Take a Number
Most of you will be surprised to learn that doctors in California went on strike about 32 years ago, seeing only emergencies for several days. That got the attention of the so-called public servants in Sacramento and they passed an emergency malpractice reform package called AB 1xx. The best feature was a cap of $250,000 on pain and suffering, or non-economic damages. This allowed insurance companies to plan for future risks and kept some of them from leaving the state. Many key states such as Florida have no such law, and certain fields of medicine such as obstetrics and neurosurgery are becoming endangered species.
Today’s doctors are a much different breed. Solo practitioners like me are becoming rare. It used to be said that organizing physicians was like herding cats, but that old-fashioned pioneer spirit is giving way as group practice becomes the norm. I say that without passing judgment. It is what it is. The new doctors are about 50% women, often working part-time in corporate settings and retiring in their prime. Priorities have changed.
When I began blogging I promised my wife I’d avoid politics, but in this year of presidential campaigning it’s chasing me. The profession is under attack from all sides and no one speaks for us. There is a “crisis”, a word politicians use as a pretext to empty your pockets.
In 1976 during the strike, and again in 1993 when Hillary Clinton’s secret task force was scheming to take over health care which represents 14% of our economy, I sent letters (how old-fashioned is that?) to my patients, and some of the phrases I used still ring true. Under a government-run system, your doctor will no longer be anyone special to you, and vice versa. You can expect the compassion of the Internal Revenue Service, the efficiency of the Post Office, and the interpersonal skills of the DMV.
Fifteen percent of our citizens are uninsured. That is not a crisis, it is a personal choice made mostly by healthy young people who have decided is not worth buying insurance at its current cost. Government cannot fix that any more than they did car insurance by making it mandatory. In fact it is because of government’s heavy hand in controlling so much of the system through its Medi-Care and Medic-Aid plans that costs are spiraling upward. We also are a free country, not likely to allow bureaucrats to tell us what care we may get. Our medical care is the envy of the world; thousands of foreigners come here for care. On the other hand it is the burden of caring for millions of illegals that threatens to overwhelm hospitals and emergency facilities.
Under the 1993 plan, it would have been illegal for patients to pay doctors for services they felt they needed; both would be subject to fines or prison. (Even Soviet Russia allowed some private practice of sorts). In England and other countries with socialized medicine, waiting lists are very long (40% of Canadians awaiting coronary by-pass die before their number comes up). Kidney dialysis is not allowed over 65. It takes months to get CT scans or MRIs.
These facts seem shocking to people of my generation, but I don’t sense much concern on the part of my younger colleagues. Insurance companies do such a terrible job of acting as intermediaries that most providers reflexively wish for government to take over because it would be “simple”.
There are constructive options available but time is not on our side. Making the system job-dependent was a ploy that made sense 70 years ago; health benefits were deductible to the employer and not taxable as income, and the labor unions went for that in a big way. In this global economy American companies are suffering competitively because of the weight of insurance and pension benefits. Employees also give up much freedom to change jobs or to choose other coverage.
Clearly we need a national market like that of car insurance, with customers calling the shots. Health savings accounts are a step in that direction. There must be national tort reform like that passed in California long ago. (Good luck getting the lawyers in Congress to let that get by them). I do not believe that electronic medical records or national guidelines help at all, and they are a real threat to your privacy.
Please remember when you hear the politicians demagoguing the issues that doctors don’t grow on trees, that they come out of training deeply in debt and often over 30, that they have skills few people possess and your lives may be in their hands. They deserve better than to be afterthoughts of political campaigns, to be swept up with the banners and placards.
Don’t forget to vote.