Shutdown

[dgs49]

An acquaintance of mine is a tax auditor for EY, and he was overwhelmed by the number of inquiries and magnitude of the issues generated by the medical device tax. Many manufacturers were completely blindsided by the scope of what constituted "medical devices," e.g., contact lens solution, sanitary pads, condoms), and ended up - at least in the first year - having to pay huge amounts of money out-of-pocket, because the tax could not be dumped on their customers, retroactively. And at $30+ Billion per year siphoned out of the economy, it is exactly the sort of tax increase that we don't need. Certainly, if an up or down vote could be taken in Congress, this tax would be killt.

[dgs49]

IMHO, single payor, while a sensible option in the abstract, is simply not feasible in this country. There are far too many huge vested interests that have been created and thrived under our current medical delivery system.

Most obviously, why would we need any insurance companies if we had single payor? The functions of insurance are basically spreading risk and administration. But if everyone and everything is covered, and administration is what government arguably does best, why the fuck would we need a thousand health insurance companies?

I had some time to kill yesterday morning and I've been having problems with a clogged ear, so I thought I'd see if they could clean it out at a local "Urgent Care" center. There were at least five people staffing the place (it was brand-new and beautifully appointed), and I was the only patient on site for the half hour or so while I was there. The actual cleaning was done by a doctor. He did a thorough job, and proved it by pointing a laser into my right ear and projecting it onto the opposite wall. Quite impressive.

I shudder to think who is paying for all this. (It cost me $100 out of pocket, as it was "out of network" for me).

[Guinevere]

An acquaintance of mine is a tax auditor for EY, and he was overwhelmed by the number of inquiries and magnitude of the issues generated by the medical device tax. Many manufacturers were completely blindsided by the scope of what constituted "medical devices," e.g., contact lens solution, sanitary pads, condoms), and ended up - at least in the first year - having to pay huge amounts of money out-of-pocket, because the tax could not be dumped on their customers, retroactively. And at $30+ Billion per year siphoned out of the economy, it is exactly the sort of tax increase that we don't need. Certainly, if an up or down vote could be taken in Congress, this tax would be killt.

Bullshit. The regulations specifically state that contact lenses, eyeglasses, and other commonly purchased retail items are not medical devices.

[Big RR]

Indeed Guin; from the Fed Reg sections you posted it appears that the operative test is whether a trained medical professional is required to install, implant, or operated the device; general retail items are specifically exempted.

[rubato]

http://www.lawyersgunsmoneyblog.com/201 ... eir-houses

Pox on One of Their Houses
[ 4 ] October 7, 2013 | Robert Farley

Noted lefty nutcase Ben Wittes:

To put the matter simply, the current Republican insistence on attaching conditions to a continuing resolution to keep government open is nothing more or less than the elevation of domestic disputes over Obamacare and fiscal matters above the security of the country as a whole and above the physical safety of its population. It is as reckless as it would have been for Democrats to shut down the government over the Bush tax cuts. And it is no less apt to raise questions about the seriousness of those who would do it.

And what of a President who—as Bush surely would have done in my hypothetical and as Obama is currently doing—stands firm and refuses to negotiate away a signature domestic initiative in the face of congressional insistence on linking its denuding to the essential security of the nation? Should we not also question such a president’s seriousness for failing to capitulate, given the stakes? Is this not a case in which it takes two to tango?

I am, generally speaking, a pox-on-both-houses kind of guy, but I have trouble seeing it that way this time. It was the House Republicans, after all, who attached these conditions to the continuing resolution, thus putting the President in an impossible situation—one in which he either lets the government shut down or both gives up a signature domestic initiative and, along the way, makes clear the presidency’s vulnerability to the most grotesque types of brinksmanship and extortion. No president worth his salt would negotiate under these circumstances—and the responsibility for the situation is thus not even between the parties. One side, and only one, created this crisis.

yrs,
rubato

[Reality Bytes]

Do you guys & gals have any best guesses as to how much longer the shutdown could go on for? Is there any sign at all of movement or deals being discussed? I need it to be over before Friday as they have shut down NASA! This makes RB a very unhappy bunny as my bucket list premium behind the scenes tour of Kennedy including the VAR & Mission Control is currently suspended and since its been 34 years since I was last in Florida and probably will be another 34 after this week before I go back again they need to stop pissing about and throwing tantrums and just get on with it.

[MajGenl.Meade]

Never mind, NASA. Never mind, medical disaster. Never mind all that.

The last straw is the Civil War Soldiers and Sailors database is shut down!!!

Because of the federal government shutdown, all national parks are closed and National Park Service webpages are not operating. For more information, go to http://www.doi.gov

.

That's it - I'm becoming a liberal. At least they kept the trains running er....website running

Meade

[Guinevere]

http://www.huffingtonpost.com/gov-deval ... 57633.html

Gov. Deval PatrickGovernor, Massachusetts
Health Care Reform Works in Massachusetts and It Will Work in America
Posted: 10/07/2013 10:59 am

As the Affordable Care Act (ACA) takes effect this month, it might be helpful for people to know how its prototype in Massachusetts is working, after nearly seven years.

Virtually every resident in the Commonwealth is insured. More private companies offer insurance to their employees than ever before. Over 90 percent of our residents have a primary care physician. Primary care is less likely to be delivered in expensive emergency rooms. Preventive care is up. Health disparities are down among women, minorities and low-income people. Most importantly, on many measures, we are healthier.

Those are the facts. The stories are better. I met a young woman named Jaclyn, a cancer survivor who got life-saving care through our version of an exchange. She had no way to afford care before health care reform -- it saved her life.

A self-employed man named Ken ignored his gastrointestinal symptoms for years because he couldn't afford to see a doctor or pay for possible treatments. Once insured, he was seen and treated for Stage III colon cancer and is cancer free today.

Over all these years, expanding health insurance to everyone has added only about 1 percent of state spending to our budget. Those budgets have remained responsible, balanced and on-time.

Expansion hasn't hurt our general economy. Unemployment has remained lower than the national average and economic growth has been higher. At one business incubator, a young entrepreneur told me he moved his start-up to Massachusetts because he wanted to be sure his young family had health insurance while his business got off the ground. Today that young man's company is employing others.

The nation's great health care challenge, with or without universal coverage, is controlling health care costs. Though health insurance premiums had been rising faster than inflation for many years before our reforms went into effect, we are now getting control of them. Average base rates increased more than 16 percent three years ago. They average less than 2 percent today. Some of that progress is the result of tools made available by the ACA. Indeed, early results show that for some individuals and small businesses, premiums may drop as much as 20 percent percent because of Obamacare.

In other words, health care reform works in Massachusetts. And it will work in America. We need it to. In one form or another, health care significantly affects business, household and government budgets, people's ability to get a job, and a child's readiness to learn. Accessible, affordable, quality care in all cases improves lives and in many cases saves lives. It gives peace of mind and economic security to families. It increases productivity for large and small employers as well as for students. It creates jobs and contributes to our economic strength. It's a powerful statement of who we are.

As the ACA is implemented this month, the entire country will begin to enjoy the benefits that we have seen from health care reform here in Massachusetts, and much more. Small businesses benefit from the ACA through new tax credits that make health insurance more affordable. With more carriers and plans to choose from, there is a more competitive rate-setting environment. People with pre-existing conditions can no longer be denied insurance. People who get really sick can no longer be kicked off their insurance. And kids can stay on their parents' plans a bit longer, until they can get their own.

Tea Party Republicans don't want the Affordable Care Act. Do they really mean they don't want these kinds of improvements in the lives of millions of Americans? I don't think so. Would they rather we address these issues with a government program instead of through the market-based, individual choices that are the framework of the ACA? I don't think that's true either. Have they proposed an alternative way to accomplish these goals? Nope. Despite a presidential election, a decision by the United States Supreme Court, and over 40 failed repeal attempts, it's clear that what Tea Party Republicans don't like about Obamacare is the "Obama" part of it.

In Massachusetts we're proud to be home to many "firsts." The first Thanksgiving. The first battles of the American Revolution. The first public library, the first typewriter and the first subway. Even the first chocolate chip cookie. Recently, the first state to achieve universal health care, the model for the ACA.

Firsts are hard. There are and will be challenges. But it has been and will be worth it. Just ask Jaclyn or Ken or any of your neighbors.

[rubato]

Industry Lobbyists are lying and their Republican hirelings are repeating the lies. Who knew?


http://www.cbpp.org/cms/?fa=view&id=3684

Excise Tax on Medical Devices Should Not Be Repealed
Industry Lobbyists Distort Tax’s Impact

PDF of this report (6pp.)

By Paul N. Van de Water

Updated October 2, 2013
Related Areas of Research



House Republicans have reportedly decided to attach to the Senate-passed funding bill for fiscal year 2014 a provision to repeal the 2.3-percent excise tax on medical devices that policymakers enacted in 2010 to help pay for health reform. The excise tax is sound, however, and the arguments against the tax don’t withstand scrutiny.

The tax does not single out the medical device industry for unfair treatment. The excise tax is one of several new levies on sectors that will gain business due to health reform. The expansion of health coverage will increase the demand for medical devices and could offset the effect of the tax.
The tax will not cause manufacturers to shift production overseas. The tax applies equally to imported and domestically produced devices, and devices produced in the United States for export are tax-exempt.
The tax will have little effect on innovation in the medical device industry. To the contrary, health reform may well spur medical device innovation by promoting more cost-effective ways of delivering care.

The Joint Committee on Taxation estimates that repealing the excise tax would cost $29 billion over the 2013-2022 period.[1] Repealing the tax would undercut health reform in at least two ways. Pay-as-you-go procedures would require Congress to offset the cost of repeal by increasing other taxes or reducing spending; one likely target would be the provisions of the Affordable Care Act (ACA) that expand health coverage to 27 million more Americans. Also, repealing the tax would encourage efforts to repeal other revenue-raising provisions of the ACA, which in turn would either require still more painful offsets or increase the budget deficit (if Congress failed to offset the cost).

The industry’s lobbying campaign against the medical device tax is based on misinformation and exaggeration, as a number of industry executives and analysts confirm. For example, Martin Rothenberg, head of a device manufacturer in upstate New York, calls claims that the tax would cause layoffs and outsourcing “nonsense.” The tax, he writes, will add little to the price of a new device that his firm is developing. “If our new device proves effective and we market it effectively, this small increase in cost will have zero effect on sales. It would surely not lead us to lay off employees or shift to overseas production.”[2] Michael Boyle, founder of a Massachusetts firm that makes diagnostic equipment, insists that the device tax is “not a job killer. It would never stop a responsible manager from hiring people when it’s time to grow the business.”[3]
The Excise Tax on Medical Devices

Congress carefully designed the ACA so that it will not add to the budget deficit. To help pay for the expansion of health coverage to 27 million uninsured Americans, the ACA either reduces Medicare payments or increases taxes for a wide range of industries that will benefit from health reform, including hospitals, home health agencies, clinical laboratories, health insurance providers, drug companies, and manufacturers of medical devices.

The ACA imposes a 2.3-percent excise tax on the sale of any taxable medical device by the manufacturer or importer of the device starting in 2013. The tax does not apply to eyeglasses, contact lenses, hearing aids, wheelchairs, or any other medical device that the public generally buys at retail for individual use.[4] Sales for further manufacture or for export are also tax-exempt.[5] The Internal Revenue Service (IRS) published proposed regulations in February 2012 and final regulations in December providing detailed guidance on how the tax will be applied.[6] The IRS has also issued interim guidance for determining the price of a taxable device and providing transition relief from penalties for failure to pay the tax.[7]

Lawmakers initially considered a higher tax, but the medical device industry succeeded during the health reform debate in halving the amount of revenue that a fee or tax on devices would raise. Since the excise tax was enacted, lobbyists for the industry have been pressing for its delay or repeal. Last year the House passed H.R. 436, which would have repealed the tax, and bills to repeal the tax have been introduced in both the House and Senate this year.

Medical devices encompass an extremely wide range of products, such as surgical gloves, dental instruments, coronary stents, artificial knees and hips, defibrillators, cardiac pacemakers, irradiation equipment, and advanced imaging technology. The U.S. medical device industry has estimated total sales of $106 billion to $116 billion a year.[8] A few large firms account for the lion’s share of this revenue. For example, Johnson and Johnson’s worldwide sales of medical devices and diagnostics totaled $27 billion in 2012; the firm had total sales (on both medical devices and other products) of $67 billion, on which it earned profits of nearly $11 billion.[9] Medtronic had $16 billion in sales and profits of nearly $4 billion in its 2012 fiscal year.[10] One trade group has estimated that the ten largest medical device makers will account for 86 percent of the sales of covered medical devices and hence pay 86 percent of the receipts from the excise tax.[11]

yrs,
rubato

[liberty]

Really, is this a crime? I remember GW “ Da Bush“ being lied about and being called much worse names than De Fuhrer.


Also Bo should be trying to deescalate the situation rather than push the level of hostility and insanity to even higher levels. He should at least be willing to talk to his opponents before they become enemy. Does he actually wanted the country to collapse for some insidious political reason. He is our leader the only person in the federal government elected by all of the states. If we fall it is his fault; he can‘t pass the buck.





Like many Republican lawmakers, Brenda Barton is furious that the federal government shutdown has forced the closure of national parks.

Barton, an Arizona state representative, took to Facebook to express her fury in a series of status updates Monday. In one, she compared President Barack Obama to Adolf Hitler.

"Someone is paying the National Park Service thugs overtime for their efforts to carry out the order of De Fuhrer," Barton wrote. "[W]here are our Constitutional Sheriffs who can revoke the Park Service Rangers authority to arrest??? Do we have any Sheriffs with a pair?"

Fuhrer, the German term for leader, is most often associated with Hitler.

"While the POTUS continues to punish the American people," Barton continued, "he keeps open his golf course, he keeps open Camp David, and he retains his and his wife's excessive staff and stable of Czars! I'll bet he has kept in service his 3 food tasters!!!"

"The Chief Executive is acting as an Imperial President," she added, "without regard to his citizens, only caring about his agenda. With all the exemptions he has unilaterally bestowed on many interest groups, could he not delay the ACA Individual Mandate for a single year? Without regard for the elected House of Representatives. What do you call that?"

But it was the comparison to Hitler that drew criticism from many, including Arizona House Democrats.

"You owe an apology to the President, and Arizona for embarrassing us," Rep. Ruben Gallego wrote on Twitter. "You [are] potentially creating problems for many government employees. [W]hat you are saying is completely incorrect and illegal."

[Big RR]

I agree, I see no crime; but I do see an ass calling someone a fuhrer. But then, this is the state where a lot worse has happened, so what would you expect?