Not a Liberal/Conservative Problem, but a Government/Bureaucracy Problem

Muslim extremism
Kim Kardashian
Internet scammers
Hackers
Trannies

 

simplifying the tax code

 

The 9% approval Congress

 

My take.

 

I'd call you uninformed about the power of the AMA but that'd be severely underestimating your understanding of the healthcare system. You're attributing multiple complaints about American healthcare to a single entity; something that every single American physician would tell you is wrong. Most doctors believe that the AMA is an incredibly weak organization that has ceded a significant amount of money and autonomy to the hospital/insurance lobbies.

To your first point: reduced competition amongst doctors. The number of doctors in the United States is limited by training positions and qualifications. There's a limited amount of seats in medical schools and limited positions for post-graduate residency training. Physicians trained abroad have to pass the same rigorous examinations that American trained physicians do, which limits flooding the market with crappy doctors. The only way to increase the number of doctors in the system, while maintaining the same quality, is to increase the amount of money Medicare spends on residency positions. This would increase government spending (/tax revenues) and probably cost more money to the lower/middle classes. Regardless, the only way the AMA is involved is not lobbying enough for more government money for more training positions; nearly every doctor would say there's not enough current physicians.

Your next point: high physician compensation. The average doctor completes 8 years of post-secondary education, graduates with an average of ~$150,000 in debt and then has to complete a 3-7 year residency plus any extra fellowships before attaining full salary. Simply put, the financial incentive has to be there or else the best minds won't go into medicine. Remove the financial burden (i.e. finance undergrad and med school) and maybe it'll be reasonable to talk about significantly cutting physician compensation. The one area the AMA has thus far succeeded at is staving off the 21% Medicare rate cut for multiple years. If someone told you your services were suddenly worth 21% less for no reason, you’d tell them to go **** themselves.

High costs of healthcare: Really has minimal to do with physician compensation. Physician compensation is estimated to be less than 10% of total healthcare costs. Over the last 50 years incredible advances in biomedical science and technology have allowed human being to live longer and through more terrible diseases than ever before in history. That technology has a huge price. A patient who goes to the hospital can expect to pay large amounts of money for breakthrough antibiotics, surgical instruments, or live-saving mechanical breathing machines. He may have consultations by multiple highly educated specialists. He sees a large bill. What he doesn’t realize (and seemingly doesn’t care about) is that the individual professional fee for a single doctor is not that much. An hour long consultation without procedures could net a physician less than $50. Saying healthcare is expensive because of the doctor’s salary is like complaining the auto mechanic is expensive because of the mechanic’s salary; the mechanic actually makes jack**** and the dealer takes a ton off the top.

Physicians as a ‘trade union’: in the past physicians have never formed large unions or collectively bargained. It was never necessary because the lack of 3rd party payers meant doctors salaries were directly tied to patient’s ability to pay. In fact, under the AMA’s code of ethics it’s considered unethical for physicians to strike because the potential harm to the patient outweighs the benefits of collectively bargaining. That's right, doctors actually cede the ability to strike and bargain for better wages for the patients' right to healthcare.

 

Agree. This is the end result of having Iowa as the first state for presidential primaries IMO. That position should rotate from state to state.

 

Devils' advocate points:
Liberal: Less carbon emissions per gallon.
Conservative: Lessens America's reliance on foreign oil, which foreign producers responded to by drastically dropping the price of gas.

This could go on and on.

 

60 vote majority

 

You would think they would, but President Obama has proposed simplifying the tax code and almost as important pretty much on a regular basis.

2009

Obama renews pledge to simplify tax code

2011

Obama calls to simplify tax code

2013

A plan to simplify the tax code

2015

None of these proposals have gone anywhere, each time these reforms were stymied by Congressional Republicans.

The worst was example was probably 2013, when the last attempt to eliminate the requirements that most taxpayers prepare returns was killed, allowing you to opt to let the IRS do it. This one had bipartisan support (they all did), but a small minority of Republicans on the payroll of Intuit and HR Block and Jackson Hewitt killed it .

We don't have liberal/conservative problem on this issue - we have a conservative problem.

Any meaningful effort at tax simplification can't ever pass until today's version of the GOP changes, it's that simple, bc any simplification effort will result in a rise in taxes for somebody, which the GOP can never do, and is why they should never be allowed to govern

 

The GOP have been pushing for the flat tax and fair tax for years.......

what bill are you referring to that Obama has put forth? Generic platitudes are not meaningful.

Obamacare makes the tax code infinity more complex.

 

I think part of his point is that the AMA is responsible for setting the qualifications and limiting the number of training positions available - they are the organization that has prevented any new med schools from opening and have limited the available number of residencies in the country. Doctors in other countries spent far less time and money in school with similar results (not necessarily the best-of-the-best specialists, but the everyday general practitioners).

The AMA is like any other trade organization: ultimately, it exists to serve its membership. Industries tend to complain about regulations, but the vast majority of regulations that require licensing and other barriers to entry are pushed by the trade organizations, because they keep competition out and raise wages. The AMA is not really any different.

Health care is a complicated topic and, in the US, a lot of different problems. But the AMA is more part of the problem than solution. Here's some excerpts from an opinion piece on the topic:

http://www.forbes.com/2009/08/25/american-medical-association-opinions-columnists-shikha-dalmia.html


But that’s not how it has worked in medicine since 1910 when the Flexner report, commissioned by the AMA, declared that a surplus of substandard medical schools in the country were producing a surplus of substandard doctors. The AMA convinced lawmakers to shut down “deficient” medical schools, drastically paring back the supply of doctors almost 30% over 30 years. No new medical schools have been allowed to open since the 1980s.

Still, the AMA along with other industry organizations until recently had issued dire warnings of an impending physician “glut” (whatever that means beyond depressing member wages), even convincing Congress to limit the number of residencies it funds to about 100,000 a year. This imposes a de facto cap on new doctors every year given that without completing their residencies from accredited medical schools, physicians cannot obtain a license to legally practice medicine in the U.S. Even foreign doctors with years of experience in their home countries have to redo their residencies–along with taking a slew of exams–before they are allowed to practice here.

...

One way to relieve the shortage of providers that the medical industry has created would be for the AMA to abandon its aggressive game of turf-protection and allow nurses, midwives, physician assistants and practitioners of alternative therapies such as chiropractors, to offer standard treatments for routine illnesses without physician supervision. For instance, midwifery, once a robust industry in this country, has been virtually destroyed, thanks to the intense lobbying against it by the medical industry. In 1995, 36 states restricted or outright banned midwifery, even though studies have found that it delivers equally safe care at far lower prices than standard hospital births.

...

The AMA does all this in the name of patient protection. But Milton Friedman, the late Nobel laureate, noted in 1961 that the AMA’s licensure and other efforts to control the supply of doctors and services had produced a net diminution of care. “Licensure has reduced both the quantity and quality of medical practice,” he wrote in Capitalism and Freedom. “It has r****ded technological development both in medicine itself and in the organization of medical practice.”

Although Friedman’s views were controversial at the time, they now enjoy an overwhelming consensus among economists. That’s because it has become painfully clear that the net effect of AMA-type restrictions hasn’t been to make better quality doctors available to more people, but to reduce existing options, especially in rural and other under-served areas.

 

No, a small minority of the GOP has been pushing that. When Dave Camp tried to simplify the tax code last year, his own party squashed it because they couldn't actually agree on what to reform.

http://www.politico.com/story/2014/04/house-gop-dave-camp-tax-plan-105261.html


For the past three years, House Republicans have been promising, as part of their annual budget, a sweeping tax rewrite that would slash the top individual and corporate tax rates to 25 percent without blowing up the deficit.

They’ve ducked questions of where they would find the trillions of dollars in savings needed to finance the rate cuts, saying they were leaving that to Camp and his committee to sort out.

“This budget accommodates the forthcoming work by House Ways and Means Committee Chairman Dave Camp,” last year’s budget said.

Camp finally produced a plan in February that won plaudits from tax experts for its boldness — it slashed sacred cows like deductions for charities and mortgage interest, though it fell short of Republicans’ long-standing promises to cut the top individual rate to 25 percent. Camp settled for 35 percent, while making good on his pledge to slice the top corporate rate to 25 percent.

Most Republicans wanted nothing to do with it when Camp unveiled his draft, professing to be unfamiliar with its details. Though Camp has since held closed-door briefings with rank-and-file Republicans to go over his plan, their disinterest is evident in their budget.


The GOP talks a good game but has never actually gotten anyone to vote for a plan - because the math doesn't work out the way they want it to.

 

Global warming BS.

The fearmongers have died down in recent years, though I suppose this is mainly due to the realization that Al Gore is not walking through those doors (to the oval office). The Earth's climate is amazingly complex but yet easy to extract such simple trends (such as the glacial cycle for the past 800,000 years). How is it that some people can spot a counter-intuitive, horrific trend with just 40 years of data held up against 800,000 years of data? I don't know. Trying to teach such alarmism is as scary and dangerous as teaching creationism in our schools.

 

That article perpetuates several incorrect beliefs, misleads or flat out lies. It looks like the Fox News of articles.

Whatever stance on limiting physician training positions the AMA once had is no longer valid. That article was factually incorrect in stating no new medical schools have opened in the last 30 years. New medical schools are opening all the time now. In Texas alone, two new UT system medical schools are opening in the next two years. Incarnate Word is considering opening an osteopathic school in San Antonio.

The AMA itself is a lobby group. It does not have the power to determine the qualifications or number of training positions available. The accrediting body for residency positions is the ACGME and the funding source is the Centers for Medicare & Medicaid Services (CMS).

The limiting factors right now are two-fold: one is CMS coming up with more funding for residency positions. It's not a popular proposition to put more money into healthcare, but frankly if Obamacare is going to put 20-45 million more people into the healthcare system, money needs to be devoted to training enough doctors to support that increase. The second is having enough clinical sites to adequately train new doctors. The average run of the mill community hospital doesn't see enough varied pathology to train anything more than a glorified NP. (LINK)

Again I will repeat, physician compensation accounts for 8.6% of healthcare spending. That's the level of sales tax. Slashing that will not make a significant impact. And it'll piss off a lot of doctors, many of whom work 60-120 hours a week to make the salary they currently make.

At any rate, it's near impossible to compare physician training and compensation in the US to anywhere else because no other country (particularly in Western Europe) expects their doctors to work as hard as the US does. Most Western Europe countries totally finance their trainee-doctors education (with the expectation of time served, like the military). They also work 40-50 hours a week with 7+ weeks of vacation a year. So a salary of $125k is not a big deal when your school is paid for and you work 1/3 to 1/2 of what your American colleagues do. Britain has a duty hour restriction of 48 hours per week for residents. The US's is 80 hours per week and I routinely broke that rule and many of my surgery colleagues routinely worked 100-120 hours a week.

 

Going back to the original point of the thread, healthcare is the government/bureaucratic problem not the AMA.

 

Sounds like you need to go to the Libertarian party.

2 issues-

1. Using the government to enrich special interests.
2. Too much divided government, which is kind of a feature of our system, not a bug.

 

The folks who control the conservative movement are not against the current tax code ibecause it is a huge benefit for the wealthy. Their complaint about complexity is merely a talking point to fool little guys and to ultimately trash government spending for the poor and middle class.

They would be content with a simpler tax system but only if it remains a huge benefit for the wealthy.

 

Also it is ridiculous and no accident that the first two states are states very disproportionately white with no major cities.

can't have our politics too "urban"