Death and taxes: certain, thorny

Death and taxes not only are certain in life — but also extremely messy to handle. This my accountant-friend Tom found out from the passing of his father and working on estate tax deductions. Better to hear it in his own words:

“At age 96 my father still had a good appetite and was able to manage his toilet chores without any help. All of a sudden he had a chill and had to be brought to hospital for checkup. Due to his old age he had to be confined. Within eight days he suffered a series of heart failure, pneumonia and stroke.

“It was difficult on our part to assess the case of my father. We do not have a doctor in the family to apprise us on what to expect. He was initially assigned an internal medicine doctor. Then two more doctors were brought in. The combined doctors’ bills amounted to more than a third of the hospital bills. The fee of each doctor was almost double the cost of the private room.

“The bills of the hospital and the doctors were settled on the day he expired. The hospital issued an official receipt (OR) for its part — and unnumbered provisional receipts for each doctor.

“I am now in the process of preparing the Estate Tax Return. The Bureau of Internal Revenue accepts only BIR-registered ORs as the estate’s deductible expenses. So I had to go back to the hospital to get ORs from each doctor.

“Through your column, perhaps I can be clarified on and suggest:

“1. What is the medical protocol in the choice and number of doctors to be assigned to a patient?

“2. What is the reasonable fee that each doctor can charge? I raise this concern since they spend only five to ten minutes per visit.

“3. Regarding doctors’ fees, the hospital should issue its OR and treat the fees as collections in behalf of the doctors. This is where the BIR can come in, and a regulation drafted to ensure that doctors pay the right taxes. The idea is to appoint the hospitals as collecting and withholding agents. The fees to be paid to the doctors, by the hospital, are net of the expanded withholding tax. The hospital will be required to submit an alpha list of the doctors and their respective fees. The implementing guidelines will be similar to current regulations for fixed-paid employees.

“I hope these will provide folks like me a level-playing field in dealing with medical costs.”

The Philippine Medical Association, Philippine Hospitals Association, and the BIR might wish to reply.

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Last December university professor and retired physician Ken Murray wrote a well-circulated essay, “How Doctors Die.” He told the story of an orthopedist-mentor Charlie, who was diagnosed with pancreatic cancer. One of the best, the attending surgeon had invented a procedure that tripled a patient’s five-year survival odds from five to 15 percent, though with poor quality of life. But Charlie was uninterested. He checked out the next day, closed down his clinic, and never again set foot in a hospital. He spent his time with the family and on feeling good. Months later he died at home. No chemotherapy, no radiation, no surgery. Medicare spent little on him.

Murray’s point is that doctors don’t die like the rest of us. They can get as much treatment as they wish from colleagues, yet opt for very little. Google-search its entirety. Here are some highlights:

• Doctors busily save others’ lives, but tend to be serene when faced with death themselves. They know the options, outcomes, and limits of modern medicine. Most of all, they know what people fear most about death: dying in pain and alone.

• A particular fear of doctors is to have their ribs broken during CPR (cardiopulmonary resuscitation). They shun what medical professionals call “futile care” — miserably, expensively opened up, perforated with tubes, hooked up to machines, and drowned in drugs.

• The interplay of patients, doctors and the system can be confusing. The family of an emergency room patient will nod when the doctors ask if they want them to “do everything.” What the family means is “do everything reasonable,” while the doctors told to “do everything” will comply to the hilt. Even doctors who hate futile care must conform when a patient asks for certain treatments. Doctors can be forceful, but some simply are poor communicators. Sometimes patients do not want CPR but doctors are not informed.

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It’ll be a very short run, so you need to catch You’re a Good Man, Charlie Brown the soonest. The Tony award-winning Broadway musical features a day in the life of the funny, dreamy Peanuts gang. Each one singing of happiness are kite-flying, baseball bungling Charlie Brown, li’l sister Sally, dog-fighting ace pilot pet Snoopy, crabby little tyrant Lucy, sensitive piano-playing Schroeder, and blanket-clinging Linus. The comedy picks up recognizable vignettes from Charles Shultz’s long-running comic strip.

In the cast are 9 Works Theatrical’s artistic director Robbie Guevara, Sweet Plantado-Tiongson, Lorenz Martinez, Carla Guevara-Laforteza, Tonipet Gaba, and Franco Laurel. Directing is Michael Williams, assisted by Toff de Venecia, who also alternates as Linus and doubles as 9 Works marketing-PR head.

Play dates are weekends till March 3: Fridays at 8 p.m., Saturdays 3:30 and 8 p.m., Sundays 3:30 p.m., at the Carlos P. Romulo Auditorium, RCBC Plaza, Makati. For tickets and other inquiries, call (02) 5575860, 5867105, 0917-5545560; or e-mail [email protected].

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Catch Sapol radio show, Saturdays, 8-10 a.m., DWIZ (882-AM).

E-mail: [email protected]