What state's doctors really want is more money

Now that doctors have resorted to strikes and threats of strikes in an attempt to wring more money out of the health-care system, it's time to drop all pretense that this dispute is about anything other than money. Doctors and politicians may talk about saving the health-care system, ensuring access to care for all, blah, blah, blah. But it's really about money.
It is, of course, unfair to say that doctors care only about money. Individual doctors no doubt went into medicine for different reasons. Some are probably there for the money; for many the money is secondary or even irrelevant. No matter what the motives of individual doctors may be, the organized medical profession is at the Legislature demanding that we as a society take money from injured people and give it to them. If the motivations of individual doctors are being misrepresented by all the emphasis upon money, that is unfortunate. The fact remains, however, that the organized medical profession has made this about money.
It's not as if the doctors can't get insurance. Last year the Legislature created a mechanism to let any doctor be insured by a state agency, the Board of Risk and Insurance Management. This cured what the doctors refer to as the "accessibility" problem. They now want to address what they call they call the "affordability " problem. In other words, they can get insurance; they just don't want to pay for it.
At the same time, the Legislature created the mechanism by which the doctors could form their own insurance company. If, as is almost certainly the case, they are being treated unfairly by their insurers, they have the option of creating their own company.
If this dispute were really about health care, the doctors would be proposing something to make hospitals safer. The Harvard Medical Practice Study, published in The New England Journal of Medicine, found nearly 7,000 deaths a year from medical mistakes in New York State. If we assume that hospitals in the rest of the country are no better, but no worse, at preventing such deaths, that means that about 100,000 people die each year from medical mistakes. Hundreds of thousands are injured. The demands of West Virginia's doctors do not address this problem.
Of the thousands who are killed or injured by medical mistakes, only about one in eight brings a malpractice claim. The rest just live with (or die with) their injuries without any compensation. The doctors are not demanding that we do anything for those people.

There are 310,000 people in West Virginia who do not have health insurance. Their choices are to never get sick, not get care when they get sick, spend themselves into oblivion paying for care, or spend the rest of their lives being harassed by collection agencies. The doctors are not demanding that we do anything about that.
Pricing policies, marketing plans, and ability to control markets have combined to make prescription drugs unaffordable for people with no insurance. The doctors are not demanding that we do anything about that.
As a nation, we spend more per person on health care than any other country. Yet we are far from the healthiest country. While there may be many conclusions to be drawn from this, one is that our overall health-care system is inefficient. If the goal is to make us healthy, then we are not spending our money nearly as wisely as are some other countries. The doctors are not demanding that we do anything about that.
The doctors put on their white coats, walked past these and other problems, and marched into the Legislature demanding that we change public policy so that their insurers and (the doctors hope) they will make more money. If they can do this, then this dispute is not over health care. It is about money.
With the strike, there is the added wrinkle that the doctors' actions won't put any money in their pockets. If the doctors get what they say they want, then their insurers will have to pay less to reimburse patients injured by the doctors'' mistakes. There is absolutely no indication, however, that this will result in lower insurance premiums for the doctors. The doctors are acting on the blind hope that the insurance companies will turn around and lower the premiums.
If the doctors were to ever resort to walking a picket line, this would result in some interesting signs: "We demand more money for our insurance companies." "Unfair! Insurance companies need more money!" Their leaders could chant, "What do we want?" and the followers could shout, "More money for insurance companies!" "When do we want it? -- Now!" It would be a moment unique in American labor history.
The doctors are not alone in calling their strike an attempt to produce some social good. Were the lawyers ever to strike, they would huff and puff about justice when what they wanted was more money. Airline pilots, air traffic controllers, etc. talk about the safety of the flying public when what they want is more money. Nowadays, it takes a good old-fashioned industrial union like the autoworkers to drop the pretense of any grand public goal and say that they are striking for money.
This is not to say that trying to make more money is a bad thing. We live in a world where everybody tries to make more money. There's no point in calling each other greedy. Everybody from the workers at Wendy's to Major League baseball players to insurance companies tries to make more money.
So should we make some new rules so the doctors can make more money?

An initial question is why we should do anything for them. Over decades we evolved a system in which butchers, bakers, candlestick makers, doctors, lawyers and everyone else had to pay for damage that results from their mistakes. Most people had insurance so they didn't have to pay directly. If there was a dispute about how much the damages were, a jury would decide. The damages were whatever the jury decided.
In 1986 the doctors and their insurers convinced the Legislature to put a cap of $1 million on noneconomic damages that could be awarded against a doctor or medical facility -- although claims against anyone else are whatever the jury thinks is fair.
In 2001, doctors convinced the Legislature to require that a person who was injured by a doctor's mistake provide the doctor with a "certificate of merit" before filing an action in court. The certificate of merit had to be a sworn statement from a medical expert saying that a mistake had been made and that the patient had been damaged. The doctor then had the option of demanding mediation of the dispute before it went to court.
Nobody else gets this kind of protection. Doctors whine about frivolous claims; this 2001 statute solves that problem. Everybody else who injures someone has to wait to be sued and defend as best they can. They don't have any mechanisms for weeding out weak claims and the right to demand mediation. Only doctors get treated with such deference.
Assuming that we should do anything else for a group that we have already done a lot for, we still have a more basic question: How much are doctors making now? They will routinely wax eloquent about how much their insurance premiums are. They never say how much they are making.
I realize that it is considered impolite to ask how much people make. Yet if mineworkers strike, newspapers dutifully report how much the average miner makes and how much the union is demanding. The same thing would be true for truck drivers, hospital workers, or, for that matter, professional baseball players. If the doctors really want us to adopt a series of policies that take money from injured people so that doctors can make more money, they need to answer the indelicate question: What are you making now? It is no more than we ask of any other workers who threaten to strike for higher wages.