Physician, devalue thyself

A physician named Jean A. Schoonover writes in today's Washington Post about the hardships faced by doctors trying to recover from debt incurred during training, calling it "Devaluation of the Doctor". After describing her and her husband's (who is also a physician) financial situation, she seeks an answer for the cause of her circumstances.

Something is wrong with our nation's outlook on health care these days. I have come to name this phenomenon the "Devaluation of the Doctor." As I hear grumbling about Congress's making more Medicare cuts and my patients' complaints about $10 co-payments while they dig $300 cell phones out of their Gucci bags, I am getting just the slightest bit bitter. Somewhere along the way, as we sat back and let insurance companies turn caring for the sick into an industry, we lost sight of the importance of medical care and those individuals who sacrifice their entire twenties to learn how to save lives and keep us healthy. HMOs have bred a population more interested in paying for a cellular phone plan than a physical. It saddens me to meet a new patient who is "transferring his care" to me (after sticking loyally to the same doctor for 40 years) just because "Doc So-and-So stopped taking Mamsi."

In other words, she places the blame on insurance companies for making her patients value their cellphones and Gucci bags more than her services, and for causing her salary to be less than she desires.

From the Austrian perspective, she is wrong in her notion of economic value.

She espouses the Labor Theory of Value, believing that her "training [consisting] of four years of college, four years of medical school and four years of residency" somehow entitles her to a wage higher than she is receiving. However, value is subjectively defined on an individual basis, in terms of how the good in question satisfies desire at the margin. A person could spend his whole life making a foozle, but if nobody wants the foozle, he will not be able to exchange the foozle for very much. Too bad the Labor Theory of Value did not die with its main advocate Karl Marx.

There is no collective 'we' appraising the services of physicians. It is an individual decision. Some individuals value the services of physicians more than other individuals do.

She deplores turning "caring for the sick into an industry". One might imagine a time hundreds of years ago, when a royal farmer similarly complained about the industrial revolution turning "feeding humanity into an industry." If he had his way, the gourmet pizza I had for dinner on Saturday probably would not have cost the equivalent of one hour's labor at minimum wage. I hope caring for the sick does become an industry. The more industrious the better.

To conclude, she makes the mistake of believing that education is an objective good.

It's a rainy day, and the neighborhood kids aren't playing basketball as usual. If they were, I'd be tempted to open the front door and holler to them, "You go, boys! Forget about algebra and focus on your three-pointer." After all, what have my hard-earned straight A's and Honor Society tassels gotten me but a fear of foreclosure?

I would holler to them, "You go, boys! Have fun while you're still young, and remember that no matter what your teachers tell you, education is only as economically valuable as it serves to meet others' desires. Therefore, make education a lifelong process and constantly adapt yourselves and learn to anticipate new skills that might be in demand. Otherwise you'll end up like the nerds who can't pay off their loans but think that they 'deserve' better from society."

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On the flip side of the

On the flip side of the coin, she has a valid complaint. Seems some people believe it is their right to receive her skills for nothing. The key phrase being As I hear grumbling about Congress's making more Medicare cuts...

Health care is not properly on the market where it really should be.

On the flip side of the

On the flip side of the coin, she has a valid complaint. Seems some people believe it is their right to receive her skills for nothing. The key phrase being As I hear grumbling about Congress's making more Medicare cuts...

Health care is not properly on the market where it really should be.

Truedat. But, she blames the insurance companies for this, not those who feel entitled to her skills for nothing.

Insurance companies are in

Insurance companies are in bed with the government getting what are effectively price controls on health care. There is plenty of blame to go around about health care in the U.S.

Insurance companies are in

Insurance companies are in bed with the government getting what are effectively price controls on health care. There is plenty of blame to go around about health care in the U.S.

No doubt, no doubt. However, I don't think you would hear her make that argument. To her, insurance companies are to blame not because they are in bed with the govt, but because of their very nature as part of an 'industry'.

I'm afraid you are right

I'm afraid you are right about that.

Health care is absolutely

Health care is absolutely not a free-market, and is entirely exempt from the forces of capitalism espoused in the U.S. and many (but not all) Western nations. I agree with the writer who noted that the insurance industry (collectively) and the US federal government are in bed together -- explicitly, insurance sets their reimbursements tied to Medicare reimbursement for the same product, delineated by a combination of ICD-9 and CPT codes (for diagnosis and service, respectively). Medicine is the only industry in which reimbursements for the exact same services decline on average between 2 and 5% per year. I certainly don't see mortgage prices, automobile prices, nor food prices declining. The only way for a physician, regardless of specialty, to escape the slavery of insurance and government-dictated reimbursement is to go "bare", i.e. not accept insurance or Medicare nor Medicaid. There is no other industry in which it is acceptable to pay 25-30% of the bill. I *WISH* I could walk up to my auto dealer, the bank that wrote my mortgage, or the grocery store and say, "know what? I think that you're overcharging. I'll give you 30 cents on the dollar for your product." THEN the situation would truly be equitable.

I recommend closing all the med schools for five years, and abolishing insurance companies and state and federal medical assistance. Let the market truly play out, unfettered. I would then have no problem doing my 10% 'pro bono' for the uninsured.