Saturday, March 10, 2012

Predators, Doctors and Wage Slavery

Society is probably too strong of a term for living among fellow human beings in these mostly United States.

I was thinking about writing a science fiction novel in which (on another planet, in a different time) doctors are predators, a sort of subspecies of the regular denizens of my imaginary civilization. Where could I get such an outrageous idea? Well, there is the opening section of B. Traven's The Rebellion of the Hanged, in which Marcelina, a Mexican peasant, falls deathly sick. Her husband Candido takes her to town to see the doctor. Candido's life savings consist of 18 pesos, but the doctor wants 200 pesos to operate. The town's leading citizen offers to loan money to pay for the operation, with the Candido to work off the loan at a timber camp, cutting old-growth mahogany. Candido accepts the loan, the Doctor operates, Marcelina dies anyway, and Candido becomes an enslaved timber worker. Thus setting the novel in motion. It is a great novel, which is why you probably never heard of it before.

Yes, I recently had a walletectomy performed. Walletectomies are the most common medical operation in the United States, and most are 100% successful. Fortunately for me they only did local anesthesia. I jumped out in the middle of the operation, so I have half a wallet left. I am hoping the rest of the wallet will grow back eventually, or that half will keep me going until I die of some other cause.

According to the American Bankruptcy Institute, 1,362,847 people filed for bankruptcy in the United States of America in 2011. According to Medical Bankruptcy in the United States, 2007, published in The American Journal of Medicine, in 2007 "using a conservative definition," 62.1% of all bankruptcies were medical. Do the math and you have about 850,000 people who went bankrupt due to medical bills or health issues in 2011. And probably more this year. It adds up.

Note too, that the habitually poor don't go bankrupt, and have their medical bills paid by Medicaid. The rich go bankrupt on occasion, but usually from bad investment decisions or cocaine habits. Bankruptcy from medical bills is a working and middle class phenomena. It typically involves losing home ownership. After you are totally impoverished, you too can qualify for Medicaid, food stamps, and Section 8 housing (warning: there is a very long waiting list for section 8 housing).

Some say maybe people should buy better insurance, then they could survive an expensive illness. The problem with that theory is that most people don't make enough money to buy the best insurance policies. Given the level of prices and wages now existing in the U.S., most people would have to live in a tent and eat grass so that all their wages could go to medical insurance. So we take our chances with less than wonderful policies.

The problem is not entirely caused by a predatory medical profession. The bigger problem is low wages. While low wages is also a complex problem, it mainly comes from decisions made internally within corporations. The people who divide up the pie take the biggest pieces, leaving crumbs for the workers. Also, some sectors of the economy are just less profitable than others, and yet someone has to do that work.

Workers today are too busy fighting each other for crumbs to organize themselves to fight for a fair share of the pie.

Modern science has provided some nearly-miraculous healthcare technology, including a few wonder drugs and amazing surgical techniques. It has also created a bunch of drugs that have little benefit to patients and yet cost tens of thousands of dollars a year to take.

Society has to be built on trust. We can't each of us be jacks-of-all-trades. We must each have our place. We also can't all be millionaires. But it seems like everyone who enters medical school thinks they are getting a ticket to be a millionaire, if they can just stick out the hazing. Because that is the way the American Medical Association set up the system over a century ago, by limiting the number of doctors allowed to graduate from American medical schools each year.

If I ran things one of the first things I would do is open a bunch of competing medical schools, maybe doubling the number of seats there are now. Then I would choose students not strictly by their grades, or ability to pay tuition, but largely by their desire to alleviate the suffering of the sick. I would guarantee them a decent, above-average salary once they were trained. And I would nationalize the health insurance industry.

Then we could trust doctors to do what is good for us, instead of what is good for their own wallets.

But that would be socialism.

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