Actually, I like babies a lot. I also like moms, and babies and moms breastfeeding. For the record, I’m also in favor of kittens and puppies and rainbows. But since I’ve been asked twice if I hate babies, I thought I’d clarify.
It started out when a friend posted to Twitter a link to a petition titled “Really, IRS?” which says:
Acne cream is more important to our health than breastfeeding. Excuse me? According to a recent article in the New York Times, the Internal Revenue Service (IRS) has determined that breastfeeding “does not have enough health benefits to qualify as a form of medical care.” Therefore, women cannot count expenses for breastfeeding supplies in their tax-sheltered healthcare spending accounts. Acne cream and denture adhesives, however, do qualify for tax breaks.
Apparently, the IRS has decided it knows more about medicine than the experts at the Department of Health & Human Services and World Health Organization who are actively promoting breastfeeding because of its significant health benefits for mothers and children.
Sign our petition reminding the IRS to leave medicine to the experts!
I foolishly questioned that on Twitter, asking whether everything with health benefits was health care. Several people replied with vigor, and since Twitter turns all serious discussions into slogan shouting matches, I tried to let it go. But since it keeps coming up in real life, I thought I’d put my position on the record.
As I said, I’m in favor of breast feeding, and agree it has important health benefits. But if you go read the original New York Times article, it becomes clear the IRS isn’t denying that. What they’re saying is that unless you have a doctor’s note saying it’s medically necessary, you can’t get the tax deduction for medical care.
That could seem unreasonable. Why is the IRS making medical decisions? Isn’t this the same sort of thing as government death panels, but run by the most heartless and hated of our bureaucracies, and target on innocent babies and their loving moms? How dare they!
That’s not what they’re up to, though. Through Congress, we’ve given them a hard job. People are supposed to pay taxes on all their income, but we make a few exceptions and ask the IRS to police those. One of those is a per-child subsidy to parents, which makes sense; people having kids is good for society, so we help them out. Another is for medical care. Which again makes sense: it seems churlish to tax people for being sick.
But there’s a problem there. There are a lot of things that people do that we don’t, as a society, want to subsidize, even if they have health benefits. Some are things that everybody has to do, like eating and exercising and brushing one’s teeth. Many more are things that for some people might be medically necessary, but for others are nice-to-haves or luxuries.
If you’re recovering from a car wreck, for example, you might really need massages as part of your physical therapy. For me, though, massages might have some health benefits, but they certainly aren’t necessary. Just because a clinic has a hot tub doesn’t mean that we should tax people more to subsidize anybody who wants one at home.
So how do we tell the difference? Well, we asked the IRS to decide for us. They could come up with a lot of very complicated rules and then audit people frequently to see if they’re behaving. But they did something easier, and more clever. Since we already have a system of experts on medicine complete with a professional body who polices them, they use that. If a doctor says something is medically necessary, the IRS takes their word for it. If not, taxpayers don’t help pay for it.
Does this leave some necessary medical expenses uncovered? Sure. Do some people use compliant doctors to sneak in stuff that shouldn’t be subsidized? Undoubtedly. But any system we pick has problems. This seems like a pretty good balance to me, and much simpler than the alternatives.
So back to breast pumps. Are they medically necessary for some people? Yes. And with a doctor’s note, you’re covered. Are they medically necessary for everybody? Definitely not. Some use them for convenience. My brother and sister-and-law, for example, got one so she could go back to work sooner. Medically necessary? No. A good idea for them? Absolutely. One we should support by raising taxes and increasing the complexity of our tax system with a special loophole? I say no.
Instead, I think we should just expand the child tax credit and let parents decide for themselves how to spend that money. If they think a breast pump is the best way to do that, great. If they think something else is more important, they should be able to do that instead, without having to get the IRS’s particular blessing. Not every good idea needs to be written into the tax code.