Best specialty for the future?

[Lokhtar]

What is a high enough marginal tax rate? 60%? 70%. this would seem far less burdensome if greater than 60% of voters actually paid income tax.

Not really, the amount of revenue you'd get from the bottom 30% would be almost negligible. It would barely make a difference.

As for what the rate should be? I don't know what the ideal rate is. More than it is now though. Probably double digit more than it is now on the absolute highest earners (meaning, seven-eight figure earners). And moderately higher on the mid-six figure earners.

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[Jorje286]

Where to start... OK, I had a well thought out and referenced response -- until my 18mo hellion hit the lit button on the powerstrip... but here's the Reader's Digest version:

Anarcho-capitalism has its merits, but has never and will never hold up in reality. Why? Human nature. Governments evolve out of chaos for reason. Granted, they eventually devolve into a period of chaos -- but rise again invariably in some form or fashion. To this end, yes, some form of taxation is seemingly necessary; yet the fact remains that any tax is a government sanctioned confiscation of property -- and, as such, should be limited to the bare minimum necessary.

This is where the real disagreement is: what is the bare minimum necessary? Do you believe establishing an army that polices the world is bare minimum necessary? Maintaining justice in society by enforcing laws? Roads?..etc.

I believe health care is a bare minimum necessary, because of ethical standards I place on the value of life and the need to ensure that suffering is kept at minimum in society for everyone (within reasonable standards). You think the moral issues with confiscating property (mostly of the rich, really) is a bigger ethical issue than ensuring access to health care. I don't.

Before going into this much further I would like to pose a couple of questions to you (whoever) in order to gauge how much you have thought about these things:

- what is "money"
- what is "the state"
- why do we have taxes
- what is the proper role of government in a Constitutional Republic? A free society?

I thought about these before, but I don't feel like typing paragraphs to answer such fundamental questions on a forum if it's not directly relevant to the discussion.

As for the last portion of your post: you're inexperience is showing. Most practicing docs have no "salary"; they earn whatever monies are in excess of their costs. On what basis do you make your assumption "very high salaries may go down slightly"? First you demonstrate a judgement bias..... only to follow up with an answer pulled straight from the splenic flexure.

Actually, the point was not to make an assumption about the future earnings of doctors, but to propose a justification for the hostile reaction to "socializing health care" in general and the bill, especially on this subforum. I can see that a lot of people here are worried that their earnings will go down because of a stronger involvement of the government.

 

[justwant]

bump..dow fell below 600.bump..

 

[bronx43]

bump..dow fell below 600.bump..

Totally irrational market reaction to the downgrade. Borrowing costs are actually lower than pre-downgrade... but then again, any disruption in the system at this point in time would likely result in some kind of fall in equities. Most people don't realize that in the grand scheme of capital flows, there's really nowhere else for the money to go.
A week or so more of this trend and I fully expect Bernanke to come out justifying QE3.

 

[MOHS_01]

Totally irrational market reaction to the downgrade. Borrowing costs are actually lower than pre-downgrade... but then again, any disruption in the system at this point in time would likely result in some kind of fall in equities. Most people don't realize that in the grand scheme of capital flows, there's really nowhere else for the money to go.
A week or so more of this trend and I fully expect Bernanke to come out justifying QE3.

...and when he does I hope he wakes with his prize horse's head in his bed.

...and agreed -- in the world of capital flows everyone is along for the ride (willingly or not).

 

[kevindement]

If you're not good at doctor-patient relationships then why are you going into medicine in the first place? I would say patholgy would probably be best in your case. Dermatology is definitely out since you would need to interact with patients all the time and look at their skin and stuff.

 

[aequanimitas11]

I disagree totally. I believe CMS is the prime mover behind decreases in salary. It has far more power than any insurer in the country and does not "negotiate", it dictates. If you take a basic surgery such as appendectomy and look at how much Medicare has cut payment for it over the past 20 years, you have your answer. Furthermore, "innovations" in billing that hurt doctors (for example, the idea that paying for surgery actually means paying for surgery and all visits for the postoperative period) invariably spring from Medicare. Private insurers just copy as much of what Medicare does as they think they can get away with.

Every extra bit of power that CMS gets (and "reform" gives it a TON) is another brick in the wall of ruining the practice of medicine.

Couldn't agree with this more.

This bill is purely about expanding access to care. There is very little that bends the cost curve down. Adding more people that don't care what that MRI on their R knee costs, when the real reason they have knee pain is because they are 5'6" and 275, will only exacerbate the problem.

The decoupling of the actual cost of treatment from the consumer/patient, and the relative devaluing of our services is a major part of the problem.

Make no mistake -- this bill had several intents and purposes; improving the nations health care system apparently was not one of them. It is a major tax bill. It is a major new entitlement. It furthers the nanny state and enables increased dependency. It buys votes. It punishes "the rich". It redistributes wealth.

Well said. This bill was about taking more money/power from the "greedy" doctors, and redistributing the wealth and power into the hands of politicians through increased regulatory control and dependence on the government.