I'll not dispute the impact on expansion and consolidation, but I will say in recent months I have seen a number of hit pieces on the 340B program, mostly bankrolled by pharma companies (not this one just calling out the trend).

The exact implementation might be flawed, but if 340b is eliminated it will kill many hospitals in underserved communities.

So any plan to change 340B should really also explain how to fund these critical hospitals.

In the way that surgeries used to be the "money maker" to subsidize other expensive service lines like an ED, pharmacy has filled that gap in recent years.

It is less hospitals getting rich off overcharging insurance for drugs and more hospitals overcharging insurers for drugs since everything else they do is a drain on finances.

Really seems to me that there should be no exemption for land tax for non profits or religious reasons. It is just far too subject to abuse, and it means that we have large churches in the middle of incredibly dense cities that pay almost nothing in taxes.

340B is half the reason hospitals can even help treat homeless individuals, people who can't afford their bills, people on end of life care, etc.

I've consulted with two large health systems that begin with A and they use 340B to subsidize all sorts of treatment.

Unfortunately American healthcare naturally seeks to socialize treatment, but instead of it being direct its in the most round about ways.

Really well executed one page executive summary at the top of the article for anyone interested. Despite the oddity of being a gdrive link:

https://drive.google.com/file/d/1wzGqzWHDQA4m8DIo174yqx-eYDk...

At least the early comments seem very focused on churches despite this article literally mentioning "religious" uses once and focusing nigh exclusively on hospitals.

Universities and hospitals are some of the worst offenders in situations like this, especially in urban cores, likely empowered by their clear transformation into state-sanctioned "non-profit" businesses that provide a good we are compelled to consume if we are a normie who wants a reasonable guarantee of a comfortable, healthy economic existence.

I'm thoroughly perplexed as what is this doing on HN and how it connects to any Hacker News?

>property taxes

Call it what it is, a perpetual rent.

There's nothing funnier than a lot of people taking some absurd principles for granted when they make no sense at all, property taxes being one of them. So imagine you grind at least 30 years of your life working extra hours or two jobs to pay for an already inflated asset based on speculated prices rather than the actual cost, only to end up with that asset in a perpetual rent agreement where if you stopped paying it you basically don't own it anymore, a rent that also isn't controlled, so you can get screwed in the future like how a lot of people ended up selling their house because their retirement isn't enough to cover such rent.

Make it make sense, the only real winners here are the banks after they collect all that compound interest throughout all these years, and the government taking all these taxes.

TL;DR taking properties off the tax roll costs the remaining taxpayers more. Pretty basic stuff. I've been talking this up to local electeds for decades, with very little progress. The only success I've had is ending the local program that makes "historic" properties tax exempt, but the huge whale exemptions for hospitals and whatnot remain.

We need a prominent [even more] obvious scam "church" to abuse the system so badly that the exemption is eliminated for all.