Doctors don’t like Obamacare

Bruce Kesler highlights the largest ever survey of doctors on the subject of Obamacare — and they don’t like it.

I can already hear the pro-Obamacare people saying, “Well, they don’t like it because it’s going to be more efficient and therefore cuts into their profits.”

Think about that for a minute.  You can have profitable efficiency (that would be a good private sector business, such as McDonalds or Apple) or you can have allegedly efficient unprofitability (and I can’t think of an example).  Let’s assume that, in a government-run program, efficiency is even possible.  And let’s take it as a given that doctors will lose money.  What happens then?

The answer is easy:  good doctors leave a system that doesn’t reimburse them.  In England, the good doctors have left and there are regular stories in the British papers about the dreadful doctors the NHS brings in from overseas. In the former Soviet Union, medicine became a predominantly female job because it was so low status — and the smart women didn’t want to do it.

Doctoring has traditionally been profitable, but it’s been an earned profit:  the top students spend four years in undergrad, four years in medical school, one year as an intern (at which time s/he can practice in prison), two years as a resident (at which time s/he can become a basic internist or family practitioner), and then one to seven years developing a specialty.  So that’s eleven to eighteen years of training.  Human nature says that, if there isn’t a big reward at the end of that trajectory, good people aren’t going to do it.  They’ll go somewhere else where they can get a larger return for the same or less effort.

And if you’re really curious what bad doctoring looks like, listen to this radio story, about a girl who was bitten by a shark and then got seen by a bad doctor.

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  • Wolf Howling

    “Profit” is a word usually followed by a healthy spit when it passes the lips of progressives.  Indeed, do recall how many of the delegates to the DNC were prepared to sign a petition calling for the outlawing of corporate profits.  I still haven’t figured out what word the progs use to describe the accumulation of wealth off the government dime, but perhaps I ought to let that thought go lest I be accused of “politicizing” such an unworthy issue.

    What never ceases to amaze me is how many of the poor and lower middle class think that the left is fighting for them.  That really is the biggest and most successful con in history. 

  • vinny

    There is an old story about a Greek healer named Melampus. He was asked by the king of Argos to help out and named his price. When the king refused the price, Melampus didn’t provide the service. In the end, it cost the kind twice as much.  Moral: pay the doctor his due.

  • jj

    One of the things I did as part of my own schooling was intern in a hospital.  We were given to understand in pretty short order that our writ ran beyond dealing with patients: we were also available as a resource for the doctors. 
    Something people forget is that doctors are also people.  Hum.  As quickly as I write the previous sentence, I rethink it.  People tend not to “forget” it: it’s more a matter that they never think of it, therefore never really knew it.  And human beings like to feel that they’re doing something: they like to win.  But the best oncologist on the planet is going to lose one whole hell of a lot more often than he or she will win.  (Imagine being a lawyer, and knowing ahead of time that you’ll lose 90% of your cases.)  It’s hard, and it sucks.  It’s exhausting, it’s wearing, and if you’re not careful it’s eat-you-alive kind of stuff.  Though they often create the impression that they forget it and move on readily, it isn’t that simple.  That’s an impression they work to create, and an attitude they strive to cultivate, because if they couldn’t do that – and I’ve encountered those who couldn’t – they couldn’t continue.  You can only get the hell beaten out of your emotional self for just so long, which is where we came in.  (And it was far more wearing on us than dealing with patents was.)
    For most, being a doctor is a calling, not a job, or even a career.  The schooling is, as pointed out above, brutal.  Being driven is pretty much a requirement.  For the first thirty-five years of a top specialist’s life there’s very close to no reward.  And, as people also don’t realize, the life is brief.  The head of otolaryngology at the hospital where I worked – the guy who did things like cholesteatoma surgery, etc. – was stepping out of the operating suite during my time there.  He was nearly sixty – and couldn’t continue with surgery where the entire operation takes place in an area half the size of a thimble: your middle ear.  The fingers wouldn’t reliably do it anymore.  He was no longer capable of driving, he assisted and consulted.  At short of sixty, so he’d been at the top of his game for about 16 years.  40 years of school, learning, assisting – then fewer than 20 years of practicing to the level of which he was plainly capable.  All the knowledge in the world, but the fingers were finished.  And – that’s the way it is for cutters.  That’s the routine.  You aren’t still doing it at 70.
    You have to want to do it.  And unlike almost anything else, you don’t do it for the money.  An interesting experiment: next time you visit your doctor, ask him or her how much a half hour of their time is worth.  98% of them have no idea.  They don’t know what their own rate is, or even if they have one – unless they’re at a clinic or something, which will set a rate for a visit.  They’ll mostly take what the insurance gives them.  (Unless it’s Medicaid, which would have them living in virtual poverty.  That’s becoming acceptable to fewer and fewer of them.)  Anybody else, from car mechanics to plumbers to lawyers will tell you: “I get X an hour.”  Doctors mostly won’t, it isn’t how they think.
    Because it is, for the good ones, a calling, we’ll always have them.  But they’ll be fewer.  For people with the raw material between their ears to do it, there are plenty of things easier and more rewarding, up to and including law school.  (Everybody talks about cutting doctor’s pay, how come nobody ever says that about lawyers?  Who does society need more?)  The reward at the end of the trail is little enough, if yoou kake it altogether evanescent, things will get interesting indeed.         

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  • David Foster

    A serious person who wanted to increase healthcare “access” would have thought in terms of increasing system *capacity*, not just programs for funding.

    Imagine that someone ran for president on a platform of giving everyone their own government-funded private helicopter. But the helicopters can only be made in FAA-certified U.S. factories, and the new administration takes measures to ensure that neither can new factories be certified, nor can the production rates of existing ones be materially increased.

    Your free-helicopter benefit wouldn’t be worth much.

    Not a perfect analogy, but pretty close. 

  • Danny Lemieux

    I actually had one foot into medical school (an interview scheduled) and then, pulled away and declined the interview at the last moment.

    One of the reasons was that I had time to reflected on all the physicians that I knew and realized how screwed-up their families were. They were always on call, they worked ungodly hours and their spouses and kids were a mess. What I also found, having studied and worked in a hospital as a pre-med student, is that it is very depressing work: their clientelle consists of sad and sick people, not healthy, happy people. It’s not for everyone.

    I have always appreciated how hard the life of a good physician really is. In very large part, they deserve all the money they earn. 

  • Ymarsakar

    Lawyers get most of their money now a days.

  • Ymarsakar

    One thing people should never forget is that Hollywood profits are never taxed by the Democrats or Republicans. Yet it is that, profit, of the purest, most useless, most decadent, kind. The Left has never minded profit, so long as money went into their bank accounts. Their problem is when profit gives the little guy money, since a guy with money won’t have to get on their knees to slave vote for the Left any more.

  • Dagwood

    Awesome post, JJ.