A High Colonic For Your Wherewithal

“The federal government has agreed to pay hospitals around the country hundreds of millions of dollars not to train doctors to alleviate a growing glut of physicians.” - The Washington Post, Aug. 24, 1997

There is fodder for thought here. Your average, uninformed American might conclude that this is idiocy - he might even find it a prize example of why we so often think our government is nuts. That’s because your average, uninformed American has more sense than Congress and the administration combined.

The way this teeny-weeny billion-dollar lunacy worked its way into the federal budget agreement, cleverly disguised as a Medicare provision, is as follows.

Earlier this year, the administration decided to give the state of New York $400 million over several years not to train doctors - a special deal, an experimental program to stave off the dreaded doctor glut. This naturally ticked off all the training hospitals in Texas, Massachusetts and elsewhere. They, too, wanted to get paid not to train doctors in order to fend off the dreaded doctor glut. So, congressional Republicans decided to eliminate this appalling example of favoritism toward New York by extending the experiment everywhere else.

Congratulations, knot-heads.

Now, the average, uninformed American might wonder just what is wrong with having more doctors. Turns out we already have 700,000 of them, more per capita than any other country, and what we especially have too much of is specialists. As in plastic surgeons who specialize in nose jobs and liposuction. But as we also know, there is still a serious shortage of doctors in rural areas, on Indian reservations, in the Rio Grande Valley and other places with concentrations of poor folks. Producing more doctors might actually induce some of them to move to these underserved areas.

Then again, more doctors might lead to … well, competition. Price-cutting. More choices for patients. All the stuff that competition is supposed to lead to. It might even lead to some cutbacks in the square footage of all those mansions doctors keep building on their local Pill Hill. Perhaps some of them might even be forced to buy Fords instead of BMWs. The glut of specialists might even encourage more doctors to go into family practice, even to emphasize preventive medicine. It is clear to our government that this is an eventuation to be devoutly avoided.

Your average, uninformed American might wonder why his congressman would reach such a remarkable conclusion. O, cast your imaginations loose, fellow Americans - let them wander over the wide world of possibilities and then pause at the fact that the American Medical Association is the biggest political action committee in the United States - the Numero Uno. That’s $13.8 million from the doctors’ PAC to our politicians from 1987 to March of this year. More than the tobacco companies, the real estate lobby, the teachers and the National Rifle Association.

Might this possibly have something to do with this curious decision? Could it be that another special interest has once more bought itself another sweetheart deal through the system of legalized bribery we call “campaign financing”?

Here’s the government, faced with mounting costs for health care on every front and about to go broke, they tell us, from providing medical care for aging baby boomers. And now it’s going to spend billions paying hospitals not to train doctors. Remember when we used to pay farmers not to grow crops? That struck us all as such a dumb scheme that we are now paying many millions to phase out that system.

A professional glut is not unknown in this nation. We need not raise the painful problem of lawyers in our time. Every 20 years or so, we produce too many engineers, a well-known cycle. For a time, after our post-Sputnik panic in the late ‘50s, we produced too many physicists, leading to a remarkable joke genre, the unemployed-physicist joke. They all seemed to have found productive employment eventually, without benefit of the government paying anyone not to train more of them.

Then again, you may have heard mention of the giant rip-offs of Medicare and Medicaid, the multimillion dollar scams that have sent the cost of those programs soaring. Is it poor folks who are ripping off the government? Is it old folks? Nope. It’s doctors and hospitals, hospitals and doctors. This would suggest to the average, uninformed American that we do not need to train fewer doctors; what we need to do is give the ones we are training some instruction in ethics. Elementary ethics.

Today’s campaign finance reform slogan: It’s government by the people - not people buy the government.

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