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Politics : Ask Michael Burke -- Ignore unavailable to you. Want to Upgrade?

To: Skeeter Bug who wrote (34988)	11/1/1998 10:36:00 AM
From: accountclosed	Respond to of 132070

<<this is a complex issue and pat answers, on either side, do not do justice to it.>> We live in a complex society. Many abstract models apply. If we go looking for the free market, we can find it. If we look at segments of our society, we (each from his/her own viewpoint/model) can find "unfairness", etc. One way of looking at this debate about fairness and physicians, etc. is that we live in a political economy. That is different than a truly free market. We levy taxes and reallocate income. The Clinton health care is an effort to say "Hey this aspect of the free market has run amok, and we are going to fix it." The political economy is dynamic. Taxes and income reallocations and laws that we pass today, we repeal tomorrow. We tinker with capital gains, health care, etc. all the time. The political economy imperfectly, dynamically balances voting power, "special interests". There is a consensus that physicians should be well paid at this point in our society, as we want bright young minds to choose that path. There is considerable debate about what well paid is. Should the market determine it, or should we control it? The problem gets complex, as if and when we politically control it, bright young minds get to weigh in with their reaction to that political control. If, for example, Wall Street analysts make on average ten times the new administered wage for physicians, then what is the new balance? Then the political process probably revisits the issue and asks itself if the new balance is optimum. We do this all the time. We want bright young minds to choose careers in education and vote to increase teachers' salaries. Anyway, I am rambling. It is indeed complex. It is also dynamic. Individuals get to choose their path. They get to decide what is fair. They get to vote. They get to exercise their interest, "special" or otherwise. And sometimes the political economy gets to decide what is in the (imperfectly determined) "national interest" at a given time. Nothing stops the debate and the struggle or the ever-changing balancing mechanism. And nothing stops individuals from trying to cope with the ever changing landscape and its rewards and frustrations.

To: Skeeter Bug who wrote (34988)	11/1/1998 11:16:00 AM
From: baggo	Read Replies (2) \| Respond to of 132070

Skeets, I agree with almost all your points and I'm not offended in the least. I may have been misunderstood a little. My specialty choice had capitalistic overtones, not my decision to become a physician. Once I learned the ropes while in med school, I was determined to be a specialist and thus have greater earning power. I, initially, was going to be a pediatrician, but after seeing the lifestyle and pay-scale, I decided against it. Am I a bad person for choosing a high paying specialty? You decide. Most graduating physicians in this country are laden with debt and are physically and psychologically overwhelmed. The debt is sometimes scary. A graduate of a private med school can have well over 100k in student loans. Malpractice insurance down the road can reach 50-75k/year depending on specialty and state. A lot of students have loans from undergraduate days. So are the only good doctors the ones who work only for the love of their job. I don't think so. Lowering admission criteria? Do you really want that to happen as a consumer? I could go on and on, but quite frankly I hate to type. Regards, Brice BTW anyone in a HMO- be assertive with your questions/rights. Specialists do have a place in this world of cheap medicine. It's your life.

To: Skeeter Bug who wrote (34988)	11/1/1998 6:45:00 PM
From: Ilaine	Read Replies (1) \| Respond to of 132070

Hi Skeet, >>>>>so, what is the solution? i don't know (at least i'll admit it). it would take a lot of expertise, knowledge, facts and time that i don't have to devote to this issue to come up with a reasoned solution<<<<< Thanks for a well-reasoned post. I hope you won't feel attacked if I voice my opinion that how much doctors are paid ought not be a public policy question. Unless you work for the government, or contract with the government, your pay is a matter between your customer and you, or your employer and you. The free market sets your pay rate, in other words. Physicians should not be singled out, and forced to accept the dictates of government. None of us would like hearing people debate our compensation, and none but those who have money, and are the objects of envy, have to. On the other hand, if they expect to be compensated by insurance companies, then they need to accept the fact that insurance companies have certain advantages in the deal-making, that is, advantages of scale, ability to walk away from a deal, ability to hire people full-time with negotiating talent, etc. Doctors don't like it because they want to practice medicine, and they miss the old days when Blue Cross just paid the bill. Well, times change, and we all have to change with the times, for better or worse. Burke pointed out that Medicare has even more bargaining power. I might point out that the federal government has a way of getting what it wants, if only due to sheer staying power, as those at the receiving end of a federal investigation can concur.<g?> I think your point about the artificial limit on physicians was very well taken. CobaltBlue