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January 28, 2006

Prescription For Failure

Here's a math question about a household budget. Say you want to understand the effect of trend lines comparing household income to a single item of household expense. That expense might be food or clothing or heat.... or, in this case, interest payments on debt. Here's the question:

What happens if household income is rising at the rate of six-tenths of 1% per year and interest payments on debt are rising 8.5% per year?

Answer: The share of income eaten up by interest payments is metasticizing like a cancer.

Now, if your income is $1 million per year and the base line interest payments are even $40,000 a year, this trend is not particularly troubling.

But, what if you are a doctor and your income is $150,000 per year while the base line interest payments from medical school and other debt are $30,000 per year? Well, then your household income is in cancer-like territory because a year from now your income will be $150,000 times 1.006, or $150,900 but your interest payments will be $30,000 times 1.085, or $32, 550 -- a net problem (before taxes) of $1,650 of more expenses than income.

Five years later, this net problem grows to slightly more than $8,000. $8,000 that the doctor needs to find from other household expenses -- or to offset with income from a second job (or, perhaps by agreeing to participate in income-generating programs offered by pharmaceutical companies). That's a cancer.

And, those are the trends lines currently describing average doctor income and average doctor indebtedness. Average. Therein lies this not-so-hidden prescription for the failure of our society's health care (at least if by 'society' we mean 'liberty and justice for all' -- for 100% of society instead of just part of society):

You are going through medical school looking at these trend lines and you have this choice -- you can sign up to be, say, a pediatrician who works with kids from all parts of society (top to bottom) at an income below the the average, or you can put yourself in a bit more debt to become a specialist focusing on the top 20% of society who have 80% of the nation's assets and, through both insurance and private means, can afford to pay bills that permit your income to be 6 to 8 times the average.

You can put yourself and your family in the position of the $1 million household with beginning debt of $40,000 -- or you can put condemn your family budget to a metasticizing cancer.

You can choose to participate in a health care system that serves the top 20% -- or you can choose justice and fairness for all.

Given our culture's sociopathological obsession with value and individualism, what's your bet on the pattern of choices made?

Posted by Doug Smith on January 28, 2006 01:37 PM | Permalink