Our Entitlement Mentality and Medical Education

I had the good fortune to attend the Kentucky Chamber of Commerce Annual Dinner last Tuesday night at the downtown Marriott. The keynote speaker was Ted Koppel and his  remarks were extraordinary in my view.

He talked about our entitlement society, but not from the perspective of a tea party member. Instead he spoke with empathy and from experience about the impact of war on soldiers and their families and decried the faux patriotism popular in America today. He pointed out our lack of sacrifice, as people, to support (read fund) the wars. In summary, Koppel believes that our entire society, yes including those fueling the tea party movement, has an entitlement mentality and he fears that mentality underlies the deficit which he says is the greatest threat to our society in over 70 years. In summary, nobody wants to pay for anything.

Which brings me to medical education…the training of doctors.

Recently, the local newspaper and television news departments have covered the escalating controversy between the University of Louisville Physicians (UPA) and Humana. The controversy, at least as reported in the CJ, revolves around, you guessed it, payment rates. It seems that UPA says that Humana wants to cut its rates to UPA physicians by 10%. Conversely, Humana denies such a charge and says that UPA wants a 10% increase in addition to a substantial increase provided by Humana a few years earlier.

Gerry Rabalais, Chair of the Department of Pediatrics at the Medical School and the leader of UPA and Jeff Bringardner, Humana’s Kentucky Market President penned dueling editorials in the CJ several weeks ago. Their points of view are as expected polar opposite on the issue of rates. Dr Rabalais reviews the critical importance of the University medical complex to our community and argues that Humana should pay its share of that added value. Mr. Bringardner rightly questions whether that is indeed the responsibility of Humana’s members, who are the ones that ultimately pay.

Like any complex issue, both Dr Rabalais and Mr. Bringardner are correct. The rational underlying their points of view lead back to the entitlement mentality decried by Koppel.

In short, we as a community need to train new doctors. No one would argue the point. Additionally, a community such as Louisville needs a first-rate medical school for important other reasons. Universities are the place that the most difficult maladies are diagnosed and treated. Research studies and clinical trials are pioneered in University Hospitals and medical schools. And, those medical schools many times give life to new companies based upon that research.

Which brings me to the point of our entitlement mentality.

No one seems to want to pay for the medical training and research. Medicare and Medicaid have inexorably ratcheted down payment for medical eduction over the last thirty years. Policy makers within Medicare question whether it is the responsibility of the federal government to pay for medical education. And, commercial payers like Humana, question whether it is the responsibility of its members, which underlies the current dispute between the two organizations.

So, who should pay?

Some might say that the medical student should pay. Let’s think about that a bit. Keeping in mind that students in medical schools are typically fairly bright, one would assume they would weigh their options when deciding to become a doctor. According to a 2005 New England Journal of Medicine article , the average cost of a four-year medical eduction ranges from$140,000 to $225,000 depending upon whether you attend a public or private medical school. That cost has of course risen substantially today. (It is important to note that this figure includes only tuition and books and living expenses, which does not cover the total costs of the medical school. My guess is that number would at least double if students had to shoulder the entire cost.

According to a blog focused on MD earnings, the average earning for an established family physician in the U.S. is about $145,000. Entry level earnings are of course substantially lower. At the same time, entry-level earning for investment bankers range from $100,000 to $130,000. Entry level. And those positions generally need only a bachelors degree and perhaps an MBA at a substantially lower cost than a medical school eduction.

You can do your own research on accountants, lawyers, actuaries, and any other profession. I guess the question is, which would you choose?

The hard fact here is that University medical schools and hospitals provide a great and valued service to a local community and it’s the responsibility of that community to support that effort. No matter what lens with which you view the University of Louisville, it is critically important that we have a strong and vibrant medical school, University Hospital and partners such as Jewish and Norton which run certain of the training programs.

There is no free lunch.

Today, policy makers haven’t proposed an alternative to a shared responsibility between the feds (Medicare), the states and private insurance carriers. So, absent a solution imposed by the people, these constituencies have to continue to pay. And the people seem to be pushing back against any kind of new government program, even if that program merely shifts the responsibility (and the cost) away from a few groups of citizens to the entire citizenry.

There has to be a better way.

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