Wednesday, January 9, 2008

Thoughts on economic theory

Thanks to recent lectures, I've been thinking a lot recently about the role that economics plays in our health care system hodge-podge. I've found that economists tend to have an extremely narrow worldview. For them, it's all about the money. To some degree, this is pervasive in our country. Measures of success or failure are, almost entirely, monetary.

I disagree. Sure, money is important, but it is by no means the most important factor in health care, even in a country where costs are spiraling out of control. Money's useful as a means to an end, but as Kaufman and Hart so hilariously reminded us in the 1930s, you can't take it with you. Monetary measures of success make even less sense in a health care context, where so many people are driven by intellectual curiosity and a desire to be useful. As newbies on SDN are regularly advised, medicine provides some job security, but if you're in it for the money, get out now.

Here's the thing. Beyond a certain personally-determined point (say, 30k, 50k, 80k -- whatever), income doesn't really matter any more. Obviously, everyone's balance point is different and depends on things like educational background, career choice, personal goals, family situation, etc. My own limit, based on my educational debt and the fact that I'm not going to have a real job until about 10 years after many of my peers, is somewhere in the region of 50k; much less than that and I might consider leaving medicine (and doing what else? writing?) Once your basic needs are met, the rest is just fluff.

I took a fantastic literary theory class in college, which made me by turns a structuralist, a psychoanalyst, a deconstructionist, and a Marxist. (I remember when I told my parents that one.) Literary Marxism, which is quite different from its economic cousin, is the view that money and class are the most important motivators. I suppose that I am therefore now an anti-Marxist. (Theory-wise, I'd peg myself for a deconstructionist at the moment. The reader brings more to the text than many other theories allow for. But that's a story for another blog.)

To recap: economics isn't everything. In fact, it may well have been an over-reliance on economic theories that got our health care system in the current mess. As Lange's excellent Understanding Health Policy states, health care is not a good in the same way that DVD players are a good -- it's too unpredictable, for one. Economics has been the driving ideology of health care at least since the turn of the last century, when charitable almshouses began consolidating into hospitals. Perhaps the debate on universal health care should turn to a different model, one that addresses both the motivations of physicians and the needs of patients.


Panda Bear said...

Har har. Print out your post. Put it in an envelope. Open it up in ten years and see how your opinions will have change.

$50,000 per year? Oh man.

Money drives everything. Not money in the sense of the printed paper or the electronic credit but the idea that money is an exchange medium for things that everybody values. We don't use chickens and bushels of grain because they're hard to carry and making change for a hen is pretty difficult. Therefore, everything you want, a house, a car, food, a vacation, books, movie tickets, savings for your retirement, are going to cost money and more than you think. Not to mention taking care of your spouse and children.

Money doesn't have to be your master but a healthy respect for the freedom it buys you is essential. Disdain for it is naive and will not withstand reality.

Panda Bear said...

By the way, it is perfectly OK if you only want to make fifty grand a year. You can, at any time you wish, give away as much money as you want to bring yourself to that magical number. The problem is that you want to set the conditions where everybody else, most of whom do not share your morality, can only make the same themselves. Quit trying to force your morality on us.

The Scrivener said...

Whoa now. I'm not trying to "force my morality" on anyone. All I'm saying is that everyone has different monetary breaking points, at which the work they are doing no longer becomes worth it. Evidently yours is higher than mine. Fine. I never said that this was a good way to determine salary, and I never said that we live in a money-free society.

Will my views change over time? Perhaps. But it was my mother, who has been working continuously for the last quarter-century, who taught me the line about basic needs and fluff.

Panda Bear said...

I was being a little toungue-in-cheek. I know you're not trying to force your morality on us, I'm just saying that many people who are idealists also want others to live their ideals. In other words, if you believed that doctors made too much money and advocated social change that decreased our salaries to that level this would hold.

As far as materialism and fluff, I am about the least materialistic person you could meet. I own no personal electronics, I drive a Toyota Echo and will probably upgrade to a Corolla some day, have no expensive hobbies, hate to shop, have very pedesterian tastes when it comes to food (I prefer Taco Bell to fine dining), but I still realize that money equals freedom.

$50,00 a year, by the way, after you pay off your student loans is going to feel like $30,000 a year which is not, I assure you, a lot of money on which to live. One day, while you are making the equivalent of 10 dollars an hour working as a physician with twelve years of rigorous education you will look around and see that, at least in my town, Burger King is paying nine dollars an hour for people with GEDs.

The Scrivener said...

There is a very important difference between idealism and naivete.

All I'm saying in this post is that if doctors' real salaries kept declining, as they likely would if universal health care were adopted, I would be willing to stay in this field until $50k (or rather, the inflation-adjusted equivalent). Do I think that $50k/year is a "fair" salary for the sort of work physicians (and especially residents like yourself) do? No. But it is my PERSONAL lower limit.

My current Saturday teaching job pays me the equivalent of about $3/hour, but I do it anyway. Just as with medicine, there are negative aspects, but I enjoy teaching enough that, coupled with the nominal compensation, it is "worth it." These are personal choices, and I understand that others may have different comfort levels.

What I want to get across is that the Almighty Dollar has some competition.