Op-ed: We can improve public health by cleaning up Washington’s tax code

Losing the front wheel on a walker might sound like no big deal to many of us. But for people with low incomes managing multiple health issues, it can turn into an emergency. It can limit people’s ability to leave home – and during this pandemic, it can make them apprehensive to let anyone in to help. Without resources to pay for a replacement wheel, they might ration critical medications until assistance arrives.

As a family practice doctor, I (Danny) see this kind of impossible dilemma regularly. When people are worried about how to pay for their basic needs, their health suffers.


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The roots of why so many people in Washington are struggling to meet their basic needs right now go back decades. For years, lawmakers have been funneling tax breaks toward ultra-wealthy (primarily white) Washingtonians and big corporations, while eliminating funding for public support programs and other important community investments.

Given that our tax code requires people with low incomes to pay six times more in state and local taxes as a share of income than the wealthiest 1%, it’s not an understatement to say that cleaning up the tax code is good for public health. Washington’s inequitable tax structure not only starves public health and health care systems of resources; it also puts additional strain on the health and financial security of people already falling behind.

Widespread financial distress and economic insecurity contributed to negative health outcomes like increased blood pressure, poorer mental health, and increased suicide during the last recession. Because of historical and persistent institutional racism, the most devastating impacts were for Black, Indigenous, and people of color. People with low incomes and those without a college degree also were hit hard.

However, these poor health outcomes didn’t occur in places where there were strong public supports and where programs existed to help lift people out of poverty, like housing and food assistance. This suggests that targeted investments can protect health.

There’s enough wealth in our state to ensure lawmakers can make the investments necessary to help Washingtonians get by.

Amazon’s Jeff Bezos recently made a record $13 billion in a single a day. Meanwhile, Olympia anticipates a $4.5 billion revenue shortfall in Washington by July 2021. As lawmakers are considering budget cuts that would devastate our communities, it’s unfathomable that Bezos and other ultra-wealthy Washingtonians are still receiving unnecessary tax breaks and not paying their share in state and local taxes. Low-paid workers and other people whose employers have laid them off shouldn’t be falling into poverty as the rich get richer.

Lawmakers must tax highly concentrated wealth to help address looming revenue shortfalls and create a more equitable tax code. They can do this by enacting taxes on excessive salaries, capital gains, and on mansions and other high-value real estate.

Very few households would be affected by these taxes. A tax on excessive salaries, for example, would impact fewer than 0.1% of Washington workers. Similarly, a tax on capital gains, sizable estates, and inheritances would only affect the very richest households – who have largely received their fortunes through racist systems that enabled white people to amass generational wealth.

These progressive tax options could add at least $1.3 billion annually to the state budget.

Finally, the legislature should support people most hurt by our tax code by funding a Working Families Tax Credit, which is modeled after the successful federal anti-poverty program, the Earned Income Tax Credit. This would provide an income boost for people with low incomes to help them pay for necessities, and it would have outsized positive impacts on people of color.

We have both seen firsthand that when people don’t have to worry about paying for food on the table and a roof over their heads, their physical and mental health improves. Amid this economic crisis, Washington’s lawmakers must fix our tax code to support the health of our people and communities.


Danny Low is a family medicine physician who serves on the King County Medical Society board and is a member of Washington Physicians for Social Responsibility. Margaret Babayan is a policy analyst focusing on public health with the Washington State Budget & Policy Center, an organization that advances Washingtonians’ economic well-being.