Tuesday, August 30, 2011

Distorted Reality?

Anonymous, who I think is from BDM Information Systems, a division of GE, left the following comment on my Buffett post after spending almost an hour perusing my site:
Your perception of reality is distorted. This is true for us all, but in your case it is pretty bad. If you are born with a lesser brain, raised poorly given poor education then you will not fare as well as your neighbours who were dealt better hands in life. You were lucky to become who you are. A decent brain, good upbringing (I assume). Now you don't want to share your luck with those less fortunate than you, and you insist on calling it hard work - not luck - failing entirely to recognise the gifts that made you work hard.
So here we are. The narcissistic Leftist generosity rears its distorted head. So...there are those who are just so far below us, so "unlucky" that we OWE it to them to share our "luck". A slightly different twist on the same old stuff. But stand and take notice, folks: Anonymous declares that these "unlucky" people have "lesser brains", the first time I have EVER heard this blatant discriminatory phrase come from the Left...or the Right, or anywhere else! Ten points for honesty, and by that I mean Anonymous has stated what he really thinks. If I were one of those "unlucky" folks, I might be offended. Of course, the Left has trained the "unlucky" to expect and demand that the "lucky" share their luck.

Notice that Anonymous removes ALL responsibility from the "unlucky". They are simply "unlucky", I guess. Their meager brain-power cannot process the consequences of their bad choices. And thus, we should "share the wealth" or the "luck" if you prefer. There is not thought of helping them improve themselves or their lot.  All we EVER hear is that the greedy "rich" won't help anyone. Siffle, sniffle.

Clearly, Anonymous didn't read the post, but assumed it said what he wanted it to say. Greedy, selfish Conservatives. Which is not what I said at all. Behold what the figures bear out: the "rich" or "lucky" are already paying all the federal taxes. I guess this isn't enough for the Left. The "lucky" apparently are expected to give everything to the unlucky until everyone's lot is equal. And the "lucky" are supposed to keep up the hard work, which apparently is a gift and not something they earned, so as to keep funneling adequate funds to the "unlucky".

I'm sorry, Bunky, but I think I do close to my share. Between federal, state, local, sales, capital gains, and whatever other taxes, I pay well over 50% of my income out to some government agency or another. That's a lot. In addition, My group writes off 10-15% of its income as bad debt, serving the underserved, or "unlucky", who cannot pay.

This argument played out on AuntMinnie.com recently. My friend Dr. Sardonicus pointed out:
I, and basically all of my radiology colleagues, give away 25-30% of our services. Give away, as in free. And then on the 70% that we do collect on, we lose about half of that in taxes. If you were radiologists, then you would know this.

My personal contribution to the poor through free care is many miilions of dollars (I am an experienced radiologist). So, I am pretty much immune to anyone trying to lay a guilt trip on me.

Now, if you personally feel guilt, then please take care of your guilt yourself, and leave me out of it. There are many opportunities to volunteer, and, I guarantee you that volunteering at a free clinic will be much more economically efficient than contributing the money you make at work to the government in the form of an additional check to the IRS. If you were to donate a days work worth of money to the IRS, I guarantee that by the time it got to any poor people it would be 1% of what you gave them, after all the bureaucratic friction in the system burned up the rest

But my friend Thor, who is a Leftie academic rad, poo-poo'd the thought of generosity:
Well goodness me gracious...how silly of me not to congratulate you on your many contributions to society. Now stop being so pious. You say all this yet I am sure you are not starving or wanting for anything, correct? You knew this was the situation when you went into Radiology correct? You do know that others pay higher fees to make up for your charity care and if everyone could pay your price would be lower so your not really "giving anything away", correct?
Sardonicus responded:

Hospitals are not the same as professional corporations. They can manage the amount of indigent care they give. (particularly for profits). Indigent care is often compensated by increasing fees in other areas, as I am sure you know. . .The hospitals are fat, they do not suffer from indigent care, they pass it on. Meaning - in the face of this vicious recession, in towns where other industries are failing, hospitals are complaining because their profit is somewhat lower.

On the other hand, physicians can't simply raise fees or divert indigent care to counter cuts in reimbursement. When people don't pay (like in the last two years), my pay goes down, while I am working longer hours than before. The decrease in my pay and increase in work is essentially an increase in contributions to charity care. The primary cares are in worse shape, and have been decimated over the past 10-20 years. They can't simply jack up their fee to insured patients. Not allowed, controlled economy. That is why you see many of them becoming employees of hospitals, or becoming essentially the overseer of an army of physician extenders, or refusing to accept medicaid/medicare.

So while you may have to pay higher insurance rates to cover the indigent, I also have to pay higher insurance rates, and my income is significantly down as well.

Thor: spare us the condescending, supercilious tone.

I rather expected someone would attack. I am not expecting beatification. I rarely talk about this, and yes I did expect to do charity care and it is part of the job. I have no problem giving away my services to those who need it. In fact, I have tried many times to give away my services to someone I knew was in need, only to be told by attorneys that it would be insurance fraud and I couldn't write it off, I had to bill them. I couldn't even whisper to them to ignore the bill. Did it anyway.

Here is the point you missed: Most people don't understand that we give away our services on a regular (like every hour of every day) basis. Mostly I don't care if they don't know. BUT when people start slinging mud about high earners taking and not giving, some education is in order.

And, as above, NO ONE pays higher fees to make up for my donated professional time. We cannot raise our fees. We are in a constant battle to reduce the amount they will be reduced by. (see thread on the new CMS rules which are designed specifically to pay radiologists less for their services). I know a surgeon in a small town in our state that was hit with high layoffs. Suddenly, her "no pays" became so high she was insolvent and had to close her practice and move to another town. The hospital, by the way, seems to be making it OK. In this situation, Thor, your assertion is that other patients would pay more and that would keep her income stable. Do you see that it doesn't work that way? (By the way - our group stayed in that hospital and is taking a big hit on the no pays. It is costing us money to stay in that hospital, we can't recoup the salary paid to the people we staff it with, so I feel it directly in my reduced paycheck. Again - your idea of how this works is incorrect).

I expect no sympathy, but I expect greater awareness. I expect not to be beaten up by those with a limited understanding of the real situation. What I would like to see is an understanding that every PP radiologist (OK, every PP physician) donates substantial amounts of his/her time to the cause of indigent care. Can we have a cessation of the discussion that doctors do not contribute enough? I know of no other profession, no other business that gives away as much as we do.
Anonymous, in his Leftist, narcissistic zeal to show what a wonderful, caring guy he is, disses the "lucky" for not wanting to do even more than they already do. I'll wager he doesn't pay the amount of tax I do, nor does he donate the services given away by my group. And as Dr. Sardonicus clearly points out, we DO give them away. I can pretty much guarantee that if Anonymous got really "lucky" and won the lottery, he wouldn't give the proceeds to charity, and he would complain loudly about the 50% bite Uncle Sam will remove from the winnings.

All I can do is wish everyone "Good Luck"!


Hal G said...

Well, I hear you on the "luck" factor in achievement. I am not a physician though I work closely w/ many across the globe. I don't begrudge anyone's level of remuneration since it has little to do w/ mine. Nor do I believe just because there are ones who your detractor labeled "lucky" that they should provide a larger share than others. We all consume services and as such pay for those services. Yes, there are many socialized institutions in America (e.g., K-12 education, the GI Bill, Medicare/aid....) which are feasible and/or help those who could not afford a similar private service.

In no way does this imply that when the US spends too much it's the fault of the "lucky" and the wealthy. I came from a very modest upbringing, which was 100 times bettter than my parents' upbringing. I didn't grow up in the depression like they did, it just felt like it.

Nevertheless America has achieved greatness through individual and collective market incentives. Redistributing wealth from the "lucky" will reduce the incentives for those "unlucky" ones and set a converse tone to what makes America great.

Dr. Sardonicus said...

Anonymous (if he is reading) should consider this: I. as a physician, have done well financially. Was there some luck in being dealt a pretty good brain. Well, I suppose so. But, in my group of freshman at college, (the honors dorm) we were all pretty darn good students. I regarded my occupation as being studying and getting top grades, others didn't. Of the sixteen of us in my immediate group, 2 or three became docs. My best friend opted to work 25 hours a week so that he could buy some toys like a great camera, and he didn't study enough. Others just played more basketball or cards. In short, I pounded on myself to produce, most who didn't, didn't manage the grades. But, I guess, in the liberal theology, this, too, can be rationalized away. You see, I was FORTUNATE enough to be born with a strong work ethic, and so should share my good fortune by turning over my income to someone who will decide where it should go.
Now, of that had been part of the deal when I was going to college, I certainly wouldn't have exerted myself to excel beyond what was necessary to stay in college. Only do what would be necessary to keep me at mediocre. Game the system, in a sense, but not really. The system would be telling you that you could only succeed so much. Certainly no point in grinding it out, when you could be sunning yourself on the beach with all the college girls around you.
Is this pure theory? Why no, it was given a valid and prolonged trial. Communism in the middle of the last century really made a run at this income redistribution stuff, with the result that all the economies in eastern europe withered and died. Was anyone on the left taking notes? Probably not, they were the ones on the beach with the girls. Then, 15 years later, when they realized the train has left the station, professionally speaking, they now clamor for income redistribution, in order that they be treated "fairly"

Oh - thx for the shout out.