Letters to the Editors

April 22, 2005

Tax deduction caveat; Managed care contract incentives; Should you continue care? Co-signing correction; Is the hearing process working? A true hero; The tough choice

Tax deduction caveat I was reading through "Tax Strategies: Winning 1040 moves" [Feb. 4 http://www.memag.com/memag/article/articleDetail.jsp?id=144772], and thought you might want to clarify what's mentioned under "Deducting health insurance costs." You state: "Since Crowley is self-employed, he can also deduct 100 percent of the health insurance premiums for himself, his spouse, and his dependents." This may be true, but not necessarily. The deduction is not allowed for any month that the self-employed individual or spouse is eligible to participate in a subsidized health plan maintained by an employer. This rule applies to self-employed individuals, partners, or shareholders in an S corporation who own greater than 2 percent of stock. If the spouse is working outside the practice and has the opportunity to participate in a subsidized health insurance plan, the deduction is not allowed for that time period for the spouse or the individual.

Robert K. Murray, CPAColumbia, MO

Managed care contract incentives I read your article "Will a jury think money clouds your judgment?" [March 4 http://www.memag.com/memag/article/articleDetail.jsp?id=148879] with the usual eye-rolling indignation our tort system engenders. The post-trial interview and admission of the jury foreperson attests to what is egregiously wrong with our judicial system. The foreperson acknowledged the jury didn't believe that internist Neil Birnbaum "purposely didn't do those tests because of the contract." Yet, the jury sought to punish him, not because of negligence, but because he signed an HMO contract that included incentives. The foreperson added: "Some of us couldn't believe this stuff goes on."

Morris Cavalieri, MDDerby, NY

Interesting the jury was upset to learn HMOs push incentive contracts, and as a result found Dr. Birnbaum guilty of negligence. Go figure! The problem is physicians often don't have much choice with regard to such agreements. HMOs are large corporations holding large numbers of participants hostage, and their offer to the doctor is essentially "take it or leave it." If the doctor wants any business, he has to accept the contracts, despite nauseating clauses. This, together with last year's US Supreme Court ruling that shelters HMOs from liability [see "The Supreme Court lets HMOs off the hook," July 23, 2004 http://www.memag.com/memag/article/articleDetail.jsp?id=108998], leaves doctors practicing in a lawsuit-infested environment. And, surprisingly, tort reform hasn't done much to stem the epidemic of malpractice cases. No wonder so many physicians are looking elsewhere for something to do.

Alan L. Carpenter, MD El Paso, TX