Private benefit, joint ventures, and the death of healthcare as an exempt purpose

The private benefit doctrine has become the IRS' main policing tool for tax exemption in healthcare. The IRS' modern interpretation of private benefit has clearly become the major limitation on exempt status. This Article begins by tracing the common law origins of this doctrine and how it became such an integral part of the IRS' analysis. Next, the author looks at policy issues regarding alternative analysis to the private benefit doctrine in cases of joint ventures between healthcare providers and for-profit investors. Finally, Professor Colombo questions the expanded use of this doctrine, arguing that in its current form it has no sound legal or policy under-pinnings.     

Democracy and socialism

This paper shows that Marx's theory of agricultural rent is not an adjunct to his theory of capital at the level of distribution but is inseparably developed from it. The forms of differential and absolute rent are shown to correspond to the formation of market value and price of production in the agricultural sector respectively, these in turn depending upon the barriers posed by landed property to intensive and extensive cultivation. In appendices, Marx' critique of Ricardo's theory of rent, differential rent on the worst land, a critique of other interpretations of Marx, and the ‘historical transformation problem’ are each considered briefly.     

The role of tax exemption in a competitive health care market

The Federal Trade Commission and Department of Justice 2004 report on competition in health care raises the issue of nonprofit versus for-profit form in several contexts, including their relative financial performance, pricing behavior, and role in caring for the uninsured poor. The report, however, does not discuss in detail the connection between tax exemption and the nonprofit/for-profit debate. Is tax exemption, for example, "buying" charity care for the poor, and would withdrawal of exemption negatively impact health care for the uninsured poor? Or is tax exemption justified on the grounds of other nonprofit behavior outside the financial realm and thus not considered by the report? If nonprofit status does not result in differential financial behavior (as the report concludes) and if competition will end the ability of hospitals to cross subsidize free care for the poor (as the report speculates), is there any reason to retain tax exemption for nonprofit hospitals? This article summarizes the debate on these issues and offers some alternatives to the current structure of tax exemption for nonprofit health care providers.