werd

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The medicare cuts that are upcoming won't go through.
you're probably right, but congress keeps pushing it back by only 4-6 weeks. until we fix the reimbursement schedule it will keep hanging over our heads and the proposed cuts will continue to become more severe. actually, just a few months ago congress failed to push the cuts back in time and the cuts went into effect. the medicare billing office handled this by essentially shutting down for 2 weeks and not processing any claims. when congress finally acted again they retroactively pushed back the payment cuts and medicare claim processing once again started.
 

Lokhtar

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Yup. It's something that's going to continue to happen though. I don't really see a solution, unfortunately. The Democratic congress doesn't want to be seen as increasing entitlement spending and Republican congress won't be too thrilled to be seen as not cutting 'waste'.

So it'll just be pushed back again, as usual.
 

Narmerguy

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you're probably right, but congress keeps pushing it back by only 4-6 weeks. until we fix the reimbursement schedule it will keep hanging over our heads and the proposed cuts will continue to become more severe. actually, just a few months ago congress failed to push the cuts back in time and the cuts went into effect. the medicare billing office handled this by essentially shutting down for 2 weeks and not processing any claims. when congress finally acted again they retroactively pushed back the payment cuts and medicare claim processing once again started.
This is pretty stupid imo. How long will this continue? Years? Decades? How long has this even been going on?
 

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This is pretty stupid imo. How long will this continue? Years? Decades? How long has this even been going on?
It'll continue until things continue to get so bad that we are forced, as a nation, to do more than put bandaids on things. It'll also come when there is someone who is willing to do things that would be political suicide for the sake of the nation.
 

eablackwell

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It'll continue until things continue to get so bad that we are forced, as a nation, to do more than put bandaids on things. It'll also come when there is someone who is willing to do things that would be political suicide for the sake of the nation.
The reason political suicide isn't intentionally common or productive is that one person cannot control the entire government. And you definitely can't control it once you're out.

You could totally commit political suicide for a cause, (maybe) push it through, and then everyone hates you. Once you're gone, it will just be pushed back to the way it was.

Lose, lose situation. Half the country doesn't know what's good for them anyway. They'd happily slit the throats of those trying help them if certain figureheads told them to do so.

And that's all I'll say on a political note, because things get ugly when I talk political online. ;)
 
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...and then there is China. A single party state that aims for long term prosperity in their legislation. I guess when you don't have democracy you aren't afraid to do things that are both unpopular and absolutely necessary at the same time.
 

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Also aims for massive corruption where buildings fall down sideways because they aren't unaccountable.
Or rather, never aren't unaccountable.

Democracy doesn't guarantee the best government, just the government we most deserve. Considering that America has gone from the Greatest Generation to a sad lot of navel-gazing, self-important armchair experts who feel that ignorance and gut emotion is a better fount of wisdom than earned knowledge and careful reflection, I'd say we're screwed.
 

ronaldo23

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Eliot Spitzer was an awful governor, and he is an even worse interviewer.

The best part of the interview is when Spitzer says "What was your peak income over the last decade?"

and Rand says, "If you want this about personally, you're not going to have a very intelligent discussion. Do you want me to go into your personal past on this program? I don't think so"
 
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What a jackass (Spitzer).

He wants to put Paul on blast for earning a higher income as a doctor, and how that affects the budget? What they should've been discussing is how much a governor earns when they can spend 40 grand/year on prostitutes.
 

45408

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What a jackass (Spitzer).

He wants to put Paul on blast for earning a higher income as a doctor, and how that affects the budget? What they should've been discussing is how much a governor earns when they can spend 40 grand/year on prostitutes.
Hence Rand's rather discrete comment about not going into Spitzer's past ;)
 
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Or rather, never aren't unaccountable.

Democracy doesn't guarantee the best government, just the government we most deserve. Considering that America has gone from the Greatest Generation to a sad lot of navel-gazing, self-important armchair experts who feel that ignorance and gut emotion is a better fount of wisdom than earned knowledge and careful reflection, I'd say we're screwed.
So true. You forgot political correctness that blinds us to differences and makes working for a living sound like some plan the devil drew up.
 

LuciusVorenus

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Prostitution aside, I wonder how much money Spitzer made as governor. How about we just cut politician pay instead?
 

Lokhtar

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Prostitution aside, I wonder how much money Spitzer made as governor. How about we just cut politician pay instead?
They would never vote on that :laugh:. Even if it truly was the only way to fix the defecit.
It's such a stupid and easy thing to say 'pay them less.' Frankly, if you did, the only people who'd be interested in politics are those who are independently rich and don't care bout the income from their jobs anyway. There are enough people from those backgrounds as it is.

You can't say that politicians don't know how the common man feels if you make it so that the common man wouldn't go anywhere near politics because he can't send his kids to college if he did.

Frankly, people don't realize how much time many of these people spend at their job (I've volunteered for politicians of both parties, and seven days a week and sixteen hours a day is not really uncommon as a regular schedule - granted a lot of it's fund raising for their next election :p, but it's still exhausting).

Now I'm not saying that politicians are selfless or anything. I'm just saying that if you cut salaries you'll only be left with people who come from trust fund backgrounds and don't give a crap about the pay anyway. It's not like we're paying them millions. It's not unreasonable to pay them well enough to live comfortably.

If you want to make it so that only the financial elites have any shot at public office (they already have a huge leg up), that's fine - but you need to realize that's what will happen if you reduce the salaries too much. And then you can't moan about those people not being in touch 'with the common man.'
 
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LuciusVorenus

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It's such a stupid and easy thing to say 'pay them less.' Frankly, if you did, the only people who'd be interested in politics are those who are independently rich and don't care bout the income from their jobs anyway. There are enough people from those backgrounds as it is.

You can't say that politicians don't know how the common man feels if you make it so that the common man wouldn't go anywhere near politics because he can't send his kids to college if he did.

Frankly, people don't realize how much time many of these people spend at their job (I've volunteered for politicians of both parties, and seven days a week and sixteen hours a day is not really uncommon as a regular schedule - granted a lot of it's fund raising for their next election :p, but it's still exhausting).

Now I'm not saying that politicians are selfless or anything. I'm just saying that if you cut salaries you'll only be left with people who come from trust fund backgrounds and don't give a crap about the pay anyway. It's not like we're paying them millions. It's not unreasonable to pay them well enough to live comfortably.

If you want to make it so that only the financial elites have any shot at public office (they already have a huge leg up), that's fine - but you need to realize that's what will happen if you reduce the salaries too much. And then you can't moan about those people not being in touch 'with the common man.'
http://economix.blogs.nytimes.com/2009/11/25/your-senator-is-probably-a-millionaire/

If you've volunteered for a successful congressman/senator/governor, I'm guessing you already know a middle class (or upper middle class) person has no real chance at winning. If we want to cut costs by cutting physician pay, why is it wrong to also assume that our millionaire senators don't need their $190,000/year pay checks?

The point here is that Spitzer had the balls to ask how much Rand Paul made as a doctor when he himself drew in the largest yearly salary of any governor in the nation, despite already being a millionaire and having a father worth half a billion. Or how McCain thinks we need to "reform" social security because it's broken while gaming the system himself and drawing in $2000/month for no reason other than greed.

Are there more selfless national level politicians (Schwarzenegger said he was rich enough and California was poor enough so he declined a salary)? Yes. Are they part of an extremely small minority? Yup. So why do they think they have the moral high ground when it comes to lowering those gosh-darn excessive physician salaries?
 

Lokhtar

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http://economix.blogs.nytimes.com/2009/11/25/your-senator-is-probably-a-millionaire/

If you've volunteered for a successful congressman/senator/governor, I'm guessing you already know a middle class (or upper middle class) person has no real chance at winning. If we want to cut costs by cutting physician pay, why is it wrong to also assume that our millionaire senators don't need their $190,000/year pay checks?
Neither of them were successful :p.

And yes, they have little chance of winning. But you're making it so that they wouldn't even bother. I mean, what percentage of the budget are congressional salaries?

Are there more selfless national level politicians (Schwarzenegger said he was rich enough and California was poor enough so he declined a salary)? Yes. Are they part of an extremely small minority? Yup. So why do they think they have the moral high ground when it comes to lowering those gosh-darn excessive physician salaries?
What exactly would you accomplish by reducing salaries - unlike physician salaries it doesn't really have any sort of significant impact on the budget (and I think physician salary cuts are a bad idea, but that shouldn't be related to this). It's not going to hurt the millionaires. It's only going to hurt the few people who aren't.
 

LuciusVorenus

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Neither of them were successful :p.

And yes, they have little chance of winning. But you're making it so that they wouldn't even bother. I mean, what percentage of the budget are congressional salaries?



What exactly would you accomplish by reducing salaries? It's not going to hurt the millionaires. It's only going to hurt the few people who aren't.
If it were up to me, I'd eliminate payment to any politician worth over x million dollars and heavily tax (90%ish) any income that results from serving (gifts, etc). There's no reason any politician should get rich from politics. But that's just a tangent. My real point is that Spitzer was being extremely hypocritical.
 

Lokhtar

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If it were up to me, I'd eliminate payment to any politician worth over x million dollars and heavily tax (90%ish) any income that results from serving (gifts, etc).
That's fine (but different to an actual cut for people who aren't rich). Most politicians who aren't already rich don't get really rich until they start making seven figure salaries as lobbyists after they leave office.

There's no reason any politician should get rich from politics. But that's just a tangent. My real point is that Spitzer was being extremely hypocritical.
Yea, that line of questioning was stupid. Paul was not a PCP, which is where the biggest problems lie.
 

ronaldo23

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It's such a stupid and easy thing to say 'pay them less.' Frankly, if you did, the only people who'd be interested in politics are those who are independently rich and don't care bout the income from their jobs anyway. There are enough people from those backgrounds as it is.

You can't say that politicians don't know how the common man feels if you make it so that the common man wouldn't go anywhere near politics because he can't send his kids to college if he did.

Frankly, people don't realize how much time many of these people spend at their job (I've volunteered for politicians of both parties, and seven days a week and sixteen hours a day is not really uncommon as a regular schedule - granted a lot of it's fund raising for their next election :p, but it's still exhausting).

Now I'm not saying that politicians are selfless or anything. I'm just saying that if you cut salaries you'll only be left with people who come from trust fund backgrounds and don't give a crap about the pay anyway. It's not like we're paying them millions. It's not unreasonable to pay them well enough to live comfortably.

If you want to make it so that only the financial elites have any shot at public office (they already have a huge leg up), that's fine - but you need to realize that's what will happen if you reduce the salaries too much. And then you can't moan about those people not being in touch 'with the common man.'
I disagree. You could actually drastically cut politicians salaries (even pay them nothing), and still attract the exact same types of power hungry people. Remember...95+% of politicians are rich prior to going into office, and many of them have worked decades as trial lawyers and accured small fortunes. And even if they are dirt poor, they can bite the bullet for the few years of public service they have, and then give speeches and write books afterwards and make millions of dollars.

Maybe you are referring to lower level offices, but at the level of governor, the House, and the Senate, these guys are generally millionaires. Heck, the average net worth of a Senator is $10 million dollars. The pay is irrelevant. That being said...cutting salaries certainly wouldn't solve anything, as it represents such a small portion of tax-payer funds, and it's a distraction from the real budgetary issues that need to be addressed.. My point is that the salary for 95% of politicians is irrelevant to them, and is the last factor that attracts a person to office.

And I think Rand's defense was good. He said that his medicare reimbursements had already decreased 50% since 1993. He said, you want to decrease it another 40% for doctors...go ahead, but there may not be any physicians that will see seniors tomorrow. He also argued that it's ridiculous to balance the budget off one group of people like doctors. He suggests a 10% pay cut for all 2+ million federal employees (since they make double their private sector counterparts). Unlike other groups of federal employees...doctors aren't receiving artifically inflated compensation that is above their market value, in that medicare pays equal/less compensation than a private insurance company would.
 
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deuist

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He suggests a 10% pay cut for all 2+ million federal employees (since they make double their private sector counterparts).
Where did you get the information that federal employees make double the salary of a private sector employee?
 

ronaldo23

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Where did you get the information that federal employees make double the salary of a private sector employee?
Yeah I got it from that USA Today article. Of course, the figure includes all the lucrative benefits that public sector employees receive from government, but that is all relevant when you consider total compensation. The most striking revelation was that government salaries have grown 33% faster than inflation since 2000, despite their private counterparts suffering during the recession.

Physicians and higher trained professionals don't make more working for the government, but for almost every other profession with less training, government employees make a killing. It's not real economic growth to use taxpayer funds (money taken from the private sector) to fund an expanded government payroll whose salaries are inflated above market value.
 

deuist

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Um, does that compare equivalent jobs?


Otherwise, that's the biggest BS I've ever seen.
Typical USA Today nonsense. Did it mention that people in urban areas make more than people in rural ones? Maybe we should cut the salaries of city dwellers, too.
 

Dr Oops

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Neither of them were successful :p.

And yes, they have little chance of winning. But you're making it so that they wouldn't even bother. I mean, what percentage of the budget are congressional salaries?



What exactly would you accomplish by reducing salaries - unlike physician salaries it doesn't really have any sort of significant impact on the budget (and I think physician salary cuts are a bad idea, but that shouldn't be related to this). It's not going to hurt the millionaires. It's only going to hurt the few people who aren't.
arent most of them pretty weathly already?

Also they get full pay and benefits after they retire or quit, for life.
 

TooMuchResearch

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Or rather, never aren't unaccountable.

Democracy doesn't guarantee the best government, just the government we most deserve. Considering that America has gone from the Greatest Generation to a sad lot of navel-gazing, self-important armchair experts who feel that ignorance and gut emotion is a better fount of wisdom than earned knowledge and careful reflection, I'd say we're screwed.
Agreed. The Greatest Generation also tolerated the Victory Tax and purchased war bonds to support the war effort. Now all we have is a strange combination of "taxes are too high" and "balance the budget."
 

ronaldo23

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Agreed. The Greatest Generation also tolerated the Victory Tax and purchased war bonds to support the war effort. Now all we have is a strange combination of "taxes are too high" and "balance the budget."

I don't see how the bolded is a strange combination...we take in 2.4 trillion in taxes (the same amount we did in 2004). Does the government in 2010 really need to be substantially more expansive than it was in 2004? It's not a revenue problem at all...we need to slash the waste in government, in everything (inflated federal salaries, cut the size of the military/close bases, entitlement reform like raising SS to 70 for future generations), not tax people in a recession to pay for the irresponsible welfare and warfare state of W and Obama. The money doesn't belong to the government, it's the people's.

It's not a matter of Republican or Democrat, but both parties have completely screwed us over with horrible policies that expand government, and it's great that we have those like Rand Paul who are serious people and have little to no allegiance to the Republican or Democratic Party. Contrary to the Paul Krugman's and Ben Bernanke's of the world, inflation (and the risk of hyperinflation) is a large problem, and the measure of economic growth is not the size of the welfare state. Krugman believes that the larger the size of the federal deficit, and the more paper money circulating, the better off as a nation we are, and that if you don't support European-style socialism, you are inherently an uncompassionate person.

If anything, people today are finally waking up, and thinking deeply about how terrible government central economic planning has been for all us. The amount of grass-roots activism today is inspiring.
 
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Yes, very inspiring.

So inspiring that the economically right most Senator and the de facto representative of the tea party, who has advocated a deductible for medicare for decades.....runs as fast as he can from any mention of such a thing as soon as he's running for office.

And the grass roots activism that has just elected a bunch of people into power in the House.....who are going to vote to raise the debt ceiling as one of their first acts.

Good luck with everything. :laugh:



I'm going to really enjoy the next two years.
 

ronaldo23

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Yes, very inspiring.

So inspiring that the economically right most Senator and the de facto representative of the tea party, who has advocated a deductible for medicare for decades.....runs as fast as he can from any mention of such a thing as soon as he's running for office.

And the grass roots activism that has just elected a bunch of people into power in the House.....who are going to vote to raise the debt ceiling as one of their first acts.

Good luck with everything. :laugh:



I'm going to really enjoy the next two years.
Actually, that's untrue. His position was always that more means-testing and higher deductibles would be an effective way to create competition within health insurance and medicare, but that any change would be for future generations (those 55 and under). And, by the way, he had been making the medicare deductible comment LONG after he declared his candidacy, not before he ran for office. And as for your second clip, there is no contradiction. Rand said he doesn't support higher deductibles for seniors (as that implies he wants to PRESENTLY implement that idea), but for future generations of younger people, as one possible way to control costs. And he always prefaced the speeches saying that higher medicare deductibles would not be possible politically.

The problem is run away spending, and whether or not you agree with Paul's ideas, it's important to have a debate about how to reduce the welfare and warfare state, not to focus criticisms on the messenger of the problem. The tea-party movement, at least those within who are libertarian (and not the Palin followers), believes that the problem doesn't inherently reside with Obama or Democrats, but with both parties who have preached a variation of the same ideology for the last decade.
 
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gravitywave

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physician salaries are not a significant portion of healthcare spending, less than 10%. neither is malpractice reform, which might save 1% if it were enacted. the primary driver of health care costs is, yes, usage of the health care system.

Caveat, old numbers: "And so on Jan. 2, 2003, at Middlesex Hospital, the surgeon implanted my father's pacemaker using local anesthetic. Medicare paid him $461 and the hospital a flat fee of about $12,000, of which an estimated $7,500 went to St. Jude Medical, the maker of the device."

Americans can have the health care system that they are used to, which is the best in the world at treating certain conditions (hint - the most lucrative ones!) but not so good at treating less 'exciting' conditions (infant mortality, anyone?) and will ultimately bankrupt them. Or they can have something similar to what the rest of the OECD has, which is more egalitarian in some ways but has serious bottlenecks of its own.

another way to look at the issue: a big debate in the US cardiology community took place a few years ago when NEJM published a study suggesting that ACS patients presenting on the weekends had higher mortality than those lucky enough to get sick during the week. In Canada, the much bigger question is whether or not you'll be cathed at all in the timeframe when it might actually make a difference in your outcome.
 

shouldvestudied

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physician salaries are not a significant portion of healthcare spending, less than 10%. neither is malpractice reform, which might save 1% if it were enacted. the primary driver of health care costs is, yes, usage of the health care system.
Is it too much to expect people not to pull numbers out of their ass when debating a topic?

http://www.healthbeatblog.org/2008/01/health-care-s-1.html

Physician Salaries account for 22% of Health Care spending.
 

gravitywave

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Is it too much to expect people not to pull numbers out of their ass when debating a topic?

http://www.healthbeatblog.org/2008/01/health-care-s-1.html

Physician Salaries account for 22% of Health Care spending.
:laugh: nope.

physician salaries and physician services are two different things.

take a sharp look at those numbers. if physicians are taking home 22% of the health care costs, that's .22*2.1 trillion or 462 billion. there are about 950,000 doctors in this country. are physicians in this country averaging $460,000/yr? you go ask one, see what they say.
 

Lokhtar

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Ya - takehome pay of a physician isn't $460,000/year, but it makes sense for them to make around that because of overhead and other costs, for their takehome pay to end up being about half or less.

So we do spend 22% of the budget on 'physicians', but obviously physicians have overhead too (office, supplies, staff salaries, etc).
 

shouldvestudied

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:laugh: nope.

physician salaries and physician services are two different things.

take a sharp look at those numbers. if physicians are taking home 22% of the health care costs, that's .22*2.1 trillion or 462 billion. there are about 950,000 doctors in this country. are physicians in this country averaging $460,000/yr? you go ask one, see what they say.
As it pertains to this discussion, 22% is the key number. The rest is just semantics.

When people are talking about reducing Medicare reimbursement to Physicians, this is what they are talking about they are talking about.
 

gravitywave

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As it pertains to this discussion, 22% is the key number. The rest is just semantics.

When people are talking about reducing Medicare reimbursement to Physicians, this is what they are talking about they are talking about.
:confused: it's absolutely pertinent. Dr. Paul's argument was that you can't expect to straighten Medicare out solely by cutting payments to doctors. Physicians are already deserting the Medicare model because it doesn't pay enough - in primary care, their margins after overhead are razor thin as it is. If you cut Medicare payments to doctors by 25%, some doctors could see a 50% cut in salary because they still have to pay their business costs. It only worsens the primary care crisis.

now, if you want to talk about evening the financial playing field between specialties so that money is less of a factor in determining what physicians go into, that's a conversation we can have. but I stand by my numbers and what they mean : adjusting payments to doctors is a drop in the bucket in terms of balancing the health care budget, unless you want to drive most FP's out of the profession.

ps: i loathe Dr. Paul's politics, but he looks like a statesman next to Spitzer here.
 

gravitywave

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As a medical student you should know your 1% figure might be true if you are only considering the money saved in litigation. I'm not going to make up numbers, but the real savings due to malpractice reform would come in the form of reduced preventative care procedures physicians employ. Every single day expensive tests are done which doctors know probably aren't needed just for the reason of CYA.
those aren't my numbers, they are the CBO's - the non-partisan office of Congress whose job it is to tell the future ;)

we don't need federal tort reform, but certain states do need it to clean up their cesspool plantiff's courts.