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.