Today we are answering you questions about taxes. We talk about how investing can impact taxes, how to manage estimated payments for your taxes and qualified dividends and even answer a question about tax breaks from investing in oil and gas. We also answer a few questions about asset allocation. Before we get into all of that Dr. Dahle gives his opinion on what advice Dave Ramsey should have, but didn't, give to an unmatched doc in a mountain of debt. Listen to the Dave Ramsey call here: https://www.instagram.com/reel/Cx3Bntau-Au/?igshid=MzRlODBiNWFlZA%3D%3D

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Email from Reader:

Dear Dr. Dahle,

Thank you for all you do.

In your recent podcast with Dr. Shteynshlyuger, I wanted to correct his statement that the AMA "will not do anything to help" regarding unfair fees for EFT payments. I am an alternate delegate to the AMA for my state. Twice a year, delegations from all 50 states, national specialty societies, and the federal health services take time away from our busy practices and families to set policy and priorities for the AMA.

It is never accurate to say that the AMA "will not do anything to help" because the House of Delegates dictate what the AMA does. If an individual physician wants to advocate for stronger positions or a change in direction, they can bring resolutions to their state medical society or specialty society to ask their delegation to advocate their position and seek the support of other delegations.

That being said, the AMA has been fighting against these unfair practices for several years. In 2021, the AMA along with the 50 state medical associations and 40 specialty societies, sent a letter to CMS asking the Biden administration to take action on these unfair practices.

https://searchlf.ama-assn.org/letter/documentDownload?uri=%2Funstructured%2Fbinary%2Fletter%2FLETTERS%2F2021-10-14-Sign-on-Letter-re-EFT-Fees.pdf

Furthermore, the AMA has a multitude of resources and guides on their website so that physicians and practices know their rights and how to navigate the system.

When physicians face challenges like these, it is important for us to stick together with a unified voice. Making inaccurate remarks about our own professional organizations does not move the needle.

ALEX RESPONSE

Hi XXXX,

I greatly appreciate the fact that you listened to the podcast + found a point of disagreement. I also appreciate the time + effort delegates like you commit to running the AMA. As you can imagine, I have put quite a few hours (and $$$) into advocacy on behalf of physicians.

I’m an AMA member as well + introduced many of the resolutions that you are alluding to. I'm in solo private practice, and it appears that you are part of a small private practice as well. Our interests should align.

You are correct to some extent that members write resolutions that are supposed to set policy. In reality, things work a little differently. Perhaps that’s one of the reasons that the AMA has a 15-20% approval rating (based on membership data).

In fact, many AMA policies are set without resolutions. So why should one have to write a resolution to reverse such policies? For example, the AMA decided to call virtual credit cards a “valid” payment method. Whose bright idea is that? Valid means "legal". Nowhere does the law say that VCCs are "legal" to use as a payment from insurance to doctors; in fact, it's the opposite. I have been fighting to get that language changed for years now -the AMA Board of Directors are well aware- nothing has been done. But here is a resolution (which should not be needed).

https://drive.google.com/file/d/123olaPrMy1yA65IG_uoC5HlIv6OjA3nE/view?usp=sharing

While the AMA management keeps writing letters, it fully knows that letters will not achieve anything. Talking to elected representatives will not achieve anything either since they have already spoken.

In fact, most recently, the AMA refused to confront the insurance lobby's attempt to “normalize” virtual credit cards. Do you know who confronted the insurance lobby? The American Hospital Association, whose policy team is run by a former AMA employee. I got 500 physicians to write letters to counter the AMA's complicity with UnitedHealthcare/Zelis/etc.

I hope you would be enraged if you found out what the AMA wrote: "Need a full understanding of the financial and administrative burden impacts to physicians prior to recommending adoption" referring to the proposal of adding virtual credit cards information to a standard 835 remittance advice. See the last point on page 9 of the AMA's presentation:

https://ncvhs.hhs.gov/wp-content/uploads/2023/01/GG-Presentation-Panel-2-AMA_Spector.pdf

I asked the AMA to come out swinging against this proposal - instead it did the opposite; fortunately >500 physicians spoke out to "neuter' the AMA's anti-physician 'advocacy".

If AMA representatives want to have a public discussion + defend what they do - I’m open to the idea.

Unfortunately, I know too much and have seen how the AMA operates. I used to be a WEDI member + sat in meetings with the AMA policy VPs.

I had to fight insurance companies + the AMA. Pretty insane - right? An AMA VP said in a meeting (siding with insurance lobby) that insurances have a "right" to impose costs on physicians" - apparently, it's a free country!

In summary, you were fed "inaccurate" and 'false' information by the AMA management (who knows who is behind it?).

Did the AMA leadership mention to you that AMA Insurance (offers Medicare secondary plan to retired doctors) joined with EchoHealth, which imposes fees on EFTs + sends virtual credit cards to doctors? I had to file a complaint with CMS against AMA Insurance. I recently heard that it's still happening.

I propose that the AMA starts sticking together with doctor's interests and does what I asked it to do: (1) send a letter to CMS/UHC/Cigna/BCBSA/AHIP saying that VCCs and EFT fees are "ILLEGAL" and that the AMA is revoking its prior statement that they are 'valid". Insurance companies use the AMA's unhelpful published statements to support their "position" to extract >$10 billion / year from doctors. "Don't look at us - AMA says it's legal." (2) file a lawsuit against CMS for APA violations. They know what I am talking about.

I hope I swayed your opinion a bit about the legitimacy of my criticism of the AMA's actions. Hopefully, you + the IOWA delegation will help me REFORM the AMA.

When the AMA does not perform to expectations, it's time to do a root-cause analysis of the AMA's failures to serve the interests of physicians.

Alex

WCI #339: Dave Ramsey Gives Poor Advice to Unmatched Doc

White Coat Investor Podcast