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  • BIOETHICS FORUM ESSAY

The Medicine Show

Is there anything in basketball as beautiful as a crisp, clean back-door cut? I admire Jordanesque acrobatics as much as anyone – the astonishing hang-time, the posterizing dunks, the shots pinned to the glass or beaten back ferociously into the stands – but the truth is, anybody can appreciate the highlight reel performances. The real pleasures of the game are more subtle. It is the craft of basketball that makes my heart ache with pleasure: a quick drop-step in the low post, a classic pick and roll, a perfectly executed half-court trap. And this is the time of year, the college basketball post-season, when you can see the craft of the game in abundance. Now is the time when you can see old-school teams like Davidson or Air Force, or more recently, Georgetown, which runs a high-powered version of Pete Carrill’s Princeton offense. Sometimes, in all too brief glimpses, you can even see a North Carolina team that reminds you of the Dean Smith glory years. It makes you want to pick up a ball yourself, shoot a few jumpers, maybe even find a pick-up game.

But then those ads come on. You know the ones I’m talking about. The ones where Duke coach Mike Krzyzewski tries to sell you a Chevrolet. Or even worse, the ads for American Express credit cards, which look more like advertisements for Coach K himself: “I don’t look at myself as a basketball coach. I look at myself as a leader who happens to coach basketball.” When I see these advertisements all my repressed cynicism about college basketball comes flooding out. The star coaches whose salaries dwarf those of college presidents. The unaccredited “prep schools” that feed players to top universities. The six-figure shoe contracts, the dismal graduation rates, the “student-athletes” whose only reason for being at a university is desperation to get a try-out in the NBA. At the University of Minnesota, where I teach, the basketball program was sanctioned a few years ago after employing “tutors” to write term papers for the basketball players. If I put my fingers in my ears and just watch the games on television, I’m able to suspend my disbelief for a moment and pretend that this really is about college basketball. And then I see Coach K shilling for Amex and I think: who am I kidding? This is really about money.

It’s not all that different from American medicine. We all know, deep down, that something has gone deeply wrong with medicine in this country, and that it has a lot to do with money. This is a country where a drug rep can make over $100,000 a year to deliver minor bribes to doctors, where surgeons with perfect teeth do breast augmentations on televisionreality shows, where even bioethicists advance in their field by advising NASA or Pfizer or the Howard Hughes Institute. Yet it is also a country where 45 million people lack health insurance, and where unemployed people support themselves by volunteering for bronchoscopies or a course of untested psychiatric drugs. We spend billions of dollars on Botox and baldness drugs and let poor people go without any medical care at all.

To be honest, I don’t even like to think about it. Like the problem of big-time university sports, the problem of health care for the poor seems so vast, with so many vested interests at stake, that it feels almost intractable. It is hard to imagine that writing an article about it will do any good. The fact is, most of us are willing to tolerate the problems of market-driven health care as long as we have access to the best for ourselves. We live in the medical equivalent of gated communities, and when we feel guilty about it, we teach seminars about the people who can’t get in. Eventually the inequity starts to feel less like an economic injustice and more like an accepted fact of our social world, like the difference between business class seats and coach on an airplane. It is easier just to buy what you can afford, avert your eyes, and think about something else.

Or just watch TV. That’s what I’ll be doing this weekend. The show is too good to turn off. When Coach K comes on I’ll hit the mute button.

Readers respond

What about healthcare for the shouldn’t-be-poor? I am a doctor, $97,000 in student debt, ten years of my life given up to train for a career caring for the sick, and now I have no health plan, just a $5,000 deductible major medical policy. No dental care for the past six years, no mammogram, no pap smear, no medications. I used to get free samples, but that was unethical, so I don’t get samples anymore. One week of vacation a year for the past four years, and have had to cancel this year’s vacation entirely because I can’t afford to take a week off. The news says doctors don’t give charity anymore. Last week I did a random survey of active charts and found that I give away an average of 4.6 free services for every paid encounter. if that’s not charity, what is? And that is for people with insurance. Okay, so the charity really benefits insurance companies and Medicare, but it benefits the patients too. And the people who don’t have insurance? I give them a discount so they pay me the same as what I would get if they had insurance, and they don’t even have to pay the monthly premium. On average I collect $71 per each one hour patient encounter, of which about $45 goes to overhead. So for my advanced degree I take home $26 per hour. The attorney sends me bills for $250/hour. the accountant $125/hour. the computer guy $70/hour..

You’re right. Our system is so broke there is just no hope of fixing it. I would watch TV, but I have work to do, caring for the sick and keeping the well from getting sick if I can help it.

– A.Skaggs, MD
Lexington, KY

Published on: March 27, 2006
Published in: Health and Health Care, Health Care Reform & Policy

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