Richest Americans Now Pay Less Tax Than Working Class in Historical First

For what it's worth, I'm of the opinion that the combination of very expensive health care and the fact that health insurance is tied to employment effectively add up to a form of slavery. That's a great evil. I'm sorry it so directly affects you personally. It's easy to point to the employers who apparently benefit from the situation, but they didn't ask for things to be this way and are also struggling with how expensive your insurance is. If you lose health insurance in a layoff, that's an indication that the problem is bigger than your employer can handle on your behalf. You don't make enough money to cover your expenses - a harsh situation, but fundamentally a problem for charity, not for business.

I think when we suffer, or are afraid we will suffer, it is easy to get angry at the wrong people. I would suggest that the billionaire next door has nothing to do with your medical stress (and for all you know, may be running a foundation to cure your disease), and that your beef ought to be with a medical industry that makes critical treatment so expensive and leaves you with so few alternatives. That is the kidnapper in this scenario, and everything else is arguing over who should pay the ransom. I could point to a dozen cursed mechanisms that make things that way. With pharmaceuticals alone, there seem to be a hundred different flavors of people held hostage by extremely and unnecessarily expensive treatments - a famous one being diabetics needing hundreds of dollars to pay for a medicine that the veterinary world manages to produce for horses for mere cents.

The cost of medicine is making us poor, and somewhat enslaved to boot. This is not a problem of inequality. Medicare is an attempt to provide a financially equitable solution, and is struggling on both ends: doctors refusing to take it because it doesn't pay enough to cover their expenses, and the government concerned that the program is so expensive, it couldn't be paid for no matter how much you took from all the rich people. The problem is not the distribution of money, but the cost of the service itself.

The industry is in crisis on many levels, and due for a total reboot. And there are lots of (sometimes rich!) people attempting just that. I can point to the direct primary care phenomenon and the recent revolution in type 2 diabetes care as two obvious and recent ones. But there are zillions - I even see YC companies in the health space pretty frequently.

Broadly speaking, I would say that we as a population are becoming sicker and are leaning on a medical industry that can't own up to its own inability to make us well - but is willing to very expensively fail at the job. (And I don't just mean obesity and heart disease, though those are obvious examples - it seems to me that many health problems follow this pattern.) That opinion puts me pretty far outside the mainstream, but then again I think it is becoming increasingly obvious that the mainstream is in crisis.

There are specific paths out of the disaster, for specific people and specific problems. Look for them, and keep looking, and help others. In the mean time, be careful with frustration and rage. Plenty of forces want to exploit your anger for their ends - don't get played. Be clear on what the problem actually is and stay focused on that.

[1] I am using "Medicare" as a metonymy for Medicare, Medicaid, and similar plans both real and proposed, to pay for medical care via taxes.

The problem with exercising an option is that the stock might not be traded or can't be sold, then you have to pay the tax out of pocket, since Uncle Sam doesn't want some private non-traded stock.

"The proposal would impose a minimum tax of 25 percent on total income, generally inclusive of unrealized capital gains, for all taxpayers with wealth (that is, the difference obtained by subtracting liabilities from assets) greater than $100 million."