Why the Recent BofA Fee Controversy is Like Medicine

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docB

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For those who don't know there was a recent controversy when Bank of America tried to institute a new $5 fee for customers to have a debit card. They did this to pass on the costs of a law that forced them to reduce their per transaction fees for those cards. Congress was outraged at this response to their legislation so they called hearings. Consumer groups were similarly outraged and eventually B of A was forced to scrap the plan.

Now I am no fan of B of A but this episode shows up something about congress and the public that we need to pay attention to as physicians whose incomes are governed to a large degree by government programs. Congress cut B of A's pay and they expected them to just take a loss and live with it. When they took action to pass those costs along to the consumer they were soundly trashed.

When we get cuts or when we have new unfunded mandates heaped on us such as EMTALA, medication reconciliation, CORE Measures, etc. we react by increasing volume, adding midlevels, documenting better (to achieve higher per patient charges) and doing other things that patients hate. We could, and I argue likely will, suffer the same defeat as B of A. When the public and Congress hand us a pay cut they want us to take the cut and deliver the same service for the lower price.

Rest assured that's what they want. Consider that when people tell you that any changes coming will be "revenue neutral."

PS- I posted this in EM because when posted elsewhere this topic always degenerates into discussions of going into boutique, cash only practices rather than dealing with CMS. That's not an option for us so we don't need to go off on that tangent.

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Medicine is screwed.

What specialties are cash only? lol.
 
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Politics: the only industry where failure and incompetence further secures your own job security. The only profession where you can "fail upwards" and be promoted for gross incompetence.

Actually, I think the banking/finance industry fits this model very well.
 
This is why "regulation" is not the answer. You hate "greedy" bankers and hedge fund managers? Of course the solution is to have oversight by greedy Congressman and other politicians.

This is exactly why the founders limited the power of government. For most things government is incompetent, and private industry can achieve better results at lower costs. Government is good at a very few things: national defense, interstate commerce, and basic infrastructure. Everything else should be left up to the States or private industry.
 
I agree totally with drastic limits on government involvement in economic as well as social matters. Unfortunately, the vast majority of people cannot shake their addiction to Government as the Great Caretaker and Nurturer. However, when the money runs out, and the house of cards collapses like it is in Europe right now, we'll be left with the same rioting masses in the streets wondering where their promised cradle to grave free health care, public housing, free education through graduate school, loan forgiveness, government pension and 35 hour work week are.

I completely agree. Government shouldn't protect any corporations (or individuals for that matter) from going bankrupt. It's the threat of bankruptcy that should normally mitigate a company from taking adverse risk. If big brother is there to bail you out, what's to stop you from making risky gambles?

How about government just runs the military, keeps the interstate highways going, and stays out of the way of private industry altogether?
 
Actually, I think the banking/finance industry fits this model very well.

while this might be true with some CEOs. In general it is not. Take a look at what Goldman Sachs did when they announced a quarterly loss. They shred jobs. Thats the right thing to do. Cut where you are losing money.

Finance while I think is dirty is open to cutting those who dont perform. I envy this.
 
while this might be true with some CEOs. In general it is not. Take a look at what Goldman Sachs did when they announced a quarterly loss. They shred jobs. Thats the right thing to do. Cut where you are losing money.

Finance while I think is dirty is open to cutting those who dont perform. I envy this.

The problem is that you don't think like the Progessives do. In their world workers own the companies, and the companies exist for the benefit of the workers. If a company starts losing money, in their view the executives should take huge pay cuts before any layoffs are performed.
 
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This is why "regulation" is not the answer. You hate "greedy" bankers and hedge fund managers? Of course the solution is to have oversight by greedy Congressman and other politicians.

I'm confused. Regulation is not the answer? Was it not a lack of regulation, and lack of consequences for the culprits, that got us in this mess to begin with?

The fact that nobody was there to stop the banks from giving the minimum wage worker a 200K, variable interest loan, which he/she was sure to default on, is what led to this debacle. The only people suffering the consequences were the idiots who were stupid enough to borrow.

What is the answer then, if not regulation?
 
Birdstrike, you misunderstand, I do not think government regulation is the answer, the government can't even regulate themselves, let alone anything else. However, there still needs to be some kind of regulation, to prevent a repeat performance of what happened.

I agree with you 100% that these bailouts were a mistake, and are just prolonging the inevitable.

Who will prevent this crap from happening again if these massive corporations are not regulated and held accountable (not just by going bankrupt but by giving prison time to those who deserve it).
 
I think there was a lot of regulation that was pushing the banks to make bad loans, i.e. the Community Reinvestment Act revisions in the late 90s. The banks made these loans and then bundled them up and started to pass them around like hot potatoes, aka "toxic assets."

That goes back to my original point, they make laws and regulations without regard to the unintended but totally predictable consequences.
 
I think there was a lot of regulation that was pushing the banks to make bad loans, i.e. the Community Reinvestment Act revisions in the late 90s. The banks made these loans and then bundled them up and started to pass them around like hot potatoes, aka "toxic assets."

That goes back to my original point, they make laws and regulations without regard to the unintended but totally predictable consequences.

Which brings to mind the bazillion dollar question. Who will regulate? Who can control this corporations upon which everything in our lives hinges?

Government is out, they already tried and failed miserably, and they are probably more corrupt than all these bankers anyway.

Personally I don't see a way out, we're dammed if we regulate, and we're dammed if we don't.
 
Which brings to mind the bazillion dollar question. Who will regulate? Who can control this corporations upon which everything in our lives hinges?

Government is out, they already tried and failed miserably, and they are probably more corrupt than all these bankers anyway.

Personally I don't see a way out, we're dammed if we regulate, and we're dammed if we don't.

A combination of enough free market to allow growth and innovation restrained by a minimalist approach to regulation to stop clear problems has always worked best. Regulation that is created to attempt to achieve "social justice" always fails.
 
while this might be true with some CEOs. In general it is not. Take a look at what Goldman Sachs did when they announced a quarterly loss. They shred jobs. Thats the right thing to do. Cut where you are losing money.

Fair enough, but who did they s**tcan? C(XYZ)O's or floor level traders?

If all they fired was the lower level folks, that's like saying that we can fix the "gummint" by firing a bunch of speechwriters and secretaries.
 
Which brings to mind the bazillion dollar question. Who will regulate? Who can control this corporations upon which everything in our lives hinges?

Government is out, they already tried and failed miserably, and they are probably more corrupt than all these bankers anyway.

Personally I don't see a way out, we're dammed if we regulate, and we're dammed if we don't.

Its not corrupt to do what the law allows; why don't doctors do what businesses do? Is no one telling you? Do you not know what to believe? I know how to get deductions into savings up to more than a million dollars a year, and I am told by CME directors all the time that they are not interested, their doctors are not interested. Could this be true? Seems to me there is a high level of frustration here.
 
It is just a shell game of cost shifting.

My pet pieve of the week is the bag fee charged by certain airlines.

The real reason for the bag fee? Ticket brokers.

It is basic math. The ticket brokers receive a % of the ticket fees. Bag fees are an accessorial charge and the ticket broker doesn't receive any of that fee.

Shucks, darn.

Give the airlines enough time and tickets will be free (and the ticket brokers will be working for free) and the bag fee will be cost of today's ticket.



Most of the government regs of the past 30 years have been the same cost shifting BS. One hand doesn't see it so it doesn't exist. Some party doesn't get paid very much, but that is ok because others won't mind picking up the tab.

In the end, somebody, somewhere is paying for it.


BofA is the same way. That $5 fee is going to get past onto the small business client (aka the local hospital clinic etc) paying higher Merchant Bank service fees to process those credit cards and if that ain't enough then the little old lady with a passbook savings account is going to pay the fees. No matter what, BofA is still going to get theirs.

And in the end the consumer is still going to get the shaft.

PS: I don't have a solution, but I sure do have disgust.
 
It bothers me that people say "lack of regulation" caused the housing crisis. Bank of America doesn't want to loan to a deadbeat who can't afford a house unless there's profit in it for them. The real reason why they made those loans is the government. The Feds owned Fannie and Freddie, and authorized them to buy mortgages originally written by private companies like BoA. The logic was that every American should own a home, and with Freddie and Fannie willing to buy these toxic loans to low-income families it was easy for private banks to extend these loans with minimal risk.

Had the government not tried to create social engineering in the housing market we would not have had the real estate bubble and crash that we did. Even now Obama is still trying to "help" people by trying to get them out of their underwater mortgages. Not only is it unethical, it's unhelpful in the long run. As much as I dislike Mitt Romney, he was correct when he stated to the Las Vegas Review-Journal that we should let the market "hit bottom". You bought a house you can't afford? Too bad for you, maybe next time you'll learn your lesson and live within your means.
 
Making people responsible for their own actions? That is outrageous. You are way out of the mainstream. Clearly you have no idea what you are talking about. LOL

Come on good liberals! How can you let him get away with suggesting something like this?!

I just want everybody to pay the consequences, the idiots who took out the loans, and the idiots (geniuses?) who gave it to them.
 
You already see the fees being placed on consumers. I even have a utility bill that charges a fee if I pay by credit / debit card. If I pay by check, no fee, but have to use paper billing and pay for the postage. Right now, postage is cheaper than the fee.
 
However, there still needs to be some kind of regulation, to prevent a repeat performance of what happened.

As mentioned before by others, the regulation needs to be self regulation in the form of "risky behavior=lose your ass." It does not need to be the government.

What annoyed me the most over the last few months as I was going to buy a house is that because of the screwed up decisions of others, combined with knee jerk congressional reactions, now I can't get a normal mortgage. As a 1099 employee, Fannie Mae rules won't let a bank give me a loan that they can then sell to the government unless I have 2 years of salary in the bank, 30% down, and some other arbitrary rules. While I think making sure I can afford the house is important, 2 years salary in the bank would pay for the house such that I wouldn't need a loan.
Thankfully there are banks out there that make portfolio loans so I don't have to wait 2 years renting before I can buy a house.
 
As mentioned before by others, the regulation needs to be self regulation in the form of "risky behavior=lose your ass." It does not need to be the government.

What annoyed me the most over the last few months as I was going to buy a house is that because of the screwed up decisions of others, combined with knee jerk congressional reactions, now I can't get a normal mortgage. As a 1099 employee, Fannie Mae rules won't let a bank give me a loan that they can then sell to the government unless I have 2 years of salary in the bank, 30% down, and some other arbitrary rules. While I think making sure I can afford the house is important, 2 years salary in the bank would pay for the house such that I wouldn't need a loan.
Thankfully there are banks out there that make portfolio loans so I don't have to wait 2 years renting before I can buy a house.

Yes, that is why those portfolio lenders exist. This is a case where the rule is bad for you but good for a majority of cases. Most self employed individuals (or 1099 / independent contractors) have risky and inconsistent income. A 2 year employment history is typically necessary, after which I doubt you would need 2 years salary in the bank. There are many gov't loans that fit the criteria you mentioned, you just need 2+years of history and increasing or steady income.
 
Oh, and Americans are in deep ****.

Would have been nice to live and die from early to late 20th century, Americans are screwed in the 21st.

Is China the new America?
 
Fair enough, but who did they s**tcan? C(XYZ)O's or floor level traders?

If all they fired was the lower level folks, that's like saying that we can fix the "gummint" by firing a bunch of speechwriters and secretaries.

Well the way those things usually work is they fire the groups who dont make money. Top to bottom. FWIW their reported savings per person laid off is 1.2million. Doubt there are too many secretaries there.

High Finance people dont play around like manufacturers do.
 
What annoyed me the most over the last few months as I was going to buy a house is that because of the screwed up decisions of others, combined with knee jerk congressional reactions, now I can't get a normal mortgage. As a 1099 employee, Fannie Mae rules won't let a bank give me a loan that they can then sell to the government unless I have 2 years of salary in the bank, 30% down, and some other arbitrary rules. While I think making sure I can afford the house is important, 2 years salary in the bank would pay for the house such that I wouldn't need a loan.
Thankfully there are banks out there that make portfolio loans so I don't have to wait 2 years renting before I can buy a house.

I have a worse story of government idiocy in real estate. I buy foreclosed homes to rent. In Vegas the rental prices are high because so many people foreclosed and can't buy another house they are stuck renting. If you have a bit of cash, you can buy a foreclosed home cheaply and rent it out for a decent profit.

Earlier this year I was buying a home for about $140k with 20% cash down. My offer was accepted and everything was proceeding, when Fannie Mae, who owned the home told me to get lost because they wanted a "first-time buyer" to get the house rather than an investor. So this bankrupt, government-owned company with loads of toxic mortgages turned down an offer from someone with good credit who could get the home off their books quickly? As a taxpayer I OWN Fannie Mae and they had no right to arbitrarily do that. Someone please get government out of the real estate business!
 
I just want everybody to pay the consequences, the idiots who took out the loans, and the idiots (geniuses?) who gave it to them.

Regarding finance and regulation. In essence the govt allowed these large banks to bet on these risky loans with limited downside. This would be like me going to vegas and playing the pass line first in vegas 50/50 odds, then moving to blackjack (slightly worse odds) and then playing some prop bet with crap odds and knowing if I lose I can go and hit up someone to cover my losses.

If BofA and others would have gone belly up it would have been the right thing to do. Personally, I am happy all these people are moving to credit unions. The term "too big to fail" is a joke.

The banks, GM etc should have been allowed to fail. Sadly those in government are tightly intertwined and dont have the average joes best interest at heart.

Regarding those loans. I dont quite get how people are mad at the banks. It is/was a smart bet. They got greedy which is why they are in trouble now. The didnt disclose the risks of those loans which is why they are getting skewered. Making those loans was brilliant because if it went belly up it just fell on the taxpayers.

The govt set up a system.. why people are mad at the banks is beyond me.
 
GM wasn't going to fail because of bad decisions. They were going to fail because of unions. That being said, I don't think the government should have saved them, and I won't buy one of their cars now because of it, even though I have a large family history of working for them in Indiana.

I don't think the people were that upset at the banks. They're just upset at their relatively bad situation, especially regarding student loan debt for crappy degrees. Then between ACORN, some Canadians, and the media, they're making this thing snowball. Even now you can't get a cogent argument from occupiers as to why they are there. That woman in Atlanta is pretty spot on for the movement as a whole.
 
Regarding those loans. I dont quite get how people are mad at the banks. It is/was a smart bet. They got greedy which is why they are in trouble now. The didnt disclose the risks of those loans which is why they are getting skewered. Making those loans was brilliant because if it went belly up it just fell on the taxpayers.

The govt set up a system.. why people are mad at the banks is beyond me.

That view supposes that the banks were disinterested parties in government deregulation of the industry. Instead, they essentially rewrote the rules, using their influence with the SEC, to try and capitalize on increasing profits in the housing sector. So you can see why that may make people angry.
 
The problem in our industry is that we are "too big to fail." We already are supported by a perpetual bail out via CMS.

What we face is that when politicians say "We all need to tighten our belts." or the even more frightening "We all need to pay our fair share." they specifically mean us. We will face higher taxes and lower income. When they say we will face cuts they don't mean they will create loopholes for us to work around them. They mean get used to less.
 
That view supposes that the banks were disinterested parties in government deregulation of the industry. Instead, they essentially rewrote the rules, using their influence with the SEC, to try and capitalize on increasing profits in the housing sector. So you can see why that may make people angry.

big business is aligned with those supposed to regulate it. See my prior post. Where did the folks in the treasury come from? Hank Paulson? William Dailey the Obama Chief of Staff? Geithner? No matter R or D the big banks have guys in close with the president.

Of course the banks are interested in the rules that will be passed to govern them.

So the banks lobbied and got things the way they wanted and you are mad at the banks? I guess my view of government is different. Be mad at the people who allowed them to put these rules into place.
 
The problem in our industry is that we are "too big to fail." We already are supported by a perpetual bail out via CMS.

What we face is that when politicians say "We all need to tighten our belts." or the even more frightening "We all need to pay our fair share." they specifically mean us. We will face higher taxes and lower income. When they say we will face cuts they don't mean they will create loopholes for us to work around them. They mean get used to less.


That "fair share" argument is frightening. It's something out of Ayn Rand. No one ever defines "fair share" either as a percentage of income or absolute dollar contribution. My guess would be that "fair share" is an infinitely high tax rate adjusted to however much a politician needs it to be to play the populism card and get votes.
 
That "fair share" argument is frightening. It's something out of Ayn Rand. No one ever defines "fair share" either as a percentage of income or absolute dollar contribution. My guess would be that "fair share" is an infinitely high tax rate adjusted to however much a politician needs it to be to play the populism card and get votes.

Agreed. I was perusing the CNN Occupy pages. The quotes were often frightening. I think it is much like the middle class. Ask people what defines middle class. Also funny how people dont want to define this. Curely the answer is complex.

Whats sad is that 47% of tax filers paid NO tax. THis is a no go. Personally, I think no more than 20% -25% of those who earn money should pay NO fed income tax. The middle 50% need to pay as well, and the top too.

The discussion is ridiculous. I may have a good job and make good money but I also have over 300k in debt. Those loan payments dont pay themselves.

I also think you see the student loan contingent. They cant get jobs went to a liberal arts school and studied something where they cant make money. They finished an expensive school and didnt learn anything to help them get a decent job. Now they have 50K+ in debt and no job prospects. I would be pissed too.
 
Agreed. I was perusing the CNN Occupy pages. The quotes were often frightening. I think it is much like the middle class. Ask people what defines middle class. Also funny how people dont want to define this. Curely the answer is complex.

Whats sad is that 47% of tax filers paid NO tax. THis is a no go. Personally, I think no more than 20% -25% of those who earn money should pay NO fed income tax. The middle 50% need to pay as well, and the top too.

It is scary. As one of the founders said: "When the people find that they can vote themselves the treasury, Democracy ends". I disagree with you in that I think EVERYONE who works should pay something in tax, even if it's $1. No one should have a net benefit of "tax credits" from the system.

I also think you see the student loan contingent. They cant get jobs went to a liberal arts school and studied something where they cant make money. They finished an expensive school and didnt learn anything to help them get a decent job. Now they have 50K+ in debt and no job prospects. I would be pissed too.

I heard on the news one of the protesters saying that he should have a "guaranteed salary of $50,000/year". What he doesn't understand is that if that was enacted, $50,000 would become the new minimum wage, we'd have instant hyperinflation, and his Starbucks coffee would go up to $20.

Most of these protesters want more money, but they're not willing to work for it. The work ethic of people coming out of college these days is non-existent.
 
It is scary. As one of the founders said: "When the people find that they can vote themselves the treasury, Democracy ends". I disagree with you in that I think EVERYONE who works should pay something in tax, even if it's $1. No one should have a net benefit of "tax credits" from the system.



I heard on the news one of the protesters saying that he should have a "guaranteed salary of $50,000/year". What he doesn't understand is that if that was enacted, $50,000 would become the new minimum wage, we'd have instant hyperinflation, and his Starbucks coffee would go up to $20.

Most of these protesters want more money, but they're not willing to work for it. The work ethic of people coming out of college these days is non-existent.

I am opposed to people pulling money out in tax credits which happens now but I think if you make true minimum wage and earn about 15k per year it is hard to have that person pay income tax. I am unclear whats the deal about them paying $1. Sure, that would be fine with me. I just dont think we should take 10% of their income.

The OWS crowd just doesnt understand how these things work. As you said if you barrista at starbucks is making 50k there is no way to keep the price of your latte at $5. It would lead to inflation and all costs would jump.
 
I am opposed to people pulling money out in tax credits which happens now but I think if you make true minimum wage and earn about 15k per year it is hard to have that person pay income tax. I am unclear whats the deal about them paying $1. Sure, that would be fine with me. I just dont think we should take 10% of their income.

The OWS crowd just doesnt understand how these things work. As you said if you barrista at starbucks is making 50k there is no way to keep the price of your latte at $5. It would lead to inflation and all costs would jump.

Simply there would be a minimum tax of $1, so that everyone pays something, but no one could argue that the $1 would be a hardship.

I'm not sure why anyone listens to these OWS losers, as they haven't the barest understanding of economics, finances, or hard work.
 
The OWS people are funny. I agree they dont have much to offer. Veers, question regarding your plan.

Why would someone who is employed pay the $1 but someone who chooses not to work beit in retirement or simply because they choose to live on welfare etc not have to pay taxes?

I have no issue with $1 its not much money these days but then you are taxing those making money while giving the freeloaders even more free money.

Personally I dont believe the govt deserves more than 20% of any dollar earned. 35% plus sales tax is insane.

We need a flatter broader tax. We also have to find ways to prevent people from skipping out on paying their share.

I like the national sales tax. The fed govt collect about 11-12% of every dollar earned. The folks at the bottom get more services and pay nothing into it.

Everyone needs to have some skin in it.
 
You should take a look at this interesting Newsweek article just published.
Just talks about all the things that made western society so accomplished, and how much of that is quickly being lost.

I think the title makes the topic pretty clear: America's "Oh ****" Moment.

http://www.thedailybeast.com/newswe...american-civilization-can-avoid-collapse.html

It's definitely a good read. Most of us who are thinking human beings who can do math have already had our "Oh ****" Moment. Frankly I can't understand why anyone would continue loaning money to our country to finance our stupid decisions. We are bankrupt. Period. There is no money for Medicare, none for Social Security, and forget about "free education" and all the other goodies that OWS protesters want given to them.
 
. We will face higher taxes and lower income. When they say we will face cuts they don't mean they will create loopholes for us to work around them. They mean get used to less.

Please note, I am a private practice surgical subspecialist, so my reaction to this situation will be different from yours as an ED physician.


I could get used to making less, but I will say this, my patients, or should I say "clients," will have to get used to less as well. Meaning, I will no longer work patients without appointments into my schedule, will not see patients in the hospital when I am not on call, will not answer the ER page when I am not on call, and generally will have more time off to do as I will.

This may sound to some as harsh and unfeeling, but I have always said that when I am paid a bank teller's salary, I will work bank teller's hours.
 
Please note, I am a private practice surgical subspecialist, so my reaction to this situation will be different from yours as an ED physician.


I could get used to making less, but I will say this, my patients, or should I say "clients," will have to get used to less as well. Meaning, I will no longer work patients without appointments into my schedule, will not see patients in the hospital when I am not on call, will not answer the ER page when I am not on call, and generally will have more time off to do as I will.

This may sound to some as harsh and unfeeling, but I have always said that when I am paid a bank teller's salary, I will work bank teller's hours.

Your reaction makes sense. As providers of a service when we are told we will be paid less we look for ways to compensate. One way is to try to pass on costs (we are generally prohibited for doing this with CMS patients). Another is to increase volume to make up the lost revenue (this is difficult since most of us are working at capacity as is). Your suggestion is to reduce the quality of the service commensurate with the decrease in payment.

Your option is already being made difficult by CMS measures such as HCAHPs and other "pay for performance" metrics that will require us all to make patients happy. We will also continue to be under the threat of lawsuits and have that incentive to make everyone happy as well.

It will be difficult to take any steps on our part to mitigate the cut. They've got us coming and going.
 
It just boggles my mind, that socialists, liberals and communists continue to believe, and their entire philosophies rely on the completely ridiculous premise that the most productive members of society will continue to work like dogs when everyone in society makes the same salary, which they believe is the only solution that can bring "social justice". It seems that anyone with the most rudimentary understanding of human nature, would immediate conclude that this is ridiculous.

Of course the leaders of such socialist/liberal/communists "utopias" have never included themselves in the ranks of the "common folk" who'll all be expected to work for the same rudimentary salary as the "little people".

The fatal flaw in their reasoning is that they believe humans are fundamentally altruistic and will work for the benefit of others and society. While that may be true for a select few people, the vast majority of people always have, and always will work for their own self-interest first. This is why every attempt at socialism has led to poverty, war, and totalitarianism.
As I've pointed out in another thread, the OWS people want a guaranteed salary of $50,000/year for doing unskilled or minimal work. This would naturally lead to huge inflation, and it wouldn't improve their standard of living.

Capitalism has raised more people and nations out of poverty than any other economic system in the history of the world. To suddenly reverse course and claim that capitalism is "evil" and must be "regulated" would seek to undo that progress.
 
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