By ROB LAMBERTS, MD
My recent post about Medicare allowing patients to use drug vouchers was met by a rousing reception.
By crickets.
It seems that some saw me as one who (gasp) trusted the pharmaceutical companies to do something good. Has Dr. Rob lost (what’s left of) his mind?? Drug companies do everythingwith themselves in mind, and there are alwaysstrings attached. They can’t be trusted. They are evil. Doesn’t Dr. Rob realize that?
I have heard the same thing about insurance companies. I had a patient a few days ago use the word evil when describing the insurance industry. I myself have called them rabid wolves, have decried the outlandish CEO salaries, and have declared that they do a whole lot of things that hurt patients and make my life difficult.
The third member of the axis of evil is the government – specifically our dear congress that can act in such a decisive way. They are playing chicken with the future of physicians and patients; they are under the influence of the money of lobbyists; they are frequently more focused on party dominance and reelection than they are serving those who voted for them.
Clearly our problems would be solved if we could only rid ourselves of these evildoers. Clearly the moral fiber of those leading the pharmaceutical and insurance industries are suspect at best. Come on, simply being included on the same list as the members of congress is witness to our opinion of their morality, right?
No, actually.
OK, now it seems obvious that Dr. Rob has either gotten into some funny mushrooms or is accepting cash payments by the above mentioned evildoers. How could anyone look at what these people do to our system, what they take out of that system and put in their own bank accounts, and not call them evil?
I don’t disagree that many things that come out of each of these groups is very destructive to Americans. But consider what task each of these groups performs:
- Pharma – To design and sell drugs that treat or cure diseases.
- Insurance companies – To remove the immediate impact of the high cost of healthcare and make it more manageable for people requiring care.
- Congress – To make laws and design systems for the best interests of the citizens of our country.
All of these tasks are not only not bad, they are actually necessary. We would be worse off without them. So if the underlying tasks of these industries are not what make these groups do things that harm us, then what goes wrong? It must be the people, right?
No, actually.
I do agree that there are people in each group making decisions that help themselves and harm others, but I don’t think they are unique. Human nature drives us to self-preservation and self-promotion at the expense of others. Perhaps it’s survival of the fittest, or perhaps it’s original sin, but the reality is that people everywhere act this way. We are deluded to expect that people with an open opportunity to profit at the expense of others would always shun that opportunity.
Read history, folks.
It is far too easy to hide behind moral condemnation. The folks on the right side of the political stadium are famous for portraying the left as evildoers, but the people on the Left are just as quick to condemn CEO’s, religious leaders, and talk-radio personalities as being evil. We all like to look down on others as evildoers, seeing the replacement of these scoundrels with someone moral (like us) as the cure for any woes our system faces. Doing so is not only simplistic, it nearly eliminates any chance of working together on things, and it gives them license to call us evil when we get our chance in power.
As a doctor, I am one of the targets of the evil label. How could we doctors become rich off of others pain? How could we have our enormous salaries when our system is going down. Clearly we need doctors who are morally upright. Hearing such accusations makes me want to lash back. I see what good I do in my situation and see how others stand in the way of my doing more good. I want to jump up and down, point, and scream at the axis of evilas being the root of the problem, not me! And what would these groups do in return? They vilify us greedy doctors.
I will admit that I am very set on maintaining my present lifestyle and bettering it if at all possible. That’s pretty normal, isn’t it? True, I have resisted the temptation to choose a more lucrative specialty; I don’t whiz 40 patients through my office each day; and I don’t do procedures in my office to make extra money off of my patients. Yes, those are moral choices for me. But these choices get harder each year with the ratcheting down of reimbursement and the growing hostility toward doctors. It’s tempting to say, “Screw them, I am just going to take care of myself and open a boutique medicine clinic. I can have no pressure, more time with patients, no insurance headaches, and a much nicer lifestyle.” Many have made this choice, and I personally don’t blame them. They aren’t evil either.
The problem is not the morality of the people in the system, it’s the system itself. Pharma has been given the ability to set exorbitant prices, maintain patents for very long periods of time, and even gouge once medicines become generic. The system has been set up to encourage this, and they are simply doing what they are allowed to do. Insurance companies are under huge pressures for quarterly profits by their shareholders, and so are required to milk the maximum dollar from the system. They are allowed to do this as well. Congressmen and women are allowed to make a career out of being a politician, are not really accountable for the money they accept from special interest, and have all sorts of other rules to make it hard to stand on principle. We have set up our system that way.
I don’t think it’s wrong to condemn the practices of these groups, nor do I think doctors shouldn’t be revealed for any unethical practices. The world is better when people play nicely. But we need to hop off of our pulpits, put down our torches, and put away the scarlet letters that conveniently put the blame on others. This is not the problem of others, it is our problem. We are the ones with the power to change these things.
There is one catch: we must work with those evildoers over there to get anything meaningful done.
ROB LAMBERTS is a primary care physician practicing somewhere in the southeastern United States. He blogs regularly at Musings of a Distractible Mind, where this post first appeared. For some strange reason, he is often stopped by strangers on the street who mistake him for former Atlanta Braves star John Smoltz and ask “Hey, are you John Smoltz?” He is not John Smoltz. He is not a former major league baseball player. He is a primary care physician.
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I like your comment and your alias. We are being hijacked, and spineless doctors are not just putting up with the antics, they are freakin’ clueless or just the whores and cowards I call them to be as a group, not the whole, but a sizeable percentage!
Good concept and excellent post. This is my first time i visit here. I found so many interesting stuff in your blog. I am looking forward some more information from your end, it’s really helpful for me. I will bookmark your site to check if you write more about in the future. Please keep up the good work.
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Nate: It would be especially difficult to hijack things without a spine. You’d bend all over the place.
” These companies are hijacking the American people and have hijacked the Congress for personal gain.”
this is silly. No one forced people to do business with any evil insurance company. American people choose to do so for any number of personal reasons. There are plenty of good insurance companies or other ways to buy insurance that eliminate most of the perceived evil and do so at a cost close to the evil company. It is the publics choice to work with the evil, they are not hijacked
My first reaction is that evil is a somewhat childish concept that belittles the importance of the rest of what you had to say.
Pharma, Insurance co’s and Congress have one thing in common – they’ll screw you for a buck (or thousand) in the blink of an eye – they like you and I just want to better themselves!
Does that mean I’d rather have a world without them; no, emphatically no.
But that’s not the same as trusting them… every grown up should understand that a politician only cares before you’ve voted; pharma companies would rather have a profitable solution to a questionable condition than a non-profitable solution to any of the myriad of diseases that afflict the third world; and an insurance company will always try to squirm its way out of its obligations…
we live in an imperfect but very wonderful world!
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If I may add my two cents. I believe those of us in the health care industry – and by that I mean those who actually take care of patients – are growing a little cynical by what we see and here. Whether it be from hospital administrators, all the various vendors or the so-called experts and politicians. I for one have grown very tired of the argument that all those mentioned are “evil”. To me it’s like saying the sky is blue. Everyone knows they have their own interests in hand, now let’s move on.
One of my co-workers hates pharma, insurance and D.C., in that order I believe. However, we do need to work with them, as was pointed out above. But, as I grow older I see how absolute power, absolutely corrupts. In this case, it seems the wrong people are giving the information and the wrong people are making the decisions. Sure, everyone wants to believe in the story of Mr. Smith going to Washington, making a difference for the little guy, in this case, our patients. But it just doesn’t work out that way. They get trapped by what traps many of us, ambition and a potential for a better lifestyle.
So, it’s true, “we” have to work with “them”, but in this case I would use the old quote, “keep your friends close but keep your enemies closer”.
Not Exactly, I like your comment and your alias. We are being hijacked, and spineless doctors are not just putting up with the antics, they are freakin’ clueless or just the whores and cowards I call them to be as a group, not the whole, but a sizeable percentage!
There are the usual suspects who challenge me and just think their position is better or holier than mine, yet, they are not peer equivalents like Dr Lamberts. I don’t know this blog author, but, I know his peer equivalents, and, I truly respect and admire people who have the gonads to speak out and challenge the stupid status quo. And this man is one of them!
In the end, and I hope my colleagues stop and think about this, go back to your training and consider those who were the cherished mentors and supervisors who touched your souls in training, and realize that if you accepted the committment in becoming an MD, this is the final bullcrap that we have to take a stand and not just refute, but fight against to advocate and represent those who we agreed to treat and support, as patients. This is what being a doctor is about, maybe not all of it, but a sizeable part of it.
And I am not interested in being polite or politically or internet-ally correct in the following: screw you dissenters and people who only have one agenda–yourselves! Thank god you are not doctors for the most part. You would fail if you were MDs and probably lose your licenses by now if monitoring boards did their jobs right. If you took the Hippocratic Oath and meant it, you would not be arguing this matter now. So, those who challenge and demean those of us who are fighting the Washington intrusion, well, you know what I would like to print here. And find out if it is anatomically possible!!!
Again, to Dr Lamberts, I for one appreciate your posts here. They are the few and respectable comments about what should be a “Health Care Blog”!!!
Mr Holt, if you read these comment sections, take note!
Logic is cogent. I am just not as cynical/paranoid. I do have a spine.
“The system has been set up to encourage this, and they are simply doing what they are allowed to do.”
Flawed logic, my friends. These companies are hijacking the American people and have hijacked the Congress for personal gain. They are doing all that they can get away with.
The spineless doctors put up with these antics, having been sold out by such groups as the AMA, whose leaders, also, have hijacked the organization for personal gain.
Add a fourth to the axis of evil, and even more more malignant to the destruction of medical care and physician function: the greatest hijackers of the all, the HIT manufacturers.
Exhausted: Not calling people evil is not the same as accepting behavior. The things that are done are reprehensible, and people should be held accountable for this. My point is not to be polite, it is that calling people names does not just not work, it gets in the way of change.
By the way, AA and other addict groups do not say that their behavior is OK, they say it is “insane” because it causes such agregious harm and they still do it. Only those who are in denial of their addictions say otherwise.
Dr. Lamberts is correct. Insurance companies and pharmaceutical companies are not evil. And neither is Goldman Sachs or BP. For the most part, they are simply trying to maximize profits while following the rules of the game.
The problem is with the rules of the game. And in this case, we the voters are to blame.
It is always easier to blame problems on some evil character that you don’t know very well. But you never solve problems this way.
I respectfully disagree with you, colleague. We are a culture of great risk for addictive behaviors, be it drugs, sex, power, and the largest disruptor, money. And our political system engages in overlap of these types, and they are hooked beyond negotiation and compromise. That is why incumbents are hopefully to be tossed by November. They are losing in primaries now, so the public is getting wise.
Just pay attention to not only who argues against this, but what the arguments are to keep the status quo. If not fellow addicts, then the clueless and terminally optimistic. It is deeds, not words that define us, and the failures in the House and Senate have acted very loudly and ineffectively. And I think you know this.
Being polite and respectful gets used against you by addicts, so remember that too.