With health-care reform about to break upon the nation, the demonization of those who refuse to get with the program will soon begin. On Wednesday, Hillary Rodham Clinton offered a preview of things to come with an attack on “price-gouging, cost-shifting and unconscionable profiteering” and a promise “to take on every special interest group.”
Which groups? Any populist campaign for health reform will have three obvious targets: the insurance companies, the drug companies and the doctors. For the insurers I hold no special brief. True, they have the thankless job of harassing doctors (to keep costs down) and patients (to pay up more) while trying to make a profit. But the peculiar combination of zeal and incompetence with which many carry out these tasks is enough to make one indifferent to their fate.
I have somewhat more sympathy for the drug companies, the first victims of the Clinton demonization campaign. The drug companies stand accused, among other things, of making profits from copycat drugs-this in a country with a zillion four-door sedans and a dozen varieties of baseball bat. Indeed the supposedly damning statistic that 58 percent of new drugs are not really new means that an astonishing 42 percent are new, i.e., constitute genuine therapeutic advances and make real contributions to human well-being. What other industry can say that?
But I reserve most of my sympathy for the third inevitable subject of demonization: doctors. They will certainly be asked to take a cut not only in pay but in independence and status. And the implication will be that they should be lucky that they’ve gotten away with that, given their arrogance and opulence.
Now, I’ve known my share of arrogant doctors, and a few given to opulence, but I have found them as a class to be admirable, unusually hardworking and dedicated. (Full disclosure: I’m a doctor, inactive, having seen my last patient 15 years ago this month.) In fact, if all American industry operated at the level of the medical profession we would not be talking endlessly about the failure of American competitiveness.
It is well known that the United States has the most expensive health care in the world. What is not well known is that we have by far the best health care in the world. It is no accident that ailing Saudis come to America for their serious problems. It is equally no accident that so many foreign doctors come here for their training.
Last March, after the doctors’ challenge to the Hillary Clinton commission for excluding them from its deliberations, Bryant Gumbel asked this of Dr. Richard Corlin of the American Medical Association: “In the greedy excesses of the Reagan years, the mean income of the average physician nearly doubled, from $88,000 to $170,000. Was that warranted?”
This from a man who pulls down $2 million-plus a year for chatting, which is not exactly brain surgery. But apart from the chutzpah of the question, there is the implication that doctors’ salaries are a result of “the greedy excesses of the Reagan years”-which conjures up images of leveraged buyouts, insider trading and assorted financial shenanigans.
In fact, doctors’ salaries are a result of very specialized work with grave responsibilities carried out on an often grueling schedule. Newsweek put it succinctly: Doctors’ salaries are “hardly excessive, considering that most doctors work 60 hours a week or more, live tethered to beepers and graduate from medical schools with debts as big as home mortgages.”
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Doctors have the most extensive and expensive training of any profession: 11 years or more of higher education, which leaves them, on average, $56,000 in debt before they even start practice. Clinton talks a lot about the ethic of hard work and responsibility. Well, a doctor’s youth is an exercise in discipline and delayed gratification. There is no other profession in which training is so long, hard, and poorly rewarded. Doctors spend their 20s in labs and libraries and then in emergency rooms on brutal 36-hour shifts, and when they finally get to the point of earning, they get zapped for being greedy.
The hounding of doctors has only begun. It is not just a question of pay. It is a question of being hassled and harried for either inadequate care or too adequate care at a time when the lunatic litigiousness of this society makes overtreatment a matter of essential self-defense for a doctor.
Already doctors are being driven to distraction by insurance companies calling to complain that Smith with the abdominal hernia has been in hospital for three days whereas regulations stipulate 2.2 days, and so what if his blood pressure is 80/50.
The first effect of these assaults on medicine will be to drive out of the profession a large cohort of especially experienced doctors in their 50s and 60s who have enough to retire on but would like to continue to practice because they love it and are good at it. They will have had enough of the paperwork, the directives, the societal opprobrium. When the 55-year-old pediatrician, whose medical judgment honed by 30 years’ experience is an irreplaceable national resource, is sent into early retirement, the country will have suffered a grievous loss.
So let’s reform the system. Let every sector take its hit. But when we hit on the doctors let’s do it with a measure of respect, and spare the self-righteousness.