Thursday, April 14, 2005

Greedy greedy greedy greedy docs

Atul Gawande--author of Complications and estimable breaker of the physicians-are-infallible-gods code of silence--offers a lengthy and somewhat muddled liberal fret about how insurance plagues our healthcare system, in the New Yorker.

For my money (literally), nothing could be more screamingly obvious than single-payer as antidote to the grotesquely iniquitous and wasteful gougefest that is the American private-insurance health system. Especially when you read about another alternative, in the person of a general surgeon who accepts no insurance at all, requiring cash on the nail from patients who can then choose whether or not to battle it out with their own insurers:

'He had practiced general surgery at the same East Coast hospital for three decades. He loved his work, he said. He did not have an unduly heavy schedule. His office hours were from nine-thirty to three-thirty on just one day a week. He did about six operations a week....And he no longer had to cover midnight emergencies. I asked him in some roundabout way how much he earned doing this. "Net income?" he said. "About one point two million last year."'

This paragon of business sense, who seems to charge over ten times the typical (admittedly chintzy but not that chintzy) reimbursements for surgical procedures (e.g. $8,500 for gallbladder removal as opposed to $700), feels that 'For doctors to think we have to be altruistic is sticking our heads in the sand.' By way of justification he notes that 'The C.E.O. of Aetna’s compensation is now ten million dollars,' as if that weren't simply another shrieking index of how fucked of a paradigm for-profit healthcare is. The blood runs cold.

Clearly, giving the market an even freer hand in setting medical costs is not going to result in reduced barriers to health care for those who can't afford it now. Nor will it result in equitable distribution of quality care. If docs like this one, 'something of a star in his field,' can price themselves out of reach of all but the tiniest elite, the rest of humanity will have to content itself with its sundry designated layers in a deteriorating parfait of more affordable dregs. There aren't words for how not good enough that is.

I do take hope, though, from the level of social and political engagement I've seen in many medical students, particularly in the Action Committees at the American Medical Students' Association. When I interviewed at Cornell, a 2nd-year MD-PhD student actually quoted Howard Zinn to me! Given how shockingly conservative and socially callous is the American medical establishment (notably the AMA), I'm hopeful that the rising generation of docs, who got into this gig knowing full well we weren't ever going to pull down the truly stupid coin of yore (not that we will do badly at all, mind you), will reinject some of that spirit of helpfulness and social engagement that I do believe, corny old fucker that I am, is fundamental to the practice of good medicine.

Weblog Commenting and Trackback by