Thanks for the thoughtful piece. I do not have paul’s first hand experience with medicos, but I spent a lifetime in socialized med (US Military from birth to retirement.) and have strong opinions about how I think medicine should go—-fee for service, HSAs, catastrophic insurance with high deductibles, tort reforms, etc. I think your observations are right on and will use your words in ongoing discussions with my 35 year old PA daughter. I also want to “educate” my 87 yr old father-in-law who, while mostly conservative, is in the single payer and “doctors make too much” camps. He gets this from misinterpreting EOBs we get for him and his wife who are both invalids and have approached maximums in care, as well as listening to main stream media (he is blind.) Keep up the musings. Today’s main site entry was especially thought provoking. Here’s hoping the senior cutoff for the games is 60 to keep all you fire breathing 50 somethings on the side lines. Wait, as I read that, it is un-c/f like and Paul will get on me about whining for an age waiver. Let there be a superseniors, too, and then you 50s can go for it.

Second – doctors are monopolists. I think that sets them up for a kind of resentment. I’m trying to get access to a friedman video describing how medical practice might be better without the monopoly power of govt licensing – but doctors, the medical profession, made a deal with the devil. There’s a consequence.

All that said, I got to watch my dad practice medicine as a pediatrician. The late night calls, consistent weekend work – he was as you eloquently describe above always there for the patients. He struggled to recover from the irregular sleep – it was harder as he aged. We know now that work like that literally takes years off of humans’ lives. In short, I know how hard my dad, and the doctors of that generation worked, and how much heart and soul was delivered to their work. I don’t know if it was good for the doctors, but it was good for most of their patients.

The thing I can’t get over – the obvious conclusion – is that only one arrangement ever produces higher quality with lower costs: cooperation and market competition. How to bring that to medicine is an interesting challenge – wish I could say I’ve digested Porter’s book. It would involve having results and cost information available for consumers to consider when selecting which doctors and what care to seek. But stats may not be useful for this kind of analysis – they may not be able to account for enough variables.

Of the various boogey men that are advanced – greedy doctors, greedy insurance companies – there is no mention whatsoever of government’s starring role in the suboptimization of the world’s greatest health care system. I would be stunned at the foolish consistency, but it makes sense if one assumes the President has a big STATE agenda. I hope enough of the public has now seen the wolf under the sheep’s skin worn throughout the campaign.