My wife often poses the joke “Do you know the difference between doctors and God?” with the punchline being “God doesn’t think he’s a doctor.” The atrocious behavior of my neurosurgeon made me wonder: How does anyone get away with acting like this?
In part one of my deep brain stimulation to fix the tremors in my hands, two holes are drilled into my skull while my head was secured in place by a metal cage with a plexiglass box fitted over it. I was sedated to a level where I was awake but didn’t feel any pain when the drill bit went through my skull, although I could hear it—a sound indescribable yet at the same time unforgettable.
What I also heard was the surgeon continually yelling at the staff, “What I want you to do is just stand there and not move. There is not a thing you can do for me. I guess I must do everything myself. Just stand there and don’t move.” Soon after, I heard him say, “This equipment is so dated. I mean like it’s twenty years old. Why can’t we get any new equipment? My god, this is the end of days. Why do I have to work with this stuff?”
All of this after checking into the hospital one day, being told the surgeon was called away to an emergency and rescheduled for the next day at noon, and then being called in a panic by his office that he was running ahead of schedule and if I could get there at 10 a.m. We rushed to get there at the appointed time only to wait and wait after arriving at the operating room. Getting on the elevator to the operating room, the surgeon said, “I’m going to go have a cup of coffee.” I think he had more than a cup.
In the definitive history of American medicine The Social Transformation of American Medicine: The Rise of a Sovereign Profession and the Making of a Vast Industry, Paul Starr wrote, “The key source of physicians’ economic distress in 1900 remained the continuing oversupply of doctors, now made much worse by the increased productivity of physicians as a result . . . [of the] squeezing of lost time from the professional working day.”
Starr points out that the number of medical schools expanded at the end of the nineteenth century. From the founding of the American Medical Association (AMA) in 1847 to 1900, the number of medical schools more than tripled. And while America’s population more than doubled between 1870 and 1910, the number of physicians increased more than 150 percent.
“The weakness of the profession was feeding on itself; ultimately help had to come from outside,” Starr wrote. Help came in the form of the Flexner Report, penned by Abraham Flexner, brother to the powerful Dr. Simon Flexner, a key player in the chase for a vaccine to battle the 1918 Spanish flu.
Abraham was not a doctor himself. While the report was commissioned by the Carnegie Foundation, “Flexner’s report was virtually written in advance by high officials of the American Medical Association, and its advice was quickly taken by every state in the Union,” Murray Rothbard explained in Making Economic Sense. Using the Flexner Report as a guide, the AMA was able to use the state to cartelize the medical industry. Rothbard wrote:
The result: every medical school and hospital was subjected to licensing by the state, which would turn the power to appoint licensing boards over to the state AMA. The state was supposed to, and did, put out of business all medical schools that were proprietary and profit-making, that admitted blacks and women, and that did not specialize in orthodox, “allopathic” medicine: particularly homeopaths, who were then a substantial part of the medical profession, and a respectable alternative to orthodox allopathy.
The report recommended closing schools, discarding competing therapies, and firing minority doctors that were considered substandard. “Medicine would never be a respected profession . . . until it sloughed off its coarse and common elements,” wrote Starr. Medical schools had been closing before 1910, with 20 percent shuttered in the four years before the report was published. Capital requirements for modern laboratories, libraries, and clinical facilities “were what killed so many medical schools in the years after 1906,” he wrote.
Rothbard explained further:
In all cases of cartels, the producers are able to replace consumers in their seats of power, and accordingly the medical establishment was now able to put competing therapies (e.g., homeopathy) out of business; to remove disliked competing groups from the supply of physicians (blacks, women, Jews); and to replace proprietary medical schools financed by student fees with university-based schools run by the faculty, and subsidized by foundations and wealthy donors.
The burgeoning cartel meant “a skewing of the entire medical profession away from patient care toward high-tech, high-capital investment in rare and glamorous diseases,” wrote Rothbard, “which redound far more to the prestige of the hospital and its medical staff than is actually useful for the patient-consumers.”
Abraham Flexner, according to Starr, “had an aristocratic disdain for things commercial.” The high-minded Flexner Report “more successfully legitimated the profession’s interest in limiting the number of medical schools and the supply of physicians than anything the AMA might have put out on its own.”
The result: after peaking at 162 medical schools in 1906, by 1922, the number had been cut in half. The Flexner Report (a.k.a. Bulletin Number Four) recommended that the number of schools be reduced to thirty-one. Fortunately, more than seventy survived. Left up to Flexner, twenty states would not have had a single medical school. Legislators intervened. The report “was the manifesto of a program that by 1936 guided $91 million from Rockefeller’s General Education Board (plus millions more from other foundations) to a select group of medical schools,” according to Starr. Two-thirds of these funds went to only seven schools.
Medicine made a great leap in the Progressive Era. “The transition from household to the market as the dominant institution in the care for the sick,” in addition to increased specialization of labor, “has created emotional distance between the sick and those responsible for their care,” Starr wrote, “and a shift from women to men as the dominant figures in the management of health and illness.”
Mike Holly wrote in a 2013 Mises Daily piece:
Since the early 1900s, medical special interests have been lobbying politicians to reduce competition. By the 1980s, the U.S. was restricting the supply of physicians, hospitals, insurance and pharmaceuticals, while [at the same time] subsidizing demand. Since then, the U.S. has been trying to control high costs by moving toward something perhaps best described by the House Budget Committee: “In too many areas of the economy—especially energy, housing, finance, and health care—free enterprise has given way to government control in ‘partnership’ with a few large or politically well-connected companies.”
Part two of my procedure involved making two incisions to connect the wires from my brain to a battery that would be implanted to my chest. I arrived at the scheduled time of 12:30 p.m. The rep for the medical hardware to be placed in me told us the surgeon was running late. When my wife complained, the rep said, “He’s a busy man.” She replied, “We’re all busy. I’m going to complain.” He calmly said, “He won’t care.”
When I rolled into the bright lights of the surgical center’s operating room, the clock on the wall said 17:45 (military time). The next thing I knew, I woke up in recovery. The surgeon’s physician’s assistant commented on how good I looked. A nurse who had spent the last four hours apologizing for how far behind they were helped my wife put me in the car. There was no sign of the surgeon. Another American medical success story.
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