DOCTORS SPEAK OUT ON HEALTH CARE REFORM

MEDICAL PERSPECTIVES

By : Dr. Herbert G. Butts, M.D. (Gastroenterologist Specializing in Anal Repairs & Sphincter Reconstruction); President, Union of American Physicians for Fiscal Strength, Washington, D.C.; Contributing Editor, The American Medical Journal (Finance & Insurance Section); M.B.A., The Wharton School of Business (Thesis on ‘Margin Management in Health Care’); Top 25 Donor, Radiologists for Unlimited Investment Opportunity Without Taxation (Houston, Texas).

Once again, Congress debates health care reform. Once again, our Nation’s representatives want to squander America’s treasure on wasteful programs intended to provide medical treatment to those who cannot afford private health insurance. They say they want to bring justice and humanity to a system that should care about people, not profits. They say they want to turn a new page in the history of American medicine. They have not really said how they will do this. But one thing is certain: It is going to cost a lot. And when government programs cost a lot, taxes go up. When taxes go up, people with money wind up footing the bill for those who don’t have enough.

As a physician, I welcome Congress’ efforts to reform the health care system. I support any initiative that will bring quality health care to more Americans. But there is a caveat to my support: I will not support any Congressional action that does not guarantee that every doctor will make at least $2,000,000 net annually under the new system. Put simply, doctors are trained professionals. People need us. We know how to fix damaged hearts and sew on severed limbs. We don’t work for free. And we’re not here to help. We’re here to make a living—a really good living. Congress cannot expect us to work our miracles without paying us what we deserve.

Congress must recognize that health care would be meaningless without doctors. Doctors are the only people in our society with the technical knowledge necessary to heal the sick. True, mothers from coast to coast know home remedies for sore throats and colds. But very few mothers know how to anaesthetize their children, draw up detailed charts documenting their health in illegible handwriting, drape them in the customary supine manner, monitor their heart rate then perform precise anal surgery on them with laser equipment. Mothers may be able to cure a mild flu with chicken broth and bed rest. But only we can excise anal cancer polyps or save their children from massive head trauma. No spices, orange peels or herb soups will stop a cerebral hemorrhage. For that, you need a doctor. When the chips are really down, you need us.

Yet many Americans—including dangerous liberal Democrats in Congress—think that we doctors entered our profession because we truly want to relieve suffering. They think we perform anal examinations on 700-pound women because we care about their health. They think we remove ugly intestines because we truly want to save people from cancer. In short, they fatally misjudge our motivations. We doctors would not have gone to school for 25 years if we did not expect to make a fortune after age 40. We would not have spent decades in operating rooms and labs if we did not expect a massive reward for our efforts. And we would not have sacrificed our youth working sleepless 140-hour shifts every week after medical school. Put simply, we have worked extremely hard. It is not about the patient; it is about us. We have suffered to get where we are. As physicians, we will not allow Congress to insult us by paying us less than $2,000,000 every year. It’s about time that someone thought about the doctors for once, not the patients. After all, we do all the work. Patients just lie there under anesthesia and wake up later. That’s pretty lazy, if you ask me.

Doctors need something to look forward to. As President of the Union of American Physicians for Fiscal Strength, I speak for every doctor when I say that we like money. No one in our society works as much as we do. No one in our society delivers such tangible worth as we do. Think about it: When you bring your sick mother into the hospital, our skilled work saves her from death. Isn’t that valuable? If we didn’t spend our whole lives studying and scurrying around hospitals, we could not have saved your mother. Don’t you think we deserve a big salary for that? We are happy to save your mother, but remember what we go through every day, too. We expect to be well compensated for our services. If we did not have large salaries, bonuses and insurance incentives to look forward to, we would not want to get up in the morning. How would you feel if you knew you had to stitch an immigrant’s anal canal for 14 hours for a paltry $500,000 per year? What if you had to stick your finger up a homeless person’s anus for a lousy $500 weekly stipend from a city bureau? And what if you faced medical malpractice charges for creating a vaginal fistula knowing that Medicaid will pay you pennies—if anything at all—for your toils? You wouldn’t like it, let me tell you. In a word, physicians face tremendous stress and difficulty every day. Only sufficient salaries can provide the motivation necessary for physicians to cope with the pressures unique to their trade.

We sincerely hope that Congress will recognize that health care reform will not succeed without our support. No matter what Congress decides to do, it must ensure that every doctor in America receives at least $2,000,000 per year. We leave it to Congress to decide how to organize our pay rates. Obviously experienced doctors must receive more than the minimum salary. Obviously radiologists must receive double the going rate for comparable internists. And obviously doctors who secure favorable results for more patients should receive “performance bonuses.” If Congress really wants to reform health care, it will provide suitable incentives for doctors. If doctors know that they will receive a $750,000 performance bonus if they remove 15,000 polyps per month, they will more zealously remove polyps. A world with fewer polyps is a better world. Congress can achieve goals like these if it simply pays doctors what they deserve.

Many liberal Democrats say that doctors need to consider the “common good” in order to change focus in American health care. They say that doctors must play a “philosophical role” in changing the way our country approaches the issue. We strongly disagree.

First, as medical professionals, we are neither politicians nor philosophers. We are technicians. We are bodily repairmen. No one expects a mechanic to care about philosophy. The same goes for doctors. We are no different from any other worker. We ply our trade and we expect pay for our labor. We stitch, cut, suture, order lab tests and write prescriptions. We do not philosophize. The “common good” is not necessary to perform incisions, administer chemotherapy or clear an artery. While our skills may result in “good” for society, the “common good” is certainly not necessary for technical medical work.

Second, we are really not all that different from other workers in the economy. Although our skills may be especially valuable, we want the same things from life as everyone else. We want to own real estate. We want stable investments. We want cars. We want savings accounts. We want to send our children to college. We differ from average workers to the extent that we work harder. We spent a long time in school and even longer in professional training. It is only fair that we receive some special compensation for our incredible sacrifices. That is why we expect to own at least a second home, and maybe some income-producing rental properties. These are reasonable expectations. Every American deserves some reward for performing valuable work. In that regard, doctors are no different from anyone else in our society.

In brief, it is both unrealistic and unfair to ascribe some special “nobility” to doctors. We work for the same reasons everyone else does. Congress must understand that. We are not saints. We are just trained professionals who perform impressive work. Saints work for free. Professionals don’t.

As our representatives continue to debate health care reform, we demand that they remember the doctors. We are the real miracle workers who make our system great. Our system became great because doctors receive the pay they deserve. They have an incentive to work hard. Over time, those incentives led to revolutionary new treatments, medications and procedures. Until now, our system proved that when doctors get paid, anything is possible.

True, some people in our system could not receive care. But that was a small price to pay for the medical miracles we achieved through proper pay. We expect that Congress will recognize that health care in America depends on well-paid doctors. Without at least $2,000,000 a year, the miracle well will run dry. No one will endure 25 years in school and sleepless 140-hour weeks without a suitable reward to covet. Our country has always rewarded hard work and valuable service. Our health care system is no exception.

We do not care whether Congress adopts universal care or retains our private market system to provide health coverage. We simply demand that every physician in this country receive at least $2,000,000 per year. It is a simple demand. We do not care where Congress gets the money for our salaries. We simply remind Congress that without at least $2,000,000 every year, no doctor will have an incentive to repair anal canals, invent new erectile dysfunction medications or deliver deformed children. In this light, it is in the national interest to keep paying doctors, even if that means taxing other professions. We are the only technicians who can save lives. We deserve to be paid commensurate with the importance of our skill and knowledge. If we do not receive what we are worth, we’re walking. We don’t care what the State disciplinary boards say. This is about fair pay, not duty.

You want us to save your mother when she breaks her hip, don’t you? You want us to save your child when he falls down a drainage pipe and fractures his skull, don’t you? You want us to successfully replace your jaundiced wife’s liver, don’t you? You want us to find a cure for cancer, don’t you? Well, we won’t do any of these things unless Congress guarantees that we get at least $2,000,000 a year—every year. We don’t care where the money comes from. We just want it.

We might be doctors. But we’ve worked hard in our lives. We’ve learned how to cheat death and extend life. We’ve learned how to read medical charts and MRI scans. We know what masses are benign and which ones aren’t. This is valuable knowledge. We don’t share it for free. We spent 25 sleepless years to learn our craft. Congress had better pay up or no one’s going to get it.

IN PRAISE OF SURGEONS

I recently wrote that civilization spawns and perpetuates enduring falsehoods. Until relatively recent centuries, “traditional morality” posed an almost insuperable barrier to scientific inquiry. “Taboo,” “awkwardness” and “religious condemnation” combined to frustrate attempts to use human sense to understand physical phenomena. Although my last essay dealt with a more specific scientific inquiry (sexuality in the animal kingdom), today I apply the same reasoning to a much broader scientific pursuit: Medicine.

Medicine is a scientific discipline. It aims to repair the “human organism” through direct and chemical interventions. Those interventions, in turn, represent the sum total of scientific observation concerning the human body. To that extent, medicine shows its scientific moorings. Like any scientific pursuit, medicine focuses human observation and deductive reasoning onto a tangible, perceptible object: The human body. There is nothing “metaphysical” about this. Men began assembling medical knowledge by watching sick and injured people. They experimented with various cures. Over the centuries, they saw what treatments worked. Ultimately, they came to understand that the human body is an observable phenomenon. By understanding the body’s physical characteristics, they devised more effective cures. To that end, they began to investigate the body more closely. In short, medicine depends on human reason to observe and analyze human biological processes.

But it has never been easy for scientists to use reason. Throughout history, societies have condemned scientists for candidly making reasonable inquiries into subject matter considered “morally off limits.” This was especially true for physicians working in medieval Europe. Church doctrine forbade tampering with dead bodies because people believed that desecrating a corpse would jeopardize the soul’s chances for salvation. Yet physicians could not carry out their scientific work without actual human specimens upon which to make comprehensive observations. Many early medical scientists risked execution by stealing or buying dead bodies to perform dissections. Until the 17th Century, “traditional moralists” labeled pioneering medical scientists “grave-robbers.” Despite these challenges, early physicians laid the sensory groundwork for later investigators. They risked everything to apply their reason in a world that eschewed reason for superstition.

With the Enlightenment, governments began to see that human reason offered better opportunities for power than religious doctrine. After all, scientists showed that they could invent extremely useful devices—especially weapons—and political leaders liked that. In order to hasten discovery, governments began to allow scientists to freely use reason in scientific pursuits. Nonetheless, medicine lagged behind other scientific disciplines because social taboos concerning the human body remained very strong. Christian theology had a hand in perpetuating these reservations, primarily because Christianity holds the human body in contempt, preferring instead to focus on “otherworldly life.” These ideas died hard; and they frustrated physicians who could not make the observations needed to discover effective treatments.

Governments began easing their grip on medical inquiries. Beginning in Italy and England, new legislation introduced capital offenses punishable by “death and dissection,” explicitly authorizing physicians to take the bodies of hanged criminals for anatomical investigation. See Murder Act of 1752, 1751 Parliament, c. 37. Physicians did not care from whence came the bodies they observed; a human body is a human body. These measures spurred more detailed anatomical insights, as well as more effective treatments. Interestingly, however, mainstream society continued to regard medical science with suspicion. After all, legislatures intended their “death and dissection” penalties to be particularly harsh. They represented the social view that physicians were still disgusting grave-robbers. To an average citizen, the idea that a person would want to receive the body of an executed criminal was morally revolting. At the same time, Parliament believed that criminals would fear postmortem dissection more than mere execution—and thus refrain from murder—because postmortem dissection was somehow sacrilegious and “dirty.” (See Murder Act of 1752, calling postmortem dissection “[S]ome further mark of terror or infamy” upon the punishment for murder; See also William Hogarth’s painting The Reward of Cruelty). Despite the stigma and suspicion, physicians continued their work. And today we are all better for it.

In this historical light, I praise physicians for their perseverance against social prejudice. In recent decades, of course, society has accorded far more respect to the medical profession than ever before. But from a historical perspective, doctors have come a very long way against very long social odds. Like all sciences, medicine had to fight through persistent social myths and stultifying moral norms. Ultimately, medicine assembled the objective knowledge it needed to fully understand how the human body operates. Combining that knowledge with other scientific inquiries on chemistry and physics, doctors learned how to treat injuries and diseases, making life better for all.

None of these things would have been possible if doctors had adhered to “traditional morality.” In a fundamental sense, doctors are scientists. As such, they must reject social prejudice and apply pure reason. They are not afraid to acknowledge that man is an “animal” with body systems that can be understood in the same way that animal body systems can be understood. That may seem obvious, but “traditional morality” recoils from the notion that man is an animal. In fact, western theology draws lofty distinctions between animals and men. In the Old Testament, God gives Man dominion over “every creeping thing that creepeth upon the earth.” Genesis Ch. 1:26. But medicine never could have developed if scientists did not acknowledge that man has living organs, just like any other mammal that “creepeth upon the earth.” Man exhibits the same biological processes as animals: He breathes, he sleeps, he bleeds, he eats, he excretes, he experiences pain, he grows old, he dies. Physicians moved beyond the rhetoric about human superiority. They were not afraid to see that man had a body that could break down and fail. Through reason, they learned how to repair it.

Viewed abstractly, physicians, doctors and surgeons perform useful work. I often criticize modern medical institutions for their obsessive focus on money, but that does not diminish my abiding respect for medicine as a profession. After centuries of scientific inquiry and taboo-busting, physicians learned how to stop influenza, transplant malfunctioning hearts, eradicate the black plague, treat venereal disease and even remove cancerous tumors before they spread to the rest of the body. They discovered medicines that ease pain and improve physical well-being. This is valuable work. In its basic substance, medicine is good: Doctors cure disease, heal wounds, take away pain and provide hope to desperate people confronting desperate physical challenges. Modern insurance practice and financial concerns do not alter that basically good substance. Through reason and scientific inquiry, doctors have created a truly beneficial craft.

I often marvel at medicine, especially when I compare it to other forms of work. When a lawyer goes to work each day, what does he really deliver? At the end of his day, what has he produced? He has shown up at court in a suit, asked the judge for another week to hand in a paper, then gone back to the office to ask solemn questions to an injured person about how they slipped on a sidewalk. Or he may have negotiated a merger deal, making some rich guy even more money. But what does a surgeon do? He gets up early in the morning, puts on his scrubs, goes to the operating room and saws open a little boy’s head to remove a life-threatening brain tumor. Afterward, he takes off his mask and tells the boy’s family that he is resting and should recover. In both cases, “professionals” applied their knowledge to “help” someone.

You tell me which service is more meaningful.

After studying law, I gained more respect for medicine because I compared the substance of both professions. As the above example illustrates, the lawyer delivers “value” by defending another person’s financial interests, while the surgeon delivers “value” by literally saving another person’s life. In my eyes, the surgeon delivers dramatically more value. Life is more valuable than money, no matter what any insurance company says. Surgeons take away pain and save lives. Lawyers argue and bicker to save money. The difference is so striking and so embarrassing that it should make any lawyer reevaluate whether he is actually a “professional.” Still, surgeons have not received respect as a profession until relatively recent times, while lawyers always had a high place in society. Lawyers represent the dominant values of society because law reflects and embodies dominant social values. Those values once condemned surgeons as grave-robbers and butchers. But now look at them. Their “butchery” can save a lawyer’s grandmother from cancer, while all the lawyer can do is seek summary judgment in some esoteric contract dispute and win money.

I praise surgeons for their dedication to the abstract substance of medical science. Through human reason and intrepid determination against social prejudice, modern medical science has come a very long way. I am thankful for that. I must be emphatic, however, in restricting my comments to abstract substance. The current form and practice of modern medical science is an entirely different subject. Modern medicine is a tremendous achievement in human civilization. It saddens me that business concerns, money and class structure impede access to this achievement. I can only hope that, one day, everyone has an opportunity to benefit from them. Is it not sad that, after overcoming social taboos and achieving a respected place in society, medicine may now only be available to the wealthy? What good are science and knowledge if only a few can enjoy them?