By: Jane M. Orient, M.D.,
For many, “the 1%” are the “super-rich,” the “millionaires and billionaires” (as if it didn’t take 1,000 millionaires to equal a single billionaire). “Occupiers” think that “the 1%” have more money than people should be allowed to have, so our government should take some of it and distribute it to “the 99%.”
But this would not be enough to be sure that “the 99%” have everything they need, especially medical care. So let’s look at “the 1%” in a slightly different way: the 1% who have exceptional knowledge and skills, who could provide us with the medical care we need and presumably deserve.
Doctors are generally not in the 1% of the super-rich, despite what many people think. But regardless of their financial status, why should they be allowed to hoard their skills? After all, government (or “we all”) helped to pay for their education, or helped build the hospitals in which they work.
As one internet commenter recently asked me: “How does it help ME for you to be independent? My husband and I depend on Social Security and a military pension.”
Indeed, a physician’s independence doesn’t help the government’s wards, and might siphon some of “society’s” resources away from them.
When I stopped accepting money from Medicare, one of my patients told my receptionist, “I paid my taxes; she should have to prescribe my hormones.”
Many people seem to think that their needs trump the rights of others—at least of the specially “privileged” 1%—to their property or even their liberty.
We could engage in an argument about the effects of policy based on this logic. Suppose the government had told me, in 1970, that I could go to medical school, spend the prime of my youth studying like a demon, often working 36-hour or longer shifts, pay huge tuition fees, work for three years of residency at less than minimum wage—then be an indentured servant for the rest of my life.
As many talented young people are doing today, I might well have said “no thank you” and chosen a different career path. Or finding out too late, I might, like workers in socialist paradises, develop effective systems gaming or work avoidance strategies. Patients of course are not well served by doctors with a slave mentality. Slaves tend to be surly and nonproductive, focused on avoiding punishment rather than on doing the best job possible. They are not risk takers or innovators.
But let us not use the utilitarian argument that socialism doesn’t work. Let’s pretend that it does. Should we advocate such a system? Or reject it because it is morally wrong?
Most people these days seem to think that if they get a better job offer, they should be able to accept it. But what about “the 1%”? Suppose that a patient values a physician’s services and offers to pay more than Medicare allows? Better still, offers to pay up front without costly, frustrating busywork requirements? Should the physician be free to accept?
If that patient is enrolled in Medicare Part B, today’s answer is that it would be against the law, at least if the physician is not opted out of Medicare. Soon, as “reform” proceeds, it might be against the law for any physician to accept a better job offer.
This would mean that it would also be unlawful for a patient to receive a treatment that deviates from the uniform minimum. How could I treat “the 1%” of patients who are seriously sick better than the 99% who are healthy?
Socialism means that there is no unalienable right to life, liberty, or property. Some must be enslaved or sacrificed.
Freedom is morally right. Slavery is morally wrong—even if the new slaves belong to a group that is perceived to be “advantaged” or “privileged,” and the wards of the state who receive the conscripted services to be “disadvantaged” or “vulnerable”
Fortunately, freedom also brings prosperity and wonderful new medical treatments. But even if it didn’t, we would be morally obligated to choose it.
Jane M. Orient, M.D., Executive Director of Association of American Physicians and Surgeons, has been in solo practice of general internal medicine since 1981 and is a clinical lecturer in medicine at the University Of Arizona College Of Medicine. She received her undergraduate degrees in chemistry and mathematics from the University of Arizona, and her M.D. from Columbia University College of Physicians and Surgeons. She is the author of Sapira’s Art and Science of Bedside Diagnosis; the fourth edition has just been published by Lippincott, Williams & Wilkins. She also authored YOUR Doctor Is Not In: Healthy Skepticism about National Health Care, published by Crown. She is the executive director of the Association of American Physicians and Surgeons, a voice for patients’ and physicians’ independence since 1943.
