as i stated on my blog: arnold is a complete and utter tool..

so start charging lawyers so we can provide free counsel to folks who need it..
Samuel Fink is not far off... tax teachers for schools, tax policeman for protection...
this is the tip of the iceberg..

as i said... let's tax HOLLYWOOD...come on arnold... you'll be back, right?
i swear my state has gone to hell in the 5 years i've been gone.

when i get back, trust me, i'll be fighting like mad..with the CMA and
the indian medical association which is up in arms about it, as they should be..

He's from my pind =)

With respect to the tax v. fees debate, I recall in law school a U.S. Supreme Court case that held unless the levy is generally applicable, it's a fee and not a tax. I don't have the time to research it now, but do any other lawyer types remember this case?

Second, while the bottom line in doctor's incomes have taken a significant hit in the past 10-15 years, I still don't know any doctors in the U.S., outside of residents or fellows, who are hurting for money. This is a progressive tax that I don't necessarily have a problem with. The problem I have is that you are replacing one hedgemonic bureaucracy, the insurance industry, for another, the California government. On the one hand, I don't trust the insurance industry. On the other hand, I don't trust the government to implement a universal health care system efficiently and fairly. If there was going to be a major policy shift in the health care industry, I would be more interested in seeing more progessive regulation of the privately run industry.

This may be an extremely naive question, but why is it that in the past few years I have heard about so many doctors complaining about high insurance costs and how expensive it has become to run a practice - yet every doctor I know in the Bay Area is living in a huge house with a fancy car? I'm trying to understand the point these doctors are making, but at the same time, how am I supposed to feel pity for them when all their kids are in private schools and they're obviously pretty well off.

Go Arnold! Terminate the doctors!

this proposed event will drive doctors out of california, and will also affect medical students on what field they choose (most will stay out of primary care, since those are the lower end of the pay spectrum)

and as for fancy cars and rich doctors sonia--that is a minority... trust me.. and i'm sure you're talking about doctors who are brown (our society albeit loves to keep up with the jones, no matter if you are doctor or not)..

it's not pity it's principle..

how would you like to be taxed for your website to provide free weddings for everyone?
(stupid comparison, but you get the gist)...

and yes, the overhead and insurance is sky high, esp for obstetricians and neurosurgeons... the average malpractice insurance for these specialties run into the hundrends of thousands of dollars per year...that is why a few years ago, a lot of ob/gyn and other sub specialties, closed their doors.. i think it hit pennsylvania the hardest..

this interview with sanjay gupta:

Let's take a look at some of the neurosurgery malpractice premiums around the country, $267,000 a year to be able to practice neurosurgery in Pennsylvania. That's for malpractice alone. That's how much it costs. Michigan, where I was practicing before, $120,000, and Georgia, about 70,000. So definitely, a significant problem around the country.

how would you like to be taxed for your website to provide free weddings for everyone?

I thought the doctors were in favor of universal health care, they just didn't want to be paying taxes narrowly on themselves to pay for it.

As for malpractice, there is some evidence that if medical associations were better at policing doctors who were involved in malpractice, rates would go down.

universal health care has it's own issues... but we were for it until arnold sprung up this tax for us to help pay for it.. that caught the docs who were supporting the bill off guard..

malpractice rates vary from state to state...

I agree with Sriram that most physicians aren't "hurting" for cash. Though I admit I should probably research this more before posting, I'm not a huge fan of a "gross income" tax . Off the top of my head, I think it would disproportionately hurt certain specialists like OBGYNs, who pay exhorbitant med-mal rates. I also find it interesting that he would choose to hit essentially small business owners, rather than tax corporations (especially the Healthcare industry) during a time of high growth. Finally, if Medicare/Medicaid is examplary of how this new universal healthcare system will be set up, lets just say that we will be debating the administrative pitfalls of this programs for years to come.

I guess I'm not really looking at this situation from just this 'tax on doctors' perspective. I just looked at tax stuff last night and it just pisses me off the way it all works. 15% tax if you make $8,000 a year and 35% if you make a million? I think I'm just annoyed.

Ms. Pea, unfortunately I have to disagree with your opposition to the plan. Feasibility and viability are key to legislative change and this is a political sea-change- a Republican bringing something to the table other than empty hands. It's time to grab it and plan for later amendments (once passed) to the imperfect, yet politically necessary, legislation. Of course, I'm informing myself from the process of politics and I gather you are speaking from a different set of interests.

In fact, quite prominent progressives and social democrats are more or less in favor- Brad Delong, Paul Krugman, Ezra Klein- that I've read so far. Nary a mention to the 2% skimming off doctors, let alone opposition.

this proposed event will drive doctors out of california, and will also affect medical students on what field they choose (most will stay out of primary care, since those are the lower end of the pay spectrum)

This seems like a worst-case scenario to me. While general income level might decrease, there are still good reasons to become a doctor. Personal satisfaction, relative job-stability (correct me if I'm wrong, but I would think the unemployment rate of M.D.'s is far lower than the general unemployment rate), and the status of doctors in general society. I agree that the principles of the tax might be a bit specious. Even if the tax, and the universal plan for that matter, get implemented, I just don't see it leading to a collapse in California's medical system.

How do countries like Canada pay for universal health care? Is it part of the general tax?

i'm not a big proponent for universal health care.. take a look at canada and the uk, the quality of care, and the length of time you must wait to get anything done is preposterous...and these are first hand experiences with family members..i've worked at county hospital in this country, and everyone does get healthcare when they show up... (you know, these hospital are some of the best, rather than the beverly hills based cedars sinai, which i would never be treated at)..

this also chaps my hide:
The plan, which would cover illegal aliens, would also increase spending on preventive medicine and require insurers to offer coverage to everyone and to pump at least 85 percent of premiums into patient care...

i can bet a few beans that the number of ilegal aliens would increase as well for the state..
awesome. simply brilliant.

Sriram,

Employer-based health care, which Germany and Japan's universal systems rely on, is a poor choice. There's no compelling fiscal or policy reason to use it, and employer's, frankly, should not be in charge of their worker's health care. It's just a silly way of organizing it.

Canada's system is too biased against the private sector; some degree of private, supplementary insurance should be allowed. We do not live in an equal society and we've never had a problem with allowing the richest to benefit from their funds. But if Canada's problem is that they have a ceiling, our problem is that we don't have a floor. Liberals shouldn't construct a system that stops Americans from getting ever-better health care, but we need one that guarantees a certain level of care. In essence, we want a floor without a ceiling.

France and Britain are more interesting, Britain for their enormous cost control and France for the fact that their health care is really very good. But Britain's frugalness has a price -- care simply isn't as good, surgeries are underused, medicines under-prescribed, and so forth. While they still have better outcomes than we do, it's only because so many of our citizens are totally without access to health care. If you had to decide where to be treated, you definitely want it to be here.

France is more my speed. Government provided, ceiling without floor, etc. The lack of a gatekeeper leads to overuse (i.e, the French go to the doctor's too often), but that's changing their, and it could easily be side-stepped here. What a shame, then, that France is so off-limits in political dialogue. But whether or not we can invoke the French, they're the closest thing to a model structure out there, and we should study them for ideas. [link]

Chick Pea: Would you rather the illegal aliens suffer without medical care so that doctors can be richer by 2% of their income?

are still good reasons to become a doctor. Personal satisfaction, relative job-stability

obviously there are amazing reasons to become a doctor...but in reality, most people will shy away from primary care.. it's just makes more sense.. a lot of folks have hundreds of thousands of dollars in college/med school loans that they must pay off... and a primary care docs salary won't cut it, esp after taxation...

i just had lunch with a friend who is finishing up her training in cali, and is considering moving out if this bill passes.. she is dead serious.. and i can understand where she is coming from..

as for canada and how they pay for it? here is a great article from wiki

Currently in Ontario, people who earn salaries above CN$20,000 must pay an annual health care premium ranging from $300-$900. Funding for medicare in Ontario also comes in part from a dedicated Employer Health Tax (EHT) that ranges from 0.98%-1.95% of employer payroll. Eligible employers are exempted from EHT on the first $400,000 of payroll. British Columbia, Quebec, and Alberta charge similar premiums. Alberta charges $44 a month or $88 per family, though as Alberta approaches debt-free status, there has been talk of removing them.

Each province in Canada manages its own healthcare system. For example, each province issues its own healthcare identification cards and negotiates with the federal government for money to cover healthcare costs. Each province also provides its own prescription drug benefit plan, available to every Canadian regardless of income level. The prescription drug benefit is, however, adjusted for income, with a higher co-payment required for those with higher personal incomes. The prescription drug benefit is very comprehensive and rarely excludes a medication. Where a medication is excluded that is needed by a patient, the patient applies for coverage under the plan for that drug using a Section 8 form.

Dental care is not covered by any government insurance plans. Canadians rely on their employers, individual private insurance, or simply pay cash themselves for dental treatments.

I guess I'm not really looking at this situation from just this 'tax on doctors' perspective. I just looked at tax stuff last night and it just pisses me off the way it all works. 15% tax if you make $8,000 a year and 35% if you make a million? I think I'm just annoyed.

then dear, you'll be really pissed to learn that those who make the million charge off their mobility costs, partial residential costs, communication costs, charity as pre-tax expenses.

jobs are for tools. kick the man.

I forgot to tell you to scroll down for Canada in detail or just jump, but the comparative systems are there in detail.

Chick Pea: Would you rather the illegal aliens suffer without medical care so that doctors can be richer by 2% of their income?

of course. i want my bentley. doesn't every doctor? (and if you don't think that is an ultra facetious remark, then you truly don't get me)
i say, we should all pay for it, not just the doctors. why are we the only profession taxed?

i say, we should all pay for it, not just the doctors. why are we the only profession taxed?

I dont think they tax doctors to fund legal aid (which btw are funded by the lawyers in private practice as all the interest accrued on client accounts goes to finance legal aid)

I dont think they tax doctors to fund legal aid (which btw are funded by the lawyers in private practice as all the interest accrued on client accounts goes to finance legal aid)

i didn't know that, thanks for the insight.

Interesting. Is Chick Pea the only one defending the doctors in all of this?

Interesting. Is Chick Pea the only one defending the doctors in all of this?

why am i not surprised?

Aren't there more doctors and med students out there? Rupa, where are you?

I dont think they tax doctors to fund legal aid (which btw are funded by the lawyers in private practice as all the interest accrued on client accounts goes to finance legal aid)

This goes directly to my first comment (#3). Yes, lawyers fund legal aid, but you can hardly say that low income individuals are afforded adequate access to the courts via programs such as legal aid. Likewise, whether or not a tax is levied on doctors or everyone as a whole to fund universal health care, I don't think it will be properly implemented to give access to those who are denied adequate access under the current system.

rupa is busy interviewing around the usa and trying to figure out her rank list i bet..

Ms. Pea,

Would you accept Arnie's proposal minus the 2% tax/fee?

this bill will personally affect me. it will affect a lot of friends that i know through school. would i have accepted it without the 2%? likely yes, but i still don't know if it is the answer to everything. there are a lot of unknowns. healthcare in california is really pretty crappy right now... even on the job hunt trail this year, tons of people tried to dissuade me from going back... even my own folks..

“Why not tax teachers to provide money for better schools?” complains Dr. Samuel Fink, a Los Angeles internist.

Umm, because, teachers make $30K a year while doctors make $300K.

of course. i want my bentley. doesn't every doctor?

If a 2% salary cut will kill your bentley plans, then you probably shouldnt be buying one anyway.

ritam, obviously you don't get me.

most doctors do not make 300k.
please get your facts straight.

how would you like to be taxed for your website to provide free weddings for everyone?

hell, if I could make enough money on just running the site, I'd pay my 2%. It would be better than working 10+ hours at a "day" job and then working on the site at night =)

:)

Arnold S. is an advocate? lol. One thing you can be sure of. It would be the $25,000-100,000 p.a.middle classes who would pay the most dearly for everybody, and it is possible that doctors are now edging down toward the "middle" area, what with all those malpractice suits. My friend already pays a quarter of annual salary to insurance, and she only makes 35,000.
The rich don't even need insurance, and Congresspeople get theirs paid for as part of whatever it is they do.

Doctors in the US make way too much money in the US anyways. Health, like police and fire services, should be a government service. Taxing away their excess profits like this is a roundabout way of achieving this.

(wearing a turban almost the same shade of blue that Manmohan Singh wears)

I like black and white best personally. Although I have seen leopard-skin print turbans on Southall Broadway once or twice.

would i have accepted it without the 2%? likely yes,

The CMA should be lobbying state Democrats then. I wonder where the siphon is pointed to next if the CMA can scrap the 2% in negotiation with Arnie?

I wonder where the siphon is pointed to next if the CMA can scrap the 2% in negotiation with Arnie?

hollywood? ;)

Under Mr. Schwarzenegger's proposal, Medi-Cal would be extended to adults who earn as much as 100 percent above the federal poverty line and to children, regardless of their immigration status, living in homes where the family income is as much as 300 percent above that line, about $60,000 a year for a family of four. Medi-Cal is currently limited to adults with children, and children with documented residency are covered if their family's income is up to 250 percent above of the poverty line. [link]

I just did some crude maths and 2% of, say, a take-home revenue of $90,000 is $1,800. Doctor's be damned! Pass this SOB! Besides, if Dem's don't get on board, the GOP will have an enviable talking point that they proposed a half decent bill and the Dems stonewalled it. And that's just bad politics heading into '08. Especially as health care climbs up the important issue ladder. Ms. Pea, I'll personally give you $1,800 if it means your support and you working the phones to get your CA doctor friends on board =)

Chick Pea, I never wanted to reveal my career on this site (now you'll all wonder how I get time to comment here so much)...but this stupid 2% idea is horrible. I agree with your comments 100%. Thanks for representing.

There are far too many problems with Governor Schwartzenegger's plan. As I think about it, this will only exacerbate the problems for those that he is allegedly trying to support.

If he does levy a tax on gross receipts on doctors and hospitals, that will serve as a serious disincentive for doctors and hospitals to operate in California. The result will be that they will move their operations to other states.

At the same time, the availability of free health-care for illegal immigrants will create an incentive for greater immigration to California from both Mexico and other states.

The result will be a decrease in the supply of quality health-care and an increase in the demand for health-care. Who will be hardest hit by such a scenario? Of course, those who are unable to take the time or expense to cross state borders for affordable health-care--the poor.

I just did some crude maths and 2% of, say, a take-home revenue of $90,000 is $1,800.

the doctors may have their kachchas in knots because 2% of 500,000 from a clinic is $10K gone to taxes... $10K that could have gone towards a new vehicle, new computers, new equipment, the sexy receptionist etc. besides, to fight against taxes is a fundamental right :-)

Doctors in the US make way too much money in the US anyways. Health, like police and fire services, should be a government service.

Hmm, unfortunately, med school is a bit more time and money consuming than police and fire school =)

Doctors in the US make way too much money in the US anyways. Health, like police and fire services, should be a government service.

for my next project i will solve global hunger by lunchtime.

At the same time, the availability of free health-care for illegal immigrants will create an incentive for greater immigration to California from both Mexico and other states.

i stated this problem before.
people will flock from other states, whether it be texas, or florida.. free healthcare will be the new incentive..

-chuckle- the proposition is 2% of gross income yaar. the take home pay will be affeted by less than $1,800.

Yah, I just noticed that. My maths have always been falthoo. Nonetheless, gross-this, net-that, two-percent, poo-percent, it's not enough to sink the whole ship. Republican interests have stonewalled this debate for so long and Democrat interests have been so divergent in what they want, that it's worth it. Some Dems want the whole enchilada a la France, some want the chimichanga like England and some want the taco auf Germany. Bas! The political climate is ripe. This is chimi and changa. Let's grub and grab it.

Chick Pea, I never wanted to reveal my career on this site (now you'll all wonder how I get time to comment here so much)...but this stupid 2% idea is horrible. I agree with your comments 100%. Thanks for representing.

thanks for coming 'out'.. i'll likely become mashed into hummus before this is all over.

Hmm, unfortunately, med school is a bit more time and money consuming than police and fire school =)

amen to that..
some cardiothoracic surgeons train 12-13 yrs AFTER medical school.
and being someone's b*tch for that long is taxing. and no, it's not like grey's (blech) anatomy...

thanks for coming 'out'.. i'll likely become mashed into hummus before this is all over.

This is what makes it difficult to talk about these issues on a forum like this...the physician's POV will always be attacked as greedy and heartless. But if subsidising healthcare is a goal, then it's SOCIETY'S responsibility, not in any way disproportionately physicians' responsibility.

Yes... it's pretty rich to hear lawyers taking the high road...

Basically fees are just taxes that muncipal and state governments can more easily pass.
Does this bill make any attempts at parity taking into account a physician's speciality/malpractice premiums/service to underserved areas?

But if subsidising healthcare is a goal, then it's SOCIETY'S responsibility,

cardiothoracic surgeons will suck blood out of your veins if they can and they do. dont let them. only you can stop this madness now. call now. if you dont do it, who will. - pan to image of sad looking curly sue sucking thumb and holding hand of pregnant woman in flower print dress - aawww. kill. kill.

Yes... it's pretty rich to hear lawyers taking the high road...

I wouldn't necessarily say those of us commenting are taking the high road. If the post was about a 2% tax on lawyers to ensure legal representation for those in dire circumstances, I would be making the exact same arguments. Likewise, many of the factoids that chick pea cites with respect to doctors are the same for lawyers. If you are working for a corporate big money law firm, yes you are rolling in dough. Those of us that chose not to go down that route still have trouble meeting paying back school loans, just like medical residents. As with doctors, I don't know of any lawyers that are in the poor house. Those who are living on $35k a year have chosen that lifestyle, just as those doctors who go into primary care.

Those who are living on $35k a year have chosen that lifestyle, just as those doctors who go into primary care.

Lets cut the bull shit on primary care providers. Even the lamest primary care provider nets more around 80-90k in profits. Of course the primary care provider is not making as much as the surgeon etc. but they still make way way more than a lawyer who works for legal aid ($32 to $42 depending upon the geographical location) or a civil rights organization.

As with doctors, I don't know of any lawyers that are in the poor house.

Even the lamest primary care provider nets more around 80-90k in profits.

This is what makes it difficult to talk about these issues on a forum like this...

agree wholeheartedly.

But if subsidising healthcare is a goal, then it's SOCIETY'S responsibility, not in any way disproportionately physicians' responsibility.

More paying patients means more money for doctors and hospitals, right? We're reducing the costs to hospitals of having uninsured patients, therefore their revenue should increase. If that's so, what's wrong with levying a fee on them in return?

The governors office actually claims that these measures are revenue neutral for doctors and hospitals. I don't believe that, but I think they will have less of an impact than the medical establishment currently claims.

are pharmaceutical companies included in this taxation scheme? and won't doctors/hospitals just increase their fees to cover the tax, thus passing the burden onto their patients?

Ms. Garbanzo bean, I'm with you on this one all the way.

Seems like the same arguments get re-hased time to time, but 'universal healthcare' for a diverse and large nation like the United States isn't all that feasible.

The idea that US taxpayers will be subsidizing illegal aliens isn't all that appealing to me. All immigrants to this country need to be brought into the economic loop, above the table, so responsibility is shared appropriately.

California has financial issues as it is. Universal healthcare won't be coming around here anytime soon. Gotta find the money to pay for it first, especially with the State's other million competing needs. If anything, a system in Cali will probably be half ass, underfunded (like other things) - a total shit sandwich.

A better start for Universal healthcare would be something on a far smaller scale (City, village, township) level, where property tax (or some minor resident tax) helps cover preventative and primary care needs for a smaller group of people. Better funding for a school's nurses office, maybe a physican can come in time to time for shorter hours for said kids. Something along those lines. North Dakota or a similar state with a small and homogenous population would be a better candidate than California. Frankly, California is the worst candidate to implement at universal health care system.

So why are states with strong Republican pro-business governors proposing this?

Great discussion. Chick Pea, I am with you. Let me try to give a broader overview as to why this 2% tax is idiotic:

Let's say an oncologist's gross revenues for the year are $1,000,000. Two percent of that is $20,000. From the million, deduct overhead costs (running an office, malpractice insurance, employing staff, etc.). Also, keep in mind that DOCTORS OFTEN PAY FOR THEIR OWN MEDICINES UPFRONT. So now you may be down to $200-300K. The two percent tax would take $20,000 off of that. If you were making $300K before, you are now making $280K. (And this is a pretty picture, assuming that everything has been collected.)

Fine. That is still a lot of money. But, like others have stated, you're diminishing incentives for doctors to stay in California:

*Doctors are already harangued with an incessant amount of bureaucratic busywork, such as dealing with HMOs simply trying to get paid for their work. This takes time away from dealing with patients, frustrates doctors and often forces them to lose focus.

*On top of this, malpractice insurance is extremely expensive, and it's no joke that you're dealing with a very litigation-happy populace (read Atul Gawande's book for more).

*On top of all this, you want to deduct thousands of dollars from a doctor's paycheck?

I AGREE, doctors usually make a lot of money. But when you take all of the above into account, the true fact is that being a doctor nowadays can be VERY DEMORALIZING. People have this image in their head that doctors just go to work, treat people, and get paid shitloads of money. No - there is so much paperwork, busywork, arguing with the insurance companies, dealing with testy patients, dealing with malpractice carriers, and now a significant tax?

The point is this: why would anyone want to become a doctor when you can go into another field (such as law, banking, etc.) which doesn't have the same sorts of hassles?

It's really easy and simplistic to just throw up your hands and say, "Well, who cares, they already make a lot of money." I know this sounds obnoxious if you are a starving writer or artist type, but come on, you knew what you were getting into when you got into it. We all make choices which affect our income, and public policy shouldn't be driven by our bitterness.

Especially considering that law and banking pay just as well as some medical specialities, it's a slap in the face to doctors.

So why are states with strong Republican pro-business governors proposing this

Who said just because they were Republican means they had the right idea? The answer to me is politics. Take something the Democrats campaign on, make a good effort, it will fall through at some point, and they fought the good fight.

Call me a cynic, but I don't think these efforts are genuine. The capital (money, time, and talent) needed to pull something like this off well is tremendous. Like I said, for an experiment, its better to start off on a far far smaller scale.

miss shalini and mister guju dude: thank you.

Individual attorneys don't fund legal aid.

You are wrong. They do fund legal aid though they are not the sole funders.

So why are states with strong Republican pro-business governors proposing this

?

Who said just because they were Republican means they had the right idea? The answer to me is politics. Take something the Democrats campaign on, make a good effort, it will fall through at some point, and they fought the good fight.

It's Nixon in China, it's more credible coming from a Republican since it's not part of their ideological disposition and he runs a chance of alienating traditional supporters. My understanding is that there is a fair amount of business support for this, or at least enough to give him (and have given Romney) cover.

As far as illegal aliens using universal healthcare, upon their arrival at a hospital or clinic the authorities should be alerted and they should be deported to their point of origin. After they are cleared of any condition that immediately threatens their lives of course. And the bill should go to their government.

Gazsi

I'm not saying there isn't support for such an idea. But something as big as Universal healthcare needs critical mass. I don't see it yet. Now, I'm some genius comes up with a system where you can cut the cake and eat it to, I'm all for it. I'm just saying that in an attempt to cover everybody, quality does take a hit.

And coming from someone who does QA work, quality over quantity argument rages every where in every field. That's why, in order to preserve quality, one needs to scale back the grand plan and start from the ground up. Not top down.

Instead of dicking around with capital intesive plans like these, maybe Cali can throw more money where it's needed. In education and making sure school children get the right nutrition. We already have a 'universal' education program, and it is failing miserably.

Now, I'm some genius comes

Now, IF some genius comes...

People have this image in their head that doctors just go to work, treat people, and get paid shitloads of money. No - there is so much paperwork, busywork, arguing with the insurance companies, dealing with testy patients, dealing with malpractice carriers

I don't necessarily disagree with your argument save this one point. Pretty much every profession contains hassles that are analagous to those you listed.

As far as illegal aliens using universal healthcare, upon their arrival at a hospital or clinic the authorities should be alerted and they should be deported to their point of origin. After they are cleared of any condition that immediately threatens their lives of course. And the bill should go to their government.

How would you identify illegal aliens? Anybody who isn't carrying their passport at the time? Hey Dad, carry a passport with you when you go out for a walk, just in case you get hit by a car, I don't want you to get "deported" to India.

Heard the following argument on NPR this morning - reason for high medical cost in the US
1) Cost of living is high in the US, hence higher costs
2) Compared to other fields/industries where prices are determined by the supply/demand curve, in the medical industry the supply side of equation drives the prices. Physicians and hospitals determine what tests, procedures & prices. The patient i.e the demand side of the equation has no say in this.

I agree with Chick Pea- there seems to be a lot of misplaced anger at "rich doctors" but as someone pointed out, the average income for an MD in the U.S. is about $90,000. I know doctors that have had to move or give up their specialty because the cost of insurance is so ridiculous. If anyone should be penalized, it is the insurance industry and not the physicians. Reducing the number of specialists just lowers the quality of care for everyone.

Why should it stop with Doctors? California is full of Movie Stars, IT professionals, Venture Capitalists and others who manage to make ungodly amounts of money with minimal contribution to society. At least the Doctors do something positive for society. It's easy to point at a group that seems to be largely successful, and therefore justify that they should have to bear burdens that the rest do not. That does not make it fair or right. America is still a democracy, not a socialist country.

all professions have headaches and unnecessary bullshit that blinds them from the real end goal...

gaszi

As far as illegal aliens using universal healthcare, upon their arrival at a hospital or clinic the authorities should be alerted and they should be deported to their point of origin. After they are cleared of any condition that immediately threatens their lives of course. And the bill should go to their government.

um yeah. sure. hospitals can never turn people away. sometimes i want to deport legal residents. where would we send them?

People have this image in their head that doctors just go to work, treat people, and get paid shitloads of money. No - there is so much paperwork, busywork, arguing with the insurance companies, dealing with testy patients, dealing with malpractice carriers

I don't necessarily disagree with your argument save this one point. Pretty much every profession contains hassles that are analagous to those you listed.

Another opinion (they're like assholes, everyone has one)

It is perceived that doctors earn disproportionately more than the work they're asked to do. For the reasons chick pea and shalini have stated, a relative of mine decided to work for Kaiser Permanente for significantly less money than he would in a private practice (Nephrologist) because under Kaiser's umbrella, the overhead/stress is less.

kaiser is the anti-christ to doctors in california. agreed: less headache, i was considering a job there.. but would not out of principle.

Well, I am willing to pay 2% extra tax, if they make a regulation to keep all non-engg/non-IS/non-compsci grads from becoming programmers. All these 'its so easy' guys are eating my paycheck.

Oh, did you know the immigrants pay some kind of immigration fees, that is suppposedly collected to 'train Americans workforce, to upgrade their skills?' That runs in billions per year.

I guess all of us are getting shafted one way or other, arent we?

I agree with Chick Pea- there seems to be a lot of misplaced anger at "rich doctors"

I haven't detected any "anger" on this thread towards doctors, whether it's Ms. Pea or any other M.D. (though, anyone who got angry at our garbanzo should have his/her head examined). I'm just trying to understand why a group of professionals, whose average income is 90K a year, which is well above the national average, is in such an uproar when it comes to a program that many of them endorse.

Only on SepiaMutiny could a debate about the persecution of doctors and their tax bill become so heated.

A tax on doctors for univeral health insurance, WHAT? Why not allow the market to establish a more affordable access to healthcare? This is something I have heard hubster discuss at length: The American Medical Association approves medical schools. The American Medical Association places very strict requirements on medical schools and limits the number of new medical schools that can be opened. This limits the number of doctors in the medical profession, increasing the price of doctors. It also decreases the amount of medical services provided to society. Although these doctors as a group may be "better qualified" than the prospective doctors who are not admitted to medical school, such restrictions (which have not been proven to be related to the quality of doctors) preclude the existence of low-cost doctors for routine medical services or for people who cannot afford expensive doctors. If more medical schools are allowed to open, the same medical licensing standards (i.e, Step 1 and Step 2 tests) can exist but there will be more doctors and a lower price for medical services but there will be more doctors and a lower price for medical services. Good doctors will still get paid a lot of money, but "mediocre" doctors will be available to provide low-cost care.

It'll be like the legal services market.

(though, anyone who got angry at our garbanzo should have his/her head examined).

very kind sriram..

I'm just trying to understand why a group of professionals, whose average income is 90K a year, which is well above the national average, is in such an uproar when it comes to a program that many of them endorse.

because we were not aware of the 2% tax during our endorsement..this was 'sprung upon us' when arnie unveiled his 'great master plan' to the public... i'm not sure we would've endorsed it if we had known this fact beforehand...

But Mahal's admiration soured when Schwarzenegger revealed that his plan would force doctors to give up 2 percent of their gross incomes to help fund coverage. "We are very discouraged and disappointed," Mahal complained. "We had no warning."

sure consent us on things, and show us the ENTIRE plan.. don't go onto removing the right arm when we went in thinking you were removing our right knee.
thank you.

What makes me crack up is that this very dry post about health policy has three times as many comments as my other post this morning about S-E-X.

Y'all need to have your priorities re-examined :P

They do fund legal aid though they are not the sole funders.

Bust out classic rock post and you will see some real action :)

The only thing I am scared of, If all 'real' doctors leave Cali, then probably I will have to go a plastic surgeon for Primary care :(

Well , the waiting room will be more fun at least :D

What makes me crack up is that this very dry post about health policy has three times as many comments as my other post this morning about S-E-X.

Y'all need to have your priorities re-examined

actually i'm proud that people are taking interest/sharing insight/opinions on this subject...
(god, i'm sounding like an auntie)

I will have to go a plastic surgeon for Primary care :(

Well , the waiting room will be more fun at least :D

plastic surgeons will be the first to runaway..

I'm just trying to understand why a group of professionals, whose average income is 90K a year, which is well above the national average, is in such an uproar when it comes to a program that many of them endorse.

National average may be 90K. But how far does that money take you in say, the San Fran Bay area vs. Sacramento? Or New York city vs Rochester or Buffalo? Throw in college loans amounting to a small house payment (Med school and undergrad), the picture turns a little less rosey. Plus it is about the motivation. You grind through years of schooling, only to hear society tell you that your profession is priviledged and you don't deserve the cash you make.

Chick Pea - I've heard the arguments about Kaiser, frankly, I don't know much to say either way. That was the justification my relative used to go to Kaiser in Sacramento (the area being less expensive than San Fran bay area, too). Personally, I've had Kaiser for 3 years in S.Cal and I don't have any complaints. Doctors, nurses, and any extra check ups I've needed were immediately addressed. But like I said, I don't know much more that the superficial stuff.

Anyone who thinks doctor make too much, take a look at the fing I bankers. Doctors in our soceity go to hell and back to get an education, and they are still one of the few professions where you need to have solid values day in and day out to do the job. Its a pure fiction that they live pie in the sky. Doctors are almost always middle class kids who work their ass off. And now, in order to fix what society should be doing together, once again, shunt it off to a specific segment of society

I-bankers work their tails off!

Take a deep breath, folks. This discussion is not about what profession is easier/harder, what profession requires more schooling, or whether doctors have it good or bad. This discussion is about the proposal for universal health care in Cali and the CMA's reaction to it.

I am not a doctor and I am against this 2% exclusive tax on doctors. Universal health care needs Universal funds. Howzz that for a slogan.

I'm from Massachusetts where the local government has approved a universal health care type approach toward healthcare in this state. Here, the state will charge a $295 per head fee to employers that will not provide health insurance to their employees. I'm sure you can imagine how crazy the Business Associations went here, saying it was not their responsibility. It still passed, because premiums have become ridiculous. The point is, the cost is going to have to shift somewhere. Generally, we the taxpayers bear the onus of the cost when emergency care moves from the docs office to the emergency room.

I agree that medicine is probably not as lucrative as it was before, but still there is a certain job security in it that is undeniable. The viewpoints here are especially interesting since we all, at some point in our youth, were probably encouraged to be doctors. Perhaps the expectations are different for folks getting into colleges these days (with more options and a greater understanding of what it means to be a doctor)?

To Sriram's point about doctor's not hurting for money...this is true, but the burden should be shared among all overpaid capitalist pigs (sarcasm intended) and not just doctors.

On the other hand, it's not clear how much doctors will benefit from universal health coverage. Clearly, this will increase the demand for their services and given the rather fixed supply of doctors, their compensation is likely to rise. If that's the case, this tax is no different than raising property taxes near homes where you're going to build a subway stop to pay for the stop (the homeowners still come out ahead because the subway stop raises their property values by far more than the tax).

That said, I do think doctors inflate their compensation through monopolistic practices. They severely limit the number of new doctors each year, creating supply/demand imbalances which raise their pay. There are literally thousands of people rejected from med school each year who are 99% as qualified as people who were accepted.

The kooky med school/residency system makes professions like dermatology one of the highest paid. Not for a good reason, like it's brain surgery and requires a genius, but because of a huge, artificially created supply/demand imbalance.

I still don't know any doctors in the U.S., outside of residents or fellows, who are hurting for money.

Doctors spend half their life (college, residency) making next to nothing. Do you even know what the cost of going to medical school is? Why should they give up 2% of their salary to fund some pompous ass' grandiose ambitions?

I recall in law school a U.S. Supreme Court case that held unless the levy is generally applicable, it's a fee and not a tax.

Nobody addressed this point (I think), so I thought I would. A fee is a tax if it is generally applied to everyone, and if there appears to be no nexus between the reason for collecting the "fee", and the benefits incurred from collecting it. In that sense, the 2% levy on physicians would appear to be more of a fee than a tax.

Of course, this is mostly semantics. The legislature will treat the fee like a tax, while labeling it a fee. And the physicians will pay the fee like a tax, while complaining that it's a tax, not a fee.

I think the CMA has a legitimate complaint...not so much because I think it will affect the quality of certain types of care (which has, IMO, become a rather convenient strawman for the medical industry), but because other professionals are not required to subsidize services to indigents in the same manner.

Personally, I think the ideal solution would be to levy the fee/tax on the malpractice insurance providers. That way, everyone is happy...the doctors, the lawyers and the legislature. The insurance industry won't be happy, but they can just suck it up!

It's not just doctors in California that are going to be taking a hit, from the Cato@Liberty:

Instead, Schwarzenegger actually proposes to use an old Medicaid trick that would put non-Californians on the hook for much more than half the cost. First, he would boost state payments to providers, which triggers federal matching funds. But then he would tax the providers so much that he would recover the state’s initial outlay plus most of the federal matching funds, which he would then use to finance the rest of the plan. At the end of the day, California would spend zero extra dollars on provider payments, yet the ruse would net an additional $1.3 billion from taxpayers in other states.

So, don't worry--it won't be just the doctors that will be making less money. If you live in the U.S. you'll be footing the health-care bill for the illegal immigrants in California. Maybe they'll send a thank you note?

Viva las immigrantes

Doctors spend half their life (college, residency) making next to nothing. Do you even know what the cost of going to medical school is? Why should they give up 2% of their salary to fund some pompous ass' grandiose ambitions?

First of all, they don't spend 1/2 their lives making next to nothing. They don't even spend close to 1/2 their professional lives making next to nothing. I will not count college because most white collar jobs require a college degree. I will count med school but only to the extent that it requires a year or two more than other professional degrees. I'll give you the point that you are making less than market value when it comes to residency, but not next to nothing seeing as how you are still making at least as much as the average school teacher, an equally important societal asset. You can, without too much difficulty, convince me that the 2% tax is unfair. You will never convince me that I should somehow feel sorry for you because of the sacrifice you CHOSE to make to become a highly trained professional with significant earning potential.

No one is asking anyone to feel sorry for anyone, but the scapegoat here becomes the doctors, for a system that they have as little control as anyone else

To clarify my school teacher comparison, I mean that they too are underpaid professionals, but don't have the benefit of doubling or even tripling their income after the completing an initial training phase.

I-bankers work their tails off

you are right, the excel monkeys do work their tail off.

So, don't worry--it won't be just the doctors that will be making less money.

It's not clear that doctors will be making less money with universal healthcare and a 2% tax. The universal healthcare will create significantly more demand for their services, either allowing them to see more patients (by using spare capacity) or increasing their fees.

No one is asking anyone to feel sorry for anyone, but the scapegoat here becomes the doctors, for a system that they have as little control as anyone else

Doctors have lots of control over the medical system. In fact, way too much control because they use their clout to limit the number of doctors, driving up compensation. Ever wonder why doctors in the US make so much more money than their counterparts in the UK or Canada but nearly everyone else in the healthcare system makes about the same money in all three places? It's because doctors use monopolistic practices to drive up their wages!

Doctors have lots of control over the medical system. In fact, way too much control because they use their clout to limit the number of doctors, driving up compensation. Ever wonder why doctors in the US make so much more money than their counterparts in the UK or Canada but nearly everyone else in the healthcare system makes about the same money in all three places? It's because doctors use monopolistic practices to drive up their wages!

Hahahaaa. Sure. bwahahahaaaaaaa. yes. right. bhwawahahahaaaaaaa

You will never convince me that I should somehow feel sorry for you because of the sacrifice you CHOSE to make to become a highly trained professional with significant earning potential.

i am not asking someone to feel sorry for me. i'm damn proud of what i do, that i can help others out when i can...but i don't like the rug being pulled under me and being blindsided.. lay what you have on the table.. without shady dealings..esp when you ask for the support of the CMA.. arnie, go back to hollywood, don't you have anything better to do?

and as for residency pay, it sucks ass..i once calculated our pay and hours put in... i would be making more, with less headache at mickey d's..

there is no free lunch for anyone these days.. this will i'm sure trickle down to everyone's pocket..

I do think doctors inflate their compensation through monopolistic practices. They severely limit the number of new doctors each year, creating supply/demand imbalances which raise their pay. There are literally thousands of people rejected from med school each year who are 99% as qualified as people who were accepted.

The kooky med school/residency system makes professions like dermatology one of the highest paid. Not for a good reason, like it's brain surgery and requires a genius, but because of a huge, artificially created supply/demand imbalance.

it is a monopoly as is every other profession.. yes, specialties put caps on their numbers and such.. but like economics, you need to be able to have jobs for those who graduate and attract others into the field/s...

i don't agree with 99% as qualified... a little over exaggerated to say the least..i was on the admission committee at my med school, and shuffled through some of the applications which were apalling, whether it be academic or otherwise.. and of course there were some folks who were nobel laureates.. but that is the case with every field..

and do what others do if you get rejected, go to the carribean, or back to the motherland and get into medical school there..several friends and family members have taken that route if they can't get in.. nothing wrong with that, if you're that keen on becoming a doctor..

Individual lawyers arent required to contribute a percent of their gross income to fund universal legal aid.

A part of the legal aid funding comes from lawyers in private practice as all the interest accrued on client accounts goes towards legal aid funding.

it is a monopoly as is every other profession..

By contrast, the # of med school / specialty slots is pretty directly managed from up high by the AMA.

It's because doctors use monopolistic practices to drive up their wages!

most doctors who make money...make money--but not in medicine...
it's other things that they do.. whether it be real estate, or stock market...
most of the 'richy rich' physicians think outside their degree..

The AMA is most definitely a monopoly (#77)

Hmm,
Was just wondering. Doctors will have to pay more money, so doctors increases fees, so then insurance has to pay more money, so insurance increases the premium. So in the end, will it not be us, who ends up paying more money ?

And trust me..plastic surgeons will never leave california ;)

..plastic surgeons will never leave california ;)

sad.. i was esp apalled at one of those nitwits who told a 17 yr old or so, what else she needed to have done rather than what she was originally going in for (on one of those true life bits on MTV years ago), i was so apalled that i wrote to the medical board... blech...granted the gal wasn't that 'confident' in herself to begin with, but come on now.. there is a thing called ethics, esp in elective surgical procedures.. that 90210 show is also another BLECH...

I'm not a doctor and am 90% with the pea on this one. Schwarzeneggar's proposal is fundamentally flawed on a number of levels:

1. Taxing Docs
For those who think California doctors make a ridiculous amount of money, you are sorely mistaken. While there are a minority (a very small minority!) of "fat cats," most doctors in this area are gutted by high malpractice insurance rates, overhe