John, please elaborate. And what, if anything, are you asking the group to do about it?

James Stout I don't believe this is the plce for the type of discussion that your question deserves. It is no more right for Mr Reid to stop discussion of a particular bill than it is for the GOP to filibuster bill after bill after bill that otherwise have passed both houses of Congress. But to get at the core issues would require that we have a Constitutional Convention, with such issues as apportionment, filibuster and states rights on the table.

Ok, let's see how it goes. Political posts make me nervous. They seem to denigrate quickly and require a lot of monitoring.

If that happens, I'll move this off the discussion page. Fair warning. :-)

John Eckberg Joe, Thanks for asking. Mostly I'm curious what a group like this concludes. It's interesting to watch debate and discourse. As you might guess, I personally, think it's offensive and a raw abuse of power. Couple that with one of the dumbest and most debilitating taxes in the history of government and you have a bad bad combo for patients, the economy and jobs. James has a point about endless filibuster I must say. President Obama's jobs bill has been hung up without cause time an time again. Now is payback time, I suppose.

But two wrongs doesn't make a right. Reid should enable debate - period. I want to see Senators vote. Look at how many more Democrats came out of the weeds in the final House bill when they were forced to chose: went from what, nine to what, 37? I'd like to see the Senate vote and then the Senators go home to their districts and face the music, if you're asking me what I want. As for what the group should do, I don't know. Enable debate, I suppose. I think it it ironic as well as tragic that very little impact, compared to the harm elsewhere, will hit Nevada, because there's next-to-no medical device industry in Nevada or, for that matter, Montana, where the other bright light behind this tax, Sen. Baucus, dwells. Look at the tally of the 8,000 signatures - 20 from one state and but a few from the other.

Reid is effectively telling workers and jobs creators and their elected representatives in Pennsylvania, Minnesota, Indiana, Illinois, California Ohio, Michigan, Massachusetts and a bunch of states represented in the tally at http://www.no2point3.com/top-states to go fly a kite. Go away. Get out of here - that their concerns don't warrant Senate discourse. It's shameful is what it is. But I would like to know what others think and will pipe down now.

James Stout That principle is in conflict with that of one person, one vote. Remember, states are largely anachronisms. We have to compete globally as a nation, not as 50 individual states. It is time to recgnize that America is a single nation. States rights needs to have a decent burial.

John Eckberg Hey JG - Thanks for asking but no, I'd prefer term limits. That would solve a lot of ills. But that's blue sky wishful thinking - sort of like pondering whether a cloud is cumulous or cirus as a tsunami fills the horizon. What I'd prefer that debate be enabled in the upper chamber, particularly when states like Minnesota get unamimous votes for repeal of a law that was a terrible idea when it was hatched and has only gotten worse as its implementation nears. This tax is a no joke levy that is going to kill innovation, jobs and, frankly, ultimately, patients.

James Stout Mr. Eckberg: Term limits just add power to unelected bureaucrats. I dislike taxes as much as anyone, but do you have any actual, verifiable facts to support your hyperbolic assertion that the medical device tax 'is going to kill innovation, jobs and, frankly, ultimately, patients'?

Joerg Schulze-Clewing James, it will make the cost of any medical device go up by 2.3% in the US, plus compliance costs. It's as simple as that.

James Stout And your position is that a mere 2.3% tax 'is going to kill innovation, jobs and, frankly, ultimately, patients'? Be realistic.

Joerg Schulze-Clewing James, do not make up positions for other people. Where did I say that it will kill patients? Quote, please.

And yes, it will kill some jobs, that's for sure.

James Stout It is a simple cut-and-paste: " This tax is a no joke levy that is going to kill innovation, jobs and, frankly, ultimately, patients" This is directly from Mr. Eckberg's comment.

John Eckberg Okay when I get a minute, I will tell you all about the Harrison fetal
stent and want this tax will mean to the future of devices for humanitarian
purposes. Not sure it will convince you but maybe a Senate aid or even
Senator will stumble upon it and think twice about what's happening to
thousands of small companies and the component supply chain.

John Eckberg
Director, Media Relations
The Cook Group
812-320-7112 - Mobile

Sent from my iPhone

Joerg Schulze-Clewing James, you responded to me and I did not say that.

Joerg Schulze-Clewing John, long term any cost increase in med devices will ultimately increase loss of life. Whether it is caused by a an extra tax or other circumstances. We saw that very clearly at Endosonics. In some countries, often those with socialized medicine, they used our IVUS catheters a lot less during stenting procedures than in the US. Mostly because of unfavorable reimbursement rules. It is a well known fact that the risk to die increases in critical stenting situations if you don't use IVUS.

Joseph W. Rafferty John, Global device innovation comes from start ups not the strategics. When a start up is challenged for cash and might, might have only a 4-6-8% net profit on a given device...paying a 2.3% tax will absolutely impact that companies sustainability and ultimately it will stunt innovation in the US. So a 2.3% tax may move more innovation offshore as has been the trend these past 2-3 years....
Does less innovation impact patients?

John Beasley, MSc, RAC (US) To answer the original question ... YES, it is right for a Senator to do so, no matter the population of the State he represents. That is the SENATE (remember, each State gets 2 and only 2). If you are worried about representation based on population, go to the HOUSE. That is how our government was established.

James Stout Mr. Rafferty: The flaw in your argument is that innovation is done by the start-ups, which are not profitable by design, and exist on venture funding; when they do go out, they initially have wide margins. When they start to become profitable, they are often merged into larger organizations, whose margins can support a small tax.

I feel this issue is just another cost that will ultimately effect the outcomes of millions of citizens of this great country. Seems like these days people protest and disapprove our government I most of what rhey do. We the people are ignored and they do whatever they want. They say through our election process you can change the political polices and issue we face. But this country and our leadership is not blue or red (maybe purple) but ultimately at the end of the day democrat or Republican there actions are bought and paid for by someone! Guess what the people who pay out billions to law makers could care less about the people!

James Stout Mr. Beasley: Glad to see you are back in town, if only briefly. With the vast disparity in representation between the various states, it is probably time to rethink the over 200 year old system of how the House and Senate are populated. As is clear by the main question, the entire idea of proportional representation needs to be revisited in light of current reality. The idea of states rights was a failure under the Articles of Confederation; and, it was a failure during the Civil War (What defeated the South was what they were fighting for).

Joseph W. Rafferty James, possibly you have seen these pase three or four years the lack of VC funding for startup technology....subsequently start us have to be much more efficient with what little VC, Angel and private equity they can raise. On the contrary, start ups by design lose significant money early until they get cost of goods down and can generate significant revenue to support a sales team....bottom line is if a cash poor start up that can't get a B or C round of funding, has to pay the 2.3% they may not be around to see the acquisition by a strategic.

James Stout Mr. Rafferty: The lack of VC and other early stage funding has been with us for almost all of the last decade, since 2001. Nowadays emerging growth companies generally look overseas for funding, particularly Asia, as domestic private funding is scarce, and venture capital funding, even when available is confiscatory. Most start-ups that I have been aware of and/or worked with for the last 30 years, lose money (not always intentionally) until they are acquired. It is very rare for a start-up to become a stand-alone success in the medical device/diagnostics/biotechnology area.

Joseph W. Rafferty James so we agree a 2.3% tax on an unprofitable start up that has very few funding options will have a significant impact on innovation? Agree!

James Stout No, I do not agree. A tax of 2.3% is merely a cost of doing business, not terribly burdensome; in addition many start-ups have various forms of grants and other research credits, which can be used to absorb expenses, such as taxes. No, I do not like the tax for another reason: 2.3% is trivial, but people with the authority to tax have a tendency for taxation to creep the rates. It may become 4% next year, and 10% a few years later. And 10% would be quite burdensome.

Joerg Schulze-Clewing James, none of the medical start-ups I have as clients get any grants or research credits. 2.3% is going to be major for them, very damaging. The cost of doing business in the US is high enough as it is and this tax just piles on. It's wrong.

James Stout Mr. Timourian: That's a good point. Start-ups are usually, as you point out, underfunded, and the medical device tax, as small as it is, can be burdensome.

John Eckberg Hello all, I want to get a brief response out today that details how, without a doubt, this tax is going to lead to increased mortality for patients. In February 1997 The Harrison Fetal Bladder Stent was approved by the FDA as a humanitarian device. As I understand it and there will be some shorthand in this detail, this tiny conduit was developed by Cook to be percutaneously placed into a fetus so poisons do not build up and lead to loss of life of the unborn baby. We are limited to sales of no more than 4,000 units in the U.S. It's entirely possible that the Research and Development costs could exceed any revenue from such products.

Unless this tax is repealed, companies will find themselves in a difficult position with regards to Humanitarian Devices. Can firms afford to spend the money on R&D knowing that not only will companies not get their money back from the device that is developed but now, instead, companies will be taxed on what sales there are for the product. We have another project ongoing for a life-threatening congenital defect that impacts .05% of all live births in the U.S. That doesn't sound like a lot but it's estimated to be 2,000 babies.

There is no question that this tax will lead to fewer life-saving products, particularly with regards to development of devices that fall under the humanitarian device exemption, and therefore patient suffering will be prolonged and mortality will likely grow.

John Eckberg And as for the tax being "small" and "minor" . . . It is far more complex than tax supporters content. This is not candy being sold at the local candy store. A top line tax, when applied to earnings, that is, what used to be called Earnings or EBITDA (Earnings Before Income Tax Depreciation and Amortization) this tax will represent a sliding scale of significant to crippling percentage of increase. If companies are marginally profitable today, this tax could claim all that profit. For companies that have a 35 percent tax rate and about $1 billion in top line sales in the U.S., this tax will be an additional 15 percent tax when applied to earnings. Unlike most sales taxes, which are paid by consumers, not producers, this tax represents for some companies a 40 percent or more increase in their tax rate - and that leap is coming in just one year.

Nor can companies simply tack on 2.3 percent to the price and call it a day. Hospitals and GPOs will not enable that and have already called upon federal authories to ensure that the tax is not passed along to them. U.S. medical device companies compete in a global arena. When one or two companies, those with foreign business units in low-tax nations, hold firm on price, that will prevent others from raising prices. Hope this sheds some light on the impact of this tax.

Scott Sauve James, you need to revisit, maybe for the first time the history of America and how the constitution was established. Many of the founders wanted population only representation but then the smaller states felt they would have no voice compared to the larger states. The compromise was to have the senate with two representative per state would lend balance to the population only. Much of what you disagree with is a liberal mindset that believes that a central government has a better understanding of what is needed better than state and local government. History records that this is flawed, and it is rare to find a case where Washington DC know what to do better than locals. The founding fathers knew that the growth of the federal government needed to be limited and thus you often hear "limiting principles" often discussed in the supreme court. That is the reason for the second amendment...it is not only for the ability of citizens to own guns to hunt or to protect themselves and their property, but also to protect the self for excesses of the government. Again, liberal thinking also holds that even according to the law where majority rules, there are minority rights, with minority being the lesser

Scott Sauve ...with the minority being the ones with the lesser votes, thus rules like filibuster are in place to protect the minority parties. I bet you had no problem with filibuster when your guys where in the majority. Again, our system is set up with checks and balances between state and federal rights and with the executive, legal and legislative branches of the federal government. A case can be made that many of those checks are being abused by the current administration, but they are there for the protection of the people.

James Stout Mr. Suave: Right! The current administration is to be faulted for using the filibuster relentlessly to block majority approved legislation. Try again.

James Stout Mr. Suave: The federal system was adopted as a compromise to placate smaller states, I agree. But states rights has no future. We need to compete as a nation, not as 50 balkanized entities. Remember, the Roman Empire failed because conservatives refused to accept that times had changed. Let's not repeat that error in a blaze of phony patriotism.

This is a very interesting discussion and represents a large portion of my Master's dissertation. Hopefully Joe doesn't mind me plugging this here, as it seems topical. My apologies if this is not appropriate, I just assumed that perhaps it may be helpful for the group to have a forum to express their feelings on these issues. As a researcher and business professional, I am interested in representing all sides of the debate.

My name is Nema Semnani and I am conducting research for my Master's dissertation. My research focuses on the impacts of the 2013 tax levy on the industry as a whole, medical innovation, and subsequent healthcare costs. Considering that this is a multifaceted issue, I am hoping to obtain feedback from a wide variety of sources including but not limited to healthcare providers, medical device professionals (regulatory, finance, sales, marketing), healthcare analysts, and those working within the Venture Capital sector.

Interviews will take place via phone/skype and shouldn't be longer than 30-45 minutes. The results will be compiled and kept anonymous. I certainly understand how busy everyone must be and it is with this in mind that I thank you very much for your time and consideration. Please let me know either by private message/email or comment within this thread if you are interested in having your voice represented in a London School of Economics publication.

All the best,
Nema

Joseph Schwartz Is it right that one Senator from a state of low population could hold up a vote? Yes it is, because it is a rule voted upon by the Senate to govern their own actions. If you don't like it vote out your Senators. However consider the fact that one of the biggest fears of our founders was Mob Rule...a tyrany of the majority. The Electoral College is a hedge against the most populous states having undue influence in an election. The filibuster is a similar rule. The flilabuster, although stifuling debate on the floor, actually gives holders of minoritry opinions the oportunity to "make their case" off the floor. Much discussion is fostered that otherwise would not occur. I had this starkly illustrated in a college class where the class was pemitted to vote on class policy. The first vote was whether to require a simple majority or a super majority. The super majority rule was initially in place before the vote. Although the overwhelming opinion was for a simple majority, the temporary rule allowed those of us with the minority opinion to pursuade more to our point fo view. The majory still held sway and a simple majority was approved. Once that occurred there was no longer any chance for discussion. A vote was held and the majority ruled. I, for one, would not like to see our government work that way. The irony iis that most of the class was so intent on getting their way, they did not see the lesson inbedded in the exercise. Checks and balances, although sometimes frustrating, are an important facet of ourt form of government...a representative Republic, not a true Democracy. I hope it stays that way!

James Stout Mr. Schwartz: Except that, as the GOP has so feverishly shown, that the systems you praise so highly, can be easily defeated, and we end up with minority rule. Remember, democracy is about the process, not the outcome. And an ideology-driven faction, like the GOP, has found tht it can pervert the process to achieve, if not a desired outcome, at least no action on issues it does not favor.

James Stout The lesson is that where you are dealing with people who are not of good will, then the democratic process can be defeated, no matter how many safeguards are built in.

Joseph Schwartz Mr. Stout, the conservatives of Rome stood for very different ideas than the conservatives of today in the USA. I could make the case that their opinions more closely reflect that of today's progressives than conservatives. Let's not use blanket terms to cloud the real issues. Ideas matter. It is also not likely that states rights result in "Balkanized Entities", most of our states believe or come to believe in the same principles. Have you failed to notice how laws, like Megan's Law, tend to sweep the states until all or very close to all apply them. States are ment to be laboratories of self government. One tries something and if it works others adopt it, if it fails, they often still try it, if it fits the prevailing governing philosophy. It takes another state with vision to come up with a new policy that works to replace a failed on. This innovation is very difficult on the larger federal level, as it is for large corporations. Innovation generally does come from smaller units and this tax will reduce innovation by making it more difficult for start-ups who have innovative ideas to get them started. The company I work for is a model of this...a larger company resisted innovative ideas so some of the engineers left to start their own company. They believed in what they were doing so strongly that most of them went without pay for several years until the company became solvent. We are now a multi-billion dollar a year company. We still try to be innovative, but the FDA's policy of being more restrictive of 411K submissions, make big innovations more costly, only small innovations can fall under 411K submissions...add to that the 2.3% tax and innovation is inevitably going to be stifled. Profit is not evil, it is a powerful motivator. If a company cannot be profitable, it cannot continue to exist.

Checking in ... everyone still happy here?

Shall I let the conversation continue even though it's become more about politics than medical devices?

Joseph Schwartz James, "The lesson is that where you are dealing with people who are not of good will, then the democratic process can be defeated, no matter how many safeguards are built in." I agree whole-heartedly...that is why our founder's said that our form of government is designed for a Christian people and is wholely unsuited for any other. Those who would remove the influence of religion, and specifically Christianity from all public life should consider strongly just what it is they are asking for. Not to imply that those who hold Christian beliefs are perfect, but in the history fo our nation, those beliefs held a strong sway aver people's behavior. It is only the past hundred years where Existentialist beliefs separated a person's behavior from their beliefs, that this influence of religion on a persons behavior has been negated.

Joseph Schwartz Joe, can you realy separate the two? Isn't a tax, by nature political? As I said in an earlier post, "ideas are important" they have consequences and the consequences of a political idea "taxing the rich corporations" are under discussion here. Didn't you start the ball rolling with your poll on this topic?

James Stout Mr. Schwartz: There is some truth in what you say, and I support capitalism, innovation and progress. It is, however, also true that the states are being used in many cases to thwart progress, such as minority rights, union rights, voting rights, gay rights, women's reproductive rights, etc., by conservatives who do not want to enfranchise non-white, non-Christian, non-heterosexual, non-male citizens. And you are wrong about the Roman Empire: the conservatives then, as now, labeled non-Romans as 'other', and refused to enfranchise them.

James Stout Mr. Schwartz: This is not a Christian nation, and never has been. The Establishment Clause, preventing the establishment of a national religion, and the Freedom of Religion Clause, which allows one to choose or not choose a religion for private worship, together create a much more enduring and valuable right, the Freedom from Religion. I think we would agree that we have more scientific information than existed 2000 years ago, and even 200 years ago. We can also say that, at the very least, the existence of any god, whether one denominates it as he, she, it or they, is, at best, questionable, since there is no valid, verifiable scientific information showing that such a being actually exists. The separation of one's behavior from one's professed beliefs has existed as long as man, and is documented in writings since there was writing.

Joseph W. Rafferty Joe Hage,
To have one person continue to take a contrarian and elitist positions on whatever topic is discussed.....ends the respectful exchange of ideas. Probably not your goal from the start...

Joseph Schwartz Is that how my comments are viewed, contrarian and elieist? I thought this site was set up for the free exchange of ideas. No one is forcing anyone to take them for their own only listing them for consideration. I will respectfully bow out of this discussion despite wishing to respond to Mr. Stout's statement. Which I feel is a gross distortion of my postion.

Charles D Robbins III-MBA,CMfgEng Taxing any manufactured goods, which are intended to be used for the well being of mankind, at point-of-manufacture strangles the competitive life out of this device in the world market and dooms it to low competitive niche placement against many other products from other countries which have a form of investment tax credit or export tax credit. Especially those products which are already made in a 925 tax exemption environment. This tax will make these products non-competitive.

If this tax is applied at the point of manufacture, it also will roll through all channels of product distribution with the amount of the tax being factored higher by means of a multiplier at each iteration of distribution and sales, giving it a final multiplier that will assure high price..

David N. Muchemu MS,MBA,PhD(Candidate). Does this really belong here? Can we stay out of politics.We all have our political beliefs,and economic theories.Some liberal ,and some conservative.The lines are drawn.Why would we as a group want to get sucked into that?

David N. Muchemu MS,MBA,PhD(Candidate). John,
If you are so sure of how the majority feel about your post,why post it for debate?

John Eckberg It is the American thing to do. Debate and discuss particularly when the issue is so important to patients, workers and companies.

David N. Muchemu MS,MBA,PhD(Candidate). Sound like an answer from FOX NEWS!

To the moderator: you just lost one member of your group.

Joseph Schwartz Sorry to see you go David, are you so insecure in your own opinions that you can't stand to see them debated?

John Eckberg Hey David, Though you may not be able to read this since you are gone but you ought to know that I am as left as the next guy and, in fact, for what it's worth, campaigned for Kucinich - not once but twice - and wrote in Jesse Jackson one year because he was the only one articulating what I believed. No fan of FOX NEWS, but I do find O'Reilly to be highly entertaining. Guess that means there's 119,999 folks left. Do hate to see anybody quit, I must admit.

Here's my take in a nutshell. President Obama ought to show some leadership, recognize this was a dumb tax cooked up by a couple of Senators who have no medical device companies in their state and announce from the Rose Garden tomorrow before the Supreme Court rules that it should be repealed. I mean, it wasn't his idea. This mess landed in the Oval Office with a big thunk.

John Eckberg http://no2point3.com/all-signers I don't know, 8400+ reasons why this is a necessary topic

Bill Welch Taxes are on revenues so sell away. If you have a great idea, taxes don't discourage you from developing it, in fact there are right offs for R&D expenses. Maybe it's more a question that taxes may determine where you pursue it. As a wise man once said, I want to be the guy who pays the most in taxes, means I'm making more money than the next guy. We are not oppressed by taxes just the perception that we are.

James Stout Mr. Welch: Excellent point! As I am sure you are aware, taxes are lower now than at any time since the early 1950s.

James Stout Mr. Welch: Excellent point! As I am sure you are aware, taxes are lower now than at any time since the early 1950s.

Joe Tomko A couple of apolitical history lessons, and then and answer to John's original question:

Scott Suave, the primary reason for the second amendment was to defend against tyranny (whether on the scale of government or some thug who wants to rob your store) so we would not have to overthrow another government, nor allow others to otherwise infringe upon our God given rights. Hunting was not a concern as hunting was then so commonplace that it was as normal as breathing. States are now adding a "right to hunt" to their respective constitutions as hunting has been under attack natiowide.

James Stout, we are and always have been a Christian nation. We, as a nation, are also a republic, not a democracy. A democracy is only a tiny step from mob rule and therefore anarchy. California has degenerated into a cross between a republican and democratic form of government, if you want to see what a democracy leads to. Much of the Constitution was influenced by biblical laws found in Deuteronomy. Many letters between our founding fathers debating our constitution amongst themselves reflect this. Our founders were a deeply religious people and even said that our constitution was designed for a christian people and would fail if we as a people are not Christian.

John Ekberg, I am suprised to hear you are a liberal, I would have thought otherwise from reading your comment on various discussions. The original intent of our Constitution was that the House of Representatives represents the individual person. Senators were originally appointed by their respective governors to represent the interests of their respective states. Being appointed, they answered to their respective governor, i.e. their state as a whole. Mthey did not have to pander to various groups in order to get reelected. When the progressives passed the 17th Amendment making the senators electable, they then became politicians just like the representatives have always been. Now, while I think it is a cowardly move that Harry Reid is blocking the vote because it shields the other senators from having to be accountable for their respective votes, it is in the spirit of our founding fathers that he protect the interests of his state. Even if that interest is to sponge money away from the producing states. Even if that interest is counter to the national interest.

The original intent of our fathers was that laws passed by both houses benefit both the people and the states. I would like nothing more for these senators to have the courage to stand up and say "This is my vote, reelect me or vote me out based upon this vote." but that will not happen because of Hairy Reid. Dispicable coward.

Joe Tomko To further my last paragraph, when senators are appointed and the representatives are elected, we get/got laws the benefitted both the individuals and the states. With elected politician senators, we get bad bills becoming bad laws, irrespective of party.

Dennis Tagliaferro The issue whether the law maker comes from a state of low population or not isn't what is important. The prime concern is WHY the filibuster is happening and the consequences of whether a law passes or not. There will indeed be negative effects if medical costs go up, whether 2% or 20%. This comes down to integrity of intent. If we want to keep medical costs down, then you don't inflate expenses by making this county's citizens pay for free benefits to illegals at election time to get votes. Government should enable manufacturers to reasonably conduct research and innovation without arbitrary penalty.

James Stout Mr. Tomko: I will only respond to the response addressed to me, and let the others answer you for theirs. I repeat, and you can verify this with the writings of the Founding Fathers, especially Messrs. Franklin, Jefferson and Adams, that this is not a Christian nation. Those three gentlemen in particular were religious sceptics, and deeply distrusted organized religion, as do most people who are intelligent and educated. The most that can be said about the other Founding Fathers is that they viewed religion as a way to keep people in line, not as representing the absolute truth.

James Stout Ms. Hyzer: Good comment. Well-thought out, and based upon life experience.

John Eckberg And they were, in general, slavers. That's not the Christianity I know.

James Stout Mr. Eckberg: You are quite right. And women's rights was only a line of thinking in Abigail Adams' corresondence with John. And that is a strong suggestion that we need to update our belief systems at least once every generation.

Religion.... politics .... I am just waiting for somebody to interject sports into the thread in order to fully develop the concept of non-relevant tangents.

Dennis Tagliaferro Ms. Hizer, I admire you're well thought out worded comments and agree with you. I feel that an agency like the FDA is needed. Many countries have their own agencies and manufacturers must comply when and where their devices are sold. We do have another real worry to be concerned about however- namely those countries that are stealing our patents. This issue has been on the national and international news many times. We invest 10's of millions of dollars in research, development, manufacture, and marketing only to find that others infringe on the patent and then under sell us. Safety also has to be regarded as a concern as much as the specific economics involved. We in this country have the power to not invest in these overseas markets. We will empower ourselves by retaining our inventions. Yes, FDA costs will rise but forestalling on losing what we invent will maintain our profitability.

James Stout Mr Timourian: Very true.

Joseph Schwartz James, you said "The most that can be said about the other Founding Fathers is that they viewed religion as a way to keep people in line, not as representing the absolute truth. " Actually it is the LEAST that can be said. THis is a myth perpetuated by progressives. And yes, some of the founding fathers owned slaves, but it was Christians, working through the political process, not progressives or the government, that worked tirelessly to ABOLISH slavery. Progressives worked hard to minimize the effect of abositionists. See the hisotry of Planned Parenthood. And concerning the medical device manufacturers getting a free ride, is there not already a user fee, just renewed AND INCREASED by congress. The 2.3% tax is NOT to cover regulation, but to cover the FREE RIDE of healthcare users. Why is it wrong for manufactures to get a free ride but not citizens who, at the risk of sounding harsh, are often poor (a relative term) due to their own poor choices. Under the current thinking, those who make right decisions, be they companies or individuals, are penalized for doing so through higher taxes, while those who make poor choices are REWARDED for doings so and thus ENCOURAGED to continue making poor choices. I am all for helping the poor, but the government way of forced charity, is a poor way to accomplish that, with most of the dollars going to support the beaurocracy who's job it is to dispense this government charity. Private organizations are better suited to doing this and can better police against abuse.

Joe Miller History has proven that the true Christians have by far provided the best governments and economies. The problems now in America is that our "government" has totally gone away from its christian underpinnings. Our Capital city is replete with christian ideals literally written all over it. People being what we are are imperfect and tend toward evil. In most places in america and the military we have seen the prohibition of even mentioning the Holy name of Jesus lest we offend someone. Praying in Jesus name and having elected officials invoke his name is NOT state religion! those that dont beleive are FREE to not listen and beleive as they see fit without fear of state retribution.
I know this doesnt fit into the original discussion except to say the Ried and the rest of the GANG on capital hill do not talk the talk so to speak as evidence by their actions and endorsements of many things unwise and immoral!

James Stout Mr. Schwartz: Christians were also the bulwark of those who supported slavery, since in the first 100 years after the Revolution, there were few other religions. The ongoing, sometimes acrimonious dialogue in this country has always been between the various splinter groups of Protestants, as to which one was closest to God. And Christianity in some parts of the country have supported slavery and discrimination to the present day. But this has nothing to do with taxation, which is, after all, the putative basis of this discussion. For a better discussion of that, I refer you to the very thoughtful comment above provided by Ms. Hizer, which is based on actual experience.

Joseph Schwartz Except that it ignores the use tax already in place and now increased, making the 2.3% tax unnecessary and redundant. The purpose of which is other than to cover the cost of regulation. It is to fund to free healthcare of the rest of the bill. Therefore the 2.3% tax will never be enough so it will have to be inreased on an almost yearly basis until US device manufactures colapse under a tax burden which makes them unable to compete with foreign manufactures. Taxation Always results in less of a produce. You know this, it is reflected in the policy of taxing tobacco products, and now proposed taxes on fatty foods such as burgers and fries. So the question I have is Why would the governemnt WANT to reduce the production of US medical devices? Is the real reason the transfer wealth the other countries (we are the evil rich Americans who are hording the world's wealth)? I'll refrain from comenting further on the slavery issue since so many object to this digression from the topic, despite the fact that those with Christian views did NOT bring slavery up originally. Funny how we are discouraged for responding.

James Stout Mr. Miller: Let us explore your comment. What are 'true' Christians? Are they the original followers of Luther, who butchered not only Catholics, but also fellow Protestant, but who may have happened to be followers of Calvin and Zwingli? Was it the Catholics of Spain, from the time of the Reconquista to Franco? Perhaps you were thinking of the Protestants of New England, who conducted actual witchhunts, and crucified Quakers for opposing the death penalty? Or could it be the largely Baptist congregations that supported the KKK? Or the Christians in the northern states who quietly went along with and still support real estate, education and employment discrimination against blacks, Hispanics, Jews, Muslims, women and gays? What do you mean by 'true' Christians?

Joseph Schwartz James, all those you list, other than Baptists, were state religions and as such cannot be considered true Christians. Although they would have contained some true Christians, most would not be. Only by name and place of birth. The concept of a person living in a garage does not become a car, they are by nature a person. True Christians are ones who live up to the teachings of the founder and head of the real church, Jesus Christ. The Southern Baptists split from the northern because they supported slavery, indicating they had departed from following the head. The northern Baptist were already along the road of departure. Even so, true Christians will never be able to perfectly follow the teachings of Jesus, they will always be flawed and imperfect as long as they walk this earth. Ad far as real estate discrimination, it is a fine line between the rights of a property owner (a constitutional right) and the rights of a tenant (a derived right). The right of ownership should never be a license for treating another wrongly. I don't know that this is the forum for debating property rights versus tenant rights but we can, perhaps in a differnt venue.

We still OK on this thread? The religion side-track is making me uncomfortable.

James Stout Mr. Hage: You are right. I will refrain.

John Eckberg While Ms. Hizer is entitled to her opinion and I appreciate that she posted for sure, unfortunately it's skewed and flawed. I'd argue that the FDA, by keeping safe devices off the market unnecessarily, actually, devices that are likely to be safe, they are harming patients who are running out of hope or have simply run out of hope and are waiting to die. If a device gives me a 70% chance at extended life but without it I have a 100 percent chance of mortality then I will take my chances. The Sapien heart valve is a good example. How long was it available in Europe.

So while I'd take my chances, if I don't have money for a plane ride to Europe, I can't get the device. But the FDA won't let me.

Also, it's just not true that device companies have gotten a "free ride" for many years. Where'd she come up with that. Last time I looked, and that would be FY2003 to FY 2010 the budget for FDA's medical device program rocketed from $218 million to $368 million, a 69% increase, while full-time equivalents at the FDA increased 18 percent from 1,485 to 1,755.

Think of those full-time equivalents this way. For every one of them, companies have to hire to answer their questions and respond to the whims of the particular investigator. Call it a bureaucracy tax. I don't know where Ms. Hizer lives but in my neighborhood, $368 million a year in fees is not exactly a free ride. Not that it hasn't paid off. Medical devices are safer than ever: just 2 tenths of one percent of cleared 510K products over a five year study and just 4 tenths of one percent of cleared PMA products, according to AdvaMed. By the way, those great results reflect more on industry efforts and standards than the FDA. The FDA doesn't manufacture anything.

Nice to have opinions and offer them. And like toes, most people have 10 of them. But it's nicer, I think, to have opinions supported by facts. The medical device industry has been paying its way with ever escalating fees (that serve as a barrier to entry for many start-ups, by the way) and the highest corporate tax rate in the world.

Next up from me, as long as I don't violate any of Joe's rules, is a double-play: why device companies should be enabled to repatriate profits from overseas units without paying the onerous tax penalty levied by the U.S., and how this 2.3 percent tax on sales may indeed be a haircut for global device giants and thats why they see it as a good thing and are not particularly keen on seeing the tax repealed for it's a barrier to entry and will drive down their R&D because acquisitions in the future will not be so pricy. . .
John Eckberg
Director, Media Relations
Cook Group
www,no2point3.com

James Stout Ms. Hizer: Good answers. Push back!

John Eckberg JP Morgan stock analyst Michael Weinstein in a note to investors Thursday. Medtronic inc., the nation's largest device maker, estimates the tax will cost it as much as $150 million in 2013, a spokeswoman said. Stryker Corp. said in a statement Thursday that the $130 to $150 million in will owe next year could consume one-third of of its research and development budget.

Smaller companies will take the worst hits, Mr. Weinstein wrote of the tax, which applies to sales rather than earnings. Small device makers could see earnings per share fall by 10% he estimated.

Here's sobering but affirming news from a Wall Street Journal story: "Medical-supply firm Zimmer Holdings, hospital-bed maker Hill-Rom Holdings and other device makers have also attributed planned layoffs to the tax. Mr. Scott warned that more companies could follow. Because the tax is on total sales, rather than profits, companies with the smallest margins, such as unprofitable start-ups, will face the deepest impact, Mr. Scott said.

"The tax looms at a difficult time for the industry, as patients delay elective procedures, such as knee replacements, and federal investigators probe companies over aggressive marketing tactics. Unlike other health-care sectors, analysts don't expect device makers to benefit much from the expected flood of newly insured patients because they depend largely on older patients who are already covered by Medicare

James Stout Mr. Timourian: You are generally right when you talk about taxation, but you seem to overstate the power of taxation to 'discourage startups, hamper success, [and] make it difficult to raise money.' I know of no startup that has been discouraged from launching because of taxation; and the problem with raising investment money in the US for medical device startups goes far, far beyond a miniscule tax like the one we are discussing.

James Stout Mr. Timourian: Again, there is some truth in what you say, but one has to be careful about overgeneralization. For example, there are countervailing forces, such as the JOBS Act, which enables smaller companies to go public more readily, with fewer regulatory burdens, enabling some to raise money more easily, and at better terms than are usually offered in the venture capital community.

Michael McCarthy, MBA, BS, RRT-NPS Any politician that stifles business or innovation is bad for America. Where do people think jobs come from? Here's a clue: It's not from DC.

John Eckberg Ms. Hizer, Never a big fan of he-said-she-said and only posted before because you claimed device companies got a free ride. It was either not true or a lie. I prefer to think that you were just uninformed about that. Comments from the uninformed sometimes need to be challenged with facts so that's why I wrote.

And if you want to look for companies that are high-fiving your beloved Affordable Care Act and the medical device tax on gross sales that will absolutely decimate this industry when it is imposed, it would be your Big Pharma, where, apparently, you gained so much knowledge. I wondered why I saw pictures of Pfizer execs leaving an Obama fundraiser in the New York Times recently. Then I figured it out: they dumped money into Obama's relection campaign and the pay-off was an Act that did not tax them and the administration keeping low-cost drugs out of the pipeline so Big Pharma could write prescriptions to tens of millions of newly insured Americans. Device companies, as you probably know, are usually small with fewer than 100 employees.

I don't know a thing about the Guidant deal with Cook but based on the accuracy of your other contentions I'm absolutely certain it's not how you portray it. By the way, you and Mr. Stout have a real nice mutual admiration society going. He didn't reply to my contention that this tax is going to lead to increase mortality by inhibiting humanitarian devices. That's the thing about liberals - when the facts get in their way, they ignore the facts. Conservatives do it too, I think.
John Eckberg
Media Relations Director
Cook Group
www.no2point3.com

The device industry received a big financial gain from ad Advamd Orthopedic institutions, residencies,societies and others turned away from direct industry support. Industry was aked , in good faith, to place thebsame amount that they previously spent into the Omega fund, and OREF, which would then be distributed by a committee to residencies and fellowships on application. The amount put into these funds is a small fraction of what was previously spent, so this money is being kept by the companies as profit. Perhaps a tax is required for medical education???

I do not believe that one Senator should be able to stop negotiations and discussions on any issue. If the two Senators from a state have heard from their constituents then perhaps there is a limited discussion, but nothing is put on hold. No one understands the medical device industry until you've got great experience within it operationally. Whether a start-up, small or large company, the issues are still the same that a 2.3% tax is an extraordinary tax to place upon an industry that has continuously and progressively produced new technologies that have saved lives and made our lives much better, over the past 35 years I've been working in the industry.
I would think FDA and the federal government could gain far greater revenues from stopping the near "immediate" approval of generic drugs when FDA and any scientists or consumers know that they are different. In my opinion we should stop making people guinea pigs for drugs that have never demonstrated safety and effectiveness. We have a much bigger problem to face with FDA approving generics as "equivalent" to name brand drugs, the insurance companies use that as an excuse to get you to immediately switch to the generic (to save money and because they won't pay for the generic any longer), pharmacists don't know the difference (in fact they don't know anything about the contents of generics because they are not required on the labeling), and we all are suffering. In fact, we are taking ingredients for our drugs from overseas without doing sufficient background and testing on the component and how it changes with each batch. Get all drugs to prove safety and effectiveness and have them pay the fees. In addition, elimination of all (except President and Vice President) continuing salaries and medical care (that far exceeds what the population can get) for government workers at all levels will surely provide more than sufficient revenues as compared to taxing medical devices.
Let's think about the big picture folks and stop hurting the few. it's time to change our attitudes about change in this country.

J. Donovan Gentlemen,

We all have worked, or presently work for companies that have to make a profit. What does the Senator from Nevada do? Forget politics for a brief moment. Listen to him, how he delivers a speach, tone of voice etc. His ideologies and beliefs are counter productive to any form of capitalism. This man is an EXTREME lightweight in intellectual capability. He has no challengers except from other senators? He would never be able to hold a position of management, or authority in any company I've ever worked for. FACT!!!

J. Donovan and ......NO its not right that he can hold up a debate. But welcome to the US Senate!!
Mediocre talent at best.....surrounded by lightweights!!

What will probably happen is that the major med device companies will move their lower margin items off shore to low cost countries. I know my former employer was going to have to write a check for $50 million each year if this went through. That was their R&D budget for the year. They will make the costs back but with a large impact to the suppliers here in the US.

Michael McCarthy, MBA, BS, RRT-NPS Harry Reid is in for 4 more years. There is nothing we can do about that but putting him into the minority will defang him. That's a real possibility in November.

Mark J. Kania, MBA. Then we should find a way to impeach/remove Sen Reid from office.

Pattie Rotondo The amount of legislation currently tabled by Mr. Reid is astounding. Neither he nor any other congressperson should be able to ignore bills sent to them for consideration. It is a disservice to the people congress is meant to serve to allow one person so much power.

James Stout Ms. Rotondo: Keep in mind that whatever the Senate passes is now automatically filbustered, so don't be too critical of Senator Reid.

Pattie Rotondo I will continue to be critical of Sen Reid as well as any politician that lacks the intestinal fortitude to argue his point in open congress rather than hide behind the systemic tricks that allow issues to be avoided.

James Stout Ms. Rotodo: Have you ever thought that, with the many issues of healthcare, taxation, budget issues, and obstructionism that he daily faces, that Mr. Reid might have other priorities, in the larger picture, than a relatively small tax affecting only a small portion of the economy, and only indirectly?

Pattie Rotondo Mr. Stout, you entitled to you opinion, as am I. These issues are best settled at the ballot box. I take issue with you analysis and how the fallout with affect the industry. I hope I am wrong but my past record on analysis of this sort suggests otherwise. I hope the industry will do well but be aware that many have reasons to doubt your sunny appraisal. Good Day.

Mark J. Kania, MBA. There must be a constitutional method of removing him from office.. We must get control of the US Senate in November. This is the most important election in our lifetime.

Bill Welch The CEO of Medtronic received 25 M which approaches 20% of the additional 150 M tax they will be asked to pay. I've heard no one mention the untold benefits of a healthier workforce once access to healthcare is expanded. No more waiting until going to the emergency room is the only option. I think that in itself will more than pay for the 2.5% tax levy and indeed fulfills a responsibility we have as a society to those who cannot contribute to our economy in an unhealthy state. Linear thinking never solves large problems only further cements the status quo and alienates us from our "connection' to others and a higher order.

John Eckberg It's worth repeating, since Mr. Stout insists on parroting lies and/or talking points from his Young Democrat Club meetings: whatever else the Affordable Care Act is about, it's not about imposing a "miniscule" or "minor" or "small" tax on medical device makers, our nation's most innovative industry.

A 2.3 percent tax for a company that sells $1 billion annually in the U.S. represents a new $23 million tax on earnings. Assuming an existing 30 percent tax rate on U.S. corporate taxes, that is, a credit of 2 percent for job creation and, say, another 3 percent for research and development credits, and assuming tax deductibility of this new 2.3 percent tax on gross sales, that means our mythical medical device company will be paying another 15 percent tax on company earnings thanks to the device tax.

For some companies the scenario is far worse. For others, the giants, well, it's going to seem like a haircut when compared to annual profit and will likely be yet another barrier to entry for nimble American start-ups.

Add this new tax to the 5 percent in state taxes already paid, the 30 percent corporate tax, just about the highest on the globe, and our mythical typical medical device company will be paying a tax rate of 50+ percent of earnings. This new tax represents, by the way, a 40-50 percent increase in federal taxation in just one year or a 100 percent increase for companies that do not yet have a profit. It can't be passed along to GPOs, IDNs and hospitals because this is a competitive space and companies that manufacture in low-tax nations will have an immense price advantage because they are starting from a lower tax base.

So what does this company have to do to its top line to have profits stay flat in 2013? The company has to grow its top line by $200+ million.

This is not a miniscule tax. It's a 40+ percent increase in a company's federal tax rate in just one year. Or more.

If society wants to fulfill its obligations to those who cannot contribute to our economy because they are unhealthy, then society should impose a tax on what causes those health problems: wheat (obesity/diabetes II), alcohol (too many diseases to list), tobacco (too many fatal afflictions to list) or fast food. Don't impose a tax on the industry that solves the most pressing medical issues of our time because it will only force publicly traded companies to head for the hills of Ireland, Canada and many other low-tax nations.

John Eckberg
Media Relations Director
Cook Group

James Stout Mr. Kania: The good news is that progressives are well on their way to increasing their lead in the Senate, and may even retake the majority in the House from the regressives. This is due mainly to the regressives being utterly corrupt in their methods for the past four years, as well as the progressives being on the right side of history.

John Eckberg What I like most about this board and the emerging media of LinkedIN is that on a currated group like this one - props to Joe the Commissioner - one can learn so much.

Somebody pointed out in an earlier message that this tax was going to claim $50 million from his previous employer. That was just about equal to the annual research budget when he worked there!

Think about that ratio spread out company by company across the states of Massachusetts, Indiana, Illinois, Wisconsin, Minnesota, over in North Carolina and into California. This is not a tax as much as it is the piracy of medical device R&D now and for years to come by a Senate Finance Committee that had no idea what it was doing when it hatched this notion three or four years ago.R&D in this field is basically a euphemism for rooms of engineers.

The equivalent of an entire industry's R&D budget from 2010 is going to disappear each and every year into the black hole of government spending? Here's what's frightening to me - If one job is lost in the industry, doesn't that equal 1.5 jobs lost somewhere else? Retail, commerical services, shoe repair? But mostly this confiscation of medical device R&D spend will do irreparable harm to patients immediately and for the forseeable future.

John Eckberg
Media Relations Director
Cook Group

James Stout Mr. Eckberg: I find that these discussions are best when the participants forge their arguments from verifiable facts, and then move toward solutions, don't you? We need to avoid wild, unsupportable claims, even when containing a fig leaf of random numbers.

Joe Miller The 2.3% excuse tax is taken right off the top of a company's earnings. All it takes is simple math and a basic understanding of business to fully understand the impact this tax will have on the medical device industry. Not to mention the suppliers if materials and subcomponents. As medical device companies scale back and move offshore these suppliers will also fold for lack if work. The tax will also stifle any new and innovative medical devices that will actually lower cost, reduce procedure time and invasivness and most importantly patient risk! Obama is not an idiot he is highly intelligent. He knows what this entire AHA legislation will do to the economy and he knows that it's not sustainable. So I keep having the same nagging question: Why is he and the courts allowing it to stand?
Anyone have any answers?

James Stout Mr. Eckberg: Please correct me if I am wrong, but you seem to subscribe to the urban legend that all government is bad, and all taxation wasteful. It is true that all governments are made up of people and therefore imperfect, but the solution would seem to be not to eliminate government, but work to improve its efficiency. One example illustrates this point. America must compete in the world as a single nation, not as 50 balkanized entities. Thus it would make sense to harmonize the various state laws and regulations, even perhaps eliminate the states as separate sovereignties. After all, states are largey relics of a time when the first colonies were each separate entities, with separate histories; as the core argument of this discussion states in its title, a very small, otherwise inconsequential state can exert an influence greatly in excess of its population. A demonstrably outdated layer of bureaucracy is kept in place, increasing costs of business and decreasing efficiency and competitiveness. How about it? Are you ready for some new thinking?

James Stout Mr. Miller: The ACA was allowed to stand because Mr. Justice Roberts, who apparently does not like it, found that it was within the power of government to implement a tax. He correctly read the role of the Supreme Court as being a review of the constitutionality of legislation, and no more.

James Stout Ms. Hyzer: That is always the way to stymie the regressives: show them verifiable facts.

Michael McCarthy, MBA, BS, RRT-NPS Mr. Stout: Our nation was founded on the premise of States' rights. You would need a new Constitutuion to change it. That would require a Constitutional Conventiont that would necessarily put everything on the table, including the Bill of Rights. Personally, I don't think our present leaders are made of the same cloth that our founding fathers were. Not interested.

You suggest government to be more efficient. What better way than by NOT raising taxes and requiring they live within their means? Like you and I do.

Michael McCarthy, MBA, BS, RRT-NPS The one thing we DO know about Obamacare, it will cost trillions of dollars. No one in their right mind would think that this boondoggle is anything more than a government power grab. People will not be healthier as the medical system does not make people healthy. We ourselves do that. Healthcare Postal Service Style.

Here's my beef with the 2.3% sales tax. From Forbes: "The 2.3 percent excise tax on medical devices is a savage blow to innovation. Note that this tax is on sales, not profits. It cuts into the top line, not the bottom line."
I have been through this exercise with supply chain managers, "Its just a 3% cost reduction we are looking for...that won't really affect you much"
If our net profit is say 9%. That 2.3% tax brings profits down by 25.56%. If we have a revenue of $9M, and we had a net profit of $810K, our profit loss with this tax is $207K. The salary of two engineers plus benefits. Can someone explain to me how this is a small tax?

Back to the original question, John Beasley is correct. Although the only reason Reid can do this is because he has the majority. We need to vote correctly in November on all fronts. I've learned this late in life, but what we have and cherish in America only works well if we are all engaged in what we want from and for this country. Our system is only as good as our efforts. Funny how that is no different than the companies we work for. Capitalism, truly ingenious but not for the lazy minded.

John Eckberg No wonder James Stout didn't want to talk about this topic when Joe initially enabled the query to be launched. The magnitude of this tax is only now emerging. All of the annual R&D budget, $50 million, from a company where a group member once worked? That's astonishing.

The question remains should Sen. Harry Reid have the power to thwart the will of Congress Members who represent millions of households in Southern California, Ohio, Wisconsin, Minnesota, North Carolina, Pennsylvania, Massachusetts...pretty much every state in the union, including a smattering from Nevada, according to a roster compiled at www.no2point3.com?

Scott Pedersen Why support any type of tax ? There are many good and reasonable comments, however, in my perspective, why should the government increase this burden on legitimate economic growth ? That is why many companies are leaving America. It is the small startup companies that fuel our economy. No to the 2.3 % tax. Write your local Federal Representative or Senator and tell them what you, as their constituent would have them do in response to the Robin Hood Rulings.

Jac Higgins, CHFP Looks to me that this thread got hijacked from an original discussion of Senate rules to the merits of the medical device tax. John Beasley answered the question. /thread

Joe Miller As I said before President Obama is an intelligent man as are the staff and
cabinet members. You don’t get into those positions by being stupid and
unintelligent. Having said this, it is very obvious to the thinking man or
woman that this entire healthcare legislation including the 2.3% excise
tax, will not be good for our nation (with the exception of a very few
points). So the question that I still have is, why would anyone in
government, who duty it is to safeguard our liberties, etc, demand a
legislation so damaging and so dangerous in terms of personal liberty and
economic survival of a nation?

The numbers don’t lie, this tax and this healthcare bill are so burdensome
it will decimate our already weakened manufacturing base, drag our economy
below levels of 3rd world countries and endanger our future freedoms like
no other foreign enemy ever has.

If any one has an answer I would like to hear it.

Thank you

Mark J. Kania, MBA. I think this administration clings more to its Socialist ideology than to its sworn duty to serve and protect its people as a democracy. Controlling healthcare gives them the ultimate power over us. They continue to circumvent the US Constitution and pass legislation that the majority of Americans do not want. The US is the world leader in medical device development, and we need to keep it that way. This underscores the importance of removing this administration and Senate leadership in the November elections.

Joe Miller I still cant help but think there is another agenda with this
administration. Nothing this administration has done has been beneficial to
this nation (or at least very few things). This administration’s over the
top spending, along with this new tax and healthcare legislation and a
multitude of other really bad ideas that they have implemented make for a
non-sustainable economy and society. To me this administration is
intentionally deconstructing this nation in order to either destroy it,
turn it over to another nation, or rebuild it into a total dictatorship.
Reid, Pelosi, Frank, (late Kennedy), Obama, and his 50+ lobbyist turned
Czars cannot be trusted with the reins of leadership in this nation.
Obama(Sotero) himself is an enigma, Half his family is in Kenya, He was
allegedly born in Hawaii, and has a SSN that was issued out of New Jersey!
Where did this guy come from?

If the masses in America make another mistake and re-elect Obama in
November, God help us all, worldwide for people that value their freedom!

Mark J. Kania, MBA. The American system of economics and justice is being dismantled before our eyes.
Did he actually celebrate on July 4th? I think not. Whoever's side he is on is certainly not the working people of this country.Let's not make this same mistake again.

Jac Higgins, CHFP The sky is falling, the sky is falling...
If America could survive the Civil War, two World Wars, Korea, Vietnam and 20 years of (questionable) war in the Mid-east, we can survive HCR.

Bill Welch and 8 years of GW. 5 years from now you'll be saying how did we go this long without it.

Mark J. Kania, MBA. Some healthcare reforms are needed, but this is a very poor piece of legislation in so many ways. Take the $500B cut to Medicare, for instance. Our seniors deserve better, and the financial health of our hospitals will suffer as well.

J. Donovan Wow!! what profound statements from the Progressives. The Sky may not be falling yet; but ACA/HCR is the biggest threat to American Democracy and capitalism in 236yrs. This Administration is not even mediocre. 4yrs from now we will be saying "what were we thinkng" Change? Please......this "child" of president is NO leader. He is the great divider. I can honestly say he would not be able to hold a job where he had to turn a profit, manage people and grow an industry. As Mark K. said his agenda is questionable and his motives less than honorable.

Anyone on this board ever said to their supervisor " I'm doing it this way; regardless of the data" aka ....."we have to pass the bill to find out whats in it" Really?
That is called incompetence and civic negligence. But the American public puts up with this representation again and again. We get what we deserve.

Jac Higgins, CHFP The better performing hospitals can recover these loses through VBP, by meeting the quality standards they should have met on their own. The hospitals which see the glass as half full? They will need our help.

Jac Higgins, CHFP Really? Is the President "the great divider" or do Rush and Glenn Beck better fit this mantle?

Bill Welch I guess Social Security and Medicare weren't threats to democracy. The status quo is unacceptable. There are no other alternatives I've heard floated that will bring all into the risk pool and better the health of this nation. Are you pro-freeloader and anti personal responsibility ?

Michael McCarthy, MBA, BS, RRT-NPS Obamacare will not bring everyone into the risk pool. It will cost trillions of dollars and we will still have millions going to the ER for their primary care. This is fact.

J. Donovan Those programs have been managed so poorly since the 60's it is not even worth the trouble to discuss it with you. Medicare has been running on accountancy "Duck Tape" laughable to any prudent individual who understands actuarial science. Secondly, the "dirt bags" in both parties have borrowed against the SS system that it's almost the same as CDS's that brought down Lehman Bros. and caused the mess in 2008. And Yes! they are threats to the Federal Government and Democracy if they are to continue.
But I guess adding another Trillion to the budget makes me a free-loader. By the way.....things don't float. They get rammed down the American peoples throats by less than mediocre talent. No one on this board is privy to the garbage and nonsense that is discussed everyday by the weak minded people we elect to do a very simple job. You don't spend what you don't have? It's really that simple.

I'm slowly learning my lesson: Posts with a political bent will generate potentially hundreds of comments (many from the same dozen people). As the conversation prolongs, the comments get more divisive.

For now, I'll keep the thread open but I'm inching closer to shutting it, as I did with the mandatory healthcare poll a few weeks back.

Please review your commentaries before hitting "Add Comment" and ask, "Does my comment add a meaningful point to a discussion about medical devices?"

Tricky business, this moderating-a-forum thing.

Thanks for listening.

Scott Pedersen Did anyone notice the Ten's of Thousands of pages of addendum that were added to the Affordable care act, effective July 05, 2012. It apparrently outlines what Doctors can and cannot prescribe, testing that can and cannot perform and ultimately has tied the hands of clinicians and physicians to practice evidence based medicine. What I think this means is, with the 2.3 % taking on all device products, this Act is attempting, with some very sharp teeth, to inhibit or out right prohibit, I would, with kid gloves say, curtail the use of new and successful medical device and pharmaceutical treatments.

Joe Miller Does anyone know of a source that boils down this massive nation killing
legislation to easy to digest ACCURATE bullet points so that it can be read
by the average citizen?

Jac Higgins, CHFP Scott,

While I have not had a chance to read the "tens of thousand of pages" added to ACA, I do know that VPB is evidence-based, and many hospitals can't even meet these standards. I was involved (in a very small way) in a 2006 CMS demonstration project which laid much of the groundwork for VBP. A key finding was a clear and indisputable correlation between quality of care and cost: without exception the hospitals with the best outcomes were best at controlling their expenses. Set a standard of care and enforce it across all service lines and all physicians. This is an important start to lowering healthcare costs for all of us.

Jac Higgins, CHFP Joe,

You're not going to find an Executive Summary of ACA that is not politically charged.

Michael McCarthy, MBA, BS, RRT-NPS Evidence changes with time. I'm sure the government regulations will keep up with the cutting-edge technologies. (yuk yuk)

Mark J. Kania, MBA. Its safe to say that most Americans are disappointed and resentful that they've been force-fed this legislation. Having more meaningful debate beforehand would have produced a bill that was truly democratic in nature.

John Eckberg Whatever the ACA is and does, this much to me is clear: it should not have a tax on industry in it, particularly the one corner of the industry that is not going to gain from 30 million to 50 million new patients as most of those individuals are already covered through Medicaid/Medicare, etc.. The House agreed 270-146. Now it's up to the Senate. I have no idea how to move the Senate to do anything.Does anybody have any notions?

Still, lawmakers fixed ACA mistakes before - the dumb 1099 reporting requirement, for instance.

Senators from states that have so much to lose need to debate and decide on the repeal, which has a broad bi-partisan river of support in the House and can't let it be held up by a pair of Senators in regions that have next-to-know medical device presence.

Personally, and in answer to what needs to be done, I think Senators and lawmakers from N.C., Minnesota, Pennsylvania, Ohio, Ind., Ill., Calif., Fla and N.C., particularly the half dozen or so that have not announced support of the Repeal, well, they need to hear from company owners/constituents.

Letters to the Senate office work okay. Letters to the editor work better because they are scarier. particularly if a Senator is called out in it in it.

The best thing about this string is whenever somebody says they wrote to their Senator or other legislator. Love to see that activism. Shows the power, too, of social media, I think.

Anyhow, Senators from states like WVa., Ore., NJ, Nevada, Montana, Kansas, where the Dem Senators are from, didn't worry about a "pay-for" when they dumped that useless 1099 reporting standard. That change to the ACA came just weeks after it was passed and nobody said Boo about a pay-for then.

Worrying, too, about a "pay-for" that hasn't even been collected yet is the ultimate arrogance by tax creators. Why should there be a "pay-for" for a tax that has not been collected yet?

Michael Lubov Hey guys:

Sad to say, this is just the way it is today. Right wingers block Left winger things, Left wingers block Right winger things. Republicans block Democratic things, Democrats block Republican things.

Arizona has fewer residents than Brooklyn, NY. Why should Sens. McCain and Kyl be able to block something that more people that live in their state want?

We have lost our way! Our legislators used to care about America and Americans. Now they only care about reelection, campaign contributions and speaking fees.

Activist judges are the ones who vote against what you wish for. If you like the Citizens United decision then the Supeme Court voted properly. If you hate the decision on Obama Care then Justice Roberts exceeded his authority.

Be careful what you wish for - you may get it!

Patrick Brown Excellent discussion so far. Usually these things dissolve into blue or red rhetoric. I am enjoying reading the differing opinions.

Dan Stipe Mr. Eckberg,

I understand that the Cook Group is violently opposed to the tax and is actively engaged in encouraging its repeal. Personally, I don't think the tax is a good idea. But I have also not seen any convincing argument that it will kill innovation. I can think of no tax that isn't ultimately passed on to the consumer. I would like to understand why this tax is different.

John Eckberg Hello Dan Stipe, Not sure we are violently opposed to this tax but we sure are vigorously opposed to it. Here's how the dominoes are going to fall....no, make that are already falling. When companies like, say, Boston Scientific, face a new and annual $150 million tax bill, they don't usually have that kind of cash sitting in passbook savings. So they look at operations and figure where they do have that kind of cash. Often/usually, it's in research and development. Companies need to do R&D to find new approaches and develop new devices. When clinical trials cost $15 million to sky's-the-limit, firms have to have plenty of cash on hand to develop new devices or to direct to new clinical trials.

But when a tax of this magnitude comes down the pike, firms have little choice but to raid R&D (that is, innovation) to pay the tax bill. Sure, they can lay off folks but labor is a fairly small percentage of the cost of doing business compared to the tax bill and labor costs in the U.S. compared with say, Ireland, are a wash anyhow. But for sure, lay-offs are happening as a result of this tax. So is curtailed R&D. R&D (or innovation) becomes the rainy day fund to pay a new tax.

Why, you wonder, can't companies just pass along the tax with higher prices - a new cost of doing business. Two parts to that answer and I don't know which is more important. 1. Global companies compete in a global arena. Companies based in Zurich (3 percent base tax rate, compared to the U.S. base rate of 30-35 percent depending upon whether companies have job-creation credits) that manufacture in China and dump on patients in Oregon have an immense price advantage even before this tax because of the lower corporate tax rate. This tax, I think,creates a tipping point of no return for the device industry in the United States, particularly with start-up.

Also, companies no longer sell only to hospitals. IDNs and GPOs call the shots these days on price. And they are always looking to source from the least expensive provider. Finally, another, probably even more important, aspect is this: we're not selling candy, cashmere sweaters or MP3 players. We are selling medical devices and those prices are negotiated for, usually, no less than 18 months. Most of the time prices are set for three to five years. There are no clawback provisions in those accords, either. So when a tax like this comes along, device companies can't simply raise prices because of those pre-existing long-term purchase agreements. I wish the Senate and the House had asked these questions before they went behind closed door and came out with this dumb idea.

Thanks for asking, Mr. Stipe.
John Eckberg
Media Relations Director
The Cook Group

Jac Higgins, CHFP John,

"...GPOs call the shots these days on price..."

This was not my experience at Amerinet.

Jac

Dennis Tagliaferro VERY interesting analysis and perspective! Previous comments had been made about a Senator's right to block legislation based on the state's population density, removing the right to filibuster, and other things to limit our precious U.S. constitutional right to free debate in Congress. These are dangerous grounds to purse- our constitutional rights are the world's envy and that's why people emigrate to America.
The SUBJECT IS THE TAX and how to deal with it. After hearing more debate, I now feel that this tax will not be helpful to the medical industry for a variety of reasons. Two stand out: 1). Costs are high already and there is constant debate to lower them- now we are planning to add to the bottom line? and 2). The increase will be passed on to the consumer or companies will fire (politely called layoff"s) to compensate for the tax cost.
One helpful approach could be to add an import tax for certain countries. This common worldwide practice is done to protect many industries. Foreign competitors, ex., as cited above in the Zurich / China connection, are dramatically under selling us. Remove their preferred tax status to keep things on a level playing ground- the US will not be any different than other countries in this regard. Stringent reciprocation must be made against those countries (names not mentioned) who infringe on patents (thereby lowering their R+D costs big time) and directly subsidize their industries to lower prices even further below any possible competition. Besides increasing their national revenue, they are targeting other other legitimate economies. This is one method to protect our industry without adding more punishing taxes.
I don't know if this is the best avenue to pursue but hopefully someone is looking into it.

Dan,
You are correct that under normal conditions a tax would just be passed on to the consumers but you miss 2 points that make this law especially damaging to innovation.

1. This tax is on revenue not profit like most taxes. Most innovation comes from the startups who tend to not be profitable for many years. Taxing revenue favors bigger companies who are already profitable and less likely to innovate.

2. The insurance environment won't allow for drastic price increases. Through Medicare/Medicaid the goverment has effectively placed a cap on what hospitals can afford to pay for medical devices. These pricing pressures combined with the ever increasing cost to bring a device to market, make it more difficult to sell a device to a hospital at a profit.

If you believe what drives companies to innovate is profit then you can see how negatively impacing profit will negatively impact innovation.

Another negative effect of the tax is one that we have already seen. Some of the larger medical device companies have already released plans to lay people off in response to the tax. This definitely makes it more difficult for those companies to continue to grow and innovate.

This is a fine example of the use, or perhaps misuse, of the Jeffersonian idea of a bicameral legislature. The concept was created to protect the states with low populations from being overwhelmed by states with large populations, in legislative actions. It is in direct opposition to the one person one vote rule that is popular right now. However, conflicts between states are now a minor concern compared with conflicts between political parties.

Dan Stipe Mr. Eckberg and Mr. Runey,

Thank you for that information. Just what I was looking for to inform this debate. I'll be interested to see if there are any countering views.

Several things strike me: 1) That the tax is on revenue and not profits is a compelling argument. Are there no other taxes levied on revenue? 2) One contention is that the tax won't be passed onto to the consumer because of longer-term pricing contracts. I can see how this might be the case for devices already being sold in the market. Yet many companies find ways to pass increased costs on even in very competitive markets -- the airline fuel surcharge, for instance. For new devices, the cost of the tax will be factored into the selling price and thus will be passed on. Companies will still innovate at a profit. 3) Even in a global economy, medical devices sold in the U.S. need to meet a level of quality. There is certainly pressure to buy at the lowest cost possible. But for medical devices, you can't just go to Walmart. 4) I agree that without profit there's little motivation to innovate. Indeed, without profit there would be no industry whatsoever. But need does not go away, and there will always be those who will seek to satisfy that need -- at a profit. Could it be that innovation is driven more by competition than by profit?

Don't get me wrong -- I still think the med device tax is a bad idea, just from a gut level. Increased cost always has a stifling effect. But I'm not convinced that the tax won't be passed on to the consumer, nor that it will kill innovation and will send jobs overseas. The tax is not going to help our industry. But I don't think it's the grave threat that many are making it out to be.

John Eckberg Mr. Stipe, If you don't see this as a grave threat, then, frankly, there's nothing I can do to change your mind. I would urge you to start noticing lay-offs: thousands at Stryker, Medtronic, Hill-Rom and others. It goes on an on. Research centers being built in Ireland and China, $150 million cost for Boston-Scientific for the new tax.

How can a tax possibly be passed on to a consumer when U.S. device companies are in a competitive space? All it takes is one company, a company based in Ireland, for instance, a company that once was based in Massachusetts, to not raise prices and that's that. Buyers will chose the lower priced item. Simple as that.

You can make up "what ifs" and "how abouts" all the live-long day and deny that GPOs and IDNs are now aggressively and unapologetically demanding price reductions (some systems even have online auctions in a race to the lowest price...) but ultimately, well, this chat string is ending up a tedious argument and it feels like it has an insidious intent. I can't keep track of and rebut all the misinformation and outright lies put out by the progressives, who are slavishly devoted to this president, and when I answer others' questions, like yours, the reply degenerates into "well, I still believe it's not a very grave threat..."

It is becoming a waste of bytes and time.

What if you owned a company and one day the government told you that you were going to have to continue paying the highest tax rate in the world and oh, by the way, we have a new tax and it's going to be on your top line - before you pay back investors, cut salary checks, pay utilities, pay vendors, before you do anything else? What if your total tax rate was 55%? You'd move to Costa Rica or Ireland or Canada in a New Jersey nanosecond. And that's exactly what's happening.

Jac Higgins, CHFP John E., [...All it takes is one company, a company based in Ireland, for instance, a company that once was based in Massachusetts, to not raise prices and that's that. Buyers will chose the lower priced item....]

Oh how I wish it were that easy: tell the docs, "you can't use BSx cans because MDT cans are less expensive". Let's see how far that goes.

Dan Stipe Mr. Eckberg,

I don't have a dog in this fight and I have no insidious intent. I'm looking for truth, not platitudes and talking points. The debate is degraded when you say things like "misinformation and outright lies put out by the progressives". I've already stated that I think the tax is a bad idea. I'm seeking to be more informed on the issue and to better understand its implications.

Mark J. Kania, MBA. Mr Eckberg: Thank you for the excellent analysis and insight on this issue. There is no doubt that this tax will have a negative impact on industry innovation. We have seen the medical industry shed thousands of jobs over the past 18 months in anticipation of industry changes, which include this tax.

John Eckberg Mr. Stipe, Understand your wish to hear and conclude. I'll let others chime in here for a while. It's what I like about this specific curated chat string anyhow. The diversity of thought and perspective.
John Eckberg
Media Relations Director
The Cook Group

I am glad you are raising the awareness of this John. The tax has already caused thousands of lost jobs with more to come.

From where I sit as one already being impacted by this both in reduced employment opportunity and start-up handicap... 2.3 on profits would not have the same impact or cause as much concern as the demanded 2.3 on net value. Remember it applies whether the product is actually sold or transfers without sale. A 2.3 on profits can be managed as a cost. Income tax makes sense, it is a percentage of what you make. Sales tax makes sense, it is a consumption based tax at POS. A tax on value completely disregards the likely scenario where the required piece of pie due is greater than what is actually available to give. The closest generic analogy most would understand is if they applied the same thing to capital gains... you buy a house for 80k, you sell it for 100K, you make 20K. Currently you pay tax on the 20k you make. Under the new system you would pay tax on the *appraised* value of the house, not what you sell it for, what profit you make on the transaction, or even if you sell it or give it away at a loss. How do you pay it??? This would bring the housing market to it's knees, just like it will do to the med device industry. Horrible idea that is not based in reality. Classic government 'solution'... the fix is worse then the problem.

With 167 comments, I think it's time to retire this string.

Thanks for the discussion, everyone.

Joseph Schwartz Joe did you really shut this down...there were so many questions raised that were not answered. Mr. Miller asked why the President would deliberatly destroy a section of the US economy. He needs to look into anti-colonialism to find the answer. Mz. Hizer is convinced oversignt is needed, but does that give the FDA the right to tell you what you can or can't call your product? How does that improve safety, yet it increases costs of R & D. Then Mr Steck compared the tax to home sales. He did not go far enough to show the huge difference. THe tax on 20K at 2.3% is $460, but on 100k is $2300, $3000 more than the "profit" in the sale, but that does not take into account inflation and the fact that the owner probably paid 240K for the house if they held a 30 yr mortgage.

OK, Joseph, you're not the first person to ask me to revive this string.

Honestly, politically-charged discussions are SO MUCH MORE work for me to moderate (and I don't make any money doing so)!

I'll open it again for a while but may well shut it down again (to protect my sanity).

Thanks for your ardent contributions.

Actually the population is over 4 mil. and politics run the country not the people that elect the law makers.

Michael Lubov And money runs the politics!

Joe Miller As far as this tax goes it will not be good for business. Furthermore this is a tax on Gross income not net which will further impact business. To most people this tax is obviously a bad idea and is greatly unpopular. With a president that has so recklessly spent money (300% more in 3.5 years than BushII did in 8 years) and plans to spend billions more + as yet to be financed monetary obligations to SS and Medicare totaling over $100 trillion this nation has outstripped it ability to repay even the interest on what we as a nation owe!. Even if Obama taxed everything at 100% it still wont be able to pay even the interest of our debt.
Having said all of this, for what its worth, why would a seemingly intelligent person like Obama even consider going down the road of tax and spending when we cant even begin to pay back what we owe now instead of making the needed changes and drastically cutting back? This is the question I would like to see answered. We all know there are programs and other expenditures that the government makes that it should not be making.

Ron Ellsworth Joe M, you running for office or something? We can use some good leaders to help pull us out of the Bush Depression.

Michael McCarthy, MBA, BS, RRT-NPS Ron: Reagan pulled us out of the Carter depression. He was rewarded for it with a second term and we benefitted by the end of the cold war. So, is this Bush's depression or a Bush / Obama depression? Let's be fair.

Dan Stipe Joe Miller asks, “Why would a seemingly intelligent person like Obama even consider going down the road of tax and spending when we can’t even begin to pay back what we owe now instead of making the needed changes and drastically cutting back? This is the question I would like to see answered”.

Joe, austerity in the midst of recession does not work. That has been proven in Europe. The evidence is in and there’s no disputing it. Yes, our debt is too high and is unsustainable. But the time to reduce it is in times of prosperity. Private sector GDP has risen under Obama. It’s government spending that has fallen, mainly due to Republican insistence on austerity. This thread started by asking whether it’s right that a Democriatic senator from a low-population state can freeze debate on an issue. I would ask is it right that Republicans – the minority party – in the Senate, can filibuster every initiative that the President and the Democrats have put forth?

Our debt has increased under Obama because of necessary measures taken to avert a full-fledged depression caused by the financial crisis in 2008. Tax revenue is down because employment and incomes are down. Interest rates are so low now that the government can virtually borrow money for free. Now would be the time for real stimulus to rebuild our crumbling infrastructure and get people working. The private sector is flush with cash but is not investing because there is no demand for their products. Get people back to work and they’ll be able to spend again, demand for goods will come back, companies will invest to meet that demand, tax revenues will increase. That will be the time to reduce the debt. Austerity measures will simply dig the hole deeper.

Michael McCarthy, MBA, BS, RRT-NPS To be fair Bush spent $700 billion in stimulus before the wreckless spending started in 2009. The person above that said that the government is exercising austerity now is completely in the dark. The government has grown exponentially under Obama. I'm not saying all of it was bad. We did learn from the depression that trying to balance the budget during a financial crisis is not wise but throwing money away on frivilous ideologically driven projects is simply waste. Herbert Hoover also put up barriers to trade which thankfully we haven't done much of. It's time to bring the government out of the spending frenzy though. Austerity, no. There is no danger of austerity coming out of Washington DC with either of these spending parties. The question is do we need completely out of control spending or something more subdued. The private sector is flush with cash. It's like a giant spring getting tighter. When the government stops talking about crushing business owners with various taxes and super-regulations the private sector will come back to life with tremendous GDP growth and subsequent job growth. You simply have to remove the impediment to growth and right now that is the Democrats. You can't have a president saying, "you didn't build that" and not put fear into the entrepreneurial base of our nation. The perception is that eventually the government is going to nationalize everything. This is a terrible environment to invest in. After January we'll see. What the government is doing now is not working which sums up the Obama administration for me.

Herbert Hoover also raised taxes in the early days after the stock market crash. Obama wants to do the same. Why? The Democrats benefit when folks are dependent on the government. I would hope this is not their motivation but they aren't dumb people and know this will crush the recovery.

Michael McCarthy, MBA, BS, RRT-NPS Frank: It's amazing how many folks are not aware of the facts you present. People don't pay attention. Barney Frank had a long-term homosexual liason with the CEO of one such group. And Senator Dodd got a sweetheart of a deal on a mortgage from Countrywide. Yes, the last two years of the Bush presidency was dominated by a growing Democrat party that benefitted from the housing collapse with the presidency and a super-majority in the Senate which has now given us Obamacare, a government coup like nothing in history.

And now, 6 years later they're still blaming Bush. That's not much to run on.

Joseph Schwartz Have you noticed the President's ads on tv? The man who won't salute the flag suddenly wears flag pins on his suit lapel and flag ties...it makes me sick to my stomach to see his outright attemp to deceive the voters. I hope the magority are smart enough to see through it.

Michael McCarthy, MBA, BS, RRT-NPS The voters are easily deceived. That's the scary part.

Joseph Schwartz Sorry for my "typo's" I meant to type $300 in my earlier post; majority and attempt to deceive in my last post. Joe Miller, you keep asking "why?" Obama was well on his way to becoming a capitalist when his communist mother (funny how they want the wealth of a capitalist country but want to destroy the sytem that created the wealth). She couldn't stand by and watch so she put her son under the tutilage of another communist who schooled him in anti colonialist rhetoric. He now firmly believes America has raped the third world of its wealth and he wants to give it back. This is why he won't allow drilling for oil by American Companys on American territory, but he will pay Brazilians with American tax dollars to drill, in the Gulf of Mexico, of all places. He won't stop until he has turned the US into a thrid world country...or the voters stop him first. You staunch Obama supporters, is that what you really want?

Dan Stipe Flag pins? Communist mothers? Really? This thread has devolved into nothing more than another version of Fox News.

John Eckberg Sad what happened to the discussion

Michael McCarthy, MBA, BS, RRT-NPS Dan: Which news service do you recommend? They all seem to have a slant. I hear both sides at Fox. I hear the left from the rest. Ever watched MSNBC? I think they aren't human. I think they are aliens.

John: Politics has replaced war. It's always nasty whether you're on the good side or the bad side. But it's still better than war.

Joseph Schwartz Haven't you seen the comercials? I saw the same one four times during the Olympic coverage last night. They even zoom in to make sure you know it is a US flag on his lapel. And from what I can tell, only 50 stars rather than 59.

And down we go again. This conversation is closed.

If you wonder why, read the last half-dozen comments and (rhetorically) ask, "How is this consistent with the stated group goal: To build the industry's only spam-free, curated forum for intelligent conversations with medical device thought leaders."

I will delete future posts to this thread without notice or correspondence.

Respectfully,
Joe

Love the argument by Obama and others RE: Medical Device Taxes; "these companies will be gaining access to over 30MM new candidates for medical care, thus increasing their profits, so they can afford to pay these necessary taxes." Who are they kidding. With the past and continued poor payments provided by the federal and state governments for any medical service or device, companies strapped with these new taxes will NOT provide more profits, but cause greater losses in revenues and profits which will result in more layoffs and unemployment. Our current society is becoming less informed about what the real facts and realities are along with becoming more apathetic which is only going to result in more government controls and more problems; i.e. unemployment, lower wages, and a total breakdown in societal structure. The signs are already here, if your willing to see them. When is this country going to wake up and stop this insanity? I fear it is too late already, but I believe in a strong industrial, capitalistic America, and can't wait for the day we break out of this terrible negative spiral and become the great country we once were. If you believe in this stronger America, keep spreading the word of hard work and prosperity so we can build this country back up, but ONLY vote for Strong and Responsible Leaders; not the clowns we have in Washington today.

Patrick Brown Yes I thought President Obamas reasoning on that to be suspicious as well.