And it might be a little... over emotional. Yeah, sorry.
As these things often do, this ball of bile built up from a Facebook discussion on socialized medicine .... oops, I mean Universal Health Care. They're different. Really. No, really. Hey, look, a bird.]
Well, sure... we should totally regulate medicine. It's just a bunch of money grubbing, Porsche driving bastards that hold us hostage for our own health and close their office 2 days a week so we can pay them to play golf. Socialize the bastards...
...not so fast there, Bub. This seems to be the general consensus. But -- as someone that grew up in a doctor's house, if you feel this way, you might just be... wrong. And I don't mean a little wrong.
Let me give you a character sketch of the guy in the white coat. You probably see him one time for 15 minutes... and you're already crabby because the magazines in the lobby are 14 months old and are were not a subject matter that is in the least bit interesting. You're sitting there naked under a rustly paper smock and you aren't feeling good in the first place or you wouldn't be here. So let's meet Dr. Joe Average, shall we?
A doctor is the ultimate small businessman. He's like an electrician or a plumber -- except maybe not quite as wealthy. He runs a very small business. In the old days it was just Dr. Average and one sidekick that played the role of receptionist, secretary, nurse and billing department. Now with the complexities of insurance, government rules, FDA, HIPAA, Medicare, Medicaid.... Now it's more likely that the small business has dedicated salaried positions for each of those roles. It's just more complicated.... Not the actual healing part, but the business of healing. And unfortunately that adds tremendously to the cost of health care. But I am sure some sort of Presidential edict or some nice Congressional reform will somehow regulate the business in a way that will allow those 4 positions to go away to reduce costs, right? Or maybe the reform is part of that "job creation" we are always hearing about and we'll get 4 more dedicated resources.
...But we're getting ahead of ourselves. If you want to know Dr. Average, you'll need to go back a ways. Like many of us, Dr. Average went to college. You know all those science courses you hated and bitched about? You remember changing your major just so you didn't have to take so many? Well, Dr. Average had to take lots of them. They were hard. Some so hard that he barely squeaked by... but he squeaked. Those that didn't were weeded out, which was the intent. Following that, he applied to medical school, which is damned hard to get into. He did 4 years there, working some on the side to try to cash flow the whole operation. Next was a year as an intern. He then applies for a residency program where he spends 3 years specializing in surgery. Note that each of these steps is a weed out... and not everyone makes it. People wash out at every step of the way.
During much of that training, he is technically a doctor, but not paid like one. He is paid $25 a month -- yes, per month. For that paltry sum, he works 36 hours on and 12 hours off -- with most weeks being 100+ hour weeks. He is a proud guy and totally against any such nonsense as government sponsored public housing.... Yet, unfortunately that's the only place he can afford to live. Gunshots outside were a regular occurrence. You learn the only way to safely dry clothes is to hang them up inside -- otherwise they'll just get stolen.
Once the hell of the training is over, real doctoring begins... and to be honest, the schedule is pretty similar. A normal week is probably 70 hours. A rough week is 80-100. There is no such thing as night and day. Things happen. The phone rings. He goes. Weekends... well he might get every other one off if he's lucky. But 7 day weeks are pretty normal. People will laugh and poke fun and talk about how his office is closed on Thursdays so he can play golf. But Dr. Average never corrects them. The office is closed so he can schedule surgeries starting at 6 am and lasting until well after his supper is cold.
And lets not forget Emergency Room on call rotation. This is in addition to his regular patients, who pretty much feel they can call him any time of the day or night and he will cheerfully help them. ER on call is another level of hell... another layer of hours that come at odd times and interrupt an already filled schedule. And while we're on the topic of ER on call, I'd like you to think back to all those child rearing memories... to all those family gathering times: Christmas, New Years, Thanksgiving, Easter, 4th of July. There will be none of those memories for Dr. Average. For the first 20 years of his career he will almost always find himself holding the on call pager during traditional holidays. In fact, this is the supreme sacrifice Dr. A faces. Many of these interruptions are normal everyday folks that are super grateful for his work, but they are just as likely to be drunks, prison inmates, wife beaters and drug addicts. But it doesn't really matter if they are a drug addict or the mayor -- they all trump the holiday.
Due to the life and death nature of his work, he never gets the time he wants with his wife and kids. And by the time he has enough seniority to pull a few strings and try to spend the time, the kids will invariably be sullen, snotty, difficult teenagers that don't appreciate him. And he'll just smile and swallow it. They'll be in their mid 20s before they realize what a heroic, hard working, honest man he really is.
On the odd night, he will finally get time away from his super stressful work. Most of us would vegetate in front of a television. But Dr. Average will go and sit in a big overstuffed yellow chair and worry and fret and contemplate on every patient he has in his little black book and when he's done with that he will beat himself up for every patient he couldn't help. Sure, he comes across as sort of quiet and stern, but when no one is looking he sheds tears for those losses, too.
Government sponsored Medicaid for the indigent? Dr. A. really doesn't need that. He gets lots of patients that can't pay at all or maybe just can't pay the full price. He just lets them pay what they can... or nothing at all. Some of them bring him produce or meat they grow themselves. And the bill is marked as paid because that's just the right thing to do. Making people better is a passion. He'd do it for free. Getting paid is just a nice benefit when it works out. This sort of stupid, silly, backwards way of thinking will eventually be impossible. Between tax laws and Medicare and Medicaid and various regulations too numerous to list, this sort of "Just fix them" attitude will become a thing of the past. In fact, at some point folks will start telling him exactly what he can charge for each and every procedure. His desire to fix folks that just can't afford it will prompt him to take trips to places with awful conditions in Africa and Central/South America. Here folks will walk an entire day for his treatment and pay him with nothing but a smile -- a payment he is more than willing to accept.
In fact, government regulation will turn that one man/one jack-of-all-trades secretary shop into a huge paperwork factory that requires 2 additional workers to handle. And the current over-litigious society we live in doesn't mean he possibly will be sued. It means he most probably will be sued some day. You see: people die. Some people die no matter what you do. There might be 5 right choices for treating someone... and all 5 might still not fix them. It's just how it is. We are mortal. And some folks just won't understand that. The real cost of this is that no hospital is going to let Dr. Average walk in their super secret doctors-only back door unless he is fully insured. And that insurance will cost him more than $100,000 a year. Don't you bitch and moan to me that you cannot afford $1000 a month for health insurance. That guy that's treating you is paying 100 times that amount of money just for the right to treat you.
Sure, you see some stereotypical doctor driving a red Ferrari and living in a 42 room villa. And you think "He's gotten rich off of my ills." But I really don't think so. You'd be awfully surprised at just how little he's making after expenses:
- office space rent in probably one of the higher cost parts of town
- salaries and benefits for all the office staff
- equipment for the office
- malpractice insurance and various and sundry legal fees
So now, there you sit in your crinkly paper gown, hating this rich son of a bitch for making money off your sickness. You want to regulate his life some more. You want to stick it to him and those awful insurance companies. And I'm here to tell you the saddest news of all: He'll let you. He'll let you because unlike you or I, he doesn't have a job. He has a passion. He can't NOT do what he does. Doctoring is what he is. It's his identity. It's the reason he wakes up in the morning. He'd do it for free and he'd do it for a loss.
This is the guy you want to enslave.
- Seriously. You should read The Millionaire Next Door. The author was interviewing the wealthiest folk in America. He expected a bunch of slick doctors, lawyers and investment bankers... and found out the average millionaire was an average Joe that lived within his means.
- Oh, sure, you'll say "but that was back then... there's been a whole lot of inflation." Okay, if you do the math then that's $200 a month or $0.50/hour in present dollars. You live on that!
- People will argue that this is lunacy. Why would we want them sleep deprived? Well, because they need to figure out that this is how they are going to live for the next 20 years. Sure you can say "just hire more doctors" but if you turn around and bitch about the cost of health care, I'll punch you in the crotch.
- If you live in a 3 million dollar house with 100% mortgage your net worth in this venture is still zero.