Supreme Court: Mandate Stands

[SurfingDoctor]

Obama has a history of increasing spending without positive results. History repeats itself.

Other presidents (from both parties) have done the same and will continue to do so in the future. So yep, history does repeat itself.

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[SurfingDoctor]

Why is it mandatory to wear seatbelts, but not wear a helmet on a motorcycle?

Because then there would be no organ donors.

 

[FunnyCurrent]

Anyone else worried about the exchange programs? I am not trying to start a partisan argument here, just someone please ease my concerns....

Tuition is at an all time high, financial aid is virtually nonexistant and some residency programs are starting to lengthen (e.g. 7 years for gen surg). The way it stands, when current medical students graduate and finish residency, we are going to have substantially higher debt than our predecessors.

State funded exchange programs are going to take over private insurance to a large extent (even CNN mentioned this morning estimated 20 million people we lose private insurance coverage for state exchanges rather quickly). This makes sense, why would an employer PAY for insurance when they can let the state subsidies cover their workers?

And for how this effects physician income? Currently, private insurance companies reimburse physicians at 50-60%, some good ones as much as 70%. Medicaid and medicare (expanded on the ACA, a good thing for sure) only reimburse at 17 and 19% respectively. So, if you see medicaid patients, you can expect to receive 17$ for every 100$ that you bill.

Undoubtedly, the state funded exchange reimbursements will mirror those of the federal programs that already exist (medicaid, medicare) rather than private insurance. After all, most states are broke anyway. I don't see how physician salaries will do anything but decrease (drastically, it seems). Also, it seems that this will eliminate ANY possibility of operating a private practice.

I am not in medical school to become filthy rich. I am just fearful of what the future holds, because, truth be told nobody knows how this will all play out. Any thoughts on this? Is my understanding/logic way off? Can anyone interpret this differently?

I am not prepared to start over, invest (risk), and pursue something else. Provided I match Ophtho I think I would be more unhappy with other careers available to me (law, engineering, teaching/research, etc) regardless of income. For better or worse I am willfully stuck in this field. Naturally, if reimbursements truly tank my career will look a lot different than what I presently imagine. I don't see myself working more and more hours becoming a martyr just to keep a practice open. First, I would probably try to match EM instead of Ophtho. Second, I would work locum tenens and as little as possible. Third, I would live in a foreign country when I wasn't working where I can enjoy a favorable exchange rate, cheap beer, great food, beautiful women, and white sandy beaches.

Regardless of what the future holds I think I'll be okay.

Optimism

 

[RIPSanto]

I am not prepared to start over, invest (risk), and pursue something else. Provided I match Ophtho I think I would be more unhappy with other careers available to me (law, engineering, teaching/research, etc) regardless of income. For better or worse I am willfully stuck in this field. Naturally, if reimbursements truly tank my career will look a lot different than what I presently imagine. I don't see myself working more and more hours becoming a martyr just to keep a practice open. First, I would probably try to match EM instead of Ophtho. Second, I would work locum tenens and as little as possible. Third, I would live in a foreign country when I wasn't working where I can enjoy a favorable exchange rate, cheap beer, great food, beautiful women, and white sandy beaches.

Regardless of what the future holds I think I'll be okay.

Optimism

Wish SDN had a "like" button

 

[startoverat40]

Obama has a history of increasing spending without positive results.

if the stimulus is what you are refering to, then the evidence proves you wrong. In fact the stimulus was too small, and that's why the recovery has dragged on so long.

 

[SoundofSilver]

How is it setting a new precedent when the purchase of vehicle insurance is already compulsory for those wanting to drive a car?

The government can regulate how you use something e.g. to use a car you must have insurance, not be drunk, wear a seatbelt, etc. We have a choice of whether or not we want to drive and therefore we can choose not to buy insurance based on choosing not to drive.

Health insurance is different because you are now compelled to buy something from a private company or face a tax due to the simple fact that you exist. Before the ruling today, I would have said a single payer system would be more constitutional based on the precedent set by medicare, but I guess that's a moot point now.

Also, auto insurance laws are state level issues. Another difference is that driving w/out auto insurance results in civil or criminal penalties depending on where you live rather than a tax increase. Not buying health insurance cannot be considered an infraction or a crime (based on the individual mandate's invalidation under the commerce clause), it just subjects you to a new tax. Refusal to pay the resulting tax would be the crime.

 

[operaman]

Our laws are full of tax penalties just like this one. For example:

You pay a tax penalty for not having children.

You pay a tax penalty for not buying a house.

Now you'll face a penalty for not buying health insurance.

 

[RIPSanto]

if the stimulus is what you are refering to, then the evidence proves you wrong.

Whats with all the pre-meds posting in allo?

 

[RIPSanto]

Our laws are full of tax penalties just like this one. For example:

You pay a tax penalty for not having children.

You pay a tax penalty for not buying a house.

Now you'll face a penalty for not buying health insurance.

I think there is a difference between a tax penalty and a tax deduction?

 

[startoverat40]

Whats with all the pre-meds posting in allo?

what's with people's sense of ownership on an open internet forum?

 

[operaman]

I think there is a difference between a tax penalty and a tax deduction?

True. I used 'penalty' in its general sense, not in its tax-specific lingo sense. Probably should have used a different word.

The principle still applies though: You pay higher taxes because you don't do something or buy something. The wording may be slightly different but the concept is the same. If I have a child I get a tax credit; If I chose not to have children, I pay more.

 

[RIPSanto]

what's with people's sense of ownership on an open internet forum?

I am sorry, I thought you would catch my sarcasm... I wasn't serious

 

[JackShephard MD]

Socialist Russia wants you.

These are the dumb comments that make American politics and discussions worse. You don't need to demonize people who disagree with you.

That's all well and good, and I agree that it's lazy to blame everything since 2010 on Obama and the ACA, etc, and it's lazy to use anecdotes as the basis for fear-mongering. Frankly, I'm neither in love with nor vehemently opposed to the ACA. It just irks me when the pro-ACA side is so black-and-white in calling the docs who may actually have a legitimate reason for making a business decision based on the new legislation "greedy."

I am not prepared to start over, invest (risk), and pursue something else. Provided I match Ophtho I think I would be more unhappy with other careers available to me (law, engineering, teaching/research, etc) regardless of income. For better or worse I am willfully stuck in this field. Naturally, if reimbursements truly tank my career will look a lot different than what I presently imagine. I don't see myself working more and more hours becoming a martyr just to keep a practice open. First, I would probably try to match EM instead of Ophtho. Second, I would work locum tenens and as little as possible. Third, I would live in a foreign country when I wasn't working where I can enjoy a favorable exchange rate, cheap beer, great food, beautiful women, and white sandy beaches.

Regardless of what the future holds I think I'll be okay.

Optimism

lol, well I'm optimistic too. As for your, "match EM" strategy, that seems a bit far fetched. I mean, you'll be preparing your application in a few years, do you really believe you'll have an idea of what your practice environment will be over the next 20 years in 2014?

Whats with all the pre-meds posting in allo?

They're in purgatory and very eager to be medical students.

what's with people's sense of ownership on an open internet forum?

It's a pervasive human quality to take ownership or claim territory. Who knows why. I think it's all over medicine, well beyond the SDN allopathic forum.

 

[SurfingDoctor]

The government can regulate how you use something e.g. to use a car you must have insurance, not be drunk, wear a seatbelt, etc. We have a choice of whether or not we want to drive and therefore we can choose not to buy insurance based on choosing not to drive.

Health insurance is different because you are now compelled to buy something from a private company or face a tax due to the simple fact that you exist.

Also, auto insurance laws are state level issues. Another difference is that driving w/out auto insurance results in civil or criminal penalties depending on where you live rather than a tax increase. Not buying health insurance cannot be considered an infraction or a crime (based on the individual mandate's invalidation under the commerce clause), it just subjects you to a tax penalty. Refusal to pay the resulting tax would be the crime.

You are required to pay into social security, you are required to buy police and fire protection, you are required buy military protection, the list goes on... the list of taxes that is.

 

[bashir]

Our laws are full of tax penalties just like this one. For example:

You pay a tax penalty for not having children.

You pay a tax penalty for not buying a house.

Now you'll face a penalty for not buying health insurance.

Thank you, Operaman, for stating it so simply. As the Supreme Court ultimately ruled, the "individual mandate" is simply a new income tax, which can be avoided by purchasing health insurance. In other words it's a tax deduction. In that regard there is absolutely nothing groundbreaking or "scary precedent-setting" about it. The Obama administration was, naturally, not eager to pitch it as a tax but that's all it is.

 

[SoundofSilver]

You are required to pay into social security, you are required to buy police and fire protection, you are required buy military protection, the list goes on... the list of taxes that is.

The difference is those things are provided by the government. Private health insurance is not. This is new.

 

[bashir]

The difference is those things are provided by the government. Private health insurance is not. This is new.

You can get tax deductions for buying certain fuel-efficient cars from private companies. Everybody who does not purchase such a vehicle in a given year pays higher taxes. Not new.

 

[DoctwoB]

I also fall under the "meh" side of this ruling. The ACA was never a big change to begin with. I support prohibition of denial of insurance coverage based on pre-existing conditions and understand that without increasing the insurance pool this would cause rates to sky-rocket. Medicaid expansion helps increase coverage which is good, but with crappy insurance that fewer and fewer docs will accept, exacerbating the de-facto two tiered system that exists, and accelerating the already existing state budget crisis due to medicaid costs.. Nothing is done to curtail the massive growth in health care costs and malpractice was untouched.

Don't know why everyone made such a huge deal about this. The ACA was a strip of duct-tape on a structure that will collapse under its own weight over the next few decades. The primary problems of US health care costs (poor lifestyle choices by populace, absence of rationing/too much care of marginal benefit, perverse incentives, end of life costs, etc.) were all untouched.

 

[kpcrew]

The government can regulate how you use something e.g. to use a car you must have insurance, not be drunk, wear a seatbelt, etc. We have a choice of whether or not we want to drive and therefore we can choose not to buy insurance based on choosing not to drive.

Health insurance is different because you are now compelled to buy something from a private company or face a tax due to the simple fact that you exist. Before the ruling today, I would have said a single payer system would be more constitutional based on the precedent set by medicare, but I guess that's a moot point now.

Also, auto insurance laws are state level issues. Another difference is that driving w/out auto insurance results in civil or criminal penalties depending on where you live rather than a tax increase. Not buying health insurance cannot be considered an infraction or a crime (based on the individual mandate's invalidation under the commerce clause), it just subjects you to a new tax. Refusal to pay the resulting tax would be the crime.

okay that makes a lot of sense. The thing is that insurance works best when everyone has more or less the same chance of getting a certain condition. To only cover part of the population defeats the whole purpose of having insurance in the first place because insurance companies will just go for the population with the lowest risk to maximize profits. Those who need the care the most will be left out. I can see how setting a precent would be wrong but why is mandating a certain level of health care for individuals wrong? Why wouldn't it be considered a public safety issue? Either way, when someone gets sick, they're going to get treatment. Having universal coverage would help spread risk and prevent bankruptcy due to bad luck.

Obama has a history of increasing spending without positive results. History repeats itself.

This argument is disingenous. Congress controls spending, not the presidency. Also, a lot of the spending can be traced back to previous administrations, due to unfinanced wars, unjustified tax breaks and massive amounts of deregulation.

 

[SoundofSilver]

Thank you, Operaman, for stating it so simply. As the Supreme Court ultimately ruled, the "individual mandate" is simply a new income tax, which can be avoided by purchasing health insurance. In other words it's a tax deduction. In that regard there is absolutely nothing groundbreaking or "scary precedent-setting" about it. The Obama administration was, naturally, not eager to pitch it as a tax but that's all it is.

I agree with your line of reasoning to a certain extent. However, I'm not sure "buy a private product and you can avoid this new tax" has ever been done before on the federal level. Tax deduction does not equal avoiding a tax penalty. Tax deduction for an electric car purchase is a reward. There is no reward for buying health insurance, you simply don't have to pay the penalty. There is no tax penalty for failing to buy an electric car, not getting the reward (i.e. tax deduction) does not equal a penalty.

 

[operaman]

I agree with your line of reasoning to a certain extent. However, I'm not sure "buy a private product and you can avoid this new tax" has ever been done before on the federal level. Tax deduction does not equal avoiding a tax penalty. Tax deduction for an electric car purchase is a reward. There is no reward for buying health insurance, you simply don't have to pay the penalty.

Well, we have definitely had "buy a private product and avoid this OLD tax."

Buy a mortage and avoid paying some of your income tax.

This is arguably one of the most popular provisions in the tax code.

 

[JackShephard MD]

Well, we have definitely had "buy a private product and avoid this OLD tax."

Buy a mortage and avoid paying some of your income tax.

This is arguably one of the most popular provisions in the tax code.

I don't see how deducting an old tax is any different from penalizing via a new tax.

I'm with operaman on this one.

It's like if the government decided to double taxes followed by giving a tax break, then that's fine. Yet keep taxes the same and add a penalty, then that's an awful new precedent!... The sky is falling thing gets old.

 

[Kunu]

So what would the GOP do instead to make healthcare more affordable and accessible?

(crickets chirping)

Tax free private health care accounts so people can *gulp* afford, save (I know- working and paying your own bills- foreign concept to liberals) and pay for their own expenses?

 

[bashir]

I agree with your line of reasoning to a certain extent. However, I'm not sure "buy a private product and you can avoid this new tax" has ever been done before on the federal level. Tax deduction does not equal avoiding a tax penalty. Tax deduction for an electric car purchase is a reward. There is no reward for buying health insurance, you simply don't have to pay the penalty. There is no tax penalty for failing to buy an electric car, not getting the reward (i.e. tax deduction) does not equal a penalty.

The only difference is that the deduction is being implemented at the same time as the tax it is meant to offset. I can't see how that marks a substantive departure from the way we have always incentivized certain behaviors with the tax code. The only reason we are even having this debate is because the law refers to a "penalty" rather than a "tax" for political reasons.

 

[operaman]

If Obama can survive the election, the "tax" angle may actually help with implementation and compliance. For some reason, people loathe taxes so much that they will do any measure of things to avoid them.

My personal favorite are when states have "tax free weekends." These have become incredibly popular, but you have to think that if a store threw a "everything in the store is 7% off!" sale, the parking lots wouldn't be nearly as full.

The ACA depends on a massive expansion of coverage to pay for guaranteed issue. The penalties are not really high enough to make it an economic no-brainer to buy health insurance. I'm hopeful that the anti-tax mentality will lead to more coverage as people attempt to stick it to uncle sam one co-pay at a time.

 

[shiftingmirage]

Tax free private health care accounts so people can *gulp* afford, save (I know- working and paying your own bills- foreign concept to liberals) and pay for their own expenses?

Last year I had ~15k worth of medical expenses. It would take me a whole lotta time to save up that much money.

Savings accounts work great for little things, but one needs a fallback when something bad happens. Also, Americans, and maybe people in general, are pretty bad when it comes to saving money.

For some reason, people loathe taxes so much that they will do any measure of things to avoid them.

I've always found it interesting the number of people I saw in clinic with their medicaid card in one hand, and iPhone in the other.

 

[calvnandhobbs68]

Tax free private health care accounts so people can *gulp* afford, save (I know- working and paying your own bills- foreign concept to liberals) and pay for their own expenses?

Hey look it already exists! Nice try.

http://en.wikipedia.org/wiki/Health_savings_account

If you want it to cover all your medical expenses have fun trying to save up 100K to cover your hospital stay.

 

[Acoustic]

Last year I had ~15k worth of medical expenses. It would take me a whole lotta time to save up that much money.
I've always found it interesting the number of people I saw in clinic with their medicaid card in one hand, and iPhone in the other.

Ya, the first part is why insurance even exists. The whole health spending account already exists to some degree, but it's basically only useful for routine visits or prescriptions, does nothing to really protect you in case of emergency.

The second part is more or less an argument against government programs as a whole. A number of pediatricians I know talk about seeing that all the time - mom with an iPhone asking for prescriptions for Tylenol for her kids so she can use government healthcare to pay for it.

We were made to watch what was basically a propaganda movie in class a few weeks back. In it, a poor woman who had no job described her absolute interest in not looking for a job, because she needed healthcare and so it was better for her to not work and get government help instead. They were trying to spin it to be sympathetic for her, but it's that kind of attitude that conservatives say is the problem with government programs.

 

[osumc2014]

let's discuss how it will effect us, who's going to foot the bill? Those with incomes >$250,000 will pay another big tax to pay for it?

 

[Acoustic]

let's discuss how it will effect us, who's going to foot the bill? Those with incomes >$250,000 will pay another big tax to pay for it?

Wasn't the individual mandate addressing just that: making everyone foot the bill?

 

[cetac]

I think the ACA, overall, is a net benefit, but that the mandate being upheld might sadly prove to be the nail in the coffin of Medicare for All. The mandate requires people buy private insurance or pay a penalty, which means the already powerful health insurance industry will become infinitely powerful, for practical purposes.

When the day comes that our country has sufficient political and cultural capital to buy in to single payer we will have been spending the years prior feeding, grooming and training the opposition via providing them with the entire U.S. population as customers.

 

[JackShephard MD]

I think the ACA, overall, is a net benefit, but that the mandate being upheld might sadly prove to be the nail in the coffin of Medicare for All. The mandate requires people buy private insurance or pay a penalty, which means the already powerful health insurance industry will become infinitely powerful, for practical purposes.

When the day comes that our country has sufficient political and cultural capital to buy in to single payer we will have been spending the years prior feeding, grooming and training the opposition via providing them with the entire U.S. population as customers.

But administration costs are capped for insurance companies now, which is a plus.

I agree with you that it's a net benefit.

 

[osumc2014]

Wasn't the individual mandate addressing just that: making everyone foot the bill?

CNN says there's a medicare surtax for those making > 250,000

http://money.cnn.com/2012/06/26/pf/taxes/health_reform_new_taxes/index.htm?hpt=hp_c2

 

[naus]

According to the 2010 income survey, the average neurologist made 268k annually (25th% 190k and 90th% 413k). It's not like they are family care physicians, I'm sure if he still took care of all those patients he would still earn more than most FM physicians.

Bull****. That's including all benefits. FM physicians by your measure make around $200 too.

 

[naus]

I think the ACA, overall, is a net benefit, but that the mandate being upheld might sadly prove to be the nail in the coffin of Medicare for All.

Medicare for All? How about keeping Medicare for 65+ solvent first (which is currently supported by the working population from 18 to 65)?

One million American physician incomes are only 8% of Medicare expenditures. You can cut our incomes to $0 and still have huge insolvency issues with Medicare. The bleeding hearts here would do everything they can to get the government to push our incomes as low as possible, meanwhile nurses in California already make more than primary care physicians.

We didn't sign up to be martyrs.

 

[JackShephard MD]

Bull****. That's including all benefits. FM physicians by your measure make around $200 too.

I wouldn't call it BS. I would just say it includes all benefits. You do realize that not all working individuals receive these benefits and they are therefore in some ways, income.

It's not my measure, it's the MGMA survey. And yes, according to that survey, FP makes around 200k (25th% 160k and 90th% 300k).

 

[JackShephard MD]

Medicare for All? How about keeping Medicare for 65+ solvent first (which is currently supported by the working population from 18 to 65)?

One million American physician incomes are only 8% of Medicare expenditures. You can cut our incomes to $0 and still have huge insolvency issues with Medicare. The bleeding hearts here would do everything they can to get the government to push our incomes as low as possible, meanwhile nurses in California already make more than primary care physicians.

We didn't sign up to be martyrs.

No one's stopping you from making a living. It baffles me that individuals in the top 1% of earning + disposable income in the history of man can hold a thought they are not financially well off. It's sad.

Think about this, 53% of the world lives on a few dollars a day. The average physician earns nearly 300 times more money than the average person in the world. The average physician is in the top ~3% of earners in the richest country the world has ever known. Yet, most think they are underpaid and struggling. It's a joke.

You're nowhere near being considered a martyr.

 

[adenocard]

Think about this, 53% of the world lives on a few dollars a day. The average physician earns nearly 300 times more money than the average person in the world. The average physician is in the top ~3% of earners in the richest country the world has ever known. Yet, most think they are underpaid and struggling. It's a joke.

You're nowhere near being considered a martyr.

What a horrible flawed argument

 

[Medstudentquest]

Medicare for All? How about keeping Medicare for 65+ solvent first (which is currently supported by the working population from 18 to 65)?

One million American physician incomes are only 8% of Medicare expenditures. You can cut our incomes to $0 and still have huge insolvency issues with Medicare. The bleeding hearts here would do everything they can to get the government to push our incomes as low as possible, meanwhile nurses in California already make more than primary care physicians.

We didn't sign up to be martyrs.

Agree 100%. Like I have asked many times before why can't the cutting start at the bottom? Part of the problem is that we are all a bunch of pansies. We are getting screwed royally while everyone, and i mean EVERYONE in healthcare is winning at our expense. Nurses, NP, PA, administrators, etc.

Half of specialties already make crap and now they are attacking the other half that takes twice as long to complete and make better $$. I say if they want a nationalized healthcare system, then let's do it all the way.

Let's follow France-hours cap at 35/week, we don't pay for medical education, malpractice is minimal at best. Not to mention, let's be protected like every other employee in America-let's strike when we need to. Freaking nurses do it, teachers and cabbies do it.

The fact that we just sit there while they are gouging us is absurd!!!

 

[Medstudentquest]

No one's stopping you from making a living. It baffles me that individuals in the top 1% of earning + disposable income in the history of man can hold a thought they are not financially well off. It's sad.

Think about this, 53% of the world lives on a few dollars a day. The average physician earns nearly 300 times more money than the average person in the world. The average physician is in the top ~3% of earners in the richest country the world has ever known. Yet, most think they are underpaid and struggling. It's a joke.

You're nowhere near being considered a martyr.

When you make the same as the nurses and PA's that you supervise, will you also make that argument?

I guess you don't value the sacrifice and effort that it takes to become a doctor, nor the opportunity cost. When engineers, nurses, bankers, lawyers, and just about every other professional makes the same or more that we do, and they all go home at night and are free on the weekends, with 1/2 the time it takes to get through everything we get through, are you ok with that?

It's sad that you don't stand up for your profession dude.

 

[naus]

No one's stopping you from making a living. It baffles me that individuals in the top 1% of earning + disposable income in the history of man can hold a thought they are not financially well off. It's sad.

Think about this, 53% of the world lives on a few dollars a day. The average physician earns nearly 300 times more money than the average person in the world. The average physician is in the top ~3% of earners in the richest country the world has ever known. Yet, most think they are underpaid and struggling. It's a joke.

You're nowhere near being considered a martyr.

When you get out of medical school I hope you negotiate for $2 a day total compensation package so that it'll be in line with the other 53% of the world.

I'm quite speechless at your post to be honest. This kind of naïveté and economic illiteracy is hard to imagine for someone pursuing a professional doctorate.

 

[Acoustic]

When you make the same as the nurses and PA's that you supervise, will you also make that argument?

I guess you don't value the sacrifice and effort that it takes to become a doctor, nor the opportunity cost. When engineers, nurses, bankers, lawyers, and just about every other professional makes the same or more that we do, and they all go home at night and are free on the weekends, with 1/2 the time it takes to get through everything we get through, are you ok with that?

It's sad that you don't stand up for your profession dude.

Not only are doctors really bad at ensuring their own interests and lobbying as a whole, many promote the opposite.

 

[calvnandhobbs68]

When you make the same as the nurses and PA's that you supervise, will you also make that argument?

I guess you don't value the sacrifice and effort that it takes to become a doctor, nor the opportunity cost. When engineers, nurses, bankers, lawyers, and just about every other professional makes the same or more that we do, and they all go home at night and are free on the weekends, with 1/2 the time it takes to get through everything we get through, are you ok with that?

It's sad that you don't stand up for your profession dude.

LOL I'm not sure where you get the idea that they go home at night and are free on the weekends but rest assured many other professionals work till 7 at night and on the weekends too (not including nurses with their union mandated shifts and break times).

I'm all for standing up for pay as a profession though especially because we have to make sure we don't get run over by the nurse/ancillary staff unions. I think it's crucial to emphasize the point tht physician pay makes up such a small slice of healthcare costs already that cutting it at all does basically nothing.

 

[ArcGurren]

When you make the same as the nurses and PA's that you supervise, will you also make that argument?

I guess you don't value the sacrifice and effort that it takes to become a doctor, nor the opportunity cost. When engineers, nurses, bankers, lawyers, and just about every other professional makes the same or more that we do, and they all go home at night and are free on the weekends, with 1/2 the time it takes to get through everything we get through, are you ok with that?

It's sad that you don't stand up for your profession dude.

Are you out of your mind? In what alternate universe have you ever seen a lawyer, banker, or nurse work like that?

 

[ArcGurren]

LOL I'm not sure where you get the idea that they go home at night and are free on the weekends but rest assured many other professionals work till 7 at night and on the weekends too (not including nurses with their union mandated shifts and break times).

I'm all for standing up for pay as a profession though especially because we have to make sure we don't get run over by the nurse/ancillary staff unions. I think it's crucial to emphasize the point tht physician pay makes up such a small slice of healthcare costs already that cutting it at all does basically nothing.

Nurses might have mandated break time and work in shifts, but so do lots of doctors (well, not the break time, but definitely the shifts). Maybe physicians should start being more proactive about forming unions.

 

[Medstudentquest]

Not only are doctors really bad at ensuring their own interests and lobbying as a whole, many promote the opposite.

No kidding. No wonder no one gives a darn about us and we are getting screwed royally. I mean teachers talk about how they are so important for the future of america, nurses talk about how they are important and make almost as much as some PCPs, NP/CRNA types also have such serious lobbying that again their salaries are insane. And what do we have? people like these who are ok with working twice as hard for less than what a CRNA makes.

It's absolutely sad. I am so glad that I don't have loans and could quit at a moment's time, but this type of ideology is really damaging to our profession.

 

[SoundofSilver]

Also included in the ACA is something called a value based payment modifier where medicare will begin to move away from a fee for service model to a system that pays physicians differently based on quality and cost of the care they provide. This begins in 2015.

Thoughts?

 

[Medstudentquest]

Are you out of your mind? In what alternate universe have you ever seen a lawyer, banker, or nurse work like that?

Seriously? My husband is in one of those professions, makes 6 figs, and comes home at around 6-6:30pm with an hour commute. No weekends, no call, no holidays. Nurses work usually 3 12 hour shifts. So if one of their shifts falls on a weekend, they have most of the week off. Bankers may be the exception but they make twice what most docs make, with a ton less education.

 

[henge]

The only difference is that the deduction is being implemented at the same time as the tax it is meant to offset. I can't see how that marks a substantive departure from the way we have always incentivized certain behaviors with the tax code. The only reason we are even having this debate is because the law refers to a "penalty" rather than a "tax" for political reasons.

Agreed.

I'm not sure "buy a private product and you can avoid this new tax" has ever been done before on the federal level. Tax deduction does not equal avoiding a tax penalty. Tax deduction for an electric car purchase is a reward. There is no reward for buying health insurance, you simply don't have to pay the penalty. There is no tax penalty for failing to buy an electric car, not getting the reward (i.e. tax deduction) does not equal a penalty.

This came up in oral arguments over the ACA. One of the justices asked if the government could raise each person's tax by the exact amount that the person would pay as a penalty/additional tax if they did not have health insurance, and then give to each individual who did have health insurance a tax credit of equal amount. Those who did not have health insurance would not get the credit. The net result is exactly the same thing as taxing/penalizing those who don't have insurance. The attorney challenging the ACA could not explain why the scenario the justice presented would be unconstitutional. And he couldn't because if you accept that the government can change tax owed through the use of deductions and credits, there simply is no difference between a general tax increase coupled with a targeted credit/deduction and a targeted tax. The "reward" argument you make is merely a formal distinction lacking in substance.

Socialist Russia wants you.

I realize this particular comment was not directly about the mandate, but the since we're talking about ACA, you should refer to other nations that have health insurance mandates, like Switzerland (AAA bond rating), Netherlands (AAA bond rating), Australia (AAA bond rating) and Japan (AA- bond rating). http://en.wikipedia.org/wiki/Health_insurance_mandate

It's always disappointing to read posts in discussions like this that somehow assume that the ACA is some sort of radical program. Every advanced nation in the world has universal health coverage, and as noted above, four prosperous, democratic, human-rights-respecting, slavery-barring nations with long-lived, reasonably healthy, largely nonimpoverished citizens have a health insurance mandate. It's not like we're plunging into completely uncharted territory here, and it's not like the our forerunners have imploded, descended into anarchy, slavery, impoverishment, etc.

 

[JackShephard MD]

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