Culture George Clooney explained: “It was a surprise in 1974 when The Sting beat out The Exorcist for Best Picture. We have reviewed that decision and it is concluded that by editing out the infamous vomiting scene , which dismayed many of the Academy voters, your motion picture would have won. The government has arranged for this scene to be eliminated from all existing prints of this motion picture. Each of you will be awarded $10 million dollars, to account for the revenues that should have accrued at the box office due to a “Best Picture” designation, although for each the cost of this year’s tax for the Affordable Care Act will be deducted. Congratulations on this achievement.”

Now that it has been recognized that the Affordable Care Act is to be funded by taxes, what other taxes will be put into place? Will a fine for spitting on the sidewalk be collected by the IRS as an Unsanitary Practices Tax? Will a fine for a moving violation be changed to a National Road Safety Tax? Will the IRS be empowered to collect a fine on an overdue library book as an Excessive Literary Intake Tax?

News of the future, 2014: Singer Lauryn Hill today was exonerated of all charges of tax evasion after a 2012 ruling that she deliberately neglected to report $1.5 million in income. Tax court judge Wesley Snipes declared, “Whereas it is obvious that Ms. Hill did not intend to pay taxes on a large amount of income, she could have avoided putting herself into jeopardy by inflating expenses to use as an offset from income and by income-averaging over the previous 37 years of her life. Since this could have been done, all charges will be dropped and she will be given back all fines so far collected against her, minus this year’s fine….uh, tax, for the Affordable Care Act.”

In terms of taxation in medicine, there are multiple possible ways to raise money to support the government’s burgeoning bureaucratic behemoth . Will there be a tax on heavy particle therapy? Will that be exempted now that the Roberts Proton Therapy Center has opened ( a coincidence ? ). More likely, every time a patient needs an excisional biopsy, this could require payment of an excise tax. Insertion of any type of catheter could generate an income tax. Migraine therapy would be subject to a head tax. I need not say what would accompany the administration of paclitaxel, docitaxel, and carbazitaxel (especially since paclitaxel was originally derived from the Pacific yew plant, genus taxus ). Finally, anyone with spinal problems would have to pay back taxes.

News of the future, 2014: Charles Manson , who in April, 2012, broke a 20 year period of silence to endorse effort to curb global warming, was today ordered freed from Corcoran State Prison by California State Supreme Court Justice Woody Harrelson . Judge Harrelson based his decision on the fact that Mr. Manson’s defense for the charge of conspiracy in the deaths of Sharon Tate and Leno and Rosemary LoBianca could have been handled differently. “It needs to be considered that ever since Mr. Manson was convicted, practically every celebrity , with the exception of that weirdo loser Phil Spector , has gotten away with every variety of crime,” Harrelson explained. “There is no question that, with a more innovative defense , with more merciless trashing of the investigating officers , and more appropriate use of psychosocial historians to blame his actions on everyone else , Mr. Manson should have been acquitted. I will also award him $40 million dollars in reparations for false imprisonment, minus the amount of tax for the Affordable Care Act for this year.”

The problem seems to proceed from the fact that, to this date, nobody except Chief Justice Roberts has ever read the entirety of the Affordable Care Act. Elucidative details are, in fact, elaborated in such sections as pages 1335-1338 and 1426-1439 . It still remains that, when the entirety of the act has been studied, we will all agree that its purpose is to serve mankind.