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.

Believers in Obama . . .

Thomas Sowell
Monday, October 20, 2008

Telling a friend that the love of his life is a phony and dangerous is not likely to get him to change his mind. But it may cost you a friend.

It is much the same story with true believers in Barack Obama. They have made up their minds and not only don't want to be confused by the facts, they resent being told the facts.

An e-mail from a reader mentioned trying to tell his sister why he was voting against Obama but, when he tried to argue some facts, she cut him short: "You don't like him and I do!" she said. End of discussion.

When one thinks of all the men who have put their lives on the line in battle to defend and preserve this country, it is especially painful to think that there are people living in the safety and comfort of civilian life who cannot be bothered to find out the facts about candidates before voting to put the fate of this nation, and of generations yet to come, in the hands of someone chosen because they like his words or style.

Of the four people running for President and Vice President on the Republican and Democratic tickets, the one we know the least about is the one leading in the polls-- Barack Obama.

Some of Senator Obama's most fervent supporters could not tell you what he has actually done on such issues as crime, education, or financial institutions like Fannie Mae and Freddie Mac, much less what he plans to do to stop Iran from becoming a nuclear nation supplying nuclear weapons to the international terrorist networks that it has supplied with other weapons.

The magic word "change" makes specifics unnecessary. If things are going bad, some think that what is needed is blank-check "change."

But history shows any number of countries in crises worse than ours, where "change" turned problems into catastrophes.

In czarist Russia, for example, the economy was worse than ours is today and the First World War was going far worse for the Russians than anything we have faced in Iraq. Moreover, Russians had nothing like the rights of Americans today. So they went for "change."

That "change" brought on a totalitarian regime that made the czars' despotism look like child's play. The Communists killed more people in one year than the czars killed in more than 90 years, not counting the millions who died in a government-created famine in the 1930s.

Other despotic regimes in China, Cuba, and Iran were similarly replaced by people who promised "change" that turned out to be even worse than what went before.

Yet many today seem to assume that if things are bad, "change" will make them better. Specifics don't interest them nearly as much as inspiring rhetoric and a confident style. But many 20th century leaders with inspiring rhetoric and great self-confidence led their followers or their countries into utter disasters.

These ranged from Jim Jones who led hundreds to their deaths in Jonestown to Hitler and Mao who led millions to their deaths.

What specifics do we know about Barack Obama's track record that might give us some clue as to what kinds of "changes" to expect if he is elected?

We know that he opposed the practice of putting violent young felons on trial as adults. We know that he was against a law forbidding physicians to kill a baby that was born alive despite an attempt to abort it.

We know that Obama opposed attempts to put stricter regulations on Fannie Mae-- and that he was the second largest recipient of campaign contributions from Fannie Mae. We know that this very year his campaign sought the advice of disgraced former Fannie Mae CEO Franklin Raines.

Fannie Mae and Raines were at the heart of "the mess in Washington" that Barack Obama claims he is going to clean up under the banner of "change."

The public has been told very little about what this man with the wonderful rhetoric has actually done. What we know is enough to make us wonder about what we don't know. Or it ought to. For the true believers-- which includes many in the media-- it is just a question of whether you like him or not.