During all the deal/no-deal fracas last week in D.C., we hear a lot about the Federal government furloughing "non-essential" personnel. The Center for Studying Health System Change reported in a 2008 survey that "almost half of physicians’ practice revenue was derived from public sources—about 31 percent from Medicare and 17 percent from Medicaid." If that stat is close, that fastens you and I squarely on the government teat as surely as a single G5/P6 crack mom or double-dip pensioner squawking over how government better not cut his benefits. Were you prepared to have your payments withheld if the government shut down? (a rhetorical question, I realize the government withholds them all the time) Are you, am I "essential"? When the money runs out - again, a rhetorical query, since we're long past broke - when the money runs out, will doctors, hospitals, nursing homes, surgi-centers, and all the rest that have been mainlining government cash really escape the horrible shakes to come?
Here on April 15th, Tax Day, the day we all bow and pay fealty to the founder of the dependents' feast, I recall the quote of a fictional physician, the neurosurgeon Dr. Hendricks in Atlas Shrugged, who pursued the Hippocratic ideal far more effectively than we 21st century government workers:
“I quit when medicine was placed under State control, some years ago,” said Dr. Hendricks. “Do you know what it takes to perform a brain operation? Do you know the kind of skill it demands, and the years of passionate, merciless, excruciating devotion that go to acquire that skill? That was what I would not place at the disposal of men whose sole qualification to rule me was their capacity to spout the fraudulent generalities that got them elected to the privilege of enforcing their wishes at the point of a gun. I would not let them dictate the purpose for which my years of study had been spent, or the conditions of my work, or my choice of patients, or the amount of my reward. I observed that in all the discussions that preceded the enslavement of medicine, men discussed everything – except the desires of the doctors. Men considered only the ‘welfare’ of the patients, with no thought for those who were to provide it. That a doctor should have any right, desire or choice in the matter was regarded as irrelevant selfishness; his is not to choose, they said, only ‘to serve.’ That a man who’s willing to work under compulsion is too dangerous a brute to entrust with a job in the stockyards – never occurred to those who proposed to help the sick by making life impossible for the healthy. I have often wondered at the smugness with which people assert their right to enslave me, to control my work, to force my will, to violate my conscience, to stifle my mind – yet what is it that they expect to depend on, when they lie on an operating table under my hands? Their moral code has taught them to believe that it is safe to rely on the virtue of their victims. Well, that is the virtue I have withdrawn. Let them discover the kind of doctors that their system will now produce. Let them discover, in their operating rooms and hospital wards, that it is not safe to place their lives in the hands of a man whose life they have throttled. It is not safe, if he is the sort of a man who resents it – and still less safe, if he is the sort who doesn’t.”