Saturday, November 27, 2010

If You Are a Physician or a Money Manager, It's Time to Leave the Country

Because I occasionally run columns about leaving the country, I get frequent questions as to when it will be time to leave.

The answer I always give is that there is no set time. It depends upon who you are and especially what industry you are in. If you are a surfer dude, where the only important thing is the height of the waves, then you could probably survive in the United States even if Fidel Castro gains control of the country.

On the other hand, if you are in the securities industry, you should probably already be gone. The SEC is totally out of control. If you raise capital for small companies, the environment in the U.K., especially with AIM, is much better.

If you are going to trade by aggressively digging out information and thus making the market more efficent by doing so, Asia is probably the place from which to do so. The SEC considers this information seeking "insider" trading. Ironically, Don Chu who was arrested this past Wednesday was caught on tape saying he was much more comfortable operating out of Asia because the Asian regulators weren't as intrusive. He should have really gone with that instinct and stuck to operating out of there.

Another group that should be packing bags is physicians. This is what recently caught my eye in WaPo:
Want an appointment with kidney specialist Adam Weinstein of Easton, Md.? If you're a senior covered by Medicare, the wait is eight weeks.

How about a checkup from geriatric specialist Michael Trahos? Expect to see him every six months: The Alexandria-based doctor has been limiting most of his Medicare patients to twice yearly rather than the quarterly checkups he considers ideal for the elderly. Still, at least he'll see you. Top-ranked primary care doctor Linda Yau is one of three physicians with the District's Foxhall Internists group who recently announced they will no longer be accepting Medicare patients.

"It's not easy. But you realize you either do this or you don't stay in business," she said.

Doctors across the country describe similar decisions, complaining that they've been forced to shift away from Medicare toward higher-paying, privately insured or self-paying patients in response to years of penny-pinching by Congress.

And that's not even taking into account a long-postponed rate-setting method that is on track to slash Medicare's payment rates to doctors by 23 percent Dec. 1. Known as the Sustainable Growth Rate and adopted by Congress in 1997, it was intended to keep Medicare spending on doctors in line with the economy's overall growth rate. But after the SGR formula led to a 4.8 percent cut in doctors' pay rates in 2002, Congress has chosen to put off the ever steeper cuts called for by the formula ever since.
This isn't going to sit well with the ObamaCare crew. I won't be surprised if an edict comes down that physicians will be required to take on X number of medicare patients, at incredibly low rates as part of a condition to continue to be allowed to practice in the U.S.

Physicians, according to the WaPo story, are already due for a 25% cut in rates they can charge medicare patients. Lobbyists for physicians have been able to hold off the cuts to date, but when ObamaCare really starts to kick in the cuts will come.

If this comment from  Robert Berenson, a Commissioner of the Medicare Payment Advisory Commission, doesn't sound like trouble for doctors, nothing does. From WaPo again:
The argument that doctors literally can't afford to feed their kids [if they take Medicare's rates] is absurd. It's just that doctors have gotten used to a certain income and lifestyle.
When Commission heads start thinking about doctors earnings as a problem because they have gotten "used to a certain income and lifestyle."  You know that these regulators are using Karl Marx written, and not Adam Smith written, instruction manuals.

I don't think private practice as it is known today survives five years. If I'm a physician, I'm packing my bags. If I'm an aggressive money manager, I'm on the plane.

For most of the rest of us, I think we have a little time, but not much.
The America of my youth is gone forever, together with youth itself, and while this latter cannot be prevented, the loss of the former is a reversible tragedy – although it seems much less reversible than ever, sad to say.
-Justin Raimondo

No comments:

Post a Comment