In the movie It’s a Wonderful Life we learned that every time a bell rings, an angel gets his wings. This simple chime of a bell can somehow confer morphological changes to a mystical being. The opposite seems to hold true for politicians. Whenever Barack Obama begins to speak of insurance companies, a little bit of truth dies. In the most recent debate I heard him say that insurance companies are greedy as if to imply they are unethical and have the sole purpose of trying to make Americans’ lives miserable. This rhetoric of greed as applied to Wall Street, insurance companies, big businesses, hospitals, and doctors is a bit off the mark.
Greed is a good thing. The knowledge that harder work leads to more money causes men to put in more hours and complete more goals. Obtaining more wealth is a seemingly reachable prize that can be obtained by creating better products, by developing more efficient methods, and by taking new risks. Greed is the invisible hand that runs the United States. Its roots span back as far as the Declaration of Independence. Our forefathers were not seeking religious freedoms when they broke away from Britain; they wanted lower taxes. It’s the reason the Spanish-American war was fought. It’s the reason Henry Ford developed the Model T. And it’s the reason that doctors are willing to work 80 hours a week.
Whenever an applicant applies for medical school he has to come up with a convoluted explanation as to why he wishes to become a physician. Many of the personal statements I have read in recent years center on helping other people, delivering health care to those in need, and providing access to those who cannot reach. In reality, many people are seeking a $200,000 a year job. An applicant who can say, “There’s no way I would do this for $30,000,” is much more honest. And yes, while there are some people who would deliver healthcare for free out of the goodness of their hearts, enrollment in medical schools would significantly drop, and the number of physicians in the nation would be at a critical shortage if greed were taken out of the equation.
Greed is a wonderful thing. We should embrace it and get people to work harder and more efficiently by dangling this prize in front of them. I know what you’re thinking. “Have you bothered to read the news, Half MD? The whole reason we’re in this economic mess is because of the predatory lenders and the greedy people on Wall Street!” I would counter that by saying the whole reason we’re in this mess is because of unethical behavior and stupidity. Greed did not cause banks to dole out $300,000 mortgage loans to persons making $40,000 a year—but stupidity did. Greed did not cause banks to sell unfunded insurance plans to each other—but unethical behavior did. On the other hand, when greed is contained within ethical boundaries and wise decision-making, it can be a force for good and for change.
Medicare could use its dollars to influence physician behavior for the better. It could offer higher payouts to those doctors that use a centralized electronic medical record system. It could grant bonus money to the lowest 20% of hospitals with nosocomial infection rates. Someone will counter by saying, “But then greedy hospitals will simply not report their nosocomial infection rates so that they can earn bonus money.” And I will respond by saying, “No, unethical hospitals will not report such embarrassing data.” A greedy, honest hospital will develop more safety barriers to prevent the spread of infection.
The next time someone says to you, “Those insurance companies sure are greedy,” usually counter back with, “I hope they are.”