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Doctors Going Broke?

This post was inspired by an article I read today: http://money.cnn.com/2012/01/05/smallbusiness/doctors_broke/index.htm, by Parija Kavilanz.

“Doctors in America are harboring an embarrassing secret: Many of them are going broke.”

I’m not going to recite the article, read it at the link above. The reasons recited by doctors for their financial woes include: shrinking insurance reimbursements, changing regulations, and rising business and drug costs. A reason offered by some experts is lack of business acumen on the part of doctors. Medicare reimbursements have shrunk (and are scheduled to shrink more), and private insurance reimbursements tend to follow Medicare rates. Medicare reimbursement rates for drugs declined, so selling drugs at a profit to patients (after buying them from the pharmaceutical companies, which made a profit), has faded as a profit center (not all doctors, in all jurisdictions, had the right to sell drugs at a markup, it seems).

So, what’s my point? Well, I saw one study which tracked new small businesses opened in 1992, and only about 29% of them were still going in 2002. If doctors are exempt from the perils of the business world (or ought to be), I’m unaware of that. Oh, I know, it’s a bigger deal if a community loses its family doctor than if it loses a souvenir shop or something, because health is perhaps more important than tchotchkes. But the consequences of a business shutting its doors does not bear any relation to its survivability that I know of.

Maybe more importantly, I perceive a systemic flaw in the system. Medical care is driving many Americans into bankruptcy (and actual death) sometimes, even insured Americans (who are bleeding money into insurance premiums). Now we hear doctors are having it tough financially. I say that if something costs consumers a ruinous amount, yet does not provide a living to the producers (doctors in this case), something is terribly wrong. It reminds me of the issue of farmers barely eking out a living while everyone else is paying high prices for food. Maybe that’s “liberal” or “socialist” thinking. After all in the dog-eat-dog and cat-eat-mouse foodchain of Capitalism (gotta capitalize high concepts), if the middlemen (and women) out-work (do I mean out-scheme?) the producers and consumers, then the great god Mammon should provide them with more of the gold. My solution? Well, it’s no secret, I favor universal tax-supported health care, where doctors and other providers don’t have to worry about running a business because they are on salary. There, I said it.

As for doctors selling medicine at a profit, I’m against it. Big Pharma puts its money into developing a medicine (and then puts twice the amount they paid to develop it into idiot TV ads). Yes, they deserve a reasonable profit. Medicine is, and should be (if not nationalized) a service industry entirely, not a retail goods industry. That’s my opinion.

So, do I want Doctor Zhivago to have to close his doors? No, I don’t. I would like to know why medical practices can’t control their overhead, but, then, I’m not a doctor (although I did run a law office). Here’s a cautionary tale (might remind you of the disputes between millionaire athletes and billionaire team owners). In Florida (and doubtless other states) the doctors constantly whine to the legislature about the huge premiums they have to pay for medical malpractice insurance, usually calling it a “crisis.” Some sad tales come forth of doctors paying hundreds of thousands of dollars per annum for malpractice premiums, even without ever had a claim made against them. So, the reasonable question is posed to the doctor paying those premiums: how much do you have left over after paying all overhead, including those monster premiums. Well, like unto the billionaire ball team owners, they don’t want to answer that. Why? Well, because there isn’t much sympathy to be had if the leftovers amount, on an annual basis, to multiples of what Joe and Jane Lunchbox anticipate making in a lifetime of hard work. Oh, you might ask, how did I get here from a discussion of bankrupt doctors? Easy, I think probably the vast majority of doctors are not closing their doors, and many of those who are shutting down are probably the authors of their own misfortune.

Anyway, I’ll save my sympathies for the unwell who can’t afford treatment.

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