[HN Gopher] Reining in America's $3.3T tax-exempt economy
       ___________________________________________________________________
        
       Reining in America's $3.3T tax-exempt economy
        
       Author : telotortium
       Score  : 166 points
       Date   : 2024-06-20 16:03 UTC (6 hours ago)
        
 (HTM) web link (taxfoundation.org)
 (TXT) w3m dump (taxfoundation.org)
        
       | jdonaldson wrote:
       | Most of the money there is in hospitals. I don't think it does
       | the economy any good to tax those. Love to hear arguments the
       | other way.
        
         | dmckinno wrote:
         | Healthcare is a slippery slope. Don't tax hospitals, but tax
         | pharmaceutical companies? Don't tax pharmaceutical companies,
         | but tax the income of doctors?
         | 
         | I think the point of the article is that it's really hard to
         | make these judgments and doing way with the whole system
         | entirely makes the most sense, which seems reasonable to me.
        
           | willcipriano wrote:
           | "Best I can do is tax you like you have socialized
           | medicine[0], then force you to pay 2 - 4 fold what those
           | other counties private systems cost to actually get care for
           | most of your life." - Every politician in my entire life time
           | 
           | [0]https://data.oecd.org/healthres/health-spending.htm
        
             | ceejayoz wrote:
             | Quite a few politicians suggest we take one of the various
             | approaches the rest of the OECD countries do, as they're
             | clearly more cost-efficient... but _that_ gets derided as
             | socialism.
        
               | willcipriano wrote:
               | Then they vote for another war instead.
               | 
               | They also never make the point that we are already paying
               | for it. They want to tax me more, when if they were as
               | efficient as the NHS I'd have two healthcare systems with
               | money left over.
               | 
               | Medicare for all will never see the floor until everyone
               | currently over 60 is gone, at a minimum. They are all in
               | on it.
        
               | ceejayoz wrote:
               | The US can clearly afford _both_ , as your chart
               | demonstrates. It shows we pay more in tax than the other
               | OECD countries pay _in total, including taxes_ for
               | healthcare.
               | 
               | We've picked the least efficient worst-of-both-worlds
               | scenario out of a fear of anything that sounds like
               | socialism ("public option", "Medicare for All", etc.).
        
               | willcipriano wrote:
               | Its corruption. Explain it in the terms I have on the
               | national debate stage, everyone is on board. NHS style
               | healthcare AND lower taxes. You'd win every election, but
               | you'll never see that stage.
        
               | whoitwas wrote:
               | No one would win anything. Money wins elections. If you
               | had this platform and money, you find an early grave.
        
               | antisthenes wrote:
               | > The US can clearly afford both, as your chart
               | demonstrates.
               | 
               | The chart doesn't demonstrate anything of the sort. By
               | definition, sovereign governments can afford literally
               | anything, since they can print the currency within the
               | country. It will just cause inflation.
               | 
               | That statement is complete and utter reductionist
               | nonsense.
        
               | ceejayoz wrote:
               | We are _currently_ paying for both.
               | 
               | The fact that our current setup costs 2-3x any other OECD
               | nation indicates reform to be more like their systems is
               | likely to _reduce_ costs, not increase them.
        
               | pessimizer wrote:
               | The US government is currently paying as much per capita
               | for healthcare as socialized systems, then individuals
               | pay _again._ If we can afford what we 're doing now, it's
               | obvious that we could afford a socialized system. It
               | costs less.
               | 
               | The reason we don't have one is because Democratic
               | politicians, funded by healthcare and drugs, are so
               | willing to lie about the math for money, and the media,
               | funded by ads for healthcare and drugs, are so willing to
               | help them.
        
           | csdreamer7 wrote:
           | > Don't tax hospitals, but tax pharmaceutical companies?
           | 
           | Hospitals, to maintain their nonprofit status, have to
           | provide charitable contributions. One way is when patients
           | apply for payment reduction or discharge because they can not
           | afford to pay. Patients need to apply for this so they have
           | documentation to give the IRS.
           | 
           | > Don't tax pharmaceutical companies, but tax the income of
           | doctors?
           | 
           | How often do you ask a doctor to work for free? They still
           | get paid by the hospital.
           | 
           | Yes, pharmaceutical companies, which as far as I know are
           | private, also have something like this. This is preventing
           | media coverage and Congress imposing max cap on prices on
           | public assistance programs (prices private insurance will use
           | for leverage) so they can keep charging what they want.
           | 
           | > I think the point of the article is that it's really hard
           | to make these judgments and doing way with the whole system
           | entirely makes the most sense, which seems reasonable to me.
           | 
           | The point of this article is to attack the nonprofit
           | competitors to their due paying members. They gloss over many
           | details and as I posted elsewhere; they even defensive of the
           | tax loopholes of their due paying members.
        
             | FireBeyond wrote:
             | > How often do you ask a doctor to work for free? They
             | still get paid by the hospital.
             | 
             | Oftentimes, physicians are not paid by the hospital at all.
             | They will form consulting groups and work for the
             | consulting group which will have a contract with the
             | hospital, or they'll do something C2C.
        
         | bagels wrote:
         | I think it's hard for people to reconcile $1000 10 minute
         | doctor visits, and $10,000 IVs with tax free status.
        
           | steego wrote:
           | Or you could look at Kaiser Permanente, which is the exact
           | opposite of this and the biggest nonprofit cited in this
           | paper.
           | 
           | Unless you go to 3rd party provider for a non-emergency, you
           | will never get hit with this type of nonsense. Everything is
           | reasonably priced.
           | 
           | It's a nonprofit organization that handles the financing and
           | providing healthcare services which gives them an incentive
           | to manage costs.
           | 
           | The ACA marketplace gives them an incentive to provide good
           | service because you can always sign up for different
           | insurance at the end of the year if you don't like the care
           | they provide.
           | 
           | Personally, I suspect this study was sponsored by the big
           | health insurance companies who want to get in the same game.
        
           | supertrope wrote:
           | While the exact line items are made up the money to pay
           | nurses ultimately has to come from somewhere.
        
         | softfalcon wrote:
         | It's called universal government provided healthcare. We have
         | it in Canada. Gets rid of that nasty, unnecessary, "for profit"
         | medical sector.
         | 
         | Though, I think that may actually be as-large or a larger
         | problem for America than non-profit taxation/exemption
         | policies.
         | 
         | You have to admit, you could clamp down on the other crap
         | easier if healthcare being a "non-profit" wasn't such a big
         | deal due it just being managed by the government.
        
         | EasyMark wrote:
         | I think mostly what we need is transparency for nonprofits,
         | list of all salaries, expenses, capital expenditures, bonuses,
         | etc before one can really say what makes sense. Including for
         | "customers" (patients). If you know how much it takes to run a
         | nonprofit then people will begin to understand if they are
         | price gouging or if there's some huge expense that the general
         | public is unaware of. We need the light of day put on these
         | ventures so they can't hide info AND keep their nonprofit
         | status. For example, I wish we were much harsher on religious
         | non profits that get mixed up in politics and support
         | candidates and parties, they should lose their tax free status
         | immediately.
        
       | guntars wrote:
       | > The majority of tax-exempt organizations today are business-
       | like in form and function, including credit unions, hospitals,
       | utilities, insurance companies, universities, professional
       | athletic associations, golf clubs, and consulting firms, to name
       | a few.
       | 
       | Missing a big one there. I know that taxing religious
       | organizations would NEVER fly in the US, but.. can you imagine?
        
         | babypuncher wrote:
         | I'm OK letting religious institutions keep their tax exemption,
         | but we should make them adhere to the same standards as
         | 501(c)(3) organizations (non-profits). A whole lot of churches
         | would either start paying taxes, or expose themselves as frauds
         | with those financial transparency requirements.
        
           | r00fus wrote:
           | This exactly - the existing hypocrisy leads to religious
           | organizations essentially being tax-exempt political
           | organizations.
        
           | nickpeterson wrote:
           | I think you're right, but it's probably better to try and
           | remove their exemption and then settle on this. They'll
           | scream either way because unethical hucksters will do
           | anything to keep fleecing people.
        
             | edmundsauto wrote:
             | It might make them feel even more empowered to inject their
             | religious beliefs into politics. Nowadays there is a paper
             | thin pretend curtain around that, I believe, due in part to
             | tax exemption.
        
           | PopAlongKid wrote:
           | There is a loophole where a religious organization doesn't
           | even have to file any paperwork with the IRS to establish its
           | tax exempt status. While $5,000 doesn't sound like a lot,
           | that limit was probably set many years or decades ago and
           | never adjusted for inflation (so the original intention could
           | well have been a much higher level of revenue).
           | 
           |  _" Tax Exempt Organization Search (Pub. 78 data) is based on
           | information received in applications seeking recognition of
           | exemption under Internal Revenue Code section 501(c)(3).
           | Churches, their integrated auxiliaries, conventions or
           | associations of churches, and public charities whose annual
           | gross receipts are normally not more than $5,000 may be
           | treated as tax-exempt without filing an application. Also,
           | many churches are included in group exemptions (see below).
           | Thus, they may not be listed in Tax Exempt Organization
           | Search (Pub. 78 data)."_
           | 
           | https://www.irs.gov/charities-non-
           | profits/contributors/other...
        
           | Alupis wrote:
           | This doesn't work in practice, because of freedom of
           | religion, freedom of assembly, and separation of church and
           | state, ie. constitutionally guaranteed rights.
           | 
           | Taxing churches would then be a way for government to
           | suppress and eliminate religion/religious organizations they
           | do not like. Start taxing today with a "reasonable" tax, and
           | tomorrow you can raise tax obligations until operation is
           | unsustainable. A la "subsidize things you want more of, tax
           | things you want less of".
           | 
           | Despite what non-religious and/or anti-religious people may
           | want, this is untenable and almost certainly
           | unconstitutional.
           | 
           | As an aside - the federal government has plenty of money. We
           | don't need to go looking in the seat cushions for pocket
           | change. Instead of "Reining in America's $3.3T Tax-Exempt
           | Economy", we should be "Reining in America's Overindulgent
           | Lifestyle and Runaway Spending Spree".
        
             | toast0 wrote:
             | > Taxing churches would then be a way for government to
             | suppress and eliminate religion/religious organizations
             | they do not like.
             | 
             | I don't know what the IRS standards are for recognizing
             | religions, but taxing unrecognized religions and not taxing
             | recognized religions seems like a bigger potential for
             | suppression of undesired religions than taxing all of them.
             | That said, I don't think I've heard of a case where
             | IRS/government refused to acknowledge a claimed religious
             | organization?
             | 
             | Of course, you can't have free exercise of religion if it's
             | taxed. I do think it'd be nice to have public tax returns
             | or similar, but I guess that's really for the membership to
             | demand more than the government.
        
               | sneak wrote:
               | > _That said, I don 't think I've heard of a case where
               | IRS/government refused to acknowledge a claimed religious
               | organization?_
               | 
               | Perhaps illustrating your point, but worth noting anyhow:
               | the dangerous for-profit cult of Scientology actually had
               | to infiltrate the IRS with their own people to get their
               | tax exempt status.
               | 
               | https://en.wikipedia.org/wiki/Operation_Snow_White
        
             | guntars wrote:
             | By that logic, does having philosophical or political
             | discussions at a local coffee shop once a week qualify it
             | for a tax exempt status?
        
             | tzs wrote:
             | Churches can in fact by taxed.
             | 
             | For example Texas once had a sales tax exemption for
             | periodicals sold by churches that consisted solely of
             | material to promulgate their faith, and the Supreme Court
             | in Texas Monthly v. Bullock, 489 US 1 (1989) [1] said that
             | such an exemption violated the establishment clause.
             | 
             | In Swaggart Ministries v. Cal. Bd. of Equalization, 493 US
             | 378 (1990) [2] Swaggart contended that California's
             | subjecting them to sales/use tax was unconstitutional. The
             | Court said it wasn't.
             | 
             | [1] https://caselaw.findlaw.com/court/us-supreme-
             | court/489/1.htm...
             | 
             | [2] https://caselaw.findlaw.com/court/us-supreme-
             | court/493/378.h...
        
               | Alupis wrote:
               | Your post seems to be misleading. Both rulings focus on
               | selling goods to non-members, which seems rightfully
               | taxable.
               | 
               | This discussion is about taxing churches/religious
               | organizations in general on all revenue/income (ie.
               | tithe, donations, membership fees, etc). That would very
               | likely be unconstitutional, as that would limit the
               | organization's ability to assemble and practice religion.
        
             | sircastor wrote:
             | > we should be "Reining in America's Overindulgent
             | Lifestyle and Runaway Spending Spree".
             | 
             | If you're interested in knowing where your federal tax
             | dollars are going, put your numbers in and take a look.
             | It's possible this is the most productive thing Intuit has
             | ever done.
             | 
             | https://us.abalancingact.com/2023-federal-taxpayer-receipt
        
             | snapplebobapple wrote:
             | I don't think this holds water, especially when the default
             | behaviour is to just treat them like any other business.
             | You could make this absolutely dead simple by exempting
             | donations from tax but taxing all other forms of income and
             | removing all deductions.
        
               | babypuncher wrote:
               | My problem is the lack of transparency with how donations
               | are handled. Many churches primary source of income is
               | donations, which they turn around and spend on private
               | jets, lavish clergy salaries, or even for-profit
               | endeavors like giant shopping malls.
               | 
               | Because churhces are exempt from all the transparency
               | required of normal nonprofits, they can easily mislead
               | their congregations about how that donated money is
               | spent.
               | 
               | If someone decides to switch churches because they found
               | out that most of the money they donated was not actually
               | going towards charitable causes, that would be an
               | absolute win in my book.
        
               | Alupis wrote:
               | > Many churches primary source of income is donations,
               | which they turn around and spend on private jets, lavish
               | clergy salaries, or even for-profit endeavors like giant
               | shopping malls
               | 
               | You're describing maybe a dozen or less mega-churches -
               | not the thousands and thousands of typical churches.
        
             | babypuncher wrote:
             | Except churches would still be tax-exempt. All they would
             | have to do is make their finances public, so that the
             | people donating money to them know what that money is going
             | towards.
             | 
             | If they don't want their congregations to know how much
             | they spent building a giant mall or buying private jets,
             | then they can choose to pay taxes instead. If you don't
             | think your congregation will care about the private jets,
             | then by all means, keep your tax exempt status.
        
           | sneak wrote:
           | Religious organizations are not tax exempt.
           | 
           | Congress is authority-exempt from making laws that can apply
           | taxes to them in the first place.
           | 
           | It's not like we tax everyone, then exempt religious
           | organizations; the "everyone" that is able to be taxed does
           | not include establishments of religion in the first place,
           | thanks to the wording of 1A.
        
             | vundercind wrote:
             | Sure they can. They can't _selectively_ tax only the ones
             | they don't like. Which is actually closer to what happens
             | now.
        
         | segasaturn wrote:
         | The phenomenon of "megachurches" and "televangelists" in
         | America fascinate me, you have guys like Pat Robertson driving
         | Rolls Royces and flying in private jets, all paid for tax-free,
         | in the name of a religion that commands its followers to give
         | everything they have to the poor. It's all so perverse.
        
           | hobotime wrote:
           | Pat's income from his mega church and gifts in kind are
           | taxable.
           | 
           | I'm not saying he's a good person, but he has personal income
           | just like the rest of us. The odd clergy exemptions to the
           | personal income tax are not that large:
           | https://www.irs.gov/taxtopics/tc417
        
             | ceejayoz wrote:
             | > he has personal income just like the rest of us
             | 
             | And like the rest of his fellow mega-wealthy, he'll be able
             | to fiddle it away in a number of ways.
             | 
             | The flights (and dinners, and cushy hotels, and big
             | parties) will be for "church business". The "fair rental
             | value" of his home will be immense, and "reasonable
             | compensation for the minister's services" will be something
             | the IRS is reluctant to fight over.
        
           | pram wrote:
           | A lot of the original evangelical megachurches were directly
           | influenced and guided by Peter Drucker who was a big
           | "scientific management" figure, if that tells you anything.
           | He was a direct mentor to Rick Warren who started the
           | Saddleback Church, which is like the modern megachurch
           | template. Pretty interesting rabbit hole to go down.
        
         | downrightmike wrote:
         | Religious orgs do nothing but prey on the weak and break them
         | so that they can never be free and have to rely on the church.
         | And then there's all the land that they use once a week, and
         | that is a complete waste. All that needs to be taxed, they
         | shouldn't exist. You want to pray, cool, don't waste resources
         | and pay your share.
        
         | throw7 wrote:
         | Nah. I can imagine the country without the first amendment and
         | it wouldn't be pretty.
         | 
         | The big one they missed were think tanks. That's where the real
         | corruption is. Oh and will you look at that... the Tax
         | Foundation is a 501(c)(3) think tank based in D.C. Things that
         | make you go hmmm.
        
           | rho138 wrote:
           | How is this covered by the first amendment? No one is
           | stopping anyone from practicing their own belief system.
        
         | sircastor wrote:
         | I used to belong to a very large Christian faith, with members
         | all over the economic spectrum. One of the major tenants of the
         | faith is paying tithing. I think most people adhere to it, but
         | I seriously wondered many times if the wealthier among the
         | faith would pay their tithing if it didn't result in a
         | substantial tax break.
        
           | happyopossum wrote:
           | > would pay their tithing if it didn't result in a
           | substantial tax break
           | 
           | Do you understand how tax breaks work? If you make 100k, and
           | tithe 10% of that you don't get a 10k tax break, you just
           | don't pay taxes on that 10k. You're still out the money, and
           | best case you could rationalize it as only costing you 8-8.5k
           | (depending on your marginal tax rate), but it's not some
           | magic sauce that gets 'the wealthier' free money.
        
             | sircastor wrote:
             | The concept is this: When you're donating reasonably large
             | amounts of money to charity (a church in this case) you can
             | deduct that amount from your taxable income while
             | simultaneously supporting an organization that you like
             | (your church) If that feature goes away, and now you have
             | to pay tithing on top of paying taxes at your full income
             | tax bracket rather than a reduced bracket, are you still
             | willing to pay your tithing?
        
               | 1oooqooq wrote:
               | didn't trump change to tax limit donations to 300 now?
        
         | larsiusprime wrote:
         | Good question! Let's imagine!
         | 
         | Most of the value of churches is in real estate. I imagine a
         | lot of the Mainline protestant denominations (typically the
         | most liberal), who have low and declining attendance, would be
         | hit the hardest as they own a lot of historic downtown
         | properties worth in the tens of millions.
         | 
         | Conservative Protestant, and Catholic churches own a lot of
         | real estate too, but they have bigger congregations.
         | 
         | If you have a $10,000,000 property that owes 1.5% property
         | taxes a year, that's about $150,000 in taxes every year.
         | 
         | If you have 15 families earning $100,000 a year who each tithe
         | (or 30 families earning $50,000 a year), then you break even on
         | those taxes (you still have the rest of your church expenses to
         | pay, of course).
         | 
         | I'm not aware of the rate of tithing and attendance in
         | Conservative Protestant, and Catholic churches, but I'm
         | guessing it's higher than in mainline Protestant Churches. I
         | imagine non-mainline churches also have a wider portfolio of
         | real estate; they probably own their own share of prime real
         | estate in downtown city centers, but most of their churches are
         | likely dispersed in suburban and rural areas with much lower
         | value land.
         | 
         | My hypothesis (confidence: 75% sure, but haven't done all the
         | necessary math) is that if you were to push for a full repeal
         | of church property tax exemptions, Megachurches, Conservative
         | Protestants, and Catholics would be very upset about it, but
         | would probably be able to weather the storm, and Mainline
         | protestant churches and other minority religious organizations
         | with high value urban property and low relative attendance
         | would essentially be wiped out overnight.
         | 
         | In short -- if you're a liberal, be careful what you wish for.
        
           | galleywest200 wrote:
           | Who says it has to be property taxes? Make them pay taxes on
           | advertising or other such activities.
        
           | happyopossum wrote:
           | Your entire scenario here is based around a local (state and
           | county) tax, and has nothing to do with the federal tax code
           | the parent article is concerned with.
        
             | HDThoreaun wrote:
             | The church has no profits. Making religion pay property tax
             | is the only thing turning them into for profit institutions
             | would do.
        
       | brink wrote:
       | I'm Christian, and I don't think religious orgs should be tax
       | exempt.
       | 
       | It may have worked well until now, but I worry that in the future
       | it will allow future administrations to threaten tax-exempt
       | status for churches that don't conform their teaching to
       | society's preferences in the moment. Churches shouldn't be in it
       | for the money anyway. We should just rip that entire band-aid off
       | and undo something we never should have done in the first place.
        
         | wang_li wrote:
         | What would that even look like? Gift taxes are paid by the
         | giver not the recipient. Currently you don't even have to
         | report it if it's less than $18,000 per year per recipient. If
         | you give less than $13 million in your lifetime you don't have
         | to pay any gift taxes anyway.
         | 
         | I have a feeling that most people probably don't give $18,000
         | to their churches annually. At a 10% tithe rate, that's
         | $180,000. Wel above the median household income.
        
           | bombcar wrote:
           | Donations to correctly setup churches (and some but not all
           | non-profits) can be tax deductible from income.
        
             | loco5niner wrote:
             | For me that's only true if I itemize. With the standard
             | deduction being $29,200 for me this year, that's a tall
             | hurdle. And at that, the only benefit is any amount over
             | the standard deduction.
        
       | Aurornis wrote:
       | > More than half (55 percent) of all the income generated by
       | 501(c)(3) organizations comes from tax-exempt hospitals and
       | health-care plans.
       | 
       | The median operating margins for hospitals is around 0% or some
       | times negative. Injecting more costs into the system is only
       | going to push prices further upward.
       | 
       | > The majority of tax-exempt organizations today are business-
       | like in form and function, including credit unions, hospitals,
       | utilities, insurance companies, universities, professional
       | athletic associations, golf clubs, and consulting firms, to name
       | a few.
       | 
       | I'm completely on board with clamping down on tax exempt status
       | for a lot of these other businesses, though. Credit Unions are
       | nice, but they're still just banks. Insurance companies are
       | obviously businesses. Athletic associations, golf clubs,
       | consulting firms -- What is even going on that allowed these to
       | be nonprofits?
        
         | pstrateman wrote:
         | They don't distribute profits to their members.
         | 
         | The only thing making them pay tax will do is create an
         | accounting nuisance where they drive profits and thus taxes to
         | zero.
        
           | chrislloyd wrote:
           | If they drove profits to zero by distributing it to their
           | members, wouldn't that incur income tax?
        
           | addicted wrote:
           | And how will they do that? You can't just "drive profits to
           | zero by accounting nuisances". Otherwise every for profit
           | organization would do that.
           | 
           | (Although, separately, this is what IKEA does but they setup
           | an extremely intricate multinational structure to achieve
           | this, and this is what Amazon does, but that required heavy
           | re-investment which only worked because the markets trusted
           | the reinvestment would eventually be profitable and therefore
           | invested in AMZN despite it not showing profits).
           | 
           | They'd have to do it by paying salaries or buying products,
           | etc all of which are also taxed, and usually at rates higher
           | than taxes on profits.
        
             | bombcar wrote:
             | The reason for-profit companies don't "drive profits to
             | zero" is that the shareholders would eventually notice and
             | complain.
             | 
             | There are some technical for-profit companies that
             | effectively drive profit to zero and the shareholders don't
             | care, because that was the purpose.
        
               | SoftTalker wrote:
               | Amazon famously had negative profits for years as they
               | spent on building out their infrastructure.
        
               | lotsofpulp wrote:
               | Amazon did not consistently lose money. They were
               | basically breaking even since the early 2000s and they
               | proved they could turn on the profit faucet anytime they
               | want once AWS came around. Although, they still heavily
               | invest in infrastructure development, hence the continued
               | low profit margins.
               | 
               | https://www.stock-analysis-
               | on.net/NASDAQ/Company/Amazoncom-I...
               | 
               | See Amazon v Walmart net profit margin 1999 to 2018
               | graph.
               | 
               | https://mgmresearch.com/amazon-vs-walmart-revenues-and-
               | profi...
        
             | afpx wrote:
             | I read things like this though:
             | 
             | "In each year from 2014 to 2018, about half of all large
             | corporations had no federal income tax liability."
             | 
             | https://www.gao.gov/assets/gao-23-105384-highlights.pdf
        
               | EasyMark wrote:
               | Yes but there are plenty of ways to do that with R&D,
               | capital write-offs, "business expenses", reinvestment,
               | etc . I don't think there are nearly that many for
               | charities and other nonprofits.
               | https://www.investopedia.com/financial-edge/0512/how-
               | large-c...
        
             | pstrateman wrote:
             | You answered your own question, they just spend more money.
             | 
             | How does non profits spending money inefficiently to burn
             | revenue help society?
        
           | AlbertCory wrote:
           | Wrong. If they're not 501(c)(3) then donations to them are
           | not tax-deductible.
        
         | Y_Y wrote:
         | > The median operating margins for hospitals is around 0% or
         | some times negative. Injecting more costs into the system is
         | only going to push prices further upward.
         | 
         | Maybe it's for the best.
        
         | stefan_ wrote:
         | I see this sentiment a lot with US internet providers - "but
         | they aren't making any money as is, it must be a real tough
         | business environment". I think there are limitless ways for bad
         | actors to make lots of money in a broken market that doesn't
         | mean there must be a unidimensional monopolist giga corp at the
         | center of it raking in all the margin.
        
         | sandworm101 wrote:
         | >> The median operating margins for hospitals is around 0% or
         | some times negative.
         | 
         | Then they should not have to worry about paying income taxes
         | regardless of their classification.
        
         | hondo77 wrote:
         | So, if their margins are zero (or negative) then there's no
         | profit so nothing to tax so no additional costs, right? Or am I
         | missing something?
        
         | stiglitz wrote:
         | > The median operating margins for hospitals is around 0% or
         | some times negative
         | 
         | I found this page that seems to agree-
         | https://www.definitivehc.com/resources/healthcare-insights/h...
         | 
         | That shows a negative median operating margin for the last 5
         | years. How can an industry carry on losing money like this?
         | This must be only part of the story, right?
        
           | ndriscoll wrote:
           | The answer is right in the OP:
           | 
           | > More than half (55 percent) of all the income generated by
           | 501(c)(3) organizations comes from tax-exempt hospitals and
           | health-care plans.
           | 
           | They can carry on losing money because they are often
           | charities. Isn't a 0% or less margin what most people would
           | naively expect for a charity?
        
             | unyttigfjelltol wrote:
             | Hospitals certainly appear to be operated for the benefit
             | of physicians and administrators, and their compensation is
             | an expense not profit. The relevant statistic is highly
             | compensated leaders, not profit.
        
               | ndriscoll wrote:
               | True, though they'd still be paying payroll taxes. To me,
               | it seems like the thing nonprofits could maybe let you
               | "get away with" is building up an endowment that can fund
               | sinecures, which could effectively turn it into a sort-of
               | super IRA for the ultra-wealthy (i.e. with no required
               | distributions for your beneficiaries after you die, you
               | could have an effectively everlasting traditional IRA
               | that your descendants control and could access through
               | fake salaries). This has the side "benefit" of letting
               | your descendants save face and pretend to have important
               | charity work that they do as opposed to being a layabout
               | that lives off great-grandpa's wealth. If you do it
               | right, they might even believe it themselves!
        
               | FireBeyond wrote:
               | Many hospitals never employ a single physician. Or next
               | to zero.
               | 
               | Am a paramedic. All of the ED physicians in the Level 2
               | Trauma Center I take most patients to are not employed by
               | the hospital, but by a collective called "XYZ Emergency
               | Medical Providers". The hospital then (I don't know these
               | details) contracts with the collective. I also believe,
               | very similar to a union, that if the hospital wishes to
               | hire a new provider, they may handle all the
               | interviewing, but ask for the collective to hire them.
        
             | EasyMark wrote:
             | You'd have to be pretty naive, I'd say a nonprofit still
             | needs to save some money to handle the ebb and flow of just
             | existing and to have some money tucked away. I'm not sure
             | how that works since I've never been part of one, but there
             | has to be a way, because it's the only pragmatic approach
             | to anything that lasts more than a few months.
        
           | mfer wrote:
           | Healthcare systems costs and operations are a mess. Here are
           | a few examples, hospital systems setup places that can do
           | anything which adds complexity and increases costs. So, they
           | are not cost optimized. The more a facility can do the more
           | it costs to do any one thing.
           | 
           | Hospitals loose money on many procedures while making some
           | money back on others.
           | 
           | There is also costs around staffing. For example, nursing
           | schools aren't producing the growing number of nurses needed.
           | Supply and demand kicks in.
        
           | asdfsdfas wrote:
           | You're still seeing heavy consolidation in the industry which
           | is a clue something fishy is going on-- why would a hospital
           | system _choose to grow_ for instance? where would the $$ come
           | from to buy other ones?
           | 
           | The answer is hospitals target negative operating margins to
           | meet various rules-- even though their "surplus" (ie profit)
           | isn't taxed, it has to be near-0 to maintain non profit
           | status. And, besides the normal games of revenue timing and
           | amortization, they expense profitable activities to related
           | parties.
        
             | alephnerd wrote:
             | > why would a hospital system choose to grow for instance?
             | where would the $$ come from to buy other ones
             | 
             | Not all networks are for-profit.
             | 
             | By merging into larger networks, you allow hospital
             | networks to consolidate the very expensive back-office
             | processes like billing, insurance, IT, procurement,
             | staffing, etc.
             | 
             | All the intermediate "glue" needed for medical care has
             | grown expensive due to either compliance or general
             | profiteering, which forced consolidation in order to
             | leverage economies of scale.
             | 
             | This is why both for-profit and non-profit networks have
             | been increasingly merging.
        
               | mistrial9 wrote:
               | as an outsider to this system of systems, I don't think
               | anyone understand all of the parts, or all of the
               | dynamics going on.. details with factual references are
               | very much appreciated on this weighty subject!
        
             | EasyMark wrote:
             | I agree, someone, somewhere is making money off this stuff
             | and know how to hide it or all these hospital groups would
             | be belly up in a few years. What's even more scary is all
             | the rural hospitals that are going bankrupt at an
             | escalating pace (in the USA). I have lots of "country
             | folk"relatives and I worry about them. The closest hospital
             | to my mother Is 20 miles away, if that one shuts down the
             | closest is 55 miles away. I have at least 5 within 5 miles
             | of me, 2 of which are major regional surgical/oncology
             | centers because I live in an urban area.
        
             | JumpCrisscross wrote:
             | > _seeing heavy consolidation in the industry which is a
             | clue something fishy is going on-- why would a hospital
             | system choose to grow for instance_
             | 
             | Economies of scale. When an industry faces headwinds,
             | characterised by broad-based low or negative operating
             | margins, the standard move is consolidation.
        
           | jandrese wrote:
           | I think it means that administrators appear out of the
           | woodwork to consume any potential profit a hospital may make.
        
         | downrightmike wrote:
         | We know they are screwing us: "What they show are price hikes
         | ranging from 575% to 675% being automatically generated by the
         | hospital's software."
         | https://www.latimes.com/business/story/2021-12-10/column-hea...
        
         | SoftTalker wrote:
         | > What is even going on that allowed these to be nonprofits
         | 
         | They are operating as non-profits, as defined by the IRS code
         | and the law?
         | 
         | "Athletic associations" for example includes your all your
         | local youth sports clubs. There's a lot of activities that can
         | be done for a charitable purpose that may be organized under
         | 501(c)(3) and similar regulations.
         | 
         | Yeah a Credit Union is like a bank, but it's not a bank. It's
         | not operated for profit.
         | 
         | All but the smallest non-profits all have to file an annual
         | Form 990 which is mostly public. You can go look them up, if
         | you're wondering what they do and how they spend their money.
         | 
         | If they have income that is not directly related to their
         | charitable purpose, they are supposed to pay tax on that.
         | According to TFA that is weakly enforced, and while that may
         | need fixing we need to be careful that we don't throw out the
         | baby wth the bathwater.
        
           | lmm wrote:
           | What is the baby here though? What's the benefit to having
           | all these entities be tax-exempt? Would it really be so bad
           | for the likes of youth sport clubs to pay normal taxes on
           | their (presumably tiny) profits?
        
         | cmiles74 wrote:
         | I work in the healthcare space and hospitals, in my opinion,
         | are motivated by profit. The rise in private equity purchases
         | of hospitals indicates that the money is going somewhere and
         | it's certainly not any kind of "charity".
         | 
         | Perhaps many small, poorly run hospitals have consolidated into
         | a handful of large, poorly run hospitals. Still, that's no
         | excuse to let Kaiser Permanente generate billions tax free.
        
           | alephnerd wrote:
           | > The rise in private equity purchases of hospitals indicates
           | that the money is going somewhere and it's certainly not any
           | kind of "charity
           | 
           | MSOs are organized as LLCs, not 501c3 organizations.
           | 
           | The kinds of hospital networks that are run as 501c3s would
           | be something like a CommonSpirit Health, Advent Health, UPMC,
           | Mass Gen Brigham, etc.
           | 
           | > Perhaps many small, poorly run hospitals have consolidated
           | into a handful of large, poorly run hospitals
           | 
           | Kinda. That's how CommonSpirit Health came to be, except
           | backend management is basically centralized.
        
           | systemvoltage wrote:
           | Wait... what's wrong with motivated by profit? If the service
           | sucks, they'll lose customers.
           | 
           | Focusing on profit is fundamentally sound unless you're a
           | monopoly, which tend to be when Gov sticks its beak into
           | things it shouldn't.
        
             | cmiles74 wrote:
             | I agree, there's nothing wrong with focusing on profit.
             | 
             | The "non-profit" organizations are given tax-exempt status
             | because they are centered around providing a public or
             | social benefit, they explicitly should not be focused on
             | providing a profit to their owners.
             | 
             | In my opinion the majority of people can't afford to choose
             | their hospital. Often it's the one that is within their
             | means to travel and provides the service they require,
             | regardless of the quality of their services. And, of
             | course, after a serious accident you end up wherever the
             | ambulance brings you.
        
             | Keegs wrote:
             | > If the service sucks, they'll lose customers.
             | 
             | We're talking about hospitals. Many areas are served by one
             | local hospital. And where there are several, it's typically
             | the ambulance who decides where you go. It's also pretty
             | difficult to compare one hospital with another.
             | 
             | IMO hospitals resemble utilities where market forces aren't
             | enough to guarantee good service.
        
               | happyopossum wrote:
               | > And where there are several, it's typically the
               | ambulance who decides where you go, not you.
               | 
               | Don't necessarily disagree with most of your sentiment,
               | however the vast majority of hospital patients do not
               | arrive in an ambulance, or even through the ER.
               | 
               | A lot of hospital services are elective or planned
               | (surgeries, pregnancies, etc) and for those I've found it
               | very helpful to 'shop' for the best options.
               | 
               | Also, the one time I was in an ambulance, they asked
               | which hospital I wanted my daughter transported to.
               | 
               | All that said, it isn't always possible or feasible to
               | choose - but it's not because of an ambulance.
        
               | vundercind wrote:
               | Yeah, it's usually insurance network that decides where
               | you can go (if you don't want to go bankrupt)
        
               | systemvoltage wrote:
               | You're making an assumption that a hospital is a
               | monopoly. I explicitly said "unless it's a monopoly".
               | 
               | Ok, if "many areas have one hospital"... I don't think
               | that's true _at all_. Most areas have multiple hospitals.
               | Most people live in metropolitan or suburban areas.
        
               | jandrese wrote:
               | Depends on your definition. Do you only have 1 local
               | hospital if there is another in a city that is a 2 hour
               | drive away? Maybe only 1 hour? 30 minutes? Where do you
               | draw the line?
        
               | wernercd wrote:
               | maybe if regulations and taxes weren't so high, there
               | could be more competition? Transparency and the like
               | would help...
               | 
               | Increasing taxes and removing alternatives is never a
               | good deal.
               | 
               | "market forces aren't enough" government forces aren't
               | enough either.
               | 
               | The VA is the penultimate example and I wouldn't wish
               | that upon my worst enemy. That's where our veterans go to
               | commit suicide in the parking lots waiting on help.
               | 
               | 22 Veterans.
        
               | rqtwteye wrote:
               | "The VA is the penultimate example and I wouldn't wish
               | that upon my worst enemy. That's where our veterans go to
               | commit suicide in the parking lots waiting on help."
               | 
               | The people I know who use the VA are quite OK with it.
               | It's not perfect but none of them would want to put up
               | with the insanity the rest of us has to.
        
               | Clubber wrote:
               | It really depends on the hospital.
        
               | FireBeyond wrote:
               | > We're talking about hospitals. Many areas are served by
               | one local hospital. And where there are several, it's
               | typically the ambulance who decides where you go. It's
               | also pretty difficult to compare one hospital with
               | another.
               | 
               | Paramedic here. It's typically, effectively, your
               | insurance that dictates how we decide where you go.
               | 
               | If you're an acute, time-sensitive patient, then from a
               | multitude of angles, "closest appropriate facility" makes
               | sense.
               | 
               | Perhaps you dislike a hospital, or it's inconvenient, and
               | you're not as acute or timely a patient, and your view is
               | "I want to go to X hospital, and since I'm paying, why
               | shouldn't I get to choose?"
               | 
               | As a paramedic, personally, I don't care.
               | 
               | However.
               | 
               | Your insurance does. And their perspective (sometimes
               | rightly, and quite regularly wrongly) is that if you are
               | well enough to bypass a hospital or multiple hospitals en
               | route to a "chosen" facility, then did you need the
               | ambulance? And if you didn't need it, why are "they"
               | paying for it?
               | 
               | What they want to see happen, and what generally is
               | actually the better option, as a provider is "we will go
               | to the closest facility where they will assess and
               | stabilize you as needed. if you then wish to be
               | -transferred- to your facility of choice, they will
               | organize that" (and, since the insurance criteria and
               | questions are met, and a physician ordered the EMS
               | transport, you should be covered).
               | 
               | Even beyond that, the area I'm in we have two hospitals.
               | One is a Level 2 Trauma Center, one is a Level 3, but
               | they're mostly comparable except for, well, acute trauma.
               | We as providers will have a solid perspective of patient
               | load in the ED of those hospitals, so I might ASK, not
               | TELL you, hey, we might want to go to Hospital B, not A.
               | And occasionally, though diversion is a convenience, not
               | a concept under EMTALA (we can still absolutely show up
               | at the ED with a patient even if they're "on divert"),
               | some of the facilities here will round-robin to balance
               | patient loads.
               | 
               | (Also, don't start me on Certificates of Need, where new
               | hospitals essentially have to get the permission of
               | existing hospitals in the area before they can open -
               | essentially, "will you be okay if we take patients away
               | from you"...)
        
             | refurb wrote:
             | A comment on YC, a social media platform formed by a
             | venture capital organization, and a comment saying
             | "motivated by profit" gets downvoted.
        
               | uoaei wrote:
               | Almost as if communities are neither monoliths nor
               | hiveminds!
        
             | uoaei wrote:
             | > fundamentally sound
             | 
             | The language you've chosen is baldly ideological and
             | leaaves no room for good faith discussion.
        
             | Peanuts99 wrote:
             | As someone from the UK this is a strange thing to hear
             | about a healthcare institution. In my view the end user is
             | a patient and not a customer.
             | 
             | If a sandwich shop produces bad sandwiches then eventually
             | people stop buying them and shop around. This doesn't work
             | with hospitals. In the worst case, dead people can't shop
             | around.
        
           | gruez wrote:
           | >The rise in private equity purchases of hospitals indicates
           | that the money is going somewhere and it's certainly not any
           | kind of "charity".
           | 
           | Ironically when they get bought out by PE they lose their tax
           | exempt status, so that's kinda solving the problem.
        
             | Projectiboga wrote:
             | If purchased with "carry forward" capital than it becomes
             | tax differed until any of that is withdrawn.
        
               | twoodfin wrote:
               | That's apples and oranges. PE-owned businesses pay
               | corporate income tax just like any other for-profit
               | entity.
        
         | jadbox wrote:
         | Credit Unions are far more than just banks. That's like saying
         | Apple iOS and Linux are pretty much the same. They both do have
         | similar features, but the relationship towards the user/member
         | is arguably different in practice. I.e. cooperative owner vs
         | customer-to-extract.
        
           | garciasn wrote:
           | That's like comparing for-profit higher ed and not-for-profit
           | higher ed.
           | 
           | Both are entirely motivated by money; one just is overt about
           | it.
           | 
           | Everyone is all about making the most money in the fastest
           | way possible and few truly give a hoot about the people they
           | use to achieve the goals.
        
             | danudey wrote:
             | Both are motivated by _money_ , but only one is motivated
             | by _profit_. The drive to increase profits over and over,
             | year over year, indefinitely is to the detriment of society
             | as a whole.
             | 
             | Meanwhile, not-for-profit entities like credit unions don't
             | need to justify _not_ making an extra few billion dollars
             | this year compared to last year, meaning they 're less
             | likely to make customer-hostile moves for their own sakes.
        
             | AlbertCory wrote:
             | What no one has stated so far is: jobs and salaries at non-
             | profits have almost no discipline applied to them; market
             | or otherwise. If they lose a little more money this year:
             | ok, so what?
             | 
             | WETA (the public TV station) paid Sharon Percy Rockefeller
             | $855,000 in 2022. The 12 highest paid employees all made
             | more than $300,000. Maybe they are all "worth it" but how
             | could you prove that WETA wouldn't function just as well at
             | median salaries for everyone?
             | 
             | https://apps.irs.gov/pub/epostcard/cor/530242992_202206_990
             | _... (page 71)
        
           | jltsiren wrote:
           | From my non-American perspective, any organization that
           | exists to provide material benefits to its owners / members /
           | employees / other affiliates is a for-profit organization. A
           | non-profit should pursue public interests, and only its core
           | activities should be tax exempt. If a non-profit operates a
           | business, that business should pay taxes normally.
        
             | nickff wrote:
             | The problem is that there are no truly 'public' interests,
             | there are only clusters of private interests. Going down
             | this route would eliminate all non-profits (which I'm not
             | entirely against).
        
               | jltsiren wrote:
               | And other people claim that the personal is political and
               | that there are no truly private interests.
               | 
               | In practice, there is a shared understanding what acting
               | in the public interest means in that particular society.
               | Laws can also provide a non-exhaustive list of examples
               | to clarify the meaning.
        
               | nickff wrote:
               | I disagree that there is a 'shared understanding'; for
               | instance, the latest Freakonomics podcast episode
               | featured an interview where the subject stated that live
               | theatre was a social good that was critical to a
               | functioning society, and worthy of public subsidy. I like
               | theatre, but think it's a luxury good. There are many
               | similar 'interests'.
        
               | jltsiren wrote:
               | It obviously depends on the society. Theatres run or
               | subsidized by a state or a city are common. In many
               | countries, supporting national culture is seen as one of
               | the key functions of the government. Most people in those
               | countries agree with that, and even those who don't
               | generally understand that they are in the minority.
        
               | lmm wrote:
               | > In practice, there is a shared understanding what
               | acting in the public interest means in that particular
               | society
               | 
               | No there isn't lol. Half of society thinks promoting one
               | political party is in the public interest, the other half
               | thinks promoting the other one is. Same for religions,
               | same for handling unwanted pregnancies, same for
               | education...
        
             | PaulDavisThe1st wrote:
             | "Profit" means income in excess of expenses, and in for-
             | profit companies the profit is used either reinvested or
             | paid to the owners as a dividend.
             | 
             | Credit unions (and other US 501c3 organizations) do not
             | exist to make a profit, and any income they have in excess
             | of expenses is reinvested. There are no dividends.
             | 
             | These are two utterly different sorts of things.
        
               | jltsiren wrote:
               | As I said, that was my non-American perspective.
               | 
               | You gave a specific legal definition in a single
               | jurisdiction. It does not match the definition in many
               | other jurisdictions or the intuitive understanding many
               | people have.
               | 
               | From my perspective, there is no fundamental difference
               | between an ordinary company distributing its profits as
               | dividends, an employee-owned company distributing profits
               | as higher wages or bonuses, and a coop distributing its
               | profits by providing better/cheaper services to its
               | members. They are all for-profit businesses. Only the
               | mechanisms of profit distribution are different.
        
               | rqtwteye wrote:
               | "Credit unions (and other US 501c3 organizations) do not
               | exist to make a profit, and any income they have in
               | excess of expenses is reinvested. There are no
               | dividends."
               | 
               | A lot of non-profits funnel the "income they have in
               | excess of expenses" to their execs or friends of the
               | execs who provide business services. They don't reinvest
               | or give to charity.
        
               | bongodongobob wrote:
               | I don't see the difference. Just increase what you pay
               | your execs. Boom, you didn't make a profit.
        
               | piperswe wrote:
               | If there are no dividends, then why is my checking
               | account called "Dividend-Bearing Checking"?
        
         | justin66 wrote:
         | > Credit Unions are nice, but they're still just banks.
         | 
         | That's just lazy and ignorant. This falls into the _please read
         | the relevant material on wikipedia_ category.
        
         | eli_gottlieb wrote:
         | >The median operating margins for hospitals is around 0% or
         | some times negative. Injecting more costs into the system is
         | only going to push prices further upward.
         | 
         | Well if they can't run themselves within a budget constraint
         | and require outside subsidy/transfers to function, they should
         | be public services rather than private firms, for-profit or
         | nonprofit.
        
         | bobthepanda wrote:
         | Credit unions and regional banks have historically been
         | advantaged in the US because these types of lending
         | institutions make up a disproportionate amount of rural and
         | small business lending.
         | 
         | One notable feature of the banking system in the US is that
         | it's relatively unconcentrated. Only three major banks hold
         | more than 10% of deposits in the US, at which point the feds
         | actively block bank mergers barring something exceptional, like
         | JPMorgan Chase absorbing SVB to save it.
        
         | Workaccount2 wrote:
         | Amazon didn't make money for years.
         | 
         | These hospitals are spending immensely on expansion. Just think
         | about how every (or the one) hospital around you seemingly has
         | all manner of offices and facilities everywhere. Many even have
         | gyms/"wellness centers".
         | 
         | You don't build a gym when you are borderline bankrupt. You
         | build a gym when you need to spend money.
        
         | tiffanyh wrote:
         | > The median operating margins for hospitals is around 0% or
         | some times negative. Injecting more costs into the system is
         | only going to push prices further upward.
         | 
         | You only pay taxes on Profits (not Losses).
         | 
         | So what's the argument you're trying to make?
         | 
         | It's not like paying taxes would cause you to become
         | unprofitable.
        
           | dgtfxxtfhh wrote:
           | Nope. Property taxes.
        
             | maximilianroos wrote:
             | Having non-profits pay property taxes -- similarly to how
             | they pay employer taxes -- seems like a good step. Property
             | taxes are in part a fee for benefits which non-profits
             | receive.
             | 
             | It would also incentivize local governments to encourage
             | the growth of non-profits. Currently Cambridge's tax
             | revenue is negatively affected by Harvard's growth...
        
         | moomin wrote:
         | I mean, if they're not turning a profit, taxation isn't going
         | to be a problem, but what I really want to know is: the USA has
         | the most expensive health care system in the world, with the
         | worst outcomes of any first world system. How is it not making
         | money?!
        
         | glompers wrote:
         | A healthy proportion of local American hospitals were set up
         | and later expanded through many, many rounds of charitable
         | proto-crowdfunding in the first place. Fraternal (Shriners),
         | ones with Saint in the name, and so on.[0] Credit unions were
         | of course formed to provide local lending pools in good times
         | and bad and to smooth out the peaks and troughs of credit
         | availability.
         | 
         | The phenomenon that a lot of American credit unions now
         | advertise and compete with the capital markets (for where to
         | get money from, or where to invest it) and with interstate
         | banks, or that farm-credit nonprofits compete with nationwide
         | programs, is an unanticipated and relatively recent legal
         | development (and most interstate banking holding companies
         | themselves are only 40-50 years old - before that, they
         | couldn't coordinate across state lines).
         | 
         | The wider phenomenon that it sometimes seems like "everybody
         | with the choice to do so" is merging into the fast lane due to
         | red tape and other incentives is partially sampling bias, but
         | even if it's true I don't consider it to provide proof that we
         | should get rid of any remaining slow lanes. Probably we need
         | more specific types of slow lanes, some of which will let you
         | switch lanes later but cost you the back taxes.
         | 
         | There are many different nonprofit tax code section 501 types
         | already, but I don't think that nonprofit status itself is a
         | very well tailored conceptual solution to answer "what kind of
         | slow lanes are useful nowadays?"
         | 
         | There are many commons and cooperative options that are hard to
         | shoehorn into 501(c)(3). It would be nice to have some social
         | benefit activities protected from taxation even in otherwise-
         | taxable cooperatives. While some American state legislatures
         | have enacted a "Low Profit Limited Liability Corporation" or
         | L3C status available, the first thing you learn about it is
         | that it is no different in tax status from any other LLC. HM
         | Government in the UK offers a CIC or Community Interest Company
         | business model, and this requires all profits to be reinvested
         | for the benefit of a geographical area designated by the
         | enterprise, and has an asset lock so that its possessions
         | cannot be distributed to shareholders, although there can be
         | shares traded -- all of which might be steps in a promising
         | direction. But again there is no tax exemption (partial or
         | total) for which these social enterprises are specifically
         | eligible.
         | 
         | [0] https://en.m.wikipedia.org/wiki/Jewish_Hospital
        
         | clcaev wrote:
         | Perhaps limit employee income differentials in these non-
         | profits and have stricter rules regarding definition of
         | employment.
         | 
         | Require democratic voting among a broad membership, including
         | customers and/or employees, not a tiny board passed down among
         | a small group of insiders.
         | 
         | Of all of these, I support credit unions having this status.
         | Their members have a democratic vote.
        
       | francisofascii wrote:
       | Setting more appropriate land taxes would be a good start, which
       | is much easier then trying to figure out how to tax income. The
       | harder part is reducing the tax liability based on the "public
       | good" or "how benevolent" the organization is. Hard but not
       | impossible. For example, a private golf club would pay higher
       | taxes than a public golf course. Or a church that allows anyone
       | in or has tons of community outreach to the neighborhood pays
       | less or no taxes vs a church that has tons of requirements or
       | hoops to jump through.
        
         | downrightmike wrote:
         | According to Glassdoor, the average salary for a Catholic
         | priest in the United States in 2024 is $104,699 per year, with
         | an estimated total pay of $206,187 per year. This includes an
         | estimated additional pay of $101,488 per year, which could
         | include cash bonuses, tips, commission, and profit sharing.
         | 
         | https://www.glassdoor.com/Salaries/catholic-priest-salary-SR...
        
           | francisofascii wrote:
           | I don't think that figure is accurate. Most priests make
           | under 100K. And priests are taxed as individuals, not as non
           | profits, so I am not sure of the relevancy.
        
           | svieira wrote:
           | The fact that the second entry on that list was "Baptist
           | Hospital" makes me _slightly_ suspicious of the validity of
           | the data.
        
           | laweijfmvo wrote:
           | sorry, what "profit" sharing??
        
           | ecshafer wrote:
           | Priests are taxed as individuals so this doesn't seem
           | relevant. But besides the fact that glassdoor's salary
           | estimates are at best ludicrously off. Several of the top
           | companies for "Catholic priest" on that page are protestant
           | organizations, so I will take this with a grain of salt.
        
       | gumby wrote:
       | Hear hear. But why not abolish the category completely?
       | 
       | > The U.S. needs a principled, rules-based approach to 1)
       | distinguish between benevolent organizations and tax-exempt
       | businesses,
       | 
       | There's no reason why a food kitchen, museum, university, church
       | or whatever can't simply run at a loss in perpetuity (or until it
       | can't get any more donations). No decision on its tax status is
       | needed.
       | 
       | Charities pay the same price for phone service, postage,
       | salaries, rent etc. Yet we'd have a complex infrastructure for
       | deciding if they should get a break on one line item, taxes.
       | Sawing off that whole infrastructure would simplify things
       | greatly.
       | 
       | I don't mean to sound like some Libertarian here. It's just that
       | I've long considered the distinction between "non profit" and
       | "for profit" crazy.
        
         | readthenotes1 wrote:
         | It's another complication in the tax code for the cognoscenti
         | to exploit
        
         | spyckie2 wrote:
         | Policy is not always about how much tax one pays, it's about
         | landscaping your society.
         | 
         | The difference between a town with unique, local shops and a
         | town with sprawling landscape of walmarts is the policies of
         | those towns, one of the big ones being tax code. Policy is just
         | a way to execute on decisions for what kind of social outcomes
         | your society wants.
         | 
         | In this instance, abolishing the category completely is
         | essentially saying we don't want any non-profit organizations
         | to exist as a legal structure, which is probably not the
         | intention.
         | 
         | Policy design favors strongly directed outcomes over reducing
         | complexity of legal code (because we have a robust legal
         | institution). So, yes, it is increased complexity. But most
         | complexity is not out of reach. Most small organizations have
         | the budget to handle policy complexity, even if many
         | individuals do not.
         | 
         | Ideally, good policy is tested as well and actually creates the
         | effect it was intended for. A great example of bad policy
         | design, IMO, is the plastic bag ban in California. Its
         | intention is to reduce plastic waste, but the actual
         | implementation probably didn't.
         | 
         | All in all, it's a deep issue because you can then argue if the
         | non-profit status really creates benevolent organizations AT
         | ALL, or if it just creates tax-exempt businesses. But if you go
         | down that route, you're essentially "joining" in the
         | conversation - it's exactly what this article (or the research
         | behind the article) is trying to figure out.
        
         | toast0 wrote:
         | > Charities pay the same price for phone service, postage,
         | salaries, rent etc. Yet we'd have a complex infrastructure for
         | deciding if they should get a break on one line item, taxes.
         | Sawing off that whole infrastructure would simplify things
         | greatly.
         | 
         | I mean, they often don't pay the same prices. Recognized
         | organizations often have a lower price option for many
         | services. Landlords often charge below market rent to
         | charities. Utilities often have a lower tariff for charities.
         | Charities may not have to pay sales tax, so the goods they need
         | are less expensive (yeah, that's another tax, but). Nonprofit
         | Mail is printed material eligible to be mailed as USPS
         | Marketing Mail(r) at significantly reduced nonprofit postage
         | rates. [1]
         | 
         | Salaries sure, except there's a good amount of people who will
         | work for less or free, if it's for a charity they find
         | compelling.
         | 
         | Qualifying for the break on income taxes drives the discounts
         | on all the other things.
         | 
         | [1] https://faq.usps.com/s/article/What-is-Nonprofit-Mail
        
           | bombcar wrote:
           | From a 10000 foot view, the non-profit designation is the way
           | the government says "the tax we'd get from you, and your cost
           | to file the paperwork, is not as valuable as what you
           | provide, so we'll skip it."
           | 
           | It's one of the available "force multipliers" that the
           | government has to try to "cost X but do Y" - just like
           | backstopping loans, etc.
           | 
           | It does distort the "market" - that's the whole point.
        
             | gumby wrote:
             | Actually non-profits to have file just as much annual
             | paperwork as a regular tax return, plus getting the status
             | takes a long time and involves a lot of paperwork too.
             | 
             | And if they aren't making a profit they aren't paying
             | taxes, regardless of filing status.
        
       | Laaas wrote:
       | Non-profit tax exemptness is good actually. It incentivizes
       | charity over profit-seeking ventures. Changing this would
       | increase taxes in the short term but be bad long term.
        
         | addicted wrote:
         | Unfortunately non profit != charitable.
         | 
         | That's what this article is all about. Separating charitable
         | non profits from non charitable non profits and taxing the
         | latter.
        
           | Laaas wrote:
           | No, a non-profit is by definition a charity _for something_.
           | It's a public benefit, and thus not taxed.
           | 
           | If it's not a charity, but uses 501(c)(3), that's just tax
           | fraud! Tax fraud is already illegal!
           | 
           | You read the law at
           | https://www.law.cornell.edu/uscode/text/26/501
        
             | addicted wrote:
             | I deliberately avoided the usage of the term "charity"
             | because the legal definition for tax purposes is indeed
             | different from what people colloquially think of as
             | charities.
             | 
             | I used the unwieldy terms "charitable non profit" and "non
             | charitable non profit", and your link proves me right by
             | explicitly pointing out that charitable organizations are
             | only 1 form of non profit that is tax exempt.
             | 
             | > exclusively to religious, charitable, scientific,
             | literary, educational, and fraternal purposes
        
             | HDThoreaun wrote:
             | Most hospitals are not charities. Theyre run by MBAs and
             | everything is about profit margins
        
         | readthenotes1 wrote:
         | I know someone in real estate who is advised by his wealth
         | advisor to set up an apartment building that gives lower rents
         | to wounded veterans in his small town.
         | 
         | That way it would be non-profit and he wouldn't have to pay
         | property taxes and the one or two wounded veterans might get a
         | good place to stay but he would be making bank with the other
         | tenants
        
           | bombcar wrote:
           | As a note these kinds of things the IRS figures out ...
           | eventually, and then they have you.
           | 
           | The realities of real estate investment involves a ton of
           | things, but there is probably some advantage to renting to
           | veterans, it's not to the point of writing off the entire
           | income from an entire building.
        
         | SketchySeaBeast wrote:
         | The trick there would be to actually incentivize charity
         | instead of bloat and wallet fattening.
        
         | rqtwteye wrote:
         | That's the theory. In practice it incentivizes a lot of
         | corruption.
        
       | egh wrote:
       | Incoherent argument. Non-profits pay sales taxes, income taxes
       | for employee salaries, and, in many cases, property taxes. The
       | only thing they aren't ever paying taxes on is profits,
       | because... they are non-profits. They don't pay out profits to
       | owners.
       | 
       | Some non-profits are exempt from property taxes and other taxes
       | (e.g. universities) and abuse this by becoming huge landowners.
       | This should probably be reined in.
        
         | bombcar wrote:
         | You can pretty closely simulate a non-profit with a for-profit
         | enterprise with a bit of "clever accounting" _as long as you
         | 're not taking profits out_.
         | 
         | Once they come out, they get taxed, as salary or distributions.
         | 
         | What the for-profit ALSO gets taxed on is "income" but if you
         | manufacture expenses you can keep your income low or non-
         | existent (this is what companies do when they transfer their IP
         | to a tax haven and then charge themselves for it).
        
         | oceanplexian wrote:
         | It's ridiculous we are trying to find more ways the government
         | can rent-seek. Corporations are taxed on profits, they are
         | taxed when they pay employees, the employee is taxed on their
         | income, and the employee's post tax dollars go to pay sales
         | tax, the remaining money goes to businesses that pay tax, and
         | then the whole thing repeats again. The government is a literal
         | parasite on the economy.
         | 
         | I am repeatedly surprised when people argue that lower taxes
         | don't improve the economy, it's as obvious as water being wet
         | or the sky being blue.
        
           | EasyMark wrote:
           | I think it's because most people who declare "less taxes are
           | good for the economy" don't want to pay taxes at all and
           | would be willing to let infrastructure and society rot in
           | order to make a few more dollars. There has to be an optimal
           | level, and surely it isn't always "less".
        
             | Jach wrote:
             | Meanwhile the infrastructure is not exactly doing great in
             | many places, and it seems doubtful that it would be doing
             | particularly better with more taxes collected. Anyway,
             | there's been a pretty clear trend towards not-less, even in
             | just the last few decades (really, compare quality of
             | services and infrastructure at revenues and debts in the
             | 90s to now), without a clear sign that it's actually worth
             | it or that more would make anything better. A fruitless 20
             | year war didn't help either.
        
               | Teever wrote:
               | How does infrastructure look in places like Norway and
               | Finland?
               | 
               | Why can those countries have what they have but America
               | some how can't?
               | 
               | What are they doing that America isn't?
        
               | asdasdsddd wrote:
               | They have a high trust society where people follow rigid
               | norms thereby lowering the cost for infrastructure. For
               | example, they probably don't need to clean the streets as
               | much because people don't shit on the sidewalk.
        
             | Clubber wrote:
             | >and would be willing to let infrastructure and society rot
             | in order to make a few more dollars.
             | 
             |  _In fiscal year (FY) 2023, the government spent $6.13
             | trillion._
             | 
             |  _The federal government spent $44.8 billion on
             | infrastructure in 2023 and transferred an additional $81.5
             | billion to states._
             | 
             | That's a hair over 2%. Certainly you can imagine people
             | wanting to cut the budget in other places.
        
         | Dalewyn wrote:
         | >They don't pay out profits to owners.
         | 
         | And then there are damning examples like Mozilla
         | Corporation/Foundation.[1]
         | 
         | There are organizations that should be registered and handled
         | as non-profits, but I also think a lot of the non-profits today
         | are scams warranting a clean up.
         | 
         | [1]: https://assets.mozilla.net/annualreport/2022/mozilla-
         | fdn-990...
        
           | bhelkey wrote:
           | This is a sixty page document. Is there something specific
           | you want to call attention to?
        
             | Dalewyn wrote:
             | 1. It's a non-profit organization, see page 2.
             | 
             | 2. The chairman received just over $6.9 million dollars in
             | compensation, see page 8.
             | 
             | 3. Consider the above against what I replied to earlier.
        
               | asdasdsddd wrote:
               | The 6.9 million is income taxed so what's the problem, it
               | would be the exact same tax scheme if it was a for-profit
               | business.
        
               | Dalewyn wrote:
               | One of the justifications argued for non-profits is they
               | "don't pay out profits to owners".
               | 
               | MoCo/Fo is one, particularly outlandish, example where a
               | "non-profit" makes a substantial profit and pays it out
               | to its owner(s).
        
       | ProllyInfamous wrote:
       | Tax. The. Church.
        
         | loco5niner wrote:
         | When I tithe to my church, I've already been taxed on it. It
         | would be a real bummer for it to be taxed again.
        
           | AnimalMuppet wrote:
           | You're not taxed on it if you deduct your charitable
           | contributions. (Presuming you're in the US, and don't make so
           | much that you're under Alternative Minimum Tax, and maybe a
           | few other assumptions...)
        
       | kemotep wrote:
       | It's hard to take the Tax Foundation seriously when they say we
       | need to aggressively go after non-profits when one of their
       | current top articles is handwringing about the Trump tax cuts
       | expiring.
       | 
       | The tax code absolutely needs to be simplified. Corporate taxes
       | are not as efficient as Land Value taxes but if lowered or
       | eliminated it and replaced it with the LVT, what would that even
       | mean for "non-profits" at that point?
        
       | jeffbee wrote:
       | There's something weird about the article, as if "1 billion" has
       | been used as a placeholder for a real figure that was never
       | filled in. For example in at least two places it says that the
       | gross and net tax gaps are $1 billion, but the IRS estimates are
       | close to $500 billion.
        
       | csdreamer7 wrote:
       | A lot of complaining about the tax exempt economy, but almost
       | nothing about large corps that get away with deferring taxable
       | income; and would lead to much fewer grants and dues from these
       | companies that pay the Tax Foundation's bills.
       | 
       | The Tax Foundation glosses over, and sounds defensive, over the
       | swiss cheese rules for corporations right now. A lot of us have
       | been discussing a tax credit that Congress recently changed that
       | only large tech companies would see a tax benefit to take over
       | the paperwork.
       | 
       | https://taxfoundation.org/blog/corporations-zero-corporate-t...
       | 
       | Then there are flat out tax breaks such as oil revenue being
       | exempted from AMT with generous deductions that normally take
       | other firms years to get.
       | 
       | https://www.investopedia.com/articles/07/oil-tax-break.asp
       | 
       | A few of the organizations they complain about are either owned
       | by the US government, works very, very closely with US govt, or
       | are state institutions. Why should the US tax itself? It just
       | adds more paper work because it would need subsidies. A US
       | Government institution has so many more responsibilities than a
       | private corporation. The real reason is that many large corps
       | want to get rid of the spoiler in their market and already
       | collect even more revenue (make credit unions and the deals they
       | offer go by-by).
       | 
       | Congress enacted these institutions decades ago to stabilize the
       | market and provide access to people the corps did not want to
       | serve. Banks are still retreating from rural areas-think of how
       | much worse it will be if credit unions have to more profit
       | focused.
       | 
       | Taxing state institutions such as universities; this US Supreme
       | Court will not be receptive to that even if Congress does pass a
       | bill; and politically, it is not going to happen.
        
       | jedberg wrote:
       | I'm ok with hospitals not paying taxes. In fact it would be great
       | if they got tax credits. Any taxes imposed on hospitals will just
       | make health care cost more and not provide any benefit to
       | society.
        
         | rqtwteye wrote:
         | Yes, let's pump even more money into an already obscenely
         | overpriced system.
        
           | jedberg wrote:
           | The assumption is that any credits would be tied to lowering
           | costs for patients.
        
             | Analemma_ wrote:
             | And that assumption is insane.
        
             | rqtwteye wrote:
             | Lowering cost for patients is not an objective of this
             | system. They will take the money and pay their execs and
             | shareholders more.
        
       | tmpz22 wrote:
       | > An "Outside the Lines" investigation of 115 charities founded
       | by high-profile, top-earning male and female athletes has found
       | that most of their charities don't measure up to what charity
       | experts would say is an efficient, effective use of money.
       | 
       | https://www.espn.com/espn/otl/story/_/id/9109024/top-athlete...
        
       | ein0p wrote:
       | With the Congress as rotten and corrupt as it is today, good luck
       | trying to "rein in" anything of this magnitude. I'm sure the
       | bribes will be quite a bit fatter though if they pretend to be
       | interested in solving this problem.
        
       | wernercd wrote:
       | Yes... lets make life more expensive by getting rid of taxes.
       | 
       | The reason life is so expensive OBVIOUSLY isn't because of the
       | massive and ever increasing tax burden. NOOOO of course not. Its
       | because people aren't taxed enough.
       | 
       | So lets increase taxes more so we can have goverment solutions to
       | the government problem. Obviously we simply aren't governmenting
       | enough.
       | 
       | Yo dawg... I heard you like government. So I got some government
       | to put in your government!
        
         | apsec112 wrote:
         | US taxes as a percent of GDP are close to post-WWII lows
         | 
         | https://www.crfb.org/blogs/2023-revenue-plunge-confirms-2022...
        
       | nycticorax wrote:
       | Don't most economists think that corporate profits should not be
       | taxed? (When all else is held equal.) By that argument, the real
       | problem is taxation of the profits of for-profit corporations...
        
         | mcmcmc wrote:
         | No, that's a wild generalization. _Some_ economists think that.
         | Some are paid to say it. And many more think the opposite.
        
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