Originally Posted By Polupharmakos:
Oh, get off your high horse.
Negative. This horse is a Cadillac, son! Livin' the life of luxury, up here.
How about this: let's all just start by agreeing that helping old guys get it up is a morally excellent and worthy activity. OK? And let's dispense with this morally superior bull. We on the same page?
I bristled at your remark because I feel like whenever people shit-talk the cash-money (and, as you say, elective) side of medicine, I always feel like they're going to segue into a justification for reaching into other people's pockets at gunpoint. That's clearly not what you intended, so I was wrong.
I consider all of the choices above to be morally irrelevant.
Somebody asked why all hospitals don't carry anti-venom routinely. The answer is money. It is expensive to get anti-venom. For you to carry anti-venom, that means you must at the very, very, very, very least break even on the anti-venom when you administer it. Probably not even that. You have some costs associated that you have to recoup somehow. You with me?
I got angry at what I thought you were implying with your disdain for Viagra, not because I don't understand Economics. In two months I'll have a Bachelor's degree in the fucking subject, after all.
Let's step back. I'll throw a rhetorical question out there. What, for the financially ambitious medical professional, is the promised land? What do you go into if you want to make bank? Here's the answer: fields where you offer a service that people want to pay for; fields where you don't have to involve insurance; fields where you can turn away a patient unless there's cash on the barrel-head. No money? No workey.
Oh hell yes. Why would I ever enslave myself for people who can't pay?
No. Doctors don't owe anyone anything. Having a pulse doesn't entitle anyone to enslave anyone else so that they can continue having it.
She'll pay for those. But when she gets breast cancer? Does she want to pay for that? Should she pay for that? The prevailing attitude in this country seems to be no.
I worked with a pediatric orthopedic oncologist. He cut bone tumors out of kids. Kind of a complicated task. He did ok, money-wise. A colleague of his went into fixing bunions. Practically no overhead; relatively short procedure; relatively low risk; just fork over the cash and get your bunion out. Dude made bank.
But NO MORAL JUDGMENT HERE. I WANT TO MAKE THAT PLAIN, LEST YOU GET RILED.
Nope, no moral judgment at all, just simple observation.
I want to make it plain that I understand the economics of these situations.
Here's another one for you. I worked with a family doc who told me he lost money on every vaccine he administered. He only offered vaccines to try to get patients to schedule appointments for their kids, and he was considering having to stop giving them, because they weren't cost effective. Now, do vaccines improve the quality of life of enough people that your hackles don't get raised?
I'm all in favor of vaccines, I think they're great, and I think it sucks whole ass that people don't want to pay up for the things which have enhanced the lives of hundreds of millions of human beings. Sounds like your buddy had a crappy business plan.
Now me, I'm fine with patient autonomy. And although I rag on those folks, I do admire my classmates who managed to keep their desire to help people alive throughout their training. And this rant isn't even really directed at you, more at the country at large.
But here's my point, restated. When you have a culture like ours, where people are happy to pay for elective stuff they don't really need, and aren't happy to pay for 'non-elective' stuff that they really do need, the ultimate outcome is that elective stuff is going to move forward in terms of innovation and technology, and the non-elective stuff is going to stagnate, if not regress. [span style='font-weight: bold;']And sure, if patients are fine with that situation; if they are fine with investing in the future of ED drugs, cosmetic surgery, and the like, well then, that's ok. Their call. I don't have a problem in the world with that.
The non-elective stuff you're talking about is hideously expensive, and like you've said, doctors not only have difficulty making money off of it, in many cases they're actively prevented from so doing by the kinds of laws that compel them to get screwed over by patients who can't pay for the non-elective stuff. On top of that, the elective stuff, as you say, is cheap and makes people happier (rather than just not-dead, which is nothing to scoff at, certainly) and therefore experiences orders of magnitude more demand, so the doctors get tons of work.
The incentives are fucked up, for sure: the facts of the market for non-elective care make for weak incentives to go into those fields, while there are tons of incentives to go into elective medicine.
Now: so what? I still don't understand what you want to happen. I got all bowed up at your remark because I assumed what comes after the disdain for the elective-medicine guys is a call for some kind of governmental intervention to force doctors to do this or that, but I certainly jumped the gun on that subject. So how do we change the structure of the incentives so that the non-elective, life-saving stuff is incentivized, too?
Just don't be surprised when you end up with the situation I saw this last summer, when the entire nation was scrambling for chemotherapeutics that simply weren't there. I wasn't keeping up with the viagra supply, but I'm willing to bet it wasn't in any danger.
Yep. And the lines for gasoline at the stations ended almost instantly once the price controls on it were removed during the Oil Crisis. People respond to incentives. How do you propose to change the incentives? I'm just an undergrad econ student, I don't know enough about the market for medicine and pharmaceuticals to make the call.