Sunday, July 31, 2011

Doctors Lose

Okay, time for a little political venting. If you don't like to read the rantings of a right wing upper middle class physician, then you can certainly skip today's topic. My opinions may turn off some people and incite others to question and ridicule my thoughts, but hey, it's my blog. I'll write about whatever I want to.

First up, the ongoing farce that is the U.S. federal government and it's attempt to keep us from sinking deeper into banana republic territory by allowing itself to borrow even MORE money so we can pay our creditors the billions of dollars we owe them. The latest news as of Sunday afternoon is that the Senate is close to reaching a compromise for raising the debt ceiling while also reducing the budget deficit. Of course the senators don't have the time or the guts to declare in detail the areas they would cut the federal budget. So they will form a "special committee" that will decide how to cut $1.8 trillion by the end of the year. If the committee can't figure out a way to do that, then the deal would require an automatic $1.2 trillion budget cut, half from the Defense budget, and half from Medicare providers. Social Security, Medicare, Medicaid, and food stamps benefits, ie/ most of the entitlement programs that constitute the majority of federal spending, would be spared. Got that? Another $600 billion lopped off the payments to doctors, hospitals, nursing homes, and anybody who is trying to take care of our sick and elderly. This will just make it easier and more justifiable for doctors to drop their Medicare patients even though there is already a shortage of Medicare providers willing to work for below market rates. How many more hospitals will go bankrupt if more Medicare reimbursments are cut?

Even before the current debt negotiations, there was already talk that Medicare is going to reduce the subsidies it provides hospitals for training medical residents as part of its cost cutting measures. One proposal would slash approximately 60% of the funding for hospitals to train residents. What happened to all the teeth gnashing about the shortage of doctors, especially in the primary care fields? People think we can just keep building more medical schools to relieve the physician shortage, as is already being done. But if there are fewer residency spots open to train all these new doctors, there will be no relief from this doctor shortage. Unless of course people are once again willing to go see a doctor labeled as a "general practitioner" with no board certification as their primary care giver. There's even talk that hospitals might consider charging money to enroll in the more competitive residency programs. How about that you orthopedic, dermatology, ophthalmology, anesthesiology residents? Would you be willing to add to your student debt load by paying to be in a residency program?

Finally I'm sick and tired of hearing about how the "rich" should pay more of their fair share to support the government and get us out of debt. President Obama famously defines the "rich" as any family who makes over $250,000 per year. Not that I agree, but since the average anesthesiologist, and most families who have doctors as breadwinners, make more than that, I guess you can call me "rich". However, I feel like I pay far more in taxes than what should be considered fair. Consider, that I pay the 35% federal income tax bracket. Then add in the confiscatory 10% California income tax. Don't forget the 12.6% Social Security tax, which will go up with the advent of ObamaCare. Also add in 2.9% Medicare tax, also going up with ObamaCare. Then there is the unemployment insurance tax, worker's comp insurance tax, and the disability insurance tax, I'm already at or above 60% of my income being seized by the government for being a productive member of society. I'm not even counting sales taxes, property taxes, business taxes, and various other licenses and fees. In the meantime, over 40% of the nation's population don't pay any federal taxes at all. Yet these are the same people who receive most of the government benefits and bellyache loudest about the "rich" paying their fair share of taxes. The only interaction I have with the government is when they have their hands in my pockets to take more money. To me this system definitely isn't fair, and it's not because I don't pay enough taxes for the comparatively few benefits I receive. And don't lecture me about how the government is paying for the roads I'm driving, the schools my children attend, or the safety of our country. Everybody is receiving those same benefits yet a large percentage of people don't have to pay for them.

This is a dangerous path our country is heading. A preview of the future has already played out here in California. In our state, the top 1% of income earners pay 50% of all income taxes. Yet there is never enough money to go around. The people who pay little or no taxes will have the upper hand in a democracy because there are simply more of them than the rich. They will keep voting in politicians who cater to their needs and demand that somebody else pay for all of it. After all, it's not coming out of their pockets and the "rich" can afford it, right? When 20% of all income in this country comes from the federal government, it is easy to understand that cutting back benefits will be next to impossible. I'd say that to be truly fair in our country's tax scheme, everybody, with no exemptions, should pay some income taxes, sort of like the alternative minimum taxes in reverse. Even if it is just 1% of their income, having a little skin in the game, having something to lose if taxes are raised, will completely change the perspective of people in the country. Yeah you can raise my taxes, but I want to see that EVERYBODY gets their taxes raised.

That is my two cents for the day.


  1. I'm right there with you...having adult citizens who pay ZERO income tax is a road to disaster. Everyone should have a minimum income tax burden of at least $100. Consider it an annual citizenship copay.

    Speaking of which, every publicly-funded health care plan should ALSO have a co-pay, even if only $10 for an ED visit (and less for urgent care or primary care). AZ (where I live) is trying to implement such a thing for its Medicaid population and you would think people were being asked to give up an extremity.