April 11, 2010

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First there was Dr. Cassell firing patients. Then there's "dermdoc" bragging on a message board that he has just laid off his first Obama-voting employee. From CBS News' Political Hotsheet:

Last Friday, someone going by the name "dermdoc" posted a thread on a message board for Texas A&M students and alumni with this topic: "Laid off my first Obama voting employee today."

"Our reimbursement rates are spiraling downward, taxes are projected to go up with Obamacare, so I did it," the person wrote. He later added: "I made this decision because I can."

"It is kind of interesting watching their face as you explain to them the economic consequences of the policies of the guy they voted for," wrote dermdoc.

The original message board thread has now been removed, but that didn't deter "dermdoc" from expanding on his original thesis.

"Elections have consequences," wrote dermdoc. "If you vote for someone who raises my taxes and lowers my income, you pay the cost."

"My office manager and med business guru have calculated that this is just the beginning. Tax rates are going to go through the roof with additional Obamacare taxes AND the expiration of the Bush tax cuts," he added. "And most analysts think reimbursement rates for docs will go down about 20-25% the next 2 years, and that is BEFORE Obamacare really kicks in."

(h/t Mugsy)

Before I go sideways ballistic on this guy, I'll try and sort out fact from fiction, just a bit.

Reimbursement Rates for doctors

Reimbursement rates for doctors are part of the famous "docfix" package that Sen. Tom Coburn (R-OK) is holding hostage along with an extension on unemployment benefits. The House passed the docfix last year, but the Senate is a bit slower on the uptake, largely due to the political obstructions placed on the pathway by the likes of Senator Coburn and his cohorts.

From the name "dermdoc", it can be inferred he is a specialist, probably a dermatologist. Specialists are a bit piqued about the health reform bill because it allows for a bonus to primary care providers, to encourage incentives for more to either return to or enter the field.

As insurance companies took over more health management authority, it was far more lucrative for doctors to skip primary care entirely and jump into a specialty. Medicare and insurance reimbursement rates have always been far in excess of what they pay primary care physicians. There are two consequences to this. First, the number of primary care physicians dropped drastically; and second, health care costs careened out of control as specialists tended to order state-of-the-art testing and treatments.

One of the centerpieces of the health care reform bill is to put primary care providers back in the center of the health care picture. This is good for us and it's good for reducing costs, because most conditions don't require a specialist, and having a primary doctor who knows you, your family, and your specific circumstances means there's a history they can draw upon to make decisions about treatments. This doesn't mean specialists aren't necessary. They are, but not always as a first-line option.

Consequently, specialists are a bit annoyed at the prospect of losing their monopoly over different parts of your body to a more holistic approach.

Beyond that, isn't it time that doctors considered the cost-saving measures in the law? After all, streamlining claims procedures, Medicare codes, implementing electronic health records, and standardizing it all is also part of "Obamacare". Doesn't it make sense that if they save money on these aspects of providing care, it will flow through to them?

dermdoc's real issue: The Bush tax cuts expire 12/31/2010

Make no mistake. When the Bush tax cuts expire, there will be screams from many different corners of the country. All the high rollers will (gasp!) have to pay a reasonable income tax for the privilege of keeping 75 cents on every dollar or so. Pardon me if I don't bend over weeping for those earning in excess of $300,000 when they have to pay extra taxes. That Medicare tax increase for "Obamacare"? An extra $900 or so. Big Frickin' Deal.

And check this comment on the same thread:

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But race didn't have anything to do with this doctor's feelings toward Obama, his employee, or the health care bill, did it? None whatsoever. Sure thing.

My personal message to whining doctors

Get over yourselves. It's law, it's staying law, and you're going to make a boatload of money one way or the other so you can fund your racist conservative teabagging buddies in the Southern states. If it's so repugnant to you to practice medicine for the welfare of patients instead of the welfare of your checkbook, get out of the medical profession, get out of the way, and let someone who gives a damn step in your place.

And pass your 35% tax credit for insuring those employees over this way, would you? The most absurd part of this doctor's rant is that he either doesn't give his employees health insurance, in which case he's part of the problem, or he does. If he does, and his practice has less than 25 employees he's entitled to a 35% tax credit on what he pays to cover them. A dollar-for-dollar tax reduction on cost of benefits for employees that he didn't have last year.

In the end, all politics is local, and what dermdoc did was retaliate out of political pique at an employee who now will drive his tax bill up by claiming unemployment benefits. Good job there, dermdoc. Mighty compassionate of you, but not very fiscally responsible.

UPDATE (Nicole): Apparently unused to the wild and wooly world of the blogosphere and the unvarnished criticisms that go with it, "dermdoc" has denied any layoffs and slams the media for not doing any actually confirming before running the story (h/t Scott):

there was no layoff of anyone at my office.

Any of you reddit dweebs can check my employment records or call my office on Monday.


I was merely making a hypothetical because of frustration with decreased reimbursements and future increased taxes.

It is really hard to believe that simply by posting a topic on the internet that I could make newspapers, several national talk radio talk shows-WITHOUT ANY VERIFICATION.

Whatever. What has the US become when you have entire web sites of people sitting around just waiting to screw with people and their families without even checking out the source.

Granted, all of this is my fault but any "Ag" who would screw with other Ags or this website because of one unverified post needs to seriously check out their life.

All you lefties can call off the preemptive strikes on me or my family, my wife actually was the one who made me do this because she feared for our safety.

I am done.

Guess dermdoc should consider himself lucky that his story wasn't one that Drudge, Malkin or Breitbart would have a problem with. If he thought lefties were harsh on him, can you imagine what those readers would have said?

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