Arnold Schwartzenegger has a new opponent, and this time he’s battling a desi [Thanks Chick Pea!]. The governator’s latest adversary is the head of the the California Medical Association, Dr. Anmol Mahal. 
The Fremont, Calif., gastroenterologist admired Schwarzenegger’s goals–coverage for all of the state’s 36 million residents and improving health care for kids. “It’s in some ways very visionary,” Mahal said later. But Mahal’s admiration soured when Schwarzenegger revealed that his plan would force doctors to give up 2 percent of their gross incomes to help fund coverage. “We are very discouraged and disappointed,” Mahal complained. “We had no warning.” [Link]
It is strange enough for me to see two of the highest profile Republican governors in the country pick up Hillary Clinton’s banner of universal healthcare, but stranger still for me to see a turbanned face (wearing a turban almost the same shade of blue that Manmohan Singh wears) staring back at me from the pages of the MSNBC article on the subject.
The racial aspect of this is striking because this is a plan designed, in part, to cover the health expenses of illegal aliens. This is a complete about face from former Republican Governor Pete Wilson’s strategy of demonizing illegal aliens. Having a desi doctor as the face of the opposition adds another twist, framing this as a debate between wealthy legal immigrants and poor illegal ones. That makes the politics more interesting, but also more complex.
The crux of the doctors’ disagreement with the plan is the way in which it will be funded:
… nearly 30 percent of the plan’s costs [will be covered] by levying a $3.5 billion “coverage dividend” on doctors’ (and hospitals’) gross revenues. “Why not tax teachers to provide money for better schools?” complains Dr. Samuel Fink, a Los Angeles internist. [Link]Some medical practices would suffer more than others, doctors complain. Assessed on gross revenues rather than net income, the 2 percent fee hits doctors with high overheads harder, including oncologists, pediatricians and general practitioners–whose overhead costs may amount to 50 to 60 percent of their revenues. [Link]
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p>Here is how the costs break down across various economics groups:
… companies with 10 or more employees who do not provide health coverage be required to pay an “in-lieu fee” of 4 percent of their payroll. Hospitals would contribute a “coverage dividend” of 4 percent of gross revenues, while doctors would pay 2 percent of gross revenues. [Link]
The language of fees is important for two reasons. Firstly, the Governor doesn’t want to be seen as raising taxes:
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Schwarzenegger has steadfastly refused to call them taxes, but some of his own allies in the business and fiscal conservative communities say that’s exactly what they are…. some accuse the governor of being hypocritical, noting that Schwarzenegger criticized his Democratic opponent during the 2006 campaign for supporting a plan that would put billions of dollars in new costs on businesses to pay for health care [Link]
Secondly, there is a constitutional issue involved here:
The tax-vs.-fee debate is more than a question of semantics: It could decide the fate of the proposal. Tax increases require a two-thirds vote in the Legislature, while fees need only a majority. The larger threshold would give Republicans virtual veto power over critical pieces of the governor’s health plan. [Link]
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p>The CMA is girding their loins for a hard fight on these issues, hopeful that the administration will yield ground:
Negotiations have only just started. Dr. Mahal promises that the CMA will lobby hard to cut the provision that docs help pay for the plan. Schwarzenegger has signaled that almost everything is open for discussion–“I look forward to everyone having those debates,” he said on the day he unveiled his plan. [Link]
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One thing I’m sure of – Sacramento lobbyists will be as happy as pigs in $h1t for a while …
chick pea, yeah i know what you mean. actually at my school, the onus is actually on the med students to organize talks on such topics, and then try getting their colleagues to come. i think it would make so much more sense to make it an official part of the curriculum, and there has been some movement towards that, but right now it seems like just us trying to educate each other.
Seconded. The AMA, while claiming to look after doctor’s interests, have also inadvertantly made practicing their craft more difficult.
razib: you think I’m the type to hold back on training more docs? Please, I argue for creative solutions, like more training and more incentives for teacher-track types, more choice, etc.
Part of the problem in my area is that the powers that be decided about ten years ago that there would be a glut in my area, there would be no jobs, so they people jumped ship and didn’t join the profession when they heard this talk. These are the same know-it-alls that now realize, uh oh, should have trained more docs in this area….
I’m of two minds on the credentialing thing. I think we should train more docs, but I also see a lot of bad medicine out there and if we are going to ‘lower’ standards (widen the pool), we need to ramp up better training, which means more support of docs who primarily do patient care and teach, like, uh (cough), me 🙂
I second von Mises: a lot of the regulation in medicine, both from within and without, holds back the profession.
The critical parts of medicine are self-regulated because medicine operates more like a guild than most other modern professions around. This makes it much harder to get basic changes through, and means that self-policing covers up a multitude of sins (they are very poor at taking care of criminally negligent doctors, and penalize whistle blowers).
Whether Schwartzenegger’s proposal is good or bad, doctors have to change their attitudes and mode of organization. When hospitals tried to create a standardized checklist of pre-op safety procedures — like what pilots do before take off — they were opposed by doctors who didn’t want standardization on principle – they saw operations more as an art than a craft. That’s absurd. It’s one industrial procedure like all the rest, and too many doctors were making very basic errors to be allowed to go without such basic safety protocols.
Sorry, I’ll write more about this soon – I can actually post on it since one of the main doctors doing research into reducing errors is desi.
I view the AMA the same with I view the teacher’s union – with some sympathy, but largely as obstructing basic necessary changes.
It’s funny how engineers have no problem listening to criticism of their profession, but doctors bridle instantly. I had an ex who started to seethe the minute I mentioned anything about the error rate in operations. Did not want to hear one word of it.
Ennis: I think you are right on the mark about the ‘bridling at error’, but I think a part of it is displaced fear (MD as psychologist!): fear at being seen as a bad doc, fear of being sued, and, well, a certain amount of confidence, nay arrogance, that comes with making life and death decisions.
Ennis, regulation is both good and bad. And, by the way, I’m the type to be into things like checklists. For every good regulation you can bring up, I can bring up a bad one. For instance: our path fellows are required to spend a certain amount of time in clinic, but that clinic time uses up time at the microscope, so that there is a trade-off. Good to learn clinical context, bad to not learn scope skills. I think that a little more flexibility in this from the the accreditors would allow for better training.
I’ll e-mail you: I want to talk to you more about this 🙂
You’re not talking about Atul Gawande, are you? He gave a grand rounds in path around here a while ago….very good speaker, but frankly, it was a bit general and short on specifics. Perhaps he didn’t have time.
MD – Yes, Atul Gawande. I have more to say on the topic, but it’s slightly less well baked or possibly inflamatory, so I’ll save the posts until I have the evidence lined up, but I’m happy to talk offline with you. The nice thing about libertarian doctors is that they’re not knee-jerk defenders of the status quo.
While I am in no way disputing the need for pre-op safety checklists, and I don’t know anything about the specific example you are talking about, surgery is not an industrial procedure. Many “standard” operations are not standardized. Different surgeons have different approaches. One thing you learn in medicine is that there are many ways to skin a cat, and it’s good to know a couple of different ways. Good doctors are adaptable. And medicine is an art as much as it is a science–it has to be, because you are dealing with people, not inanimate disease processes alone.
And I don’t think most young doctors, libertarians or not, are interested in supporting the status quo. Most of us are hoping for change. The AMA is not necessarily representative of most physicians–very few people in emergency medicine, for example, are members.
Razib, I totally agree with you. I don’t think it would be impossible to expand the number of medical school slots and still maintain the same standards. There are a lot of people that don’t get into medical school that are adequately qualified.
Ennis: the reason some of us are libertarian/small gov conservative types is that the status quo makes us insane with annoyance….. 🙂
deshishika: I agree. It’s not a libertarian thing. A lot of docs are ready for a new leadership….or any leadership at all that reflects the daily reality.
Ennis paji — Is there any Sikh related issue you don’t bring to our attention? Most of your posts revolve, either around India/Hindu bashing or Sikh-ism.
enuf: i think he would’ve posted about this even if dr. amol wasn’t sikh.. this is the CMA vs arnold. the president happened to be desi, and a lot of desi’s are doctors…hindu, muslim, sikh, bahai, etc…
but ennis when are there going to be postings about legumes? now that is what i’m waiting for ;).
Huh? The story was brought to my attention by Chick Pea, because Anmol is a desi doctor, not because he’s a Sikh.
What’s the matter – you didn’t like my post on the hottest female law school dean?
while perhaps a part of the problem is the “limited labor supply,” another is the fact that many medical students are discouraged from entering primary care fields, because of the fact that those fields simply do not make as much money as specializing in something…most students are saddled with considerable debt upon graduation–who can blame them?
not to mention primary care fields for some reason have a less “prestigous” reputation–that’s a shame, especially since a lack of primary care is one of the factors that is contributing to our overburdened system. people–especially the working poor–put off seeing a doctor until their faced with acute illness, and are forced to go to an emergency room, when care would be at it’s most expensive. taking pills to treat your hypertension is a lot less expensive than treating a heart attack (which would include costs for the ambulance there, all the physicians that see you, tests they put you through, procedures they do, etc).
btw, i hear there are some up and coming physician organizations, so that the AMA won’t be the only voice for physicians… http://npalliance.org/
“people–especially the working poor–put off seeing a doctor until their faced with acute illness, and are forced to go to an emergency room,”
sparky is this because of the lack of of primary care or the fact that they (the working poor) have no means to pay for primary care?
Are y’all calling AMA an union? Seems like it. Economic theory says unions are great for union menbers, but not so much for everybody else.
Ennis – The link to the post about the hot law school dean, Please.
The Bush proposal to allow tax deductions for individuals purchasing health care seems like a good idea. People with obscenely expensive insurance plans provided by employers pay taxes on the value above 15K and for those whose employer provided insurance is worth less than 15K, u get to take the full amount as a deduction. I think I read the national average as somewhere around 13K. A good first step and definitely better than taxing doctors to pay for the uninsured.
glass houses, you’re right–it’s both. the managed care system has made such that the uninsured are unable to afford even basic care. it also created the system based on reimbursments, which one may argue, contributed to physicians being more attracted to procedure-oriented specialities (where you get paid a decent amount for each procedure you do), rather than primary care (where you get the same amount of money whether you spend 5 minutes talking to a patient or 15 minutes talking to a patient). in any case, there really has been a decline in physicians entering primary care–esp family medicine.
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As someone pointed out earlier, even primary care docs make around 100K and should have no problem paying off their debt. There are also loan forgiveness programs like the Public Health Service and the Indian Health Service. The problem with these is you have to sign up when you start med school for them to be maximally useful to you and people might not want to commit that early. Some med schools also offer scholarships for those hoping to go into primary care. Part of the reason fewer people are going into primary care is that the work hour restrictions make specialties like surgery seem less daunting.
For a lot of poor people who use the ED as their primary care, there are a myriad of complex factors that go into their situation. Lack of access to care is just one. Inability to pay, lack of information about payment plans or free clinics, inability to take time off work to go see a doctor during office hours, and a denial about having any health problems at all are others. Many primary care doctors also take the easy way out, advising patients to be seen in the ER rather than making time to see them during office hours (maybe they are overworked). And finally, you don’t have to pay any money up front when you come to the ER if you just say you don’t have any, whereas most primary care offices expect some kind of payment initially if you don’t have insurance.
certainly, no matter what you go into, you’ll be able to pay off your debt eventually–but rational or not, i think it is still something many consider when they decide what field to go into.
and those programs you mentioned, are great, but i think another thing that deters students from taking advantage of those programs is that you can’t pick where to practice for those years you committed? i may be mistaken on this though, so please correct me if i’m wrong.
No, you’re mostly right. I think you can request to go certain places with the Public Health service, including many urban areas, but you’re not guaranteed to get the assignment you want. You usually owe them 4 years. With the med school programs, you’re usually required to stay in the state. I agree we need more primary care docs, but there are huge shortages of some specialists too–foot surgeons for example (I’m not surprised by that one!).
Chick Pea, can you elaborate on what’s wrong with Kaiser Permanente? I only know of it vaguely, and whenever I toy with the idea of moving to California, Kaiser’s always in the back of my mind as a possibility. What are the drawbacks? Any good things about it? Thanks.
As for the main point of this thread (the 2% fee), all I can say is that if society deems healthcare as something that should be handled by society (i.e government) then it needs to be funded by society too; and like our tax system, the principle of wealthier people giving a higher % of their income to this goal is understandable. But doctors, despite being integral parts of the system, and making their living from the system, should be no more responsible for its financial underpinnings than is anyone else. They should not be responsible for its FISCAL aspects anymore than other members of society with similar incomes to physicians are. It truly is like levying a fee on teachers to fix the educational system, or charging astronauts to enhance the space program.
Amitabh – the notion behind the fee is that doctors and hospitals will be making more money if more people are insured, and therefore they ought to contribute more to this insurance scheme. Whether this is true or not is a different matter, but that’s the rationale.
amitabh: it’s like david vs. goliath, starbucks vs. mom&pops coffee… it’s the giant taking over all the other private practices… i’m a bit biased, since familly has been there for over 30 years and has seen the entire flux of medical care going from private practice to large groups, hmo’s, ppo’s… california isn’t a great climate to practice medicine… it’s a whole new ballgame…
in the past, friends who had kaiser insurance hated it… i’m sure you can get care, and they’ve likely worked out the kinks in the system from 15- or so years ago…
but alas, again, i’m not joining the big guns… too bureacratic for my taste.. if you want more info, feel free to send me an email.
yes eventually you will pay off debt.. i’d just go stircrazy in primary care though…after clinics discussing diabetes and hypertension day after day, it got taxing (in medschool)..kudos and mass respect to those who are doing it though, since they really are the backbone and the so-called ‘real doctors’ out there…
a lot of folks that are in primary care, are having a difficult time making it in california due to cost of living, etc… so it can definitely change the path you would like to pursue based on financial gains in other fields… a person i know was a pediatrician for 10 yrs and then switched into radiology, but not for financial gain (they live in another state), but due to getting tired of the crazy parents… it is also another field that would drive me batty… cute kids, crazy parents…
it is incredibly high, you need to insure people, malpractice issues, etc.. and you need enough places where med students can go for training and see enough patients… low quota, no med school.. programs get put on probation when you can’t meet the requirements…residencies included..
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yes they do, and? it’s not a post about which profession earns the most, deserves the most respect (teachers are amazing, without them, i wouldn’t be where i am today…and i will never forget that), etc..it’s about taxation in california… and yes, to cover illegals, who don’t even pay taxes… maybe i’m a bit harsh, but the line needs to be drawn somewhere…
in the end.. a doctor is a doctor is a doctor.. whether you finish first in your class or dead last.. you’re still an MD… at my school it was pass/fail.. no grades…our motto p=md…
have you seen the film ‘a day without a mexican’… ? yes, it would be a lot harder on us, to pay fair labor rates, but it would be the honest thing to do, and would improve some workers life who are getting screwed in migrant camps around the usa…. i’d rather pay more.. (and yes, likely more than the 2% of my gross income) to buy fruit, get my imaginary house cleaned, etc.. it’s fair and square and legal…
funny thing.. arnold recently broke his leg… i wonder where he went to get his healthcare… oh yeah, ucla, with one of my favorite orthopods… ask him if he told him about the bill he was wanted to pass right before his surgery….. um… likely not.. wonder why he didn’t get his leg fixed in idaho where he had his accident or closer to sacremento…that is another story entirely… this was added for humor sake….
Thank you Chick Pea.
Yes, pea, and I agree – it would be way better to pay people appropriately and to do it through a legalized channel. That said, I really don’t think that’s going to happen anytime soon, so in the meantime I find it disingenuous for people to blame the burden of our social service spending on undocumented migrants & workers.
Looks like we often forget the fundamentals. The wages in this country are gone out of hand whether its health care or any other sector. As a consequence services cost more and the vicious cycle continues. However, things breakdown when the money is tight. If we have real growth in the country government will have no problem funding healthcare at any cost. What Arnold should do is invite physicians from countries where English or Spanish is the language of medical education. They, who have successfully completed the US “medical boards” should be given 5 year visas and contracts to work in state or community hospitals for 50k a year. This is the current scenario in construction, hospitality and food service sectors. Here, the immigrant influx has lowered wages in these sectors enabling living affordable to all of us. Isn’t what is good for the goose is good for the gander?
i’m not blaming the entire burden of social service spending on illegals… but i am going to blame some of it on them…why?
because, i’ve seen a TON, and I mean a ton of illegal women, who have had their kids in california (specifically), and get medi-cal healthcare benefits for them, and continue to live off of my tax dollars without ever working…. my mother once asked one of them if they ever worked, and they laughed and said, ‘why?’… that is when you get frustrated and hit the fan…
chick pea–wow that is disheartening to hear that people abuse the system that way. i’m kind of surprised though–is their quality life really that good, that they don’t feel the need to work and rather just get by on government aid? and i thought most undocumented immigrants came here to work to send money back home? i don’t much about it, i’m genuinely curious.
“i’d rather pay more.. (and yes, likely more than the 2% of my gross income) to buy fruit, get my imaginary house cleaned, etc.. it’s fair and square and legal…”
Chickpea I agree with you but you also said “a lot of folks that are in primary care, are having a difficult time making it in california due to cost of living, etc…”
These two quotes are linked…part of the reason we have a semblance of a middle class in the US is because of the rates we pay our migrant workers (and workers abroad who get 10cents for NIKES that cost 100$ and up)..otherwise strawberries would be 10-20 $ a quart or more (JAPAN)…which would mean that MDs would have to make more $$ to live in CALI or MA or NY, etc. Health care costs would soar accordingly. Which again would leave the lower classes out of the loop. It’s the monopolistic enforcement of scarcity that is the problem. The free markets will ultimately serve the agenda of the elites.
a lot of them do, a lot of them don’t.. a lot of them have found out how to play the system to their favor… and that is making a lot of hospitals overwhelmed with us footing the bill…
california being one of the states that house a lot of illegals… i’ve seen it first hand.
I think it’s a good idea in theory, but 50K? You would be creating an underclass of “foreign” doctors who are making far less than their American counterparts for what will probably end up being a very hard job, and that’s just not fair. 50K is not much more than what most residents make during training.
a lot of them have found out how to play the system to their favor… and that is making a lot of hospitals overwhelmed with us footing the bill…
If you are really ill and you go to the hospital to get treatment/surgery/medicine etc you are not playing or gaming the system. Dont you doctors have to take the hippocratic oath?
I have a friend who is an entrepreneur and who is young and healthy. Therefore he only carries catastrophic insurance for himself. However, when he has a minor condition that he can’t treat for himself (large splinter that went in deep enough to be painful for days) he’s surprised at how much doctors charge. As in (if I remember) close to $200 for the 5 minutes it took to remove the splinter.
Sometimes, when they hear that he’s uninsured but will pay cash, they cut their fees by 2/3rds.
Part of this is about insurance, but part of this also has to do with doctors fees being astronomical. That’s more money per minute than big lawyers charge.
It reduces my sympathy for doctors considerably.
Dont you doctors have to take the hippocratic oath?
heck yeah we do, this is not about hippocratic oath.
Not all doctors feel the same way about illegal immigrants as chick pea. Virginia has a sizable population of illegals, nothing compared to california probably, but still significant. They are very challenging to care for, especially because of the language barrier. It frustrates a lot of doctors, including me. But our society is dependent on illegal immigrant labor for a lot of things, so we can’t begrudge them medical services. If there are idle illegal immigrants, I’m sure they are outnumbered by those who do work, and who often wait until they are very, very sick to come to the hospital because they can’t leave work. I realize things might be different in California, but this is my take on it, working in society’s dumping ground for it’s medical misfits (the ED).
“You would be creating an underclass of “foreign” doctors who are making far less than their American counterparts for what will probably end up being a very hard job, and that’s just not fair.” Desishiksa, this is whatÂ’s happening in every sector in this country. How about the “underclass” immigrants in other sectors? Are you saying it is OK for them? They all work for much lower wages than their American counterparts. The “foreign” doctors have the chance to say no if they desire!
Are you talking about legal immigrants or illegal ones? I don’t think my friends in computer programming are making much lower wages than American programmers. An immigrant working at Macys gets paid the same as an American working behind the same counter.
And you’re talking about the government setting up a program, I assume–government funded jobs don’t have a two tiered system of payment for Americans vs non-Americans.
I don’t think my friends in computer programming are making much lower wages than American programmers. An immigrant working at Macys gets paid the same as an American working behind the same counter.
I do not know whether you are aware of all this or you are willfully ignoring some major occurences: 1) Underemployed, and use of contractors
More than often legal immigrants are underemployed either due to visa bind (H, L, whatever can sometimes stop you from changing employers, and/ or seek promotions), green card processing (that can take upto 6 years, etc., technicalities of labor certification can bar you even from simple promotions, sometimes), and cultural differences. Also, the use of contractors is very wide spread from white collar to blue collar jobs. An example is that an X corporation only hires citizens and green card holders as regular employees but legal immigrants as contractors. Even with strict laws of labor certification, there is a huge bandwidth of salaries to low ball them, and deny them other benefits (medical, retirement, etc.) This is very common, if you look around.
2) H visas/ Green card for physicians
Thre is already H-visas and green cards from physicians where they sign a bond that they will for X years practice/ work in rural (and specified) areas of US in return for sponsorship. Say being a doctor small town in Idaho rather than Boston, and that does limit salary potential. Please visit USCIS (INS) homepage for more details.
You keep your eyes open you will see all this…….otherwise, everything is lalalala
The guy in H1B/GC process gets paid low. But not the contractor, he charges the same or in most cases more than what they pay citizens, because the CEOs dont want the responsibility of the project failing, and hiring 50 people to do a 6 month project. In the end it works out for everyone. Technically the guy is getting paid low but not according to the corporation, they are paying the same amount or possibly more than they would pay for a full time employee.
But not the contractor, he charges the same or in most cases more than what they pay citizens, because the CEOs dont want the responsibility of the project failing, and hiring 50 people to do a 6 month project. In the end it works out for everyone. Technically the guy is getting paid low but not according to the corporation, they are paying the same amount or possibly more than they would pay for a full time employee.
Sometimes yes, sometimes no.
A contractor as a high-end employee – maybe yes, maybe no. A contractor as a janitor – most probably being low balled.
Walk into big corporations, often janitors are contractors. A contractor is not necessarily a C++/ Java software engineer always. Even those cases, sometimes benefits are withheld.
An example is that an X corporation only hires citizens and green card holders as regular employees but legal immigrants as contractors. Even with strict laws of labor certification, there is a huge bandwidth of salaries to low ball them, and deny them other benefits (medical, retirement, etc.) This is very common, if you look around.
How can H-1s be hired as independent contractors? Indendent contractors work for themselves. H-1s need a company to pay them the prevailing wage rate and sponsor their visas.
Middle-men
How can H-1s be hired as independent contractors?
Through a body shop or consultancy company. Some examples are TCS (Tata Consultancy Services) or mom and pop consultancy services for farm work to cleaning services to software. Most of the H-1s are contractors. ALM, sometimes (huge disclaimer: not always) fresh H-1Bs make little more than graduate stipends, with middle men keep a significant share.
Prevailing wages is the median wage for that job in that state (determined by Department of Labor in your area), not even for that company. So company has to only pay median for you to your body shop***, irrespective for what they pay to their regular employees. The devil is in the detail.
Let’s not forget how even green card holders (mostly, diversity lottery folks) who are not well versed in English are treated.
*** They are people who have straight jobs with competitive salaries on visa but cases I am presenting are not at all minority.
Some random thoughts from a callous, insensitive, money-grubbing physician who is texting this in between holes of golf….
1.) Some doctors make a lot of money. Others do not make as much as you think. High gross, but the net profit is sucked away by the overhead (malpractice insurance, licensing exams that we have no control over, arguing with insurance companies who decided they are no longer going to pay what they agreed to pay you for your services). Blah blah blah whiney doctor…I know. – Procedures = money. Multiple Procedures x short procedure time = lots of money – Thought, spending time with patients, figuring out what the hell is going on = very little money
2.) Medical school is freakin’ expensive – I was lucky in that UT Southwestern, a Texas medical school, was relatively inexpensive with tuition of $10,000 per year compared to Columbia (option 2) at $29,000 tuition alone (NYC ain’t cheap and pimpin’ ain’t easy) – There is still college to pay for.
3.) Fees and Licensing exams add up
4.) Malpractice insurance premiums need to be reduced – There should be a loser pays system. You bring a lawsuit against a doctor and lose then you pay the doctor’s attorney’s fees and court costs. Doctors do screw up. Cut off the wrong leg, give someone an antibiotic they are allergic to, sexually assault your patients, fine that’s a resa ipsa loquitor . Those doctors deserve to get sued.
The bottom line is that people sue for a.) bad outcomes not necessarily bad care and b) doctors who are jerks. You can be a crappy doctor (I’ve seen plenty) but if you are all folksy with your patients and they like you, they will not sue you even if you screw up. The current system is almost a bit of a shakedown in which it does not matter whether everything was done right or not. Do I settle for $50,000 or pay absorbant lawyer fees AND take the chance that I might lose (Deal or No Deal).
5.) People want universal health care but no one wants to pay for it – Tax everyone then at flat rate 1%, 2%, 5% of their gross income. No deductions, just a pure flat rate. We all chip in and help one another. We have to pay fees to fund stadiums when we rent a hotel or rent a car, why not health insurance.
If I tell people I’m a doctor they almost have this image that I’m this insanely rich, happy, good-looking, and all around terrific person with a smoking hot wife. Alright I’m only mildly rich. In all seriousness as an intern, resident, and fellow (8 years) I got paid between $35,000-45,000 dollars a year.
If you want to go into medicine do it for the love, not the money. Real estate developers, investment bankers that’s where the insanely rich money is at.
Holler back Pea!
Sifox: ever heard of cost shifting?Those who pay, pay for those who don’t. They are taxed at the time of delivery of care (or the bill).
Are you talking about legal immigrants or illegal ones? I don’t think my friends in computer programming are making much lower wages than American programmers. An immigrant working at Macys gets paid the same as an American working behind the same counter.
Whether they are legal or illegal attempts are made to pay immigrants lower. Low paying hourly sales jobs in Macys will pay the same to all employees. However, managerial or higher jobs do not follow these rules. This kind of discrepancies is seen at higher and also at lowest levels, where salary offers are made following interviews etc… I know south Asian physicians who were offered poor packages to join group practices and also have met computer programmers who are on visas who are paid nowhere close to their counterparts here.
Through a body shop or consultancy company. Some examples are TCS (Tata Consultancy Services) or mom and pop consultancy services for farm work to cleaning services to software. Most of the H-1s are contractors. ALM, sometimes (huge disclaimer: not always) fresh H-1Bs make little more than graduate stipends, with middle men keep a significant share.
But the H-1s are still employed by the middle man/consultancy company. I know about the ridiculous wages paid to H-1s. In fact this whole consultancy racket is just one big fraud. They get college kids with OPT’s about to expire and lure them with promises of H-1 once they have learnt some hot programming language. You have to sign a promissory note worth tens of thousands of dollars and you become a slave to the H-1 granting company. A lot of these companies are set up desis.
Prevailing wages is the median wage for that job in that state (determined by Department of Labor in your area), not even for that company. So company has to only pay median for you to your body shop***, irrespective for what they pay to their regular employees. The devil is in the detail.
True but the prevailing wage rate is a floor and not a ceiling. Also there are skill levels, experience levels etc. Here is a good place for the determination of prevailing wage rate.