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Tax changes since the 1980s made pass-through entities (S-Corps) incredibly lucrative. This structure, often labeled "small business," now accounts for over half the income growth for the top 1%, shifting the focus from publicly-traded company wealth.

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An anesthesiologist in private practice as an S-Corp can pay a lower effective tax rate than a salaried hospital counterpart with the same income. The pass-through structure allows them to avoid payroll and Medicare taxes on business profits classified as distributions, not wages.

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