# Tax us more, doctors urge



## Kalatzi (22 Mar 2012)

Reproduced under the fair dealings provision of the copyright act from the Globe & Mail 

Tax us more, doctors urge (Are the lawyers listening?) 

Michael Babad | Columnist profile | E-mail 
Globe and Mail Update

Tax us more, doctors say
 A group of doctors is taking a page from Warren Buffett's tax-the-rich call, urging the Canadian and Ontario governments to tax higher-income earners more. I hate extra taxes, but I like their argument and applaud their efforts. 

Doctors for Fair Taxation plan to announce their scheme in Toronto this afternoon, calling for additional taxes on people earning more than $100,000. You'd be hit with an additional 1 per cent if you earn between $100,000 and $170,000, 2 per cent if you earn up to $640,000, and 3 per cent for up to $1.85-million. Above that it would be 6 per cent. 

"We feel that this is a moral argument," Dr. Michael Rachlis, who founded the group that so far boasts more than 50 physicians, told The Canadian Press. 

"We cannot talk about throwing people out of work and cutting needed programs for people," said Dr. Rachlis, an associate professor at the University of Toronto. 

"If the situation is that dire that governments are really feeling that that should be done, it seems to me that the only way to think of that is to tax higher-income earners who've seen their taxes fall a lot."

The group projects that the Canadian government could take in some $3.5-billion from the plan, and the province of Ontario $1.7-billion. 

"Our group considers higher taxes a small price to pay for a more civilized Canada," Dr. Rachlis said. 

Their tag line is: "Doctors to governments: Tax us. Canada is worth it!" 
•
Doctors for Fair taxation website

A commendable initiative, I think.  Not likely to be everyone's cup of tea.  It'll be interesting to see how this plays out.


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## Eye In The Sky (22 Mar 2012)

I'd sign their petition, no question. 

But hey, if someone only made $1.85 million last year, I can see how you _might_ be struggling to make ends meet, and can't handle more taxes.


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## PuckChaser (22 Mar 2012)

Tax them more, or just stop giving them crazy raises every year?


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## ModlrMike (22 Mar 2012)

From the perspective of someone else who works in medicine, I think the issue is not that we need more money, but that we need to use existing moneys more wisely. For example: I work in an ER. In the course of a year, I will see enough patients to cost the taxpayer just over $1M. That's before tests etc... just to talk to me. Of that number, at least 50% of my patients could be better served by their own MD or a walk in where the cost would be just over $50K. In addition, I spend a great deal of time doing paperwork which has been imposed by various levels of government. Not a cost effective use of my time. 

I see on average 50% of patients who don't need to come to ER, and who already have family doctors. I'm not counting the ones whose doctors are too busy. I'm talking about folks who have had their complaint for months or years, and have not even tried to see their doctors. Add in the "I felt sick this morning", "I thought I was going to throw up", "I had a pain, but it went away and I need you to tell me what it was" etc and we flush health care dollars down the toilet at an amazing rate. The public screams that there's not enough money in the system; I retort that they should be more responsible, after all it's their money. Healthcare is not free in this country, except if you don't pay taxes. Those who do pay taxes pay an astronomical amount relative to what they get in return.

The answer is not to tax more but spend less, or at least spend less wastefully.


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## OldSolduer (22 Mar 2012)

How many of these doctors have accountants that can squeeze every tax loophole they can so they won't have to pay taxes?


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## Eye In The Sky (22 Mar 2012)

ModlrMike said:
			
		

> The answer is not to tax more but spend less, or at least  and spend less wastefully.


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## Edward Campbell (22 Mar 2012)

ModlrMike said:
			
		

> From the perspective of someone else who works in medicine, I think the issue is not that we need more money, but that we need to use existing moneys more wisely. For example: I work in an ER. In the course of a year, I will see enough patients to cost the taxpayer just over $1M. That's before tests etc... just to talk to me. Of that number, at least 50% of my patients could be better served by their own MD or a walk in where the cost would be just over $50K. In addition, I spend a great deal of time doing paperwork which has been imposed by various levels of government. Not a cost effective use of my time.
> 
> I see on average 50% of patients who don't need to come to ER, and who already have family doctors. I'm not counting the ones whose doctors are too busy. I'm talking about folks who have had their complaint for months or years, and have not even tried to see their doctors. Add in the "I felt sick this morning", "I thought I was going to throw up", "I had a pain, but it went away and I need you to tell me what it was" etc and we flush health care dollars down the toilet at an amazing rate. The public screams that there's not enough money in the system; I retort that they should be more responsible, after all it's their money. Healthcare is not free in this country, except if you don't pay taxes. Those who do pay taxes pay an astronomical amount relative to what they get in return.
> 
> The answer is not to tax more but spend less, or at least spend less wastefully.




 :goodpost:

I agree with you. Higher taxes accomplish little, except to defer needed procedural reforms and to take money away from productive, job creating investments and give it to inefficient bureaucrats.


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## Kalatzi (22 Mar 2012)

Seeing as how most people are aware that cuts need to be made. 

Ontario has a health premium. One has to pay for use of an ambulance, to discourage misuse of the service.  BTW any time I've been in an ambulance I've had NO say in the matter. 

The idea of an ER surcharge, possibly with an optional credit for genuine need for low income,  has been floated in the past, and never gotten anywhere, perhaps this may be it's time, if presented properly. 

That said it happening in Ontario with Premier McGuinty are somewhere between 0 and NIL.


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## Kalatzi (22 Mar 2012)

Mods - I'm also taking a look at the 100 Million for Health care with nothing to show for it thread - That seems to be getting NO reponse. 

This thread is getting response - but we seem to be going off topic

Perhaps merge the two???


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## mariomike (22 Mar 2012)

ModlrMike said:
			
		

> From the perspective of someone else who works in medicine, I think the issue is not that we need more money, but that we need to use existing moneys more wisely. For example: I work in an ER. In the course of a year, I will see enough patients to cost the taxpayer just over $1M. That's before tests etc... just to talk to me.



I never worked in one, but I treated and transported many patients, for many years, to many hospitals.  In 1967 the call volume at Metro Ambulance was 45,000. Now they process about 334,000 calls per year, and respond to approximately 265,000 of them. Call volume is  climbing steadily as the "baby boomers" age. The geographic boundary has not changed. I know the population has increased, but not that much. 
This shows the situation in Los Angeles, but could just as easily have been Toronto by the time I retired:
http://www.youtube.com/watch?v=EDHwAwhf-xs



			
				Kalatzi said:
			
		

> One has to pay for use of an ambulance, to discourage misuse of the service.



In Ontario, normal land ambulance costs are billed at a rate of $240.00, of which all but $45.00 is covered by your provincial health insurance.
The hospital sends you a bill for $45. You pay the hospital, they send you a receipt. Then you send the receipt to your insurance company, and they send you a cheque for $45.



			
				Kalatzi said:
			
		

> BTW any time I've been in an ambulance I've had NO say in the matter.



You have the right to refuse, but it's a bit complicated.
Cancellation/Patient Refusal:
Once on scene, paramedic(s) will not be cancelled off an emergency call unless every reasonable
attempt has been made to gain access to or locate the patient. If the patient cannot be located, a
police officer’s badge number, fire captain’s name or an EMS Supervisor’s number must be
obtained and recorded on the completed Ambulance Call Report.
No paramedic shall refuse to provide ambulance service or emergency response service unless
directed to do so by the CACC.
When a patient refuses service the following procedures will apply:
• In all cases the patient will be examined unless there is a refusal to be examined.
Examination findings must be noted on the Ambulance Call Report.
• If the patient refuses medical care/transport, the paramedic(s) will advise the patient of any
associated risk.
• Paramedics are to be familiar with and follow the requirements of Consent to Treatment and
Capacity Assessment as well as Refusal to Treatment as described in the Medical Directives;
• The paramedics will have either the patient and/or a substitute decision maker sign the
Ambulance Call Report. If the paramedic is unable to obtain a signature they are to contact
an EMS supervisor immediately.
• If, in the opinion of the paramedic, the patient requires medical aid but refuses, every effort
will be made to leave the patient in the care of a responsible person whose name, telephone
number and address will be clearly noted on the Ambulance Call Report. If no other person
is readily available, contact the CACC and request the attendance of the Police and/or an
EMS Supervisor.
• The cancellation portion of the Ambulance Call Report must be completed and appropriate
details included on the form specific to the situation as outlined in the Ambulance Act and
the Basic Life Support Patient Care Standards.
If Allied Emergency Services Personnel/Agencies, EMS Supervisor and/or any other qualified
personnel witness the cancellation of the ambulance, the name, address and/or allied services
identification number must be recorded on the Ambulance Call Report.


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## Brad Sallows (22 Mar 2012)

Well, they could always write cheques to the Receiver General for Canada with "Gift to Canada" written on the memo line, if they really have a depth of commitment to their conviction.

It is possible that more tax revenue is needed.  However, we won't know if that is true until we cut (as in, eliminate entirely) all the spending on things that really are not important (grants, subsidies, whatnot).  First show the existing funds can be spent responsibly and then I might agree to provide more.


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## cupper (22 Mar 2012)

Jim Seggie said:
			
		

> How many of these doctors have accountants that can squeeze every tax loophole they can so they won't have to pay taxes?



It's been my experience that doctors typically are crap at making financial decisions.

I know of at least two group practices in Halifax area that thought that it would be great to build their own building, with the group located in one part, and rent out the remaining office space to other businesses. In both cases the groups went into receivership, sold off the buildings and ended up renting their former offices from the new owner in one case, and moving the practice to another office building all together.

Even down here south of the Border they aren't much better. The family practice I go to, they opened up in a new building when I first started going there. It had twice the office space they needed for the number of doctors, but it allowed for expansion. After about two  years they ended up  walling off half of the building, and they still don't have anyone using that part.


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## OldSolduer (22 Mar 2012)

Yes they are doctors for a reason, but they have accountants and lawyers. They hide their wealth very well.


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## Edward Campbell (22 Mar 2012)

Jim Seggie said:
			
		

> Yes they are doctors for a reason, but they have accountants and lawyers. They hide their wealth very well.




If we really want low paid doctors we'll get stupid ones ... you get what you pay for; you want first rate medical care then the MDs deserve first rate salaries; ditto lawyers and engineers. Celine Dion, Andrew Ladd* and other entertainers are overpaid, MDs are not, nor is my accountant.

__________
* Captain of the _Winnipeg Jets_


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## blacktriangle (22 Mar 2012)

Agreed ERC.

I had surgery a while back and had a great specialist. I told him I would not want his job, and that I am happy that he is paid well. Not all doctors are as switched on as he is, but a salary cut or tax increase will only make that worse. 

There are definitely people out there that take too much out of taxpayer's pockets, but I don't believe doctors are among them. 

With that said, it seems like we need to find ways to optimize the money we are spending on health care, as "more money" isn't always that simple. I think the same is true for the CF/DND. Unfortunately, I don't have the solution on just how to do that.


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## cupper (22 Mar 2012)

E.R. Campbell said:
			
		

> ditto lawyers and engineers.



There are high paid engineers?

I think I'm getting ripped off. ;D

Seriously though, Doctors typically make significant 6 figure salaries. But they also have to pay the office overhead from said salary. For all intents and purposes they are small business owners. So after all gets said and done, they may only take a small portion of that salary home. (at least that is the case for GP's)


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## exabedtech (23 Mar 2012)

Tax those rich bastards is a great rallying cry.  Why should they enjoy high incomes after working like dogs to get where they are in life?  They should because they've earned it.

Adding more levels to the increasingly complex tax code only benefits the accountants.

I'd prefer to see an approach that simplifies the tax code by closing loopholes.


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## dangles (23 Mar 2012)

exabedtech said:
			
		

> Tax those rich bastards is a great rallying cry.  Why should they enjoy high incomes after working like dogs to get where they are in life?  They should because they've earned it.
> 
> Adding more levels to the increasingly complex tax code only benefits the accountants.
> 
> I'd prefer to see an approach that simplifies the tax code by closing loopholes.



I would argue that not every rich person earned his way into the top of the economic hierarchy - a great many are born into it, through having the right connections or a healthy inheritance. 

Even if this wasn't the case, why would they worry about being taxed more than the poor - they already have more than enough to sustain themselves and live in luxury. 

Yet, it's too bad many of the people who have the power to  make decisions based on this proposal would be the one's hit with the tax...

With all of this said though, I know through all the times i've been injured and in the hospital that the doctors, nurses and other staff are worth every single penny. 

At any rate, I guess the obvious question we are all forgetting here is where the extra tax money would be allocated.


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## medicineman (23 Mar 2012)

Personally, I think we should take a page in the ER from something I heard about on my rotation through Sick Kids in Toronto - the Saudi fellows said that triage at home was done by a senior resident or attending physician in the waiting room.  If the kids were in fact emergencies and ill , they were seen, but if they weren't ill, the parents were told in no uncertain terms to go away and see their GP.  They wondered why it was always a mad house in the ER - because the Canada Health Act prohibits us from kicking people to the curb (though I do remember a few crusty ER docs in KGH that had no issue telling people to get lost if the place was busy and the patients weren't as sick as they thought they were/wanted to be).

There needs to be better allocation of resources, not necessarily more money - having mandatory return of service aggreements for graduates of medical training in this country to work in underserviced areas of the province they trained in for instance, so that people have a local primary care person they can see fairly readily and not have to wait 3 months in some cases for an appointment; opening more "Doc in a Box" or walk in clinics or even just changing a local emergency room into a fast track centre (if there are several hospitals in an area) to deal with walking wounded or what we'd call Sick Parade issues; better public education as to what actually constitutes an emergency; better teeth in legislation to actually allow ER personnel (docs or delegated and trained personnel like senior RN's, NP's and PA's) to say "Look - go to the walk in or to your own doctor" if someone shows up in the ER needlessly; and lastly, people in this country seriously need to get a grip, grow a pair, and learn to suck up some things - nothing in life is painless and there will always be little things that go wrong with you.  You don't need to go running to the doctor the minute your nose starts running with a cold...and you won't believe how many people will show up looking for that magic bullet to get rid of that sniffle even though it's been there for only an hour.  Another thing would be hiring more hospital based physicians/PA's/NP's to staff rural hospitals so that the folks doing primary care don't have to worry about also working in the ER, OR, delivery rooms, ICU's, etc - there is roughly a 2 month waiting list to see many of the family docs here simply because they are double or triple hatted running the hospital as well, so sometimes are only in the office 2 weeks out of 4.  

I did have another rant to preface this, but I think my spleen is smaller for now.  To be honest, we can throw a whole load of money at things, but for some reason, it always gets misdirected by the overly high priced help at the blunt end...and never to the pointy end.

 :2c:

MM


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## Fishbone Jones (23 Mar 2012)

Of course, the more you want to tax any highly paid group, doctor et al, the more tax shelters that get created. The more that get created, the more they are used by these groups.

So, no matter how much they seem to be falling on their swords, or taking one for the team, the higher their PR status as defenders of the downtrodden gets. 

While in actuality, they are probably going to pay less tax than they were originally.

Besides, there is no single group that has the authority to speak on behalf of every professional person in that demographic.

No more than my union, no matter what they say or believe, speaks for me.


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## Edward Campbell (23 Mar 2012)

cupper said:
			
		

> There are high paid engineers?
> 
> I think I'm getting ripped off. ;D
> 
> Seriously though, Doctors typically make significant 6 figure salaries. But they also have to pay the office overhead from said salary. For all intents and purposes they are small business owners. So after all gets said and done, they may only take a small portion of that salary home. (at least that is the case for GP's)




Majors and (some) CWOs in the CF make six figure salaries, so do a lot of civil servants with one (bachelor's degree) and few years of experience. General practitioners/family physicians are the people who seem to be is shortest supply here in Canada - maybe it's not surprising given that, after a very long, grueling education/development regime, they are paid about the same as a Capt/MWO. 

Specialist require even longer to reach their earning potential - if a specialist enters university at 18 (s)he doesn't start (high wage earning) practice until the age of 30+ - and then, as Cupper points out, they have to pay to run their small business.

Those (few) doctors who think they are under-taxed, are, as Brad Sallows says, free to make a donation to the Government of Canada.

For my part I am pleased that my physician, my accountant and the engineers and technicians who keep me safe are adequately paid for their education, skill and dedication. I am less enamoured with the pay : performance ratio of e.g. hockey players, bureaucrats in Veterans Affairs, CBC newsreaders and whoever is charge of clearing ice off the sidewalks in Ottawa.


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## OldSolduer (23 Mar 2012)

E.R. Campbell said:
			
		

> If we really want low paid doctors we'll get stupid ones ... you get what you pay for; you want first rate medical care then the MDs deserve first rate salaries; ditto lawyers and engineers. Celine Dion, Andrew Ladd* and other entertainers are overpaid, MDs are not, nor is my accountant.
> 
> __________
> * Captain of the _Winnipeg Jets_



Edward, I agree that you get what you pay for. If the doctors are that adamant, let us see their tax returns for the last seven years to ascertain if they are paying their fair share.

Just my  :2c:, after I have paid my taxes....


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