At my regular check-up yesterday, I carried on my usual “how are things” conversation with my doctor of over 15 years. He asks about my mom, I ask about his kids. Over the years, we have developed a decent rapport for two people who see each other for about 15 minutes a year.
On the whole, my doctor is a jovial guy. He’s smart, personable, wears a bow tie. Yup, he’s that guy. Gray hair, distinguished, smiley bow tie guy.
But this year, our usual five minute catch up took a turn. After my examination, he told me, as always, to meet me in his office to go over any issues I might be having. I waited in the chair across from his desk. But, when he entered the room, instead of sitting at his own chair, he plopped down in the second visitor’s chair next to me, slumped down in it, turned his distinguished gray head and said “I’m gonna get a job driving a cab.” Perhaps responding to my shocked expression, he continued “It would just be easier.”
This is the state of our health care system. It’s so screwed up that even happy bow tie guy cannot find the bright side.
I probed him, asking what did he feel the big problems were. He said he was sick of hearing that the US health care system is second rate. He is completely certain we still have the best care in the world. The problem is that the system does not allow doctors to do their job. The issue he was focused on is generic prescription drugs. According to him, generic drugs can vary up to 20% from the name brand in terms of dosage of the active ingredient. This makes it nearly impossible for a doctor to know how a patient is responding to a drug and how to adjust their dosage accordingly. He said, “I don’t care what Obama says – generic drugs are not the same!”
There are so many sides to this issue – the consumers, the pharmaceutical companies, the insurance companies and, of course, the health care providers. We all think we know where the evil is coming from – the profit-driven players: insurance and pharmaceutical companies. And yes, they are evil, BUT, the profit motive is what keeps these companies in business. The profit motive fuels jobs, research and development, advertising and marketing and the billions of dollars they contribute to the economy as a whole. This is not something that can be converted to a not-for-profit, government-run model completely. The profit motive is what makes American health care among the best in the world. Any plan with a chance of being successful must keep this profit motive in tact.
The challenge will be to find the balance – how do we allow these companies to stay profitable AND provide fair and appropriate care to American citizens?
A very good friend of mine is a doctor at Columbia Presbyterian Hospital in New York City. She graduated from Harvard and got her medical degree at Columbia. She is probably the smartest person I know. A few years ago, she called me to see if I could introduce her to a journalist friend of mine because she was thinking of switching careers. I couldn’t believe it because she had wanted to be a doctor since high school. I asked her what was behind her decision and she said, “I’m a fellow at Columbia Presbyterian and I make the same money as my husband’s executive assistant”.
Now, that’s a wake up call. Of course, this was a few years ago. You know, those years where the financial services industry was rewarding itself (and its executive assistants) to the tune of all the money in the world, which is now lost, due to the fact that it never actually existed. So, yes, this executive assistant was paid a much larger sum than your average executive assistant, but still, it seems a stretch that there would be any economy where this would be the same as a surgical fellow at a major hospital.
My friend decided to stay a doctor because she’s a good doctor and it’s what she wants to do. But to ignore that compensation factors into all of our decisions, is naive and unnecessary. There are other countries who do not have as robust a commitment to the free market economy as America claims to have. I think the reason Obama is coming under so much fire from his own constituency is because he is representing what is essentially a conservative-style commitment to this ideal. What I like about his spin on it, is that he is saying “Listen, profit motive is good, evil people who cheat and take advantage of it (like our friends at Pfizer) are evil.” This is exactly the same issue with the financial services industry – there’s nothing inherently wrong with the development of new financial products, but there is something wrong with corrupting, polluting, cheating, and over-leveraging them for short term gain at the expense of the long term financial health of the entire world!
The fact remains that we need the free market (FREE market, the real kind of free, not the kind of free that’s sort of free except for when it favors people who happen to have influence in Washington) to be involved in our health system. When the best and brightest in a given profession are not appropriately rewarded, they will not stay. Why should my friend, after years of busting her butt to graduate from the top universities to be a doctor at one of the top hospitals, make the same amount as someone who provides admin support? Why should my doctor, after years of providing health care, in one of the wealthiest areas of the country, feel that he would be happier driving a cab?
This health care issue is deep and complex. It affects you personally no matter what. Tune in – listen to Obama’s speech and develop your own opinion. Think about your own situation and what health care system would work best for you. Think about the free market economy and how it should intersect with insurance and health care. The time is now and we all need to be engaged in an actual, substantive debate.
And though I’m sure my doctor would make a great cab driver, I think he’s pretty useful right where he is.
