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

I think that's largely meant to prevent having a large number of primary votes cast prematurely, and to prevent bankrupting campaigns for lesser known candidates by forcing them to shell out higher-than-average advertising, travel and lodging dollars early on. Also it bolsters the relevance of individual state interests in the political process, and forces candidates to visit, campaign and cater to those needs rather than rely on national polls and media outlets.

 

Yes, but why is it always the same two small states that candidates are forced to "visit, campaign and cater to"? Why doesn't Mississippi, Kentucky, Maine, Wyoming, etc. get a shot to set the national dialogue (and get catered to)?

 

The locals and legislative caucuses probably do a significant amount of lobbying to keep it that way as well, same reason the College World Series will always be in Omaha.

 

S. 1074

HR 5050

HR 1069

HR 1368

...among others.

 

Make prostitution legal.

 

Why would a everyone be opposed to a group of people who feel that their gender does not match their sex? I can understand being opposed to being misled by a trans person, but those who are open should not be discriminated against or face hostility. Do you also hate other members of the LGBTQ community? What about people of other non-sexual subcultures like vegetarians, those with disabilities, etc.

 

That's funny because I was going to say climate change too, but with the exact opposite conclusion.

Of course, agreement on this issue -- like with simplifying the tax code and many other issues -- is blocked not because the two sides can't agree that something must be done, only that they can't agree on what must be done. Each side holds out on the status quo because they can't get everyone to go along with their own solution.

On climate change, I hope our next Republican president brings back the carbon trading idea. Maybe by then, voters will have forgotten that Obama once supported it and it won't be anathema to half the country. Conservatives should like it because it is a market-based solution, and liberals should like it because it addresses an acknowledged threat.

The other one I would mention is that everyone should agree to stop building expensive military vehicles that the Pentagon doesn't want.

 

What about term limits?

Conservatives should like it because it limits long term special interest relationships and cronyism

Liberals should like it because it presents more opportunities to apply main stream media advantages to getting new candidates elected

 

Conservatives like to have long term special interests and cronyism that benefit their heavy money contributors. Why do you think otherwise? Fox?

Conservatives with the unlimited money to spend on buying politicos their S. Ct. championed have an extreme advantage in spending on both conservative and mainstream media. What makes you think otherwise? Fox?

 

I'm guessing TurboTax, accountants and the like are against all of these. Republican are against it because???

IRS has all the info to automate a tax return for majority of folks already. You just need to review and sign off. It's a major simplification for tax filers.

 

Republicans are against it because:

1) they collect money from Intuit, HR BLock et al(as do a few democrats)
2) Republican anti-tax crusaders (Norquist et al) who think eliminating filing hassles will make people hate taxes less and hurt their raison d'etre

Republicans are not against higher taxes so much as they are against allowing the Democrats/Obama to succeed at basically anything. Why do you think Republicans insisted that (regressive) payroll tax holidays expire along with Bush-era tax cuts for the top earners? They aren't against taxes, they are against things Democrats want.

 

That is not even remotely close to what people are talking about when they say 'simplify the tax code'

 

I stewed on this for a while and muttered an expletive or too when coming up with a response. Clearly you’re passionate about the topic. You raise many valid points. However, the tone I get is that physicians provide bad service, physician salaries and barriers to entry (aka standards) need to be slashed, and this could all be done unilaterally without severe backlash, decrease in healthcare quality, and a highly disgruntled workforce with little/no incentive to work hard.

You picked an extreme example to highlight a point, but yes many people agree that the limitations on certain foreign countries’ physicians coming to practice here is too much. However, where’s the line? Should physicians trained in Nicaragua, Liberia and Vietnam be allowed to practice in the US without any vetting?

I take issue with your assertion that ‘service is terrible’ because of physicians. The overwhelming majority of practicing physicians are good at their jobs and more than adequately qualified to treat the average patient. Healthcare delivery is exponentially more complicated than just a single doctor/patient interaction. Government and insurance mandates require so much time/effort in billing/documentation that physicians don’t actually get to practice that much medicine anymore. A recent British medical journal published a study that medical interns were spending an average of 7min per day per patient while doing nearly 30min of paper work per patient. Believe me, physicians would like to spend more time with patients; we got into the field to help people.

The debt argument I’ll never understand. The average primary care doctor makes $150k, typically starting at age 30. Competitive specialties and sub-specialists typically start earning full income at age 33+. The average medical school debt burden is about $140k. Many graduates have $300k+ in debt. Do you have any idea how scary a time it is in medicine right now that people have taken on that level debt and people want to cut their future earning potential in half? Many doctors don’t get their educational debt paid off until their 40’s. It’s easy to bemoan the amount of money they get paid without paying any heed to the tremendous financial and educational burden it took to get there. I’ve said it before, if you think doctors make too much that’s fine but you can’t tackle the compensation without addressing the financial cost to get to that level.

Engineers make high 5/low 6 figures with a bachelors degree. Why is it unreasonable that a physician, who went to school/trained for 7 to 15 years on top of that are compensated significantly higher? Doctors are in the top 1% in education.

A friend and co-resident of mine is 28 y/o married with two children. He makes $50k per year currently but has $200k in debt. Do you have any idea how scary that is financially on top of all the time/effort?

I think most doctors would admit that something with healthcare needs to change. But without a honest discussion of how those changes will benefit physicians in some way, its all white noise to us. No one is really offering any positive solutions to doctors right now. The only thing that’s come out lately are more metrics and bureaucracy to the practice of medicine.

 

Because every other trade union in the world gets to collectively bargain?

How are you interpreting that I said doctors should receive more unilateral benefits? I said if doctors were going to take a huge haircut on salary then they should also take a huge haircut on the cost of education. Why is that unreasonable?

How in the world is a student-doctor supposed to pay back $200-$300k debt on a $100k salary while maintaining a family. The economics simply don't match. Take away the positive financial incentive while maintaining the negative incentive is a sure fire recipe for crappy healthcare. It's the reason why the best and brightest don't go into basic science, there's no money there.

 

Law is a perfect example of a field that's been heavily watered down by relaxing barriers to opening new schools. The cost of any random lawyer is significantly lower than what it used to be, but there's also a significant amount of crappy lawyers. That's exactly what would happen in medicine.

As I've stated before physician salaries are 8.6% of healthcare expenditures. They are really not a major driver of market prices. So no, that's not economics 101.

Again I will repeat, the medicine in 1970 is not the medicine practiced in 2015. I don't have the exact numbers, but I'm certain the amount of money spent on medications, labs, expensive procedural tools, radiology/surgical equipment as a percentage of healthcare expenditure is significantly higher now than it was 45 years ago. Conversely, I'm certain physicians salaries as a percentage of healthcare expenditures is significantly lower than 45 years ago.

There's no debate more money is being spent on healthcare than in the past; the evidence just doesn't support physician compensation being the primary driver of that.

 

Many fellow countries have similar barriers to entry; Canada has socialized healthcare and also wouldn't let that guy practice there without the same stipulations. Not saying it’s right, but in this instance America isn’t alone.

Every country in the world has a problem with access to healthcare, regardless of payer system. Canada and Britain, two countries with socialized healthcare/reduced physician salaries are among the worst when it comes to wait times. If you think otherwise, you’re fooling yourself.

You are sorely mistaken on the why PCPs see more patients now than before. Reimbursements on primary care have significantly fallen in the last 30 years. Whereas a doctor could see 20 patients a day and make $200k before, the significant increase in paperwork per patient (thanks Medicare) combined with falling reimbursement means PCPs have to work significantly harder/see more patients to make the same amount (or even less). Skyrocketing incomes is not a phrase you hear in primary care. In fact, the government is actually starting to raise reimbursements for primary care because it recognized that seeing 50 patients a day is unreasonable.

What do you propose? Capping the amount of patients a doctor can see per day? Capping the amount a doctor make per year? Canada tried both. What they got were doctors seeing 20 patients in the morning and then taking the afternoon off to play golf.

What it boils down to is you can’t force people to work harder for less pay. Maybe in the short term, but never long term. That’s management 101.