HJAR Sep/Oct 2023

“The earth belongs always to the living generation. … Every constitution then, and every law, naturally expires at the end of 19 years. If it be enforced longer, it is an act of force, and not of right.” – Thomas Jefferson to James Madison, 1789 today). Post WWI, the top marginal tax rate was reduced to 58% in 1922, to 25% in 1925, 63% during the Great Depression, and steadily increased, climaxing in 1944 at 94% on income over $200,000 ($34,387,356.32 today). Following World War II’s tax increases, top marginal individual tax rates stayed near or above 90%, and the effective tax rate at 70% for the highest incomes, until 1964 when Kennedy lowered the top marginal tax rate to 70%. It was lowered to 50% in 1982, 28% in 1988, slowly increased to 39.6% in 2000, then was reduced to 35% for the period 2003 through 2012. I guess the good old days for all of us was before 1913, and if you were super wealthy in the ’80s when Reagan lowered your taxes. What does all this mean to us as healthcare leaders today? Everything. It means we should take a look at every aspect of our system and not be afraid to break it if it is not serving us. Like nursing burnout — do 12-hour shifts make sense? Not enough doctors? Should we be opening the door to new medical schools and expanding others? Behavioral health issues? Oh, good gracious, there is so much to be done in this department … where to start? We need to have a post-pandemic assessment of our entire system top to bottom. And I resubmit the question that has been asked for over a decade, one that often trips us up: Is healthcare a right or a privilege? Jefferson was surprised and disappointed that a Bill of Rights was not included in the U.S. Constitution. I wonder if he had been writing that list today if he would include healthcare, which now constitutes 20% of the GDP. Who is making money from what arguably should be a right? People do not choose to get sick. Boy, but if you do, and you are not over 65 and are not impoverished, you will pay, and you will pay dearly. I ask, why are we penalizing the sick who are not retired or not poor? Can’t we do better as a society? Do we need for-profit insurance companies who are denying credible claims and driving up premiums to line the pockets of their corporate benefactors? As the once silent generation, my generation, steps into power, I ask us to question everything. Why are we doing this? Is it smart, is it kind, is it beneficial, and is it merciful? And if we cannot answer “yes” to all those questions on each of the policies before us? Slash it. Each generation has had to take a look around and make a self-determination. May I humbly suggest the above guidelines for ours as we move forward. And oh, yes, quit taxing single people at higher federal tax rates than married folks … that doesn’t make sense at all — will someone please figure that out, too? Good luck! Dianne Marie Normand Hartley Chief Editor editor@healthcarejournalar.com HEALTHCARE JOURNAL OF ARKANSAS I  SEP / OCT 2023 9