WHILE I'm hoping for the best from President Clinton's long-awaited and much-delayed health-care reform plan, a recent conversation I had with an old college friend leaves me feeling none too optimistic about the prospects for any serious reform.
My friend, an eminently successful surgeon I'll call George, spoke with unbridled animosity about the increasing intrusion of government into the medical profession since he began practicing 18 years ago. "It's impossible for doctors to make it in this country anymore," he said, blaming the sad fate of physicians on "socialized medicine."
The Clinton administration, George is certain, will only make things worse. It was hard enough to make a decent living under recent Republican administrations, "with all the paperwork and regulations," George told me, but Mr. Clinton's tax policies "are destroying the incentive and initiative of the people who make America go."
I've known George for 24 years. He works very hard. He has three different practices in two cities, and he also teaches at a major university medical school. When he speaks of our old college swimming coach, long dead now, he gets tears in his eyes. He's been married to the same woman for 16 years, and together they are raising two obviously much-loved children. George is a good and caring man. A decent man.
He is also a man who owns a lakefront home built to his specifications. Tied to the dock in front of the house are his houseboat, his ski boat, his fishing boat and his runabout. His children go to private school. He drives a Mercedes Benz. He belongs to an exclusive country club. His wife just bought a $2,000 coat. I don't know what his annual income is, but I know it's well in excess of $250,000.
During our conversation, George made multiple references to the Wall Street Journal and Forbes, explaining to me that "Forbes is a magazine that CEOs and other important businessmen read." He made no references to the Journal of the American Medical Association or the New England Journal of Medicine, but he did advise me to invest in mutual funds.
He also told me that Health Maintenance Organizations (HMOs) "don't give people any choice" and that HMOs "are denying people medical care they need." When I asked him to give me an example of someone who was denied medical care by an HMO, however, he replied that it was hard to give a specific example. I repeated my question several times, and each time he was equally evasive.
I suspect he was embarrassed to give me an example of what he meant because the kind of choice -- the necessary medical care -- he has in mind is high-priced elective cosmetic surgery. Indeed, a very large portion of George's income derives from making people look better. I'm not talking about face-lifts here, but neither do lives hang in the balance when George wields his scalpel. Let me give you an example:
When I was a teen-ager, I went through the windshield of a car. I was badly cut up, and I've some ugly scars on my neck that are still quite visible 30 years later. George knows how to remove scars like that, considers their removal a medical necessity, believes he is performing a humanitarian service for which he deserves to be amply rewarded and doesn't wish to hear that my scars and I have grown rather fond of each other over the years.
I don't mean to make George look bad. I've encountered doctors who are truly mercenary, like the one who charged $475 to examine my niece's broken collarbone for 15 minutes, and then prescribed a brace for her that turned out to be too small. I don't believe George is that unscrupulous or that incompetent. I believe he's still the decent man I met my first week at college.
That's what's so depressing about the conversation I had with him. Here's a man who earns year after year at least 10 times what I earned in the best year I ever had, and he thinks he isn't making it; who believes that by performing expensive, esoteric surgery, he's helping to "make America go;" who sounds more like a stockbroker than a caregiver; who seems frighteningly incapable of looking beyond the needs and wants and desires of his own immediate family.
I realize that one doctor does not a survey make, nor are doctors the only factor in the equation of health-care reform. But I can't imagine that hospital bureaucracies, health insurance companies or pharmaceutical manufacturers are any more eager for genuine health-care reform than George is, or any more capable of imagining what life is like for those many, many Americans who are truly struggling to make it.
Meanwhile, George has got a hell of a lot of disposable income to spend in defense of what he perceives to be his self-interest, he's adamantly opposed to any kind of reform that will damage his perceived self-interest, and he has working for him one of the most powerful lobbies in the United States.
I'd say George has a lot more reason to feel optimistic about the ultimate outcome of President Clinton's health-care reform plan than I do.
W.D. Ehrhart lives in Philadelphia.