The editorial I wrote in response to Dr. Lilly’s article in the Springfield News-Leader has generated a host of comments on the News-Leader site, many of them quite diverting, both in the sense they are funny and that they avoid the issue. In one I am called an “old duffer” to which I take some exception. Please, allow me to be a middle-aged duffer. My duffer-hood has only recently begun. Also, there was reference to my inflated salary, supposedly one of six figures. It is obvious that these posters do not know how to use the Internet because the State of Missouri makes public the salary of all its employees. This is a cruel exaggeration. When I came to Missouri State they hired me in at $29,000 a year, hardly six figures. But people who make such charges do so because they are resentful not only that the state employs people who do mind-work but also because such work may be beyond their understanding. Finally, a suggestion was made that professors be paid $20.00 per student per week, that figure chosen, one supposes, as a disparagement of the education process. In my case, that would mean a salary of more than $160,000. Please, write your representatives and actively work to make this scheme a reality.
As for the health care issues, it was interesting for me to see that there were actually comments made that attempted to downplay the well-known statistical evidence that health care in this country is not what it might be. Life expectancy and infant mortality rates are not the whole picture and present more than a few difficulties when being used to judge the adequacy of a health care system. However, coupled with the amount of money being spent and the lack of access to health care by millions in the population, the picture becomes rather bleak indeed. Dr. Lilly’s powerpoint is not persuasive. The problem lies not in the narrative itself, although there are issues that could be taken with certain points he makes, but the interpretation of the picture that he paints. Yes, third party insurance was abused just like illegal drugs are abused. But without pushers the problem of drug abuse would change considerably. Similarly, where were the AMA and the medical profession in general while all this was going on? They were doing what the hospitals, the insurance companies, the medical device companies and the pharmaceutical companies were doing – coining money. Let him produce the great campaigns that doctors undertook to convince the public that medicine was being oversold. If there were any, they were few and far between. If today, you should suggest that cost is a factor in the health care debate, the very same individuals who complain about the costs start shouting “death panels.”
One of the snide comments on the News-Leader blog concerned the fact that doctors pay so much for their education. In many nations around the world, medical school like university education in general, is either much less expensive than in the U.S. or is funded by the state. Imagine, physicians graduating without having to pay back enormous debts right out of the gate. Physicians today are the highest paid profession in the United States, earning considerably more than physicians in most other industrialized nations. Even so, physician salaries are only about 20-25% of total health care expenditures. None of this truly matters, unless we get the debate under control. This apparently is not within the capacity of a certain segment of our population. Some physicians are going to work hard to keep the present system intact or even to eliminate the government health care programs that now exist in the name of some free-market hokum (although there are more than a few physicians working for positive change). This will continue to allow them to reap enormous profits off the backs of frightened Americans who imagine that they need to throw a sacrifice of their virgin dollars into the health care volcano in order to protect themselves and their loved ones. This strategy does not seem to be working and a fiscal reckoning is approaching when some hard decisions will have to be made. The medicine may not taste very good but ultimately we may have to take it. Either we will realize that human decency requires that we extend health care coverage to everyone, or that we allow people to sicken and die because they are too poor to afford care, which, in fact, is happening already.
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