Thursday, December 27, 2012

Paradoxes: What Happens If Doctors Fall Off Fiscal Cliff?
A paradox is an argument that produces an inconsistency or absurdity, typically without logic or common sense.
Definition of Paradox
December 27, 2012 – A “doc fix” is unlikely in the next four days.  If a deal is not struck, doctors will fall off the fiscal cliff.  For physicians, this means a 26.5 % SGR cut and a 2.0% sequestration reduction,  on top of a 12% to 13% hike in income taxes for the typical doctor.
According to the tax policy center, going off cliff will produce these tax increases.
·         Incomes of $75,000 to $100,000 - $3688 increase

·         Incomes of $100,000 to $200,000 -$6633 increase

·         Incomes of $200,000 to $500,000 - $14,643 increase
It can be argued, of course, that it’s about time government redistributed income from the “haves” to  improve the lot of the “have-nots” -  those on Medicare and Medicaid and with income 4 times below the poverty line.
Still,  there is something inconsistent, illogical, noncommonsensical, and pradoxical  about this approach, which Obama seems to favor.  

It is paradoxical  that his administration refuses to cut entitlements – the major factor behind the budget deficit.  It is  paradoxical in a capitalistic economy that historically raising taxes always decreases government revenues to help the poor.

The third paradox is that if doctors lose 28.5% of Medicare revenues by going  over the cliff, some 30% to 50% of physicians will respond by stopping  seeing Medicare and Medicaid patients since reimbursements from these sources will no longer meet their practice expenses – all of this just as 78 million baby boomers and 30 million to 40 million are becoming Medicare and Medicaid eligible.  

Physicians are being told by some politicians, that none of this will ever happen.  A “patch” will be found.
These paradoxes and the patch theory  remind me of the old slave song,  “Rabbit in De Briar Patch,” which goes like this.

Rabbit in de briar patch,
Squirrel in de tree.
Wish I could go huntin’,
But I ain’t free.

Rooster’s in the hen house,
Hen’s in de patch,
Love to go shootin’,
But I ain’t free.

Rooster’s in de hen house,
Hen’s in de patch,
Love to go shootin’
But I ain’t free.

Rooster’s in de henhouse,
Hen’s in de patch,
Love to go shootin’,
But I ain’t free.

Doctors may no longer be able be free to see patients on entitlement programs who need their services,  and patients may be unable to find doctors to provide those services.
Tweet: If doctors go over the fiscal cliff, they may be unable to afford to see Medicare and Medicaid patients.

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