Canada's System sucks for you, but it is good enough for me

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Ducttape said:
current status:
2018’s Most & Least Federally Dependent States
generally speaking, "Red" states and "sunbelt states" appear to be more dependent on fed dollars.

in fact, most unbalanced states - ones that gave more to the feds than they got back - are in the NE (ie NY and NJ).
The States That Give and Get the Most Federal Dollars
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Yeah, I think my plan would unbalance the states even more because 25k is nothing to a Californian but a lot to a Mississipian.

But that means the liberal populous states would have more money to exact social plans. Frankly, they're entitled to that money if you ask me.

OTOH, Kentucky can implement massive libertarian reform, zero corp tax x 20 years, zero min wage, etc.

I feel like we really underuse federalism...
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hyperalgesia said:
I'd like to see what would happen if the fed didn't tax individuals at all but instead taxed the states based on population (including illegal imm). And then otherwise, leave the states alone. For example, if you said every state owes 25k/head/year and they can distribute the burden however they like. A progressive state might have a 70% IT over 1 mil or whatever. And continue to allow "sanctuary cities".

Other states might do a "fair tax" VAT or some combo of taxes. Some states might say no cap gains tax, no min wage, etc. and use the proceeds to provide universal health care in their state.

States could then take some responsibility and stop blaming the fed for every problem they can't solve like healthcare and "income inequality".

I would just like to see a kind of laboratory where different ideas are tried...
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you would have to de-nationalize everything. medicare, etc. too much red tape. basically, you would be creating 50 different countries. states already have significantly different tax structures
 
How many of you in private practice would actually stay in medicine if we all got paid Medicare rates?
 
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Dr. Ice said:
How many of you in private practice would actually stay in medicine if we all got paid Medicare rates?
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I haven’t done the math on what an inpatient or outpatient doc would make on literally just medicare but the answer is I probably would have went into something else
 
drusso said:
Couldn't afford to stay in practice.
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I don’t think I could either..40% drop in salary plus higher tax burden. I’m already in a heavily taxed state. It’s amazing how much the topic has gotten traction lately. It’s all over my news feed like click bait.
 
SSdoc33 said:
you would have to de-nationalize everything. medicare, etc. too much red tape. basically, you would be creating 50 different countries. states already have significantly different tax structures
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With one common defense and one constitution to ensure basic liberties that we all agree to.

The states would define themselves. Their culture, their vision.

To me it sounds awesome...
 
hyperalgesia said:
With one common defense and one constitution to ensure basic liberties that we all agree to.

The states would define themselves. Their culture, their vision.

To me it sounds awesome...
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the balkanization of america? why stop at states? why not counties? or towns? or neighborhoods.

you realize you would have third world countries (arkansas, alabama, west virginia) as well as economic powerhouses right next door. plus slavery. there's that, too.

in general, the "red" states or "flyover" states would be even worse off than they are now -- see ducttape's post above.
 
SSdoc33 said:
the balkanization of america? why stop at states? why not counties? or towns? or neighborhoods.

you realize you would have third world countries (arkansas, alabama, west virginia) as well as economic powerhouses right next door. plus slavery. there's that, too.

in general, the "red" states or "flyover" states would be even worse off than they are now -- see ducttape's post above.
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Agree some “flyover” states would suffer. There is a bit of protection against slavery mentioned in the constitution, though.
 
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does that sound like the United States of America?

if power resided almost exclusively with the states... would slavery be protected? didn't we have some sort of conflict about this, say, 150 years ago, and if memory serves correctly, it could not be corrected at that time with a constitutional amendment. and certain parts of the country argued that certain people did not have inalienable rights - women, black, Asian, etc...


to ferris and sb247- i don't understand your point. this is the total amount of money given to each state, and the total amount collected by the feds. deductions like these shouldn't factor in the total. if they did, it would make the disparity worse.
 
drusso said:
I'll have to go out business if this policy prevails...
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im not fear mongering here, and i dont like it either.

however, most of the top candidates for the democrats endorse some sort of single payer or "universal" healthcare. that doesnt mean it is necessarily going to happen, but with the current trend, it is not inconceivable that the house, senate, and white house go democrat. that would be then only way, IMHO.

it is entirely possibly that the polarization of DJT will lead to single payer.
 
SSdoc33 said:
the balkanization of america? why stop at states? why not counties? or towns? or neighborhoods.

you realize you would have third world countries (arkansas, alabama, west virginia) as well as economic powerhouses right next door. plus slavery. there's that, too.

in general, the "red" states or "flyover" states would be even worse off than they are now -- see ducttape's post above.
Click to expand...
The flyover states. See that's just it, I don't think they will become 3rd world at all. I think they will function much better if they are free to implement policy how they choose.

This is your big chance to prove that progressive ideas work in practice and don't lead to Venezuela. Massachusetts can finally show us all to eliminate income inequality and give everyone free everything. Vermont can show us how great things are if you punish the evil CEOs who take more than their fair share...

Slavery has been unconstitutional since 1865. Like I said, we have a constitution. Nothing changes in that regard. We are all stuck with gun laws, roe v wade, civil liberties, equal rights, etc. There are constitutional issues that we deal with together.
 
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I agree with SSdoc..I think we will inevitably go single payor and I think the dems will control everything after 2020. If some extreme leftist is elected single payer can happen in the next 5 years. I’m gonna start hunkering down now and exploring other career options
 
Dr. Ice said:
I agree with SSdoc..I think we will inevitably go single payor and I think the dems will control everything after 2020. If some extreme leftist is elected single payer can happen in the next 5 years. I’m gonna start hunkering down now and exploring other career options
Click to expand...

There would be such a large exodus of independent doctors leaving medicine; not everyone will want to work for the post office.
 
why is it that all conservatives think that liberals all want complete equanimity?

what this country needs is balance - balance between capitalism and complete equality. balance between libertarianism and socialism. we aren't getting that right now. and going to the opposite extreme is unlikely to happen.


in case you didn't know, the South did not willingly acknowledge or agree to the 13th, 14th or 15th Amendment.. the 13th Amendment, released in 1964, was not ratified until 1985 because of ratification by new Southern state governments that were set in place to be sympathetic to Abolition. for the 14th Admendment, they were bribed with the promise of representation to Congress in exchange for voting in favor. clearly, had the North not won the Civil War, those 3 Amendments would not exist (at least not with respect to slavery)
 
Ducttape said:
why is it that all conservatives think that liberals all want complete equanimity?

what this country needs is balance - balance between capitalism and complete equality. balance between libertarianism and socialism. we aren't getting that right now. and going to the opposite extreme is unlikely to happen.


in case you didn't know, the South did not willingly acknowledge or agree to the 13th, 14th or 15th Amendment.. the 13th Amendment, released in 1964, was not ratified until 1985 because of ratification by new Southern state governments that were set in place to be sympathetic to Abolition. for the 14th Admendment, they were bribed with the promise of representation to Congress in exchange for voting in favor. clearly, had the North not won the Civil War, those 3 Amendments would not exist (at least not with respect to slavery)
Click to expand...

Read this:
Overcharged: Why Americans Pay Too Much For Health Care
 
Ducttape said:
why is it that all conservatives think that liberals all want complete equanimity?

what this country needs is balance - balance between capitalism and complete equality. balance between libertarianism and socialism. we aren't getting that right now. and going to the opposite extreme is unlikely to happen.


in case you didn't know, the South did not willingly acknowledge or agree to the 13th, 14th or 15th Amendment.. the 13th Amendment, released in 1964, was not ratified until 1985 because of ratification by new Southern state governments that were set in place to be sympathetic to Abolition. for the 14th Admendment, they were bribed with the promise of representation to Congress in exchange for voting in favor. clearly, had the North not won the Civil War, those 3 Amendments would not exist (at least not with respect to slavery)
Click to expand...
At least 3 of the more “popular” potential Democratic presedential candidates have stated they would be in favor of single payor. Why would the “opposite extreme” not happen if these people are already touting it as a promise?
 
Ducttape said:
in case you didn't know, the South did not willingly acknowledge or agree to the 13th, 14th or 15th Amendment.. the 13th Amendment, released in 1964, was not ratified until 1985 because of ratification by new Southern state governments that were set in place to be sympathetic to Abolition. for the 14th Admendment, they were bribed with the promise of representation to Congress in exchange for voting in favor. clearly, had the North not won the Civil War, those 3 Amendments would not exist (at least not with respect to slavery)
Click to expand...
Umm, what? 13th was ratified in 1865 by most of the Southern states. Yes they were bullied into it, but that no longer matters.
 
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Ducttape said:
does that sound like the United States of America?

if power resided almost exclusively with the states... would slavery be protected? didn't we have some sort of conflict about this, say, 150 years ago, and if memory serves correctly, it could not be corrected at that time with a constitutional amendment. and certain parts of the country argued that certain people did not have inalienable rights - women, black, Asian, etc...


to ferris and sb247- i don't understand your point. this is the total amount of money given to each state, and the total amount collected by the feds. deductions like these shouldn't factor in the total. if they did, it would make the disparity worse.
Click to expand...
No they wouldn’t because blue states have higher state income tax which is then deducted off federal income tax filings. This is basically allowing those blue states to divert federal income taxes directly to state govts.
 
lobelsteve said:
PEV. I bring more to the table than I take away.
Click to expand...

How can you be certain that you're not part of the problem? Absent SOS arbitrage, pharmacy mark-ups, lab & ancillaries we're all just drilling teeth. Take away the over-inflated ancillary utilization and your PEV is in the toilet. If independent doctors and the government prevail against hospital over-lords in site neutral payment law suit the owners will show the employees no mercy.

38 hospitals sue HHS over site-neutral payment policy

"To keep you is no benefit, to destroy you is no loss."
 
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yes, sb247, but on the macro level, the amount they send to the feds is > than the amount they get back.

when these personal deductions get taken away this year, then the amount they send to the feds will be >>> than what they get back from the feds, and each person in these blue states will get even less money back - from state taxes...
 
drusso said:
How can you be certain that you're not part of the problem? Absent SOS arbitrage, pharmacy mark-ups, lab & ancillaries we're all just drilling teeth. Take away the over-inflated ancillary utilization and your PEV is in the toilet. If independent doctors and the government prevail against hospital over-lords in site neutral payment law suit the owners will show the employees no mercy.

38 hospitals sue HHS over site-neutral payment policy

"To keep you is no benefit, to destroy you is no loss."
Click to expand...

We are all part of the problem. I can go back to treating TBI and CVA once society goes full stoic towards pain. No meds, no procedures. If your leg goes to sleep and buckles, use the other leg. No MRI, no PT, no meds. Bite on this rope.

For the next few hundred years, I will have a job.
 
lobelsteve said:
We are all part of the problem. I can go back to treating TBI and CVA once society goes full stoic towards pain. No meds, no procedures. If your leg goes to sleep and buckles, use the other leg. No MRI, no PT, no meds. Bite on this rope.

For the next few hundred years, I will have a job.
Click to expand...

dont say that.

dont ever say that.

there is nothing worse than a rehab ward. maybe OB/gyn residency, but inpatient PM&R is a close second
 
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Ducttape said:
yes, sb247, but on the macro level, the amount they send to the feds is > than the amount they get back.

when these personal deductions get taken away this year, then the amount they send to the feds will be >>> than what they get back from the feds, and each person in these blue states will get even less money back - from state taxes...
Click to expand...
That may end up being true, but without calculating in the amount of federal taxes currently deducted due to state income tax we cannot accurately discuss which states “cost more”

But to be clear here, I want all welfare to end so I’m cool with stopping federal welfare to states regardless
 
lobelsteve said:
We are all part of the problem. I can go back to treating TBI and CVA once society goes full stoic towards pain. No meds, no procedures. If your leg goes to sleep and buckles, use the other leg. No MRI, no PT, no meds. Bite on this rope.

For the next few hundred years, I will have a job.
Click to expand...

If reimbursement is driven down to Medicare rates, I'll have to find a new job. Derm. Always liked Derm...
 
Dr. Ice said:
I agree with SSdoc..I think we will inevitably go single payor and I think the dems will control everything after 2020. If some extreme leftist is elected single payer can happen in the next 5 years. I’m gonna start hunkering down now and exploring other career options
Click to expand...
Congress went through hell to get the MACRA disaster passed right after the Obamacare experiment decimated the ranks of democrats.

I just don't see Single Payor as having serious potential as law.
 
Before we all go planning out careers in plumbing and carpentry, do remember that these are campaign promises. They are worth exactly what campaign promises are always worth.
(But I cant say I haven’t wished I’d become a plumber a time or two, mainly after having to pay one)
 
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Ducttape said:
why is it that all conservatives think that liberals all want complete equanimity?

what this country needs is balance - balance between capitalism and complete equality. balance between libertarianism and socialism. we aren't getting that right now. and going to the opposite extreme is unlikely to happen.


in case you didn't know, the South did not willingly acknowledge or agree to the 13th, 14th or 15th Amendment.. the 13th Amendment, released in 1964, was not ratified until 1985 because of ratification by new Southern state governments that were set in place to be sympathetic to Abolition. for the 14th Admendment, they were bribed with the promise of representation to Congress in exchange for voting in favor. clearly, had the North not won the Civil War, those 3 Amendments would not exist (at least not with respect to slavery)
Click to expand...
VA Hopeful Dr said:
Umm, what? 13th was ratified in 1865 by most of the Southern states. Yes they were bullied into it, but that no longer matters.
Click to expand...
At least these 2 states are progressive
Alabama, Mississippi only 2 states to celebrate joint MLK, Robert E. Lee Day
 
Everything except cash based is becoming a Chinese assembly line. With our masters and owners, whether it's hospital admin or insurance or Medicare, taking more of a cut to support the weight of growing bureaucracy.

The escape would not be derm, it would be a cash based setup.
 
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