Shouldering the burden of our neighbours: how exemptions in US tax law affect global and domestic health philanthropy

J. Sam Meyer

LSE Research Online Documents on Economics from London School of Economics and Political Science, LSE Library

Abstract: 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?

Keywords: health policy; philanthropy; tax law; politics; global health; US (search for similar items in EconPapers)
JEL-codes: I18 K34 (search for similar items in EconPapers)
Pages: 11 pages
Date: 2021-04-12
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Published in Journal of Health Policy and Economics, 12, April, 2021, 1(1). ISSN: 2732-4729

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