Healthcare Should NEVER Be Free

Is Healthcare A Right?

Yes, Healthcare probably is a right, but it should never, ever be free

Now Dr. D is a Socialist (I’m not talking little ‘s’ Palin-calling-Obama-names socialist, but big ‘S’ from-each-according-to-means-to-each-according-to-needs Socialist) but he still believes medicine should never be free if we want to keep it.

So what’s a nice Socialist boy like Dr. D doing defending the financial exploitation of sick people?

Okay, now that I have your attention…

Rights and Responsibilities

If something is a Right then it must be someone’s Responsibility too.

We have the right to vote. This means someone is responsible to run a fair election and count the votes. We have the right to a fair trial. This means someone is responsible for maintaining an impartial court and providing a public defender. Make sense?

If Healthcare is a Right then someone is Responsible for funding and running an efficient healthcare system that cares for everybody... and that someone is Dr. D.

Dr. just paid about $60,000 to the US treasury and as a bleeding-heart he also did a lot of volunteering and giving to healthcare for the poor. (Dr. D puts his money where his Socialist mouth is!) Like most people with well-paying work, D contributes large percentage his resources toward the general welfare.

Dr. D is also the dude that gives away the free healthcare.

WTF, free healthcare in the USA?

Yep, if you are broke ER care is free by law.

News Flash to Republicans: Socialist Medicine has been here for decades! Doesn’t it just make you feel dirty?

If Healthcare is a right then Dr. D is the dude responsible, because over half my waking hours and dollars earned are spent providing that right. Actually, we are all responsible for it.

We're already providing free care—we’re just doing a piss-poor job of it:

Bad enough that Republicans are right to complain that our kids already owe China trillions of dollars we’ve wasted on healthcare.

Also bad enough that Democrats are right to point out that millions of uninsured are sick and dying without the care they need.

The current state of the healthcare system

So let’s think responsibly about this...

Human Nature Is a Bitch

We Socialists are big picture dreamers. We like to feel we do some good, without get bogged down in the details. Young D used to give a $10 to every homeless dude that asked. It felt good and kept me restricted to a diet of mostly ramen during school. Then I started working at homeless shelters and realized that the bills I gave usually ended up spent on crack. Giving a crackhead money isn’t responsible. Responsibility is a lot harder.

Are you comparing sick patients to crackheads? Yep!

We are all subject to the same rules of human nature. The problems of human nature affect everyone and always fuck up our brilliant plans. (This blog has spent considerable time dissecting how the foibles of human nature make doctors one of the most screwed up and difficult types of people you'll meet.)

Humans are naturally self-serving and take the path of least resistance.

We occasionally rise above our natures, but when we create a system we should expect people to generally act like typical human beings—and by ‘typical’ I mean jerks.

We guarantee the Right to vote and to justice, but because we recognize that human nature people lust for power we have to make a Responsible electoral and jury system that isn’t easy to cheat.

I’m in favor of giving free food to people that need it, but if I laid out a buffet of delicious food on the corner with a note that said, “Just take one plate, and only if you’re hungry.” It would likely all end in the trunk of the first person that drove by—even if that person already had a million in the bank.

Sorry, but human nature sucks! Why do we expect free medical care to be any different?

But people wouldn’t do that with medical care would they?

Dr. D sees it every single day: People call ambulances to bring them to the ER for runny noses and dry hands. People getting a free $1000 emergency room visit demand antibiotics for viral and then don’t fill what is prescribed. People come to the ER to get “checked out” just because there’s nothing good on TV.

Most people will treat anything that’s free like it’s worthless and waste it without even thinking. Just look what we did with this planet God freely gave us!

Free Stuff Has Consequences

Medical care actually isn’t free. It is really expensive. It takes a lot of resources and work to create even the simplest doctor’s visit. Somebody is responsible to pay the bills for free care, and even though Dr. D chipped in $60K this year, our kids are still in the hole for 14 trillion bucks.

A responsible system must be sustainable, and free-for-alls just aren’t sustainable.

The freeloaders also screw up system so it can't work for the people who actually need it. Dr. D gets to deal with a microcosm of this every time we don’t have space for real emergency patient because the ER is full with people who checked in because they were bored or lonely. It happens a lot.

Rationing Healthcare

Healthcare is a right. We owe it to our fellow human beings. We would be some sorry bastards if we just sat by and watched poor people die preventable deaths. We owe it to our kids to create a responsible and stable system to guarantee these rights. The only way I see that you could possibly have free medical care is if it is heavily rationed.

OMG, did Dr. D just say rationing? Get the pitchforks and torches! (BTW, I love how my Conservative friends get so worked up about rationing something they don’t want people to have at all.)

Human beings will frequently use their freedom to go all apeshit. We need to have someone responsible enough to prevent us from exercising our rights to the extent that we harm others.

We have the right to be free but we also have the police to arrest those who use their freedom wrongly.

But nobody wants a police state and nobody wants a free medical system that is constantly saying NO.

Totally free healthcare might not be as nice as you hoped.

What we really want is for people to restrain themselves. Some saintly folks may do this, but most of us will follow our baser natures to disastrous results.

Valuing Healthcare

Yeah Dr. D, but if human nature is really that shitty why doesn't everybody misuse their freedom and end up in handcuffs?

Sorry to bruise your college-educated ego, but it isn’t because you’re such a better person. You just have a whole lot of incentives to stop you before the handcuffs. Some are social incentives—you’d be ashamed to act out—but many are financial. Misbehaving will hurt you in the pocketbook.

Everyone has different values and motivations, but we all accept that money has some value. If we want universal access to medical care then it has to cost money.

It doesn’t have to cost much money. In fact healthcare is best if kept inexpensive. The “free market" cost of healthcare is a huge barrier to most people’s access. But there has to be some barrier. Drop the cost to $0 and you get a tidal wave of people wasting very costly care.

I guarantee that if every person who came to the ER had to pay $2 up front the number of frivolous visits would drop by 80%.


I’m not saying that no rationing will ever be a necessary, but if we insure healthcare has value to everyone rationing care will be the exception rather than the norm.

You want everyone to have healthcare? Never give it away for free!

Okay, Dr. D has managed to piss off both the Left and the Right!

The floor is now open to your comments. Just try and be civil with each other.

Next post Dr. D will studiously avoid politics and return to the regularly-scheduled programing on Doctor-Patient Relationships.

Are Doctors Rich?

(Part of an ongoing series Should I Become A Doctor?)

People rarely ask about income directly, but Doctor D gets a lot of wink-wink nudge-nudge questions about his finances such as,

“So what you drive, doc, a BMW?”

or

“It’s hard making ends meet sometimes, but you wouldn’t know about that, would you doc?”

So to answer your questions Doctor D will throw open the doors to the secret realm of physician personal finance:

"Where'd I get the money? Med School, Bitches!"

Last year Dr. D made about 150,000 dollars, which is a lot of money. (The Medical Mafia makes sure MD's get paid well in exchange for our souls!) Uncle Sam and student loans took a pretty large chunk of that, but still Doctor D has more than every non-medical person he knows, and he is a Primary Care Doctor, which is one of the lowest paying specialties!

Now before you start filling out medical school applications dreaming of big money let me warn you about the downside: You spend about a decade of your life working for free and amass a mountain of debt to get here.

Dropping Out and Adding Up

Everyone considering the financial benefits of medical school should calculate their drop-out sibling equation:

Doctor D has a brother about his age. Brother D was a smart dude, but he never liked school so he dropped out in high school. Brother D immediately started making money working at low-skilled but steady jobs while Dr. D was toiling away at medical education.

Brother D’s lifetime earning was very gradually rising while Dr. D’s debt was increasing, until one day Dr. D started making big bucks. Dr. D and Brother D sat down and did the math problem.

The answer: 41

Doctor D will be 41 years old before his MD catches up with his drop-out brother's GED in lifetime income!

Our paths diverged at about 17 years old. Doctor D is 32 now so he has another 9 years till he’s made as much money in his life as Brother D.

Medical School isn’t exactly the quick way to riches.

But in this economy who can complain about making six figures? Doctors do it all the time, but nobody is listening.

Doctors work hard and we get rewarded. It just isn’t as rewarding as some pre-med students and patients think.

"You know you laidies can't resist!"

By the way, Dr. D drives the cheapest car Toyota makes—it’s the first new car he ever owned.

What do you think?

Pre-meds and Med Students: Did the financial rewards of affect your career choice?

Patients: Do you think income differences between you and your doctor harms your doctor-patient relationship?

Doctors: Are you satisfied with your income? Do you feel you deserve more or less?

Doctor D always loves to read your thoughts in the comments.

Be Cheap!

Cheap Gifts Are Better!

Part 5 of How To Thank A Doctor

Doctor D has been amazed at all the kind things readers have done for their doctors, but D's a bit disturbed by the funds some of you are putting into your gratitude!

Believe it or not, the less money you spend on thanking your doc the better! A doctor is not your niece at Christmas who will only be impressed if the gift put you in debt. In fact, any gift you obviously spent money on is likely to make your MD uncomfortable.

Why?

Reason #1: Lawyers

As I've mentioned before, we doctors live in constant dread of bloodsucking lawyers. A clever lawyer can turn even a friendly gift into a felony, so doctors have all been taught to shun gifts of any value.

A gift worth anything can be legally considered a payment for services. If Doctor D took care of you for free and you give him a gift he loses all of his "Good Samaritan" legal protection and can be sued vigorously. If I accept a gift from someone who already paid through insurance I'm in even more trouble. One of those slippery lawyer-types could point to Doctor D's gift and scream, "Fraud! Kickbacks! Felonies!"

Doctor D likes his job and doesn't want to lose it on a legal technicality, so please keep the gifts worth nothing: a written-in card or some cookies you baked is as valuable as you should go.

Rule of thumb: If your doc could conceivably resell your gift for more than $1 on eBay, don't give it!

Reason #2: Doctors Are Overpaid

Let's face it: physicians aren't hurting for purchasing power.

While the business of keeping a medical practice afloat may be frustrating and getting worse, the actual annual salaries of those of us in medicine are usually much higher than our patients'. Doctor D is in one of the worse paying medical specialties and he still makes almost twice as much as his friends. D isn't getting rich doing this, but he's never going to worry about keeping food on the table.

I also know how much medical care costs: way too much! A serious workup or a chronic illness can bankrupt you. I'm glad you're thankful, but when you bring me an expensive gift after you just paid thousands to be poked, prodded, and embarrassed in the medical meat grinder it just kills me. I don't need things of value. I wish you'd spent the money on yourself, and just written me a heartfelt thank you note.

If you like giving really valuable gifts then give them to teachers or police officers. Those guys sacrifice just as much as doctors to make the world a better place, and the pay they get is just sad.

Listen to Your Inner Cheapskate When You Thank Doctors!

Doctor D tries to politely decline expensive gifts, but it still ends up awkward.

So go cheap: really cheap—don't even worry about paying Hallmark for those fancy cards. The patient gifts that Doctor D treasures most are simple homemade cards, produced with simple paper and pen.

Have you every given or received an expensive gift in a doctor-patient relationship? How did it go? Ever have a gift declined?

What is the coolest "worthless" gift you ever got?

Doctor D always loves to hear your stories in the comments!

The Medical Mafia (Price Fixing in Medicine)

Question for Doctor D:

Why does it cost so much to see a doctor?

Great question! There are lots of good explanations, but Doctor D's gonna give you a revisionist history lesson that will open your mind:

Doctor D's gonna take you way back to the US over a hundred years ago: There were lots of doctors and visiting them was cheap. Doctors made a middle class living and medical schools worked like apprenticeships. Doctors did their best, but they didn't have most of the cool lifesaving stuff doctors have now.

But big change was coming...

New biomedical research was going to alter medical practice forever, and "The Man" saw the opportunity to create a cash cow medical-industrial complex that would swallow the US economy whole. But first The Man had to knock the little guys out of the action...

The newly incorporated American Medical Mafia Association made its move, hiring the intellectual hitman Abraham Flexner to execute their takeover.

That shady Mr. Flexner visited every medical school in the country. He knew exactly how to break the legs of the competition: Science.

The Flexner Report: An offer you can't refuse.

Medical science was bringing wonderful new knowledge into medicine, but in 1910 Flexner demanded that every doctor should be a scientist too. Every doctor must do years and years of basic science training before ever caring for patients. Flexner also recommended in his report that every medical school that wasn't associated with biomedical university research should be destroyed!

The mafia power play worked. The Flexner Report was hugely influential. The American Medical Mafia Association was given control over every medical school in the country. Don Flexner sent almost half the medical schools to "sleep with the fishes." With the little medical schools out of the way, the mafia now had complete control of who got to be doctors.

New Doctors: Nothing personal. It's just business.

The personable old "doc" of the past was replaced with the new scientific physician who knew more about organic chemistry than human interaction. New student doctors were taught to approach their patients with the cold objectivity of a scientist watching an experiment.

With the warmth and kindness of the doctor-patient relationship gone the study-weary doctors had no one to identify with but each other. Doctors became less a part of their communities and more a society unto themselves—making them easier for the medical mafia to control.

With total control the medical mafia cut supply to increase demand. With fewer doctors the price of a visit skyrocketed. Even doctors who might want to work for cheaper couldn't because of the massive debt from their new med-science education.

It's All About Control

The medical mafia keeps a tight stranglehold on medical schools. This country's population has gone way up in the last 100 years, but the medical mafia has been keeping a tight lid on the number of doctors. You might think with the current doctor shortage they would be begging every smart young person to go into medicine. Nope!

You want to be a doctor? You have to get excellent grades in lots of brutal courses, do a bunch of work on cells in a laboratory, be the president of some student organization, study like mad for the MCAT although it has nothing to do with medical practice, and promise them a decade out of the prime your life. Even still they're likely to say "No!" Every year thousands of bright students are refused entry to medical school even though they would make excellent doctors.

Why?

Refusal gives them power. It makes the ones that do get into the club special, powerful, and always in demand. With a stranglehold on the doctoring business the Medical Mafia has its fingers in every clinic and hospital in the country.

Ever wonder why the United States has to import doctors who barely speak English? Now you know. It's the only way to circumvent the Mafia's blockade on doctor supply.

But couldn't we just train more American doctors, shorten the length of medical education and lower its costs, and allow medical visits to be affordable and doctors to return to the middle class? You think The Man would let us get away with that? Forgetaboutit!

Abraham Flexner
"Kiss the ring, bitches!"

So next time you or your insurance shell out $600 for a visit to a specialist remember the Medical Mafia and Abraham Flexner. Don Flexner has been dead fifty years, but trust me he still owns us little guys.

Show some respect! The Medical Mafia is just taking your money for your own protection!

So what do you think? Most of medicine still sees Abraham Flexner as a hero. Doctor D's story may be silly, but most of the facts are true. How do we undo 100 years of history? How do we recreate quality medical care that doesn't bankrupt the country?

Doctor D looks forward to your ideas and observations in the comments.

Why Not Call? (Exhaustion and Economics of Phone Calls)

A reader writes:

Why do I have to take time off of work and make an appointment for my doctor to explain test results? Wouldn't it be much easier to do over the telephone?

It would be easier to discuss this over the phone, and cheaper. Your doctor isn't paid for talking to you over the phone. Getting info over the phone is always a win for patients and a loss for doctors.

Primary Care Doctors (like Doctor D) for whom much of the job is educating you about your health are making a less and less every year (we're the green line) and we started out as the lowest paid physicians. Primary Care clinics are just barely scraping by, so when it comes to discussing your labs they can either do it over the phone for free, taking time away from seeing patients, or bring you in and get paid by your insurance to have the same discussion. The economic solution usually beats the common sense solution.

Now, I don't want this to sound like one of those Happy Hospitalist I-don't-get-reimbursed-for-all-I-do posts. Primary Care is still a good job and Doctor D doesn't have to worry about keeping food on the table.

But when Doctor D worked at Crayzee Clinic he spent many hours every day getting patients results, refills, and forms without pay. He did his best to call patients when he could, but if he knew it was going to be a long talk he usually had you come to the office. Doctor D had to keep some work during office hours—as it was he barely saw his wife or son while working primary care. Of course, some docs avoid phone calls because of greed, but most in primary care are just exhausted having to see more patients faster and faster while doing more paperwork in the evenings. An appointment to follow up tests was usually pleasant and easy, and didn't keep Doctor D in the office later at night after office hours.

But for the patient, it sucks! You have to get off work and drive to the doctor's office, just to get information you could have gotten over the phone. You can and should ask if your doc can call you the results without an appointment. Your heathcare is already too costly without extra visits. But please realize that this is harder on you doc, so don't abuse it. If you are the sort that needs to ask lots of follow up questions please schedule a visit instead of tying up your doc on the phone for 20 minutes!

Okay, after a long blog post about money and reimbursement Doctor D feels dirty and must go bathe the Happyishness off of himself.

This is one of those annoying situations that forces either you or your doc into a financially frustrating situation. The solution proposed on most doctor blogs is billing for phone calls.

What do you think? Would you be comfortable being billed for phone calls? It would save you costlier office visits. Or do you want to keep phone contact free?

Should I Get A Medical Alert Bracelet? (Upselling Healthcare)

A question from WarmSocks:

When should someone wear a medical alert bracelet? Nobody has ever recommended that I should consider it, but my med list seems awfully long so I'm wondering if it would be appropriate?

The purpose of the alert bracelet is two-fold:

1. To provide vital information in an anticipated emergency.
2. To make money off of people with illnesses.

Should I wear a bracelet? Do you have a condition likely to cause you to be found unconscious, and have something about you that would make your care different than the average unconscious person? You should probably carry a brief list of your medical conditions and medicines, but most of those things don't require a bracelet.

These bracelets are marketed to people with things like insulin-dependent diabetes or heart rhythm problems. The bracelet basically says, "This is likely the reason I'm unconscious and this is what to do!" I've seen a lot of diabetics and heart patients with such bracelets, but I've never seen these bracelets make much difference. Paramedics always check blood sugar and heart rhythm as soon as they find you in such situations, so in my experience people with and without these bracelets get about the same care.

The best reason I can see for a bracelet is a rare condition that rescuers aren't going to be thinking about. Diabetics need not worry—we check a sugar on everybody that's unconscious, bracelet or not. (Other reasonable situations to have a bracelet would include: severe anaphylactic reactions to medicines or if you don't want to be resuscitated if your heart stops. )

The second reason for bracelets is to stimulate the economy. The healthcare industry is massive and you—the patient—are the cash cow. If you stop consuming all the medical accessories and extras then the Healthcare economy might shrink! Proven, effective care can be a narrow margin business, but all the physical and pharmaceutical accessories that you see marketed keep the Healthcare Business healthy even in lean times.

If you call a bracelet company they will say that your daily aspirin or history of ankle sprains should definitely qualify you for a bracelet. "Let's bill your insurance, and for a bit more you can get a stylish 14 K gold band for it!"

Your doc should be able to tell you if your condition really needs a bracelet or not.

But be careful if you doc is offering bracelets or any other "value added" products in their office for your convenience! With Primary Care profit margins razor thin, a lot of doctors are going over to the darkside and letting corporations talk them into adding "secondary income streams" to their practice. If your doctor is selling something (bracelets, supplements, skin rejuvenation, etc.) other than medical care you should run the other direction. Your doctor should be an advocate for you, not the spokesperson for some product line.

Is Doctor D may be alone in his righteous anger about MDs who sell extras in their practices? D was highly offended when Little D's doctor was selling vitamin products at the clinic. Mrs. D told Doc D to quit being a pinko Commie and accept that capitalism works this way. Do you mind if your doctor makes extra by selling products?