Connecticut wants to tax doctors

They are proposing a 3 percent tax on doctors’ revenues:

“I am working harder, putting in longer hours, seeing my family less only to see my after tax income decline,” Foley said. “And now you want me to give the state 3 percent of my revenue, this in addition to the taxes I already pay on my income. … A 3 percent tax would cripple my business.”
After listening to the complaints, O’Connor repeatedly asked witnesses if they had any other ideas how to generate funds to pay for universal health care. Almost to a person, the witnesses said they realized such an endeavor would be expensive and funding it complicated. But they were at a loss to suggest any viable alternatives, saying it would require further study.

Care to give some suggestions?

Update -
The mere talk of a doctor tax has caused this prospective physician to think twice about practicing in CT or CA:

Right now I am deciding where to practice when I am finally done with my military commitment in 12 months. I am in a good position since I am a urologist and the demand for my specialty is huge right now. I was considering the Northeast (since my wife and I are from Long Island), but this 3% tax thing is making me think twice. If CA and CT do it, it will probably sweep all the ‘Blue’ states. This murmur of a 3% tax in the northeast has sealed our fate and we will be heading South…

Comments

Anonymous
Talk about shooting oneself in the foot…
Connecticut may wind up with universal health care and nobody to provide it.
How about a 3% tax on lawyers to pay for the judicial system?
The Independent Urologist
Providing coverage for all people would benefit everyone, so everyone should pay for it, not just a few people, such as the providers and cigarette makers and cosmetic surgeons. That is absolutely rediculous.
Anonymous
“Connecticut may wind up with universal health care and nobody to provide it.”
OR
They might end up with doctors who are more interested in helping people than profits.
I suspect that if the medical herd were thinned along the greed lines, you would see a measurable benefit . . . even before a single penny was counted.
Happyman
I fear greatly that this illogical approach will not be seen that way by the masses.
People outside the realm of providing healthcare seem not to be able to dissociate their doctor / employet / insurer combination from each other. They view them as one big organization in cahoots to “take care of me”. For example, how many times have all of seen the patient who is annoyed after writing a medication that has huge copays, or writing a script for a mammogram then having to wait 6 months for the test? The annoyance is generally directed (mostly) at the provider, whose snafu resulted in their loss of income.
Most people only know (1) that SO MUCH money comes out of their paychecks for health insurance; and (2) who their doctor is. The rest of the equation is a blur, and that seems to be by design.
A 3% tax on docs makes no sense. arnold is doing something similar in california. In NY, this will really hurt primary care docs. Despite what medicare said at the end of 2006, I am seeing declines in reimbursement for medicare patient for e&m codes. anyone else seeing this?
Happyman
“They might end up with doctors who are more interested in helping people than profits.”
delusional, really.
What they’ll end up with is the same outcome of declining insurance/medicare reimbursements:
1-more patient visits per doctor per day, who will be chasing their tails to make the same income as last year and keep up with office overhead (how would you feel if you got a pay cut instead of a cost-of-living increase on your job this year?);
2-decreased patient and doctor satisfaction
3-less willingness by docs to handle seemingly non-urgent matters by phone
4-any form completion will require a patient visit
5-more dumping of bullshit problems onto specialists
6-more injudicious use of the ER
7-specialists will respond by performing more endoscopies, stress tests, echos, etc. (not that i agree at all with that, but it is inevitable)
8-see 1 through 7
Kevin
Comment above was deleted.
Please refrain from personal attacks.
Thanks,
Kevin
TBTAM
If we are taxing, then let’s tax those who make the most income – the insurers and Big Pharma. Taxing the docs is like taxing the assembly line workers salaries instead of the company.
Anonymous
While we’re at it, let’s add a 3%tax on the income of those US soldiers serving in Iraq to help fund this expensive war.
Let’s not forget that the money to be alotted for the increase in health care expenditures is being spent to fund the war in Iraq. Let’s not miss the big picture.
Anonymous
Right now I am deciding where to practice when I am finally done with my military commitment in 12 months. I am in a good position since I am a urologist and the demand for my specialty is huge right now. I was considering the Northeast (since my wife and I are from Long Island), but this 3% tax thing is making me think twice. If CA and CT do it, it will probably sweep all the ‘Blue’ states. This murmur of a 3% tax in the northeast has sealed our fate and we will be heading South…
Anonymous
Kevin, South Carolina, and Chester County, in particular, could use some “new blood”. We have new homes being built in our rural areas that I am sure you’d love to live in. You should contact Dr. Samuel Stone in Chester, and see if he can pave the way for you to come south; we’d love to have ya!
Anonymous
What a great idea! We can really extend that and better fund our government all the way around. We can add surtaxes to teachers for schools, get contractors to pay for our roads, selectively tax farmers to pay for food stamps, and best of all, Congressmen to pay for pork barrel spending!
Anonymous
Well, why not, if they can get it from you.
Not from me, I have more self-respect than to let myself be treated like a second class citizen, I would move or quit!
Anonymous
Uh oh! Another mass physician exodus. Where are all of you going?
Anonymous
We are coming to your house and pitching tents. Hope you have plenty of port-a-potties.
Anonymous
Kevin, you have a great blog, and I check it every day, but I must say that as a third year medical student, I get really, really depressed by it.
Can you imagine the outrage if politicians suggested taxing police officers 3% to fund anti-crime measures? Or taxing soldiers to fund a new cruise missile?
And to the genius who posted “They might end up with doctors who are more interested in helping people than profits.”
Profits?? I just want to be able to pay off the quarter-million dollar student loan debt I’ve incurred. How dare you question my own or any other physician’s altruism? Do you think we just coast through med school with our good looks?
Anonymous
Welcome to America.. the land of classism. The democrats plan to sweep congress, the presidency, etc. through classism. It is sad. Democrats like to say the American dream is dead. That we live in two Americas…. I like to think that they are the ones killing it. Being a doctor is one of the few jobs left that anyone can make it in no matter how much money you start with or how many connections your family has. I’m a first year medical student. My class is one of the most diverse groups of people I have ever been around my entire life. Democrats will not be happy until medical jobs are no longer a good career choice. Then we will wonder where all the good jobs went. Democrats hate success in America because they profit of the country feeling poorer and feeling that the government can help. People wonder why the auto industry can’t compete when the main cars they sell are SUVs are the democrats have made every one think it is a sin to drive an SUV. People wonder where the tech jobs went when we they were busy painting Microsoft as the billion dollar monopoly giant that has to be stopped. People will wonder what happened to the drug industry in ten years when those 100000 drug rep jobs no longer exist and as well as the scientists that support the research into new drugs. Just ask Wal Mart how it feels to be perceived as a successful US company. Who stands to benefit if America is poorer … well it seems that the party of the poor and underserved not only will help them with big government spending if they are elected, but they will help put them there. It is a self fulfilling prophecy.
This is extremely off topic. It probably doesn’t make any sense, but it just what I have been thinking about recently… sorry to waste your time
bbcreag
911,
Agreed. Every college student thinking of going into medicine should read this blog.
959,
Brilliant. You have discovered the agenda of the left. In essence they say to the successful “you are evil and you must have cheated and must be cut down to size”. To the masses they say “you are to stupid, too poor, too black, too hispanic, too cheated by the successful guy and therefor you need us (the democrats) because you are too whatever to ever become of anything.”
Anonymous
How dare I [question your altruism]?
Well I didn’t . . . but your righteous indignation says much.
Please note (that which should be obvious): in my greed selection scenario – by definition – a doctor already practicing (or planning to) would fall into one of two groups: (1) those who pack up shop and move elsewhere because of the tax and (2) those who don’t.
Neither is inherently morally superior. Just a predictable effect of said tax (which all the doc.s here seem to acknowledge).
So that being said . . . let us see why perhaps your argument is going to elicit little sympathy amongst anyone other than yourselves (tho’ realistically your “non-atruistic” threats may likely kill the tax).
First: you make nearly 2x what doctors elsewhere make and a lot more than your patients.
The average incomes of $274,000 for specialists and $173,000 for general practitioners are, respectively, 6.6 and 4.2 times those of the average patient. The rate in the other countries is 4 and 3.2.
Next: Student loans?
Compare median lifetime annual salary to median educational debt at graduation, and you will find that doctors do better than those in other professions requiring advanced degrees (lawyers, engineers, architects, etc).
Lastly: What do we get?
http://www.thehealthcareblog.com/the_health_care_blog/2007/03/policyquality_w.html
“Despite this high expenditure in the US, the 2005 Commonwealth Fund International Health Policy Survey of sicker adults from six countries (Australia, Canada, Germany, New Zealand, United Kingdom and US) found that ‘(t)he United States often stands out with high medical errors and inefficient care and has the worst performance for access/cost barriers and financial burdens.’ 4 The US lags behind many other countries in indices of quality of care. In 2006 the US ranked 43rd among the world’s nations in infant mortality, with 6.43 infant deaths per 1,000 live births, behind the top performing nations such as Singapore (2.29), Sweden (2.76), France (4.21), Canada (4.69) and United Kingdom (5.08), 5 and was 29th among developed countries in maternal mortality. 6 Schoen et al. (2006)7 found that the US lags behind other countries on indicators of mortality and healthy life expectancy, with the US performance relative to a benchmark of 100 being 51 for efficiency and 66 across all domains, the lowest for any comparable country. A 2006 survey of primary care physicians in Australia, Canada, Germany, New Zealand, the Netherlands, the United Kingdom, and the United States revealed ‘striking differences in elements of practice systems that underpin quality and efficiency. ….. U.S. physicians were among the least likely to have extensive clinical information systems or incentives targeted on quality and the most likely to report that their patients have difficulty paying for care.’”
Now please stop acting like petulant children and please rationally respond to what will likely become a common policy debate in the near-future.
Here . . . I will start:
We do need to lower your administrative burdens (and thus costs).
Plus, I think that a completely protected/confidential “Morbidity and Mortality” national database/forum should be established so that doctors can discuss and learn from each other without the fear of this info coming back to hurt them. Setting the issue of malpractice aside, I think this would go a long way toward improving quality of care.
And yes . . . pharma/device mfrs/hospitals/ins/hmos all have contributed greatly to this mess as well.
But despite their economic encroachment on your autonomy – YOU ARE THE GATEKEEPERS – so you (collectively . . . as a profession) could do alot more than protecting your own pocket-book. I don’t mean that as an insult . . . it is a sincere request.
This either/or (us/them) mentality is neither descriptively accurate nor analytically helpful.
Anonymous
Anon:
You might want to take a good hard look at your stats. What is considered “infant mortality” in this country is not considered a viable fetus in other countries. there are lies, damn lies, and statistics.
Anonymous
anon (1:57):
I see you are rehashing someone else’s weak argument about one of many stats.
To begin: I agree infant mortality would – alone as measured – be a silly proxy for overall quality of our healthcare. Seeing as I did not use it as such, your “zing” is rhetorically and analytically empty.
But while we are on that subject, I read the article whose point you regurgertated so eagerly to prove whatever, and there are some other problems with infant mortality as a metric. Namely that much of the real differences have nothing at all to do with contemporary medicine and everything to do with (a) sanitation, and (b) basic vaccination and antibiotics – advances that have been around for quite a while.
One could dramatically raise the infant mortality rate in a few countries without an MD in sight if one wanted.
Anyways . . .damn statistics.
So assuming you don’t have some quirky post-modern belief that no measure is really up to the task of comparing health outcomes, I’ll just ask point blank: do we really get our money’s worth off that 2 trillion or could things be better . . . could we knock out those preventable errors and wasteful practices or are things just peachy?
And please try to actually address a substantive point if you choose to quibble. . . refrain from sophmoric attempts at “gotcha,” doc. I am open to honest debate of fact and policy, but I have better things to do than pointing out the obvious to you.
Anonymous
No anon, what you have shown is that you have no understanding that different countries have different measurements of WHAT is a viable fetus. This measurment has nothing to do sanitation/vaccination/abx. The only one trying to play gotcha here is you.
Anonymous
okay . . . [sigh] . . . how about we stop this silly obfusctaion right now.
you win . . . we have the best infant mortality (but we just don’t know it).
happy?
now does that change anything? the only reason i picked that quip to support the general assertion that our health care is not quite stellar as it should/could be was because Dr. Kevin had just referred to the article in a recent post.
there are many more measures. what about the other ones specifically addressed? what about the unacceptable rate of iatrogenic death? how about the fact that autopsy studies reveal a 40% of misdiagnosis in terminal patients (1/3 of which could have prevented death if corrected) and the fact that same error rate has not improved since 1938 (this study was done by doctors at harvard using their hospital records)?
please address my point.
here . . .i will spell sumething incorrectly and give you a ready-made basis for tangential obfuscation.
Anonymous
To use the same rhetorical trick:
OK fine. American doctors are a scourge on the health of the nation.
Paying them less (by taxing them more) is going to help the problem how?
Conciergedoc
Why all the bickering amonst ourselves? This is probably part of the problem in the first place.
3% of MY revenue in this enviroment. Well, if this passes, physicians have no once else to BLAME EXCEPT OUR COLLEAGUES WHO CHOOSE TO STAY IN CT. If this law passes, I don’t care how hard it is, or how it’s spun as doctors abandoning patients, or greedy doctors.
DOs/MDs need to protest and march out with their feet! No other industry I can think of would accept this communist approach, except cigarettes (and we know how well that industry is growing anyway), would accept that!!
Stop worrying what will happen if you leave. The state will finally gets it’s chance of seting up free care clinics and staff them all with care extenders.
Absolutly crininal to target the doctors.
And the entire greedy doctors argument, oh please spare me. If our nations top cardiologists choose to spend time doing bikini waxes, and not improving upon their skills, what does that imply. MDs as a group need to stop fearing what the press, or community will think about them. Care for your patients, devote to your patients, but seeing 30 patients a day for a 9 minute visit, and that will obviously have to increase by 3%, does less of a service than jsut leaving the practice altogether.
MDs as gatekeepers? Sure in an dream world. Read the post about the forced ER admission. What about the recent theology of defensive medicine? Is that just paranoia.
3#rd year med student. I’m just getting started in real life practice myself. I don’t think it’s really as bad as all the whineing we do, but I sympathize completely. But if in 5 years, I discover it is as bad as my colleagues state, I may just shut down my practice and find an alternative career. I’m hoping that by building my practice like an efficiently run business, not a charity, keep my overhead low, productivity moderately high (but not at expense of patient face time), and make smart decisions about which managed care plans I CHOOSE to join from teh begining (not be desparate to take everything just so I can pay my med schl debt), I hope to have a successful ideal practice.
We doctors whine really well, but we are terrible at actually spending the time necessary to fight for what we think is wrong. How many people are active in AMPAC, local county state med societies, even join your local chamber of commerce as a business, or even read fighintgdocs.org? Stop complaining and act. If not the previous “oh I remember how good it was” generation, then my generation.
Anonymous
hey guys
I am starting medical school in the fall, and all this talk has really started to worry me. I think it is outrageous that doctors who sacrifice so much time, sweat and money should be targeted. The politicians are really sneaky. If Edwards or Hillary is sooo worried about the big bad rich greedy doctors who need to be stomped on, why don’t they donate some of their small fortunes to healthcare of the poor?
Anyways I have a ton more I could say, but most importantly, what advice can you doctors give us future doctors in standing up for physicians rights? What do we need to do? Are we making a mistake? I love science and people, but I don’t think I will deserve being the one who everyone targest (patients, politicians, public) for their problems when I will work no less than 100% to give the best care I can:(
Anonymous
I Googled the Connecticut tax and found your blog. Nice job. I’m an ob/gyn about 13 years out of residency active in teaching, clinical practice, some research, and administration. It’s possible the CT tax, if enacted, will drive some physicians out of state, but I doubt it. A few years ago Florida’s citizens passes an amendment where a physician will lose his or her licence after “3 strikes” due to malpractice cases or administrative issues. We had a very hard time recruiting for many months after that, but few people left the state. It is just as hard for doctors to pack up and move their school-age kids, spouses, and perhaps elderly parents as it is for everyone else. One would hope that a substantial number of CT doctors would hit the road (there are physician shortages in many parts of the country) but this probably will not happen.
Anonymous
Oh please. You doctors are the most overpaid people on the planet. You use the fact that the patient isn’t paying directly to inflate your fees well beyond any fair pricee. And you control the numbers of doctors to keep the price high.

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