A young doctor reflects on his career

 When I was a young man, I had a friend who was a doctor. We were the same age, each just making his mark.

He was an excellent man, as good a husband, father, friend and citizen as he was a physician.

He was a faculty member at the University of Texas Medical Branch in Galveston, the state’s oldest public medical school. Historically, the medical school had an agreement with the state to treat poor patients. It made sense. The medical students needed to be trained. The only way for them to see a variety of cases was to see patients from all over the state.

The medical school provided care at rock-bottom prices. When the legislature met, the state paid the bills.

When I was a young reporter, I saw officials in rural counties in East Texas grapple with the problem of providing care to penniless people with cancer. Some of those county commissioners were good bulldozer operators but they could barely read. The only thing they knew to do with penniless cancer patients was to put them on a bus to Galveston. That’s just the way things worked until, one day, the business model collapsed.

The state wouldn’t pay. The medical branch, allegedly a state institution that got surprisingly little income from the state, declined to accept patients who were uninsured and couldn’t pay.

Kicking poor people who have cancer out on the street was, at one time, a novel idea. There were protests. People said some cutting things about greed.

My friend the young doctor smiled wanly and reflected on the trajectory of his career: valedictorian in high school, National Merit Scholar, dean’s list in college, medical school. As a kid, he’d always done whatever adults told him kids should do, and then he woke up to find he’d suddenly been transformed into a greedy, grasping parasite on society.

My friend got into medicine not to help people. He had some abilities that most of us simply don’t have. He felt an obligation to use that talent.

He was a good man in a bad system.

Yesterday’s note was about how an economist, Walton H. Hamilton, had warned 90 years ago about the problems of choosing to operate medicine on a business model. His warnings were ignored. He was called a socialist and communist.

Some leading doctors of that day said that physicians could be trusted to put profit out of their minds when prescribing expensive procedures. And doctors certainly wouldn’t consider profit when prescribing drugs such as opiates. People who imagined there could be a problem with that in this country were just naïve, they said.

You could, given today’s crisis, choke on the irony.

But that’s not the point of this note. The point is that we are still pretending, after 90 years, that the jury is still out on the idea — the concept that a business model is the best way to promote good medicine in this country.

The verdict was in long ago.