Did Reagan kill small business?

[♪alt13]

If Obamacare is making healthcare costs rise, then it failed, correct? Or is it designed to fail so we switch to a one party system? Is that a good thing or a bad thing?

Here is one bad thing about a one party system: The Dr's get paid on a capitation system. Most of America is currently based on a fee for service system. This means that if you go see the Dr, and he does an exam, a throat swab, and a culture, he gets paid for an exam, throat swab and culture. There is incentive for the Dr to see as many patients as he can during the day, because he will get paid more if he does 10 exams vs 3 exams.

In a capitation system, the Dr's don't get paid by procedure. They get paid by patient. This means that Select Health agrees to pay me $10 per patient per month. So, if I sign up for 5,000 patients, I get a check for $50,000 a month for EVERYTHING I do. Now, where is the incentive for me to see more patients? Also, that $50,000 doesn't go into my pocket. I have to pay taxes, my employees, debt, rent, supplies, etc. So, where does a Dr make his money in a capitation system? By limiting employees and patients. Whether I see 100 patients or 1,000, I get paid $50,000. So, wouldn't it be smarter for me to see less patients (this means less expenses, because every patient I have sterilize a room, use cotton swabs, tongue dispensers, the meat paper to sit on, etc) and have less employees?

That is why in other countries there are such long waiting periods to see specialists and Dr's. Because there is NO incentive to become more efficient. If you were told, no matter how hard you work, you will make $5,000 a month, would you bust your rear off, or do the least amount possible? Especially if there isn't any room to advance (promotions/raises/etc)? Then toss in the fact that you are run by insurance companies, and they like to do things like raise subscriber fees (what the patient pays to the insurance company) and decrease what they pay the Dr's (which means they have more money coming in and less going out, profits baby). Why would you work hard, knowing that you playing a game you can't win?

You can have a single payer system that is fee for service.

 

[One Brow]

If Obamacare is making healthcare costs rise, then it failed, correct? Or is it designed to fail so we switch to a one party system? Is that a good thing or a bad thing?

I don't think if ever promised to make every single cost fall, just over all costs not rise as quickly.

That is why in other countries there are such long waiting periods to see specialists and Dr's. Because there is NO incentive to become more efficient.

I agree with you that there are disadvantages to capitation, just as there are disadvantages to fee-for-service. However, I don't see how a practice that hires fewer people and keeps its patients healthy enough to need fewer visit as inefficient. By some notions, that would be more efficient.

Also, isn't Medicare also a fee-for-service program, but is nonetheless single payer? So, being single payer does not necessarily mean capitation. For example, the German system has private insurance companies handling patients, but the policies are paid by the government (with bonuses for handling people with chronic conditions). Germans are happier with their system than Canadians, British, and Americans.

If you were told, no matter how hard you work, you will make $5,000 a month, would you bust your rear off, or do the least amount possible?

Well, if you do too little, you'd lose patients, wouldn't you?

 

[franklin]

There's a huge concept missing from this tidy tale. A tiny bit of federal debt. You paper over a lot when you claim that trade is mutual. The ledger isnt simply balanced, nuff said. Who are the winners and losers? What role does debt play?

I think we need to have discussions about market protections which dont devolve into relying on natural or quasi-natural functions of "the market" to regulate itself. This + debt forgiveness = awesome.

Fixed.

We borrow a little more from China and use it for welfare to those who lost their extremely low paying jobs to China. China does the work and gives the stuff to us for free. Hard to call that anything but a win for us.


China realizes they're screwing themselves which is why they are green with envy. We win no matter what they do. They want their cake and to eat it too but cannot without the CP losing power, so they suck and swallow to keep the masses in check. Their only other option is to democratize and allow their citizens freedom to spend those dollars back into our economy.


Besides, you missed the part where markets (Basel Accords) or mandate (Plaza Accord) eventually force the imbalances to move the other way (i.e. Japan was forced to appreciate their currency in 1985 by dictate, and market forces made them depreciate it after becoming a net importer in the 21st centruy). Trade imbalances never go in one direction indefinitely.

 

[One Brow]

Anyways, hope some of this makes sense.

That makes a lot of sense, thank you. I appreciate why you are so angry and upset. If you don't mind, I'm curious about a little of this.

Is the drop in payout from Delta ($75 of the $80 you are losing) is coming from Obamacare regulations, or would they have done that anyhow?

Also, I've heard of Delta, but not of Select Health. Are they a different insurance company? Can a person with Delta insurance go to Aspen, and if so, does Aspen get $700 from Delta for that crown? Is Delta killing their own provider network?

Also, are you allowed to, and able to, join some sort of loose network with other dentists, that negotiates these things on your behalf? Are you in one?

 

[[size/HUGE] fixed [/size]]

Fixed.

We borrow a little more from China and use it for welfare to those who lost their extremely low paying jobs to China. China does the work and gives the stuff to us for free. Hard to call that anything but a win for us.


China realizes they're screwing themselves which is why they are green with envy. We win no matter what they do. They want their cake and to eat it too but cannot without the CP losing power, so they suck and swallow to keep the masses in check. Their only other option is to democratize and allow their citizens freedom to spend those dollars back into our economy.


Besides, you missed the part where markets (Basel Accords) or mandate (Plaza Accord) eventually force the imbalances to move the other way (i.e. Japan was forced to appreciate their currency in 1985 by dictate, and market forces made them depreciate it after becoming a net importer in the 21st centruy). Trade imbalances never go in one direction indefinitely.

This is too macro for me. Who is "we"? The burden of debt isn't shared in this country in a way that deserves a "we".

 

[green]

That makes a lot of sense, thank you. I appreciate why you are so angry and upset. If you don't mind, I'm curious about a little of this.

Is the drop in payout from Delta ($75 of the $80 you are losing) is coming from Obamacare regulations, or would they have done that anyhow?

Also, I've heard of Delta, but not of Select Health. Are they a different insurance company? Can a person with Delta insurance go to Aspen, and if so, does Aspen get $700 from Delta for that crown? Is Delta killing their own provider network?

Also, are you allowed to, and able to, join some sort of loose network with other dentists, that negotiates these things on your behalf? Are you in one?

As for the drop, Obamacare isn't necessarily the cause, but the excuse. They use the fear of that to explain their rising costs to raise your subscriber fees, and lower payouts to Dr's. So, they use Obamacare fear charge more and pay less, increasing profits, where that money is used for bonuses and lobbying and campaign donations.

Select Health is a different insurance company. Yes, if you have Delta, you can go to Aspen. And Aspen does get $700 for the crown, whereas a solo, small practice doc only gets $500. As far as killing their own network, no, they aren't. Because that small owner doc has to work. When Aspen puts them out of business, they get the Dr. to come work for them. When that happens, Aspen Dental will probably go through what I am going through now, with lower reimbursements.

No, I cannot join together with other dentists to negotiate fees or drop insurances. That would break anti-trust laws. Insurance companies can get together and decide what to pay out (back to the HD/Lowes example a couple pages ago), but if the Dr's do that, or if all Dr's drop an insurance in protest of fees, they will be tried as felons.

 

[franklin]

This is too macro for me. Who is "we"? The burden of debt isn't shared in this country in a way that deserves a "we".

Pardon?

 

[green]

I don't think if ever promised to make every single cost fall, just over all costs not rise as quickly.



I agree with you that there are disadvantages to capitation, just as there are disadvantages to fee-for-service. However, I don't see how a practice that hires fewer people and keeps its patients healthy enough to need fewer visit as inefficient. By some notions, that would be more efficient.

Also, isn't Medicare also a fee-for-service program, but is nonetheless single payer? So, being single payer does not necessarily mean capitation. For example, the German system has private insurance companies handling patients, but the policies are paid by the government (with bonuses for handling people with chronic conditions). Germans are happier with their system than Canadians, British, and Americans.



Well, if you do too little, you'd lose patients, wouldn't you?

Your big assumption is that people would be healthier under a capitation plan. In all the offices where I have worked, capitation patients have been the worst off and needed the most care.

Medicaid, in Utah, was fee for service, but recently switched to capitation. I actually am currently selling one of my practices because I have lost about $50,000+ a month since the switchover. I have had to fire almost the whole staff and have gone from seeing 40-50 medicaid patients a day to 8-10. And I am still running at a loss.

 

[One Brow]

Your big assumption is that people would be healthier under a capitation plan. In all the offices where I have worked, capitation patients have been the worst off and needed the most care.

I can see where, for dental, it would be a bigger issue.

 

[[size/HUGE] fixed [/size]]

Pardon?

Fo real?

 

[Hantlers]

If your small business isn't thriving, it's not because of somebody else, it's because of you.

Perhaps the problem is that instead of blaming ourselves, we want to blame somebody else...somebody else who usually ends up being a big, rich company.

Wanna know why they're a big, rich company? It's because they're better at their business than you are. Things are changing, learn to change with them. Evolve, adapt, do better with whatever you do. Where I live, we have one Starbucks, and it doesn't even get that much business. Why? Because the local coffee shops have better coffee, latte's and whatever else they make there, and they offer competitive prices to go along with great service. Shockingly the local coffee shops that didn't have those went out of business. Is that Starbucks fault? Absolutely not. If you do your job well, then you don't have a problem. If you do your job average to below average, then you have a problem, and it's you.

 

[8]

If your small business isn't thriving, it's not because of somebody else, it's because of you.

Perhaps the problem is that instead of blaming ourselves, we want to blame somebody else...somebody else who usually ends up being a big, rich company.

Wanna know why they're a big, rich company? It's because they're better at their business than you are. Things are changing, learn to change with them. Evolve, adapt, do better with whatever you do. Where I live, we have one Starbucks, and it doesn't even get that much business. Why? Because the local coffee shops have better coffee, latte's and whatever else they make there, and they offer competitive prices to go along with great service. Shockingly the local coffee shops that didn't have those went out of business. Is that Starbucks fault? Absolutely not. If you do your job well, then you don't have a problem. If you do your job average to below average, then you have a problem, and it's you.

Correct, but there are regulations in place that make it much more difficult for entrepreneurs than in previous eras

 

[franklin]

Fo real?

I didn't realize we make the destitute pay down our symbolic federal debt. Please explain this burden you speak of.

 

[One Brow]

If your small business isn't thriving, it's not because of somebody else, it's because of you.

Perhaps the problem is that instead of blaming ourselves, we want to blame somebody else...somebody else who usually ends up being a big, rich company.

Sometimes, this is accurate. Sometimes, the big, rich company leverages assets you don't have in a way you can't match.

 

[b_line]

If your small business isn't thriving, it's not because of somebody else, it's because of you.

Perhaps the problem is that instead of blaming ourselves, we want to blame somebody else...somebody else who usually ends up being a big, rich company.

Wanna know why they're a big, rich company? It's because they're better at their business than you are. Things are changing, learn to change with them. Evolve, adapt, do better with whatever you do. Where I live, we have one Starbucks, and it doesn't even get that much business. Why? Because the local coffee shops have better coffee, latte's and whatever else they make there, and they offer competitive prices to go along with great service. Shockingly the local coffee shops that didn't have those went out of business. Is that Starbucks fault? Absolutely not. If you do your job well, then you don't have a problem. If you do your job average to below average, then you have a problem, and it's you.

Says the gov't subsidized farmer. I agree that in general, this principle of being a smart business works, but sometimes the regulations are such that they favor the big guys, and the small guys can't hack it.

 

[The Thriller]

If your small business isn't thriving, it's not because of somebody else, it's because of you.

Perhaps the problem is that instead of blaming ourselves, we want to blame somebody else...somebody else who usually ends up being a big, rich company.

Wanna know why they're a big, rich company? It's because they're better at their business than you are. Things are changing, learn to change with them. Evolve, adapt, do better with whatever you do. Where I live, we have one Starbucks, and it doesn't even get that much business. Why? Because the local coffee shops have better coffee, latte's and whatever else they make there, and they offer competitive prices to go along with great service. Shockingly the local coffee shops that didn't have those went out of business. Is that Starbucks fault? Absolutely not. If you do your job well, then you don't have a problem. If you do your job average to below average, then you have a problem, and it's you.

Sometimes this is true.

It was probably more true 30 years ago before we returned to Gilded Age economics.

 

[Hantlers]

Says the gov't subsidized farmer. I agree that in general, this principle of being a smart business works, but sometimes the regulations are such that they favor the big guys, and the small guys can't hack it.

I would suggest you not make quips about government subsidized farmers when you don't know if they're actually taking money from the government.

FWIW, I'm against government subsidized farming. But the funny thing is, if it goes away, so do small farms. Basically all it's doing is keeping those farmers afloat so I can't buy their land. I don't need the governments money. I'm good at what I do.

 

[b_line]

I would suggest you not make quips about government subsidized farmers when you don't know if they're actually taking money from the government.

FWIW, I'm against government subsidized farming. But the funny thing is, if it goes away, so do small farms. Basically all it's doing is keeping those farmers afloat so I can't buy their land. I don't need the governments money. I'm good at what I do.

so, you get zero tax breaks for being a farmer or land owner then?

 

[Hantlers]

so, you get zero tax breaks for being a farmer or land owner then?

I get tax breaks for running a corporation. Also, farm subsidies don't really have anything to do with tax breaks. Keep on trying though.

 

[b_line]

I would suggest you not make quips about government subsidized farmers when you don't know if they're actually taking money from the government.

FWIW, I'm against government subsidized farming. But the funny thing is, if it goes away, so do small farms. Basically all it's doing is keeping those farmers afloat so I can't buy their land. I don't need the governments money. I'm good at what I do.

I guess I should clarify a little more, rather than just a one line personal attack. As a landowner, and farmer, I would assume that your land is in the greenbelt classification, so you get a tax break that way. When you went to college, did you get any sort of financial aide or tuition break for being the son of a farmer? Do you get to write off supplies and materials on your taxes? (I know other small businesses get to write off supplies, etc, but the point remains that it is a government subsidy). So while you may not take money from the government, your profit margins would surely be smaller if you had to pay a higher tax rate on land, equipment, etc. Not to mention the benefit you get from being a farmer's kid, or if your kids go to school.