The medical device tax is a good example of malicious bureaucracy. How can services be subsidized by the goods applied by the services? The first-order cynical

The medical device tax is a good example of malicious bureaucracy. How can services be subsidized by the goods applied by the services? The first-order cynical answer is that medical devices are primarily used by rich Republicans who can easily afford a few percent extra on their artificial knees. It requires no imagination to see why a left wing moonbat would vote for such blatant pandering. The second-order cynical answer is that poor minorities have worse health, and a huge unfulfilled need for medical devices. Thus the device tax is a ghastly unintended consequence of well-meaning liberals. The third-order cynical answer is that it is an intended consequence. They want Lashonda's artificial pancreas to pay for little Cindy's counseling. Much like lotteries exist to get poor people to send rich kids to college. The fourth-order cynical answer is that the whole thing is secretly a ploy to generate plot material for someone's Dune/Washington, D.C. crossover fan fiction.