I just purchased an item from Amazon and I was charged sales tax on this purchase. So, how does it work? Some items are taxed and others are not?

There was a concept a few years back that internet sales should be exempt to promote growth of that marketplace.

But now the internet is fully mature. I buy from Amazon not because it's tax exempt but because there's a huge selection and -- for $80 a year -- I can get anything I buy in two days without having to drive all over town.

It's time to treat these companies like any other business.

Absolutely, Internet companies need to start paying taxes on sales they make to CA residents.

The false premise as I see it is not where the company exists but rather, where the buyer exists.

If I live in California and I buy a product, I use it here in California, it should be taxed just like the item I buy down at the corner store.

The fact that most companies do not pay their out of state use tax is just another example of why companies cannot be counted on to do the right thing or have high standards. They go for the bottom line at almost every turn.

What about the use tax? You probably talked about it but I missed it. CA residents who purchase from out-of-state that don't pay sales tax are supposed to pay CA use tax. why can't the Board of Equalization implement procedure and enforcement there. They can work or set up affiliation with other states, I take?

What if CA lowered the overall sales tax rate, include the web sales, level the playing field and not increase the overall taxation on purchases?

Pardon me but what is the definition of Taxation Without Representation? Isn't that exactly what your guest wants these companies to do? To pay taxes into a state where they have no representation...

What difference will this make? California has a $24 billion dollar deficit and it is one of only a few states that have both sales and income taxes. Let's figure out how to create a balanced budget, then we can worry about taxing yet another aspect of our lives.

My impression is that online buyers are disproportionately higher-income. Amazon and other online sellers should not be a way for higher-income Californians to avoid paying taxes they owe. I buy a lot on Amazon and take the time to figure out what I owe and pay the use tax every year (which is a time-consuming pain). People owe tax on items they buy on Amazon--it would be much more convenient for the taxpayer if Amazon withheld these taxes directly, it would be fairer to lower-income individuals who don't buy as much online, CA businesses, and those few taxpayers who actually pay the use tax.

So here we have another advocate of raising taxes.... For what? Where would the average citizen of California see any benefit from this type of action? We're already paying 9.75% here in LA County for things we need to purchase to continue our everyday existence. By forcing these taxes on internet sales the ONLY thing that we'll be doing is feeding the beast of government. The legislature will have another revenue stream that they can over-commit, at which point they'll need to find yet another source of income to fund their undisciplined "governance" of this state.

Can you please ask your guest "how many of thoes 1 in 4 people in Los Angeles coming into the hospitals without insurance are illegal aliens??? Why won't anyone discuss that element of the problem????? Taxpayers should NOT have to PAY for people here in this country illegally - they are BREAKING THE LAW - why are we rewarding them???

I think the discussion on online sales tax was completely twisted by your guest who was obviously advocating more taxes on Californians. The sales tax in discussion may be collected by Amazon but it will be paid by residents of California. One more way government wannts to tax us. Why a representative of opposing view was not invited to the program anyway for us to get a balanced view of the subject?

This is not a new tax. Californians are required to pay the sales tax on purchases from out of state, but nobody does. The legislation to make out-of-state vendors collect this tax just closes a loophole. As to fairness, why should we give Amazon a 9.25% advantage over local businesses?

There is a separate issue that you have not investigated yet. MANY of the small "mom and pop" businesses in parts of LA are not paying taxes correctly. What they do is have two cash registers...one for cash, the other for charge/debit. ALl the cash sales just disappear, leaving only the charge/debit as taxable. This often puts the owner just above the poverty line where they can receive benefits such as PELL grants, CAl grants, etc. for their children to offset the cost of college. Meanwhile, they are driving Mercedes and BMW's.

Another issue is free lunch for children. It seems like a taboo item, but there are almost NO safeguards regarding this program. You simply fill out a form stating your income and size of family. Almost always, your child gets free or reduced lunch/breakfast. However, no one is asked to submit a W-2 form, or verify in any way what their actual income is. The schools are complicit in this because in order to qualify for Title One status, you must have a certain percentage of your students on free and reduced lunch. Having gone from a Title One school (teacher) to a non-Title One school, it is SHOCKING to see how LITTLE funding there is in the regular school as compared to the Title One schools. There is NO money for anything.

People forget that regulating interstate commerce conducted from private homes is not new with the internet. After all we've had mail order catalogs since before the USA was founded! 3 principles collide when this happens: that buyers have the obligation to pay tax, that it is easier to get sellers collect it, and that Congress has authority over interstate commerce to avoid a mess of conflicting regulations.

The first two principles say that sellers should collect tax. When they do so the seller isn't actually paying tax, they are just collecting it for the state. But the third says that in the case of interstate commerce, states can only make sellers pay tax if Congress says they can. This is a question of law, not fairness. Will federal law let California simplify its life by making Amazon enforce California's laws on Californians? If so, then California can collect an estimated $1 billion/year in unpaid taxes.

There is a reasonable legal theory under which California can do that. It would be cheap to let California's lawyers test this theory in court. Is there any possible reason to not let them try?

My Dad died at 96, sharp as a tack, a year ago. He had quintuple bypass at 81. At 92, he had a pacemaker and the quality of his life, physically, was the never the same because of all the meds that were prescribed post surgically. He said himself, that as much as he loved and appreciated us, he wished he could have passed away at 90--the prime of his life. More interventioin--esp. at an older age--is not always better.

In regards to late life medical care costs. Three comments: 1) Is this a "duh" statement - Gee, if the body is shutting down - it's going to need more medical care 2) Everyone is unique, and quality of life is most important 3) To quote Monty Python, "I'm not dead yet!"

I think the decision of treament for ederly patients should be decided on a case by case basis. If an expensive procedure will add to the quality of life for the person it should be allowed. This decision is different from adding years to a life that is already dependent on extensive medical care. My 86 yr old mother if very healthy and walks an hour most days. Her doctor wants her to have shoulder replacement operation due to arthritis. Even at her age he recommends this for her because she is independent and has a good quality of life.

WHY should we ration health care for those who have PAID into the system ALL their lives through taxes and co-pays becasue we want to provide for millions of illegal aliens? Why should I pay for Jose who has broken into my country, sent his earnings home TAX FREE and then falls off a truck with a serious head injury, needs the ICU and millions of $$$ in care NEVER having paid one $$$ into the ystem, while my Grandmother, who has earned taxable income all her life, needs a kidney transplant at 78 yrs old BUT Jose has already used the money!! WHY are Americans so whipped by this need for socialism. As a heathlcare worker I have seen the problem!!...its JOse and his coworkers and illegal babies! Close the borders, charge these "residents" their share and you may just see a savings. I invite ANY of the listeners to visit a trauma hospital in Calif and count the uninsured and illegal patients receiving the world's best healthcare!!! Somehwere I made a wrong trun and ended up in France :-(

regarding the rationing of health care, i am an RN who used to work in ICU-CCU in northern california. i think decisions to ration care should be based on an individual basis, with the patient and the doctor being the ones to do this. i am very scared to hear the talk of rationing, because i think it could be a slippery slope. will the government force the elderly and disabled to die because it is cost effective? will we deny chemotherapy to a retarded person, or an autistic child? to a person with alsheimers? who determines whose life is more valuable? i work with disabled children(i am a school nurse)and i know their care is expensive. will we deny them the care they need to live to their highest potential? and by the way, younger people are not necessarily healthier than older ones. in our school district, we have hundreds of kids with diabetes due to the obesity epidemic.

REGARDING END OF LIFE COSTS

Time magazine wrote a wonderful article on this exact subject. They showed that the prestigious Mayo Clinic spends half the cost as UCLA on the last two years of a patient's life. And they dispense excellent care. But their model of efficient and effective care is not rewarded in our current "pay per procedure" format. Look to the Mayo protocol for our solution on this subject.

No matter which direction we choose, I think a stronger effort to manage fraud is necessary as well.

Here in the San Gabriel Valley for example, there are a significant number of cosmetic eyelid surgeries done by asian doctors, on asian patients, and billing the insurance companies by using the diagnosis of ptosis. I think the hospitals are complicit because they too benefit from the billing.

j

Rationing of health care might sound cold, but the role of government is to ensure a good quality of life for its citizens, not necessarily to have them live as long as possible. The cost of life extension should then be bore for the most part by private parties and not by the government. On that note, how do you quantify concepts such as 'quality of life' in order to do a cost-benefit analysis? It seems to me that this is the bigger question, and one that isn't being addressed

As a provider I take Medicare with a secondary but I will not accept any private ins because I have to fight for payment and wait 3-6 months for payment. This is a ruse that a Beaurocrat make decisions, the Ins beaurcrats ration care all the time!

Single payer for all!

We should not pay hundreds of thousands of dollars to keep an old, very ill patient alive when we are not paying for all children to be immunized and for all people in the country to receive adequate healthcare. We need a single payer system, but that's not likely to happen. A public option is necessary. Medicare isn't terrible as one of your guests insists. I'd be thrilled to have Medicare right now, but I still have a few years to go. Currently I have a perfectly adequate HMO, however, it has the limits that all HMOs have. With Medicare, you can go anywhere you like, barring the few doctors that won't take it.

Its obvious that Charlotte as she admitted in her own words hasn't "thought things through"

When my 80 year old mom was dying (two weeks ago) we had a very hard time getting the Drs and hospital to STOP running tests and doing things mediacally that would not have any difference in the outcome. Thank God for the hospice people.

The BIG question nobody asks or answers is why a c-scan costs $11,000 - is that how much elecricity it takes to operate the machine; is that how much the wages adds up to for the people to operate it - where does the $11,000 come from?

adding to my earlier comment:
procedures like pacemakers and hip replacements are not usually considered extraordinary measures. they are not out of the ordinary or experimental and should be covered by any government health plan.
speaking of age, what about the 50 yo male who doesn't take of himself, has a myocardial infarction(most CAD is preventable with lifestyle changes)and thus needs an expensive heart bypass operation? compare this to the healthy 84 yo who has taken care of themselves all their life, and now needs a pacemaker. age should not be the determining factor.

RE universal health insurance
i'm 80 years old, i seldom use medicare, when i use it is with great satisfaction and PERSONAL RESPONSIBILITY, if the government can eliminate abuse, dr's greed and educate the people to help themself, money will be ample.

rationing medical care is just commun scense, no heath care to dying terminal old people and/or 6 onces primies (viable fetus).

All scarce goods and services are, and must be, rationed because there is not enough resources to provide everyone all they want. The question is "How shall we ration the health care, or anything else?"

Price, need, first come first served, personal characteristics, lottery?

The answer depends on the values of the individual considering the problem. Fairness, equality, efficiency? There is no one right answer, but fairness would suggest a single payer system like they have in Europe. I don't favor a value added tax to pay for it because it is mostly another sales tax which does not tax services, and therefore places a much heavier burden on lower income families.

Some of my family members who were corporate ex-pats stay in contact with other ex-pat families after returning to the states... do you see this kind of social network developing in these towns?

When one is 15, 18 is old, when one is 50, 60 is old and when one is 78, 79 is old. I recall a dear hippy friend who always said we should die out at age 40, leaving the world to the young poeple. He was compliant, and dropped dead at age 40. Who decides the age of no return?. Are we going to have "health gestapo"? Or is it more humane to arbitrarily pick an age, and away we go. If it is decided that I am going to have so many years to live, with care, then I want the right to off myself...hand me the poison ahead of time please because I trust myself more than I do the guests on this program..

When should we spend money on healthcare and why? At the end of life is the natural time to expect to spend. But rationing may be too crude an approach. The issue was important for both of my parents. In my mothers case too much healthcare may have been provided, rationing may have been a benefit to her and the quality of her life. In the other care too little care was given. The quality of my fathers life could have been quite good if competent care had been given a few weeks or even days earlier. Based on my observations and as a person in a healthcare profession, I think the problem is the motivation for providing healthcare. Maybe a better approach would be to ration the profit in healthcare and encourage saving on the costs by providing care when it is of most value to the individual.

I want to thank you for having the courage to approach a very, very difficult topic, end-of-life medical care. Dealing with it is the primary goal in controlling our runaway medical costs. Achieving better living standards, i.e., 30% of all Americans are obese, not just overweight, will help, but the real cost control comes with resolving end-of-life issues. The overwhelming expenditures (80%) come at the end-of-life, and the issue is incredibly difficult (even though insurance companies make those decisions every day). The President provided a perfect example when he touched on the topic recently. His grandmother was diagnosed with terminal cancer and given, at best, nine months to live. Then she fell and broke her hip. Hip replacements are routine but they are very expensive. Here is the problem I did not hear mentioned today (I did not get to listen to all of the program), the fact that, in the short run, medical expenses are a zero sum game. A new hip for the President's grandmother means a bunch of children will not have hot lunches at school, some qualified college students will not get loans, a failing bridge will not get repaired, etc. etc.

Medical care now takes 16% to 18% of the total GNP (that is total amount we all have to share) and it is headed for 30%. Every percentage point increase crowds out some other desirable activity. Health care expenditures MUST be considered in that context. I understand all to well that there are some hard choices ahead, and the sooner we start talking about them, the better. So thanks again.