Thursday, June 21, 2012

Thursday Op-Ed: Fact or Fiction You Be the Judge

The last few days have validated the anger and frustrations that run rampant within the medical device industry based on the diversions in your comments.  Its also interesting when someone criticizes TSB but can't get off the site and comments incessantly, but we still respect those individuals first amendment rights, regardless.  Anger and Frustration? Definitely. Informed and knowledgeable? Maybe at best. The question that TSB must ask our readers is whether anyone has a comprehension of the nuances that encompass the MDET?  Do Americans have the flexibility or the ability to adapt to change? No. Contrary to that old expression "change is good," everyone would like to keep the status quo even when everything is collapsing around you.  What would happen if we actually attempted to change?  What if we really moved forward and provide medical insurance to an additional 33 million people?  

The facts are self-evident.  We know that the medical device tax will not cause manufacturers to shift jobs overseas because the tax applies equally to imported and exported medical devices, and devices that are manufactured in the United States for export are tax-exempt.  Fact, the tax should have little or not effect on innovation since it may motivate medical device companies to innovate cost effectively.  As more pressure is placed on companies to lower the ASP, how will companies sustain profits?  As many Baby Boomers enter their golden years, who will subsidize your Medicare entitlement in event of a major catastrophic event?  Nuvasive? Globus? J&J? Orthofix? Zimmer? Contrary to your beliefs, you'll be standing in line waiting for your Medicare entitlement because your argument will be that you paid for it, and you're entitled to it. If you deny it, you're not only lying to our readers, you're lying to yourself.

If the Affordable Care Act expands coverage for an estimated 33 million uninsured or unqualified Americans, who will benefit?  Does anyone believe that any of the aforementioned companies will not benefit from healthcare reform?  The medical device industry is a $120 billion dollar industry. Ten of the largest device makers account for 86% of sales which means that they will account for 86% of receipts of the excise tax.  Despite what you read, the tax creates no incentive for these companies to move manufacturing overseas.  This tax is an equal opportunity employer, meaning that the tax will apply whether your products are manufactured in the U.S. or abroad.  The 43,000 potential jobs that would be lost, as cited by AdvaMed is not credible to say the least because it is based on hypothetical assumptions.  AdvaMed hired a consulting firm by the name of Battelle to assess the effect of a "hypothetical event" that would result in an annual decline of $ 3 billion in revenues for the medical device industry.  Batelle utilized a quantitative economic technique called an "Input-Output Model" that measures the interdependency between different sectors of the national economy.  This model measures the output of one industry in relation to the input to another.  The model assumed that an estimated 10,000 jobs would be lost in medical devices, and 29,000 in other sectors.  But the question must be asked whether this model is valid in analyzing changes based purely on a hypothesis, and as many of you know, a hypothesis is nothing more than a mere assumption or guess.  Don't believe it, just ask the geniuses at AIG. In addition, there are severe deficiencies between perception and action. 

Case in point.  When Stryker announced plans to layoff 5% of its workforce they cited the excise tax.  Yet, they also stated that their aims of restructuring was "to allow for continued investment in strategic areas and drive growth despite the ongoing challenging economic environment and market decrease in procedure."  The immediate response, critics jumped on blaming the excise tax. The reality is that whether you believe it or not, or have drank the kool-aid, layoffs in 2011 had nothing to do with a proposed device tax in 2013.  What it comes down to is math, you know the subject that most American children despise.  If you increase coverage for 33 million people, will there or won't there be opportunities to increase revenues? Of course if you're Lukianov, you are concerned that young people will not increase your revenues because their needs for spinal implants are minimal compared to the elderly.  How can you argue that the tax will have a negative influence on innovation?  The Medical Device Industry is driven by the following factors;
  • Financial Incentives
  • Demanding, Uneducated, and Price Insensitive Patients
  • A Supportive Investment Community (where else can you find these margins)
  • Regulatory Requirements
  • Physical and Human Resources
The reason medical device innovation has slowed over the years may be attributed to a combination of  factors such as stricter regulatory requirements, insurance companies denying coverage, and a real lack of innovation.  Don't believe it, just look at Precision Spine, aka a wolf of a different cloth.  You know Jim Pastena can walk around telling himself its innovation, sooner rather than later he believes it. What have you seen lately?  Line extensions?  Product modifications? More "me-too" products?  The reality is that the system is broken and its not the fault of one party, all parties are accessories to a broken system and must be held accountable.  TSB knows why you're angry and frustrated.  Happy Days just don't exist anymore. You have bilked the system and you don't want things to change, you want them to stay the same.  TSB understands, no one likes downsizing from a Porsche to a Chevy do they?

Are there certain provision in the tax that need modifications?  You bet.  But we will never resolve these challenges if we do not sit down and negotiate.  The spine industry is great at deal making, but sucks at negotiating.  At the end the industry can be proactive or reactive, its up to you.

Next Week:  The IRS



84 comments:

  1. We await USSC decision with bated breath! I am devised - love the idea of eliminating pre-existing condition bar but hate the idea of mandate health care. It sounds so fascist.

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  2. Correction: divided NOT devised

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  3. Laws mandate no driving under the influence, its hazardous to everyone's health. Laws are enacted to protect the public, so what's different from Romney Care, that the government mandates coverage, we're all paying for it one way or another.

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    1. Driving laws and the mandate for auto insurance is to protect the other guy from you. Health insurance mandate is the govt protecting you from yourself. As far as Romneycare, I disagree with it too, but at least the states have the authority to enact something like this, Congress does not.

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  4. I love the hypothetical, we need to read the bill to find out whats in it! Is that kinda the hypothetical you are talking about TSB?

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    1. Do you even understand what an Input-Output Model is? Oh you never got out of Econ 101.

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    2. 10:32 also known as the genius commentator tells us what's in it since you are soooooooo smart.

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    3. here is a hypothetical for you, Lets abort all of the female fetuses in China over the next few years and then...Oh wait that has already been done, nevermind. Bottom line is that there are always uninteded consequences that negate all of the supposed upside to these wonderful ideas the government comes up with. Sometimes our elected officials do not always think these things through is all I am sayin.

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  5. If you are really serious about the positive impact of increased Govenment spending on employment and the economy as a whole; the easiest solution would be to double Medicare reimbursement to device companies and Surgeons....I assure you, my Wife will spend it as soon as I make it!

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  6. TSB/MM I love how you hide behind the vail of this blog all the while pointing out the names and faults of others and excutive teams. You call them out by name and bash them. Why don't you please let us know who you are and lets see and hear from others that may know you, what secrets you have hiding in your closet....time for you tim come of of the closet douch bag!

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    1. Be careful what you ask for Mitt Romney Jr.

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    2. TSB sounds like 11:20 is having another anxiety attack

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    3. 12:55 Merriam Webster here if you're going to call people d-bags at least learn how to spell the word veil, and the douche correctly, man you are way too tense, you are stressed out, you are plagued by fears that you know are irrational, is your heart pounding, ease up Dude life is too short, don't read this blog if it makes you crazy.

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    4. TSB how threatened is your admirer by your presence? Could it be that you have some dirt on them?

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    5. 1:39 You forgot a question mark at the end of your question. If you are going to correct somebody, at least make sure you do it correctly. I am Ron Burgundy?

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    6. it's a run on sentence lmao

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  7. 12:55 pm Are you Steve MacMillan, ex-CEO Stryker. Soon to be FDA's inside snitch puppet for J & J Depuy Synthes Spine Division. LOL You disclose who you are first then I will.

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  8. I am H.R. Puffenstuff shit for brains..1:07! Did you get canned from Stryker? Sounds like someone is a little bitter!

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  9. 1:07 who invited you into the conversation?

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    1. The same agency that invited you, InQTel!

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  10. who is Precision Spine? read on Buford's feed that they bought spinal usa for $72M. didn't know consultancy agreements counted as revenue, much less generate any multiple of it in an acquisition. i've never even heard of precision spine. sounds like a equity inflating load of BS to me.

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  11. Au contraire about the jobs shifting overseas. What may happen is that many companies will shift all their manufacturing overseas and sell the products OUS only, completely leaving the USA out of the picture. The company will not have to pay a USA tax if they do not make or sell the product in the USA.

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    1. Are you serious or delirious? Think about how ridiculous your comment sounds. A major player in the market place will forgo sales and profits to avoid a 2.3% excise tax in the most lucrative healthcare system in the world. It's evident that you have no knowledge of foreign markets, stick to taking orders and covering cases.

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    2. TSB,
      You're showing some ignorance as well by saying the tax won't lead to jobs moving overseas. Companies are already on the verge of outsourcing because foreign labor is cheap and their margins are slipping. Taking an arbitrary 2.3% will absolutely cost jobs in the US either by reductions in staff or finally tipping the scales to move major segments of manufacturing overseas. You can't remove a few billion dollars from the pie and expect no illl effect on workers.
      The problem with the tax and the ACA is the precedent the leave for future government interventions. Why not tax banking an extra 5% since we bailed them out. GM should get an extra 10%. The end result is a government with free reign to pick on any entity the choose and higher prices for the consumer. Please don't insult us by saying these companies should just absorb it for the sake of the poor, that's not why people and companies risk money to enter a market.

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  12. Get serious about companies selling overseas you have no clue as to what the international markets are like, margins suck, you need a surgeon advocate before you get any product sold.

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  13. MM,
    Layoffs in 2011 have nothing to do with a law in 2013? Have you ever tried to plan a business with thousands of employees, distributors, manufacturing, logistics etc? Blowbamacare has added HUGE uncertainty to our industry, and the end of Bush tax cuts are a knife at our investors' throats. Once again, if you tax something you will get less of that thing (econ 101, or maybe you were an education major).

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    1. You are so stupid. Genius, how do you explain declining reimbursements on hips and knees and surgeons do more volume than ever. You ever thought that the unintended consequences of increased taxes might be more r&d, productivity and competition. You obviously have never planned a business so leave that to those with the mental capacities to do so. Speaking with you is like arguing with my two year old daughter. Run Forest run.

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    2. You sound pretty stupid too if you think the increased volumes by surgeons reflects increased productivity. They are loosening their indications to do more surgery to make up the loss of revenue. Those additional surgeries, by the way, cost WAY more than the amount saved on physician reimbursements so the net is a huge increase in healthcare spending, just so the docs can make up for the loss of revenue. We have all seen surgeons change their procedures, at an increase of cost to the hospital, just so they can bill a few hundred more for themselves (facet dowels, PEEK interbody versus bone, adding a bit of bone graft during a hardware removal, etc). Fee for service is the same as supply and demand, drop one and the other goes up.


      The notion that increased taxes increases R&D is a new concept to me, please explain that one with your business planning expertise. I guess it also leads to increased hiring? If all that good stuff resulted from increasing taxes, then it would not be unintended.

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    3. This is your most intellectual reply to date (because it supports my position). Yes decrease reimbursement led to increased surgeries which have led to increased healthcare costs. So what is to say that if you increased taxes companies wouldn't innovate and try and sell more to maintain their sales and profits much the same of surgeons. Where the models potentially differ is with reimbursement where t is not a true buyer and seller relationship. Subsequently after reimbursement decreased and volumes went up, insurance companies reacted and increased premiums. That in turn has led to less patients being insured and now volumes are 20%-30% less for most surgeons. Which all points to how markets operate and adjust and the need to look at both sides of the supply and demand equation.

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  14. 6:30 are you the guy that keeps quoting Economics 101, maybe that's your problem you never took anything else than Econ 101 LMAO

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    1. 6:30 I didn't know they offered Econ 101 at your local community college. Your beauty college degree doesn't help you pontificate about the idiosyncrasies of markets.

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  15. TSB - do you honestly think that the device tax will not have negative impacts on innovation or employment? Let's do a micro analysis. Every company, large and small, creates a discounted cash flow forecast for a project before they decide to invest in it. Obviously, there will be projects with very large expected net present values, and those projects will be funded... device tax or not. But, let's talk about the marginal projects. At the hundreds of companies out there in this industry, you better believe that there are dozens (maybe hundreds) of projects where adding in the device tax cost to the financial model takes that project from a NPV postive to an NPV negative. Guess what, those projects don't get funded. If those projects don't get funded, guess what... employees don't get hired and whatever innovation may have come out of that project doesn't happen. Sadly, the reason that these "marginal" projects (that would have provided employment and potential innovation) don't get started is not due to lack of expected demand or too high of costs... it is solely due to an arbitrary REVENUE tax that bureaucrats somehow decided was a smart idea. These bureaucrats absolutely killed the employment and innovation that would have come from these projects. It is very sad that most people can't understand this basic, obvious, simple logical outcome of such a stupid policy.

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  16. For newly developed product, I have seen more than one company choose not to manufacturer or sell a particular product line the USA. This is both with creating a product with the intent to never sell it in the USA and other product lines with the intent to begin with the OUS market (because it can be done quickly), and then eventually bringing it to the USA market, but then the US market launch never comes to fruition. The cost of bringing it to the USA market with the regulatory hurdles, patent issues, reimbursement problems, other company’s products to compete with, hospital and GPO pricing demands, less surgeons choice in device selection, and product liability issues are all deterrents. And now add the excise tax and it is even more of a deterrent and may be the deciding factor to not bring the new product to market in the US. For some companies these risks are just too high and any possible ROI is predicted to be too low. Many companies are creating new manufacturing factories OUS and existing product lines gradually shifting to those OUS manufacturing locations. Although those existing product lines are often still sold in the USA and would still be subject to the new excise tax, those product lines eventually become obsolete, with the company having to decide if it is worth it to upgrade the product line or just let it die (or let it die only in the USA). We have all seen companies discontinue product lines without having new and innovative products to replace them with. It is a gradual process and the effects may not be readable noticeable until it is looked at cumulatively over a long period of time. Many of the major players have publically stated that they are more interested in international and emerging markets and are making it the main part of their strategic plan. There is less emphasis on the USA market like years past.
    End result: 1. less incentive for companies to create new and innovative products 2. less jobs in the US 3. less choice for American surgeons and patients. 4. slowing medical device advancement.

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    1. If companies decide to pull out of the US market or not launch products because of the device tax then they will not be competitive with the companies who decide to participate in the US market. There is a reason most of the world's biggest healthcare companies are based in the US. Care to guess why? My guess is a 2.3% device tax will not substantially change that reason. My guess is the companies who choose to leave the US markets will become uncompetitive and will continually lose market share and face decreased sales and profits. Just venturing another guess but I am guessing they didn't have much of a product to begin with.

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  17. Hey Nancy, since the bill was all passed, signed, sealed, and delivered aren't we supposed to now understand it? Has anyone fully deciphered Obamacare yet???including the Royals who passed it to find out what was in it?

    The Bill is a legal Rubik’s Cube in the dark. I heard that the Medical Device Tax is actually a value added tax. Can anyone absolutely refute this? If this is a VAT what is its real cost implications prior to market? What is the passed along cost impact to society regardless of how the veiled law reads or is interpreted? What will be the unintended consequences of this bill leaning forward? Should we not be concerned about a bill affecting 18% of GDP? Could this be the beginning of the end of the America we once knew? When did everyone decide to stop asking questions and become partisan shills?

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    1. You've obviously read it. Care to share a link so we can be as informed as you?

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  18. The tax bogey man is coming you all better run. How come when we didn't have this tax, which hasn't started there wasn't a renaissance and explosion of jobs and innovation? I mean the prevailing theme of this blog for the last two years has been where has the innovation gone? Oh right everyone started downsizing before the 2% tax while margins are at 700%. Right. Just a small flaw in the previous posters (Larry, Curly and Moe) logic, how come companies are not pulling out of Countries like France, which has extremely high taxes and state mandated low cost of goods. No company to my knowledge has pulled out of France where pedicle screws go for $250.00. What gives? The US has had some of the historically lowest taxes during the last decade and we have some of the highest unemployment, what gives? Taxes don't stifle jobs and innovation, idiots like you do. Come on Ann Coutler, think about it.

    Why don't you stop inferring that others whom don't share your opinion are socialists and communists and come up with an argument or position that is actually defensible with logic. If companies can't figure out how to compete and innovate with some of the LOWEST taxes of the industrialized countries with the highest asps than good riddance. Talk about pretzel logic. Taxes haven't killed jobs in the US, corruption and idiots have.

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    1. Maybe you should move to France and put us out of our misery?

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    2. Taxes don't stifle jobs? You are a blithering freaking idiot! Taxes take money out of a company, a company responds by trimming staff or freezing new hires. Simple and pure black and white. To state otherwise reflects your mindless following of ideologues or utter stupidity. Either way, you are fucked!

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    3. http://johntorinus.com/book/

      http://www.entrepreneurship.org/en/Blogs/Policy-Forum-Blog/2010/December/A-Tax-Code-for-Job-Creators-and-Growth.aspx

      http://johntorinus.com/general-blog/taxes-and-business/debt-limit-job-creation-rhetoric-off-the-mark/

      http://www.americanprogress.org/issues/2011/06/marginal_tax_employment_charticle.html

      Just a few articles I found by googling the subject. No, taxes don't stifle jobs. There is no evidence to support your argument. The "pure black and white" shows otherwise.

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    4. The U.S has the highest corporate tax rates in the world.

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    5. Your wrong. The U.S. has the highest base rate before tax breaks/deductions. After all the tax breaks, loop holes, write offs and deductions the U.S. has one of the lowest tax rates in the world. First three pages from google.

      http://en.wikipedia.org/wiki/List_of_countries_by_tax_rates

      http://thinkprogress.org/economy/2012/03/30/456005/reminder-corporate-taxes-very-low/?mobile=n

      http://www.businesspundit.com/12-countries-with-the-highest-lowest-tax-rates/

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    6. Like I said, the U.S has the highest corporate tax rate in the world.

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    7. 11:56AM: What many if not all that call for higher taxes don't seem to understand is that even if the government increases taxes only on the rich, everyone suffers. No matter what the "rich" would have spent that money on, it is more efficient than the government. If they would have blown it on goods and services, then that would have caused jobs. If they would have invested the money that was taxed away, it would have been a source of capital that creates jobs. For every dollar the federal government taxes, a buck and a half is removed from the economy. High taxes, tax uncertainty, and high regulatory burdens cause higher unemployment.

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  19. Now there's an intelligent reply. Where would you rather he move Kentucky, isn't that a foreign country lmaol

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  20. 1:08 Maybe you should move to some country where you don't have to pay taxes? I am sure you can find some thriving economy in Africa or South America where there are little or no taxes. Thriving healthcare as well, it should be right up your alley. You can bring your products to market quickly, with no approval process, taxes or insurance. Really low rates of unemployment too. It is amazing what no taxes has done for the job market in some of those countries. Only problem is the devices don't sell for much but I hear that is where all the companies that are picking up and moving out of the US are going.

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    1. even if you leave/renounce citizenship you are still responsible for paying taxes to the US govt for 10 YEARS on income earned via US income.

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    2. I will pay your taxes if you leave, I am sure they are not much.

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  21. You have this one wrong TSB. The little talked about fact is the 2.3% tax is on total revenues, not profits. This means there is no shift for the cost of R&D, quality assurance, manufacturing, or distribution. Depending on the size of the company and the amount they invest in innovation, the tax could net up to 22% of profits realized. This will hurt many companies and penalize them for money spent on innovation. As someone with a masters in Econ, I can tell you all economic theory is based on assumptions and those assumptions can easily be manipulated by economist. Having said that, this theory has merit and will prove to be more accurate than most.
    The other thing you don't consider is that spine procedures will not be done with out some kind of beurocratic approval process. This means the decision to bring any patient to the OR will face a new level of scrutiny never before seen. All of this will be flanked by falling reimbursement as the unfunded liabilities continue to rise and the government runs out of other peoples money to spend. Wait, money has never been cheaper so we can just continue to borrow against our future and that of our children. At some point we need to face out of control government spending and growth or we will find ourselve's where Greece is today.
    Margaret Thatcher said it best " socialism is great until you run out of other peoples money to spend". Do we need to have change in our industry? Absolutely, but it needs to be through negotiation and not dictated by elected officials that want to regulate everyone except for themselves. Why don't they pass a law similar to the sunshine law that prohibits them from accepting gifts and trips from special interest groups and lobbyist? What's good for the goose should be good for the gander. Just one man's opinion.

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  22. I absolutely agree with about a law that prohibits or at least tracks gifts and donations from special interest groups. I also agree that government spending needs to be reigned in. Unfortunately we can't reduce spending only and get out of this mess were in. People are going to have to realize that taxes will have to be raised. Economic theory needs to be carefully examined if low taxes are key to job growth because recent history would show otherwise. Obviously that is just one factor in a very complex economy as is the device tax in the healthcare industry. I personally would start with fraud, abuse, over utilization, and the money made by health care facilities, industry and yes incomes of physicians. The pie is going to get smaller for us all and were going to pay more in taxes for that small piece and that is unavoidable. It would be that way if it was just about demographics, which obviously there will be many other factors influencing declining market conditions.

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  23. Wow, did 5:30 just say we need to look at the incomes of surgeons? I thought Spine was the last bastion of Capitalism, but I guess not. Why would someone put themselves through 12 years of training, sleepless nights, tons of debt, just to have Barack Hussein mandate their pay? Once again, Econ 101 would help a ton.

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  24. ever try to report fraud, you should try it sometime. You even get a 1-800 number with direct access to an answering machine, wow! If you call the Taxpayers against fraud office in Washington D.c., they are actually very helpful, but they will tell you that it is not realistic to expect the federal government to take you seriously unless your fraud is worth a minimum of $10 million. If you are really serious about going after the bad guys you need to get really good whistleblower attorneys. Keep in mind, however, your claim must go after fraud that is attached to really deep pockets or else its not worth their time either. Nobody is really interested in convicting anyone clearly guilty, their number one priority is going after the big bucks!!

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  25. http://johntorinus.com/book/

    http://www.entrepreneurship.org/en/Blogs/Policy-Forum-Blog/2010/December/A-Tax-Code-for-Job-Creators-and-Growth.aspx

    http://johntorinus.com/general-blog/taxes-and-business/debt-limit-job-creation-rhetoric-off-the-mark/

    http://www.americanprogress.org/issues/2011/06/marginal_tax_employment_charticle.html

    Just a few articles I found by googling the subject. No, taxes don't stifle jobs. There is no evidence to support your argument. The "pure black and white" shows otherwise. Some of the first articles are worth reading about to see one companies CEO's unique approach to curbing healthcare costs. If anyone cares I can find conservative economists who have taken Econ 101 who agree that taxes have very little net affect on job creation. Most jobs are created by small businesses and companies under five years old. Those business owners/entrepreneurs care very little about tax rates. Multi billion dollar corporations who are in profit mode, are no longer growing and are most likely cutting jobs care very much about tax rates.

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    1. Blogs supported by liberal left money? That is a great way to prove your point. As stated above, anyone can manipulate numbers to show you the rainbows and unicorns you are looking for. Yes, if the consulting fee is high enough, most conservative economist would go along with your nonsense. Small business owners are the most concerned about tax rates you ass, they are the true job creators and a shift in taxes affects their bottom line more than any large company. They have payroll tax, social security, Medicare, health insurance, liability.... All taxes added on and that increase with every new hire so they have to constantly do the math to see if it makes sense to expand. Whereas large corporations have the money to invest in areas for identified growth even if the profit is not immediate.
      Let me guess, you went to a liberal university and had some really swell professors who indoctrinated you into being the under educated ass you are today. I'm sure you think our taxes should go towards paying back your student loans as well. Take off your occupy wall street uniform, shave, shower, put on your big boy pants, and get a job so you can become a productive member of society and move out of your mom's basement.

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    2. So the multibillion dollar companies are cutting jobs and very concerned with tax rates? I think that contradicts your starting opinion that "No, taxes don't stifle jobs". As a small business owner, I can tell you without question that as my personal tax burden changes, it has a direct correlation with my willingness to hire a new employee. You can read all the studies you want, but I can tell you that a tax code that incentivizes me to hire would result in new jobs. One that doesn't will not. Black and white. Ivory tower studies by economists who have never worked are not what I resort to when I am deciding to hire someone.

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    3. Multi billion dollar companies and even multi million dollar companies cut jobs to adapt to market conditions and to maximize profits neither of which has a direct correlation to taxes. Your one small business owner and I am another. I can tell you the tax rate or proposed tax changes have absolutely no bearing on my hiring I just hired two new sales representatives. I hope uncertainty keeps you on the sidelines if we compete in the same business, which I am guessing we do as were on the Spine Blogger.

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    4. 6:12am. Undereducated liberal? No you're confused. That would be all those under, errr, not educated right wing pundits. HAnnity? Drop out. Drug addict Limbaugh? Drop out / Flunk out

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  26. I would like you to find a conservative blog that supports your premise that taxes effect job creation or growth and backs it up with data. The reality is that history shows during periods of high taxation the country experienced job growth and during periods of low taxation the country lost jobs, which of course contradicts everything you have been saying since I started reading Spine Blogger. I have just gotten sick of hearing your spew your mindless propaganda that I can only guess you have picked up from or been brainwashed by conservative talk radio. Good idea, formulate all your opinions from a prescription drug addict. At any case you have yet to ever try to substantiate or back up your arguments and always resort to name calling when your theories are called out for being dead wrong.

    Wrong as usual in regards to small business owners. By nature most small business owners concentrate on growth not profit. Small business owners file their own taxes and not the companies and on average make less than 250k, are not the rich/wealthy and for the most part proposed tax increases wouldn't effect them or job creation.

    For your information I am a small business owner, shave and shower every day (sometimes I shower three times a day if you really want to know about my personal hygiene) and wear my big boy pants every day. Have a great weekend, be nice to your fat wife and your dirty redbone kids and remember when your drinking cheap beer and grilling out hot dogs to cuss the President and that smart ass blogger for your miserable existence. After all it is all our fault and we really want all your money. After all if we had that we could probably buy a.... new truck.

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    1. what a waste of water

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    2. The job creation that you and your socialist friends all like to brag about during times of higher taxation is all in the public sector! More unsustainable jobs and unfunded liabilities, that will really help the economy and the future for our kids. Growth in government programs and government jobs does nothing for the private sector. The economy can only recover and stabilize with private sector growth, not public sector. This is economic fact and can not be refuted, look at the last 50 years. Wait facts and truth are just an inconvenience for you liberal intellects.
      For the record, I live in the Northeast, have a post graduate degree, and am an executive for a mid size device company. I do quite well and this will have little impact on me directly, I am worried about my children and our industry as a whole. I am smart enough to know the pendulum should never swing too far left or right, balance is needed. Right now we are in the midst of one of the most radical periods of leadership since FDR and the new deal. People are waking up to the crap you and your kind spew in the name of fairness and I can only hope that Wisconsin is a sign of things to come. I do wish you success and all that it brings, as long as it is own your own merit and not on the back's of taxpayers. I have busted my ass for the level of success I have achieved, that should be an opportunity available to anyone willing to pay the price and earn it. No one is entitled to success.
      I do not know what your educational background is, but you are on the wrong side of the facts on this one. As a small business owner in our industry, I have to assume you are a distributor. You don't think this tax affects you? Wait till your manufacture informs you that they have to cut your points... The truth is not always kind or easy to see.
      On a side note, attack my wife and children because you have no merit to your argument? That is the level of acumen I would expect from a liberal like yourself who hates facts and inconvenient truths. Your intellect is rivaled only by your class.

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    3. Bullshit. The job growth is from the private sector. Government jobs are being cut across the country due to state budget shortfalls. You slimy bitches are physically incapable of having an honest debate, aren't you?

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  27. Incorrect about public private sector jobs. Obama has created more private sector jobs while Bush created more public sector jobs with lower taxes, see below. Your theory makes sense that with higher taxes the government would use that revenue for public sector jobs. It just doesn't factually play out that way. When you go to war you have to hire a lot of people. When you don't fund the wars with taxes, down the road the country will have to raise taxes to pay for them.

    http://thinkprogress.org/economy/2012/06/01/493849/obama-bush-jobs-record/

    http://zfacts.com/p/318.html

    I apologize for attacking your wife and children it was childish. I don't like my hygiene, clothing or living arrangements being attacked either and it is very easy to hit back. If your from the Northeast, have a post-graduate degree and are an executive it would help if you got a "fact" right once in a while. Try backing up your arguments with something other than calling people liberals and socialists because they realize we have debt and deficits, which we can't save our way out of. I do think it is very funny that you routinely incorrectly stereo type black men, Democrats, and Southerners but don't like it when you get a dose of your own medicine.

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    1. Again the source you are using is based on data that is not factual. Just like the 4.2 million green jobs that have been created by simply changing the definition of a green job, I'm sure you must have seen the senate hearings or at least the sound bites. Look at the website you are using ( think progress.org ) it is a liberal biased website no better at facts than the conservative talk radio people you bash. I do not argue that Bush was no good for the country and spent money like a drunken sailor, but that doesn't mean you have to throw good money after bad. I agree with your point about the wars, but you need to balance the increases in tax revenues with cutting bloated and duplicate programs that do no good. There is more fraud and waste in government than there is in healthcare.
      If you look at the economy during the Reagan years and part of Clinton's years in office, there was a balance of revenues while controlling the growth of government.
      I take offense to the assumption that I stereo type black men, democrats, and southerners. I am African American, I was born and raised in the South, and don't have a problem with democrats, just the progressive movement that has hijacked the party.
      Thank you for the apology, I am sorry for taking a shot at you and your hygiene. Lets just agree to disagree on this issue.

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    2. Bush increased the size of government more than Reagan and any other president. CONs are big government borrowers and spenders and the facts bear this out.

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    3. Any other president, other than the current one? You can't bash Bush's spending and government expansion without acknowledging that Obama has done worse by multiples of Bush's numbers

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    4. False, Bush passed the first bailout that unfortunately Obama got stuck with the bill of as well as two wars. Bush's last year compared very similarly to Obama's years as president. If we wen't to a dinner and I ordered Champagne and Lobster and stuck you with the bill would it be your fault you paid too much for dinner? Here is an article from FORBES, I know they are part of the "liberal" media with socialist tendencies. Unfortunately it was Bush's policies that are way more responsible for the deficits and debts from one of the most conservative sources I could find.

      http://www.forbes.com/sites/jasonoberholtzer/2012/02/01/obama-vs-bush-breaking-down-the-deficit/

      http://www.washingtonpost.com/business/economy/ezra-klein-doing-the-math-on-obamas-deficits/2012/01/31/gIQAnRs7fQ_story_1.html

      http://www.washingtonpost.com/business/economy/us-deficit-to-top-1-trillion-for-4th-year-in-a-row/2012/01/31/gIQAWmKweQ_story.html

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  28. I cited two sources and copied the first few links from Google in the previous blog. I am not a liberal nor really democrat and damn sure not a socialist or communist. I do believe you need a strong middle class for capitalism to function as it relies on consumers. I believe in a strong military and have no problem with war for the right reasons if it is paid for, there are bad people. However, it is probably not a good idea to get fiscally overextended with wars, which is the main reason almost every empire has fallen. I don't believe in gay marriage, marriage is between a man a woman. However, I do believe in fiscal responsibility and there hasn't been a Republican in the last thirty years who has balanced the budget. Deficits are as Republican as they come and are the whole reason the country is in this financial mess. It didn't help that we had to bail out Wall Street and the banks and there weren't too many democrats or liberals working at Wall Street or the banks. If you look at the budget around 25% goes to the military, 25% percent to Medicare and Medicaid, 25% to Social Security and 25% to government programs. The only problem is the budget equals a 150% of our tax revenue and wait till interest starts adding another 25%. If you cut out all the government programs and just left Social Security, Medicare and Medicaid and the Defense budget alone and paid the interest owed on our debt we wouldn't have enough tax revenue to fund our obligations. That obviously doesn't include the 500 BILLION dollars of government programs. Explain how you are going to reduce government spending to meet our financial obligations, you would have to eliminate all government spending? In 2014 if you cut out everything from the budget but social security, Medicare and Medicaid, Department of Defense spending and interests obligations we do not bring in enough tax revenue to meet those needs. The economy needs to improve and taxes have to go up as well as government spending needs to be reduced to get out of this fiscal mess.

    Obviously I can't change your opinion and we can agree to disagree. I won't shove my politics down your throat and I appreciate you doing the same but I am sick and tired of misinformation and people who have no idea about what their saying forcing misinformation on others. Do your research, most of this information was cited from the conservative website below. Notice the Mitt Romney for President. Hey the Republicans could and have done worse.

    http://www.usgovernmentspending.com/federal_budget_detail

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  29. Well said. I actually agree with most of what you said. Politicians in general spend out of control to make sure they keep their constitutes happy to get re-elected. Let me clarify my thoughts on controlling spending. You have to address the sacred cows of Medicare, medicaid, military spending, and then look at wasteful programs. It is next to impossible to actually cut an existing program, what we need to do is freeze the level of spending while strengthening our economy. This will increase the amount of tax revenues, you can couple that with closing many of the existing loop holes for the top earners without changing actual tax rates. This will again increase revenues and over time will chip away at our deficit.
    I would prefer to see a flat tax, there is a great book ( The Flat Tax) that breaks this down with facts and figures quite well. The IRS and it's maintenance and upkeep are another area of huge spending. Make the tax code simple and straight forward for all and let everyone have a little skin in the game. Add a product tax on all new purchases and you increase revenues proportionately on those with the most disposable income. The book goes to great lengths to explain rebates for commodities so they are not held against middle class families. Even if you do not agree with the premise, it is a quick and informative read.
    I could not agree with you more on the misinformation, but it is prevalent on both sides. Just look at the recall election in Wisconsin, the mainstream media ran with stories saying Walker's policy had cost the state over 180k jobs. When department of labor facts showed that over 40k jobs had been created in that time period.
    I like Mitt because he has faith and values, he has also shown an ability to work well with the other side during his time in MA. I am not far right, more center right leaning and I don't believe too far in any direction is good.

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  30. All those childhood stories were entertaining and helped to keep our minds occupied as we searched for things to do on a warm summer day. I'm reminded of the story of the frog in the pot of warm water and how we could just as easily substitute a Synthes Rep for the frog.
    The pot of warm water would be all the statements coming from corporate telling you how everything is going to be o.k. and to keep your head down and do your job. All the while they collect fat multi-million dollar bonuses. To my knowledge, you reps who have sold the products and driven growth haven't gotten the promise or guarantee of a bonus other than, we will let you know within 90 days of the closing what your territory and comp plan will be.

    The corporate hand reaches over and turns up the temperature a notch.
    In just under 90 days you will receive your new offer from the DePuy/Synthes company. When you're hit with the 18 month non-compete do you decide to jump out of the pot and swim in cooler waters, or will you continue to put your head down and do your job? When you discover your territory is now a sliced and diced shadow of itself, will you jump from the pot? The temperature is rising.

    The hand reaches over and turns up the heat another notch.
    When it is explained to you in black and white that your comp plan will stay like it is through December 2013, do you jump from the pot and move to less restrictive fishing grounds or again put your head down and do your job? After all, where do you think the direction of your commissions is going to head? The temperature is rising!

    The hand reaches over and turns the knob to the highest setting.
    So by late 2013 you're trudging along in you territory with an 18 month non-compete anchored to your back and no idea what your comp plan will look like other than a menu of cafeteria style options. Of course, with each benefit option chosen by you your commissions will decrease.
    The water is now at a gentle boil and your hide is cooked. You finally realize you don't have the strength to jump from the pot of water due to the 18 month non-compete anchor strapped to your back or all the so called specialist and territory assist reps who could easily walk into your accounts (or account as it may be) and replace you. FAHRENHEIT 212!!!

    The table has been set right before your eyes and yet so many of you continue with the head down approach and believe JnJ is going to take care of you. All the DePuy reps for the spine distributors have their new contracts in place when they went as direct employees. They got 8% and an 18 month non-compete.
    Remember one of the wise sayings your grandmother used to say "IT'S NOT OUR WORDS, BUT OUR ACTIONS WHICH DEFINE US". So keep your heads down and continue to listen to wordly promises as the temperature gets turned up and their actions indicate a different intention. You will make a fine appetizer on the JnJ table that has already been set.
    J

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  31. 11:25 Very well stated. I'm in that very same position now with DePuy Synthes, we were all promised that our jobs would be safe now I'm not so sure. One thing is sure that there will be plenty of openings real soon.

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    1. They are cutting jobs, the talent assessments will be crossed with the amount of revenue/rep a given territory produces, if the number is below a million in sales per rep, the slash is coming. My buddy is an RSM and gave me the low down. Lots of Synthes guys in RSM and AVP positions too. JnJ will talk a good "credo" game, but they will cut you out in two seconds if it helps the bottom line.

      Don't feel bad for going to a competitor. They may have given you an opportunity to put food on your table, but you also sold strong and put food on the table along with bonuses for many AVP's and marketing people. This company is cold and heartless, everything was setup to take the reps they want hostage and flush what they don't. Cuts are coming and you better talk to your close docs openly about whats really happening. Anytime a VP of sales says "walk into your accounts with your competitive counterparts and show a united front." and "don't worry about your territories, that's irrelevant.". Clearly shows a disconnect and a lack of concern with the field.

      The reps who get a territory cut or lose their job entirely, I hope you are motivated now more than ever to dominate your marketplace and earn your kill. I left Depuy just recently during their hostile takeover of our distributorship. Breath of fresh air and the surgeons who understood knew Depuy wasn't the end all be all in spine. "They sell the same stuff, too bad they got Medtronic arrogant." - no joke, from one off my docs.

      Delete
  32. I've seen 5 DePuy and 2 Synthes reps within a 100 mile radius leave over the past 6 months. There's a great big flush coming. Hopefully the smart and savvy reps will find and create greener pastures for themselves.

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  33. The Depuy reps who stayed on board when their distributorship got flushed were scammed. Hope they move on before it was too late. I hear lots of Synthes guys are in leadership positions calling the shots and protecting their own. This could be a monumental blow up. It makes sense, brand new president and vp of sales to lead integration- they know full well as many as possible will go direct- going direct allows Synthes leaders to assimilate quickly and run the show. The veteran reps who get screwed are going to take off.

    For the record, I left Depuy last year when our group went direct, I still keep in touch with lots of guys and their resumes just got updated...again. I'm glad I didn't sign the 18month non-compete. What a ruthless company DepuySynthes is starting to appear to be!

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    1. That is exactly what I'm seeing in Cali. I'm in a territory that has been completly blown up by turn over, hospital contract lock outs and POD's. My Synthes counter part is in the same position and my new manager is Synthes I'm not liking my chances.

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    2. Start interviewing now! I am! Don't trust what any RSM or AVP says. They're stalling you.

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  34. Ron Sacher of JNJ in Fl is the only manager that is worse than Kosta's boy Guy Cassone, RIP. Good luck to the poor reps who drink the Eclipse coolaid.

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    1. Is he the Sacher that was involved with Impliant, if so, WTF

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    2. 2 different guys

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  35. 18 mo non-compete? R U HIGH? Fight The Man!

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  36. I didn't realize when I signed on for JnJ and they said how much they wanted me that it was for only 6 months. Thanks for the loyalty Depuy...dirty play.

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  37. Thanks 5:58 that's scary. We all take this job personally and every day we fight the fight. And many of us have years of service with DePuy only to be stresses out by this mess. DePuy really could care less about any of us. There will will allot of high quality talent that will be available to a company who cares about it"s people. The Credo are only words nothing more nothing less. Best of luck to all of us in Cali who have proudly carried the red dot.

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  38. What happened to guy cassone?

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    1. Destroyed the entire Syn-Tezz FL team and was fired for falsifying POs. Ran back up North with his tail between his legs, to threaten & intimidate another sales team.

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  39. Cement shoes. The names certainly fits the image doesn't it?

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