A commenter on my last post wrote:
And how is the current system better for doctors than Europe's? Why do doctors fight universal care so hard when they get a worse deal from the insurance companies than European doctors get from the governments?
I think that this is a very good point. Clearly I was lamenting how much trouble the current system gives both patients and doctors. So why not change to a universal health system? How could that be any worse?
If the last post were the whole story, there would be no argument. My purpose, however, was not to describe the system, but simply what is wrong with that system. There is another side. Complaining is easy (and even fun), but I would not still be practicing medicine if there were not reasons to stay.
Here is my view on the good side of our system:
I could go anywhere in the US and get a job. I have nearly 100% job security. If I wanted to live in Hawaii, I could. If I wanted to live in the city, I could. There are jobs everywhere for primary care physicians. Even if the worst happens and the system "falls apart," people will still need doctors.
Since we own our practice, we could change it in whatever way we saw fit. If we wanted to drop insurance and go cash only, we could. If we wanted to do more procedures, we could. If we wanted to pick up hospital care again, we could. Nobody is looking over our shoulder and telling us what to do.
If worse comes to worse, we drop insurance. Many are doing it and doing quite well. It's very nice to know there is an emergency exit.
3. Access to services
This is the big differentiation from a single-payer system. If I have a patient who has severe sciatica who is developing weakness to his leg, I can order an MRI and get it done today - and it will be paid for. Yes, there are some waits my patients have to endure (try getting an appointment with a dermatologist), but they are much less than in Canada or the UK. The delays in those systems cause significant harm to patients as well - as shown by the significantly higher cancer survival rates in the US.
Last I checked, the docs in Canada and the UK were not raking it in. The salaries for doctors as a whole are still higher in the US than in other countries. Yes, the disparity of cost between specialist and PCP is too wide. Yes, the docs now have to fight for the dollars in ways they never have before. But there is no evidence that any other system pays better (in fact the evidence shows the opposite).
If I am lazy, I earn less money. If I work hard, I earn more money. Having worked for the VA hospital (our single-payer system), I know that there is little motivation to be efficient. Things happen when they do, and everyone gets paid the same, regardless. The difference is even remarkable between private practices and large institutions. I remember when I switched from a hospital-owned practice to one that I owned, I stopped griping about being busy. The change was immediate.
Sure, the system needs changing; but simply changing who is writing the check will not make things get any more efficient. It is not those writing the checks that necessarily need changing, it is those cashing them. Too many people have their finger in the pie that should be shared by doctors and patients.
Do I get frustrated? You bet. But I do still have enough good to give me reason to hang around.