So needless to say it’s been awhile since I’ve posted.  There are three reasons for this (in no particular order):

1. MDs are greedy and there is nothing I can do about this, so I am trying to move on (MDs make it difficult though).
2. I am nipples deep in my dissertation and it gets the vast majority of my time.
3. I am learning C#/.NET.  It takes the vast majority of my “free” time.

Until either #2 or #3 are cleared off my plate (the dissertation will be done by spring 2010) posting will be light to non-existent.  Click the RSS feed link at the bottom.  It’ll be good for you.

Friendly, neighborhood doctor

Working in a hospital I get a interesting, and largely unique, perspective on how they operate and how the people who work in them think.  One of the more interesting things I have encountered is the phenomenon of the “poor MD”.  I was in my lab when I overheard two physicians, in the hallway, talking about how poor they were!  They were bemoaning the fact that their student loans had exited the grace period and now the payments were coming due.  At the time I just thought it was two guys who were just pissing and moaning and it did not mean anything.  Later, I heard a surgeon saying the same thing.  This time this MD was talking to me so I pressed her on the matter.  She really did believe that the “money was leaving the profession”.  Those who know me know this would not be allowed to stand so I called her out on it.  I have the ability to give someone a look that clearly indicates that I believe they uttering the dumbest thing I have heard in quite a while.  The presence of this look initiated a session of stammering and hedging on her part.  As it turns out the money is good.  As it turns out the work is mind numbingly boring at times.  As she speaks I’m doing some math in my head:  she makes in two months what I make in a year and she makes in a day what the population of 33% of the planet makes in year (that’s over 2 billion people).  What it came down to was that she expected something different.  I thought that maybe she was just having a bad day until I ran into a much better example.  I was talking with a male MD about something and he mentioned how poor he was.  “Again?”, I thought.  MDs seemed to be obsessed with their student loans and they treat them like bogymen (I’ll come back to the student loan issue below).  Same story as the female but with one little twist.  The female MD drove a beat-up Celica, the male drove a shinny, new Porsche.  Unfortunately for both of us, he left before I got a chance to compliment him on his titanium balls (though I have been referring to his car as a “penis-mobile” ever since–it annoys him, makes me laugh).

Freddy Kruger of student loans

So exactly how bad is the student loan situation for MDs?  The usual advice from financial advisers who aren’t named “Suze Orman” is borrow about twice the starting salary of the job you are likely to get with your education.  In my case my total student loan debit will be around $35,000.  My starting salary as tenure-track assistant professor (the starting salaries for industry are usually a bit higher) will be about $40,000-45,000 in Charlotte dollars (2009).  That is a ratio of  0.875-0.77.  I do not complain about my student loan debt except to bemoan the fact that some universities, Ph.D. students have $0 debt from their graduate education (but I have made my bed).  Let us compare.  According to the AMA, the average total student loan debt for a newly graduated MD is $154,607.  The median starting salary of a post resident MD is $143,000.  A less than back breaking ratio of 0.92 (which incidentally is a better debt-to-income ratio than I have).  Also, this means that even if MD salaries were cut in half by the upcoming “health care reforms”, they would still have a manageable level of student loan debt.  They would not be able to live the plush lives they do now but that is not such a bad thing.  But in the end that’s really the issue.  I have yet to encounter an MD who convincingly makes the case that they became a physician for anything other than the money (with a close tie for second being the “cool factor” and lifetime employee regardless of your competence).  In the end, MDs take advantage of an artificially created shortage of physicians to bolster their own salaries and even though the vast majority of physicians are not members of the AMA they still are more than willing to profit off the situation and offer no challenge to the draconian regulations the AMA is allowed to impose in order to start a medical school and I have yet to hear any MD group advocating for the enhanced importation of foreign doctors.  In the end, it is not the student loans which scare physicians and MD wanna-bes, it is the thought that the salary may not be there one day.  They are right to be afraid, their salaries will fall as they have been overcharging for many decades now.  They should count themselves lucky that consumers patients are not asking for a refund.

Socrates said that the job of philosopher (a group of which I am a member) is to prepare for death.  The years spent reading and writing are all a way to hone ourselves so that when death approaches we can meet it head held up.  When Socrates was convicted of corrupting the youth of Greece he did not beg for his life, he did not spew venom at his executioners, instead he ordered that a debt be paid.

In America we fear death. We spend the vast majority of our health care dollars at the end of life, largely for procedures that don’t extend life, ease pain or improve the quality of life.  We have a knee-jerk reaction that says we must “pull out all the stops” to prevent death.  But death is a harsh bookie.  It will not be cheated and it will get all that it desires.  Only once we rid ourselves of the foolish, false notion that death is something to be feared and embrace death as the last act of the lives we choose to live, that true health care reform can be had.  Until then we will always be the nation that spends the most money and gets the worst outcomes.  Because we spend it in an effort to unring the bell.

Uwe Reinhardt has a good piece on the NY Times Economix blog but he misses the mark on one point.  He says:

Whatever the insurance industry may say about its prowess in the market for health services, it has always been relatively much weaker than doctors and hospitals in that market and therefore quite frequently has had to raise its premiums at double-digit rates from year to year.

This is only half true.  Compared to hospitals, namely the large companies that own them, the insurance industry does have weak market power.  Physicians are a whole other story.  While I am by no means in solidarity with physicians (they are largely responsible for the health care mess that is American health care), they do not have really any market power.  If a physician does not want to do business with a certain insurance company the only recourse that physician (or practice) has is to not accept patients from that insurance company.  Given the consolidated nature of the insurance industry I doubt a physician can just refuse to see a given population of patients.  A Hobson’s choice if there ever was one.  The only exception to this is the largest health insurance provider… the United States government.  There is a growing number of physicians who are refusing to see Medicare patients.  The payouts are below private insurance so physicians cannot maintain their desired salary if they have a high concentration of Medicare patients in their practice.

The Referendum by Tim Kreider.

It has one of the best descriptions of children and why I do not want any.

The New York Times Letters section contains a letter referring to “Health at Every Size”.

Let me state this simply:  You cannot be a person (of any sex) who is 5′2″ and weights 250 lbs and be considered healthy, because you are not healthy.  Sorry.  Unless you are an elite athlete, BMI matters.  Now I’m off to Chic-fil-a.

This would be the third blog I have started in my life and only now have I realized something.  I do not have a voice, not in the writer’s sense of the word.  Writers spend a great deal of time finding and refining their voice.  No one would ever confuse Christopher Hitchens with Thomas Friedman.  They each have a unique voice.  I realized today that the entirety of why I don’t seem to be able to write anything is due to the fact that I do not have a voice.  My writing is nondescript and my ideas lack insight.  If you wonder why this blog sits fallow for weeks on end, now you know.

I really have to stop reading the comments attached to news stories (especially on MSN).

Between Mark Sanford and the rest of the Republican “family values” bunch, Sandra Tsing-Loh, Laura Kipnis and the rest of the marriage is dead bunch, the Chinesegovernment (well all dictatorial, totalitariangovernments) and what is happening on Wall Sheet, it is making me rethink my stance on hypocrisy.  It really should not be sufficient to damn one’s argument but when the hypocrisy is so rank, so abject, so shameless I am not sure there is any argument that needs rebutting.  I really don’t know.