Megabill implications for anesthesiologists

This forum made possible through the generous support of SDN members, donors, and sponsors. Thank you.
There are docs here who also openly admit using the same real estate tax deduction as the billionaire guys. But on a smaller scale.

They are all equal opportunities loopholes except for richer u are. The bigger the tax advantages.
Yup. Its not illegal.

But its not sustainable. So makes much more sense to target the wealthy who can sustain the tax increase without any change in their lifestyle.

Will that happen? No. Because the avg Republican voter thinks they will get rich (and this be affected by inheritance taxes), or thinks that rich folks will hire less workers or pay less because they get taxed on their inheritance (also won't happen)

So, for now, the misinformed voter is causing the issues
 
Yup. Its not illegal.

But its not sustainable. So makes much more sense to target the wealthy who can sustain the tax increase without any change in their lifestyle.

Will that happen? No. Because the avg Republican voter thinks they will get rich (and this be affected by inheritance taxes), or thinks that rich folks will hire less workers or pay less because they get taxed on their inheritance (also won't happen)

So, for now, the misinformed voter is causing the issues
I mean it is illegal in the sense that a lot of the people claiming these deductions in their context as doctors would lose in a tax court because of the radically liberal interpretation of them but the mechanism to enforce those laws has been defunded by Republicans because crime is legal under their reign. We all have an equal opportunity to cheat the tax code now since the IRS can no longer effectively enforce it.
 
I mean it is illegal in the sense that a lot of the people claiming these deductions in their context as doctors would lose in a tax court because of the radically liberal interpretation of them but the mechanism to enforce those laws has been defunded by Republicans because crime is legal under their reign. We all have an equal opportunity to cheat the tax code now since the IRS can no longer effectively enforce it.
Well. I was referring to real estate and tax loopholes.

You can buy a property for 10 million, wait 20 years and its now worth 30 million. You can take a loan out, for 20 million, pay no taxes. You can also tax deduct the depreciation.

Then when you die, you can leave it to your kids and they pay zero taxes when they sell it

All legal
 
There are docs here who also openly admit using the same real estate tax deduction as the billionaire guys. But on a smaller scale.

They are all equal opportunities loopholes except for richer u are. The bigger the tax advantages.
What real estate tax deduction do you mean?
 
It took me until 2004 and 2009 to realize the Democrats are just as guilty as the republicans for protecting the ultra rich

Both Kerry and Edwards got exposed as tax cheats/frauds in 2004 while promising to tax the rich. Just the irony

Final nail in the coffee with super majority control for democrats in 2009 to have a law in place to claw back transaction and stock gains up to 3 years (due to the AIG implosion). As my hedge fund cousin in London always told me “IBG” as in “I’ll be gone” before people realize it

That piece of legislation died quickly because the Democrats had no intention of hurting the people that donated to their campaigns. Wouldn’t you like to be a doctor who never gets clawed back in terms of malpractice? That’s essentially what the democrats let slide. The Dodd frank law that was finally passed was so watered down it excluded that provision. Some executives voluntarily gave up their bonus. Most did not. But they certainly did not want any law to codify bonus and executive compensation clawbackup to 3 years.

It’s not the republicans protection the ultra rich. It’s the Dems as well.
 
I’m not really a democrat or a republican but I will admit Biden was completely demented and a figure head at least toward the end of his presidency. I don’t think Trump won the last election as much as the democrats completely screwed the pooch. They should’ve spent bidens four years grooming someone and giving them “wins.” Trump is a bully con man. I’ll call it like I see it.

The fixes are so easy in concept but so hard to implement. Cracking down on immigration is a great idea…but raiding workplaces is stupid. The main issue with these people is they don’t pay taxes - All this is fixed with a national sales tax. Every dollar earned however is spent.

We also need to hold Americans more accountable for their ****ty behaviors. People on disability for morbid obesity is ridiculous. People still smoking is ridiculous. People doing illicit drugs is ridiculous. There needs to be lots more consequences for these people. They are too large a percentage of our population. I’m all for work requirements - idle hands do the devils work. I wish we could deny care to people caught positive for cocaine (for example) - maybe they’d stop doing drugs, maybe they wouldn’t - either way problem solved 🤷‍♀️
I’m pro-choice, want my taxes lowered, don’t like Trump or his authoritarian regime, like doge in theory but not execution, want a decent path to citizenship for people who want to come and work in this country…. Love the idea of a national sales tax (and import tax if you decide to buy that Mercedes in Germany and bring it here) but these tariff wars because we buy more from Vietnam then they buy from us is stupid.
Idk does that make me a republican or a democrat 🤷‍♀️ so hard to tell anymore - they both seem to not fix the right things


Where do you propose they find undocumented immigrants since most of them work for a living and spend their days at work? Night time raids at their homes?
 
Last edited:
I’m not really a democrat or a republican but I will admit Biden was completely demented and a figure head at least toward the end of his presidency. I don’t think Trump won the last election as much as the democrats completely screwed the pooch. They should’ve spent bidens four years grooming someone and giving them “wins.” Trump is a bully con man. I’ll call it like I see it.

The fixes are so easy in concept but so hard to implement. Cracking down on immigration is a great idea…but raiding workplaces is stupid. The main issue with these people is they don’t pay taxes - All this is fixed with a national sales tax. Every dollar earned however is spent.

We also need to hold Americans more accountable for their ****ty behaviors. People on disability for morbid obesity is ridiculous. People still smoking is ridiculous. People doing illicit drugs is ridiculous. There needs to be lots more consequences for these people. They are too large a percentage of our population. I’m all for work requirements - idle hands do the devils work. I wish we could deny care to people caught positive for cocaine (for example) - maybe they’d stop doing drugs, maybe they wouldn’t - either way problem solved 🤷‍♀️
I’m pro-choice, want my taxes lowered, don’t like Trump or his authoritarian regime, like doge in theory but not execution, want a decent path to citizenship for people who want to come and work in this country…. Love the idea of a national sales tax (and import tax if you decide to buy that Mercedes in Germany and bring it here) but these tariff wars because we buy more from Vietnam then they buy from us is stupid.
Idk does that make me a republican or a democrat 🤷‍♀️ so hard to tell anymore - they both seem to not fix the right things
Cracking down on immigration is a waste of money until they craft a robust immigration policy.

Create an incentive for folks to register. Low level benefits, taxes, path to citizenship, legalization, amnesty. Then you legitimize the 99% of folks who are beneficial to society.

Then the only ones left are the ones we dont want. They cant work, or get benefits, so they wre much easier to identify and remove, and mich less expensive.

Why are we spending billions to remove cheap labor that increases gdp
 
Why are we spending billions to remove cheap labor that increases gdp


Xenophobia and racism like every other time this country had an “immigration crisis”.

Why else would we admit South African “refugees” while eliminating special immigrant visas for Afghans who helped our military during the war.
 
There are docs here who also openly admit using the same real estate tax deduction as the billionaire guys. But on a smaller scale.

They are all equal opportunities loopholes except for richer u are. The bigger the tax advantages.
They aren’t loopholes because they are law.
 
Where do you propose they find undocumented immigrants since most of them work for a living and spend their days at work? Night time raids at their homes?

NO NO tens of millions hardened criminals INVADED us!!! The fact that they’re shopping Lowes and Home Depot months in for people to deport to keep the MAGAs happy is all by design!
 
They aren’t loopholes because they are law.
Correct. So people can’t complain when upper middle class people use the same tax laws as the uber rich people

The laws are made to benefit the rich first. And anyone else can take advantage of it is an afterthought

Notice most of the tax laws benefits apply to the poor and middle class (phased out incomes for things like the new auto loan interest rate phase out like 150k? Same with the ev tax credit Biden signed in 2022 phase out at 150k

Child tax credit phase out is 200k/400k.

We HENRY are an after thought for the government policy makers in terms of tax cuts. That’s why I said this new tax law doesn’t move the needle off 99% of docs who make 300-600k. The HENRYs
 
Correct. So people can’t complain when upper middle class people use the same tax laws as the uber rich people

The laws are made to benefit the rich first. And anyone else can take advantage of it is an afterthought

Notice most of the tax laws benefits apply to the poor and middle class (phased out incomes for things like the new auto loan interest rate phase out like 150k? Same with the ev tax credit Biden signed in 2022 phase out at 150k

Child tax credit phase out is 200k/400k.

We HENRY are an after thought for the government policy makers in terms of tax cuts. That’s why I said this new tax law doesn’t move the needle off 99% of docs who make 300-600k. The HENRYs
All the analyses out there are incorrect.

The top 0.1% is killing it. Saving 300k+ is amazing. I understand these people pay a lot of taxes but I believe putting that money in the hand of the 2nd/3rd/4th quintile would have a better effect in stimulating the economy.

What a bunch of us here (top 5%) gonna do with that money (20k+)? Buying more stocks; speculating in the housing market preventing middle class people from owning a home. The system is rigged.

 
Last edited:
I dunno why these clowns are laughing. H.R. 879 and S.1640. Named Medicare Patient Access and Practice Stabilization Act. Retroactively aims to halt CMS cuts and adds a 2% boost to MPFS. Bipartisan bill. Nothing to do with MAGA. I realize it still needs to pass, but it has strong bipartisan support and is being propped up by multiple large medical societies.
 
I dunno why these clowns are laughing. H.R. 879 and S.1640. Named Medicare Patient Access and Practice Stabilization Act. Retroactively aims to halt CMS cuts and adds a 2% boost to MPFS. Bipartisan bill. Nothing to do with MAGA. I realize it still needs to pass, but it has strong bipartisan support and is being propped up by multiple large medical societies.
Nobody's laughing, it's just that some of us have been involved in or following the ASA and its political arm for decades, and talk of a doc-fix, rural pass through, and the like has been on the agenda for DECADES. Every session, it's "so close," they say, and every session, it falls out. So let's see what actually occurs.
 
Nobody's laughing, it's just that some of us have been involved in or following the ASA and its political arm for decades, and talk of a doc-fix, rural pass through, and the like has been on the agenda for DECADES. Every session, it's "so close," they say, and every session, it falls out. So let's see what actually occurs.
I gave up on the ASA a while ago. They SUCK. Piss poor job of representing physicians, IMHO. Dead piss poor job of representing anesthesia subspecialties.
 
All the analyses out there are incorrect.

The top 0.1% is killing it. Saving 300k+ is amazing. I understand these people pay a lot of taxes but I believe putting that money in the hand of the 2nd/3rd/4th quintile would have a better effect in stimulating the economy.

What a bunch of us here (top 5%) gonna do with that money (20k+)? Buying more stocks; speculating in the housing market preventing middle class people from owning a home. The system is rigged.

Top 0.1% always kills it. The fact is that no one here or anywhere will actually vote for what’s better for their neighbor or community. We are all selfish and only vote for those who we believe will benefit ourself individually. If anyone disagrees, they are lying.
 
Top 0.1% always kills it. The fact is that no one here or anywhere will actually vote for what’s better for their neighbor or community. We are all selfish and only vote for those who we believe will benefit ourself individually. If anyone disagrees, they are lying.


No and not lying.
 
Top 0.1% always kills it. The fact is that no one here or anywhere will actually vote for what’s better for their neighbor or community. We are all selfish and only vote for those who we believe will benefit ourself individually. If anyone disagrees, they are lying.
I voted for Harris despite
1) being obviously likely to benefit from Trumpian tax policy
2) being personally screwed by Kamala Harris when she was Attorney General in CA and directed the DOJ to revoke firearm permits for military members stationed in that state

Some of us actually care that Trump is an unintelligent, incurious, uninformed, spiteful, pathologically lying, rapist whose overall economic and foreign policy plans are objectively harmful to the United States, our allies, and the rule of law.

But yeah. Go ahead and tell yourself that everyone is just as self-centered and ethically flexible as you are when voting. If it makes you feel better.
 
Top 0.1% always kills it. The fact is that no one here or anywhere will actually vote for what’s better for their neighbor or community. We are all selfish and only vote for those who we believe will benefit ourself individually. If anyone disagrees, they are lying.
I vote dem. I would expect that given my income, Republican would benefit me more.

Then again, i do benefit from clean air, reducing global warming, improved gas mileage and now EVs/solar.

So I suppose i do vote to benefit myself as well
 
I vote dem. I would expect that given my income, Republican would benefit me more.

Then again, i do benefit from clean air, reducing global warming, improved gas mileage and now EVs/solar.

So I suppose i do vote to benefit myself as well
Do you vote straight dem? From house senate and local?

There are so many shady politicians regardless of political affiliation. Look at that Louisiana representative Jefferson hiding all that money and the constituents still vote him year after year till he finally got arrested

Same with Marion berry the Washington DC mayor.

Sex lies drugs prostitution, all the criminal activity you can name and the dude goes to jail and still gets re elected by the democrats till he died. Some people are so hard core with democrats they will vote for anyone on the democratic ticket

That’s how trump gets votes. People like shady. Millions like shady. God bless America.
 
Do you vote straight dem? From house senate and local?

There are so many shady politicians regardless of political affiliation. Look at that Louisiana representative Jefferson hiding all that money and the constituents still vote him year after year till he finally got arrested

Same with Marion berry the Washington DC mayor.

Sex lies drugs prostitution, all the criminal activity you can name and the dude goes to jail and still gets re elected by the democrats till he died. Some people are so hard core with democrats they will vote for anyone on the democratic ticket

That’s how trump gets votes. People like shady. Millions like shady. God bless America.
I vote dem for congress and pres because the GOP representatives tend to be pretty extreme maga these days. Just look at the crazy Republican candidate in Texas running around screaming that the flood was fake/ due to cloud seeding, etc.

Sometimes local races will have more moderate GOP and more extreme dems (push for rent control) so i have voted Republican in those cases
 
Doge cuts responsible for Texas flooding deaths. And now I hear the big bill has a Limit of 200k for federal student loans for medical school? Limits for law school?
I have to say this is sooooo much worse than I thought Trump would be this time.
 
Doge cuts responsible for Texas flooding deaths. And now I hear the big bill has a Limit of 200k for federal student loans for medical school? Limits for law school?
I have to say this is sooooo much worse than I thought Trump would be this time.
Lets see. They fire and/or ban the climate scientists. Then they cut/fire FEMA workers.

Then the **** hits the fan as soon as a climate related emergency hits.

Who would've thought?
 
Doge cuts responsible for Texas flooding deaths. And now I hear the big bill has a Limit of 200k for federal student loans for medical school? Limits for law school?
I have to say this is sooooo much worse than I thought Trump would be this time.
It’s a bad bill. Only people benefits are ice immigration 45 billion dollar contractors. And rich people or people who like to do non medical independent contractors work section 199a
 
I gave up on the ASA a while ago. They SUCK. Piss poor job of representing physicians, IMHO. Dead piss poor job of representing anesthesia subspecialties.
Whether you like or dislike the ASA is hardly the point, and in any case, whether they are good or bad at representing our interests is irrelevant; they’re the only ones doing it. My point is that we’ve been supposedly on the cusp of having all of these stupid legislative things fixed for decades, and Until it actually happens, any rumors or promises are about as useful as tits on a boar.
 
Always funny that physicians that have a business are subject to income phase outs, but say a realtor making a million a year isn’t. Would be nice if there was more lobbying for increased Medicare reimbursement and better tax treatment of physicians as opposed to explicitly punishing physicians.

Canada for example has incredibly generous tax policy for physicians by comparison and waved a bunch of their licensing barriers. Sometimes it’s a bit tempting as apparently I would pay less taxes there according to some physician friends.
 
Always funny that physicians that have a business are subject to income phase outs, but say a realtor making a million a year isn’t. Would be nice if there was more lobbying for increased Medicare reimbursement and better tax treatment of physicians as opposed to explicitly punishing physicians.

Canada for example has incredibly generous tax policy for physicians by comparison and waved a bunch of their licensing barriers. Sometimes it’s a bit tempting as apparently I would pay less taxes there according to some physician friends.
Really?!?! I didn’t know this about Canada. Do you have details?
 
Whether you like or dislike the ASA is hardly the point, and in any case, whether they are good or bad at representing our interests is irrelevant; they’re the only ones doing it. My point is that we’ve been supposedly on the cusp of having all of these stupid legislative things fixed for decades, and Until it actually happens, any rumors or promises are about as useful as tits on a boar.
Yea except they arent the only ones doing it. ASA had little to do with this bill.
 
Lets see. They fire and/or ban the climate scientists. Then they cut/fire FEMA workers.

Then the **** hits the fan as soon as a climate related emergency hits.

Who would've thought?

Same thing they did for covid and then pretended like it was nothing
 
Yea except they arent the only ones doing it. ASA had little to do with this bill.
Of course they had to do with this bill. Who don’t think has been lobbying congress session after session, including this one, to include these provisions in bills that generally have nothing to do with doctors and payments?
 
Of course they had to do with this bill. Who don’t think has been lobbying congress session after session, including this one, to include these provisions in bills that generally have nothing to do with doctors and payments?
mostly? The AMA. ASA too, in part. But the ASA’s interests are unclear to me. They represent anesthesiologists AND nurses, so who's best interests are they representing exactly?
 
Top 0.1% always kills it. The fact is that no one here or anywhere will actually vote for what’s better for their neighbor or community. We are all selfish and only vote for those who we believe will benefit ourself individually. If anyone disagrees, they are lying.

This is false. Some of us actually want our children and grandchildren to have a prosperous country. The big beautiful bill will increase our national debt and make things worse. But the bigger issue is neither party has shown that they care about our fiscal situation as a nation. One party likes to tax and spend more on their agenda (deficits) while the other wants to cut taxes for their base while maintaining or slightly increasing the spending leading to larger deficits.
 
This is false. Some of us actually want our children and grandchildren to have a prosperous country. The big beautiful bill will increase our national debt and make things worse. But the bigger issue is neither party has shown that they care about our fiscal situation as a nation. One party likes to tax and spend more on their agenda (deficits) while the other wants to cut taxes for their base while maintaining or slightly increasing the spending leading to larger deficits.
Totally agree. The left here do not get it. The left has zero interest in controlling the deficit. They don’t want to cut programs. Just add more benefits/services by increasing taxes.

Obviously the republican plan cuts taxes and benefits. That’s not good either.

In summary. We need a 3rd national party to get the big two in its place.
 
This is false. Some of us actually want our children and grandchildren to have a prosperous country. The big beautiful bill will increase our national debt and make things worse. But the bigger issue is neither party has shown that they care about our fiscal situation as a nation. One party likes to tax and spend more on their agenda (deficits) while the other wants to cut taxes for their base while maintaining or slightly increasing the spending leading to larger deficits.
That is an exceedingly generous take on the legislation that just passed. It 'slightly' increased spending?
 
Totally agree. The left here do not get it. The left has zero interest in controlling the deficit. They don’t want to cut programs. Just add more benefits/services by increasing taxes.

Obviously the republican plan cuts taxes and benefits. That’s not good either.

In summary. We need a 3rd national party to get the big two in its place.


Thought you “love chaos”.

IMG_4732.jpeg
 
Last edited:
This is false. Some of us actually want our children and grandchildren to have a prosperous country. The big beautiful bill will increase our national debt and make things worse. But the bigger issue is neither party has shown that they care about our fiscal situation as a nation. One party likes to tax and spend more on their agenda (deficits) while the other wants to cut taxes for their base while maintaining or slightly increasing the spending leading to larger deficits.
False. They cut taxes and spend just like the dems. Don't believe me. Look at the numbers.
 
Totally agree. The left here do not get it. The left has zero interest in controlling the deficit. They don’t want to cut programs. Just add more benefits/services by increasing taxes.

Obviously the republican plan cuts taxes and benefits. That’s not good either.

In summary. We need a 3rd national party to get the big two in its place.
The left controls the deficit far better.

Neither balances it
 
Really?!?! I didn’t know this about Canada. Do you have details?
Essentially their entire business income is a 401k. You can therefore invest all your $ within the business and only get taxed when you withdraw it later. Overall means a much lower lifetime tax burden. But again I’m not an expert at all about this sort of stuff, and this is just from some of my friends.
 
This is false. Some of us actually want our children and grandchildren to have a prosperous country. The big beautiful bill will increase our national debt and make things worse. But the bigger issue is neither party has shown that they care about our fiscal situation as a nation. One party likes to tax and spend more on their agenda (deficits) while the other wants to cut taxes for their base while maintaining or slightly increasing the spending leading to larger deficits.
All of this was predictable, and predicted.

You voted for and got the tax cut you valued above everything else.

Please don't shrug away how bad this bill is with some weak both-sides-bad diversion. Some buyer's remorse is OK.

I don't expect you or anyone who voted for Trump to ever come out and say their reasons for doing so were wrong. Or to admit they were fooled. It'd be enough to hear them admit that things didn't turn out how they expected, and that they'll have different priorities when voting next time. Everyone makes mistakes.

At this point the best anyone can hope for is to turn either the Senate or the House over to the Democrats at the midterm elections. As ridiculous as some of them are, some good old fashioned gridlock would at least mitigate some of the damage Trump can do.
 
Do you have some data you could share to support that?
Oh, its not a controversial topic. Its pretty widely reported


Blinder and Watson reported that budget deficits tended to be smaller under Democrats at 2.1% potential GDP versus 2.8% potential GDP for Republicans, a difference of about 0.7 of a percentage point. They wrote that higher budget deficits should theoretically have boosted the economy more for Republicans, and therefore cannot explain the greater GDP growth under Democrats.<a href="U.S. economic performance by presidential party - Wikipedia"><span>[</span>1<span>]</span></a> Since 1981, federal budget deficits have increased under Republican presidents Ronald Reagan, both Bushes, and Trump, while deficits have declined under Democratic presidents Clinton and Obama. The economy ran surpluses during Clinton's last four fiscal years, the first surpluses since 1969. The deficit was projected to decline sharply in Biden's first fiscal year



 
That’s a pretty easy thing to look up. Do you disbelieve what the “data” show?
Some of the data is just pure luck. Had Clinton stayed on 8 months later. He’s been screwed

Had bush 43 left 5 months earlier. He’s be considered a great president in terms of the economy. The economy was roaring 2003-2007 with bush 43

The economy tanked 2000-2001 with Clinton leaving bush coming on with markets peaking jan1 and tanking throughout the next 20 months

Just a matter of sheer months can affect data.
 
Top