The Point Washington Update - July 25, 2013
In this edition of The Point:
- CMA lobbies senators to protect charitable gift tax deduction
- ObamaCare rollout faces physician shortage
- Conscience, liberty and duty
Excerpted from "Religious Charities Ask Congress To Save Charitable Deduction in Tax Overhaul," The Chronicle of Philanthropy, July 22, 2013 -- Members of a newly formed coalition of religious charities visited Capitol Hill last week to persuade members of the Senate to back the charitable deduction as they draft recommendations for a massive federal tax overhaul that must be submitted by Friday. In a face-to-face meeting, members of the new Faith and Giving Coalition told lawmakers-including Sen. Orrin Hatch, a Utah Republican, and Sen. John Thune, a South Dakota Republican-that the charitable deduction meets that three-pronged standard.
"We feel it's important that [Congressional] members hear from the faith-based community because of the importance of private giving to what we do," said Steven Woolf, senior tax policy counsel at the Jewish Federations of North America.
The coalition was formed two months ago by John Ashmen, president of the Association of Gospel Rescue Missions, and the National Christian Foundation. Its members include such groups as the National Association of Evangelicals, Salvation Army and World Vision.
Jonathan Imbody, vice president for government relations with the Christian Medical Association, said his organization had not previously lobbied to protect the charitable deduction. But the approach taken by Sen. Max Baucus and Mr. Hatch spurred his group to join the coalition.
"When you read the letter that says they're starting with a blank slate," Mr. Imbody said, "that's enough to get you going. If you want something included you'd better speak up."
President Obama has failed in repeated efforts since 2009 to impose a 28 percent limit on the value of itemized deductions for such expenses as mortgage interest, state and local taxes and gifts to charities as a way to help tame the federal budget deficit. Non-profit advocates say the proposal could reduce donations by as much as $9 billion annually.
Obama administration officials have said that the change would affect single people with incomes of more than $200,000 and married couples with incomes above $250,000. Taxpayers with incomes below those levels who do not itemize deductions would not be affected.
CMA Vice President for Government Relations Jonathan Imbody: "Behind closed doors, Members of Congress have been proposing charitable gift deduction cuts that would severely harm giving, charities and those they serve. That's why I joined several colleagues from leading nonprofit organizations last week to meet at the Capitol with four U.S. senators and staff, to urge them not to kill tax breaks for donations to charities--a move that would hurt donors, cripple faith-based charities and deprive those they serve of desperately needed services.
"A person gives from the heart, of course, but tax policies can significantly influence how much donors feel able to give. The charity deduction is unique in that it simply acknowledges that a person is giving away income to help others in need. The charitable gift deduction is not a loophole--it's a lifeline.
"With the self-imposed deadline for Congressional action--i.e., a draft bill by the end of the month--fast approaching, we need to explain clearly and quickly why the proposed cuts to charitable giving would harm millions of Americans. Please visit CMDA's Freedom2Care website now to learn more and take action on this issue that impacts your charitable tax deductions, ministries like CMDA and, most importantly, the millions of individuals served at home and abroad through American charities."
Excerpted from "Get ObamaCare, while supplies last," USA Today, column by Paul Howard, July 11, 2013 - On Oct. 1, the uninsured can start signing up for coverage under ObamaCare. But should every policy be sold with an asterisk: Guaranteed access to care ... while supplies last?
Maybe. The unpleasant truth is that we don't have enough doctors to offer quality care to a growing number of Americans, never mind the nearly 30 million uninsured who'll begin to gain coverage under ObamaCare starting in 2014.
Changing demographics and perverse reimbursements are the main culprits. But ObamaCare didn't do much to address the underlying problems. Estimates vary, but the Association of American Medical Colleges predicts the U.S. will be short 130,000 doctors across all specialties by 2025. In fact, about one-third of all doctors plan to retire in the next decade.
Today, nearly 20 percent of Americans lack adequate access to primary care because there aren't enough physicians. About 30 percent of doctors won't accept new Medicaid patients. About one-third of ObamaCare's insurance expansion will come through expanding Medicaid.
ObamaCare relies on primary care providers to coordinate care in the hopes of lowering costs and improving outcomes. After adjusting for population growth, aging and demand for care created by the newly insured, we estimate that by 2025, the U.S. will face a shortage of 30,000 primary care physicians, nearly 5,000 of which are attributable to the expansion of insurance under ObamaCare.
Medicare grossly underpays primary care doctors compared with specialists and pays nurse practitioners 85 percent of what it pays doctors for the same services. And medical students are leaving school with crushing debt.
ObamaCare's focus on expanding health insurance left many of our biggest access-to-care challenges untouched. Get ready for Health Care Reform 2.0, starting next year, when many of America's newly insured realize that they have to get in line to see a doctor when they need one.
CMDA CEO David Stevens, MD, MA (Ethics): "Why go to school for seven or eight years to become a primary physician when you can make 85 percent of a physicians salary as a nurse practitioner by adding just a couple more years of schooling to your undergraduate degree? You also will come out with a lot less debt. The median debt for a public medical school in 2012 was $160,000 and for a private $190,000.1 It is no surprise that only 25 percent of allopathic school graduates are going into primary care, but even that statistic may be misleading since 75 percent of students matching to internal medicine programs go into specialties.2 That is one of the reasons that osteopathic schools are prospering. Their number has grown from 19 campuses in 2000 to 37 in 2013.3 More than half their graduates go into primary care.4 Unfortunately, their debt load average on graduation is higher than allopathic schools by almost 25 percent.
"Economic disincentives have seriously damaged primary care and, if surveys are right, it will be worsened by the large number of physicians planning to retire early due to their concerns about Obamacare.5 Ultimately, patients will pay the price with decreased accessibility and poorer health.
"The ranks of mid-level professionals are increasing dramatically to fill in the gaps, but we should be concerned that a significant drop in primary care physicians will leave a dangerous knowledge and experience void between what mid-levels can provide and what specialists should handle.
"This cloud does have a silver lining! With the need for more physicians, it has opened the door for two Christian osteopathic schools to be up and running by this fall and two more are in the planning stages. I've also noted that there seems to be a higher percentage of Christian students on secular osteopathic campuses than allopathic ones and they seem to maintain a more balanced life."
5 NewsMax "Sixty percent of the doctors responding to the Deloitte Center for Health Solutions survey are likely to will retire sooner than planned in the next one to three years, irrespective of age, gender or medical specialty."
Excerpted from "What ‘Conscience' Really Means," National Review Online interview, July 12, 2013 - "Respect for the dignity of the human being requires more than formally sound institutions; it also requires a cultural ethos in which people act from conviction to treat one another as human beings should be treated: with respect, civility, justice, compassion," Robert P. George writes in his new book, Conscience and Its Enemies: Confronting the Dogmas of Liberal Secularism.
KATHRYN JEAN LOPEZ: Can conscience have enemies if we don't even agree on what conscience is?
ROBERT P. GEORGE: Sure. But one's identification of the enemies of conscience will depend on one's view of what conscience is. Today, many on the Left and even some on the Right imagine that "conscience" is a matter of sorting through one's feelings to see whether one would feel badly about doing something - badly enough, that is, that one would prefer the option of not doing it. Where one strongly desires to do something, and especially where one sees some advantage to oneself in doing it, "conscience," understood in this way, tends to be reliably permissive. If one wants to do something badly enough, "conscience" can pretty much be counted on to produce a "permission slip" - especially if one can manage to conceptualize the conduct in question as purely "self-regarding."
The distinction between liberty and license - a distinction critical to the thought of the founders of our nation and the architects of our Constitution - loses its intelligibility, and those who defend traditional notions of morality, virtue and the common good come to be perceived and derided as reactionaries, and even "bigots" and "haters."
Authentic conscience is not a writer of permission slips to act on feelings or desires. It is one's last best judgment - an unsentimentally self-critical judgment - informed by critical reason and reflective faith of one's strict duties, one's feelings or desires to the contrary notwithstanding. Authentic conscience governs - passes judgment on - feelings and desires; it is not reducible to them, and it is not in the business of licensing us to act on them.
Today, the enemies of conscience trample on those sacred rights in a wide variety of ways - everything from the odious Department of Health and Human Services abortion-drug and contraception mandates to the abuse of anti-discrimination laws to drive religiously affiliated adoption services out of business or to harass caterers, florists and others who cannot, in conscience, provide their services for ceremonies they judge to be immoral. Another way that they assault conscience is by stigmatizing as a bigot anyone who dissents from their views on morally divisive issues.
CMDA Senior Vice President Gene Rudd, MD: "Notice George's comment, 'If one wants to do something badly enough, "conscience" can pretty much be counted on to produce a "permission slip."' Of course he is speaking of the dangers of a poorly formed conscience.
"C.S. Lewis addresses this well in The Abolition of Man. Lewis rejects the view that all judgments are subjective. He explains how moral truth and values are supported objectively. He goes on to show how moral values (conscience) must be taught to each generation lest society slip into anarchy. Lewis illustrates using the body. The head provides reasoning. The stomach represents our passions (the carnal man). But something is needed between them for proper stature - the chest. The chest represents the moral values instilled in us by a rightly structured family, church and society. 'Men without chests' are dangerous.
"George is right, 'Authentic conscience is not a writer of permission slips to act on feelings or desires.' An authentic, God-honoring conscience must be formed within each of us. While we can still learn this as adults, it best occurs at the formative time of our lives, in the home. Are we training our families to have such a conscience? We cannot depend on society, or even the church, to do that for us."