Doctor, spare me the politics - you're making me sickThe other day I was listening to the news on BBC radio, and the subject up for discussion was the market-based reforms of Britain's creaking National Health Service. The BBC duly wheeled in a doctor to make the case against the government reforms and - rather predictably - he was indignant that the idea of consumer choice and competition be applied to his part of the cosy and old-fashioned government health monopoly.
Medical Progress Today
August 25, 2005
The U.K. is not the only place where doctors routinely attack market policies. In the U.S., noted physicians (and authors) like Marcia Angell and Arnold Relman have been equally hostile to consumer choice and market forces in health care. "The whole idea is unsound," Relman has said. Angell has called for drug price controls in the U.S., and for the FDA not to approve any new drugs unless they outperformed older drugs in head-to-head studies - policies which would be sure to cripple drug research and deny consumers access to new medicines. In early June, Angell and Relman even travelled to Canada to praise its Medicare system as an international model.
Less than a week later, the Canadian Supreme Court ruled that "delays in the [single-payer Canadian] health-care system are widespread, and that, in some serious cases, patients die as a result of waiting lists for public health care," and that "the prohibition against private health insurance and its consequence of denying people vital health care result in physical and psychological suffering that meets a threshold test of seriousness."
Price controls, government monopolies, and fewer choices are better for consumers? Whatever happened to economics 101?
Doctors dabbling out of their field is nothing new. In fact, Plato observed exactly the same thing way back in ancient Greece in 380BC. He pointed out the irony that practically any ignoramus feels qualified to pronounce on weighty political matters, even though a butcher would never dare advise an architect, nor a ship-builder a lawyer.
The great sage may have had a point. Doctors obviously know a great deal about osteoporosis, or kidney stones or syphilis - and much, much less about cost-benefit analysis, the time-value of money, patents, or any other topic that is critical to analyzing the proper role of government and markets in the provision of healthcare.
Or, to put it another way, your average physician has spent his education and career with his nose stuck in the Lancet, JAMA and other medical journals, and not in such tomes as Hayek's Road to Serfdom or Marx's Das Kapital. He is likely to know more about Milton Berle than Milton Friedman.
Doctors are personages of immense learning and specialisation - in medicine rather than politics and economics.
As a desk-bound policy wonk myself, I am utterly unqualified to pass informed comment on Mrs Jones' water retention problem, let alone suggest a cure. So why, then, should a doctor who specialises in such matters feel that he is qualified to determine the best way to organise a nation's healthcare system? That is, after all, a deeply political question, only meaningfully discussed by those in full command of the facts and the theory.
That is not to say, however, that doctors have no right to voice their political opinions, no matter how hare-brained. Any John Q. Citizen can yell away until he's blue in the face, and that's quite alright with me. But what I do find puzzling is that anyone should want to listen to doctors' opinions on politics, especially when one considers their lamentable inability as a profession to speak political sense.
Take the British Medical Association (BMA), for example. This august body represents the interests of 75 per cent of all doctors in the UK, and speaks on their behalf both domestically and internationally. Its policies are determined by its elected members, the majority of whom are practising physicians.
The only problem is that the policies this band of docs comes up with are, well, rubbish. Readers may be aware that Britain's health service is rather akin to Canada's in that it is both paid for by the government and run by the government, and has a near monopoly over healthcare. And, similarly to Canada, the outcomes for patients are depressingly poor, especially when one considers the vast amounts of money spent by the government. The BMA, however, wants to keep it that way.
Over recent years the Blair government has realised that by introducing some choice and competition into the health service, it is likely that standards will improve while costs will go down. Eminently sensible stuff, and in areas where they have managed to bring in competition - in heart disease, for example - waiting lists have been almost eliminated.
But this is all opposed tooth and nail by the doctors of the BMA. They bleat about the unfairness of competition and its impact on staff morale. They whine that it might lead to the break up of the sacred NHS. To the docs, it doesn't matter what works if it doesn't fit in with their political world view - which seems to be some kind of nostalgic but incoherent socialism-lite (think Marx meets Marcus Welby).
I might just be cynical about the BMA, as British doctors have managed to secure from the Blair government some of the highest medical salaries in Europe. You can understand them wanting to defend the monopoly which has allowed them to pull that one off.
But the doc rot does not stop at the shores of the Anglosphere. In fact, it seems to be a global disease. You've have probably heard of Doctors without Borders, that philanthropic band of medics who provide basic care in some of the most desperate and poor regions of the world. In that, they certainly provide a needed service for thousands of people who have been failed by their own governments.
But you should hear these doctors when they start talking politics. They seem to work from the archaic premise that any profit in medicine is inherently a bad thing. In order to promulgate the varying strands of this message, they have set up an enormously well-funded lobbying wing that has become the first port of call for health journalists from organs such as the New York Times and its British ideological counterpart, the Guardian.
These lobbying doctors have an almost swivel-eyed distrust of private enterprise (particularly American corporations) and a hatred for profit in medicine. So, they are at the very front of the campaign to eliminate private research and development of new medicines, and call instead for the abolition of intellectual property and massive increases in government funding for drug research.
Bearing mind the dismal record of governments everywhere to produce things that people actually want, their position is clearly lunacy.
Then we come to the World Health Organization - the political doctor's mother lode. This body is infested with leftist medics who delude themselves that they know a bit about how to run big, political projects.
Since they launched their bid to banish malaria from the globe back in 1998, they have actually managed to let it increase by 12 per cent. The WHO bureaudocs also thought they would try to halt the spread of AIDS with the activist-inspired, politically-correct treatment programme they named '3 by 5'. That one is not going too well either: because they concentrated too much on treatment and not enough on prevention, they have managed to permit an increase in the total number of AIDS cases to the tune of some 5 million.
The point is, doctors are obviously valuable members of society that can cure diseases and help the sick in ways that noone else can. This marvellous ability comes through years of specialised training, followed by years of work in a surgery or hospital.
But we should recognise the limitations of doctors, despite all their good work. They often do not have the experience or the knowledge to pronounce on the best way to order societies. And as the WHO shows, they are certainly not cut out to be leaders of big, political projects.
So the next time you hear a physician grousing about markets and profit, why don't you ask him if he'd let an economist remove his kidney stones?
- Why the healthcare crisis won't go away, Christian Science Monitor, 7-18-05
- Press News Limited, 6-6-05
- David Gratzer, An End to the Party Line, MacLeans, 6-14-05.
Philip Stevens is the Health Programme Director at the International Policy Network and has held research positions at the Adam Smith Institute and Reform in London, and spent several years as a management consultant. He holds degrees from the London School of Economics and Durham University.