Wednesday, October 17, 2012

Behind The Entitlement Mentality

ER physician-blogger "Birdstrike" posted an interesting essay onto, "To the patients who resent greedy doctors".

He was responding to an earlier comment made by "Johnathan Blaze":
Good, it’s about time that these greedy doctors get smacked down for being the financial rapists that they are.  Medicine in this country is the biggest, most destructive SCAM going on today. Doctors think they are entitled to RIDICULOUS amounts of money for simple routine procedures.
Dr. "Birdstrike" then makes a few observations in return, including:
In the field of emergency medicine, there are only a few situations where the physician can truly walk in a room and walk out a few minutes later absolutely certain he saved a life.  One is an emergency intubation (making a non-breathing person breath again) and another is cardioversion/defibrillation (restart a non-beating heart.)  It doesn’t always happen every day, but it is what emergency physicians and other critical care providers are paid to do. 
To be an emergency physician is a paid position.  It is not a volunteer position.  It stands to reason that emergency physicians would be paid at least as much as for a life saved as for the aforementioned goods and services, correct?  Let’s break down what a true life-saver gets paid to save an entire life, not just the hip, the breasts, the fingertip or the shoes.
What an emergency physician actually gets paid to save a life:
  1. Emergency intubation: $112  (CMS payment for CPT 31500) or,
  2. Cardioversion/Defibrillation: $131  (CMS payment for CPT 92960)
Even if one combines cardioversion with a $226 charge for critical care services provided (CMS CPT 99291) the total charge is still only $357. Therefore, according to the United States Center for Medicare and Medicaid Services, your life is worth $357, or at least that’s what they’re willing to pay emergency and critical care physicians to save it.
But I was especially intrigued by this:
I am not an economist, nor a philosopher, but this all seems to follow a theory of sorts, that I have observed...

The extent to which the value of a service to an individual approaches infinity (such as a human life saved), is the extent to which a person expects it to be provided to them for free.  [Emphasis mine. --PSH]
Any charge for this infinitely valuable service will not be considered a very fortunate undercharge.  Instead, the extent to which there is any charge at all for the infinitely valuable service, is the extent to which the receiver of the service will harbor undue resentment toward whomever profited any amount from providing it...

It is for this reason that the emergency physician that expects to be paid $15,000 for a life saved is wrong, yet the plastic surgeon is right to charge, and is happily paid by his “customers” $15,000 for a beauty enhancement service.
I think he has put his finger on a key element of the entitlement mentality.

If something is an important need (including a legitimate need such as a life-saving medical procedure), some people become extremely emotionally uncomfortable at the thought that they won't just get it automatically.  Even though the universe doesn't owe them (or anyone else) an automatic survival, they want someone to provide it.

And if they've been taught all their lives that others must morally provide for them as an automatic moral obligation based solely on their need, then anyone who fails to do so is shirking that supposed moral duty.  This implicit visceral premise comes to a head in life-and-death situations, such as emergency medicine.

Of course, people can and should take advantage of voluntary risk-sharing economic arrangements (such as true insurance), charity, and other voluntary measures to protect themselves against unforseen catastrophes, medical and otherewise.  And given our modern technology, such risk-protections are becoming more robust and affordable all the time.

But given our nature as human beings, elimination of all risk is metaphysically impossible.  And the universe truly does not "owe" us any kind of survival.  Compulsory social arrangements, such as socialized medicine, are an attempt to try to get around that basic unavoidable fact of reality -- and are doomed to fail.  But in the process, they destroy the freedoms necessary for individuals to actually protect themselves from risks as best possible.