Joe the Plumber (Page 6)

DrPete - 2008-10-16 3:33 PM

The reason that costs are so high is because HMO's short-change doctors and hospitals in the name of profit, reimbursing only for the bare minimum allowable by law for any given care. And if there's a single typographical error on any of the forms, guess what? You don't get paid.

FWIW, I work in a socialized health care system (the US Military Health Care System) and I love it. I know that I can do what I know to be the right thing for my patients without having to worry about how it'll be coded, whether I'll be reimbursed, etc. etc. and I can treat a private the same way I would treat a 4-star general with the same problem. It's a great system in which to be a doctor, and there's a reason why military surgeons are so sought after when they leave the military--I'm already getting recruiting letters and I'm nowhere close to paying off my contract.

But nobody wants a national health care system even though the only people getting rich off the system are insurance companies.

mdg2003 - 2008-10-16 4:57 PM

 Dr Pete, do you feel the concept of socialized medicine would work for the entire country? Could our government actually manage a system of this magnitude? The system you work in is considerably smaller and if I'm not mistaken funded by the government, but operated by whichever Armed Service branch in which you are commisioned. Does every branch of the service have it's own medical department or do all branches of the service answer to each other and work together toward the same common goal? This last question is irrelevant to the discussion, I'm just don't know the answer and was curious to find out.

 I think the insurance companies are a goatrope that are adding to the problem. So we remove them from the entire equation and let the government operate in this role. Do all these insurance people then become employees of the Govt or do they hit the street? I would really love to see free medical care for every person in this country. I am just reluctant to believe that the government could effectively manage a program of this size.

As a patient of the military health care system for over 22 years as a dependent and a soldier I say this: Don't fool yourself, military health care is NOT a great system. You may like it as a doc but as a patient it sucks. Long waits, never seeing the same doctor twice, limited access to medicines, etc. The reason military surgeons are sought after is because they get alot of practice, not because they are so great.

run4yrlif - 2008-10-16 4:06 PM

Maybe, but in an economy where the Dow drops 700 points on news consumer spending is down, a 30% sales tax might not be the best way to make things better. To me, adding $250 to the price of a flat screen TV might discourage me from buying one.

DrPete - 2008-10-16 4:16 PM

I think it can--the big issue is making sure that as the system is scaled up it doesn't lose efficiency. The even bigger issue, though, is figuring out how to seamlessly transition the systems to make things run smoothly. I DO think it can work, but as long as the HMO's have as strong a lobby as they do, it'll be tough to initiate. I wish it would happen, though, because it's well documented that the poor in this country can get care when they're critically ill, i.e. when prevention has failed, but the best thing for the patients (and the system, from a cost perspective) would be to provide the now sorely lacking prevention and screening care to our underserved communities.

surfwallace - 2008-10-16 4:18 PM



Understand how the proposed consumption tax works and then tell me that the price of the TV goes up $250. The taxes that the company pays for its employees is no longer there in the tax proposal. So the tax is no longer passed on to the consumer. This tax that is taken out is roughly the same tax that the consumer pays for a consumption tax. So it is a wash when you go to check out however you have your gross pay to work with rather than your net pay.

Won't there be a shortage if employers don't have to pay the payroll taxes any more? Nope. You gain new revenue streams from the people who don't pay any taxes today because they do illegal work (prostitues, drug dealers, etc.) plus you get tax dollars from tourists.

Plus you get to tax the money that all of the rich people spend rather than never seeing a dime of the money they hide in offshore accounts.

You keep more can buy the same and the country does better financially (deficit goes away immediately and jobs come back into the country from abroad). I don't know why it is so hard to grasp .

ChrisM - 2008-10-16 2:31 PM

Anyone ever heard of the Laffer Curve????

Wolff27 - 2008-10-16 2:48 PM

HMMMM - didn't last for 20 years of historic economic growth until it was stalled under the Clinton tax tax tax.

Yep - that was a terrible time!

surfwallace - 2008-10-16 5:18 PM Understand how the proposed consumption tax works and then tell me that the price of the TV goes up $250. The taxes that the company pays for its employees is no longer there in the tax proposal. So the tax is no longer passed on to the consumer. This tax that is taken out is roughly the same tax that the consumer pays for a consumption tax. So it is a wash when you go to check out however you have your gross pay to work with rather than your net pay. Won't there be a shortage if employers don't have to pay the payroll taxes any more? Nope. You gain new revenue streams from the people who don't pay any taxes today because they do illegal work (prostitues, drug dealers, etc.) plus you get tax dollars from tourists. Plus you get to tax the money that all of the rich people spend rather than never seeing a dime of the money they hide in offshore accounts. You keep more can buy the same and the country does better financially (deficit goes away immediately and jobs come back into the country from abroad). I don't know why it is so hard to grasp .

LJR - 2008-10-16 4:51 PM



There was a recession in 1991.... just sayin.

DrPete - 2008-10-16 4:31 PM

I will agree, though, that the referral/appointment system is still in need of repair for elective patients--urgent patients get seen quickly, i.e. cancers and other emergencies, but the routine referral system is a big pain.

Wolff27 - 2008-10-16 5:39 PM

Ask the doctor's who have idiots come in becuase they had a cough for an hour and want to be seen. They can't get to people because the freeloaders come in just to have something to do.

DrPete - 2008-10-16 4:31 PM

There definitely are some things that need work, as in any system, and most of that is at the front desk and in the primary care sector. I will tell you that it's not just getting "a lot of practice" that makes us good. In our surgery department we have

-2 surgical oncologists trained at Memorial Sloan-Kettering cancer center with 15 and 20 years of experience in the field

-1 advanced minimally invasive/bariatric surgeon trained at Beth Israel-Deaconess,

-1 Trauma Surgeon trained at Brown,

-1 Trauma Surgeon trained at U of Florida,

-1 Colorectal surgeon trained at U of Washington,

-2 Pediatric surgeons trained at CHOP in Philadelphia and Children's National Medical Center in DC,

-The largest breast cancer research tissue repository in the United States and ongoing research projects in breast cancer oncotyping/genomics and cancer vaccines,

-A residency program that is consistently among the top 10% in the nation and is the largest program in the nation with a 100% first-time pass rate on the American Board of Surgery certification exams.

Sounds like a bunch of hacks to me....

I will agree, though, that the referral/appointment system is still in need of repair for elective patients--urgent patients get seen quickly, i.e. cancers and other emergencies, but the routine referral system is a big pain.

run4yrlif - 2008-10-16 6:07 PM

The Fair Tax *assumes* that the manufacturers will pass their tax savings on to the consumers. To me, that's a pretty big assumption. So, if that assumption doesn't happen, you're left paying 30% sales tax (plus state and local sales tax) on everything you buy. So, that 1000 dollar flat screen, adding the 30% "fair tax", and say a 7% state sales tax now costs $1370 dollars.

ColdRingo6 - 2008-10-16 10:07 PM

Interesting to me that, after all the talk of taxes, no one really put this into historical perspective.  What do you get in a society when the have-nots greatly outnumber the haves?

Civil unrest at best, outright revolution at worst, where the poor forcibly redistribute the wealth anyway.

I'll pay more tax under Obama than McCain - and if it feeds someone, helps provide medical care for someone who couldn't afford it, puts books in the library, even pays for a $3 million projector, I'm proud to do it.

Wolff27 - 2008-10-17 8:57 AM Don't you get it - we already pay enough! America has the second highest corporate taxes in the world - who does that hurt - US. The companies pay us less and increase prices due to high taxes. There is so much waste in government it is a joke! If these crooks on both sides of the aisle actually looked at the crap they were spending money on and spent where really needed we would have no problem. There are literally millions of examples of corruption in programs. Does someone getting food stamps really need them or deserve them if they are then going to spend a hundred dollars on a pair of shoes???? That $3 Million projector is not a NEED right now - that is why we run a deficit - paying for stuff not NEEDED but WANTED> These politicians need to quit acting like children who stoled their parents credit card.

crowny2 - 2008-10-17 10:05 AM

http://www.factcheck.org/askfactcheck/did_obama_request_a_3_million_overhead.html

BIGNEW - 2008-10-17 9:18 AM Why am I, a Virginian, paying $3 million for an overhead projector at a planetarium in Chicago, Illinois. Isn't that something the citizens of Illinois should pay for themselves?

BIGNEW - 2008-10-17 9:18 AM Why am I, a Virginian, paying $3 million for an overhead projector at a planetarium in Chicago, Illinois. Isn't that something the citizens of Illinois should pay for themselves?