Doctor Fate wrote:To the first, consider that, what, about 12% more patients will be put on insurance. That can't help but impact waiting.

As to the second, so a heart surgeon steps down into PCP? Or, do you mean more doctors decide to go that route from the beginning?

The only downside I can see to that is they know they are signing up for less money (at least according to the bill, which again cuts Medicare reimbursement rates) and more red tape.

I guess we'll see.

danivon wrote:

Doctor Fate wrote:To the first, consider that, what, about 12% more patients will be put on insurance. That can't help but impact waiting.

Sure, but if the average wait for a doctor appointment is 2 days, an extra 12% would tend to make it go to...

2 days and 2 hours (based on 8 hour opening).

The only downside I can see to that is they know they are signing up for less money (at least according to the bill, which again cuts Medicare reimbursement rates) and more red tape.

On the other hand, if there's lower demand for non-PCP doctors, they could still not be relatively worse off.

I guess we'll see.

Not if the bill is repealed before it comes into full effect we won't.

Doctor Fate wrote:I'll leave it to office scheduling professionals, but I seriously doubt this is the end of the story. In other words, I think it's more complicated than just adding 12% to the time.

Again, I think this misses the mark. What it could mean, potentially, is less crowded ERs. However, I doubt we'll see ERs closing down because of new folks on insurance.

danivon wrote:Well, the rich tend not to be 'employed', don't they? Employees tend to be in the middle- and working class.

danivon wrote:Or, they pay the 'fine'/'tax' that would probably be lower, based on their income.

In 2010, House Ways and Means Committee Republicans issued a report saying the IRS may need as many as 16,500 additional auditors, agents and other employees "to investigate and collect billions in new taxes from Americans."

That assessment has been widely cited by opponents of the law. The IRS disputes the jobs number but hasn't offered another one.

"That is a made-up number with no basis in fact," IRS spokesman Dean Patterson said in an email. "The 2012 budget calls for about 1,200 employees for the IRS to implement the (Affordable Care Act), and the vast majority of those employees are needed to build technology infrastructure...

Purple wrote:Just a quick note. I'm pretty sure I've seen somewhere above in this thread the "fact" that the IRS will have to hire something like 16,000 new employees to enforce the ACA. This morning I ran across this (emphasis added):

In 2010, House Ways and Means Committee Republicans issued a report saying the IRS may need as many as 16,500 additional auditors, agents and other employees "to investigate and collect billions in new taxes from Americans."

That assessment has been widely cited by opponents of the law. The IRS disputes the jobs number but hasn't offered another one.

"That is a made-up number with no basis in fact," IRS spokesman Dean Patterson said in an email. "The 2012 budget calls for about 1,200 employees for the IRS to implement the (Affordable Care Act), and the vast majority of those employees are needed to build technology infrastructure...

I'm not suggesting that the IRS should be perfectly trusted and the House Republicans completely ignored - I merely wish to cast doubt on the final accuracy of the 16,500 number (and suggest that it not be referenced without proper attribution).
http://apnews.myway.com/article/20120707/D9VS2E3O0.html

Top IRS officials have been working with Democrats on Capitol Hill to determine how the agency will enforce President Obama’s new health care law. Republican lawmakers estimate the legislation will require the hiring of many thousands of new tax enforcement agents.

While it’s still not known exactly how many will be hired, here’s what’s clear: Under the new law, the IRS is required to fine taxpayers thousands of dollars if they do not purchase health insurance. In order for the government to enforce compliance, tax authorities will need information, for the first time, about people’s health care. Collecting that data will require more IRS personnel.

Consider what has happened in Massachusetts, which passed a similar health care bill in 2006. To enforce the individual mandate, the state’s Department of Revenue asks filers what kind of insurance they have, as well as details like whether their “sincerely held religious beliefs” are moving them to petition for an exemption from the requirement.

The form also asks workers whether their employer gives them “affordable” coverage, forcing some employees to decide between tattling on their workplace and submitting false information to tax agents.

Critics have slammed the new federal mandate for its harsh consequences (failing to buy health insurance could land you in jail) and have raised constitutional questions about its legality. And they point to the Obama administration’s recent efforts to ramp up IRS audits, especially of small businesses, as evidence that the mandate is likely to prove more onerous than previously thought.

The Obama administration’s plan to increase audits is in line with a long-term agency goal of ending the “tax gap,” bureaucratese for the amount of uncollected taxes each year. In 2001, the IRS estimated the gap at around $300 billion.

Critics call the agency’s estimates dubious and fear the tax agency will overreach in its efforts under Obama, who launched a tax task force last year in part with the goal of collecting more revenue.

A July 2009 report from the agency says the IRS is going to “increase audit coverage and better target returns for examination” including focusing on Schedule C audits that often target small businesses and the self-employed.

The document also says tax agents will share details with state enforcement agencies to increase enforcement efficiency.

To examine more Americans’ tax filings, Obama is proposing more money for the agency. His latest budget proposes “over $8 billion in the Internal Revenue Service’s enforcement and modernization programs” to support “significant new revenue-generating initiatives that will target critical areas of non-compliance.”

The administration’s plans are exacerbating concerns of some critics with the health care bill’s mandate, in part because it will require a veritable new army of enforcement agents.

A March 18 report from House Ways & Means Committee Republicans estimates the IRS will need to hire between 11,800 and 16,500 new agents to enforce the bill.

The Obama administration is quietly diverting roughly $500 million to the IRS to help implement the president’s healthcare law.

The money is only part of the IRS’s total implementation spending, and it is being provided outside the normal appropriations process. The tax agency is responsible for several key provisions of the new law, including the unpopular individual mandate.

The IRS would receive additional money for taxpayer services and tax law enforcement, and several financial regulatory agencies also would see funding increases to help them enforce Wall Street reforms, under a spending bill approved Tuesday by a Senate panel.

The Appropriations subcommittee on financial services and general government, meanwhile, released no information regarding a potential federal employee raise in January 2013. A summary of the bill is silent on the issue, and the question of a raise did not arise during the subcommittee’s brief meeting to approve the bill. The White House has requested a 0.5 percent raise, but the House counterpart bill would leave salary rates unchanged for the third straight year.

The Senate bill would provide $12.5 billion for the IRS in fiscal year 2013 which starts in October, an increase of 6 percent from the 2012 level but still 2 percent below the White House request.

Purple wrote:I'm not suggesting that the IRS should be perfectly trusted and the House Republicans completely ignored - I merely wish to cast doubt on the final accuracy of the 16,500 number (and suggest that it not be referenced without proper attribution).

Doctor Fate wrote:Believe what you want, but the government cannot keep up with all the individuals, small businesses, and big businesses, regarding their compliance to Obamacare mandates if they don't increase staffing at the IRS.

Doctor Fate wrote:

danivon wrote:Or, they pay the 'fine'/'tax' that would probably be lower, based on their income.

Which shows this law does not seriously address the "free rider" problem.

Purple wrote:Dr. Fate: PLEASE READ AND CONSIDER what I write before responding.

Purple wrote:I'm not suggesting that the IRS should be perfectly trusted and the House Republicans completely ignored - I merely wish to cast doubt on the final accuracy of the 16,500 number (and suggest that it not be referenced without proper attribution).

then...

Doctor Fate wrote:Believe what you want, but the government cannot keep up with all the individuals, small businesses, and big businesses, regarding their compliance to Obamacare mandates if they don't increase staffing at the IRS.

What's your problem? I'm not allowed to point out that the 16,500 might be biased? And by what twisting to you get from what I wrote to an imputation that I said no additional hiring would be needed?

Chill out.

"That is a made-up number with no basis in fact," IRS spokesman Dean Patterson said in an email. "The 2012 budget calls for about 1,200 employees for the IRS to implement the (Affordable Care Act), and the vast majority of those employees are needed to build technology infrastructure.

danivon wrote:

Doctor Fate wrote:

danivon wrote:Or, they pay the 'fine'/'tax' that would probably be lower, based on their income.

Which shows this law does not seriously address the "free rider" problem.

how so? They either pay for insurance or they pay a fine/tax and get minimum cover. Don't look like 'free-riding' to me.

Doctor Fate wrote:Pre-existing conditions cannot be exclusionary, the tax for not having insurance has no punishment for failing to pay it (so far), so what's the downside of free-riding?