Shouldering the Burden of Our Neighbours: How Exemptions in US Tax Law affect Global and Domestic Health Philanthropy
J. Sam Meyer
Health Policy, LSE
Faculty of Medicine, Tel Aviv University
Columbia University in the City of New York, IL
About J. Sam
Sam is the founding Editor in Chief of JOHPEC. Orignally, from Toronto, Canada, Sam is currently studying medicine at Tel Aviv University and is a Project Manager at the Israel Ministry of Health COVID-19 Task Force and at the International Consortium for Health Outcomes Measurment (ICHOM) by the Boston Consulting Group (BCG). Sam has extensive experience in trauma medicine and emergency health delivery as both a Pararescueman Commander in the military and co-founder of the first public EMS system in Jamaica. Prior to his studies at LSE, Sam worked at the Mailman School of Public Health in New York City, conducting clinical and fieldwork research in epidemiology and cognitive neuroscience.
Sam holds a Bachelors’s degree in Medical Science and Comparative Literature from Columbia University, and as an MSc Global Health Policy and Economics at the London School of Economics, Sam has focused his disserational research on health systems and performance measures of low socioeconomic populations in high-income countries. He is passionate about the social and economic determinants of health and shaping a future in clinical medicine informed by patient-driven equitable outcome measures.
Changes in healthcare have historically been driven by an equilibrium between two key institutional actors: the government and the private sector. This symbiotic relationship has offered advantages to both sides, as private foundations supplemented the resources and attention given to areas of public concern that were beyond the government’s reach, and the government reciprocally exempted such charitable giving from taxes, and afforded them the freedom to donate where they see fit. However, as the influence of private foundations only grows, their shift from a focus on domestic issues to global health may inevitably shift this equilibrium away from government benefit. Can upward trends in global health outcomes explain the downward trends in domestic ones, and if so, are tax exemptions on charitable donations responsible for the steep decline in US healthcare? In this paper, I will trace the tax exemptions in charitable giving that span from their roots in the autocratic rulers of 15th Century Europe, through their evolution to the democratic governments of today. I will analyze the public health effects of expanding tax-deductible status to organizations engaged in international rather than domestic activities. These tax exemptions are enabled by clause 501(c)(3), a law enforced by the US Internal Revenue Service (IRS). As case studies, I will analyze the Ford Family and Bill Gates, two of today's key actors in global health, who divested from the corporations they founded through their charitable foundations. Despite a glaring decline in US health outcomes, both foundations continue to invest in projects outside the US. In light of current calls for reform, quintessential questions of biopolitics emerge, namely, should one prioritize human life differently within their borders than beyond them? And, should these priorities be different for government versus private, non-state actors?