Sept. 15, 2014 SIGN IN | REGISTER

Health Reform Fight Will Raise Questions About Our Tax System

First, a shout-out to Rep. Jeff Flake (R-Ariz.), who chronicled his extraordinary “district work period” adventure in the Washington Post on Monday. I don’t know many people who could survive a week alone on a desert island — much less write about it so compellingly.

Flake can drive his colleagues on both sides of the aisle to distraction — but that is because he has strong principles, ideological and ethical. His integrity was on display, as usual, after his August island adventure when he voted to reprimand Rep. Joe Wilson (R-S.C.) — and let me belatedly commend his Republican colleagues, Reps. Jo Ann Emerson (Mo.), Bob Inglis (S.C.), Anh “Joseph” Cao (La.), Walter Jones Jr. (N.C.), Tom Petri (Wis.) and Dana Rohrabacher (Calif.), for their own courage to stand for the integrity and comity of the House.

It could not have been easy for any of them to buck their leaders and partisan pressure in this climate. If we had more of that on both sides of the aisle, we would have both a better House and better policy emerging from the true give-and-take that the process was designed to produce.

Now back to that policy process. As health care reform moves to a new stage of negotiation and action, it is clear that the funding side has at least as many issues to resolve as the substantive side. The public insurance option has become the most visible flash point, of course. But there are multiple ways to compromise or strike a balance there. There are other major issues, too, on the substance side, including Medicare payments to physicians, the size and breadth of subsidies for those given access to insurance on the exchanges, the range of people given access to the exchanges, and the penalties for those who fail to get mandated insurance. But resolving many of these controversies requires more money to pay for reforms.

Let’s face it: A large slice of the money needed is going to come on the tax side, and here there is no easy consensus. Whether it is the president’s original proposal to reduce marginal rate levels for charitable and other itemized deductions for wealthier taxpayers, additional levies on providers such as medical device manufacturers, a surtax on the wealthy, limits on the tax-free status of “Cadillac” high-end health insurance plans, or a “windfall profits” tax on insurers, there are strong opponents who are key parts of a necessary majority or 60-vote margin for success.

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