Letters

From the May 1999 issue

(Page 3 of 5)

Stephen DeGray, M.D.
Bluefield, VA

Thomas Hazlett replies: Dr. Wintory asks: "In what other area of life do we tell providers not to provide?" The answer is simple: in every area of economic life. In fact, just the other night I told the waiter not to bring me the 1991 Crystal Champagne. Hey, I was paying. The trick doctors, just like farmers harvesting USDA subsidies, have discovered is that getting Uncle Sam to pay (Medicare, Medicaid) or limiting customers’ options by mandating HMO coverage is a whole lot easier than squeezing the actual consumer for cash. But please, enough of the "next time you’re sick" threat. I am not happy to report that loved ones have indeed gotten sick with a lot worse than a broken arm, have had their health insurance deny coverage, and have heard not a peep (nor received a cent) from doctors only too eager to cash their unreimbursed checks.

Dr. Anderson wonders why I have a problem with Dr. Smith’s wanting a chance to make as much money as patients are willing to pay him, but it’s no problem at all. It’s just that Dr. Smith won’t settle for what people are willing to pay him! He wants government to force medical costs onto third parties so the expensive service looks cheap to the patient. It’s an accounting gimmick, one which encourages patients to spend without restraint and leaves a mounting burden of expenses for tax-payers and ratepayers–many of whom respond by dropping coverage until the emergency room beckons.

I was blessed to have a terrific surgeon, Dr. Robert Appleman, pluck out my gummed-up gall bladder in 1995. It is tragic that this gifted physician folded up his practice after 30 years due to the paperwork headaches now haunting medicine. (Mine was his very last operation.) But the open-ended demand which consumers thought they enjoyed busted the bank, and now they are searching for more affordable health care. The HMO pencil pushers so decried by the M.D.s are, in fact, consumer cost-containment agents. If doctors (and their newfound friends, the lawyers) pledged fealty to "consumer sovereignty" they could assist in devising systems which limited costs while bestowing bonuses on dedicated practitioners like Appleman.

Regarding Dr. Anderson’s statement that there are many excellent HMOs and no one seriously believes they should be banned: Of course they do! Not only is for-profit medicine denounced, single-payer plans in Congress and the highly touted HMO "bill of rights" regulation aim to cripple the competitive position of low-cost health plans.

Dr. DeGray’s comments do not seem to cross my article except insofar as I have ignored the degree to which his profession is forced to account for its paper clips. He claims to be offended by comments he calls "income baiting," but then goes on to bash Mercedes-Benz owners for low deductibles. I think he mocks.

The litigiousness of the American medical system is surely our common foe. But I do not understand the rage of doctors who, having the ability to band together to compete with HMOs and insurance companies, opt instead to (literally) sell out to them while yakking about what others will pay for.

If you think the HMOs are screwing up patients’ health and doctors’ wealth, then build a better insurance vehicle. If the HMO system is oppressing conscientious physicians with idiotic rules crafted by inept empty suits, then providing better and more popular doctor-run health networks ought to be the hottest thing on Wall Street since "dot-com" was virtually born.

Competing in the arrogance department would not likely be a problem for the doctors. To wit, Dr. DeGray: "Physicians assume most of the risks." Really? Is that what you whisper in patients’ ears when rolling them into the O.R.? Well then, thanks for the warning, Doc.

Muddies Waters

Richard Epstein concludes his review of The Shape of the River, a long defense of racial preferences in college admissions by William Bowen and Derek Bok, by advocating "decentralized decision making" ("Unexplored Tributaries," February). That way, each school could decide on its own whether to discriminate on the basis of race and ethnicity in selecting its students.

Professor Epstein cheerfully acknowledges that this approach runs afoul of current law, and he calls for that law’s repeal. But while we are waiting for Congress to revoke the Civil Rights Act of 1964–and I hope Professor Epstein isn’t holding his breath, as I would hate to lose him–the issue we face in the real world is this: Should colleges and universities be barred from discriminating against whites and Asians, just as they are now barred from discriminating against blacks and Hispanics?

One can defend the decentralized scheme that Professor Epstein advocates. One can also defend the law that was actually written and passed in 1964, prohibiting colleges that receive federal money from discriminating against anyone because of race or ethnicity. What is indefensible, however, is the law as it is currently interpreted by the federal bureaucracy and defended by Messrs. Bowen and Bok: a ban on discrimination against some people (blacks and Hispanics) but not others (whites and Asians).

Roger Clegg
General Counsel
Center for Equal Opportunity
Washington, DC

How did clearheaded Richard Epstein end up so muddled in reviewing The Shape of the River?