February 01, 2004

Economic Ignorance in the Medical Field

I'm on a random blog journey and I stumble across a clueless med student:

After every question, I just wanted to shake them and scream “Single-payer!” (Yes, I have a slight flair for the dramatic.) And I’m not trying to be idealistic. I realize it’s not a golden bullet. I realize health care reform is politically difficult. I acknowledge it. Fully. But how can doctors continue to work on some sort of patchwork system—like suing the insurance companies, like the CMA did with the RICO lawsuit—but not fight for a long-term change? People seem like they’re willing to fight their own fights—but not fight for medicine as a whole, as well as their patients. It almost seemed as if the doctors were more willing to deal with the hassles of HMOs (which they cited as “the reason you never get to see your kids”), but aren’t willing to try another solution, even when it was staring them in the face.


But honestly, how much of this “doctors are barely getting by” mantra am I supposed to believe? I’m a medical student, and at the same time, still a member of the public. A lot of the questions discussed “How do we get patients to realize that doctors are hurting,” and “Universal health care does nothing to address low incomes for specialists.” The malpractice issue aside, who’s struggling out there? And I mean struggling. When you’re “struggling” to make car payments on the BMW or the 5-bedroom house, you don’t count. You can live a perfectly happy and satisfactory existence with a measly Honda and cheaper mortgage, can’t you? Isn’t it more the expectation of a certain level of income that’s the problem? Not the absolute income, but the level relative to one’s societal expectations as an all-important doctor? (Sidenote: would specialists and/or general practitioners not be willing to take a pay cut to have reduced administrative workload, increase the time they’re actually practicing medicine, and possibly increase the time with their families?) Maybe it’s my societal naivete of what it’s like to have children and mortgages and responsibilities greater than oneself?

There are two kinds of economic stupidity going on here. First, there is the infatuation with the idea of single payer health systems. I left the following in comments:

"how could any other nation be insuring everyone, have higher general health outcomes, and spend less?"

For the FRG, it's very simple how they manage to get more by spending less. They're using involuntary servitude.

The health ministry has at its disposal approximately 90,000 conscientious objector draftees that it only pays peanuts for. In fact, the German military wants to end the draft but is being stymied by the health ministry because they can't afford to run the health system by paying people to do it without a prison term hanging over their heads.

A lot of public systems advertise low costs and good service but they simply do not deliver. In former eastern bloc countries the system was that the service quality is terrible unless you bribe people. France demonstrated this summer how fragile their health system is with 15,000 excess deaths due to poor healthcare planning running into generous vacation schedules.

The list can go on and on but it all boils down to a double standard. The current system is a mixed free/state system but is labeled free market healthcare and is looked at in its reality, warts and all. Public systems, by contrast, are examined in their platonic, idealized glory and it's relatively rare that you get to see the reality of poor service, slowed innovation, and unsustainability without external support like those poor german draftees.

You can bet dollars to donuts that the pay difference between a draftee's salary and what a free market worker is not included in international price comparisons for health care. Fantasy comparisons like that dominate the discussion of free market v. single payer solutions.

Single payer health systems all break down in different ways but the ultimate truth is that they all break down. In the FRG, it's involuntary servitude and a groaning budget. In France, it's dead seniors. In Canada, it's discreet trips across the border to relieve pressure on long lines for care. The symptoms vary, the disease is the same, government intervention in medical care.

The second piece of economic inanity is a complete lack of understanding of opportunity costs. If you stop your education after four years of undergraduate school, you get to start earning money. But no, doctors go to medical school instead and lose the opportunity to have tens of thousands in income while gaining career experience in some other trade. Not only that, but they usually pay for the privilege without benefit of having the money so end up leaving medical school not only without the money they could have earned but with a huge mountain of debt besides.

Then they go and get a job as a resident, a job that could not be done outside an educational program because it would be illegal. The hours worked, the pure grind would lead to much higher salaries if the job were done by people negotiating in a free market. Thus there are more tens of thousands of foregone income. Depending on your specialty, you could be losing 6 years or 10 years off your earning potential because of your career choice.

Now, a certain number of people will enter the field because they have a vocation and want to help people. But not all such people become doctors. Some are orderlies, nurses, pharmaceutical or medical researchers.

For the sheer lost opportunity, risk and responsibility, you can't beat the doctor. To get enough of them, you have to pay them well. The consequence of squeezing doctor incomes is that people leave the field. The payoff is no longer worth it and they won't pay for medical school for their kids, they don't advise others to get into the profession, and many find other things to do than medicine. If the doctor wanted a Honda and small house lifestyle, he could have had it with better hours, more respect, and and easier lifestyle as a nurse.

HT: Suburban Guerrilla (not what you think)

Posted by TMLutas at February 1, 2004 08:02 PM