healthcare, taxes and wages

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kiryan
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healthcare, taxes and wages

Postby kiryan » Mon Feb 22, 2010 4:37 pm

It occurs to me that the way we account for healthcare in terms of wages and taxes is totally ridiculous and always has been.

Because we typically get healthcare insurance from our employer and the government treats healthcare insurance / benefits as pretax dollars, we create a dynamic that can be manipulated and obfuscates true compensation. Do you know how much your healthcare insurance costs your company or just out of your pocket? How do you compare one job vs another when you are looking to quit? No, its really a bit of a crapshoot even if you do review the benefit plans from each. Companies have been getting away for a long time saying "great healthcare benefits" instead of just simply telling you the $$ amount your benefits are worth. I left a company a little over a year ago and went to a company with worse benefits (I did challenge them on that during compensation negotiations). Having a baby at the first employer cost me $350 at the second $1,500; the same "great" coverage resulted in dramatically different out of pocket costs.

But the real reason I bring this up is because of the issues with the cadillac tax... the plan to tax health insurance over a certian $$ amount. For example if you have a $30,000 a year plan it will be taxed while a $15k a year plan would not. The unions had a fit about this because basically they have over the years negotiated really good health insurance plans. Teachers and public employees are especially good about claiming to be paid very poorly while receiving a tremendous amount of compensation in benefits (and usually paying no premiums out of pocket). Enacting this tax will cause union members primarily to pay essentially higher taxes because of their benefit plans. Or to put it another way, to pay higher taxes because they are being compensated more.

Wouldn't it be a lot better if we simply stopped treating health insurance as pretax dollars so that we can stop the abuses? Obviously things would have to be done to step in the change as far as taxes go, but eventually we would get to a place where you can't manipulate your benefits (by unions or emplyoers) to obfuscate your compensation.
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Re: healthcare, taxes and wages

Postby teflor the ranger » Mon Feb 22, 2010 9:55 pm

I think to say that federal, state, and local taxes are complicated wouldn't do it justice. I think taxes are complicated because the systems by which people modify, share, and remove wealth are complicated. Even rich people agree in principle that rich people should pay more so long as there is due process.

Tax simplification is something I think every administration attempts and fails. I'm not sure how to comment further on this subject.
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Re: healthcare, taxes and wages

Postby kiryan » Tue Feb 23, 2010 2:53 am

Hmm... I think that rather than just being "complicated" it is complicated to mask the underlying special interest provisions.
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Re: healthcare, taxes and wages

Postby teflor the ranger » Fri Feb 26, 2010 1:10 am

kiryan wrote:Hmm... I think that rather than just being "complicated" it is complicated to mask the underlying special interest provisions.

Yeah well, what else are you going to do in a constitutional republic that utilizes representative democracy?
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Re: healthcare, taxes and wages

Postby kiryan » Sun Feb 28, 2010 7:16 am

order fish?
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Re: healthcare, taxes and wages

Postby teflor the ranger » Mon Mar 01, 2010 2:52 pm

McFish sandwich only 99 cents at McD's this week :D
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Re: healthcare, taxes and wages

Postby kiryan » Mon Mar 15, 2010 4:15 pm

http://www.cbsnews.com/stories/2010/03/ ... 0344.shtml

Interesting article which envisions a restructuring of the labor market under healthcare reform. Basically it makes the case that companies are likely to drop their healthplans for lower compensated people due to the required minimum standards that force policies to be too expensive relative to the base salary. The alternative of raising the fines so that the companies are better off paying for healthcare and is countered by going out of business because labor is too expensive. It goes from there to younger workers clustering in firms without healthcare and older workers clustering in ones that do provide it or firms with lower paid less skilled workers and no insurance vs firms with higher paid higher skilled workers with insurance. It also talks about an increase in contract / independent contract workers to avoid having to pay healthcare. Think about how most government and most corporations have outsourced their janitorial even if they could employ several staff to do it themselves. A big reason they outsource it is to not pay benefits.

It also makes the case that the plan amounts to a regressive tax... not sure I follow the logic. I think its point is that younger workers tend to be poorer and don't need as much healthcare anyway so it falls disproportionately on the poor and the people who don't get any benefit from it. The way I look at it, this is basically social security #2 or the social security bail out.
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Re: healthcare, taxes and wages

Postby kiryan » Tue Mar 16, 2010 4:56 am

holy shit. these are some choice quotes from an article continuing to illustrate something that democrats and republicans have been ignoring for years. Medicaid/medicare don't pay doctor's enough to cover their costs and they are dropping medicare patients left and right.

One particularly incredulous piece of idiocy is the notion that if they tax physician revenues 3% they can raise payments to healthcare providers by 11%. What that really means is adding a 3% fee on private insurance and private pays to increase government payments...

This is really why they need a single payer system... so they doctors have no other choice than to accept whatever the government wants to pay.

http://www.nytimes.com/2010/03/16/healt ... id.html?hp

Dr. Sahouri said that his reimbursements from Medicaid were so low — often no more than $25 per office visit — that he was losing money every time a patient walked in his exam room.

The final insult, he said, came when Michigan cut those payments by 8 percent last year to help close a gaping budget shortfall.

In 2008, Medicaid reimbursements averaged only 72 percent of the rates paid by Medicare, which are themselves typically well below those of commercial insurers, according to the Urban Institute, a research group. At 63 percent, Michigan had the sixth-lowest rate in the country, even before the recent cuts.

In Flint, Dr. Nita M. Kulkarni, an obstetrician, receives $29.42 from Medicaid for a visit that would bill $69.63 from Blue Cross Blue Shield of Michigan. She receives $842.16 from Medicaid for a Caesarean delivery, compared with $1,393.31 from Blue Cross.

This year, Gov. Jennifer M. Granholm, a Democrat, has revived a proposal to impose a 3 percent tax on physician revenues. Without the tax, she has warned, the state may have to reduce payments to health care providers by 11 percent.
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Re: healthcare, taxes and wages

Postby kiryan » Thu Mar 18, 2010 7:03 pm

http://seattletimes.nwsource.com/html/l ... ns18m.html

Well look at this, walgreens no longer accepting new medicaid patients in Washington because basically the state doesnt' reimburse enough. Its happening all over the country from pharmacies to doctors. And you want government to control it all.
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Re: healthcare, taxes and wages

Postby teflor the ranger » Mon Mar 22, 2010 9:27 pm

Other things Federal Government has controlled: the Japanese internment during World War 2, the bombing of Nagasaki and Hiroshima, the Vietnam war, the Iraq war (two o' dems), Iran/Contra, peace on the Korean continent, expected 70% fulfillment of promised social security benefits in 2030, safety oversight of Toyota products, financial oversight of banks and investment banks.

Next on the Fed Gov's plate: Your healthcare? (man, nothing but good times from here on out!)
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Re: healthcare, taxes and wages

Postby Sarvis » Mon Mar 22, 2010 9:28 pm

teflor the ranger wrote:the Vietnam war



Hanh was Vietnamese...
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Re: healthcare, taxes and wages

Postby teflor the ranger » Mon Mar 22, 2010 9:30 pm

Sarvis wrote:
teflor the ranger wrote:the Vietnam war

Hanh was Vietnamese...

Sarvis, we all mourn the loss of your life validation, but there are other fish in the sea.
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Re: healthcare, taxes and wages

Postby Daz » Wed Mar 24, 2010 2:26 pm

kiryan wrote:http://seattletimes.nwsource.com/html/localnews/2011367936_walgreens18m.html

Well look at this, walgreens no longer accepting new medicaid patients in Washington because basically the state doesnt' reimburse enough. Its happening all over the country from pharmacies to doctors. And you want government to control it all.



so why don't we privatize the maintenance of roads or the management of public schools? why do we even force people to go to school? it's not like our collective best interests are important right? who cares if the sick get sick and the poor die. good riddance, right?
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Re: healthcare, taxes and wages

Postby teflor the ranger » Wed Mar 24, 2010 2:33 pm

Daz wrote:
kiryan wrote:http://seattletimes.nwsource.com/html/localnews/2011367936_walgreens18m.html

Well look at this, walgreens no longer accepting new medicaid patients in Washington because basically the state doesnt' reimburse enough. Its happening all over the country from pharmacies to doctors. And you want government to control it all.

so why don't we privatize the maintenance of roads or the management of public schools? why do we even force people to go to school? it's not like our collective best interests are important right? who cares if the sick get sick and the poor die. good riddance, right?

And soft slavery is the answer?
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Re: healthcare, taxes and wages

Postby Daz » Wed Mar 24, 2010 2:35 pm

we tried the private health care option. what happened? they showed that they are capable of extracting massive amounts of money in the name of security of health and that they would not pay out. so we are changing it. if you were a gambling addict, and your bookie kept taking your bets but eventually stopped paying you when you won...how long would you continue down that road?
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Re: healthcare, taxes and wages

Postby teflor the ranger » Wed Mar 24, 2010 2:37 pm

Except you've missed a major problem:they are going to extract even more massive amounts of money now. Congratulations?
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Re: healthcare, taxes and wages

Postby Sarvis » Wed Mar 24, 2010 3:39 pm

Just read an article and it made a couple interesting points:

Finally, the bill will also reduce a different kind of inequality. In the broadest sense, insurance is meant to spread the costs of an individual’s misfortune — illness, death, fire, flood — across society. Since the late 1970s, though, the share of Americans with health insurance has shrunk. As a result, the gap between the economic well-being of the sick and the healthy has been growing, at virtually every level of the income distribution.


Since 1980, median real household income has risen less than 15 percent. The only period of strong middle-class income growth during this time came in the mid- and late 1990s, which by coincidence was also the one time when taxes on the affluent were rising.


I just like that second one, it's not really related to healthcare reform at all... just... telling. :P

http://www.nytimes.com/2010/03/24/busin ... hardt.html
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Re: healthcare, taxes and wages

Postby Daz » Wed Mar 24, 2010 4:59 pm

teflor the ranger wrote:Except you've missed a major problem:they are going to extract even more massive amounts of money now. Congratulations?



prove it. show me a single credible economist who believes that this bill is going to increase the burden on taxpayers. and if you show me someone who uses the cost of health care without including the expected cost of health care without reform subtracted, then you have my attention.
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Re: healthcare, taxes and wages

Postby kiryan » Wed Mar 24, 2010 10:58 pm

lets look at social security and medicare/medicaid. They are all bankrupt. Now what makes you think government can make healthcare reform work?

--

Daz, do you honestly believe healthcare costs can go up 10,25,50% a year for more than another decade? That is what economists predict, but it has no basis in reality. At some point we will all have to stop buying health insurance because we literally won't be able to afford it. and then we'll return to the old model, you go to the doctor when you really need it and you pay cash. yes some people won't be able to get those 150k operations for triple bypass heart surgery, but as sad as that is, the costs are unsustainable. As long as we keep paying for it, the costs can keep going up. Now that we've made the tax payer responsible for healthcare, it can go up until America collapses.

What needs to happen is people need to stop treating healthcare as an endless resource, stop treating "health insurance" as a health subscription and take responsibility for their own health (through savings and healthy lifestyles). When you remove the consequences for poor behavior (by spreading the cost to everyone), you get more poor behavior.
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Re: healthcare, taxes and wages

Postby teflor the ranger » Thu Mar 25, 2010 12:19 am

Daz wrote:
teflor the ranger wrote:Except you've missed a major problem:they are going to extract even more massive amounts of money now. Congratulations?
prove it. show me a single credible economist who believes that this bill is going to increase the burden on taxpayers. and if you show me someone who uses the cost of health care without including the expected cost of health care without reform subtracted, then you have my attention.

My health insurance went up along with my taxes. Proof enough.
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Re: healthcare, taxes and wages

Postby Todrael » Thu Mar 25, 2010 1:55 am

teflor the ranger wrote:My health insurance went up along with my taxes. Proof enough.

Even before the bill was passed?! Wow. I didn't realize time travel was in there, too.
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Re: healthcare, taxes and wages

Postby Daz » Thu Mar 25, 2010 7:29 am

Todrael wrote:
teflor the ranger wrote:My health insurance went up along with my taxes. Proof enough.

Even before the bill was passed?! Wow. I didn't realize time travel was in there, too.



that was my thought. although from what im hearing from individuals, apparently the health care companies have already started inflating costs before the bill goes into effect in an attempt to get the average person to believe that this bill is CAUSING these increases, and not an attempt to prevent just this sort of behavior.

Teflor - congratulations, i didn't realize you were one of the americans that earned over 200,000 a year. obviously you are very successful at what you do, i'm sorry that the .9% increase in your medicare taxes is going to drive you into poverty. for what its worth, it isn't so bad once you realize how few material things you need to actually be happy. maybe if the wealthy worried a bit less about poor people taking their wealth they would find the time to be truly happy and content with their life.
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Re: healthcare, taxes and wages

Postby teflor the ranger » Thu Mar 25, 2010 3:54 pm

Net Cost of Coverage Provisions in Billions of Dollars BY YEAR (note, this is not a running total):

2010 3
2011 8
2012 10
2013 10
2014 49
2015 88
2016 133
2017 154
2018 165
2019 175

Source: http://www.cbo.gov/ftpdocs/113xx/doc11355/hr4872.pdf

Nevermind that the plan simply costs money, realize that this money is going directly into the healthcare industry. The more money an industry receives, the higher its average prices become unless there is a sudden influx of providers and competitors in the market (which really isn't likely because the US is already the most well flushed healthcare market in the world).

Nevermind that by 2019 you won't be able to squeeze $175,000,000,000 out of only the top 20% of households (which includes the middle class, by the way, your elementary school class of 100 had 10-30 of these kids in it).

Nevermind that GENERAL taxes are already used to fund numerous socialized health services that will have to deal with rising overall costs. Nevermind that general taxes pay for the deficits that this will cause. Nevermind that taxes will increase to support this program. Nevermind that funds will be drawn from the general budget.

Oh, and by the way, markets react to perceived and predicted influences.

I honestly don't believe that either of you know how any of this works.
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Re: healthcare, taxes and wages

Postby teflor the ranger » Thu Mar 25, 2010 7:45 pm

http://online.wsj.com/article/SB1000142 ... theadlines

Caterpillar, the world's largest construction machinery manufacturer by sales, was one of the most vocal opponents, and announced late Wednesday that it will take a $100 million charge to earnings this quarter to reflect taxes stemming from the newly enacted U.S. health-care legislation.

Farm equipment maker Deere followed suit Thursday with a $150 million charge that, like Caterpillar's, was not included in its existing guidance. Steel maker AK Steel said Tuesday it will record a $31 million charge against first-quarter earnings.

"From our point of view, a tax increase like this cannot come at a worse time," said Jim Dugan, a Caterpillar spokesman.
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Re: healthcare, taxes and wages

Postby teflor the ranger » Thu Mar 25, 2010 7:47 pm

http://www.businessweek.com/news/2010-0 ... illar.html

New York-based Verizon, the second-largest U.S. phone company, told employees in a note shortly after the law was signed that the tax will make the subsidy less valuable to employers like Verizon and so “may have significant implications for both retirees and employers.” Spokesman Peter Thonis declined to comment beyond the text of the note.

So, do you still really think the new reform will only affect those making $200,000 a year? Or have you come to your senses yet?
Last edited by teflor the ranger on Thu Mar 25, 2010 7:50 pm, edited 1 time in total.
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Re: healthcare, taxes and wages

Postby teflor the ranger » Thu Mar 25, 2010 7:49 pm

http://www.bloomberg.com/apps/news?pid= ... e7tOWwUT6E
"$409.2 billion in additional taxes by 2019"
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Re: healthcare, taxes and wages

Postby Todrael » Fri Mar 26, 2010 2:56 am

Oh noes, it hurts the Amish, too! haha
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Re: healthcare, taxes and wages

Postby kiryan » Fri Mar 26, 2010 3:22 pm

Your article mentions the amish exclusion clause, but interesting point that there is no specific provision for an amish owned business. I thought the best quote from the article was this:

“The fundamental question is, ‘Is religious freedom trumped by a public health care program?’” he said. “There will be a religious liberty fight, but the Amish likely will be part of a bigger category than just themselves.”

But the question was already answered given the laws passed to force catholic organizations to adopt to homosexuals (they closed their adoption agencies in response) and recent attempts to eliminate the conscience clause in situations such as pro life nurses being scheduled to work abortions and doctors and pharmacists being forced to prescribe the morning after pill. I disagree with the government's recent stance on these issues as I believe it infringes on our pursuit of happiness and religious freedom.

The quote about how insurance rates are going to go up is choice as well.
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Re: healthcare, taxes and wages

Postby Sarvis » Fri Mar 26, 2010 3:26 pm

kiryan wrote:force catholic organizations to adopt to homosexuals (they closed their adoption agencies in response)


Ah Christians. Never unwilling to cause harm in order to prove a backwards, bigotted and ultimately futile point.
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Re: healthcare, taxes and wages

Postby kiryan » Fri Mar 26, 2010 3:40 pm

http://www.foxnews.com/opinion/2010/03/ ... are-plato/

Government compassion sounds so noble, but we cannot escape the fact that whoever pays holds the power to choose. It is here that Washington’s utopian plan falls short. When Washington gains control over the American health care dollar, physicians become employees of the State. When the “collective good” trumps the well-being of the individual patient, the physician’ loyalties become divided.

(heres another article about a trend where doctors are basically being forced out of private practice: http://www.nytimes.com/2010/03/26/healt ... 6docs.html . Not to become employees of the state as the above claim, but between the issues dealing with medicare/medicaid, the cut in reimbursements and the lack of negotiating power with insurance companies, they are basically selling out to health care congomlerates)

The answer lies in creating a post-Hippocratic physician by instituting what is benignly called “Pay for Performance.” Current legislation grants the Secretary of Health and Human Services sweeping power—including the power to decide what physicians should spend on the average patient. Doctors who do not “perform” effectively will be paid less that those who do. So what does it mean to “perform”?

(it means the HHS is going to decide what appropriate care is whether its breast cancer screenings or sending you to an MRI for headache. I do agree that the quickest most likely way to effect dramatic change in healthcare, and reducing costs will take dramatic change, is through powers consolidated in one person... however dangerous that might actually be.)

Physicians who care for a large number of patients on Medicare already hover on the verge of bankruptcy. Any drop in reimbursement will push them over the edge. What more powerful mechanism could be employed to end Hippocratic medicine for our elderly than to threaten physician Medicare reimbursement—unless physicians are willing to look out for the financial interests of the State? Even more, such punishment cannot be challenged in court. “There shall be no administrative or judicial review.” (Section 3007, Page 686)

(so much for transparency and accountability, but again makes sense if you want to actually effect change. Can't have 3rd parties overruling your decisions.)

This law effectively turns the portion of government that owns healthcare into a benevolent dictatorship. No longer is it a representative democracy or constitutional republic, a free market or an individual choice. Its a master planned economy, you know the kind China, Cuba, Venuzela do. All in the name of efficiency and lower costs. If you are a student of history, you already know how that works out.
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Re: healthcare, taxes and wages

Postby kiryan » Fri Mar 26, 2010 6:28 pm

total bullshit. they really want to make medical professionals slaves to the common good.

http://www.investors.com/NewsAndAnalysi ... ?id=528337

Because of the new health care law, Dr. John Dietz has an empty building that he's not sure what he's going to do with.

Dietz is part owner of the Indiana Orthopedic Hospital.

"It is an expansion of our hospital that is three-quarters finished; it had three operating rooms for outpatient surgery," he said. "Now it can't be used for that purpose. We'll have to figure out an alternative for it."

Dietz and his fellow investors put $27 million into that new building.

Under the new law there are a host of bureaucratic hoops that physician-owned hospitals must go through to expand.

• The hospital must apply to the Department of Health and Human Services and can do so only once every two years.

• It must then wait for a period for members of the community to provide input.

• It must be in a county where population growth is 150% of the population growth of the state in the last five years.

• Inpatient admissions must be equal to or greater than the average of such admissions in all hospitals located in the county.

• Its bed occupancy rate must be greater than the state average.

• It must be located in a state where hospital bed capacity is less than the national average.

• Once a hospital meets all of those conditions, it is prohibited from expanding more than 200%.

And they are the lucky ones. There are currently 60 to 65 physician-owned hospitals under construction. Those that aren't finished and don't have a Medicare provider number by Aug. 1 (Dec. 31 if the reconciliation bill passes) will probably never open their doors. Without a provider number, such hospitals can't treat Medicare patients, which are usually essential to financial survival.

The feud over physician-owned hospitals has been boiling for many years. The American Hospital Association, along with key lawmakers such as Rep. Pete Stark, D-Calif., Sen. Chuck Grassley, R-Iowa and Sen. Max Baucus, D-Mont., have made numerous efforts to curtail physician-owned hospitals. In 2003, Grassley won a temporary ban on new construction of these hospitals in the Medicare prescription drug bill.
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Re: healthcare, taxes and wages

Postby Sarvis » Fri Mar 26, 2010 6:35 pm

kiryan wrote:Physicians who care for a large number of patients on Medicare already hover on the verge of bankruptcy.



kiryan wrote:Without a provider number, such hospitals can't treat Medicare patients, which are usually essential to financial survival.



Make up your mind?
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Re: healthcare, taxes and wages

Postby kiryan » Fri Mar 26, 2010 6:45 pm

Medicare/aid is the single biggest payer in the world. Without access to medicaid/medicaid patients its hard to get a healthcare business off the ground. You can fill the beds in a matter of weeks/months. The alternative is slowly coming up to capacity with private pays which is difficult when you have so much overhead especially with a project of this magnitude. There's an addage in the restaurant business, lunch keeps the doors open, dinner turns the profit. Without the low margin lunch menu to bring people in and provide a steady flow of income, its hard to introduce people to your restaurant and to manage the cyclical flow of your patrons.

Secondly, understand that they have invested the capital to create this hospital, then the rules changed and now they are looking like they are screwed if they can't finish in time to get registered with medicaid/medicare. Understand that these rules are the poltiical whim of the day and that the secretary of HHS was granted extensive authority under the reform bill... the secretary can literally target individual physicians or specialities and facilities.

The rules cited basically try and prevent hospitals from competing with each other and physician owned hospitals from competing with managed systems (manage systems want the physicians working for them).
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Re: healthcare, taxes and wages

Postby teflor the ranger » Sat Mar 27, 2010 10:39 pm

Sarvis wrote:
kiryan wrote:force catholic organizations to adopt to homosexuals (they closed their adoption agencies in response)


Ah Christians. Never unwilling to cause harm in order to prove a backwards, bigotted and ultimately futile point.

Prove the harm they cause in ceasing to provide a service they're not obligated to.

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