Six hundred ninety-nine doctors answered a recent survey of doctors’ attitudes about Obamacare, and medicine in general. Nine in ten of them say that medicine is on the wrong track. Five in six might quit. Liberals, of course, refuse to believe that. (They dare not tell so many doctors not to let the door hit them on the way out!) But even conservatives aren’t paying attention to everything the doctors said in that survey, or why they might have said it.

Doctors talk back

The Doctor-Patient Medical Association is a new idea. Why should doctors and patients fight one another? The DPMA has a new message: doctor and patient have the same interest, deal with the same reality, and sometimes have the same enemies.

From April 18 to May 22, 2012, the DPMA asked doctors across the country about the putative President’s health care reform bill, and about other frustrating things that doctors have to deal with. Two days ago they published their Physician Attitudes Survey. Most of the 699 doctors who answered the survey are in solo, group, or office practice. (Eleven percent are in hospital-based practice. That could include the doctors who run the lab, the emergency room, and the X-ray department, and put you to sleep when other doctors operate on you. But it could also include internists and even surgeons who see all their patients in one hospital and even draw a hospital salary.) More than three out of four were in the middle of their careers. (House officers, the “Young Doctor Kildares” did not answer this survey.)

Their answers should make everyone take notice. Nine in ten said that medicine was on the wrong track, and five in six thought about quitting. Some of them might have to quit: two in three say they are barely breaking even or losing money on their practices.

They don’t want the government to help them. They just want the government to get out. And it’s not that they “don’t care.” Slightly more than half of them would rather treat some patients free of charge and not deal with Medicare or Medicaid to treat the same patient.

I  want to focus on what is best for my patients and not what a government official deems cost effective…I would be willing to do charity care weekly for the poor and underinsured if there was tort reform.

For that matter, they think medicine is off the rails as it is. Medicine, as they must practice it today, harms the doctor-patient relationship. For that they mostly blame the government. But they also blame the big insurers, and the big corporate hospital systems.

The best single thing that can repair most problems, the doctors said, is for the government to get out. But further than that, patients should ditch the insurers and start paying their bills directly. So naturally those doctors want to see the kind of reform that would let a patient do that. One doctor said:

Only the free market will fix this mess. We need to eliminate government and government-protected corporate greed from medical care.

Reporters miss the point

The Star of Life, featuring the Rod of Asclepius, the true symbol of medicine. Photo: US Department of Transportation

Liberal reporters belittled the survey. That should surprise no one. But The Daily Caller did not do such a good job, either. They picked up on the five in six doctors ready to quit medicine. But they didn’t pick up on the other things the doctors said. They at least let Kathryn Serkes, co-founder of the DPMA, sum up:

Doctors clearly understand what Washington does not — that a piece of paper that says you are “covered” by insurance or “enrolled” in Medicare or Medicaid does not translate to actual medical care when doctors can’t afford to see patients at the lowball payments, and patients have to jump through government and insurance company bureaucratic hoops.

But they missed this gem:

Are there any long-term Government run programs that aren’t riddled with inefficiency and corruption?

Nor did they quote any of the other opinions that doctors expressed. Yes, doctors blame the government, but not only the government.

When the airlines were taken over by business instead of being run by pilots, the industry went to hell. Same thing has happened to “healthcare”— doctors used to run hospitals and their practices. Now they are “providers.”

An old problem

The problem, and the debate, are decades old. Ayn Rand called the doctor “the forgotten man of socialized medicine.” In Atlas Shrugged, she said this:

In all the discussions that preceded the enslavement of medicine, men discussed everything—except the desires of the doctors. Men considered only the “welfare” of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter, was regarded as irrelevant selfishness; his is not to choose, they said, but “to serve.” That a man willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards—never occurred to those who proposed to help the sick by making life impossible for the healthy.

Enslavement can take many forms. Sometimes it starts with programs that offer carrots first, and sticks later. Before Medicare or Medicaid, doctors-in-training often worked for “slave” wages. The late William A. Nolen (The Making of a Surgeon), who trained at Bellevue Hospital in the era when Atlas Shrugged came out, earned $780 a year as an intern and about three times as much as a chief resident.

Nobody, at least nobody with a family, could get by on these wages,

Medicare changed everything. House officers today earn not much less than police officers or teachers in a public school. When Medicare started to fund care for the elderly, it funded training of doctors after medical school. The old-school attending doctors often resented the new trainees, who had no concept of what their economics had been like:

In my day, I sold my blood for toothpaste money!

But these new salaries also got doctors used to having the government pick up the tab for everything. Now they’re afraid to lose all the “benefits.” An empty belly can be as strong a chain as iron. (The attendings have their own “hook”: federal and other government grants.)

They also developed no concept of the value of a patient’s means. No one was going to tell them, as a private attending once told Dr. Nolen:

Please don’t order all those expensive blood chemistries on Mr. R___. He can’t afford them and I don’t understand them anyway. In two days he’ll be eating and drinking, and he won’t get into any trouble in so short a time.

Today it’s worse. Doctors order everything because they’re afraid that someone will sue them if they don’t!

Charity patients never have to worry about how much their care will cost. But private patients don’t have that worry, either. They find out later, only if “insurance doesn’t cover it.”

No wonder doctors are ready to quit. Obamacare might push some of them over the edge. But doctors have been ready to quit for years. You have to read all the results of that survey to get that message.

How to solve the problem

Leonard Peikoff, during the “Hillarycare” debate, said that health care is not a right. But Peikoff did not object only to direct government action. He decried all the things that insurers (many of whom follow the government’s lead) do, that distract doctors from caring for their patients. Sometimes that leads to tragedy.

No, health care is not a right. Neither is it a “privilege,” as Rep. John Lewis (D-GA) bitterly declaimed on the House floor yesterday, and declaims on his Web site. Health care is a good, like a car (or repairs on it). If you want something, you work for it or pay for it.

The doctors who answered the DPMA survey understand that. They pointed out that if patients had to pay or budget for medical services, as they do now for car repairs, they might take better care of their bodies, and do many things that would either stop them from getting sick, or catch a sickness early.

More to the point: government often hurts not only the doctor but also the patient. Free minds and free markets will solve the problems that governments, and insurers (to a lesser degree), have caused.

Related:

Ayn Rand world: public hospitals