Originally Posted by The Rani

As I've already pointed out, what I said is that they will NOT pay it. Here it is again:

I see you really have picked up the mantle from Justin. Yea, sure, that's what you meant.

You should come to NYC; we have this bridge you can sell over and over again to noobs.

Entertaining.

Originally Posted by JohnMc82

If you read the data closely, you'll see that non-finance professionals in the top 1%, like hot-shot doctors making $200-500,000 a year, actually pay much higher income tax rates than the financial leeches in the top .1%. They also pay a much higher percentage of their income to payroll, and to student loans, and to malpractice insurance. The closer you get to the top, like at the Forbes top 400 list, the more tax rates approach the reduced capital gains rate. And that doesn't really scratch the surface of off-shore holdings.

So, there's no reason to conflate driving a BMW to work with owning a private jet. It's the latter, not the former, that is the root of income inequality in America.

Doctors paying whatever taxes has nothing to do with their compensation driving up health care costs.

You're being a little defensive about the docs and their salaries; do I sense perhaps a little bit of a conflict-of-interest here? Wife?

Originally Posted by JohnMc82

If you read the data closely, you'll see that non-finance professionals in the top 1%, like hot-shot doctors making $200-500,000 a year, actually pay much higher income tax rates than the financial leeches in the top .1%. They also pay a much higher percentage of their income to payroll, and to student loans, and to malpractice insurance. The closer you get to the top, like at the Forbes top 400 list, the more tax rates approach the reduced capital gains rate. And that doesn't really scratch the surface of off-shore holdings.

So, there's no reason to conflate driving a BMW to work with owning a private jet. It's the latter, not the former, that is the root of income inequality in America.

This much is true. Malpractice insurance can eat as much as half of a typical doctor's income. A lot of your bill and your insurance costs are going directly into the pocket of some ambulance chaser (or rather, indirectly there through insurance premiums and then payout of some claim). But Dems refuse to do anything about that because the bar association is a major donor (and they'd be going after their fellow lawyers.... which politicians are always loathe to do. Must be some sort of professional courtesy.)

However, a number of doctors have told me that they're actually being increasingly marginalized by the system now anyway. The money is all going to the big corporate hospital systems. The corporations are trying to make the doctors into (relatively) cheap, replaceable labor. And you can see the money when you go into the typical corporate run hospital. Hardwood floors, granite countertops and expensive enviro-friendly materials (for the good PR) are everywhere. But, that's basically another case of creepy, ultra-rich financial dudes running everything. We're losing the small, entrepreneurial system we used to have in this country.

But then, even that may not be the biggest source of costs in the healthcare industry. I work in the tech sector, but have worked for health care suppliers in the past. Folks in that industry are so mired in regulation, it takes at least 10 times the time and money it would take to create a similar product for non-medical applications. And then, they're subject to the same out of control malpractice litigation that the doctors are.

And of course, it's the regulation and high malpractice costs that's putting everything in control of the sleazy Wall Street guys. It's literally making it too expensive for the small, independent Doctor to continue operating.

Originally Posted by playwrite

I see you really have picked up the mantle from Justin. Yea, sure, that's what you meant.

Liar.

What she wrote is what she said she meant. You just got caught (again) trying to pretend that she said something else. Your utter contempt for your audience is, as always, very instructive.

Originally Posted by Marx & Lennon

I'm tired and see no chance of anythng happening, and I'm certainly not going to hand-out two or three hundred dollars a week to fight the good fight. There are simply too many issue advocates and too much issue-related noise to suit me. If there was any possibility that this would produce results, I might be less harsh. If I'm not responding, and I'm really interested, then what about the average person with little interest and less understanding?

I truly understand your frustration. Doing things that appear to have no results can be discouraging. I've been there, so I know of what you speak. I finally had to choose a couple of issues that stand out to me as an individual. I may not ever see the results of my efforts, time, and energy, but I will know that I threw my tiny seed into the field of potential change. We humans apparently have a hard time with doing what's on our heart, then when we see no results of our efforts, we get overwhelmed and quit. i sure know I've done that throughout the years. But eventually, when something just keeps tugging at your sleeve to address and work for, we get up, dust ourselves off and keep on keepin on.

I know what I'm about to write may sound trite; but it only takes a small group of people to make a real difference in this world. And, I think you just might be one of them.

Originally Posted by JohnMc82

Of course doctors are near the top of the chart when it comes to people who work for a living, but they're not the ones who are skewing the income disparity in this country, and you sure as hell know it:

I just spoke in depth with a new doctor this past week. He just shook his head in disbelief that doctors are being peanlized and expected to make their patients do what they are prescribed once they leave the office. He indicated that his pay at the hospital because of ACA, is now going to be dependent on the outcome and satsifaction scores of his patients. It reminded me of what we are doing to teachers in this country; if their students don't perform to the criteria of success, they are the ones punished.

The parting words of this young doctor asked me why those who wrote these policies of penalizing doctors, actually understand the tremendous hard work and non-stop hours of getting through med school takes, not to mention the loans they have to pay back. I felt badly for this young doctor. And to think that we have a growing shortage of physicians in this country. It's just plain mind blowing.

Originally Posted by The Rani

What I see with activists is that people who get too personally attached to the "outcome" get frustrated and quit. It's an ego thing.
Those who understand that all we can do is sow seeds and hope that they sprout are the ones who end up being the most effective. Sounds like you've gotten there yourself. Congrats.

With sincere thanks.

Originally Posted by The Rani

Wait, what? Is that really a part of the new law?
If so, we should get ready for a lot more opiate prescriptions.

Yep, that's what he said.

Originally Posted by The Rani

Wait, what? Is that really a part of the new law?
If so, we should get ready for a lot more opiate prescriptions.

Performance pay for physicians may backfire: BMJ editorial

Pay-for-performance schemes may do more harm than good by changing the mindset required for good doctoring, experts say

EMBARGOED until
Aug. 14, 2012, at 6:30 p.m. Eastern time


Contact:
Steffie Woolhandler, M.D., M.P.H.
David Himmelstein, M.D.
Dan Ariely, Ph.D.
Ida Hellander, M.D., PNHP, (312) 782-6006, ida@pnhp.org


In a cautionary editorial alongside a related article in today’s issue of the British medical journal BMJ, leading experts in health policy and behavioral economics argue that pay-for-performance (P4P) schemes – which financially reward doctors and hospitals for hitting specific, numerical targets in such matters as preventing hospital readmissions or prescribing certain drugs – are likely to do more harm than good.


Such schemes are being adopted as a key component of the Accountable Care Organization strategy mandated by the 2010 health reform and are now part of the Medicare program, Massachusetts’ cost-control legislation and virtually all major new private health insurance payment contracts.


Yet the editorial, echoing a theme of the accompanying article, says there’s very little evidence that P4P has improved patient survival or any other measure of public health.


More: http://www.pnhp.org/news/2012/august...-bmj-editorial

Originally Posted by playwrite

Doctors paying whatever taxes has nothing to do with their compensation driving up health care costs.

As a percentage of gross pay, doctor's take-home is lower than... pretty much any profession in America. This definitely has an effect on inflating gross incomes. There are also series class-based financial barriers to entry in the profession that restrict our supply relative to other nations, where doctors are paid significantly less yet report higher levels of job satisfaction.

You're being a little defensive about the docs and their salaries; do I sense perhaps a little bit of a conflict-of-interest here? Wife?

Assuming salary represents some sort of meritocracy, who else should be at the top? Doctors heal the sick, delay death, and increase quality of life. Pretty impressive stuff.

I'm sad to say I have no conflict of interest to report, except that under different circumstances I may have pursued a career in medicine or biochemistry. I have spent seven years with journal access studying immunology and nutrition, so I could probably ace a med-school app (if I could afford to enroll, that is).

Originally Posted by Deb C

I just spoke in depth with a new doctor this past week. He just shook his head in disbelief that doctors are being peanlized and expected to make their patients do what they are prescribed once they leave the office. He indicated that his pay at the hospital because of ACA, is now going to be dependent on the outcome and satsifaction scores of his patients. It reminded me of what we are doing to teachers in this country; if their students don't perform to the criteria of success, they are the ones punished.

The parting words of this young doctor asked me why those who wrote these policies of penalizing doctors, actually understand the tremendous hard work and non-stop hours of getting through med school takes, not to mention the loans they have to pay back. I felt badly for this young doctor. And to think that we have a growing shortage of physicians in this country. It's just plain mind blowing.

We seem to have ignored access to physicians in the debate' over ACA. In short term, do we bring in doctors from other countries, make beter use of nurses, use telemedicine ( with doctors in other countries), or what?
For long term , we could try more incentives to train new doctors.
Many doctors have already limited the number of Medicare patients. We need to address this as a nation before total breakdown in system.

Originally Posted by Justin '77

Liar.

What she wrote is what she said she meant. You just got caught (again) trying to pretend that she said something else. Your utter contempt for your audience is, as always, very instructive.

Yea, toadie, you would read it that way.

Originally Posted by radind

We seem to have ignored access to physicians in the debate' over ACA. In short term, do we bring in doctors from other countries, make beter use of nurses, use telemedicine ( with doctors in other countries), or what?
For long term , we could try more incentives to train new doctors.
Many doctors have already limited the number of Medicare patients. We need to address this as a nation before total breakdown in system.

Your absolutely correct. The doctor shortage and fewer students being able to afford the extraordinarily expensive price of becoming a doctor, is a festering problem in this country. It appears that we would rather penalize doctors and keep future doctors tied to debt, than take money out of the greedy hands of the insurance industry.

When people start complaining about doctor pay, they need to realize the expense of their education, overhead costs of insurance, paying off student loans, and the emotional toll of being responsible for the lives and well being of human beings. This country needs to stop punishing doctors and teachers, while they so loyally bow to the greed of the giant corporations.

Originally Posted by playwrite

Yea, toadie, you would read it that way.

As will anyone else with the slightest command of the English language. As, contrary to your lies to the opposite effect, did you yourself. The words mean what they mean -- that's why we use them.

Originally Posted by The Rani

Last time, with feeling:


Predictable.

Oh, I love it when you slippery fish when caught get all slippery on me! Really entertaining!

Here's what you said -

Originally Posted by The Rani

...
Having checked out the website myself and looked at the rates, I don't see how anyone actually believes that anyone with an annual income of less than $11K is going to shell out $2K year in health insurance premiums. It's just not gonna happen. (Which I'm sure is why state legislators knew that refusing to expand Medicaid would effectively destroy ACA.)

Where did your notion come from of the $11K person having to pay $2K? No one can read what you wrote and not conclude that you believed the website was indicating that the ACA would be forcing such a situation. You might find it preposterous to force that outcome but you certainly are suggesting that was what the ACA was trying to do. And as you now know that was a pretty dumbfuck conclusion on your part. You know that now, so you (along with your toadies) are trying to slip out of it. It takes a pretty insecure person not to own up to simple mistakes.

The only other possibility here is that you have decided to become the alarmist for all things obvious. Soon you'll be posting alarm about the sun will be coming up in the East! Or horrors, there are actually anatomical differences between males and females!!!! Or, oh my gosh, Madonna should have given it up a long time ago! Wow, I'm mean these really are as worthwhile a post as your sounding the alarm that the $11K person will not be paying $2K in premiums!!! What would the forum do without you??? I shutter to think of how less informed we will be! Let me be the first to thank-you..... the entertainment value of your desperate attempt to slip out of a simple mistake on a chat room is epic!

The icing on the cake, however, is bringing your toadie Justin along for the ride. Priceless. It's what keeps me coming back!

Originally Posted by JohnMc82

As a percentage of gross pay, doctor's take-home is lower than... pretty much any profession in America. This definitely has an effect on inflating gross incomes. There are also series class-based financial barriers to entry in the profession that restrict our supply relative to other nations, where doctors are paid significantly less yet report higher levels of job satisfaction.



Assuming salary represents some sort of meritocracy, who else should be at the top? Doctors heal the sick, delay death, and increase quality of life. Pretty impressive stuff.

I'm sad to say I have no conflict of interest to report, except that under different circumstances I may have pursued a career in medicine or biochemistry. I have spent seven years with journal access studying immunology and nutrition, so I could probably ace a med-school app (if I could afford to enroll, that is).

Dude, don't you think it is just a bit disingenuous to take the comparison of doctors in the 1% (making $400K/yr) paying proportionally more in taxes than the CEOs, hedge funders, and other 0.1%ers and trying to imply that in general doctors pay proportionally more than EVERYONE else??? I bet you dollars-to-donuts that the effective tax rates that high paying doctors pay is significantly less compared to other 1%'ers that are also not in the top 0.1% and probable less proportionally than anyone in the top 10 or even 20% brackets that are also not in the top 0.1%.

The 0.1% are in a world of their own, but that world has little to do directly with the high cost of health care but doctor salaries certainly do. What the top 0.1%ers do is not only not germane to the issue but it is disingenuous of you to attempt to fuzz up the issue with such comparison horseshit.

I am just flabbergasted by how the same people who rail against big daddy govt not getting healthcare cost down are also the ones who defend high medical salaries and see only evil in the notion of "paying for performance." A number of you here need to look up the term "cognitive dissonance" because waiting around for your magic ponies to poop gold nuggets is a loser's game.

There's a hint of a whiff of possible change in media coverage today. On Morning Joe, Steve Rattner presented a chart putting into better perspective the cancellation issue -

http://www.msnbc.com/morning-joe#

It's a video called "Who will pay more under Obamacare."

I've recreated the graphic here -



Now one could look at this and say the issue is really confined to the 1.3% having to get a better plan without subsidies. Moreover, that will be smaller because within that 1.3%, there will be people who will pay the same or less.

However, it is also possible to add in some portion of the other 1.3% that will have to get a better plan but with subsidies because some of these people (e.g. our John) may wind up paying more even with a subsidy. One would think, however, that in this group, there would be even less people in that situation than the group not getting any subsidies.

Maybe more than half in the first group and less than half in the latter group will need to pay more. Adding that rational possibility together would bring you back to about 1.3% of the population will be paying more for better plans (either with or without subsidies).

The other issue here is the "better" plan. By "better," the ACA means the risk pool will not discriminate against women and it will accept people with pre-existing conditions. A healthy male without preconditions and who has achieved a certain level of affluence may have a beef about paying more for such a "better" plan.

We're talking about 2-3 million such people having to pay somewhat higher premiums for "better" plans that includes a societal benefit that they might not directly benefit from. On the other side of the equation, we have around 40 million people that will benefit immensely - the majority getting medical insurance coverage for the first time.

I guess healthy affluent males have been so downtrodden for so long that this trade off would be just evil. Evil I'z tels ya!!!!!!

Originally Posted by Justin '77

As will anyone else with the slightest command of the English language. As, contrary to your lies to the opposite effect, did you yourself. The words mean what they mean -- that's why we use them.

Toadies don't command anything; they just jump when master tells them or when master is in trouble with their dumbfuck assertions.

Originally Posted by playwrite

Dude, don't you think it is just a bit disingenuous to take the comparison of doctors in the 1% (making $400K/yr) paying proportionally more in taxes than the CEOs, hedge funders, and other 0.1%ers and trying to imply that in general doctors pay proportionally more than EVERYONE else??? I bet you dollars-to-donuts that the effective tax rates that high paying doctors pay is significantly less compared to other 1%'ers that are also not in the top 0.1% and probable less proportionally than anyone in the top 10 or even 20% brackets that are also not in the top 0.1%.

Not just taxes, take-home pay.

Assume a lawyer, doctor, financial analyst, and engineer... all making $400,000.

Which one has the highest student loan costs? Which one has the highest insurance burden? Which one is most likely to have lunch with friends in tax law who can find discounts, and is just as likely to write that lunch off as a business expense or charge it to the firm?

The 0.1% are in a world of their own, but that world has little to do directly with the high cost of health care but doctor salaries certainly do. What the top 0.1%ers do is not only not germane to the issue but it is disingenuous of you to attempt to fuzz up the issue with such comparison horseshit.

BULL SHIT, the .1% are the ones getting everything they want. THEY are the only ones who are represented when fake-ass liberal Democrats pass crap laws like the Insurer Protection and Unaffordable Healthcare Act. THEY are the ones who have benefited from this law via stock price appreciation, and THEY are the ones who are resisting any attempts at meaningful reform that would reduce prices and profits.

Yes, they live in "another world" - a world with direct access to politicians and media powerhouses. It's a world of excess, fantasy, hubris, and delusion. Unfortunately, that effects the rest of us who are living and working in the real world.

Originally Posted by JohnMc82

Not just taxes, take-home pay.

Assume a lawyer, doctor, financial analyst, and engineer... all making $400,000.

Which one has the highest student loan costs? Which one has the highest insurance burden? Which one is most likely to have lunch with friends in tax law who can find discounts, and is just as likely to write that lunch off as a business expense or charge it to the firm?

Granted on the student loan; although top law schools (e.g. Harvard, Yale) are way more expensive that nearly all medical schools, but I'll let you have this point. The insurance burden is a business expense - the salaries we are talking about are what the docs get AFTER ALL business expense - sorry, you loss a point. Business lunches are a draw; high-price doctors are dealing with both their corporation finances as well as their personal expenses - there is probable not a day that goes by that they are not writing off something including a lot of business lunches at the country club where they also write-of the green fee and membership because they are both discussing cases with other doctors as well as their finances with their advisors.

Originally Posted by JohnMc82

BULL SHIT, the .1% are the ones getting everything they want. THEY are the only ones who are represented when fake-ass liberal Democrats pass crap laws like the Insurer Protection and Unaffordable Healthcare Act. THEY are the ones who have benefited from this law via stock price appreciation, and THEY are the ones who are resisting any attempts at meaningful reform that would reduce prices and profits.

Yes, they live in "another world" - a world with direct access to politicians and media powerhouses. Unfortunately, that effects the rest of us who are living and working in the real world.

What reform to reduce who's prices and profits? You're trying not to talk about actual sources of prices and profits and just scream about big daddy govt not doing anything about what you don't want to talk about. It's weird.

This must be about the magic ponies. Sorry, I may have forgotten to mention that I don't do magic pony land. Maybe I need to change my signature - that notion about killing magic ponies might be confusing people about my caring about them.

Originally Posted by playwrite

Granted on the student loan; although top law schools (e.g. Harvard, Yale) are way more expensive that nearly all medical schools, but I'll let you have this point. The insurance burden is a business expense - the salaries we are talking about are what the docs get AFTER ALL business expense - sorry, you loss a point. Business lunches are a draw; high-price doctors are dealing with both their corporation finances as well as their personal expenses - there is probable not a day that goes by that they are not writing off something including a lot of business lunches at the country club where they also write-of the green fee and membership because they are both discussing cases with other doctors as well as their finances with their advisors.

Ok, even if insurance is written off as a business expense and goes untaxed, it still counts toward the ratio between gross pay and take-home pay. On the business lunches, I'll go so far as to admit that I don't have solid data to back up my hunch, other than the fact that the average doctor is putting ridiculous hours in at the office these days, and most probably don't have time for relaxed business meetings.

What reform to reduce who's prices and profits? You're trying not to talk about actual sources of prices and profits and just scream about big daddy govt not doing anything about what you don't want to talk about. It's weird.

A million times, there are a dozen proposals that are popular with doctors or voters that never get a fair hearing in Congress. You can blame Republicans all you want, but Democrats are just as responsible due to the false equivalence they give GOP positions and the half-assed attempts to prove they're different. When Reid puts Baucus in charge of writing up the insurance lobby's draft proposal, and Obama stakes his legacy on that bill, you can't just blame Republicans when the bill ends up representing the wishes of insurers more than it represents the wishes of voters, political economists, or doctors.

This must be about the magic ponies. Sorry, I may have forgotten to mention that I don't do magic pony land. Maybe I need to change my signature - that notion about killing magic ponies might be confusing people about my caring about them.

Thank you once again for reminding us of the quintessential conservative argument in favor of the status quo. It really boils down to: "This is the way it is, this is the way it has been, this is the way it will always be."

Originally Posted by JohnMc82

Ok, even if insurance is written off as a business expense and goes untaxed, it still counts toward the ratio between gross pay and take-home pay. On the business lunches, I'll go so far as to admit that I don't have solid data to back up my hunch, other than the fact that the average doctor is putting ridiculous hours in at the office these days, and most probably don't have time for relaxed business meetings.

Doctors can choose to operate as employees, limited partners or corporations. So can lawyers, engineers and most other professionals. Liability insurance is no worse for a cardiologist than it is for a professional structural engineer. The same is true for PhD level schooling costs. Yet the pay for the cardiologist is a lot higher than most ofther specialties ... law potentially being the sole exception. I also lack compassion for MDs who sign-on for excessive overwork rather than splitting their fees.

Originally Posted by JohnMc82 ...

A million times, there are a dozen proposals that are popular with doctors or voters that never get a fair hearing in Congress. You can blame Republicans all you want, but Democrats are just as responsible due to the false equivalence they give GOP positions and the half-assed attempts to prove they're different. When Reid puts Baucus in charge of writing up the insurance lobby's draft proposal, and Obama stakes his legacy on that bill, you can't just blame Republicans when the bill ends up representing the wishes of insurers more than it represents the wishes of voters, political economists, or doctors.

No arguments here. The Dems are no improvement these days, and they haven't been for a long time.

Originally Posted by JohnMc82 ...

Thank you once again for reminding us of the quintessential conservative argument in favor of the status quo. It really boils down to: "This is the way it is, this is the way it has been, this is the way it will always be."

This is true to the extent that a critical mass necessary to trigger change is just not there right now. Boomers have been split over culture war issues for decades. Xers are too cnical and the Millies ... how about you guys?

Originally Posted by Marx & Lennon

Liability insurance is no worse for a cardiologist than it is for a professional structural engineer.

Where are you getting this information? Between having a father who is a physician, having worked in the healthcare industry and having a son who was born with a congenital heart defect that has required frequent care and multiple surgeries, I have talked to more doctors than I care to count. Your information is completely at odds with what I'm hearing from them.

Malpractice insurance is ridiculously high for doctors these days. Some professions in the healthcare industry have been pretty much eliminated because it's no too expensive to insure them. For example, that's why you don't see many emergency medical helicopters. It's too expensive to insure the pilots.

Originally Posted by stilltim

Where are you getting this information? Between having a father who is a physician, having worked in the healthcare industry and having a son who was born with a congenital heart defect that has required frequent care and multiple surgeries, I have talked to more doctors than I care to count. Your information is completely at odds with what I'm hearing from them.

Malpractice insurance is ridiculously high for doctors these days. Some professions in the healthcare industry have been pretty much eliminated because it's no too expensive to insure them. For example, that's why you don't see many emergency medical helicopters. It's too expensive to insure the pilots.

... and practice libilty for a structural engineering firm stamping plans on multi-million dollar buildings is high too. So is malprctice insurance for litigating attorneys.

Medicine is not unique in this.

Originally Posted by playwrite

... (where is the Prince, anyway?) ...

You rang, My Liege?


Prince

PS:
I see you've been busy, Mr. Playwrite.
I can't wait to see what fun stuff's been
going-on around here while I was away.