I constantly give ordinary folk advice about how to survive within a corrupt healthcare system. Why not help doctors? As odd as it may seem, with today’s fascist medicine both patients and doctor are at a disadvantage. That is the nature of fascism. It is similar to a bacteria like gangrene that starts in a toe, then climbs up the leg and ends up killing the body. Unlike, gangrene fascism is only painful to those who are currently negatively affected. Gangrene is a disease present in the body. Fascism is a disease present in the United States economy. Like gangrene it will kill the organism in which it is present. Fascism destroys first those at the bottom of the food chain and climbs higher. Both are treatable. Gangrene is likely to be treated as soon as it is discovered. The chance the economy’s fascist infection will be treated, even when its presence is acknowledged is almost zero. In the first stages of fascism, all but those on the lowest rung of the income ladder prosper. Then fascism impoverishes folks on the next highest rung. That rung on the ladder then joins the lower two and becomes impoverished. This process continues until all but the highest classes of income receivers are impoverished. Those with the most political power prosper. Wealth and income are always concentrated at the top. Somewhere along this chain of destruction the economy collapses because no market is left for the upper class to sell to.
For most of economic history ordinary doctors collectively had a lot of political power. Fascism changes that. Now, you who are doctors may still have more political power than do your patients but you have lost enough to where your circumstance are in decline and you are being manipulated into making personal compromises. Mainstream economics makes the assumption that when a law is passed, all other variables remain unchanged. All various hominids are deemed to be like statues or chess pieces which when moved around the game board offer no resistance. Economics as it is taught in universities, has no utility in the real world. Laws in fact change the nature of incentives of everyone affected by the law. It is the change in incentives that determines the outcome of the law. In real world economics, which is the kind I delve in, there is no such thing as an independent variable.
Fascist medicine changes the incentives of everyone who works in healthcare. In a free market setting, doctors have a strong incentive to deal with patients and practice medicine. Under fascist medicine, the doctor has a stronger incentive to function as a clerk. In this market where a doctor’s lifestyle is threatened, functioning mainly as a clerk is the most profitable path to follow. Who will be the highest paid doctors? Those will be the finest clerks the nation’s pool of physicians has to offer. Doctors actually practicing medicine make less while their clerk counterparts clean up. In time, but perhaps not even in ones lifetime, the physician type who makes it to the top, will end up impoverished. Fascism destroys. It takes no prisoners.
Who gets what in a fascist system is determined by political power, all of societies money eventually ends up at the top. At that point, professional people, regardless of how esteemed they are today, will end up in the economic trash heap with everyone else.
Here is my advice to physicians. If you don’t mind being a clerk and you are good at it, go for it. Self interest is the only universal incentive nature provides. There is no need to apologize for being successful at achieving personal gain legally. If you are a doctor who does not enjoy functioning as a clerk, especially if you are not particularly good at it, it might make sense to try something else. The entire system we have is going to collapse. Systems that are flawed from the beginning are guaranteed to do so.
1.) You must find a way to make a living in a way that your income is not totally dependent upon laws that get passed. One suggestion is to put a sign in the office offering cash prices that are a lot closer to your current average insurance reimbursement than they are to what you are now charging cash patients. I am a whole lot better at identifying problems than I am at presenting solutions. That is because I deal in real problems and never engage in the pretense of knowledge. Problems are very hard to solve. That is why they are problems. A person operating a business has a better chance of finding solutions than someone else on the outside looking in. Just getting out of the mainstream go along to get along mode activates the sentient part of the brain and solutions start to emerge. When you play go along to get along to an extreme, you might find yourself following a judas goat. Go along to get along has short term benefits and long term consequences. The biggest benefit to go along to get along goes to those who initiate the process.
2.) Brush up on the concepts of orthomolecular medicine. Hey, I am only an economist but these folks are curing maladies on which you guys gave up trying to cure years ago. Sure, logic says these practice are ineffective. Results show otherwise. Rational people are going to eventually go with what saves their lives, even when esteemed people insist they follow a different path. Over time we are all paid in line with our utility to society. In a managed economy like we have in the United States, certain services can command a price that is greater than ones genuine current utility to society. For doctors price competition will over time determine income. Right now, if you are a physician, you are able to charge more than you would be able to given the service you are actually performing. Imbalances like these take time to reconcile. Sometimes, as when there is a complete economic collapse, the reconciliation is almost immediate. It can also be a very slow process. You are going to face extreme price competition in the future, because you have emerging new competition. You have to find a way to compete with the new competition.
Who will be your competition?
People are already getting better cures through orthomolecular medicine than through what you are providing. These cures are so cheap they are almost free. Cheap, that works better than sky high priced remedies is going to end up being used more and more. Stop telling people not to use them because folks are figuring out that it is best to tune you out in that regard. Don’t play Thomas Edison. With respect to electricity, Tesla had the better technology. Edison died trying to impose his inferior system on the country. We use Tesla’s alternating current today. In time people will do what they have to to stay alive in. In the real world, best eventually displaces not as good no matter what. Why go down with the ship?
In our system of doctors as clerks, patients get no advice to speak of. Medical tests are interpreted and usually an office visit is devoted to looking at test results and writing prescriptions. In close to 15 minutes the doctor starts acting nervous, gives superficial answers and gets the hell out of there no matter regardles. Some underling then might give the patient a printed stack of papers with information on a certain malady. It will be about the same information a patient can find on Webmd with a mouse click.
Certainly, for re-reimbursement from insurance company, this qualifies as a patient consultation or something else that is required. No one who practices medicine in that manner is going to escape competition from unexpected sources. Doctors in foreign lands, who in my opinion are completely competent, are beginning to offer phone and skype consultations for fees for less than an American doctor is likely to spend on lunch with his friends. In Texas, residents close to the border are beginning to visit Mexican physicians just on the other side of the Rio Grande. It is in vogue to disrespect foreign doctors as being quacks. It is not so. Chiropractors are now becoming experts on nutrition and counseling patients on life style changes. Pharmacists who are clearly physician’s betters with respect to drugs are consulting more with patients. Monopolies create their own competition because buyers look for alternatives to what has lost utility to them. What happened to landline phones is happening to medical doctors right now.
In a free market healthcare system, we would have cheap portable testing equipment, where blood tests could be done at home. Profit margins of providers would plummet. It pays very well to work in a profession where there is restricted entry. The system of restricted entry can change. When fascist medicine fails, it is likely to be replace with a state owned and operated system. In that case, doctor’s incomes will start dropping down to a level closer to what doctors receive under socialized medicine. Regardless, physicians are going to find it difficult to maintain their incomes and lifestyles.
Doctors as clerks is a guarantee that with every day that passes physician’s utility to society will continue to diminish. Add to that the huge income gap between that of U. S. doctors and foreign doctors is far wider than any perceived gap in competence. How long it will take for that gap to close is uncertain but it will, guaranteed. Be ready because the pressure is building.
I will leave you with a final thought. A high I.Q. does not guarantee a high level of awareness. Just because you are intellectually superior in a given activity does not mean you have any idea of what is really going on around you. You are as prone to opt for fantasy over reality as anyone else. In terms of over all brilliance, it is hard to say which is more valuable, raw intelligence or a high level of awareness. It is not good to ignore either.
The truth is a hard sell. Fantasy Free Economics gains readers one at a time. Major search engines simply do not list blogs which disagree with their political agenda. As long as folks share the link to this blog and others speaking out against the grain, the truth will at least trickle into the public consciousness.