other forums have been talking about this a whole lot but not much here. so let's get right to the point: are general surgeons gonna be making less? if so how much less are we talking about (an estimate will do as i realize exact figures aren't possible). in plain english please...no fancy graphs, charts, polls, or round about talk...just the bottom line.
so yeah...about this healthcare bill thing
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No body has a clue.... as The speaker and president have said... "everyone will know what is in the bill after it is passed".
Also, the bill has exclude the SGR provisions. Thus we can drag out all the speculation we'd like... but nobody knows. I believe the last ABS email was post in a thread recently, just scan down.
http://forums.studentdoctor.net/showthread.php?t=711166
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They have been working over a year, are doing parlimentary rules that both parties use to pass laws all the time, and when the basics of the plan is explained to people instead of just the fearmongering, more americans like the bill than don't. I don't agree with all that is in the bill, but pretty much everything you said in that post is, for all due respect, incorrect.
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Um, no. http://www.realclearpolitics.com/epolls/other/obama_and_democrats_health_care_plan-1130.html
Look at the "poll history" at the bottom, basically all the polls show disapproval for the bill since last July. Nice try though.
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thats the problem, even the people voting for the bill havent read the thing, let alone the average citizen. I guess we should trust the government to do the right thing for us.
We'll understand it once its passed.
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Not exactly true. That is not to say some of these proposed maneuvers have never been used... but it is a stretch to say "use to pass laws all the time".
As for understanding the basics, the speaker has stated we will know what is in it AFTER it passes, the president echoed this statement. Prominent democrat in congress openly stated that anyone that tells you this bill will NOT increase your health insurance cost is being dishonest.... Did the CBO say healthcare premiums would go up; YES. Did the president say the bill will decrease businesses employee healthcare costs by 3000%; YES. Did the president as a congressman say "reconcilliation" is unconstitutional; YES. Given those FACTS, I find it hard accept anyone understands the "basics"... since at the very least nobody will know until it is passed!
http://www.youtube.com/watch?v=lUd-slJc-GY
http://www.youtube.com/watch?v=fpAyan1fXCE
http://www.youtube.com/watch?v=B-_SGGcJu_c&feature=related
http://www.youtube.com/watch?v=IQh--oWAR4Q
http://www.youtube.com/watch?v=oHLk5Ikn3EQ&feature=related
http://www.youtube.com/watch?v=-f1DVFaF8E0
http://www.youtube.com/watch?v=bddVXrNCpyI
http://www.youtube.com/watch?v=Hdi4onAQBWQ
Do folks like the promise of no exclusion for pre-existing? sure
Do folks like the promise of no "lifetime limits"? sure
Do folks like the promise that their health insurance premiums will go down? sure
Do folks like the promise that they will get a free lunch? sure
those are ideas/questions in the fairly abstract.... answering yes does not necessarily mean folks generally support the current legislation. Let's disconnect the rhetoric and idealistic dreams from the reality. Just because someone claims they can save the world, does not necessarily mean their speach matches reality.
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so...when's all said and done, and even though we don't know for sure yet...it's probably gonna be that surgeons will either make less money or about the same amount as now, but most likely not more than they already are.
Actually, reconciliation is not used "all the time", and especially not on bills of this impact and cost. Whatever you think of the bill's content, this is a very slimy move that will cause me to switch party affiliation.
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Reconciliation has been used 22 times since 1980, roughly an average of 3 times per presidential term http://www.pbs.org/newshour/updates/politics/jan-june10/reconciliation_02-26.html
However, people think they are using reconciliation to pass the Entire bill. They are not. The bill already passed the Senate with 60 votes. Reconciliation will only be used to make amendments to the bill after the House has a vote on the bill (thankfully they aren't using Deem and Pass, and the House is voting on the amendments prior to voting on the bill, but then the senate must pass the amendments themselves, and to even get that to a vote, they must employ Reconciliation)
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Yes, we can all look up the reconcilliation thing and do a math calculation to determine average number of times used.... That is similar to simply listening to the parts of the given speaches and declaring someone is a savior and their bill matches their speach... parts of the speach you like to hear. the question is how and in what context?
1. The president (before president )said he was opposed to reconcilliation, and though it was unconstitutional...
2. Pelosi and others have from day one planned on using reconcilliation.... they then decide they would use a hybrid of reconcilliation along with a "deeming" it was passed without it being passed....
3. Pelosi stated she wanted to avoid having the house vote on the senate bill and thus supported the idea of not voting on it.... but rather some hybrid reconcilliation with deemed passage
4. Again as noted, ~everyone will know what is in the bill AFTER it passes.
Are they going to go through all these parlimentary/gimmicks? I don't know. But it was THEY (Dems & WH) that have endorsed and plotted the usage of such. So, let's not say the public or opponents some how de-novo are being frightened... by ?right wing? Again, Dems have promoted, pushed and planned these tactics.
My read on the constitution is as follows:
the president can only sign into law legislation that equal and identical versions have passed both houses. All this, machination and amending the senate bill prior to passage, etc.... again, WH & democrats tactics are problematic at best. It is this conduct that is creating a lack of trust and fear. It is their actions (i.e. dems & WH)...
What bugs me most about this bill is the outright dishonesty by our politicians-- and no one in the media seems to be calling them out on it. Collecting revenues for 10 years while paying out 6 years in benefits.... then declaring that this bill reduces the deficit... is just plain idiotic. Taking into account revenue from new taxes without taking account the cost of the increase in government to handle the new taxes is Arthur Andersen-esque.
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Correct. I do not understand why everyone is so quick to give the "benefit of the doubt". It is like we watch on-coming traffic on the highway during rush-hour, and because the guy behind us says it's safe, we put on a blind fold and walk out into the middle of the road.....
None of the rhetoric compared to the legislation makes any sense.... The legislation does NOTHING to decrease health insurance premiums. all reputable reports actually state this will increase premiums.
This legislation will NOT help the economy. Increased taxes are NOT going to encourage company expansion or increased highering...
The number one denier of health claims... is NOT private healthcare companies, it's the fed-governement.
The legislation will not create budget surplus or decreased deficit.... simple math says that is impossible. You do NOT expand services to 12-30 million & remove limits and result in a net decrease in costs.
The legislation will increase taxes at numerous levels... including tanning salons!!!
Why do we believe the taxes collected for years before "activation" will actually remain in an account/fund for use four years from now.... is there any historic example of this sort of achievement (i.e. not spending the incoming revenues)?
There are around 300 million Americans in this country. Depending on estimates, there are around 12-30 million un-insured Americans. This legislation is NOT for the majority of Americans.
All of the above said, why can't the WH & Dems simply state the facts and truth? Instead they are painting some pie in the sky idea to pass just the opposite. If they are so sure it is so wonderful and Americans ~subconciously want it, they should be open and honest and sell the reality.
It is the bold face, to your face lies that needs to wake people up and ask the question.... then why? If the declared intent does NOT match the legislative reality, what is the intent? what is the agenda?
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The bill that passed is and has been available in the form that passed since it passed. http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm
So the argument that we will know what is in the bill when it passes, is not entirely true. True that the amendments that will be reconciled and what exactly will be in that is not known until it passes, but is that really much different than the usual process? Typically bills don't get the press and coverage of this bill, and while it is to be expected with something this large.
Double talk and hypocracy is rampant throughout politics. Both sides. Essentially, all politicians. I am not a fan of it. But then again, people make difficult choices/decisions that border on two of their beliefs all the time. Health Care has been the cornerstone of the Obama presidency thus far, and a topic he is willing to be a 1 term president over. While he might not agree with the constitutionality of Reconciliation, it has held up through 22 previous usages, some of which I am sure have challeged the statute so must have been deemed constitutional, so to him, passing healthcare and doing what he believes will improve the lives of the american people (or whatever you feel his motive behind this legislature is) superceeds his objection to the manuever. Most those republicans out there who hate social programs, if they lost their job would surely apply for Unemployment benefits... it may pain them, they might feel sick over it, but they would still do it if their family needed it. We don't know if there is an internal struggle going on, but when Fox News and other outlets tear into him for bowing to foreign diplomats, you think he would even hint publically that the maneuver doesn't sit well with him but this is too important to let that get in his way? And I doubt Pelosi and them planned Reconciliation from day 1. Why is this? Well, 1, Pelosi is in the house, where reconciliation is not needed/used... its a senate thing... so maybe Harry Reid had it planned from day 1, but I still doubt that. They started this with 60 votes, so they figured the didn't need reconciliation because they had the supermajority needed. Maybe they have planned reconciliation since they lost Kennedy's seat, but that is hardly day 1. Pelosi not wanting a house vote, while I also don't agree with the tactic and am glad they aren't doing that tactic, is mainly a result of the order needed to accomplish what they want to accomplish. The house likely would be able to pass the senate bill with the accompaning changes that will be attempted to be passed by Reconciliation in the senate, but would not be able to pass the bill without the changes. People who will pass the changed version but not the unchanged version have concerns that what if they pass the bill with the assurance that the changes will happen but somehow they stumble? They essentially trust the Senate as much as the people do, which is none. Deem and Pass was suppose to allow them to vote on the changes without voting on the bill to help these individuals out. It seems now they can vote on the changes before voting on the original bill, which now allows these individuals to see the changes will pass the house before they commit to the original bill. It all boils down to ways to game the system to essentially get the result that would happen if they could just vote in a logical mannor or with all the caveots they want (ie, only counting the senate bill as passed IF the changes happen to it).
Fox News and the Right has gone on a full fledged attack, more demonizing the process instead of the bill. Even you are hung up on the double talk... I am not claiming I sat down and read the 2000 page document I linked you to, haven't even read any of the breakdowns. Like I said, I don't support the bill exactly, but I am a single payor backer and agree with Kucinich on this bill, but I also see the benefit it will have, and as a single payor backer, don't necessarily disagree with sharing of the burden amoungst all tax payers... simply personal belief and I see and understand the other side of it... it will be interesting to see how it plays out
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Are we saying, we as Americans must be prisoners of past corruptions and unsavory acts? If it was done in an unsavory way on a smaller scale previously, "oh, well, then you just have to accept that..."
Because folks did not pay attention before or were not necessarily interested in the fine print before... again, we should just accept that for all future legislation, no matter how important and/or wide sweeping?
Again with the justification based on historical (recent & distant) corruptions. Must we just accept and be imprisoned by it? I am reminded by what my parents used to say, "two wrongs don't make a right".
I hear this alot. I am very aware of his public speakings as to his beliefs, short term and longterm agendas... I think I linked some in an earlier post. But, the one important point, I think not well articulated, is this....
IT IS NOT ABOUT HIM!!! He won an election to represent US. The continued argument about him being crippled or his cornerstone or his legacy.... IT IS NOT ABOUT HIM!!! I don't care about his legacy. I don't care if he is a one term president like numerous before him... why would that be such a tragedy.... would we some how be taking some "entitlement" from him? IT IS NOT ABOUT HIM!!! Legislation of this magnitude should NOT be pushed and/or passed for some benefit to the WH or the Dems legacy. It is suppose to be about American citizens. Is it our obligation to build upon his cornerstone even if he chose the wrong stone?
Are you? Or, is this just some additional gift of faith? He himself felt, as a CONSTITUTIONAL lawyer, it is unconstitutional. But, since WH & Dems want to potentially use it, we should assume he was wrong on it and correct on everything else that sounds good to us?
There in lies why the early argument of it being used all the time, and implication of a normalacy fails.
And, again, IT IS NOT ABOUT THEM, or their legacies, or what THEY want. Or, at least, it's not supposed to be!
That's a good argument... since we presume they can, let's just forego the formality... Since Phelps is a good swimmer and we presume he will win, let's just give hime the gold for showing up at the olympic village and award ceremony. Who needs the actual effort anyways... it's a foregone conclusion!?!
Do you read what you write? Does that make any sense? I think you previously stated, "in the house, where reconciliation is not needed/used... its a senate thing". The parlimentarian of the senate has already stated, the process requires exact passage of the SENATE bill, then president signs into law, prior to "reconcilliation". Again, none of these processes have been used "all the time".... I dare say none have ever been used in such a backward & upside down fashion...
And, that makes sense to you? You are not at all concerned that you lack knowledge of what is in the bill? You are not at all concerned at the extreme measures and machinations being required to pass this legislation? Does it not raise the antennaes at all that in order to get this passed it requires all the double talk, etc...? Shouldn't even the most easy going person be the least bit concerned of exactly what is trying to be forced through??? Or, is it that we somehow must just have blind faith? We must kneel before the WH alter and presume all is good?
Ah, so you do appreciate the double talk and appreciate this as the well stated, multiple publically stated beliefs (by prominent Dems & WH) that this is NOT about deficit reduction, not about increasing employment, not about healthcare cost cutting, not about lowering premiums, rather... a first step to develop socialized medicine.
As for burden on ALL tax payers.... have you looked and seen who is actually paying 80+% of ALL tax revenues collected?
http://www.taxfoundation.org/blog/show/341.html
http://money.cnn.com/2009/04/15/pf/taxes/who_pays_most_least/index.htm
In any event, you final admission to your beliefs and aspirations makes most if not all of your preceding points/arguments mute.
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My concerns are this-- throughout his campaign and thus far into his time in office, President Obama has been exceedingly vague about the massive reforms he's suggesting. Hearing him talk, it's crystal clear to me that he hasn't done his homework on healthcare. To wit:
1. Declaring to the AMA that malpractice reform isn't going to have a significant impact on reducing health care costs
2. Saying that Mayo Clinic saves money because they have ALL of the treating physicians meet with patients at the same time--- which I doubt is true
3. Neglecting to say that Mayo Clinic's Medicare costs are actually HIGHER than other hospitals in this country, but they bill the government less because their private insurance and self-payers subsidizes the public
4. Saying in a press conference that recurrent tonsillitis might be better treated with allergy pills
Now, there's a vote today for a health care plan that
1. Has been billed as a deficit reducer-- even though it does it by accounting tomfoolery
2. Has put the onus on private insurance to decrease costs by increased regulations
3. Has done nothing to stop the spiraling of health care costs
I'm ALL for health care reform-- it needs to happen in this country, and the sooner, the better. But this health care plan is going railroaded through the legislative process because the Democrats need to have a big victory before the midterm elections. The full effects of this bill-- good or bad-- aren't going to be felt until Obama is at the end of his 2nd term at the earliest.
1. Declaring to the AMA that malpractice reform isn't going to have a significant impact on reducing health care costs
2. Saying that Mayo Clinic saves money because they have ALL of the treating physicians meet with patients at the same time--- which I doubt is true
3. Neglecting to say that Mayo Clinic's Medicare costs are actually HIGHER than other hospitals in this country, but they bill the government less because their private insurance and self-payers subsidizes the public
4. Saying in a press conference that recurrent tonsillitis might be better treated with allergy pills
Now, there's a vote today for a health care plan that
1. Has been billed as a deficit reducer-- even though it does it by accounting tomfoolery
2. Has put the onus on private insurance to decrease costs by increased regulations
3. Has done nothing to stop the spiraling of health care costs
I'm ALL for health care reform-- it needs to happen in this country, and the sooner, the better. But this health care plan is going railroaded through the legislative process because the Democrats need to have a big victory before the midterm elections. The full effects of this bill-- good or bad-- aren't going to be felt until Obama is at the end of his 2nd term at the earliest.
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While sticking to my original sentiment... nobody knows. Here is what I believe, IMHO, is the reality:
All physician incomes will decline accross all specialties. I suspect, at initial hit, sub-specialist, i.e. GS will be hit harder. This will actually be enhanced/assisted by the tactics of divide and conquer. The individual organizations will continue to try and get the "suffering" PCPs to point out the injustice of specialist incomes, etc.... Physicians have NOT united. They have assumed a circular firing squad approach that has only helped to serve the WH & Dems.... But, I doubt we will see any of the individual specialty "special interest" actually see a financial windfall.
This is the anecdotal evidence I have seen and/or obtained from colleagues seeking jobs:
New job postings go up. Hosp CEOs and recruiters are calling. When one of the versions of these bills look like they might pass... Job postings disappear. Already on-going discussions and/or negotiations get "post-poned". When it appears the bill isn't going to pass, jobs start appearing again, call backs from CEOs, "we are still interested, we just had a busy month, but please we would love to move forward...." This peak and trough phenom has gone on accross the country all year. You can find the same identical jobs and advertisements appearing and dissapering in concert with different pieces of proposed legislation. It is not unlike major corporations freezing hiring... They can not afford to hire and then add huge excise taxes, and benefit mandates on the new highers... especially if they anticipate those costs on their already existing employees.
Now, consider the SGR issue. All hospitals, CEOs, and Practice managers are acutely aware of the looming 20+% cut in reimbursements. No intelligent business person will presume, a looming cut that is on the books, that congress only delayed by a month or so, will not occur. To make that presumption would be stupid. Thus, to hire someone and contract them at $300+ thousand dollars in an almost guaranteed massive reduction in revenue is ludicrous.
Now, let's say the legislation passes. It is likely to be more economically sound for companies to accept the cost of the fine over the increased cost of premiums... This will move more folks to medicare/medicaid/esq type coverage and reimbursement rates. Hospitals recognize this. They recognize their payer pool will now have an increase "government payer" type pts. Again, this means a cut of revenue (completely seperate from the SGR matter). As your medicare/medicaid pool increases, your revenue decreases no matter what specialty.... If you choose not to serve this pool, great. However, private payers will cut their reimbursement commensurate with medicare/medicaid rates.
Next, as the new "entitlement" explodes and becomes ever more bloated, there will have to be cuts. Too many will be dependent on the system to stop it. Too many will cry if "their benefits" are cut. We have seen this with SS & medicare/medicaid. So, where will we see the cuts.... physicians. Because, it is easy to declare physicians both greedy and servants.
Long and short, you can expect large cuts.
A little tangental but interesting:
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Well I like sauerkraut and I like ice cream, but it doesn't follow that I'd like sauerkraut-flavord ice-cream.
The bill is an abdomination of accounting gimmicks, special interest give aways, and a new unfunded & unsustainable entitlement. The tough choices on funding were dodged (taxing union health plans as income), malpractice reform was ignored, the SGR medicare doctor pay fix was kept off the books for CBO scoring, etc.... Much of the pain that is in the bill is kicked down the road for future congresses to address begging the question of whether they will be more likely to cut their own throat then the Democrats are now.
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It is a spectacualr conflict of statements... especially coming from someone making the numerous position points you do throughout this thread... even to declare others are incorrect or innacurate... when you haven't looked!?!?
Got to agree. Alas, very difficult discussing the actual bill with "others" as noted. Especially, when "others"... have no interest in the actual bill but what doors it might open for their greater plan, i.e. single payer/socialized plan.
Somewhat like Sherlock might have said.... ~if the declared purpose and intent, no matter how noble sounding just doesn't fit the action... you must conclude the original declared intent to be a lie/facade to cover another agenda. And, that, does not take genious or paranoia to recognize. It simply takes common sense.
at best, this bill raises premiums (acknowledged by CBO & some Dems)
at best, this bill expands medicare/medicaid-esq programs
at best, this bill does NOT address expanding healthcare costs.
at best, this bill increases taxes
Final point.... while our healthcare system may not be perfect... the fear mongering is all those running around talking about it's "broken". It has room for improvement. But, please, look at the FACTS. The current legislative attempts have all been geared towards an end-game of socializing the system in some fashion to resemble Canada/Europe/Cuba/etc.... Why in the world do we think our less then perfect system will in some way be "fixed" or "improved" by moving towards systems with PROVEN track records of being worse then ours.... on significantly smaller scale of population? The legislative plans are not designed to fix a "broken" system.... at best they will BREAK a functional albeit imperfect system on a massive scale.
You can choose to continue and believe it is raining because the WH & Dems tell you it is. Or, you can turn around and look the individual in the face and say, "please use a toilet and stop urinating on me".
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Wow... I am not even going to begin to challenge where I have been misquoted, taken out of context, etc.
I've even gone on record here saying I don't like the bill...
My argument has more been that this bill in particular has been singled out because of how it has been done, and not in a way to change the system, but instead as a way to kill this bill and return to the status quo, both in medical financing and in politics. My argument is also that the medical financing issue is important enough that something should be done now, even if it is within the confines of the parlimentary system in place. I am against the Filibuster more than I am against Reconciliation, the Filibuster having been used much more frequently than Reconciliation... scrap that, I like the idea of Filibuster if enacting a filibuster does draw the whole governing process to a halt and they do nothing but floor debate until either the filibustering side gives in or the opposite side makes the consessions asked for...
I will take only one point of all that was stated into question: "Ah, so you do appreciate the double talk and appreciate this as the well stated, multiple publically stated beliefs (by prominent Dems & WH) that this is NOT about deficit reduction, not about increasing employment, not about healthcare cost cutting, not about lowering premiums, rather... a first step to develop socialized medicine."
What exactly do you mean by socialized medicine, a popular talking point but really doesn't mean anything. A single payor, which doesn't even necessarily need to be the government is that payor, doesn't necessarily mean that doctors are employees of the government, and doesn't necessarily mean socializm in any way. There is a good thread in the Topics in Healthcare forum of this site about the definitions being thrown around. I am unsure exactly if I support more of a Canadian or NIH system (both of which have government financing of health care, but execution is much differently) or even if I more prefer a Swiss type system which is closer to what we are actually approaching with these bills. I this method because, besides providing care to more people and more equitably in my opinion, it would, in my mind cut into some of the overall costs of health care by eliminating the 30% of healthcare spending that disappears as insurance company profits and administrative fees, CEO bonuses, etc.
There is a reason this thread wasn't on the surgical forum, instead delegated to forums like topics in healthcare, and it has eroded into such. I will refrain from discussing it anymore, you can attack into what I say all you guys want. I admit some of my previous posts might have been a little rushed and might not have expressed my opinion or view as articulately as I wanted... but I also respected and gave legitimacy to some of your concerns (ie, the senate bill that passed including detailed and cursory overviews have been made available since december, so what is in the bill is clearly available to be read, but I agree we don't know what changes exactly will be enacted to it...)
I've even gone on record here saying I don't like the bill...
My argument has more been that this bill in particular has been singled out because of how it has been done, and not in a way to change the system, but instead as a way to kill this bill and return to the status quo, both in medical financing and in politics. My argument is also that the medical financing issue is important enough that something should be done now, even if it is within the confines of the parlimentary system in place. I am against the Filibuster more than I am against Reconciliation, the Filibuster having been used much more frequently than Reconciliation... scrap that, I like the idea of Filibuster if enacting a filibuster does draw the whole governing process to a halt and they do nothing but floor debate until either the filibustering side gives in or the opposite side makes the consessions asked for...
I will take only one point of all that was stated into question: "Ah, so you do appreciate the double talk and appreciate this as the well stated, multiple publically stated beliefs (by prominent Dems & WH) that this is NOT about deficit reduction, not about increasing employment, not about healthcare cost cutting, not about lowering premiums, rather... a first step to develop socialized medicine."
What exactly do you mean by socialized medicine, a popular talking point but really doesn't mean anything. A single payor, which doesn't even necessarily need to be the government is that payor, doesn't necessarily mean that doctors are employees of the government, and doesn't necessarily mean socializm in any way. There is a good thread in the Topics in Healthcare forum of this site about the definitions being thrown around. I am unsure exactly if I support more of a Canadian or NIH system (both of which have government financing of health care, but execution is much differently) or even if I more prefer a Swiss type system which is closer to what we are actually approaching with these bills. I this method because, besides providing care to more people and more equitably in my opinion, it would, in my mind cut into some of the overall costs of health care by eliminating the 30% of healthcare spending that disappears as insurance company profits and administrative fees, CEO bonuses, etc.
There is a reason this thread wasn't on the surgical forum, instead delegated to forums like topics in healthcare, and it has eroded into such. I will refrain from discussing it anymore, you can attack into what I say all you guys want. I admit some of my previous posts might have been a little rushed and might not have expressed my opinion or view as articulately as I wanted... but I also respected and gave legitimacy to some of your concerns (ie, the senate bill that passed including detailed and cursory overviews have been made available since december, so what is in the bill is clearly available to be read, but I agree we don't know what changes exactly will be enacted to it...)
There's two lessons to be learned here:
1. Avoid getting into SDN debates on either religion or politics, because they are always emotionally charged and end up like this thread.
2. When avoiding lesson #1, be sure to meticulously review your posts before clicking on "submit," because your foes will dissect your words and attack your semantics to help dramatically prove their point.....sort of like politics. JAD should be thanking his lucky stars nobody pointed out how to spell speech.
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Nah, I don't concern myself too much with my spelling or grammar. Instead, I thank my lucky stars for having had the opportunity to learn to converse in 3 different languages and read ~4. But, I don't claim nor attempt to assure my spelling is spot on in any of those languages
do you mean private practice surgeons or employed surgeons? (say, a general surgeon employed by a VA hospital, or flight surgeon by U.S. Military)? Employed surgeons won't make less! The gov can't just say: "Ok surgeons, Bill's passed. Your next paycheck's gonna take a paycut of 33%."
For private practice surgeons, they will likely make less money, or they could make even more money. Reimbursements are mostly worse with Healthcare Reform, so yeah, bottomline hurt is more likely!!
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If you care about your profession, you should be politically aware/active. Keeping quiet to yourself will just allow others to make decisions for us - that's how we got in this problem in the first place. Anyway, here's the health care bill, point by point:
Page 22 of the HC Bill: Mandates that the Govt will audit books of all employers that self-insure!!
Page 30 Sec 123 of HC bill: THERE WILL BE A GOVT COMMITTEE that decides what treatments/benefits you get.
Page 29 lines 4-16 in the HC bill: YOUR HEALTH CARE IS RATIONED!!!
Page 42 of HC Bill: The Health Choices Commissioner will choose your HC benefits for you. You have no choice!
Page 50 Section 152 in HC bill: HC will be provided to ALL non-US citizens, illegal or otherwise.
Page 58 HC Bill: Govt will have real-time access to individuals' finances & a 'National ID Health card' will be issued! (Papers please!)
Page 59 HC Bill lines 21-24: Govt will have direct access to your bank accounts for elective funds transfer. (Time for more cash and carry)
Page 65 Sec 164: Is a payoff subsidized plan for retirees and their families in unions & community organizations: (ACORN).
Page 84 Sec 203 HC bill: Govt mandates ALL benefit packages for private HC plans in the 'Exchange.'
Page 85 Line 7 HC Bill: Specifications of Benefit Levels for Plans -- The Govt will ration your health care!
Page 91 Lines 4-7 HC Bill: Govt mandates linguistic appropriate services. (Translation: illegal aliens.)
Page 95 HC Bill Lines 8-18: The Govt will use groups (i.e. ACORN & Americorps to sign up individuals for Govt HC plan.
Page 85 Line 7 HC Bill: Specifications of Benefit Levels for Plans. (AARP members - your health care WILL be rationed!)
Page 102 Lines 12-18 HC Bill: Medicaid eligible individuals will be automatically enrolled in Medicaid. (No choice.)
Page 12 4 lines 24-25 HC: No company can sue GOVT on price fixing. No "judicial review" against Govt monopoly.
Page 127 Lines 1-16 HC Bill: Doctors/ American Medical Association - The Govt will tell YOU what salary you can make.
Page 145 Line 15-17: An Employer MUST auto-enroll employees into public option plan. (NO choice!)
Page 126 Lines 22-25: Employers MUST pay for HC for part-time employees ANDtheir families. (Employees shouldn't get excited about this as employers will be forced to reduce its work force, benefits, and wages/salaries to cover such a huge expense.)
Page 149 Lines 16-24: ANY Employer with payroll 401k & above who does not provide public option will pay 8% tax on all payroll! (See the last comment in parenthesis.)
Page 150 Lines 9-13: A business with payroll between $251K & $401K who doesn't provide public option will pay 2-6% tax on all payroll.
Page 167 Lines 18-23: ANY individual who doesn't have acceptable HC according to Govt will be taxed 2.5% of income.
Page 170 Lines 1-3 HC Bill: Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay.) (Like always)
Page 195 HC Bill: Officers & employees of the GOVT HC Admin.. will have access to ALL Americans' finances and personal records. (I guess so they can 'deduct' their fees)
Page 203 Line 14-15 HC: "The tax imposed under this section shall not be treated as tax." (Yes, it really says that!) ( a 'fee' instead)
Page 239 Line 14-24 HC Bill: Govt will reduce physician services for Medicaid Seniors. (Low-income and the poor are affected.)
Page 241 Line 6-8 HC Bill: Doctors: It doesn't matter what specialty you have trained yourself in -- you will all be paid the same! (Just TRY to tell me that's not Socialism!)
Page 253 Line 10-18: The Govt sets the value of a doctor's time, profession, judgment, etc. (Literally-- the value of humans.)
Page 265 Sec 1131: The Govt mandates and controls productivity for "private" HC industries.
Page 268 Sec 1141: The federal Govt regulates the rental and purchase of power driven wheelchairs.
Page 272 SEC. 1145: TREATMENT OF CERTAIN CANCER HOSPITALS - Cancer patients - welcome to rationing!
Page 280 Sec 1151: The Govt will penalize hospitals for whatever the Govt deems preventable (i.e...re-admissions).
Page 298 Lines 9-11: Doctors: If you treat a patient during initial admission that results in a re-admission -- the Govt will penalize you.
Page 317 L 13-20: PROHIBITION on ownership/investment. (The Govt tells doctors what and how much they can own!)
Page 317-318 lines 21-25, 1-3: PROHIBITION on expansion. (The Govt is mandating that hospitals cannot expand.)
Page 321 2-13: Hospitals have the opportunity to apply for exception BUT community input is required. (Can you say ACORN?)
Page 335 L 16-25 Pg 336-339: The Govt mandates establishment of=2 outcome-based measures. (HC the way they want -- rationing.)
Page 341 Lines 3-9: The Govt has authority to disqualify Medicare Advance Plans, HMOs, etc. (Forcing people into the Govt plan)
Page 354 Sec 1177: The Govt will RESTRICT enrollment of 'special needs people!' Unbelievable!
Page 379 Sec 1191: The Govt creates more bureaucracy via a "Tele-Health Advisory Committee." (Can you say HC by phone?)
Page 425 Lines 4-12: The Govt mandates "Advance-Care Planning Consult." (Think senior citizens end-of-life patients.)
Page 425 Lines 17-19: The Govt will instruct and consult regarding living wills, durable powers of attorney, etc. (And it's mandatory!)
Page 425 Lines 22-25, 426 Lines 1-3: The Govt provides an "approved" list of end-of-life resources; guiding you in death. (Also called 'assisted suicide.')(Sounds like Soylent Green to me.)
Page 427 Lines 15-24: The Govt mandates a program for orders on "end-of-life." (The Govt has a say in how your life ends!)
Page 429 Lines 1-9: An "advanced-care planning consultant" will be used frequently as a patient's health deteriorates.
Page 429 Lines 10-12: An "advanced care consultation" may include an ORDER for end-of-life plans.. (AN ORDER TO DIE FROM THE GOVERNMENT?!?)
Page 429 Lines 13-25: The GOVT will specify which doctors can write an end-of-life order.. (I wouldn't want to stand before God after getting paid for THAT job!)
Page 430 Lines 11-15: The Govt will decide what level of treatment you will have at end-of-life! (Again -- no choice!)
Page 469: Community-Based Home Medical Services = Non-Profit Organizations. (Hello? ACORN Medical Services here!?!)
Page 489 Sec 1308: The Govt will cover marriage and family therapy. (Which means Govt will insert itself into your marriage even.)
Page 494-498: Govt will cover Mental Health Services including defining, creating, and rationing those services.
Page 22 of the HC Bill: Mandates that the Govt will audit books of all employers that self-insure!!
Page 30 Sec 123 of HC bill: THERE WILL BE A GOVT COMMITTEE that decides what treatments/benefits you get.
Page 29 lines 4-16 in the HC bill: YOUR HEALTH CARE IS RATIONED!!!
Page 42 of HC Bill: The Health Choices Commissioner will choose your HC benefits for you. You have no choice!
Page 50 Section 152 in HC bill: HC will be provided to ALL non-US citizens, illegal or otherwise.
Page 58 HC Bill: Govt will have real-time access to individuals' finances & a 'National ID Health card' will be issued! (Papers please!)
Page 59 HC Bill lines 21-24: Govt will have direct access to your bank accounts for elective funds transfer. (Time for more cash and carry)
Page 65 Sec 164: Is a payoff subsidized plan for retirees and their families in unions & community organizations: (ACORN).
Page 84 Sec 203 HC bill: Govt mandates ALL benefit packages for private HC plans in the 'Exchange.'
Page 85 Line 7 HC Bill: Specifications of Benefit Levels for Plans -- The Govt will ration your health care!
Page 91 Lines 4-7 HC Bill: Govt mandates linguistic appropriate services. (Translation: illegal aliens.)
Page 95 HC Bill Lines 8-18: The Govt will use groups (i.e. ACORN & Americorps to sign up individuals for Govt HC plan.
Page 85 Line 7 HC Bill: Specifications of Benefit Levels for Plans. (AARP members - your health care WILL be rationed!)
Page 102 Lines 12-18 HC Bill: Medicaid eligible individuals will be automatically enrolled in Medicaid. (No choice.)
Page 12 4 lines 24-25 HC: No company can sue GOVT on price fixing. No "judicial review" against Govt monopoly.
Page 127 Lines 1-16 HC Bill: Doctors/ American Medical Association - The Govt will tell YOU what salary you can make.
Page 145 Line 15-17: An Employer MUST auto-enroll employees into public option plan. (NO choice!)
Page 126 Lines 22-25: Employers MUST pay for HC for part-time employees ANDtheir families. (Employees shouldn't get excited about this as employers will be forced to reduce its work force, benefits, and wages/salaries to cover such a huge expense.)
Page 149 Lines 16-24: ANY Employer with payroll 401k & above who does not provide public option will pay 8% tax on all payroll! (See the last comment in parenthesis.)
Page 150 Lines 9-13: A business with payroll between $251K & $401K who doesn't provide public option will pay 2-6% tax on all payroll.
Page 167 Lines 18-23: ANY individual who doesn't have acceptable HC according to Govt will be taxed 2.5% of income.
Page 170 Lines 1-3 HC Bill: Any NONRESIDENT Alien is exempt from individual taxes. (Americans will pay.) (Like always)
Page 195 HC Bill: Officers & employees of the GOVT HC Admin.. will have access to ALL Americans' finances and personal records. (I guess so they can 'deduct' their fees)
Page 203 Line 14-15 HC: "The tax imposed under this section shall not be treated as tax." (Yes, it really says that!) ( a 'fee' instead)
Page 239 Line 14-24 HC Bill: Govt will reduce physician services for Medicaid Seniors. (Low-income and the poor are affected.)
Page 241 Line 6-8 HC Bill: Doctors: It doesn't matter what specialty you have trained yourself in -- you will all be paid the same! (Just TRY to tell me that's not Socialism!)
Page 253 Line 10-18: The Govt sets the value of a doctor's time, profession, judgment, etc. (Literally-- the value of humans.)
Page 265 Sec 1131: The Govt mandates and controls productivity for "private" HC industries.
Page 268 Sec 1141: The federal Govt regulates the rental and purchase of power driven wheelchairs.
Page 272 SEC. 1145: TREATMENT OF CERTAIN CANCER HOSPITALS - Cancer patients - welcome to rationing!
Page 280 Sec 1151: The Govt will penalize hospitals for whatever the Govt deems preventable (i.e...re-admissions).
Page 298 Lines 9-11: Doctors: If you treat a patient during initial admission that results in a re-admission -- the Govt will penalize you.
Page 317 L 13-20: PROHIBITION on ownership/investment. (The Govt tells doctors what and how much they can own!)
Page 317-318 lines 21-25, 1-3: PROHIBITION on expansion. (The Govt is mandating that hospitals cannot expand.)
Page 321 2-13: Hospitals have the opportunity to apply for exception BUT community input is required. (Can you say ACORN?)
Page 335 L 16-25 Pg 336-339: The Govt mandates establishment of=2 outcome-based measures. (HC the way they want -- rationing.)
Page 341 Lines 3-9: The Govt has authority to disqualify Medicare Advance Plans, HMOs, etc. (Forcing people into the Govt plan)
Page 354 Sec 1177: The Govt will RESTRICT enrollment of 'special needs people!' Unbelievable!
Page 379 Sec 1191: The Govt creates more bureaucracy via a "Tele-Health Advisory Committee." (Can you say HC by phone?)
Page 425 Lines 4-12: The Govt mandates "Advance-Care Planning Consult." (Think senior citizens end-of-life patients.)
Page 425 Lines 17-19: The Govt will instruct and consult regarding living wills, durable powers of attorney, etc. (And it's mandatory!)
Page 425 Lines 22-25, 426 Lines 1-3: The Govt provides an "approved" list of end-of-life resources; guiding you in death. (Also called 'assisted suicide.')(Sounds like Soylent Green to me.)
Page 427 Lines 15-24: The Govt mandates a program for orders on "end-of-life." (The Govt has a say in how your life ends!)
Page 429 Lines 1-9: An "advanced-care planning consultant" will be used frequently as a patient's health deteriorates.
Page 429 Lines 10-12: An "advanced care consultation" may include an ORDER for end-of-life plans.. (AN ORDER TO DIE FROM THE GOVERNMENT?!?)
Page 429 Lines 13-25: The GOVT will specify which doctors can write an end-of-life order.. (I wouldn't want to stand before God after getting paid for THAT job!)
Page 430 Lines 11-15: The Govt will decide what level of treatment you will have at end-of-life! (Again -- no choice!)
Page 469: Community-Based Home Medical Services = Non-Profit Organizations. (Hello? ACORN Medical Services here!?!)
Page 489 Sec 1308: The Govt will cover marriage and family therapy. (Which means Govt will insert itself into your marriage even.)
Page 494-498: Govt will cover Mental Health Services including defining, creating, and rationing those services.
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Accross the board physicians will make less. If you are talking government employment or military service, that is a different animal, but still generally underpaid to begin with.
As for employed by hospitals, even academic centers.... if marked decreases in reimbursement, yes there will be pay cuts. Hospital employment contracts are usually reviewed on yearly basis. If you look at the "what are physicians worth" link above... you can see some general differentials. If a hospital financial planning depends on physician "x" bringing in revenues in excess of 1.5 million dollars per year in order to budget paying physician "x" a salary of $350 thousand/yr, what do you think if the reimbursement is cut dramatically? If Dr. X only brings in $700 thousand to the hospital, do you think they will continue to pay at the same $350 thousand/yr? so, if the paying pool shifts to higher percentage of medicare/medicaid and add a 20+% cut in reimbursement... no business person is going to maintain the same salary for someone that previously brought in at least 20% more revenue per year.
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Ah I see now, thanks for pointing out the good point. Both salaried and PP docs will work harder for less money!
No wonder Obama's own doctor, and Obama's cousin Dr. Milton Wolf, docs in diff. types of work environment, both diss HC Reform.
Obama's doctor dissed reform long ago. Obama's 2nd cousin was against it more recently: http://deathby1000papercuts.com/2010/02/dr-milton-wolf-stop-obamacare-says-obama-cousin/ They both, of course, emphasize 46% of doctors thinking about leaving medicine if Bill passes.
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I know I said I was done here, but I have seen this list before from my grandfather... it comes from an exerp from a single doctor, Stephen E. Fraser, MD, in a letter to Senator Bayh on JULY 23, 2009! All that you list above actually don't referrence any actual legislature and uses all the typical right wing talking points (how many ACORN referrences?)
I pointed out 2 lines right now to him, and will here:
Page 12 4 lines 24-25 HC: No company can sue GOVT on price fixing. No "judicial review" against Govt monopoly. since currently health insurance companies are exempt from anti-trust laws and already can engage in price fixing, or Page 253 Line 10-18: The Govt sets the value of a doctor's time, profession, judgment, etc. (Literally-- the value of humans.)
which describes how private insurance companies work... they pay based on "usual fees" which is based on a database they control and recently one of the largest insurance companies was forced to pay billions of dollar for artificially setting these values lower than they should be in order to decrease reimbursement rates to doctors in order to boost their profits.
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you really want in on this...still?
Yes, all these legislation are ultimately going to be geared towards or will require by necessity cuts in pay. Society looks at numbers and presumes much, i.e. 200k/yr = rich. So, to make it work, who you going to cut? They don't look at what it took to get to 200k/yr. remember, tax on the rich...."those making over 200k/yr" or sometimes, "those making over 250k/yr". They don't look to what it takes to earn that 200k/yr.
Think about the mechanic that works consistently ~6 days per week... for how much? How about the plumber... whatever number of days... but plunging your toilet. So, suppose they are now on "free healthcare". Suppose the program is unfunded and bankrupt (which it is before it even goes into law since already bankrupt from SS & medicare/medicaid = Federal credit card is way overdrawn, and we are buying a McMansion today...). Now government says we need to cut somewhere....loud cheer from the masses, "cut those greedy doctors, who needs to earn 200k/yr, how much is enough...."
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Wow...just wow. Do you have a source for the full transcript? I was trying to find one.
Me too. I haven't actually seen the bill. I dunno where to find this monstrosity of a bill. I heard it's 4,000 pages long, or 2,700 pages or the Senate Bill.
I doubt ppl on SDN read the thousands of pages either. I go to CNN and FOX, and hopefully average their biases, get a middle answer
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Stirring the pot and fanning the flames...
I'll go firmly on the record as being very much in favor of the bill, though obviously I don't think it's perfect. Last year I was afraid it would fail and the whole issue would become so politically radionuclear that no one would take it up again for a decade, but it appears we have escaped that and are actually going to pass a major piece of social legislation. I wish more were done explicitly for tort reform, malpractice caps, and explicit cost containment on the part of the patient/consumer, but hey, hopefully that will be ironed out in future iterations.
And remember-- the US is a representational democracy. We elect people to vote according to their own consciences and beliefs-- they're not mutely beholden to the polled majority on every issue.
Thankfully, as I think most of the opposition to this bill on the part of the public and docs is pure, naked self-protectionism (mixed with fear).
I'll go firmly on the record as being very much in favor of the bill, though obviously I don't think it's perfect. Last year I was afraid it would fail and the whole issue would become so politically radionuclear that no one would take it up again for a decade, but it appears we have escaped that and are actually going to pass a major piece of social legislation. I wish more were done explicitly for tort reform, malpractice caps, and explicit cost containment on the part of the patient/consumer, but hey, hopefully that will be ironed out in future iterations.
And remember-- the US is a representational democracy. We elect people to vote according to their own consciences and beliefs-- they're not mutely beholden to the polled majority on every issue.
Thankfully, as I think most of the opposition to this bill on the part of the public and docs is pure, naked self-protectionism (mixed with fear).
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My post gave credit to his source, which was a doctor sending a letter to Senator Bayh in July of 2009, and how it was about an outdated version of the bill.
I also posted previously a link to the actual bill, but here it is again.
http://dpc.senate.gov/dpcdoc-sen_health_care_bill.cfm
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good luck with that....
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you really want in on this...still?
I just can't stay away
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Just like the fear of the Right when Medicare was enacted... 40 years later, even the republicans won't think about removing medicare, even if the funding of it has some problems, and people are more satisfied with medicare than any other health insurance...
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nothing new under the sun, etc
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Well I don't like the govt running anything but since this health care bill makes everyone buy insurance....won't some docs make more money because they won't get stiffed by the guy that needed the treatment/surgery and didn't have any insurance and didn't pay anything?
First, not everyone would be forced to buy insurance. This includes illegal immigrants and those who pay a fee (which is much less than what insurance would cost).
Secondly, this plan, especially if it causes insurance premiums to rise even more (due to the mandated acceptance of pre-existing conditions and near 100% demand that a health insurance mandate would create), a lot more people will shift onto medicaid, which pays very little, even compared to medicare.
The 2 main things that might have helped doctors were not included in the bill: tort reform (due to the powerful influence of trial lawyers over the democratic party) and repeal of the SGR.
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Actually, we have a REPUBLIC..... if we can keep it.
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To be fair, this goes both ways. No one ever says anything stupid, no one is ever wrong. They were always just "taken out of context" or "thats a strawman" or "thats not what I meant at all, stop twisting my words!" Hard to know exactly but I'd be willing to bet a reasonable sum of money that if an impartial observer were to run a tally of all internet discussions as mentioned above, he'd find its at least 60/40 in favor of NOT "semantics" or "taken out of context" and in fact just "said something dumb."
And there is good reason for that. Its hard to consider all of the implications and consequences of our beliefs, and basically no one holds their beliefs for these reasons. We hold them because they make us feel good. So, if we state a position or argument or belief, and someone tries to demonstrate the CONSEQUENCES of that belief, its a simple matter to determine the result. Does the consequence make me happy? If so, then it is a legitimate interpretation of what I said. Does it make me unhappy? Well, then either they misinterpreted what I was saying or they are stupid and cannot come to correct conclusions about the implications of my beliefs! Easier to say someone took you out of context when the steps from "stated belief----->unpleasant conclusion" are simple and obvious to follow.
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Yes, I hate it when the Right does this. Its such a typical move of the Right. Whew, luckily not everyone is the Right, am I right?
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Look, the problem isn't some mean desire to keep people sick or broke or etc... It isn't fear of an imaginary boogie man.
The fear is based in the facts of reality. The facts of these pie in the sky fantasy utopian legislations.... that are NOT funded. We are not talking about a few funding problems... On the contrary we are talking about reality of a financial crisis... a real crisis. yes, I would love to feed the world with bread and water drawn from a stone... But that is not what we are talking about with these entitlements. The fear is that we just ignore one credit card, apply for another to max it out on further indulgences. At some point, you need to stop spending everyone elses money and every next generations money and then basking in the glow of how great and generous you are/were....
http://money.cnn.com/2009/07/29/news/economy/fixing_social_security.fortune/index.htm
http://www.cbo.gov/ftpdocs/27xx/doc2788/3-20-testimony.pdf
It would be nice to have a new pair of Jimmy Choo's, but someone needs to pay. It's like dealing with infants in a grocery store reaching for candy. Great, some Americans may love the medicare benefits they get on the backs of their kids and grand-kids (as described by CBO). Does that make it correct? When Mass needed bailout for its healthcare, federal government helped... but, who will help the federal government as we add another massive entitlement and/or expand medicare?
We all understand you, and numerous med-students think it is great, wonderful, generous. But, the adult thing is now to ask, how can we afford it? Have you looked and seen who is actually paying 80+% of ALL tax revenues collected?
http://www.taxfoundation.org/blog/show/341.html
http://money.cnn.com/2009/04/15/pf/taxes/who_pays_most_least/index.htm
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This is basically a wordy way of saying that I read dojo's post and generally came to the same conclusion that Jack did.
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Significant troop deployment for the better part of a decade, worst recession since the great depression, what better time to go all in on health care. Seriously... this will be sweet, I mean the VA is pretty awesome.
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A simple analogy that describes this bill in a nutshell:
There are 10 third graders in a classroom, all of whom would really like to have a piece of candy; however, there are only 5 pieces of candy in the room. The liberals' solution to the problem: add 5 more third graders to the classroom and simultaneously decrease funding to the candy supplier.
This bill does nothing to combat the rising prices of premiums, a problem the president mentioned time and time again over the past year. It does nothing to combat lawsuits (not surprisingly given who is calling the shots). It also does nothing to combat the rising cost of health care as a whole. All it does is cost the American taxpayers $600B (which, under this president, doesn't come across as a very large sum of money to spend given his history) over the next 10 years in taxes/fees/charges/fines. Not to mention, this could potentially have disastrous effects on health care for all Americans, while its original intent was to cover only 3-10% of our population. Health care is by definition a limited resource - you cannot dole out a limited resource to more individuals without watering it down in some way, shape or form.
It's really unbelievable to me to see so much arrogance, so much deceit, and so much delusional thinking from an American president and his cohorts. He and Nancy Pelosi express a level of narcissism I never thought possible in the realm of "public service."
I think it's incredibly annoying and foolish (playing with fire really) to continue to cut funding to doctors and hospitals (it will backfire one day in a very bad way), but the real losers in this mess are ALL of the American people. It has the potential to create a real divide in the quality of health care people receive. Those 15-30 million patients on Medicaid will have nowhere to go aside from academic/state/public hospitals, which they will then flood. Docs out in the community that have no longer been taking care of Medicare/Medicaid patients, along with the docs that are going to drop those patients in the future, may then resort to something along the lines of a cash-only service.
The liberals are proclaiming victory tonight; however, it is a victory only for those in chambers of congress and the white house.
There are 10 third graders in a classroom, all of whom would really like to have a piece of candy; however, there are only 5 pieces of candy in the room. The liberals' solution to the problem: add 5 more third graders to the classroom and simultaneously decrease funding to the candy supplier.
This bill does nothing to combat the rising prices of premiums, a problem the president mentioned time and time again over the past year. It does nothing to combat lawsuits (not surprisingly given who is calling the shots). It also does nothing to combat the rising cost of health care as a whole. All it does is cost the American taxpayers $600B (which, under this president, doesn't come across as a very large sum of money to spend given his history) over the next 10 years in taxes/fees/charges/fines. Not to mention, this could potentially have disastrous effects on health care for all Americans, while its original intent was to cover only 3-10% of our population. Health care is by definition a limited resource - you cannot dole out a limited resource to more individuals without watering it down in some way, shape or form.
It's really unbelievable to me to see so much arrogance, so much deceit, and so much delusional thinking from an American president and his cohorts. He and Nancy Pelosi express a level of narcissism I never thought possible in the realm of "public service."
I think it's incredibly annoying and foolish (playing with fire really) to continue to cut funding to doctors and hospitals (it will backfire one day in a very bad way), but the real losers in this mess are ALL of the American people. It has the potential to create a real divide in the quality of health care people receive. Those 15-30 million patients on Medicaid will have nowhere to go aside from academic/state/public hospitals, which they will then flood. Docs out in the community that have no longer been taking care of Medicare/Medicaid patients, along with the docs that are going to drop those patients in the future, may then resort to something along the lines of a cash-only service.
The liberals are proclaiming victory tonight; however, it is a victory only for those in chambers of congress and the white house.
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http://money.cnn.com/2009/07/29/news/economy/fixing_social_security.fortune/index.htm
But, don't waste time looking at distant past. What about the housing bubble... "EVERYONE should have a house", even if they can not afford it. If they can't afford it, well it's because the banks are predatory. How about all those extreme home makeovers... poor folks couldn't afford to upgrade their homes. Generous folks came in and did it for them... Then the poor folks turned around and took out a mortgage and lost the renovated homes... Someimes, you need a little bit of rational thought to temper a natural tendancy of generosity/charity/compassion.... You really can hurt a person with "too much" kindness. We've seen it with "pink apartments" government housing, welfare checks that encourage people to remain unemployed, consistent data showing extension of unemployment checks extends unemployment.... The list goes on and on. So, as we have in excess of 100 trillion dollars of UNFUNDED liabilities of tax payer "entitlments", now adding another huge entitlement, all I ask is exactly how we are going to pay for the already existing unfunded social programs? How are we going to pay for the new unfunded program? Those are responsible adult questions.
Rights are.... life, liberty, and PURSUIT of....
Social programs simply state, "sit at home, you don't need to PURSUE anything, cause we will go out and take from the pursuers and come back and give it to you... cause that is justice"
It is the reality that has those of us looking at the facts fear... It is the leftist fear-mongers that has people avoiding a peak into the books.... that are cooked from the beginning.FortuneArticleLinkedAbove said:
But, don't waste time looking at distant past. What about the housing bubble... "EVERYONE should have a house", even if they can not afford it. If they can't afford it, well it's because the banks are predatory. How about all those extreme home makeovers... poor folks couldn't afford to upgrade their homes. Generous folks came in and did it for them... Then the poor folks turned around and took out a mortgage and lost the renovated homes... Someimes, you need a little bit of rational thought to temper a natural tendancy of generosity/charity/compassion.... You really can hurt a person with "too much" kindness. We've seen it with "pink apartments" government housing, welfare checks that encourage people to remain unemployed, consistent data showing extension of unemployment checks extends unemployment.... The list goes on and on. So, as we have in excess of 100 trillion dollars of UNFUNDED liabilities of tax payer "entitlments", now adding another huge entitlement, all I ask is exactly how we are going to pay for the already existing unfunded social programs? How are we going to pay for the new unfunded program? Those are responsible adult questions.
Rights are.... life, liberty, and PURSUIT of....
Social programs simply state, "sit at home, you don't need to PURSUE anything, cause we will go out and take from the pursuers and come back and give it to you... cause that is justice"
So, let me "social justice" your analogy:
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So are you instead advocating a flat tax rate? That same group paying 80+% of the taxes (I assume to are looking at the Top 25% of of earners) are those who make 65% of the income... If you are, then you either don't understand the economic idea of "utility" or you really don't care about anyone but yourself...
The more realistic socialism answer to the candy problem posed is they advocate cutting the candies in half, while the republican (using the JAD addition of the 2 kids mowing lawns to buy the 5 pieces) is give the 2 kids the 5 pieces of candy, then go out get 5 more pieces of candy, and give them to those 2 kids again saying: "these kids are really important and if we don't give them all this candy, then candy will no longer exist. You don't want candy to disappear do you? Why do you hate candy? Real and true americans would ask how we can get those 2 kids 5 more pieces of candy"
The world isn't as black and white as liberals and conservatives paint it, and moderation and balance between the two is necessary. I think the most realistic answer to that solution above (and more realistic situation) is that 2 kids had parents buy them candy (trying to represent CEO's... I realize that are not given candy, but there are not many lucrative jobs for third graders), 3 kids mowed lawns (and was able to earn enough for candy), 2 kids sold lemonaid (who only made enough to... i dont know, cover all the costs of being a kid but not have enough leftover to have candy), and 2 kids sat and played videogames/watched tv, and 1 kid had to stay inside because the neighborhood is unsafe for him to go outside and his single mother who grew up poor and was a bright kid but never got a chance has to work afternoons to try to give him a better life... So yeah, those two kids whose parents bought them candy can give up a bit of their candy, when we know that they actually have 3 more candybars awaiting them at home, those 3 that mowed lawns, their candy bars aren't as big as the candy bars of the 2 kids whose parents bought them, can break off a little bit to give to the other kids, and while those 2 kids who sat and played videogames really shouldn't get any candy, but those 2 kids selling lemonaid and that 1 kid deserves a little help, while they shouldn't get that full candybar, taking a little part of the other 5, because each bite you take of that candybar isn't nearly as good as that first (utility of each bite decreases), seems pretty fair to me.
When one side wins any sort of battle pushing the balance either way, the other gets in a fit about it... When the right wins (Bush Tax cuts, current Texas Board of Education crap that is really amazing some of the things they said, like "Someone needs to challenge the experts...") the left talks about how they are destroying the country, not looking out for the little person and only caring about themselves, destroying civil liberties and becoming a corporate state, and when the left wins (Obama, this health care reform, the 2nd bailout) we are becoming socialists, they are tyranical, etc. etc. We have become such a polarized and frankly, hysterical nation.
And while the subprime lending contributed to the economic problems we are currently in (which was set up by the Dems), the bigger thing leading to this collapse is that firms would take these risky investments, bundle them, divide them up, call them secure and wonderful investments (AAA instead of the junk they really were) and sell them and make huge profits off of them... not to mention accounting fraud like seen in Lehmon Brothers where, each time before they would report their books, would sell 50billion of toxic assests to a dummy company for 50billion "cash" assest, then after the audit, buy the toxic assests back, etc. So, if there weren't the crappy loans in the first place, they couldn't have been packaged, etc. But, if they weren't trying to game the system and calling these things bonafide, and if the deregulation and lack of oversight, mainly put in place by Republicans, then when the subprimes collapsed, it wouldn't have dominoed as it did.
UGH! I hate this type of crap, but I really can't just stand by idlely...
- Joined
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I think the problem with this that the previous poster was trying to get at is that the kids will quickly realize that they will still get candy even if they don't work for it. So, the kids who are mowing lawns to buy their candy will say, "Wow! Why am I working for this candy and barely pay for it, while the kids who don't work still get candy?! I think I won't work anymore"The more realistic socialism answer to the candy problem posed is they advocate cutting the candies in half, while the republican (using the JAD addition of the 2 kids mowing lawns to buy the 5 pieces) is give the 2 kids the 5 pieces of candy, then go out get 5 more pieces of candy, and give them to those 2 kids again saying: "these kids are really important and if we don't give them all this candy, then candy will no longer exist. You don't want candy to disappear do you? Why do you hate candy? Real and true americans would ask how we can get those 2 kids 5 more pieces of candy"
It's just positive reinforcement. Don't work --> Get candy --> Continue not working.
I completely understand the position of not wanting people to be thrown out into the dark left to die. And that's where charity and churches and volunteering and altruism come in. The way the government is now, there is no reason for those aforementioned things to be there and help out. There isn't a need anymore - the government will take care of it.
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I too appreciate all the socialists/social justice/save everyone arguments. Honestly, I get it.... Yes, we can go back and forth on the candy analogies too.... And, yes, the component of loss in motivation is real.
But, the more important point in all of this is how does it get paid for? It is nice to have idealized dreams in which everyone gets a cadillac or pony or etc... However, to simply propose a "social justice" idea/ideal, without actually considering the implications and how it will be paid for is not generous, is not kind, it is cruel and destructive. There are NOT the resources for the current "entitlement" programs already in existence.
"We" continue to promise the SS retirement check. People are more and more dependent on it as their retirement as opposed to engaging in fiscal responsibility and savings. It is cruelty to continuewith the idea that the money goes on forever.... because you are making promises you can not keep.
"We" continue to promise the medicare/medicaid benefits... folks are now depending on IT as their entitlement for longterm health. Yet, it is not sustainable, it is not accepted by all.... and when it gets cut those that depended on this HOLLOW/UNFUNdED promise are hurt...because you are making promises you can not keep. Again cruel and destructive.
Now, a new entitlement. It has been sold as a means of "equality" and "fairness". Those that work for smaller employers, those that don't work, those that can't work, etc... are being promised levels of care that the "wealthy" get.... Numerous stories of the high tech care, high tech imaging, fancy drugs of all kinds. Yet, if anyone is honest, even supporters of these plans, they will tell you the way for equality is to lower the standards of care.... that is bring the level of care to generalized mediocrity....because you are making promises you can not keep. So out of "fairness", we will deny previous levels of care to those that are "wealthy" (>200k/yr) earners.
In the end, because continue to promise great ideas "we" can not afford to pay for, the system goes bankrupt, ALL loose.... which I guess = fair?
In the end, to get these massive programs started and then purpetuated, requires demonizing the "wealthy" (>200k/yr) earners.
No matter how you slice it, pushing, promoting, promising "ideas", creating the expectation and ultimate dependence on unsustainable programs is destructive and cruel. It is not compassionate. I think the thing about the road and good intentions is very applicable. Remember, the current legislation was pushed because of the "suffering" 12-30 million of the 300million population. It's not clear the 12-30 million will gain substantial benefit. It is clear there will be cuts and taxes to facilitate this legslation and potentially diminished levels of care for the >200million.
The thought process of pushing idealistic dreams without concern for consequences or how to achieve the goal is childish at best, selfish, cruel, destructive at worst.
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