The Council of Wage and Price Stability ruefully pointed out last week that with accelerating incomes -- the median is about $63,000 a year -- doctors are getting richer faster than any other occupational group. And that includes lawyers, whom the medical people overall now outearn by 2 to 1.
While lawyers are restraining the disparity by increasingly bringing suits against doctors, the surge of medical affluence nevertheless remains the most difficult domestic problem facing the Carter administration. Joseph Califano, who gave up a $500,000-a-year law practive to become secretary of health, education and welfare for about the average wage for a doctor, said last year that doctors' pay must be held down if the nation is ever to afford a national health insurance system. But even the usually optimistic Califano conceded that "we just don't know how to deal with that problem."
The reason it is difficult is that those who minister to the body, unlike those who minister to the soul, spring from a tradition that puts them at peace with personal affluence. They have no trouble harmonizing with the time-honored American interest in getting rich, as is evidenced by the investment advice carried by many medical journals. Furthermore, with our unique method of the doctor prescribing, the patient receiving, and a patchwork of insurance systems paying, ther's lots of money in the systems paying, there's lots of money in the system and no incentive to be frugal in using it. As a result health-care expenditures now exceed defense as a slice of the gross national product, and if the present pace continues, we'll all end up working for Blue Cross.
Health planners see no feasible way out, which largely accounts for the fact that our last four presidents were thwarted in thier efforts to adopt national health insurance. But there is a way out, herewith offered gratis, though unrequested, that would enable Carter and Califano to snap that losing streak without incurring the wrath of the medical profession (which can be nasty at election time) and without denying the American people needed medical care. Moreover, this could be achieved not only at no additional expense, but with considerable savings.
What's proposed here is a medical adaptation of the agricultural soil-bank concept, wherein farmers are paid for not growing crops. Borrowing that method, doctors would be paid for not doctoring, which isn't as inhumane as it sounds, in view of HEW's own contention that American medicine is rife with needless hospitalizations, medically purposeless surgery, and overprescription of drugs -- all of which run up the costs, HEW says, without producing any health benefits. Indeed, quite the contrary, according to critics of our damn-the-costs health-care system, since treatment is almost always accompanied by some risks, and many patients eventually suffer more from doctoring than from what orginally impelled them to visit the doctor.
The medical bank, let's call it, makes even more sense when we consider a peculiarity of medical economics. Doctor incomes account for a relatively small portion of overall medical expenditures -- about 20 percent. But in the course of their income-getting, they write the orders -- for hospitalizations, tests and drugs -- that account for about 70 percent of health spending. Thus, doctors are big spenders with other people's money, and that's what mainly accounts for zooming health-care costs, though they themselves, of course, are getting a slice of the growth.
Given the medical profession's political clout and understandable desire to protect its livelihood, public policy should be aimed at combining medical affluence with incentives to stay away from all but the most obviously needful patients.
My proposed medical bank would do that. Once the efficacy and economy of paying professionals for not rendering services has been demonstrated, the prinicple could be extended to other fields -- perhaps even eventually to federal officialdom itself.