User-agent: * Allow: / Trenton Butcher Block: Here's Something I Don't Understand

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Commentary on national and local events from the standpoint of a Trenton city resident and state worker.

Tuesday, January 25, 2011

Here's Something I Don't Understand

Doctors were an important source of contributions for the Christie campaign.  Why this is I'll never know because it seems that one of Governor Christie's objectives is to water down public employee health benefits.  So why would physicians want to kill the goose that lays their golden eggs anyway?

Back in April, I posted an article called "Christie Contributors Outed".  In this article I posted the list op people that gave $3,300 to Governor Christie's general election campaign.  What I didn't realize at the time was that this article would prove to be the greatest source of traffic to my blog.

I pictured this list as a kind of hall of shame.  I originally thought people would want to look at it it see if some prominent person they do business with actually gave money to this jerk's campaign.  Over time, I found it was being used for much more than this.  The list has been actively sought after by fundraisers looking for a grouping of wealthy individuals likely to give money to Republican candidates.  Perhaps the opposite of what I intended, but I don't mind the traffic.  It has also been used by people researching companies before going on job interviews, by people trying to find businesses to shop there and even by people trying to find uncle Harry's home on Christmas Day.  It is indeed a list of many uses.

I also noticed another pattern over time.  Many of the top contributors are members of the medical profession, whether they be physicians, osteopaths, chiropractors or dentists.  But why would doctors want to give money to a Roveite Republican running for Governor of New Jersey anyway.  The first thing that comes to my mind is the most obvious.  Doctors on the average have the highest income of any of the occupations people normally engage in.  True, Oprah may make more than any doctor, but most actresses or TV and radio personalities (ALL-not just the big names) average less than the average doctor.  The same with lawyers.  SOME lawyers make more than most doctors, but on the average, lawyers make less.  You got the picture, if you want campaign contributions, go after the people who have it and doctors fit the bill.  They are regularly solicited by candidates of both parties for this reason.

OK, doctors have the money and may be inclined to give to political causes.  But why Chris Christie?  For this I have only two answers, both of which make little sense because they actually go against the doctor's financial self interest.  The first is that I give to Christie because I am a Republican and support all Republicans regardless of the individual candidate.  This is the same reason why many people vote a straight ticket year in and year out.  It is just that the physicians have more spare bucks than you or I to help them financially in addition to contributing their time and vote to a campaign.  Giving to ALL Republicans just because of their party affiliation may make sense if the doctor has political ambitions and hopes to run for office some day, but most people who contribute this way do so to fill an inner emotional need (Identification with a particular party) not because of any rationally thought out purpose.

The second reason is more self-serving and rational on the surface, but in reality even more illogical.  Some doctors gave to Christie and other conservative Republicans because these candidates promise to lower taxes.  Since doctors have high incomes and tend to live in nice homes, they pay more income tax and property tax than the rest of us.  By putting Christie in power, they were hoping he could lower or at least stabilize their tax bills.

Self-serving, but short sighted.  The only reason why physicians have high incomes is because they get paid fairly well when people go to the doctor.  The only way most people (Corzine was the exception) can afford to see the doctor and have medical procedures performed is because they are covered by insurance.  In fact, most doctor's offices have signs saying "no referral, no visit" or "no insurance, no visit".  Why?  Because the concept of paying doctors directly with your own money is so rare is is considered a virtual impossibility.

The insurance system is what supports the high charges.  For instance, Horizon is billed $200 every time I go to physical therapy, which is little more than a trip to the gym with a personal trainer for about 2 hours each time.  I go three times a week, so that is $600 per week or $1,200 every two weeks.  Now what would happen if I had to actually pay full price for that therapy?  I wouldn't go because I couldn't afford it.  And that would go for 99 percent of the public.  If people had to pay full price for every test, doctor's visit and surgery, the price of medical services would either have to drop considerably for physicians to maintain patient volume, or the number of doctors would have to drop off drastically because only the rich could afford the prices physicians now charge. 

So, a society where most people have good health insurance is a requirement to maintain out health care system as it now exists  (including high physician salaries).  So why would doctors support a governor who has already reduced the scope of health coverage available to public workers and probably plans to reduce it further.  Remember, this governor has publicly promised to increase employee health insurance benefit costs to 20 percent of the value of the policy.  He will probably also increase co-pays and require workers to pay out of pocket for tests and surgical procedures as well.

Lower taxes by reducing worker health benefits?  Perhaps it's possible, to some minor extent.  Remember program costs and interest expenses eat up a larger part of the state budget than wages and benefits, so any savings to the public would be small.

For the physician, less inclusive, more expensive insurance will mean fewer doctor visits and perhaps lower reimbursement rates for treating public employees and retirees.  Remember there are 800,000 retirees and that state, county and municipal government employ more people than construction and manufacturing combined.  So watering down benefits will substantially reduce revenues at physicians offices.

Also, because county, state and local governments have pretty much a uniform health care plan, these employers together are what is known in economics as a "market leader".  Basically, if I am an employer and hope to attract the same people that government employs, I better be able to match them on my salary and benefits package, or the workers will go and work for the government instead. (Kind of like the local grocery store having to match Wal-Mart on prices to get customers).  Reduce the benefits in the public sector and private employers employing similar workers will have little reason not to reduce theirs as well.,  So if you work in a large organization, say a pharmaceutical company, defense contractor or insurance company, you better hope that the governor doesn't mess with our benefits.  And if you are a doctor, expect that these people are now also going to be less likely to afford your services.

Yes, Chris Christie may cut doctor tax bills, but I bet you his policies will cut their income even more.  They are fools for backing him.

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