I wonder if the bright-guy proponents of Obamacare at Harvard are etymologists, too. Do they get the meaning of “Hoisted by one’s own petard”?
It’s hard to be a Utopian when the real world catches up to you. I read with some amusement that, as Obamacare chickens have come home to roost, they are roosting on the heads of Harvard professors who now are squeaking that they must – oh horrors – pay more for their health insurance! I am doubly amused because I suffered through the HMO debacle years ago and remember that it was the Harvard HMO that was the first to go down. I guess these smartest of doctors not only do not understand the basic economics of buying and selling products, they also don’t learn from experience.
Now, I don’t mean to be too hard on the Harvard crowd – I stare at a Harvard logo in my living room every day, a reminder of the days my father was in dental research and taught biochemistry there. But the truth is – and it is true of most university-based physicians, cocooned in their university clinics, with university staffs and university-financed facilities – that university docs are blissfully removed from the fiscal realities of the practice of medicine. In solo practice, I knew, for example, my overhead costs: my electricity, my heating bill and the cost of the Christmas bonuses I gave my staff.
A doctor can learn a lot in the university setting and is able to spend time thinking about his or her medical specialty in ways that benefit the profession. But having a fixed annual salary and doing research don’t give you the real-world hard-knocks teaching about income versus expenses. It doesn’t teach you how many patients you need to treat to pay your overhead. There is nothing like solo private practice for teaching you the nightmarish but practical aspects of paying business taxes, of funding your staff before you pay yourself and for being scrupulous about billing so you don’t get squashed by the Medicare Nazis. Not knowing about these things makes it easy to create theoretical solutions to providing health care, and so they did.
What is sad about this is the apparent lack of insight into the problem, even now. Numerous professors (not all medical) are quoted in a variety of articles, whining about paying more but never ascribing the problem to government over-regulation. Richard Thomas, a Harvard professor of classics and a world authority on Virgil, thinks this is “a sign of the corporatization of the university.” In truth, universities, where guys gets paid $200,000 a year to teach Virgil, may need more corporatization to at least remind them of the real costs of goods and services. And I can tell you from working in a university setting, few if any physician professors understand the nightmare of dealing with the 160,000 pages of Medicare/Obamacare regulation, because those pesky details are left to university staffs and compliance departments.
My father left Harvard to get a third doctorate, an M.D., and ultimately to abandon academia to practice small-town medicine and dentistry in Iowa. Those guys in Boston may think of us as “flyover country,” but here we know where our food comes from and what it takes to grow it. We know how to fix things, how to build things and how to hunt. And those of us who practice medicine here know what it costs to do so.
For decades we have had to live with crazy rules made by the smart guys at Harvard and other famous facilities. We don’t need these guys telling us to practice quality health care – in small-town America our patients are our friends, family, and neighbors, and we would do nothing less. We don’t need Obamacare. We remember life without all that. We remember doctors who spent time with their patients rather than living on a computer to be in “compliance,” doctors who included compassion as part of the standards of care. At my local corner store where “flyover state” yokels like me get together and chat, we have an idea that medicine is between a doctor and a patient – not a doctor, a government bureaucrat and a patient.
A friend of mine who was a production engineer at Campbells soup years ago used to say, “The farther you are from the problem, the clearer the solution.” So true, so true. But what do we know. We’re not from Harvard.
