The Unpopular Doctor
A few weeks after the
talk to the Rotary, Lapius, well recovered from the laryngitis that had
rendered him hoarse 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. “I am trying to
answer stupid questions. Since I couldn’t respond 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 passive. 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 --.”