Friday, June 08, 2007

How Good Doctors Can Hurt Our Collective Health

I promise that I'll eventually get back to my posts on economics and medical school, but my thoughts have been elsewhere lately.

INTRODUCTION

Even though we've had some bad press in the last couple of decades, those of us in the "caring professions" still enjoy a degree of respect that is often not afforded to those who pursue other careers. Doctors still have more knowledge and understanding about the human body than most people could ever dream of having, and an ever shrinking (but still large majority) of patients still understand that. In fact, physicians opinions have always been considered in many facets of social policy, even those in which a profound understanding of the human body isn't remotely helpful.

Doctors may collectively be the most ignorant group of professionals in the history of existance when it comes to money. On a personal level, the number of physicians who manage to pull in incomes that rival executives at large corporations and still end up broke is astonishing. Almost all of us who spend any time around doctors know of someone who managed to big house, exotic vacation, and expensive car his six figure income into bankruptcy. Much like the other group of people who consistently show financial incompetency (those in congress), physicians have historically been involved in numerous pushes for change in social policy. There is often a significant and ignored financial component to these things as well.

THE BENEFIT OF WEALTH

So you might ask, "how does financial ignorance hurt our collective health?" It's a fair question,and one which requires some explanation. I am the first to admit that most doctors who promote changes in social policy have done so with the best of intentions. This makes the damage all the more sinister, because those involved don't understand that it is being done.

Consistently, the number one indicator associated with health is wealth. Individuals with greater access to financial resources live longer. This has been demonstrated in so many studies, that I don't even know where to begin. Yes, some indicators in the form of race and gender play a role, but socioeconomic status is still consistently associated with better outcomes within these subgroups. Interestingly, this tends to hold true regardless of differences in insurance, neighborhood, or healthcare provider. In general, this may just be the benefit of consistently having good food, shelter, and the ability to go about one's business without constantly fearing bankruptcy. It may be because people with more money also tend to have a better education, which may translate into better decision making.

Regardless of the reason, it is hard to argue with those facts.

IGNORANCE AND ADVOCACY

So we've made two very important points:

#1: Health is strongly correlated with wealth
#2: Doctors know painfully little about wealth.

This brings us to another important point:

Doctors who fail to understand wealth may infact hurt health.

Ever since the end of the second world war, people got it into their heads that physicians should be politicians. Far from the sacred doctor-patient relationship of a one-on-one partnership espoused in the Hippocratic Oath (yeah, yeah, along with all of the garbage in the oath), we've graduated to the Code of Geneva, in which physicians who don't know anything about politics, money, or social policy are responsible for and expected to be involved in expensive social policy. In fact, it would be a bit unwise to even apply to medical school if you didn't think you could pretend that your actual job of being a doctor should come second to the "demands of society" or some other philosophy in which the physician becomes all knowing guru who can seemlessly weigh the cost and benefit of a treatment for his patient against the needs of society and bring the whole world into Nirvana.

The problem is that doctors, along with everyone else, don't actually know how to do this. On a large scale, economists and the "great leaders of state" have consistently failed to create effective controlled economies. There is really no reason to believe that physicians, who are among the most financially ignorant members of society, would do a better job of perfectly balancing everyone's needs than any of these entities.

SAVING A PATIENT AND LOSING A FAMILY

After it's initial opposition to the creation of Medicare and Medicaid, the AMA and the government organizations have become strange bedfellows, with many doctors becoming reliant on the entities for income. This kind of relationship exists in an even more convoluted fashion when it comes to physicians, local hospitals, and government funding for those hospitals. Regardless of the arrangement, it is clear that many physicians are deriving a good proportion of their income directly or indirectly through tax dollars. Thus, the treatment of a patient by a physician now often correlates to a direct financial loss on the part of an unrelated taxpayer. A loss that the majority of physicians providing the treatment fail to understand.

A simple example here in Miami goes as follows:

Many individuals are losing their homes in no small part because of rising local taxes, a not insignificant portion of which go to local hospital systems. Thus, the local healthcare system is actually hurting many of the individuals in the community. Physicians who are thorough with the treatment of local patients may actually drive up the number of individuals who are losing their personal wealth. This is even more profound when the government pays for something like an organ transplant. In this example, the $250,000+ correlates to the total taxes paid by ~25 families for the entire year.

CONCERNS FOR THE FUTURE

As the ever more predictable reality of a universal healthcare system comes to fruition, I can only see the above scenario multiplied over and over again. Physician advocates for universal access and other government intrusions may actually hurt the economic viability of other sectors of the economy. In doing so, it will diminish overall wealth, which is consistently one of the best indicators of health. Thus, good doctors will actually be bad for health. Remember that a good doctor isn't necessarily a good politician.

I'll probably come up with more on this later.

2 Comments:

Anonymous Dr. Dino said...

It is one of the most appalling facts that I have had to face in the past year, maybe longer... that ER visits increase when low-income patients obtain coverage.

They need the coverage desperately, but there had better be an obstacle. Using your primary care docs and community health centers should work, but they are only a little more effective than the rest of the system keeping routine illness out of the most expensive place to provide healthcare.

I have no solutions either, but you are not off base.

2:24 PM  
Anonymous buy imitrex Sumatriptan said...

Doctors will actually be bad for health. many people had problems.
What is the solutions?

3:36 AM  

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