Doctors (and Health Care) Without Borders?

I had a thought experiment based on two truths about myself: I am all for universal health care, and I would not have strong objections to receiving a fixed salary.

But I know a lot of doctors who oppose Obamacare. I can see how having to see more patients and accept lower reimbursement rates, all while filling out disability paperwork for people you believe actually do have the capacity to work might leave a bad taste in any doctor’s mouth.

So here is the thought experiment: In this increasingly interdependent world, what if we could open up licensing regulations for physicians that would allow those of us who favor universal health care to practice in Canada or other parts of the United Kingdom, for example, and those who believe in traditional insurance-based health care to practice in the United States?

Wouldn’t that be ideal? Win-win.

I thought about the lung cancer patient in Wales whose surgery, radiation, and chemotherapy were all paid for by the National Health Service. Were he to develop metastatic disease, the NHS would not pay for Tarceva (erlotinib), because the National Institute for Health and Clinical Excellence (NICE) has decided that the cost of the drug is not worth the 8 extra weeks that the patient gets.

To some, this is the very definition of fairness. Health care is universal and is paid for by taxes. What is deemed reasonable is given to you completely free, and what is not, well, isn’t. It seems to be a more thoughtful, compassionate, and just way to practice medicine, and perhaps more practical as well. Everyone gets standard of care.

For others, the above scenario is inherently unfair. Why should a government agency decide what will be good for the individual? Why should government decide that an extra 8 weeks for any individual is futile and not worth taxpayer money? People should be able to buy what they can afford, regardless of outcome. It is their money after all.

And then I realized that it is in such societies where capitalism is unbridled that pharmaceuticals thrive. Capitalism provides pharmaceutical companies with the incentives to invest in research and development. And it is precisely that R&D that leads to the kind of information that NICE needs to make decisions about drug utilization.

Said another way, the information and innovation that come from cutthroat capitalist societies is precisely what allows the nationalized health care systems to succeed.

So while I may dislike the unabashed concern for profit that I imagine motivates health insurance agencies and pharmaceutical companies (who among us, left or right leaning, didn’t find the increase in colchicine pricing offensive?), I recognize their necessity and am ultimately grateful that what they do allows societies that do provide universal health care to do so.

Bonus: Interestingly enough, I found a paper from the economics department at MIT that says basically the same thing, not just about health care, but about welfare in general.

Dr. Chan practices rheumatology in Pawtucket, R.I.

I had a thought experiment based on two truths about myself: I am all for universal health care, and I would not have strong objections to receiving a fixed salary.

But I know a lot of doctors who oppose Obamacare. I can see how having to see more patients and accept lower reimbursement rates, all while filling out disability paperwork for people you believe actually do have the capacity to work might leave a bad taste in any doctor’s mouth.

So here is the thought experiment: In this increasingly interdependent world, what if we could open up licensing regulations for physicians that would allow those of us who favor universal health care to practice in Canada or other parts of the United Kingdom, for example, and those who believe in traditional insurance-based health care to practice in the United States?

Wouldn’t that be ideal? Win-win.

I thought about the lung cancer patient in Wales whose surgery, radiation, and chemotherapy were all paid for by the National Health Service. Were he to develop metastatic disease, the NHS would not pay for Tarceva (erlotinib), because the National Institute for Health and Clinical Excellence (NICE) has decided that the cost of the drug is not worth the 8 extra weeks that the patient gets.

To some, this is the very definition of fairness. Health care is universal and is paid for by taxes. What is deemed reasonable is given to you completely free, and what is not, well, isn’t. It seems to be a more thoughtful, compassionate, and just way to practice medicine, and perhaps more practical as well. Everyone gets standard of care.

For others, the above scenario is inherently unfair. Why should a government agency decide what will be good for the individual? Why should government decide that an extra 8 weeks for any individual is futile and not worth taxpayer money? People should be able to buy what they can afford, regardless of outcome. It is their money after all.

And then I realized that it is in such societies where capitalism is unbridled that pharmaceuticals thrive. Capitalism provides pharmaceutical companies with the incentives to invest in research and development. And it is precisely that R&D that leads to the kind of information that NICE needs to make decisions about drug utilization.

Said another way, the information and innovation that come from cutthroat capitalist societies is precisely what allows the nationalized health care systems to succeed.

So while I may dislike the unabashed concern for profit that I imagine motivates health insurance agencies and pharmaceutical companies (who among us, left or right leaning, didn’t find the increase in colchicine pricing offensive?), I recognize their necessity and am ultimately grateful that what they do allows societies that do provide universal health care to do so.

Bonus: Interestingly enough, I found a paper from the economics department at MIT that says basically the same thing, not just about health care, but about welfare in general.

Dr. Chan practices rheumatology in Pawtucket, R.I.

I had a thought experiment based on two truths about myself: I am all for universal health care, and I would not have strong objections to receiving a fixed salary.

But I know a lot of doctors who oppose Obamacare. I can see how having to see more patients and accept lower reimbursement rates, all while filling out disability paperwork for people you believe actually do have the capacity to work might leave a bad taste in any doctor’s mouth.

So here is the thought experiment: In this increasingly interdependent world, what if we could open up licensing regulations for physicians that would allow those of us who favor universal health care to practice in Canada or other parts of the United Kingdom, for example, and those who believe in traditional insurance-based health care to practice in the United States?

Wouldn’t that be ideal? Win-win.

I thought about the lung cancer patient in Wales whose surgery, radiation, and chemotherapy were all paid for by the National Health Service. Were he to develop metastatic disease, the NHS would not pay for Tarceva (erlotinib), because the National Institute for Health and Clinical Excellence (NICE) has decided that the cost of the drug is not worth the 8 extra weeks that the patient gets.

To some, this is the very definition of fairness. Health care is universal and is paid for by taxes. What is deemed reasonable is given to you completely free, and what is not, well, isn’t. It seems to be a more thoughtful, compassionate, and just way to practice medicine, and perhaps more practical as well. Everyone gets standard of care.

For others, the above scenario is inherently unfair. Why should a government agency decide what will be good for the individual? Why should government decide that an extra 8 weeks for any individual is futile and not worth taxpayer money? People should be able to buy what they can afford, regardless of outcome. It is their money after all.

And then I realized that it is in such societies where capitalism is unbridled that pharmaceuticals thrive. Capitalism provides pharmaceutical companies with the incentives to invest in research and development. And it is precisely that R&D that leads to the kind of information that NICE needs to make decisions about drug utilization.

Said another way, the information and innovation that come from cutthroat capitalist societies is precisely what allows the nationalized health care systems to succeed.

So while I may dislike the unabashed concern for profit that I imagine motivates health insurance agencies and pharmaceutical companies (who among us, left or right leaning, didn’t find the increase in colchicine pricing offensive?), I recognize their necessity and am ultimately grateful that what they do allows societies that do provide universal health care to do so.

Bonus: Interestingly enough, I found a paper from the economics department at MIT that says basically the same thing, not just about health care, but about welfare in general.

Dr. Chan practices rheumatology in Pawtucket, R.I.