Liberal doctors, healthcare crackdown

Two related stories on a deeper level, though not on the surface.

First, new doctors are more politically liberal than their seniors.

Doctors were once overwhelmingly male and usually owned their own practices. They generally favored lower taxes and regularly fought lawyers to restrict patient lawsuits. Ronald Reagan came to national political prominence in part by railing against "socialized medicine" on doctors' behalf.

But doctors are changing. They are abandoning their own practices and taking salaried jobs in hospitals, particularly in the North, but increasingly in the South as well. Half of all younger doctors are women, and that share is likely to grow.

Nobody's asking doctors to take vows of poverty, even after paying off med school loans. But, the idea that being a doctor is a great way to be your own small businessman? I hope that's falling by the boards with these changes, and doctors like this are becoming fewer:

“People who are conservative by nature are not going to go into the profession,” said (Dr. Kevin S. Flanigan, a former president of the Maine Medical Association), “because medicine is not about running your own shop anymore.”

As Dr. Atul Gawande just told Harvard Medical School graduates, medicine is becoming more and more a team-based enterprise.

Everyone has just a piece of patient care. We’re all specialists now—even primary-care doctors. A structure that prioritizes the independence of all those specialists will have enormous difficulty achieving great care.

All we need now is for med schools to stop charging tuition as though an MD were a super-MBA.

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The other, related issue?

The feds are looking at cracking down on healthcare company CEOs for negligence that fails to detect fraud by underlings.

Now, on top of fines paid by a company, senior executives can face criminal charges even if they weren't involved in the scheme but could have stopped it had they known. Furthermore, they can also be banned from doing business with government health programs, a career-ending consequence.

This, too, says that medicine needs to become more about medicine, and about team-based medicine, not big business.

That's why some libertarians, and many of us liberals, see healthcare as like a utility, and single-payer national healthcare as the best way of meeting that.

That said, the utility privatization wave of the past decade has undermined that analogy.