Bcbs of nd rate hike

[yzerman19]

I think the above gets me back to my discomfort with healthcare as a business to be invested in. It's a commodity that pretty much everybody needs, like public education, or police and fire protection. Maybe that makes me the ultimate socialist, but as I said before, socialism in medicine has been around for a long time, it's just disguised in that the money shunts through insurance companies rather than the government. Or in the case of Medicare and Medicaid, it shunts through government, then to insurers, and then to providers of healthcare.

Its kind of a keynesian debate then whether or not gov spending into private enterprise is the best way to expand economic growth. At this point we are addicted to it.

The other issue is the mobility of labor/capital. If I am very bright and motivated, I want to get paid. If it isn't in healthcare, I go somewhere else.

Think of the surgeon working 60-70 hours per week for $400k per year. if that becomes $200k, he/she isn't going to work 60-70 hours, requiring more surgeons to keep up with demand. If I am an very talented 22 year old, I then question the value of incurring $200k in debt and foregoing an decent income until I'm 30. Then you lose docs or lose docs with talent.

[yzerman19]

In this case the driver behind size isn't returns to scale, which likely occur early in the scale process, but again the negotiating leverage it gives insurers against hospitals. The bigger you are, the bigger a discount you can get. Similarly the bigger and better your hospital, the more you can get your provider to pay. The premium increases seem to have been worst in the smallest markets, where there is bound to be the least competition.

Anyway Sanford wants to build a monster new hospital and Altru has been thinking about the same, so the price gets passed on because no one can say no. The ACA isn't nearly perfect (oh no some people lost their crappy plans) but it fixed the worst parts.

I've never worked in the NoDak market, but my understanding is that it is monopoly virtually everywhere, on both sides. I guess you have oligopoly on the provider side in Fargo.

Compare that to the Twin Cities, where there are really 3 giant health systems and 3 more medium health systems, a few specialty cartels, and pretty decent competition among 4 payers. Different competitive market. Rural vs Urban healthcare is a very interesting topic from the health economics to the community economics.

[mg2009]

Its kind of a keynesian debate then whether or not gov spending into private enterprise is the best way to expand economic growth. At this point we are addicted to it.

i'm not sure you understand what keynes/hicks was getting at, because it wasn't that. Not really what the general theory was about.

The other issue is the mobility of labor/capital. If I am very bright and motivated, I want to get paid. If it isn't in healthcare, I go somewhere else.

I think you are vastly overestimating the degree to which people make decisions like this on market incentives. I think people get into doctoring because they want to doctor.

Think of the surgeon working 60-70 hours per week for $400k per year. if that becomes $200k, he/she isn't going to work 60-70 hours, requiring more surgeons to keep up with demand. If I am an very talented 22 year old, I then question the value of incurring $200k in debt and foregoing an decent income until I'm 30. Then you lose docs or lose docs with talent.

I'm not sure that this really holds. First off you have a wealth/income trade off. Yes your making less an hour, but now you need to work more to keep up. Second, I'm not sure how much freedom doctors have in setting their hours. I know in finance people work 60-70 hours a week because that what their employer and peers expect of them, take it or leave it. Law I have heard is similar though i'm less familiar with that.

I think surgeons surgeoning a few hours less a week would probably be a very very good thing. I know what happens to me when i go that long, and it isn't any condition its want people doing important things in.

[chicagolandsioux]

Its kind of a keynesian debate then whether or not gov spending into private enterprise is the best way to expand economic growth. At this point we are addicted to it.

The other issue is the mobility of labor/capital. If I am very bright and motivated, I want to get paid. If it isn't in healthcare, I go somewhere else.

Think of the surgeon working 60-70 hours per week for $400k per year. if that becomes $200k, he/she isn't going to work 60-70 hours, requiring more surgeons to keep up with demand. If I am an very talented 22 year old, I then question the value of incurring $200k in debt and foregoing an decent income until I'm 30. Then you lose docs or lose docs with talent.

Reagan and Bush I both used government spending to get the country out of recessions.

[chicagolandsioux]

Breaks are different than handouts and entitlements IMO. If one pays a 1/4 or a 1/3 of their income in federal taxes and someone else pays nothing...zero...into that federal tax pot................

I think we will have to agree to disagree on this so it doesn't go down a political tangent it shouldn't go down.

Back on topic...anything yzerman puts in this space...read it and take the time to understand it.

Though the people who pay little to no income tax pay a higher percentage of their income in taxes than you do. That is why the argument always stops at income taxes and not total taxes as a percentage of income. Because when that occurs the argument of who does not pay income taxes as talking point lose the argument.

[chicagolandsioux]

I appreciate your understanding of this topic, because it's better than mine. The last part of your statement is the part that I still don't grasp. I understand that investors think about percentages, that's a simple concept. We all want to invest our money in areas that yield the best return.

In the example where you said that by law the payments out have to be at least 85% of the premiums paid, the premiums aren't an investment, it's other people's money. The insurance companies keep a percentage of it to cover their cost of doing business. This is why I think that the "absolute" margin matters. As the insurers add more insured individuals to their plan, their cost of doing business per insured individual should go down. They need to employ people to make a formulary, for example, but once they have a formulary, it is applied to each patient. Sure, they have to employ more people to manage all the payments, denials, questions, etc., as they add more insured individuals, but they also have many costs which are fixed, so that each new patient should increase their revenue. Wouldn't this explain how the CEO of a huge insurer like United Healthcare can be paid $5 million? Did he personally invest $30 million and his return on investment is 15%?

You forgot to mention United Health being sued by their stockholders over the Dr. Bill McGuire backdating stock option scam. Where all these shares hit the market devaluing the holdings of the stockholders.

[Oxbow6]

Though the people who pay little to no income tax pay a higher percentage of their income in taxes than you do. That is why the argument always stops at income taxes and not total taxes as a percentage of income. Because when that occurs the argument of who does not pay income taxes as talking point lose the argument.

OK smokey the watchmaker...I'll bite. Factoring in all federal, state and local taxes the bottom 20% of household incomes pay on average of 16% of their overall income in taxes.

Furthermore the top 40% of income earners pay 106% of ALL income taxes and the bottom 40%...negative 9%. Meaning they are getting money back in a refund or "subsidy" at a rate higher than what they put in.

Again this has nothing to do with this thread but welcome back...under your 5th moniker. No one on this site has used "Bush I" other than you.

[yzerman19]

i'm not sure you understand what keynes/hicks was getting at, because it wasn't that. Not really what the general theory was about.

I think you are vastly overestimating the degree to which people make decisions like this on market incentives. I think people get into doctoring because they want to doctor.

I'm not sure that this really holds. First off you have a wealth/income trade off. Yes your making less an hour, but now you need to work more to keep up. Second, I'm not sure how much freedom doctors have in setting their hours. I know in finance people work 60-70 hours a week because that what their employer and peers expect of them, take it or leave it. Law I have heard is similar though i'm less familiar with that.

I think surgeons surgeoning a few hours less a week would probably be a very very good thing. I know what happens to me when i go that long, and it isn't any condition its want people doing important things in.

Been 20 years since I took macro economics, but my recollection of one of Keynes' tenets was that you could generate economic growth through government spending. That is what I am getting at.

You and I are of different opinions on moving location or switching careers, and docs aren't paid by the hour- they are paid on production- or migrating back towards # of patients in primary care and other triple aim incentives.

Why is there a primary care shortage? because even doctors (most of them)who know they want to be doctors choose every other option first, because the difference in comp is so dramatic. Be a cardiologist, make $900k, be a pediatrician, make $120k.

The commonality- investment banking, law, medicine- long hours equals big wallet. Kill the incentive, kill the work.

Good post. This is good conversation

[yzerman19]

Reagan and Bush I both used government spending to get the country out of recessions.

True, they did, in conjunction with tax cuts. Raised spending, lowered taxes. Expansionary fiscal policy that has mortgaged us to the hilt. Obama doing the same. We've spent like Drunken sailors getting us out of the Carter years, with the exception of the Gingrich/Clinton era- where an explosion in tech and com and a balanced budget stopped the bleeding.

[yzerman19]

Though the people who pay little to no income tax pay a higher percentage of their income in taxes than you do. That is why the argument always stops at income taxes and not total taxes as a percentage of income. Because when that occurs the argument of who does not pay income taxes as talking point lose the argument.

Don't 47% of people net a zero tax liability?

[yzerman19]

You forgot to mention United Health being sued by their stockholders over the Dr. Bill McGuire backdating stock option scam. Where all these shares hit the market devaluing the holdings of the stockholders.

That is an unethical, illegal action by a set of individuals. Shouldn't be held against the industry.

[UNDfaninMICH]

Its kind of a keynesian debate then whether or not gov spending into private enterprise is the best way to expand economic growth. At this point we are addicted to it.

The other issue is the mobility of labor/capital. If I am very bright and motivated, I want to get paid. If it isn't in healthcare, I go somewhere else.

Think of the surgeon working 60-70 hours per week for $400k per year. if that becomes $200k, he/she isn't going to work 60-70 hours, requiring more surgeons to keep up with demand. If I am an very talented 22 year old, I then question the value of incurring $200k in debt and foregoing an decent income until I'm 30. Then you lose docs or lose docs with talent.

Trust me, reasonable and fair pay for physicians is near and dear to me. When I make the statement that I'm uncomfortable with healthcare as a business, I'm referencing things like:

-a system of medication development which is based on "what makes money?" rather than "what is needed to solve medical problems?". This gets us things like isomers of already existing medications that work well but are about to come off patent. This also gets us direct to consumer advertising. We also get pharma reps who are paid to try to convince docs that their new product is the way to go, when it should be peer-reviewed literature that drives practice. That point is an issue that docs need to clean up, too. Those reps also have (at least I think they still have) access to prescribing patterns, so they can learn who is and who isn't prescribing their meds, so they know who to target. Absolutely, new treatments are needed all the time, but do we really need eight different brands of PPI's, several of them again just tweaks of existing ones so that a new patent can be obtained as others are coming off patent?

-a system that results in competition for resources (patients and the procedures that come with them). While reasonable people bemoan the use of ER's for non-emergency conditions because of the cost of care provided there, hospitals continue to advertise their ER wait times. Effectively, they're inviting people to come in with their non-emergent maladies, because the wait won't be too long and it will be convenient. In most communities, "wait times" are not applicable to people who have true emergencies, like MI's and traumas, because they get triaged to the front. Hospitals and medical groups are positioning themselves to perform various high dollar procedures, despite the fact that there may be a recognized center of excellence within reasonable driving distance. This is billed as service to the community, but I'm skeptical. Not every community needs a heart transplant program (an extreme example, but you get the idea).

-the fact that MD's can transition into administrative roles, work better hours, generate zero RVU's, and greatly increase their salaries. Does it truly take one million dollars in compensation annually to find good talent to be the CEO of a hospital, or VP of Medical Affairs?

-if execs at relatively small-time BCBS of ND are being compensated near the $500,000 range, one would imagine that is happening in much bigger numbers all over the country. Why is that necessary? Again, the care management/cost-lowering measures that insurance companies bring to the table are things that are quite generalizable across the country. There is no reason to have a different formulary for one plan in one state than for places elsewhere, other than the deals that insurers cut with pharma companies. Criteria for approval for procedures ought not to vary across the country. Centralize this process and employ more of the clerical types, less of the executive types.

As for the physician workforce, I agree with much of what you're saying, but I also agree with what mg says. I want young people to go into medicine because they're interested in it and have talent for it, and by and large that's what I see happening. Absolutely there should be some financial incentive for some of those people to get extra training, and to work within high-risk areas of medicine. There are some areas where this works, others in which it doesn't. Take a look at these slides on dermatology, for example: http://www.medscape.com/features/slideshow/compensation/2013/dermatology Eighth highest compensated specialty, with median comp about $300,000. A full 80% reported 40 hours per week seeing patients, or less. 67% reported less than one hour per week seeing patients in the hospital. Let me tell you, that less than one hour equals "zero" for most of them. No calls from the hospital in the middle of the night asking for them to come in and see patients. Dermatology is one of the most competitive specialties for students to get a residency spot in, so that only the ones who are considered the best and brightest of their class have a shot. Is it because learning the content requires that they be more brilliant than their classmates? Nope. It's because the residency spots are few, and the reward for that training is great pay with great hours. The big compensation comes from the fact that RVU systems value procedures over thinking, technical skills over problem solving, and dermatologists perform tons of quick office procedures.

Medical student debt is another major problem, as you mentioned. Medical students are told that their tuition pays for only a fraction of the cost of educating them. Here in Michigan, Wayne State U gets $32,000 in tuition and fees for residents ($64,000 for non-residents!). They have about 300 students. $9,000,000 per class per year. The last two years of their education are in hospitals, with largely faculty who are paid a relative pittance for having teaching med students, and the costs of the last two years to the school are mainly administrative costs. I have a hard time that believing that the $36 million annually collected in tuition goes to direct expenses of educating medical students. The total cost of attendance they list is about $55,000 per year. Given that many of these students have undergraduate debt that they need to defer so that it accumulates interest during their years of med school and residency, your estimate of debt at $200,000 is unfortunately low. From what residents tell me, gone also are the days of low-interest loan consolidation. This again drives people away from the primary care fields, as you noted.

This is not a complaint about my own state of being, I think I'm compensated well, I enjoy my work (mostly), and my debt from UND comes nowhere close to the debt that students these days are facing. Some residents, through what I would say were less than ideal personal choices (private undergraduate school, non-resident medical school) are projecting to finish residency with $500,000 in debt. I'm worried about the future.

[chicagolandsioux]

That is an unethical, illegal action by a set of individuals. Shouldn't be held against the industry.

Not holding it against the industry.

[MafiaMan]

Reagan and Bush I both used government spending to get the country out of recessions.

Hmnnn...now where have I heard "Reagan" and "Bush" references before...?

http://forum.siouxsports.com/topic/19084-dakota-student-editor-resigns-after-arrest/page__hl__+reagan%20+bush#entry678300

http://www.youtube.com/watch?v=mUg5p3BncuQ

[Oxbow6]

Why is there a primary care shortage? because even doctors (most of them)who know they want to be doctors choose every other option first, because the difference in comp is so dramatic. Be a cardiologist, make $900k, be a pediatrician, make $120k.

Getting back to the RVU and CF this is why you have primary care providers, pediatricians and family practice docs as examples, seeing patients every 10-15 minutes. More RVU volume to offset the much lower CF as compared to their subspecialty/surgeon counterparts whose CF is at a much higher dollar amount per RVU.

[Oxbow6]

Trust me, reasonable and fair pay for physicians is near and dear to me. When I make the statement that I'm uncomfortable with healthcare as a business, I'm referencing things like:

-a system of medication development which is based on "what makes money?" rather than "what is needed to solve medical problems?". This gets us things like isomers of already existing medications that work well but are about to come off patent. This also gets us direct to consumer advertising. We also get pharma reps who are paid to try to convince docs that their new product is the way to go, when it should be peer-reviewed literature that drives practice. That point is an issue that docs need to clean up, too. Those reps also have (at least I think they still have) access to prescribing patterns, so they can learn who is and who isn't prescribing their meds, so they know who to target. Absolutely, new treatments are needed all the time, but do we really need eight different brands of PPI's, several of them again just tweaks of existing ones so that a new patent can be obtained as others are coming off patent?

-a system that results in competition for resources (patients and the procedures that come with them). While reasonable people bemoan the use of ER's for non-emergency conditions because of the cost of care provided there, hospitals continue to advertise their ER wait times. Effectively, they're inviting people to come in with their non-emergent maladies, because the wait won't be too long and it will be convenient. In most communities, "wait times" are not applicable to people who have true emergencies, like MI's and traumas, because they get triaged to the front. Hospitals and medical groups are positioning themselves to perform various high dollar procedures, despite the fact that there may be a recognized center of excellence within reasonable driving distance. This is billed as service to the community, but I'm skeptical. Not every community needs a heart transplant program (an extreme example, but you get the idea).

-the fact that MD's can transition into administrative roles, work better hours, generate zero RVU's, and greatly increase their salaries. Does it truly take one million dollars in compensation annually to find good talent to be the CEO of a hospital, or VP of Medical Affairs?

-if execs at relatively small-time BCBS of ND are being compensated near the $500,000 range, one would imagine that is happening in much bigger numbers all over the country. Why is that necessary? Again, the care management/cost-lowering measures that insurance companies bring to the table are things that are quite generalizable across the country. There is no reason to have a different formulary for one plan in one state than for places elsewhere, other than the deals that insurers cut with pharma companies. Criteria for approval for procedures ought not to vary across the country. Centralize this process and employ more of the clerical types, less of the executive types.

As for the physician workforce, I agree with much of what you're saying, but I also agree with what mg says. I want young people to go into medicine because they're interested in it and have talent for it, and by and large that's what I see happening. Absolutely there should be some financial incentive for some of those people to get extra training, and to work within high-risk areas of medicine. There are some areas where this works, others in which it doesn't. Take a look at these slides on dermatology, for example: http://www.medscape....013/dermatology Eighth highest compensated specialty, with median comp about $300,000. A full 80% reported 40 hours per week seeing patients, or less. 67% reported less than one hour per week seeing patients in the hospital. Let me tell you, that less than one hour equals "zero" for most of them. No calls from the hospital in the middle of the night asking for them to come in and see patients. Dermatology is one of the most competitive specialties for students to get a residency spot in, so that only the ones who are considered the best and brightest of their class have a shot. Is it because learning the content requires that they be more brilliant than their classmates? Nope. It's because the residency spots are few, and the reward for that training is great pay with great hours. The big compensation comes from the fact that RVU systems value procedures over thinking, technical skills over problem solving, and dermatologists perform tons of quick office procedures.

Medical student debt is another major problem, as you mentioned. Medical students are told that their tuition pays for only a fraction of the cost of educating them. Here in Michigan, Wayne State U gets $32,000 in tuition and fees for residents ($64,000 for non-residents!). They have about 300 students. $9,000,000 per class per year. The last two years of their education are in hospitals, with largely faculty who are paid a relative pittance for having teaching med students, and the costs of the last two years to the school are mainly administrative costs. I have a hard time that believing that the $36 million annually collected in tuition goes to direct expenses of educating medical students. The total cost of attendance they list is about $55,000 per year. Given that many of these students have undergraduate debt that they need to defer so that it accumulates interest during their years of med school and residency, your estimate of debt at $200,000 is unfortunately low. From what residents tell me, gone also are the days of low-interest loan consolidation. This again drives people away from the primary care fields, as you noted.

This is not a complaint about my own state of being, I think I'm compensated well, I enjoy my work (mostly), and my debt from UND comes nowhere close to the debt that students these days are facing. Some residents, through what I would say were less than ideal personal choices (private undergraduate school, non-resident medical school) are projecting to finish residency with $500,000 in debt. I'm worried about the future.

You make some great and valid point in all of this.

[chicagolandsioux]

Hmnnn...now where have I heard "Reagan" and "Bush" references before...?

http://forum.siouxsp...ush#entry678300

Yzerman made a statement about government spending and I just said what they had done.

[yzerman19]

Trust me, reasonable and fair pay for physicians is near and dear to me. When I make the statement that I'm uncomfortable with healthcare as a business, I'm referencing things like:

-a system of medication development which is based on "what makes money?" rather than "what is needed to solve medical problems?". This gets us things like isomers of already existing medications that work well but are about to come off patent. This also gets us direct to consumer advertising. We also get pharma reps who are paid to try to convince docs that their new product is the way to go, when it should be peer-reviewed literature that drives practice. That point is an issue that docs need to clean up, too. Those reps also have (at least I think they still have) access to prescribing patterns, so they can learn who is and who isn't prescribing their meds, so they know who to target. Absolutely, new treatments are needed all the time, but do we really need eight different brands of PPI's, several of them again just tweaks of existing ones so that a new patent can be obtained as others are coming off patent?

-a system that results in competition for resources (patients and the procedures that come with them). While reasonable people bemoan the use of ER's for non-emergency conditions because of the cost of care provided there, hospitals continue to advertise their ER wait times. Effectively, they're inviting people to come in with their non-emergent maladies, because the wait won't be too long and it will be convenient. In most communities, "wait times" are not applicable to people who have true emergencies, like MI's and traumas, because they get triaged to the front. Hospitals and medical groups are positioning themselves to perform various high dollar procedures, despite the fact that there may be a recognized center of excellence within reasonable driving distance. This is billed as service to the community, but I'm skeptical. Not every community needs a heart transplant program (an extreme example, but you get the idea).

-the fact that MD's can transition into administrative roles, work better hours, generate zero RVU's, and greatly increase their salaries. Does it truly take one million dollars in compensation annually to find good talent to be the CEO of a hospital, or VP of Medical Affairs?

-if execs at relatively small-time BCBS of ND are being compensated near the $500,000 range, one would imagine that is happening in much bigger numbers all over the country. Why is that necessary? Again, the care management/cost-lowering measures that insurance companies bring to the table are things that are quite generalizable across the country. There is no reason to have a different formulary for one plan in one state than for places elsewhere, other than the deals that insurers cut with pharma companies. Criteria for approval for procedures ought not to vary across the country. Centralize this process and employ more of the clerical types, less of the executive types.

As for the physician workforce, I agree with much of what you're saying, but I also agree with what mg says. I want young people to go into medicine because they're interested in it and have talent for it, and by and large that's what I see happening. Absolutely there should be some financial incentive for some of those people to get extra training, and to work within high-risk areas of medicine. There are some areas where this works, others in which it doesn't. Take a look at these slides on dermatology, for example: http://www.medscape....013/dermatology Eighth highest compensated specialty, with median comp about $300,000. A full 80% reported 40 hours per week seeing patients, or less. 67% reported less than one hour per week seeing patients in the hospital. Let me tell you, that less than one hour equals "zero" for most of them. No calls from the hospital in the middle of the night asking for them to come in and see patients. Dermatology is one of the most competitive specialties for students to get a residency spot in, so that only the ones who are considered the best and brightest of their class have a shot. Is it because learning the content requires that they be more brilliant than their classmates? Nope. It's because the residency spots are few, and the reward for that training is great pay with great hours. The big compensation comes from the fact that RVU systems value procedures over thinking, technical skills over problem solving, and dermatologists perform tons of quick office procedures.

Medical student debt is another major problem, as you mentioned. Medical students are told that their tuition pays for only a fraction of the cost of educating them. Here in Michigan, Wayne State U gets $32,000 in tuition and fees for residents ($64,000 for non-residents!). They have about 300 students. $9,000,000 per class per year. The last two years of their education are in hospitals, with largely faculty who are paid a relative pittance for having teaching med students, and the costs of the last two years to the school are mainly administrative costs. I have a hard time that believing that the $36 million annually collected in tuition goes to direct expenses of educating medical students. The total cost of attendance they list is about $55,000 per year. Given that many of these students have undergraduate debt that they need to defer so that it accumulates interest during their years of med school and residency, your estimate of debt at $200,000 is unfortunately low. From what residents tell me, gone also are the days of low-interest loan consolidation. This again drives people away from the primary care fields, as you noted.

This is not a complaint about my own state of being, I think I'm compensated well, I enjoy my work (mostly), and my debt from UND comes nowhere close to the debt that students these days are facing. Some residents, through what I would say were less than ideal personal choices (private undergraduate school, non-resident medical school) are projecting to finish residency with $500,000 in debt. I'm worried about the future.

This is a great post.

The ER element is interesting, because the hospital makes money. It ties into "medical arms race" where normal economics are thrown out the window, and competition drives costs up- because the insurers are stuck- if they don't pay up, the provider might go non-par and the employers will dump the insurer.

The exec issue is an interesting one- insurance is usually thought of more as finance than as healthcare. $500k for a CEO of a company with a billion in revenue is pretty pedestrian.

Agree on dermatology...if I wanted to be a doc (and I don't, because I am money first, and that made me not go to med school) I would be a dermatologist. Ortho and Cardi can make way more, but they work like dogs.

Its not just med school- my business school debt is $100k. It is a problem. The bigger insult is that when you make more than I think $160k per year, you can't even write off student loan interest.

[BIGSIOUX]

Its not just med school- my business school debt is $100k. It is a problem. The bigger insult is that when you make more than I think $160k per year, you can't even write off student loan interest.

That is bull. Its less than 160 cause i didnt qualify my first year out and i made a little less. Patients ask why services are expensive, i like to tell them that 1800$ /month in student loans is also expensive. Especially wwhen 12k is in undeductable interest.

My favorite line from my accountant when asked about deducting it " according to the government, your too rich!"

[yzerman19]

That is bull. Its less than 160 cause i didnt qualify my first year out and i made a little less. Patients ask why services are expensive, i like to tell them that 1800$ /month in student loans is also expensive. Especially wwhen 12k is in undeductable interest.

My favorite line from my accountant when asked about deducting it " according to the government, your too rich!"

So you're not calling my post bull, you're agreeing that it is bull that you can't write off Ed interest when you clear an arbitrary threshold. I agree! That's why you take loans- to earn a good income!

[UNDfaninMICH]

So you're not calling my post bull, you're agreeing that it is bull that you can't write off Ed interest when you clear an arbitrary threshold. I agree! That's why you take loans- to earn a good income!

This is an issue that irks me every year about this time. It has bothered me less since I've started just discarding the annual student loan interest statement. Just put my head down and keep on paying. It essentially is a way to bump up the rate of taxation on certain higher paid individuals, and that's the part that doesn't feel equitable.

I would propose a system by which student loan interest paid is compared to income earned, to account for what you said: my higher income required higher dollars of student loans.

The deduction starts to get phased out for single people at modified adjusted gross income of $60,000 and goes to zero at $75,000. $125,000 and $155,000 are the numbers for married filing jointly.

So you and your buddy go to get MBA's together. You both get federal loans, because the government feels that you advancing your education is worthy of their investment. You both graduate. You are the one who chooses to work hard and gets promoted, making a handsome salary. You're doing the work your loans and your education gave you the means to do. Your buddy says to hell with it, he wants to go do something else that he finds personally fulfilling, but it also happens to be something that doesn't require an MBA, and his income is below the phase-out threshold. So now the government lets him effectively pay back less of his student loans. Fair?

See what you guys made me do? I was starting to live in blissful neglect of this little thing that pops up every year, and I truly haven't opened my interest statement this year.

Next you'll have me starting my rant on how Medicaid is a form of a tax on people who accept it as payment, because it is government paying about 2/3 of what the going rate is for a service. Can a person go to the grocery store and buy commodities that are a basic need (like healthcare is) and pick up $100 worth of groceries for $65 in food stamps? No? Shocking. I used to be very judgmental towards docs who refused to see any Medicaid patients. Now I realize that they are more comfortable with "medicine as a business" than I am.

[chicagolandsioux]

This is an issue that irks me every year about this time. It has bothered me less since I've started just discarding the annual student loan interest statement. Just put my head down and keep on paying. It essentially is a way to bump up the rate of taxation on certain higher paid individuals, and that's the part that doesn't feel equitable.

I would propose a system by which student loan interest paid is compared to income earned, to account for what you said: my higher income required higher dollars of student loans.

The deduction starts to get phased out for single people at modified adjusted gross income of $60,000 and goes to zero at $75,000. $125,000 and $155,000 are the numbers for married filing jointly.

So you and your buddy go to get MBA's together. You both get federal loans, because the government feels that you advancing your education is worthy of their investment. You both graduate. You are the one who chooses to work hard and gets promoted, making a handsome salary. You're doing the work your loans and your education gave you the means to do. Your buddy says to hell with it, he wants to go do something else that he finds personally fulfilling, but it also happens to be something that doesn't require an MBA, and his income is below the phase-out threshold. So now the government lets him effectively pay back less of his student loans. Fair?

See what you guys made me do? I was starting to live in blissful neglect of this little thing that pops up every year, and I truly haven't opened my interest statement this year.

Next you'll have me starting my rant on how Medicaid is a form of a tax on people who accept it as payment, because it is government paying about 2/3 of what the going rate is for a service. Can a person go to the grocery store and buy commodities that are a basic need (like healthcare is) and pick up $100 worth of groceries for $65 in food stamps? No? Shocking. I used to be very judgmental towards docs who refused to see any Medicaid patients. Now I realize that they are more comfortable with "medicine as a business" than I am.

Bigger picture for you. Do you find it fair someone struggling on 25K a year has to pay 9.5% sales tax on food in Tennessee so that someone making 200K a year does not have to pay any state income tax? Do you find it fair that in almost every red state in the country the lower you go on the income scale the higher percentage of their income goes to taxes than those at the top? Even to the tune of up to five times as much of a percentage? The argument of not paying income tax, such as Oxbow uses, only is to mask the fact that lower income people pay more of their income in taxes than the top. Sadder thing almost is how so many of these people will defend the ones that are giving it to them without a kiss first.

[Oxbow6]

The argument of not paying income tax, such as Oxbow uses, only is to mask the fact that lower income people pay more of their income in taxes than the top.

That argument that a higher % of total income is paid out in taxes by lower income households is BS. "Leftie propaganda"...right smokey??

I will say this again...the lower 20% of household incomes in this country pay roughly 16% of their overall income/dollars earned in federal, state and local taxes. This 20% is also in the bucket that pays a NEGATIVE 9% of the total income tax in this country. You understand the negative part??

Common sense for most people would have been to change their rhetoric and ramble when trying to reenter a message/opinion board and website under a different moniker... especially after getting the boot multiple times!! If you want to get tossed again from this site...I'll dance with you.

[Bison Dan]

I hope Chicagolandsioux comes back and posts when Chicago and the state of ILL file for bankruptcy. Maybe they're just raise taxes again?

[Oxbow6]

Don't 47% of people net a zero tax liability?

Whoa...whoa...whoa Mr. Way-Too-Smart Guy. Don't be bring that garabge here again!!