Posted on 04/02/2010 3:44:29 AM PDT by tobyhill
In focusing on the benefits of healthcare reform for small business owners on Thursday, President Obama targeted a group of Americans who need bucking up. Small-business owners are glum. Their optimism is falling despite signs of recovery.
Their outlook is important because, as the employers of just over half of America's private-sector workers, their gloom could slow the economy's progress.
"This healthcare tax is pro-jobs, it's pro-business, and it starts this year," Mr. Obama said in his Thursday speech in Portland, Maine. The nonpartisan Congressional Budget Office estimates that tax credits to cover healthcare premiums would save small businesses $40 billion by 2019.
But it's not clear that small-business owners are buying the argument. Their optimism has turned down in recent months.
It's not that small-business owners aren't looking forward to a recovery. They plan on hiring new full-time employees (26.5 percent in March vs. 10.5 percent in January) and make capital expenditures (49 percent vs. 37.4 percent), according to the Small Business Sentiment Survey released this week.
(Excerpt) Read more at csmonitor.com ...
Oooh goody! I’ve been in advertising sales a long time.
This isn’t good news for the wife and kid . . . Vacation at home this year! Woot! Let’s go to the zoo. We have enough money for the gas baby?
I want the opera and some nice dinners back. Vacation in the caribbean. Remember those days, those of you who have lost in this economy?
Who’d ever hire anyone in this climate? I’d refuse new business before I took on a staff.
I’m a doc in a two person, two location, doc-owned group.
Between the higher taxes, decreased reimbursements, increased regulations, and the rise in cost of health care insurance for ourselves and our employees, it looks like we’re going to have to give it up and join a mega group.
Which is exactly what I think these nefarious bas***** want.
Don’t go to the Carribbean. Just back. The flights are a nightmare and going through security you think you are being arrested or something. Not worth it.
Despite Obama’s “promise” of no tax hikes for those making under $200,000, here it is. Now small businesses will be paying fines (taxes) for not supplying insurance for their employees because the fines will be cheaper for them than having to supply insurance.
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Yup. Regulatory burdens always hit start-ups the hardest too, since they haven’t paid the lawyers and paper pushers yet to sort them out . . . and they are the under 200,000 crowd almost always.
Would you give us some particulars? Which airports/destinations and specific hassles, if you could?
I have been casually asking people who have recently been to Mexico and Costa Rico and everyone just says “It was great! No hassles.” These people are major progressives.
Nassau. American Eagle..Do not do it. Stood in line for 3 hours in the heat and 5 levels of security. Thought I was being booked like go to jail. AWFUL! Everyone hated it. Ruins the trip. You have to go through Bahamas and then US all in the same place.
Costa Rica does everything in it’s power to make the trip smooth for it’s tourists. That being said, no trip is without some degree of hassle.
Whenever flying to Costa Rica, my issues/pains are on the U.S. side, not the Costa Rican side.
With lots of friends like you, I’m interested in the reasons for joining a megagroup. I can think of the following:
1. Cash up front for existing practice.
2. Eliminate headaches of running a small business with high compliance requirements.
3. Ensure full schedule.
4. Time/off coverage
To be honest, I think there may be great advantages to being in a small group in the future. There certainly are today and I think large practices will have a worse time with all the things you mention.
These people should be horse whipped for trying to enslave some of the best, brightest, and most ambitious among us. I hate them for just that alone, much less what they've done to me and my country in the name of "fairness" and "safety".
Not much cash up front for the existing practice, but the other points are valid. The real estate itself is worth something, but less than it was worth 2 years ago.
My enthusiasm for covering any after hours call is waning by the moment!
The main reason for working in a large group practice (in the future) will be the regulation- there is no way one can be a businessman, lawyer and doc all rolled into one- there will be way too much paperwork, and this requires business types to handle it.
I’m interested to know why you feel a small practice will work better under Obamacare? (I hope you are right, I really want to know why you think so!)
With a smaller practice, you will find certain flexibilities and exemptions from regulation that large practices will need to comply with.
As an example, some theorize that a big new “cash for services” market will be created for those that drop out of the government insurance process. If the government tries to force you to quit taking cash, they will withold payment for services rendered to the non-cash group. The smaller the group, the less dependent on government based plan reimbursement you will be. If they penalize a group, it can only be to the extent of the groups reliance on government plan reimbursement. Large groups will undoubtedly be forced to accept large populations of government plan covered patients. You will simply have much greater flexibility in a small group.
There are many possible scenarios where this flexibility could be advantageous. For example, what if the growing backlash against electronic health records creates a demand for a practice that refuses to participate in a government HIE? A small practice could agree to keep only paper records for any given patient, this would be much more difficult to pull off with a large group. Or, perhaps the new insurance requirements will have larger groups looking to contract out to smaller, lower overhead practices.
It’s too early to determine what impact the coming changes will have. At this point, I think there is a 50/50 chance the Obamacare program will be repealed. But, there is a 100 percent chance you will see higher taxes and lower reimbursement. We already have a major restructuring of reimbursement coming with ICD10. Money will be tighter for doctors. With a small group you have much more flexibility and ability to react quickly than in a large group. Not to mention overhead and contractually responsibilities are much greater in a big group.
Although it may sound so much easier to join a large group and let some administrators deal with the hassle, some have found it harder as they end up having to follow rules and practice in a fashion that they resent and are powerless to change.
Steve,
Thank you for your thoughtful reply. I agree that it is too early to know for sure what exactly will happen. I prefer to remain small and local, and your thoughts give me a glimmer of hope that this can happen. Obviously you are very knowledgeable about this.
The best thing I can do for me and our practice right now is know as much about the bill as I possibly can, and be pro-active rather than reactive.
The most honest thing I read yesterday about the bill is that it moves the health insurance companies from providing “insurance” to just being third party payers. If an insurance company cannot exclude anyone, nor drop anyone, then it is no longer “insurance.”
No insurance company in the world would sell homeowner’s insurance to a man while his house is on fire, or flood insurance to a person who lives in a flood plain.
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