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Thread: at least it's not too late to escape from Wisconsin

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    Banned Melonie's Avatar
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    Default at least it's not too late to escape from Wisconsin

    (snip)"This exercise is especially instructive, because it reveals where the "single-payer," universal coverage folks end up. Democrats who run the Wisconsin Senate have dropped the Washington pretense of incremental health-care reform and moved directly to passing a plan to insure every resident under the age of 65 in the state. And, wow, is "free" health care expensive. The plan would cost an estimated $15.2 billion, or $3 billion more than the state currently collects in all income, sales and corporate income taxes. It represents an average of $510 a month in higher taxes for every Wisconsin worker.

    Employees and businesses would pay for the plan by sharing the cost of a new 14.5% employment tax on wages. Wisconsin businesses would have to compete with out-of-state businesses and foreign rivals while shouldering a 29.8% combined federal-state payroll tax, nearly double the 15.3% payroll tax paid by non-Wisconsin firms for Social Security and Medicare combined.

    This employment tax is on top of the $1 billion grab bag of other levies that Democratic Governor Jim Doyle proposed and the tax-happy Senate has also approved, including a $1.25 a pack increase in the cigarette tax, a 10% hike in the corporate tax, and new fees on cars, trucks, hospitals, real estate transactions, oil companies and dry cleaners. In all, the tax burden in the Badger State could rise to 20% of family income, which is slightly more than the average federal tax burden. "At least federal taxes pay for an Army and Navy," quips R.J. Pirlot of the Wisconsin Manufacturers and Commerce business lobby.

    As if that's not enough, the health plan includes a tax escalator clause allowing an additional 1.5 percentage point payroll tax to finance higher outlays in the future. This could bring the payroll tax to 16%. One reason to expect costs to soar is that the state may become a mecca for the unemployed, uninsured and sick from all over North America. The legislation doesn't require that you have a job in Wisconsin to qualify, merely that you live in the state for at least 12 months. Cheesehead nation could expect to attract health-care free-riders while losing productive workers who leave for less-taxing climes.

    Proponents use the familiar argument for national health care that this will save money (about $1.8 billion a year) through efficiency gains by eliminating the administrative costs of private insurance. And unions and some big businesses with rich union health plans are only too happy to dump these liabilities onto the government.

    But those costs won't vanish; they'll merely shift to all taxpayers and businesses. Small employers that can't afford to provide insurance would see their employment costs rise by thousands of dollars per worker, while those that now provide a basic health insurance plan would have to pay $400 to $500 a year more per employee.

    The plan is also openly hostile to market incentives that contain costs. Private companies are making modest progress in sweating out health-care inflation by making patients more cost-conscious through increased copayments, health savings accounts, and incentives for wellness. The Wisconsin program moves in the opposite direction: It reduces out-of-pocket copayments, bars money-saving HSA plans, and increases the number of mandated medical services covered under the plan.

    So where will savings come from? Where they always do in any government plan: Rationing via price controls and, as costs rise, waiting periods and coverage restrictions. This is Michael Moore's medical dream state."(snip)

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    God/dess Deogol's Avatar
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    Default Re: at least it's not too late to escape from Wisconsin

    Not if your in the healthcare profession! There will probably be more doctors per square mile than at Harvard Medical School!

    I see a whole lot more minimum wage workers in that state though.

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    Banned Melonie's Avatar
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    Default Re: at least it's not too late to escape from Wisconsin

    ^^^ I doubt that there will be all that many doctors either. Based on past experience where the billable rates for medical services are dictated according to a gov't approved 'table', a lot of doctors soon discover that they could be earning far more money as stockbrokers, lawyers etc.



    And with the proposed state income tax increases necessary to pay for Wisconsin's 'free' health care system, other Wisconsin doctors who choose to keep practicing will also probably choose to do so in a different state in order to avoid a stiff increase in their income tax liability. Hey no problem, Wisconsin can try to 'import' doctors from Pakistan to staff their new public health care system at gov't approved pay rates, just like the UK has been forced to do.

    ~
    Last edited by Melonie; 07-25-2007 at 05:10 PM.

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    Default Re: at least it's not too late to escape from Wisconsin

    Sorry I didn't read the entire article but the US health care system is so broken I dislike it when people defend the status quo no matter what change is involved.

    It was a while ago but I was talking to a doctor who worked in Beaumont telling me they could not find an oncologist (cancer doctor) while offering a million dollar salary. It may have been a partnership. For a relatively common job in the medical field and a job that only involves education,training and fellowship to command such high salaries I've got to believe the system is broken. (Apparently people don't want to move to Beaumont because it's an oil town or industrial area maybe)


    Surveys by medical-practice management groups show that American doctors make an average of $200,000 to $300,000 a year. Primary care doctors and pediatricians make less, between $125,000 and $200,000, but in specialties like radiology, physicians can take home $400,000 or more.

    In Europe, however, doctors made $60,000 to $120,000 in 2002, according to a survey sponsored by the British government in 2004.

    http://www.nytimes.com/2007/07/29/we...=1&oref=slogin

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    Default Re: at least it's not too late to escape from Wisconsin

    In Europe, however, doctors made $60,000 to $120,000 in 2002, according to a survey sponsored by the British government in 2004.
    ... which probably explains why a whole group of Iraqi, Jordanian, Indian and Pakistani doctors working for the British National Health Service were recently busted in conjunction with terrorism charges.



    The British doctors are usually also in private practice treating rich Brits who are willing to pay out of pocket for prompt non-rationed medical treatment outside of the National Health System, and earning total amounts similar to American doctors as a result of their private practice.

    (snip)"The pursuit of private practice, which generates enormous incomes among NHS physicians and surgeons, produces role models for junior doctors who aspire to material wealth as opposed to intellectual advance. Many specialist registrars expect a consultant post immediately after their training ends and a private practice associated with it. On the continent, especially in Germany and France, although private practice does occur the proceeds are often used for the good of the department as a whole and not for individual gain. British doctors choose private practice partly because they see their contemporaries, for example in financial services, earn more money than they do"(snip) from


    I would contend that in countries with socialized medicine programs that do NOT permit the option of private medical practices treating pay-out-of- pocket patients, a good number of younger doctors either wind up emigrating to non socialized medicine countries ...

    (snip)"The first and most noticeable effect is Canadian doctors leaving Canada for the United States. Dr. Warren Molberg, an emergency ward physician at Edmonton’s Royal Alexandra Hospital, says he and his colleagues regularly receive letters from United States healthcare companies. These companies apparently promise them guaranteed salaries that are much higher than what they receive in Canada and “the benefits, incentives and tax rates are also very attractive"(snip) from

    ... or pursuing more lucrative professions (per Elaine Supkis anyhow)

    (snip)"Right now, American doctors are well-paid. If they are forced to take the same sort of flat-earth income cuts the rest of us have taken, they will leave their profession and become stock brokers or perhaps hedge fund managers. Or politicians. Anything but doctors."(snip)
    Last edited by Melonie; 08-01-2007 at 03:42 PM.

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    Default Re: at least it's not too late to escape from Wisconsin

    Reform of the US health care system, to be effective, would have to be done fundamentally and at the national level.

    And what that reform needs to consist of, is changing from a system that has as its core value, making a profit, to a system that has as its core value, helping people to stay healthy and healing them when they are sick or injured.


    The Wisconsin plan is not about health care, it's about health insurance.

    We don't need to increase 'access to health insurance', we need to increase 'access to health care'.

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    Default Re: at least it's not too late to escape from Wisconsin

    t was a while ago but I was talking to a doctor who worked in Beaumont telling me they could not find an oncologist (cancer doctor) while offering a million dollar salary. It may have been a partnership. For a relatively common job in the medical field and a job that only involves education,training and fellowship to command such high salaries I've got to believe the system is broken.
    I agree that the system was broken ... but Texas voters had the common sense to take some recent steps to fix it !!!



    (snip)"An influx of doctors lured to Texas by new limits on malpractice lawsuits has overwhelmed the state board that screens candidates for medical licenses, creating a backlog that forces many applicants to wait months before they can start seeing patients.

    Officials said many of the relocating physicians are filling shortages in areas such as Beaumont, where trauma patients previously had to be flown other cities because there weren't enough surgeons to treat them. "(snip)

    (snip)"Several doctors who moved to Texas from other states said they were drawn by lower malpractice insurance rates.

    The average malpractice insurance premiums in Texas have fallen by 21.3 percent since 2003, when lawmakers and voters implemented a $250,000 cap on non-economic damages such as pain and suffering in malpractice cases, according to Jon Opelt, who leads a group of doctors, hospitals and other health care providers that fought for the changes.

    The changes are "a big factor why Texas has become a popular state to practice in," said Dr. Punit Chadha, an oncologist who moved from Chicago to Austin last year. He said his malpractice insurance premium is one-fourth of what it would have been in Chicago.

    Dr. Kevin H. Brown, an obstetrician who opened a Round Rock practice with his wife in May, said they paid $130,000 a year for their malpractice insurance in Georgia. Now, they pay a combined annual premium of $82,000 a year.

    "It was a $24,000 raise for each of us before we even got started," Brown said."(snip)


    It's fairly obvious that your statistic of US doctors averaging $200k-$300k a year sounds very high in a 'vacuum', but if you subtract some 30% for income taxes yielding $140k-$200k per year after tax, and you also subtract an annual malpractice insurance premium of $65k+ per year, all of a sudden a different financial reality starts to become apparent.
    ~
    Last edited by Melonie; 08-01-2007 at 04:05 PM.

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    Default Re: at least it's not too late to escape from Wisconsin

    Quote Originally Posted by Melonie View Post
    It's fairly obvious that your statistic of US doctors averaging $200k-$300k a year sounds very high in a 'vacuum', but if you subtract some 30% for income taxes yielding $140k-$200k per year after tax, and you also subtract an annual malpractice insurance premium of $65k+ per year, all of a sudden a different financial reality starts to become apparent.
    ~
    Problems with malpractice lawsuits are part of it but I think the problem is much larger than litigation issues. From everything I've seen doctors in the US are payed far higher salaries than in other countries and it is a good chunk of the reason why medical care in the US is more expensive. I really have no problem with people making money but for jobs that require education and a certification I think the salaries are a little over the top. Nobody includes malpractice insurance payments as part of their salary, people everywhere pay taxes.

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    Default Re: at least it's not too late to escape from Wisconsin

    umm, how much money doctors make per year as a measure of how good health care is? what?

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    Banned Melonie's Avatar
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    Default Re: at least it's not too late to escape from Wisconsin

    Nobody includes malpractice insurance payments as part of their salary, people everywhere pay taxes.
    Well, you've just proven my point. Because of our court system and the incredibly high jury awards for malpractice made over the years, in order for a doctor to practice medicine in the USA and avoid the risk of being penniless tomorrow, paying for medical malpractice insurance is an absolute necessity. The cost of malpractice insurance is astronomical, as the article I posted pointed out. Stockbrokers, bankers, etc. do not have any similar 'cost of doing business.

    Based on the above, at what levels of income do a doctor and a stockbroker or banker 'break even' in terms of after tax 'take home' income ? Obviously the doctor must earn enough to cover the cost of malpractice insurance, while the stockbroker or banker does not. So depending on the particular state and the particular medical specialty involved, the doctor must earn $65k or $100k or whatever k a year MORE than the stockbroker or banker in order to break even on after tax 'take home' income because of the cost of malpractice insurance.

    In dancing terms, the doctor works at a club that charges a $250-$450-whatever per night stage fee (= the malpractice insurance premium), whereas the broker or banker work at a club that has no stage fee. Why do dancers stay working at clubs that charge a high stage fee ? ... because the earnings potential is high enough to offset the cost of the stage fee.

    Again in doctor = dancer terms, what happens next when the gov't comes into the picture and enacts a rule that says that every private dance will cost $15 (= fixed reimbursement rate for specific medical treatments by NHS regardless of which doctor / hospital provides those treatments), and that customers must receive gov't approval before being allowed to go to the VIP room ( = prior NHS approval for any advanced medical procedure). Dancers working in upscale clubs with a high stage fee (= doctors working in states / specialties with a high malpractice insurance premium) can no longer earn the additional amounts necessary to offset their high 'cost of doing business'. So what happens next ? The dancers either move to clubs that don't charge a high stage fee (= the doctors move to different states / countries that don't charge a high malpratice insurance premium), or the dancers stop dancing and become waitresses and/or return to college to prepare for a different profession (= the doctors stop practicing medicine and become brokers and/or return to college to prepare for a new career in a different profession like law).

    Ultimately, NHS programs always get around the malpractice insurance cost problem by the same gov't also picking up the financial responsibility for the malpractice insurance and/or limiting a patient's ability to sue an NHS doctor and/or drastically limiting the size of malpractice awards. This removes the burden of malpractice insurance cost from NHS doctors and transfers that burden to the taxpayers

    This also opens the door for hospitals to to start recruiting offshore medical talent (foreign doctors who would have difficulty obtaining medical malpractice insurance under the current US system) who are willing to perform those routine NHS approved procedures (that NHS reimburses at a preset fixed rate) for a lower salary - thus leaving more profit for the hospital, but driving down the 'going rate' of pay for US doctors in general.

    Also, NHS malpractice coverage also forces doctors to follow a strict set of gov't procedures re NHS approved course of treatments in order to avoid 'going off the reservation' and exposing themselves to risk of lawsuits for which they are no longer personally insured. This in turn stifles innovation by NHS doctors, and leaves gov't approved / affiliated medical research institutions as the only ongoing source of innovative treatments and research.
    Last edited by Melonie; 08-02-2007 at 03:45 AM.

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    Default Re: at least it's not too late to escape from Wisconsin

    Quote Originally Posted by Melonie View Post
    ...in order for a doctor to practice medicine in the USA and avoid the risk of being penniless tomorrow, paying for medical malpractice insurance is an absolute necessity...
    I know of two couples where the women were both doctors, and decided to become stay-at-home mothers when each couple had their first child. In both cases, this was because of malpractice insurance. In both cases, this was very early in their medical careers. But both husbands were very successful, which provided this option. Otherwise, maybe they would have become stockbrokers instead, as you've suggested.

    I also remember reading the paper when I was in LV somewhere between 5-10 years ago, about an ob/gyn who left LV to practice in a small town in Utah instead. While he earned much less gross income in Utah, he took home much more of his earnings than in LV. So this has been going on for at least the last several years now.

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