The Truth Will Set Us FREE!

March 6, 2010
Thomas Sowell

Getting Out of Medicine

We can burden doctors with red-tape hassles, but we can’t make doctors put up with them.

Some years ago, one of my favorite doctors retired. On my last visit to his office, he took some time to explain to me why he was retiring early and in good health.

Being a doctor was becoming more of a hassle as the years went by, he said, and also less fulfilling. It was becoming more of a hassle because of the increasing paperwork, and it was less fulfilling because of the way patients came to him.

He was currently being asked to Xerox lots of records from his files, in order to be reimbursed for another patient he was treating. He said it just wasn’t worth it. Whoever was paying — it might have been an insurance company or the government — would either pay him or not, he said, but he wasn’t going to jump through all those hoops.

My doctor said that doctor-patient relationships were not the same as they had been when he entered the profession. Back then, people came to him because someone had recommended him to them, but now increasing numbers of people were sent to him because they had some group insurance plan that included his group.

He said that the mutual confidence that was part of the doctor-patient relationship was not the same with people who came to his office only because his name was on some list of eligible physicians.

The loss of one doctor — even a very good doctor — may not seem very important in the grand scheme of heady medical-care “reform” and glittering phrases about “universal health care.” But making the medical profession more of a hassle for doctors risks losing more doctors, while increasing the demand for treatment.

A study published in the November 2009 issue of The Journal of Law & Economics showed that a rise in the cost of medical-liability insurance led to more reductions of hours of medical service supplied by older doctors than among younger doctors.

Younger doctors, more recently out of medical school and often with huge debts to pay off for the cost of that expensive training, may have no choice but to continue working as hard as possible to try to recoup that huge investment of money and time.

Younger doctors will probably continue working, even if bureaucrats load them down with increasing amounts of paperwork and the government continues to lower reimbursements for Medicare, Medicaid, and — heaven help us — the new proposed “universal health care” legislation that is supposed to “bring down the cost of medical care.”

The confusion between lowering costs and refusing to pay the costs can have a real impact on the supply of doctors. The real costs of medical care include both the financial conditions and the working conditions that will ensure a continuing supply of both the quantity and the quality of doctors required to maintain medical-care standards for a growing number of patients.

Although younger doctors may be trapped in a profession that some of them might not have entered if they had known in advance what all its pluses and minuses would turn out to be, there are two other important groups that are in a position to decide whether or not it is worth it.

Those who are old enough to have paid off their medical-school debts long ago, and successful enough that they can afford to retire early or to take jobs as medical consultants, can opt out of the whole elaborate third-party payment system and its problems. What the rising costs of medical-liability insurance have already done for some, the hassles that bureaucracies and politicians create can do for others.

There is another group that doesn’t have to put up with these hassles. These are young people who have reached the stage in their lives when they are choosing which profession to enter, and weighing the pluses and minuses before making their decisions.

Some of these young people might prefer becoming a doctor, other things being equal. But the heady schemes of government-controlled medicine, and the ever more bloated bureaucracies that these heady schemes will require, can make it very unlikely that other things will be equal in the medical profession.

Paying doctors less and hassling them more may be some people’s idea of “lowering the cost of medical care,” but it is really just refusing to pay the costs — and taking the consequences.

— Thomas Sowell is a senior fellow at the Hoover Institution. © 2010 Creators Syndicate, Inc.

Ruth Bader Ginsburg and a Question of Eugenics

Does Ginsburg see eugenic culling as a compelling state interest?

By Jonah Goldberg
July 15, 2009

Here’s what Supreme Court Justice Ruth Bader Ginsburg said in Sunday’s New York Times Magazine: “Frankly I had thought that at the time [Roe v. Wade] was decided,” Ginsburg told her interviewer, Emily Bazelon, “there was concern about population growth and particularly growth in populations that we don’t want to have too many of.”

The comment, which bizarrely elicited no follow-up from Bazelon or any further coverage from the New York Times — or any other major news outlet — was in the context of Medicaid funding for abortion. Ginsburg was surprised when the Supreme Court in 1980 barred taxpayer support for abortions for poor women. After all, if poverty partly described the population you had “too many of,” you would want to subsidize it in order to expedite the reduction of unwanted populations.

Left unclear is whether Ginsburg endorses the eugenic motivation she ascribed to the passage of Roe v. Wade or whether she was merely objectively describing it. One senses that if Antonin Scalia had offered such a comment, a Times interviewer would have sought more clarity, particularly on the racial characteristics of these supposedly unwanted populations.

Regardless, Ginsburg’s certainly right that abortion has deep roots in the historic effort to “weed out” undesired groups. For instance, Margaret Sanger, the revered feminist and founder of Planned Parenthood, was a racist eugenicist of the first order. Even more perplexing: She’s become a champion of “reproductive freedom” even though she proposed a “Code to Stop Overproduction of Children,” under which “no woman shall have a legal right to bear a child without a permit.” (Poor blacks would have had a particularly hard time getting such licenses from Sanger.)

If Ginsburg does see eugenic culling as a compelling state interest, she’d be in fine company on the court. Oliver Wendell Holmes was a passionate believer in such things. In 1915, Holmes wrote in the Illinois Law Review that the “starting point for an ideal for the law” should be the “coordinated human effort . . . to build a race.”

In 1927, he wrote a letter to his friend, Harold Laski, telling him, “I . . . delivered an opinion upholding the constitutionality of a state law for sterilizing imbeciles the other day — and felt that I was getting near the first principle of real reform.” That was the year he wrote the majority opinion in Buck v. Bell (joined by Louis Brandeis) holding that forcibly sterilizing lower-class women was constitutional. In recent years, openly discussing the notion of eugenic aspects of abortion has become taboo. But as Ginsburg’s comments suggest, the taboo hasn’t eliminated the idea; it’s merely sent it underground.

To be sure, some heterodox liberals speak up. The writer Nicholas von Hoffman has written: “Free, cheap abortion is a policy of social defense. To save ourselves from being murdered in our beds and raped on the streets, we should do everything possible to encourage pregnant women who don’t want the baby and will not take care of it to get rid of the thing before it turns into a monster.”

In 1992, Ron Weddington, co-counsel in the Roe v. Wade case, wrote a letter to President-elect Clinton, imploring him to rush RU-486 — a.k.a. “the abortion pill” — to market as quickly as possible.

“(Y)ou can start immediately to eliminate the barely educated, unhealthy and poor segment of our country,” Weddington insisted. All the president had to do was make abortion cheap and easy for the populations we don’t want. “It’s what we all know is true, but we only whisper it. . . . Think of all the poverty, crime and misery . . . and then add 30 million unwanted babies to the scenario. We lost a lot of ground during the Reagan-Bush religious orgy. We don’t have a lot of time left.”

Weddington offered a clue about who, in particular, he had in mind: “For every Jesse Jackson who has fought his way out of the poverty of a large family, there are millions mired in poverty, drugs and crime.” Ah, right. Jesse Jackson. Got it.

Unlike Bazelon, I for one would like to know whether Ginsburg believes there were — or are — some populations in need of shrinking through abortion and whether she thinks such considerations have any place at the Supreme Court.

And while we’re at it, it would be interesting to know what Supreme Court nominee Sonia Sotomayor thinks about such things.