posted by Kyle on Jul 7
There is a brouhaha of sorts taking place in Washington. The American Medical Association is pushing for a Senate vote to reverse Medicare cuts that went into effect on July 1st. The gist of their argument is this: physicians are struggling, and you’re going to make them stop taking Medicare payments! This means they’re going to stop seeing Medicare patients! The sky is about to fall!!!!
I contend that the sky has been falling for a long while. Medicare has been imploding. Why? It is the very nature of government to make something as inefficient and worthless as possible. Doctors are finding that treating Medicare patients costs them money, and they’re not accepting those patients. Imagine that! With the cuts taking place, fewer doctors will see those patients. The New York Times discusses one such case:
Dr. Gerald E. Harmon, a family doctor in Pawleys Island, S.C., said he decided last week that he would not take new Medicare patients “until further notice.”
“This is not what we enjoy doing,” says a notice in his waiting room. “It is what we must do to maintain financial viability.”
Perhaps you believe that senior citizens, poor folks, and those with chronic renal disease possess a God-given right to health care. Perhaps you believe that their shortcomings amount to a virtue. If you hold this erroneous belief, then you believe implicitly that others have a moral obligation to provide it to them. If this is the case, why are you so worried about what physicians get paid? Surely they are selfless creatures who will work day and night to look after the wretched masses. That’s their moral obligation, right? Work hard in school, work insane hours in residency, and be a slave to society. Sounds like a fair bargain to me!
In any case, if you believe that people have some right to health care, then it shouldn’t matter to you how much doctors get paid to treat these people, because ultimately, they are the only ones able to provide the care. You have the need, and therefore doctors have the moral obligation to fulfill it. Done!
What this means is that if you hold this belief, you must logically conclude that this amounts to doctors trying to play a guilt trip on America so they can make more money. I would readily agree with you in that respect: the AMA, and the doctors for whom they speak, are begging for money. They look and sound a little better than that annoying guy who bothers me in the grocery store parking lot, but they’re begging. I am not in medical school so I can become a beggar. I don’t study for 10 hours per day and ace my exams so that I can get on television and beg a bunch of corrupt politicians to keep sending me stolen money. This sort of conduct is unbecoming of a physician. To the AMA and their members, I say: stand up and stop acting like children. You have no right to be paid by taxpayers, and your patients have no right to demand your care unless you voluntarily agree to provide it.
As I said in the beginning of this post: the sky is falling on medicare. Doctors are opting out, and people on the dole are having a hard time getting their health care for free. I think that this is a good thing. Medicare is a flawed program. On practical grounds it is flawed because of the regulatory nightmare that it creates. On moral grounds, medicare is flawed because it is a distribution of stolen money.
If you think this is moral, then you must logically believe that in five or six years, when I have a medical license, you have every right to put a gun to my head and make me perform medical procedures on anyone and everyone. The only recourse that I would have, according to this flawed position, is to go to congress and beg them to pay me (by means of the forceful expropriation of money from others).
If these cuts remain in effect, and further cuts are implemented down the road, it will only accelerate the inevitable: Medicare, like Ted Kennedy, has a glioblastoma. They’re both dying, and there isn’t a damn thing anyone can do about it. Congress has no more power to pass a law keeping Ted Kennedy alive than it does to save Medicare from its inevitable demise.
Medicare is going to die slowly. Lines at the offices of those who do accept Medicare are going to get longer and longer, and pretty soon you’re going to find people looking for other ways to get care. They might even choose the moral option; they might decide to pay for it! As people begin nearing the age of retirement, they’ll probably realize that they don’t want to be trapped in this debacle. They’ll probably start saving and buying private insurance for their golden years.
The gluttons feeding at the trough will indeed suffer when no one comes to fill it for them. They’ll figure out a way to survive, though, and others will learn that the taxpayer trough isn’t an attractive place. Medicare will collapse, with or without these cuts. These cuts will accelerate the collapse, and I, for one, am happy to see it take place.
As a side note: The Happy Hospitalist has an interesting perspective on this subject.
July 7th, 2008 at 9:06 pm
I couldn’t disagree with you more Kyle. It’s going to get a lot worse before it gets better. And for you idealistic position on weeding out the gluttons-they will only resort to emergency room care, costing all of us more and more. no one survives on their own anymore…didn’t you know that? haha. Mind the beer truck theory. You can hate beer all you want, but that’s not going to keep you from getting hit by a beer truck.
July 7th, 2008 at 11:09 pm
I admire your altruism. Unfortunately the type of altruism you possess can be extremely frustrating when you become a physician, so choose your specialty carefully so as to avoid the infirm, the poor and the needy. My advice is to consider aesthetics or perhaps law school in place of a residency. Seriously.
The wisdom I have acquired with the 20 years I have served since entering medical school has taught me that the greatest rewards in medicine are not financial, although we are able to make a good living in this culture.
Furthermore, health care is a right in western civilization. When someone gets sick, they go to the emergency room and get treated. Acute care hospitals are compelled to care for them and physicians, even those in private practice, must serve in order to maintain their hospital privileges. So, if you truly believe that health care is not a right, then stay away from any field that requires participating in a medical staff in an acute care hospital.
There is no question that physician salaries are decreasing and frustrations are increasing as Medicare funding is being strained. Politicians do not have the answers and doctors’ groups don’t either, but that is the system. Even so, it’s better than it was 50 years ago when many people had no resources to pay anything for their health care, and doctors routinely accepted barter for their services. The biggest boon to physician salaries was the Medicare system and now the system needs an overhaul.
I feel your pain. Practicing medicine is a continuous struggle and it never ends. But the rewards are worth it.
July 8th, 2008 at 12:09 am
One more thing: Medicare is NOT welfare and people on Medicare have paid into the system. Medicare has alleviated much hardship for the elderly who rely on it and has done so with at least as much efficiency as any private insurance. Government can provide a worthwhile service although you obviously will never believe it.
The worse frustrations in medicine are NOT from Medicare. The real frustrations, and the greatest drain on the health care system, come from the uninsured who get sick and require care… and those numbers are increasing.
July 8th, 2008 at 12:22 am
Tony, I am in complete agreement with you when you say that the rewards are worth it in medicine, and I’m not talking about the financial rewards. If I wanted to go for real money, I’d have gone to law school, and I certainly wouldn’t be interested in pursuing Neurology as a specialty.
I don’t believe that health care is a right because I don’t believe that I have a moral obligation to “serve” others. I will probably be coerced into doing so, and this angers me. I also believe that income taxation amounts to theft. I get stolen from every year. Just like I eat food from street vendors even though I know I’m going to get sick once in awhile, I’m not going to pursue a specialty in which I am uninterested in order to avoid being victimized in any way.
You make a very important point: Medicare’s creation was a huge boon to physician salaries. And now some physicians are sitting on the steps of capitol hill, hat in hand, begging to keep the money coming. That is shameful.
July 8th, 2008 at 1:14 am
Tony, let me ask you a question: If someone robs my house, does that give me the right to rob my neighbor’s house?
People who paid into medicare were robbed. This is the unfortunate truth. This does not give them the moral right to steal from someone else.
July 8th, 2008 at 1:39 am
You state, “I don’t believe that health care is a right because I don’t believe that I have a moral obligation to “serve” others. I will probably be coerced into doing so, and this angers me.”
From a social standpoint, our society has spoken and has indeed determined that health care is a right. Along with sewage, clean water and vaccines, universal health care in the form of Medicare is one of greatest achievements in the history of public health. On a personal level, however, nobody is an indentured servant… you can practice medicine and opt out of Medicare and thereby avoid “government” payment.
Neurology would be a tough specialty to practice eschewing Medicare, but not impossible. It’s too bad that you haven’t even started your career and you already feel “coerced” and “angry.” You call doctors “beggars” because their political action committee pleads their case to Congress. You seem somewhat young to be so cynical.
Relax. After all the sausage is made in Washington, primary care physicians will make 3X the median salary in the US and proceduralists will make about 5X. You will still be able to choose which patients you want to care for and you can still charge whatever you want for your services– that will never change.
July 8th, 2008 at 10:04 pm
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