Let Them Eat Flounder

“There is perhaps no phenomenon which contains so much destructive feeling as ‘moral indignation’, which permits envy or hate to be acted out under the guise of virtue.”

–       Erich Fromm

Stereotypes exist for a reason.  One of my favorite stereotypes is the hand-wringing bleeding heart who seeks to gain adoration by demonstrating their inestimable goodness, so demonstrated by telling others what to do. 

“Princeton University economists Anne Case and Angus Deaton argued during the American Economic Association’s annual meeting in San Diego that a slice of the U.S. population is getting rich at the expense of the rest of the population.”  A source used by the economists is “The Organization for Economic Co-operation and Development [which] decries U.S health care as being too expensive, claiming that it costs roughly $8,000 per household.”  The academics tag this with the historically charged description of “poll tax,” a term they must have learned in the history classes that failed to teach them the economic outcomes of large central-planning, collectivist solutions. 

The OECD:  “Together with governments, policy makers and citizens, we work on establishing international norms and finding evidence-based solutions to a range of social, economic and environmental challenges. From improving economic performance and creating jobs to fostering strong education and fighting international tax evasion…”  Our Ivy League economists are taking pointers from those with an explicit agenda for top-down, supra-national control of daily affairs.  That alone should call their credibility into question.  This is so stereotypically predictable that …

Ah ha, and there it is:  “In order to combat rising costs, Case and Deaton, a Nobel Prize winner in economics, said that everyone needs to be in the health system, via insurance or a single-payer system like Medicare-for-all, and there must be cost controls, including price caps on drugs and government decisions not to cover some procedures.”  All of which means rationing, shortages, higher costs, more government debt, and a clear two-tier system where the very well-off and/or connected get far better care than the comforted majority.

“Deaton is especially critical of U.S. doctors, pointing to the fact that 16 percent of people in the top 1 percent of income earners are physicians, according to research by Williams College professor Jon Bakija and others.  ‘Physicians are a giant rent-seeking conspiracy that’s taking money away from the rest of us, and yet everybody loves physicians,’ Deaton told the Post. ‘You can’t touch them.’” 

Despite the cartoonish stupidity of these economists, their points are worth considering because of the terrifying traction they have already gained among the benighted mob.  Do these venomous moralists believe that the evil rich physicians stole their wealth?  If so, then why not say so plainly and call for prosecution and confiscation? 

It might surprise these academics to know that apart from deferred reward and accrued academic debt, most physicians simply spend more hours at work than most of their neighbors.  Do the economists expect doctors to work even harder, or accept even less to accomplish their goodness-by-proxy?  Envy and class warfare will not provide better average health care, nor will it provide a net economic benefit for the society that seeks to enslave its physicians.  Those that believe otherwise deserve what they get.  For my part, once I’ve covered my monthly bills, don’t expect me to slog back to the ER to support those who would attack me.  I’ll be on the beach, fishing.  

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Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption. 

  14 comments for “Let Them Eat Flounder

  1. Benjamin Van Raalte
    January 21, 2020 at 11:18 am

    My last comment. I tallied up all my income divided by the hours I have worked since college. It works out to $80 an hour. Since trying to make it back end puts me in the higher tax bracket, its about $50 an hour after taxes. Maybe $7 an hour in benefits. The AVERAGE government employee makes $86,000 a year with 1700 hours a year worked (lots of holidays and vacation,etc). That is $50 an hour before taxes or about $40 an hour. They receive an average of another $50,000 a year in benefits or another $30 an hour. So I make the same or less as the average federal employee PER HOUR. Nor does my hourly even approach the one New York law firm where all 2000 partners make $1000 an hour. And if I knew what sacrifices I had to make, I would not do it again. There are some overpaid US physicians, but since the government does not do much in investigating fraud or overuse, or academic abuse, it does exist.

    • Aaron M Levine
      January 21, 2020 at 12:06 pm

      I had a discussion with an engineering student back in the 60s about doctors. We ran the numbers including tuition, house staff payments, etc. based on averages by the AMA and others. Engineers then got high paying some internships. Anyway, we found and he confirmed that for the lifetime net income for doctors did not exceed engineers until the mid 50s (ages). So the extra income came in the last 10 years of professional career. That did not include the extra hours we spent in training.

  2. David Rogers
    January 16, 2020 at 2:39 pm

    How insulting! Sir Angus Deaton and his bride, Anne Case refer to physicians as “a giant rent-seeking conspiracy that’s taking money away from the rest of us.” For supposedly elite academics, these two doofuses can’t even use words properly. (Physicians who…not physicians that). Anyway, I love Pat’s rant about this. After two minutes of research, I was able to discover that Deaton’s net worth is $5 million. What pompous anatomic posteriors they are! They are a perfect example of elites who are out of touch with the real world. What a waste of a Nobel Prize!

  3. Pat
    January 15, 2020 at 11:29 pm

    Malpractice insurance is something doctors are forced to carry by predatory lawyers, vengeful patients, and state governments. Yet price caps do not allow them to pass the cost on to the consumer.

    Nor is there any insurance for practice failure or loss of license.

  4. Benjamin Van Raalte
    January 15, 2020 at 4:24 pm

    If physicians pay is to be cut, it will require a massive pay cut for the registered nurses in the United States. Since for many physicians taking the same hours worked and instead becoming a nurse working two jobs and investing the money would be about the same amount of total income. With California nurses earning an average of 80k, working 60 years a week would be 120k, adding invested medical school debt, the time value of money, and overtime, and NOT adding the attraction of a smarter and more involved work force, it would not make sense to go to medical school in the United States. Likewise if other occupations are paid for all hours available such as firefighters, or NY train workers (one in NY made 200k) again todays physicians will seek other careers. The result of his proposal will be a brain drain into other fields, and probably less productivity. They neglect to mention nursing in most other countries is paid much less, and economist phds also paid much less too.

  5. Aaron Levine
    January 15, 2020 at 2:47 pm

    I am trusting my memory for the following. Allow for some inaccuracies. There was a 60 Minutes from 45 years ago. It covered how rich doctors were getting from Medicare. Mike Wallace interviewed an obgyn (I think) who was the highest paid doctor in Medicare or Medicaid (Nationally or in New York, I don’t recall). He had made several hundreds of thousands of dollars in billings. There was no fraud as he put the time in. In essence, Mike Wallace said that this was unfair. What would he do if the government placed a ceiling of $100K on how much a doctor would get from Medicare/Medicaid? He said he would stop seeing patients when he reached the ceiling and take a long vacation. Mike Wallace basically said that was unethical. How could he stop working when people needed to be treated. Was he that greedy not to continue to work? The response could only be done by a black man, which this doctor was. He answered, “Lincoln freed the slaves.”

  6. R Stuart
    January 15, 2020 at 12:01 pm

    Wow – I’m part of a giant rent-seeking conspiracy and didn’t even know it!

  7. PW
    January 15, 2020 at 10:01 am

    I’m really fed up with the doctor bashing. Medical costs for doctors make up MAYBE 12% of the total of health care costs and we are getting squeezed more and more every year for every penny. Not only that, being held accountable for patient behavior we cannot control.
    I’m also sick of these economists bashing free enterprise. I don’t covet Bill Gates’ money, and I don’t think billionaires are bad people who made their fortunes on the backs of others. In fact, most of them are major philanthropists, and most contribute to job creation. What I DO have a problem with, is career politicians who end up being multimillionaires. How does this happen?

  8. Roger Pratesi
    January 15, 2020 at 9:10 am

    I don’t know if it is true that 16% of the 1% are physicians but using the argument of deferred reward and hard work is not a legitimate basis for accepting that this profession should comprise such a large percentage of our economy. There are many professions that require lengthy schooling, apprenticeships and very long hours. They are equally demanding in terms of intellect and commitment. I would be very interested in the breakdown of those professions within the 1%. I would also consider the risk associated with being a doctor versus the investment and risk associated with a business owner, inventor, developer, etc. I would think doctors have a much lower risk profile.

    • R Stuart
      January 15, 2020 at 2:34 pm

      “doctors have a much lower risk profile”


      Doctors never get sued.

      • Roger pratesi
        January 15, 2020 at 9:57 pm

        They have insurance. There is no insurance for business or investment failure

        • Martha Oreilly
          January 19, 2020 at 3:46 am

          Malpractice of 50,000 s year for general surgery. You sound like you think its free. You are wrong.

    • Pat
      January 15, 2020 at 2:49 pm

      What would be the “correct” percentage? And how do we determine that?

    • Ben Van Raalte
      January 16, 2020 at 2:22 pm

      There are few if any professions that compare to surgery. 4 years of college and competition and ability to handle science. 4 years of medical school with the average work week being 80 hours, and high tuition. Surgical residencies of 6 to 8 years, up until recently averaging 100 hours a week, forced lack of sleep, call, no days off and no personal life all for below minimum wage. For many specialties still call is unpaid, and many other activities unpaid or uncompensated. All of those need to be reformed and then a new generation can be under a new pay scale. If thats what he wants he needs to propose a 6 year course of study, all free, since there is little time to work, after high school. A residency system of no more than 60 hours a week which will require hiring more support staff. All call needs to be paid, just like firefighters. If you are on call, you are working. All data entry, phone calls, etc need to be compensated like attorneys or other professions. Only after those reforms should the earnings be reduced. And they still will need to be compensatory for the extra time, training, skill level and expertise, loss of earnings, and time value of money compared to those that start earlier. Either nurse practitioners pay will have to be reduced or to account for higher tax brackets, time value of money and extra hours and not even compensating for extra skill , it would still need to be at least double a nurse practitioner. What he underestimates, since he has no concept, is the stress, the delayed gratification, the sacrifice, and the mental and physical demands of medical training and in particular surgical training. That is why even despite what he considers too high of compensation there is burnout.

      My surgical colleagues in Scandinavian countries are often done by Wednesdays with the hours.

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