The responses to my previous post - Michael Moore and Me - throughout the internet have been very troubling to me for many reasons. I will try to respond to some of these issues here.  First, there are several posts regarding how I must be greedy.  It always amazes me that everyone in our society is materialistic, but that doctors are supposed to be purely altruistic.  The hippocratic oath says nothing about healing the poor.  We do provide a remarkable amount of free or nearly free care, nonetheless.  When patients without insurance arrive in our ER, they are admitted if their condition warrants it and taken care of fully without regard for their ability to pay.  The same is true of Medicaid patients - where the reimbursements are so low that taking care of them is actually a money losing activity.  We accept full legal liability in the care of these patients whether we are paid for our work or not. I suspect that doctors provide more charity work than just about any other profession - but we get less credit for it.

I graduated at the top of my class at an Ivy League college and then spent another 11 years training for my profession- a much longer and more thorough training than is standard in countries like France and England.  I work an about 60 hr/wk, many weekends and am up all night answering pages at least once a week.  I certainly enjoy my job, but I wouldn't do it if the reward for all of my hard work and study was a salary I could get as a plumber.  It is important to realize that if we want smart doctors -- we have to be willing to pay them.

Enough defense of doctors -  I don't really expect you to cry for us.

Regarding the issues about medicine today.

First there are no easy solutions, and that includes socializing medicine.  Good medicine is expensive - regardless or who pays for it.  The ready availability of CTs, MRIs, PET scans, laproscopic surgery, dialysis, defibrillators, etc is expensive.  An MRI machine will cost 1.5 million dollars regardless of who pays for it.  Dialysis is expensive, so are the new chemo agents that Genentech is coming out with.  If we want these therapies, we have to pay for them.  If we don't want to pay for them, we have to make tough choices - no dialysis for patients over a certain age, no expensive chemo unless patients have failed the less expensive and more toxic alternatives.  One cochlear implant - or none - instead of two (even though Moore was appalled that an insurance company only wanted to pay for one.) A huge amount of our health care budget is spent in the last week of patients' lives.  Less aggressive therapy for the very ill could certainly save a lot of money. 

These are choices that we as a society haven't been willing to make.  Other country do ration care and so will we if we go to a single payer system.  There is not necessarily anything wrong with that.  But, that is what Moore is really advocating - although he doesn't seem to realize it.  How would you feel if I told you that your 75 year old mother would live longer and do better with a biventricular defibrillator for her congestive heart failure, but that the government had decided that this wasn't cost effective?

I am happy to engage in a dialogue, but cannot surf the internet to find comments on my articles.  Please post your comments on this site.