Talk to the Rotary

Daily Observer

May 31, 1973

A few weeks after the talk to the Rotary, Lapius, well recovered from the laryngitis that had rendered him hors de combat, was seated at his desk punching at the typewriter.

“Writing imperishable prose?” I asked him.

“Not exactly,” he said, adjusting the green eyeshade which he always wore when writing.

“What I have to do is answer stupid questions. Since I couldn’t answer questions from the floor at the Rotary because I had lost my voice, you remember, the night Tunney presented my lecture, I suggested that questions be mailed to me and I would try to answer them in writing. But it is a thankless chore.”

“Why so?”

“Well, if you err from the podium, you can always deny you said it. But how can you deny you said something that you have written and signed. It’s like a contract.”

“What are the questions?”

“Strangely, many people want to know why doctors are so unpopular. I thought that was covered in the talk, but Tunney swallowed my words and must have swallowed those in particular.”

“But it’s an interesting question. Why are doctors unpopular?”

“That’s just the point. They aren’t. Doctors’ offices are always crowded and appointments must be scheduled well in advance. That’s not unpopularity. Quite the contrary. And in fact the medical profession is under attack for not providing enough doctors. If people want more of them around, they must like them.”

“Well, still I get the feeling at times that we are under attack. The Physicians Forum for instance, rails against the profession as it stands and says that the elite role of the doctor must be abandoned, whatever that means. The government moves the economy into Phase Three except for doctors who stay in Phase Two. Doctors have to buy commodities at Phase Three prices with Phase Two money. It strikes me as discriminatory.”

“Of course it’s discriminatory, Harry. The government is trying to keep the cost of medical care down, and unfortunately the doctors are caught in the crackdown. But it’s not because they don’t like doctors, it’s because they don’t like doctors to earn too much.”

“What’s too much?”

“Well, no one in government has defined that yet. For instance, an executive at General Motors who earns $100,000 yearly isn’t earning too much. And when he retires on a pension of $50,000 he isn’t earning too much either, apparently, despite the fact that his contribution to society is nil. Fortunately he hasn’t in his lifetime become a necessity to society, so they don’t pay too much attention to his income. But doctors are apparently vital to the health of the country, or so the government would have you believe, so they regulate them somewhat, as they would any utility.”

“You make it sound reasonable Simon. But doctor’s fees probably don’t represent more than 20 percent of the national yearly medical bill. Look how often a patient pays $10 for a visit at the office, and $15 for the prescriptions. For two weeks of hospitalization a patient pays about $2000, even more when surgery is involved, where the medical bill probably doesn’t exceed $200.”

“Of course the big jump in medical costs accrues from the immense increase in hospital billing. That’s because for years the major subsidy to the nation’s health came from underpaid hospital employees. But they unionized and are paid union scale, which must have doubled hospital costs.”

“So why don’t people resent hospitals?”

“How can you resent a hospital? What do you resent? The building? The beds? The telephone operators? The administrator? The board of directors? It’s an anonymous entity. It’s a physical plant run by ghosts. It’s a passive entity. But a doctor is flesh and blood who is doing something actively to your body. He can be confronted. Did you ever try to confront a hospital? How do you confront a hospital? Even the doctor working in the hospital doesn’t know how to confront it. He has to go to committees. And the committees have to approach other committees. Sometimes the same people sit on both committees. You know what a committee is, Harry. A camel is a horse that was put together by a committee. But the fact is Harry, that with all the griping, no one resents either doctors or hospitals. They resent the cost of the system. Illness is a cruel accident that penalizes people financially when they are most vulnerable physically. That’s the dilemma, Harry, and the solution will not please everybody.” Lapius went back to the typewriter.

“How are you going to answer the question, Simon?” I asked as he adjusted the green eye shade.

“I just did. Now if I can only remember what I said --.”