My two o’clock consultation today was with a Dr. Benway, on the behalf of the American Medical Association. He bustled into my office precisely on time. As I offered my hand, I watched as he surveyed the available seating choices – there’s the sofa by the window, a chair at the end of it that’s opposite my desk, another chair next to the wall to the left of the door (or on the visitor’s right as they enter), a third placed immediately to my right, near the other end of the couch, facing me, a fourth placed immediately to my left, likewise facing me, but also tucked into a cozy paneled corner, offering a nice view out the window, and a fifth one, facing my desk, smack dab front and center, about three feet away from the edge. With only a moment of thought about it as he shook my hand, Dr. Benway chose that as his place of repose.
I’ve come to believe that I can tell a lot about my visitors by which place they choose to sit, and based on my experience with that, I concluded that Dr. Benway wanted to ensure he was in a position of power, and his body language made it clear that he would have very much preferred to sit at my desk, had that been possible.
“Mr. Collins,” he began, “I’m here to discuss a problem that has been plaguing the AMA for eighty years, coming and going like a stubborn case of psoriasis. I refer, of course to the eternal, creeping infection of socialized medicine, which has perennially threatened the health of the American body politic, as if it were an insidious instance of pediculosis capitis.”
“Or an extremely painful case of shingles, perhaps,” I offered, “forever coming and going away, flaring up for no good reason when you least expect it…”
“Yes,” he nodded, “or like syphilis – fulminating at first, then, in response to treatment, retreating to lurk for decades, silently gnawing away at vital organs until, at last, it’s too late to stop it.”
“An idea like a cancer,” I embellished, “starting out tiny, created at a university in some economics or philosophy department, maybe even at a school of public health, then gradually growing larger and larger, proliferating its cancerous offspring, metastasizing all over the campus, invading the political science curriculum, the public policy syllabus, the offhanded remarks of liberal arts professors teaching Dickens, Sinclair and such…”
“Yes, and, what’s more, finally breaking free of academia,” Dr. Benway interjected vehemently, “pumped through society’s circulatory system by the media, its unstable, evil cells latching on to the labor movement, the liberal politicians, the minions of federal, state and local government, and, most horrible of all,” he gasped, “infecting the minds of innocent voters!”
“Nasty stuff,” I concurred, “that socialized medicine. It’s a damn good thing the United States has the AMA to protect us from it, so we don’t end up like Sweden or Canada.”
“It’s comforting to know, Mr. Collins,” he replied, “that I’m speaking with someone who not only agrees that socialized medicine poses the greatest threat to America in its entire history, but also appreciates all the work that the AMA has done to keep that dreaded scourge away from our shores.”
“Rest assured, Dr. Benway,” I lied, “that I certainly do.”
“Yeah,” he mused, “we fought Teddy Roosevelt, we fought Franklin Roosevelt, we fought Harry Truman, we fought Jack Kennedy, we fought Jimmy Carter, and we fought Bill Clinton to stop it.”
“Actually,” I pointed out, “you fought Hillary Clinton.”
“Oh, yeah,” he acknowledged, “and, to tell the truth, she fought like a girl. Defeating her was a piece of cake, really.”
“And to think,” I mused right back at him, “the AMA accomplished that with only the best senators and representatives money could buy and an anti-trust exemption that would embarrass Major League Baseball.”
“Well,” Dr. Benway declared modestly, “we do what we can with what we’ve got, you know?”
“And a splendid job you’ve done, too,” I shamelessly flattered. “But, I take it, you’re a bit worried about… recent developments?”
“We are,” Dr. Benway complained, shaking his head. “After a century of battling this pestilence, today, Mr. Collins, the AMA is genuinely concerned that it might not triumph against this latest… relapse.”
“Could it be,” I ventured, “that it might have something to do with the fact that health care costs in the United States have risen eighty-six percent in the last twelve years? Health care currently consumes about forty percent of our GDP, you know.”
“Statistics!” Dr. Benway waved his hand, dismissive. “Anybody can compile statistics to make things look any way they want. But medicine, Mr. Collins, that’s what I’m talking about – the flesh-and-blood side of things. Why, people have no idea what it takes to make an American doctor! An entire academic career, for example, starting in elementary school, spent honing the essential skills.”
“Science, mathematics and the humanities?” I inquired.
“Of course not,” Dr. Benway sneered, “what are you, nuts? No, I’m talking about the essential skills for getting into medical school – apple-polishing, grade-grubbing, brown-nosing, learning to make convincing excuses so you can get an extra day to study before taking a big test. Later, in college, you have to face the challenges of learning how to select easy courses that maximize your GPA and figuring out what are the best strategies to identify and avoid professors who are tough graders. And then, there’s learning how to collude with your fellow premeds to sabotage other students’ work so you guys all look good by comparison – say, for example, all the premeds in an analytic chemistry class plan it so they get their oxalate reference compound in a quantitative titration lab all at the same time, then the last one to get his drops some salt in the oxalate so everybody who gets theirs after him flunks the lab. Stuff like that is what I’m talking about, Mr. Collins, the important things everyone who aspires to become an American medical doctor must do, because the AMA makes sure to limit admissions to medical schools, so there will never be enough doctors. That’s the key, right there – limit the supply and the demand will always be high! And then, of course, once we get in, there’s medical school itself, where we are taught the essentials of what it means to be an American medical doctor.”
“Anatomy, physiology, biochemistry, diagnosis and treatment?” I asked.
“Those are just the courses they teach,” Dr. Benway chided. “And that’s what I’d expect a layperson to say, too. But again, that’s not what I’m talking about – sure you have to learn that stuff, but what’s really important in an American medical school is that you learn to feel different from everybody else – superior in every way, no longer governed by the petty moral constraints of ordinary people, and absolutely concentrated on the satisfaction of your own, massive ego. Once you’ve accomplished that, you have no problem dumping that sucker spouse who put you through medical school; it’s a piece of cake to run your medical practice to maximize profits instead of your patients’ health; there’s no difficulty in lying to protect your fellow physicians in malpractice suits; moral qualms about accepting free trips to Hawaii from drug and medical device companies simply evaporate; and so forth. That’s the system the AMA constructed, that’s the system it perpetuates, and that’s the system…” he barked, leaning forward sharply to make his emphasis clear, “which the AMA cannot allow to degenerate into government administrated, single-payer, socialized medicine!”
“Well,” I informed him, “according to the latest public opinion polls, upwards of seventy percent of Americans favor a program like Medicare for people under the age of sixty-five, and more than eighty percent would even be willing to pay higher taxes to finance a national health care system. So,” I surmised, “it would seem that your usual scare tactics aren’t as effective as they have been in the past.”
“Apparently not,” Dr. Benway sighed. “We ordered our shills in Congress to use the Big Government Bogeyman, tell the public that Obama wants to put a pointy-headed, incompetent, bumbling federal bureaucrat between them and their doctor, but this time, it’s just not working.”
“Considering,” I observed, “that ninety-nine percent of federal bureaucrats are, in fact, pointy-headed, incompetent, bumblers, the implications are pretty serious.”
“What implications?” Dr. Benway raised his eyebrows curiously.
“Well, despite what Congress and the AMA assume, the vast majority of the American public are not actually fools.”
Dr. Benway squinted at me in utter disbelief. “Are you sure?”
“Absolutely sure,” I confirmed. “And if what you just told me is true…”
“Oh, yes,” Dr. Benway griped, “it certainly is. We hire only the best public opinion analysts.”
“All right then,” I continued, “in that case, what your pollsters’ survey results indicate is, that even though Americans know for certain that dealing with federal bureaucrats is a total nightmare, they have, evidently, concluded that dealing with American doctors is even worse.”
“Jesus Christ!” Dr. Benway exclaimed. “If your assessment is correct, Mr. Collins, the AMA is in bigger trouble than I thought when I walked in here!”
“What kind of results are you seeing,” I inquired, “with respect to your other favorite ploys?”
“You mean,” he asked, “blaming soaring health care costs on the pharmaceutical industry, medical device manufacturers, hospital administrators and health insurance companies?”
“Right,” I affirmed, “and then, after sorrowfully wringing your hands over their greed and mendacity, suggesting that the only solution is to pay doctors even more money.”
“Our public opinion researchers tell us that none of that stuff is working anymore,” Dr. Benway wailed disconsolately, “and when we threatened to fire them because they weren’t telling us what we wanted to hear, they laughed at us!”
“Gee,” I speculated, “maybe they’re so fed up with working for a bunch of American medical doctors, they figure if they never see you guys again, it will be too damn soon.”
“American medical doctors are not hard to work for,” Dr. Benway insisted. “If you don’t believe me, ask any registered nurse.”
“Oh,” I dryly responded, “in that case, I guess your public opinion analysts are just jealous.”
“Most likely,” Dr. Benway huffed in a self-righteous tone. “After all, whenever someone suggests that we’re hard to work for, or that we make way too much money, all we have to say is ‘Oh yeah? When was the last time you had to make a life-and-death decision on your job?’”
“I guess that works with most folks,” I conceded, “but why would it work with nurses?”
“Because nurses aren’t allowed to make decisions!” Dr. Benway roared.
“So that explains it,” I mused.
“Now you know,” my guest murmured with a gloating note. “Being a doctor has its advantages, just like being a Mason. But,” he brusquely stated, returning to a matter-of-fact tone, “since our traditional approaches aren’t working, we need some effective alternatives and we need them quickly. Obama says he wants the House and Senate to pass his health reform bill by the first week in August, and what’s more, we can’t even delay things with a filibuster – Al Franken is bound to be seated in the Senate as a Democrat by then – the scuttlebutt from the Minnesota Supreme Court says Coleman’s case is nothing but a festering pustule of necrotic legal purulence.”
“Courthouse rumors have been wrong in the past,” I pointed out. “And besides, Coleman can always appeal the case to the United States Supreme Court. If he does, even if Coleman loses there, too, Franken won’t get seated in the Senate until October at the earliest.”
Dr. Benway pondered my remark for a protracted period. “Yeah,” he whispered with a crafty smile, “that’s right. Good point, Mr. Collins. I’ll recommend that the AMA slip Coleman a huge chunk of cash so he can pay an army of lawyers to take his case to the Supreme Court and drag it out there as long as possible.”
“Glad you thought of that,” I encouraged.
“Me too,” he burbled, rubbing his hands together excitedly. “Now we’re getting somewhere! What else?”
“Right,” I shot back, playing on his enthusiasm. “You know that proverb, the one which says a camel is a horse designed by a committee? Well, the current Administration-backed bill is the product of three committees! It mandates that the federal government create a health care plan to compete with private insurers…”
“Yeah, that’s right,” Dr. Benway jumped in, “and isn’t that absurd? What would the public think if the federal government got into car manufacturing for instance? So why should health care be any different?”
“Ah, actually,” I remarked, “at the moment, the federal government is, in fact, in the car manufacturing business.”
“Oh, yeah,” Dr. Benway spat out ruefully, “so they are. Forgot about that. How about we start complaining that the government is going to force doctors to work for it?”
“Unfortunately,” I warned, “that won’t fly. Physician participation in the federal health care plan, as currently proposed, would be entirely voluntary.”
“Voluntary?” Dr. Benway’s eyes narrowed to slits as he thought. “That’s it! We’ll boycott the federal government plan!”
“That could work,” I agreed. “Provided you guys all stick together.”
“Why, of course we’ll all stick together,” Dr. Benway proclaimed. “Doctors always stick together – the Mafia has nothing on us!”
“Members of the Mafia are constantly betraying each other,” I mentioned, as offhandedly as possible.
“Oh, you know what I mean,” Dr. Benway grumbled. “I don’t suppose they’re going to force the Christian Scientists to buy health insurance either.”
“No, by the same token, there’s a religious exception. So the AMA can’t play the coercion card, and you’ll have to be very unified if you decide to boycott. Maybe some strict sanctions against members who scab and work for the federal plan would be in order. Internal discipline will be of paramount importance.”
“Okay, granted,” Dr. Benway muttered with an air of frustrated resignation. “But getting doctors to all march in the same direction is like herding cats. Come to think of it, an attempted boycott might do more damage to the AMA than it does to socialized medicine.”
“Well, there are still plenty of other angles,” I assured him. “The current bill says that employers who don’t offer health care coverage as part of their employee benefit packages have to contribute a minimum of eight percent of their payroll, except for certain small businesses, which are exempt – they get a tax credit instead. But all companies that don’t opt to pay the eight percent tax and aren’t exempt would have to offer private health insurance that meets federally-mandated minimum requirements and pay a defined minimum amount of the premiums. Otherwise, they have to join the federal government’s health plan instead. In addition to all that, the House is proposing an “exchange” system that would allow employees to choose among health care options, and wants to subsidize insurance premiums for people who participate, up to an annual income of $43,420 for single persons, with a sliding scale going up to $88,200 for a family of four. Given all that mumbo jumbo, encouraging the public to worry about getting hog-tied in bureaucratic red tape should be a dead cinch.”
“I’ll say,” my guest chortled. “That twaddle is more convoluted than a drunk surgeon’s explanation for leaving his cell phone inside a portly matron’s peritoneal cavity. I’ll recommend we get our PR team drubbing on that as soon as possible – advertising campaigns, talking points for our boys and girls in Congress, clever quips for conservative talk show hosts to spout – the works!”
“On the one hand,” I advised, “have them concoct the appropriate irrational arguments to make the public worry about whether free health care from the government would be of sufficient quality and delivered with the necessary timeliness, while on the other, have them cook up a second crock of rot that tells the great unwashed that they, as taxpayers, should be outraged if the government starts up a national health plan and makes them contribute even a token amount to participate in it. Then bombard Joe and Jane Sixpack with both campaigns at once.”
“They won’t know whether to defecate or develop acute bilateral amaurosis,” he chuckled. “Great strategy, Mr. Collins. Get the American public confused, as well they would be with a PR blitz like that, and then get them scared. And who isn’t scared of getting sick and not being able to afford a cure? Then you have them right where you want them – naked in a paper gown with their butts exposed and their God damn wallets wide open!”
“Indubitably,” I vouched.
“And what about the cost?” Dr. Benway pressed on, now considerably more ebullient. “The latest estimates say that it will cost over a trillion dollars!”
“Yes,” I granted, “that’s what I’ve heard, but I don’t know if harping on that is such a good idea.”
“Why not?” Dr. Benway queried, his expression betraying intense skepticism. “A trillion dollars is a stack of hundred dollar bills sixty-seven miles high!”
“Yes,” I admitted, “it is. But a trillion dollars is also the amount of money the American taxpayers have already given Wall Street bankers so their mistakes won’t destroy the economy. And for that trillion dollars, let’s face it, the taxpayers aren’t going to get much of anything – it’s just a bribe, really, so the average guy doesn’t have to spend three or four years with his family living out of their car and eating in church basements. For this other trillion dollars, however, the average American gets decent health care without having to decided whether to go without food, gasoline, clothes, heat or electricity to afford it. So I wouldn’t put too much faith in the ‘sticker shock’ strategy – a trillion-dollar price tag for health care is bound to look cheaper than a trillion dollars of vigorish paid to incompetents and crooks in twenty-thousand dollars suits, driving their fashion model trophy wives in half-million dollar cars to forty-million dollar mansions to get jiggy with them in a bathtub equipped with solid gold faucets and a six thousand dollar shower curtain.”
“That is pretty damned outrageous,” my guest acquiesced. “So how come those guys on Wall Street get away with it, but everybody says doctors make too much money? Those bums in the financial industry don’t have to get half the education we doctors do, and they make a hell of a lot more money! How come nobody’s mad at them?”
“Dr. Benway,” I attested, “rest assured that nearly everybody is extremely mad at them. In fact, a lot of folks hate them, and not a few people would like to kill them; and some of those would like to take about eighteen hours to do it.”
“Oh,” he murmured, suddenly crestfallen. “So those Wall Street bankers are right down there with the gangsters, pimps, child molesters, used car salesmen, journalists and lawyers.”
“And the doctors,” I added. “But, of those, at least doctors are more popular than the Wall Street bankers.”
“Ah, yes,” Dr. Benway replied, glancing at his watch. “I have to cut this consultation a bit short. There’s um… an ad hoc meeting on Capitol Hill in thirty minutes… it was scheduled just about an hour ago, and I need to stop by the bank first.”
“Make sure to ask the teller for twenties and tens – no fifties or hundreds,” I advised. “Members of Congress prefer small bills.”
“So they do,” Dr. Benway concurred as he rose and shook my hand. “You know,” he remarked in a pensive voice as we concluded our handshake, “I just don’t understand why the public perception of American medical doctors is so negative.” He sadly shook his head. “What ever happened,” he wistfully asked, “to Dr. Marcus Welby, Dr. Hawkeye Pierce and Dr. James Kildare?”
“Dr. Gregory House,” I calmly explained, “slipped Rohypnol into their Coca Cola, injected them with overdoses of succinylcholine, dissected them and burned the body parts in the hospital incinerator.”