You're taking a 2.5% hit on the incoming cost, if you are buying the product first and then selling it to the patient (aren't many of the more expensive devices sold directly to the patient?). However, once you pay the extra tax to the company, why is the patient paying it to you? In Illinois you can only be taxed once on item in the distribution chain. I'm confused. Could you talk about something specific, with actual numbers (assuming that doesn't violate proprietary information)?
Sure. A dental crown. Let's say you own a dental lab. It costs you $100 to make the crown (supplies, employees, rent, etc). You sell that crown to the dentist for $105. You put $5 into your pocket. Now, the 2.5% medical tax is on REVENUE, not PROFIT. So, you sold the crown for $105, and you now have a 2.5% tax on that. That is a $2.63 tax on that $105 crown. Now, where does that $2.63 come from? The owner's pocket. Where he pocketed $5 before, now he only pockets $2.37 ($5-$2.63). It looks like a small 2.5% tax, but to that small business owner, it was a 53% tax. So, let's say the owner decides to raise his prices to $110 for the crown. Now, his costs are $100 + the tax ($2.75). But, the owner actually makes a little more money now ($7.25), but costs have increased. So, in this case, the small business owner is ok.
BUT, he passed the cost onto the Dr. Now, the way insurance works is that the insurance companies tell the Dr what they can charge the patient. The Dr can't just raise his prices like the lab owner can. If the Dr does, it is insurance fraud and a felony. So, let's say the Dr gets $500 from the insurance company for a crown before Obamacare. Since Obamacare has been passed, Delta Dental has lowered their payouts by 15%. So, since Obamacare has been passed, the payout on a crown goes from $500 to $425. Now, let's say that it costs a Dr $300 to operate (pay for the drill, impression materials, a cute girl to suck spit, rent, debt, etc) and another $105 for the crown from the lab. That comes out to $405 in overhead. The Dr. puts $95 in his pocket for a 2 hour procedure ($45/hr).
BUT, since Obamacare has passed, payouts have decreased from the insurance company from $500 to $425. AND the lab owner has raised his prices from $105 to $110. So, my costs have gone up to $410 for that crown. BUT, I only received $425 in payment for the crown. So that means I worked for two hours for...$15.
How can I stay in business for $15, when I need $80,000 a year just to pay taxes and student loans? And no, my student loan debt isn't that high compared to a lot Dr's. I am on the LOW end of debt.
That is what I am talking about when I say that these taxes are a lot bigger than they seem. 2.5% seems like a small number. Who can't afford 2.5%? BUT, the way it is taxed makes a HUGE difference.
That is just what is happening to me currently.
So, what happens? I go out of business. Aspen Dental, who has contracted with Select Health for higher reimbursements, puts out ads for free exams and xrays, knowing that I can't afford to offer that, and knowing that Select Health pays me $425 for a crown, but pays them $700 for a crown. The ironic thing is, you see the ad for free exam and xrays, go to Aspen Dental instead of me, and you end up paying more for you crown than you do with me (you pay 50% of the fee, so $213 vs $350), but because insurance companies are exempt from anti-trust laws, they can do things like this and you are no one the wiser.
Anyways, hope some of this makes sense.