Forced Labor For Physicians

April 15, 2012 in Health Policy by RangelMD

It’s tax day and not only does Mitt Romney pay a much lower overall tax rate than 99% of Americans (by virtue of his income coming from investments and not salary), he doesn’t even have to get out of bed in order to earn up to 21.6 million per year. In fact, mega-investors like Warren Buffett and Mitt Romney probably make more money while having a bowel movement than many Americans make all year.

And this makes liberals mad. So mad that they want the investment income of multimillionaires to  be taxed at the same higher rate that many working Americans pay. Fair enough. But this still doesn’t change the fact that millionaires like Mitt and Warren don’t have to lift a finger in order to make millions. Inequality still exists! Perhaps in addition to a higher tax rate, members of the non-working 1% should be forced to perform a set amount of labor, maybe for charity? Mr. Buffett could give out free individual investment advise and Governor Romney could . . . . . do whatever he does.

Why not? After all, many physicians are regularly forced by the Federal government  to perform thousands of dollars per year in non-reimbursed charity care while being specifically prevented from claiming a loss for such care on their taxes. The scam works like this. The Federal government requires (EMTALA) all full service hospitals that accept Medicare and Medicaid to “treat and medically stabilize” any patient who presents to their emergency room regardless of their ability to pay. Because the Federal government has never effectively defined the condition of being “medically stable”,  patients usually undergo the full gambit of tests and treatments as appropriate for their condition regardless of their ability to pay. The cost of this care is often in the range of tens of thousands of dollars per hospitalization and is often beyond the financial ability of a patient who was unable to afford the cost of health care insurance in the first place. Hence, much of the cost of this care goes unpaid.

A business that loses income from a customer’s inability to pay is often able to claim a tax deduction as a business loss. In order to claim this deduction, the business must show that it incurred a net loss from providing services or products without receiving reimbursement.  However, this only applies to business expenses and not individual effort. A hospital based physician who saw and cared for a patient who never paid for these services cannot claim a deduction on his or her taxes because the physician’s business never lost any money. It is the hospital that will be able to claim a deduction on its business taxes since the care received is a service that consumed supplies, a room, and the time and effort of hospital employees who then must be paid.

As a hospital based physician I earn only what I can bill insurances and the occasional uninsured patient who pays out of pocket. In the course of a year I guesstimate that I perform $40 to $90 thousand in uncompensated care for uninsured patients admitted through the ER as required by Federal law. This is not chump change. This represents not only an extensive amount of my time and effort as well as my expertise earned from prolonged and intensive medical training but the legal liability of a doctor patient relationship for which the non-paying patient retains full legal rights to sue me for any reason.

But it’s not charity care that angers me. I would much rather have a “treat first” and worry about the billing later policy and many of these uninsured patients are in dire need of care. What angers me is that fact that I feel “forced” to work for free by the laws of the same Federal government that won’t give me so much as a pat on the ass and a “good job” before taxing the rest of my income at a rate higher than Mitt Romney’s. I’m not lucky enough to be able to earn thousands of dollars from investments while sitting on the toilet reading the Wall Street Journal. Every cent I earn is from actual work.

If the liberals can complain about unequal tax rates for millionaires then I can complain about uncompensated labor forced by the Federal government. It’s time that physicians receive an individual tax break for uncompensated care performed under Federal EMTALA laws.

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