“Of all the forms of inequality, injustice in health care is the most shocking and inhumane”
–Martin Luther King Jr.

Among the Wealthiest One Percent, Many Variations

By Shaila Dewan and Robert Gebeloff
The New York Times, January 14, 2012

The colossal gap between the very rich and everyone else – the 1 percent versus the 99 percent – has become a rallying point in this election season. President Obama positions himself as a defender of the middle class, and Mitt Romney, the wealthiest of the Republican presidential candidates, decries such talk as “the bitter politics of envy.”

The range of wealth in the 1 percent is vast – from households that bring in $380,000 a year, according to census data, up to billionaires like Warren E. Buffett and Bill Gates.

Most 1 percenters were born with socioeconomic advantages, which helps explain why the 1 percent is more likely than other Americans to have jobs, according to census data. They work longer hours, being three times more likely than the 99 percent to work more than 50 hours a week, and are more likely to be self-employed.

In one survey of wealthy Chicago families, almost twice as many respondents said they would cut government spending as those who said they would cut spending and raise revenue.

“I don’t mind paying a little bit more in taxes. I don’t mind putting money to programs that help the poor,” said Anthony J. Bonomo of Manhasset, N.Y., who runs a medical malpractice insurance company and is a Republican. But, he said, he did mind taking a hit for the country’s woes. “If those people could camp out in that park all day, why aren’t they out looking for a job? Why are they blaming others?”

Still, David Mejias, a divorce and personal injury lawyer who once served as a Democratic legislator for Nassau County, said that the system everywhere was skewed in favor of the self-employed and business owners who could deduct part of the cost of their cars, trips, dinners and even collectibles like art.

“Not only do we make more money, but if you do a lifestyle analysis, we make a lot more money,” he said. “Before we even get paid, most of our life has been paid for already.”

“I definitely see it around me,” said Anu Chandok, 36, an oncologist in Lake Success, referring to the country’s economic pain. “It just personally hasn’t affected me yet.”

Dr. Chandok said that her husband, also a doctor, was still paying off his student loans. The couple has a nanny, but Dr. Chandok’s father-in-law does the shopping and cooking.

Dr. Chandok said she had never heard the Occupy Wall Street slogan “We are the 99 percent.” Two children and 11-hour workdays, she said, do not leave much time for politics.

But when the slogan was explained as a complaint against the wealthy’s growing share of income, she shook her head. “I spent four years in undergraduate school, four years in medical school, three years as a resident and three years as a fellow,” she said. “You have to look at the people who are complaining.”

http://www.nytimes.com/2012/01/15/business/the-1-percent-paint-a-more-nuanced-portrait-of-the-rich.html?_r=2&hp=&pagewanted=all

New York Times Interactive

Of 360,785 physicians who practice in offices and clinics, 27.2 percent have incomes in the top 1 percent (over $380,000).

http://www.nytimes.com/packages/html/newsgraphics/2012/0115-one-percent-occupations/index.html

Comment: 

By Don McCanne, MD

On Martin Luther King Jr Day it seems appropriate to contemplate what he might say about the dramatic increase in flow of wealth from middle- and lower-income families to the 1 percent who constitute the uber-wealthy. It seems safe to assume that he would be concerned about the negative impact on the issues of social justice to which he devoted his life.

One of those issues was health care justice. What do you think he might say about the fact that 27 percent of physicians practicing in offices and clinics fall into the highest 1 percent of income? It is likely that he would not frame the problem narrowly as excess compensation for physicians but rather as the larger issue of an excess accumulation of wealth at the very top when there is so much unmet need amongst the masses.

But for many of us who have had experience in the trenches, we have been annoyed, to say the least, that many of these same high-income physicians refused to see our uninsured and Medicaid patients. Was it because they didn’t want to make the smallest of dents in their high incomes by using a small amount of office time on just a few patients that did not cover their costs? Or was it that they didn’t want “that element” to frequent their waiting rooms? Both, in my experience, and as Dr. Chandok’s views suggest.

One concern that many physicians have about single payer, or an improved Medicare for all, is that the government, as a monopsony, could reduce physicians’ incomes perhaps to the level of teachers’ salaries. Although incomes of physicians in most other nations are lower than in the United States, they still rank well above average. Physicians do very well, though most are not able to accumulate large amounts of wealth that a $380,000 or more income might bring.

Most physicians who are truly dedicated to serving patients would be satisfied with incomes in the top 20 percent if they were provided a practice environment conducive to optimal care for all of their patients. That, of course, is precisely a major goal of single payer.

Many if not most of those physicians who want to be in the top 1 percent might not be satisfied. When deciding on career choices they might reject medicine if it had government controls on spending, and choose an educational path that might lead to the financial services industry, corporate leadership, or entrepreneurial endeavors.

Opponents of government-financed medicine have warned that controls on health care spending might deprive health care of some of the finest and brightest minds. What? Do we really want more physicians whose primary interest is to accumulate wealth while demonstrating absolutely no compassion for the least amongst us? There isn’t much doubt about what Dr. King’s position would be.

When we are asked if single payer might reduce physicians’ incomes we don’t need to fumble around trying to craft an answer that would placate physicians with very high incomes. We should state frankly that if an individual’s goal is to have a personal fleet of luxury automobiles and a condo in every climate, then medicine isn’t the field for them, or at least shouldn’t be.

On the other hand, if the goal is to obtain the best attainable health care for everyone, while adjusting incomes to reinforce the primary care infrastructure and to provide fair but not excessive compensation for procedure-oriented specialists, then practicing medicine in a single payer environment is just what the compassionate doctor ordered.

“Of all the forms of inequality, injustice in health care is the most shocking and inhumane”
–Martin Luther King Jr.

Among the Wealthiest One Percent, Many Variations

By Shaila Dewan and Robert Gebeloff
The New York Times, January 14, 2012
The colossal gap between the very rich and everyone else – the 1 percent versus the 99 percent – has become a rallying point in this election season. President Obama positions himself as a defender of the middle class, and Mitt Romney, the wealthiest of the Republican presidential candidates, decries such talk as “the bitter politics of envy.”
The range of wealth in the 1 percent is vast – from households that bring in $380,000 a year, according to census data, up to billionaires like Warren E. Buffett and Bill Gates.
Most 1 percenters were born with socioeconomic advantages, which helps explain why the 1 percent is more likely than other Americans to have jobs, according to census data. They work longer hours, being three times more likely than the 99 percent to work more than 50 hours a week, and are more likely to be self-employed.
In one survey of wealthy Chicago families, almost twice as many respondents said they would cut government spending as those who said they would cut spending and raise revenue.
“I don’t mind paying a little bit more in taxes. I don’t mind putting money to programs that help the poor,” said Anthony J. Bonomo of Manhasset, N.Y., who runs a medical malpractice insurance company and is a Republican. But, he said, he did mind taking a hit for the country’s woes. “If those people could camp out in that park all day, why aren’t they out looking for a job? Why are they blaming others?”
Still, David Mejias, a divorce and personal injury lawyer who once served as a Democratic legislator for Nassau County, said that the system everywhere was skewed in favor of the self-employed and business owners who could deduct part of the cost of their cars, trips, dinners and even collectibles like art.
“Not only do we make more money, but if you do a lifestyle analysis, we make a lot more money,” he said. “Before we even get paid, most of our life has been paid for already.”
“I definitely see it around me,” said Anu Chandok, 36, an oncologist in Lake Success, referring to the country’s economic pain. “It just personally hasn’t affected me yet.”
Dr. Chandok said that her husband, also a doctor, was still paying off his student loans. The couple has a nanny, but Dr. Chandok’s father-in-law does the shopping and cooking.
Dr. Chandok said she had never heard the Occupy Wall Street slogan “We are the 99 percent.” Two children and 11-hour workdays, she said, do not leave much time for politics.
But when the slogan was explained as a complaint against the wealthy’s growing share of income, she shook her head. “I spent four years in undergraduate school, four years in medical school, three years as a resident and three years as a fellow,” she said. “You have to look at the people who are complaining.”
http://www.nytimes.com/2012/01/15/business/the-1-percent-paint-a-more-nuanced-portrait-of-the-rich.html?_r=2&hp=&pagewanted=all
New York Times Interactive
Of 360,785 physicians who practice in offices and clinics, 27.2 percent have incomes in the top 1 percent (over $380,000).
http://www.nytimes.com/packages/html/newsgraphics/2012/0115-one-percent-occupations/index.html

On Martin Luther King Jr Day it seems appropriate to contemplate what he might say about the dramatic increase in flow of wealth from middle- and lower-income families to the 1 percent who constitute the uber-wealthy. It seems safe to assume that he would be concerned about the negative impact on the issues of social justice to which he devoted his life.
One of those issues was health care justice. What do you think he might say about the fact that 27 percent of physicians practicing in offices and clinics fall into the highest 1 percent of income? It is likely that he would not frame the problem narrowly as excess compensation for physicians but rather as the larger issue of an excess accumulation of wealth at the very top when there is so much unmet need amongst the masses.
But for many of us who have had experience in the trenches, we have been annoyed, to say the least, that many of these same high-income physicians refused to see our uninsured and Medicaid patients. Was it because they didn’t want to make the smallest of dents in their high incomes by using a small amount of office time on just a few patients that did not cover their costs? Or was it that they didn’t want “that element” to frequent their waiting rooms? Both, in my experience, and as Dr. Chandok’s views suggest.
One concern that many physicians have about single payer, or an improved Medicare for all, is that the government, as a monopsony, could reduce physicians’ incomes perhaps to the level of teachers’ salaries. Although incomes of physicians in most other nations are lower than in the United States, they still rank well above average. Physicians do very well, though most are not able to accumulate large amounts of wealth that a $380,000 or more income might bring.
Most physicians who are truly dedicated to serving patients would be satisfied with incomes in the top 20 percent if they were provided a practice environment conducive to optimal care for all of their patients. That, of course, is precisely a major goal of single payer.
Many if not most of those physicians who want to be in the top 1 percent might not be satisfied. When deciding on career choices they might reject medicine if it had government controls on spending, and choose an educational path that might lead to the financial services industry, corporate leadership, or entrepreneurial endeavors.
Opponents of government-financed medicine have warned that controls on health care spending might deprive health care of some of the finest and brightest minds. What? Do we really want more physicians whose primary interest is to accumulate wealth while demonstrating absolutely no compassion for the least amongst us? There isn’t much doubt about what Dr. King’s position would be.
When we are asked if single payer might reduce physicians’ incomes we don’t need to fumble around trying to craft an answer that would placate physicians with very high incomes. We should state frankly that if an individual’s goal is to have a personal fleet of luxury automobiles and a condo in every climate, then medicine isn’t the field for them, or at least shouldn’t be.
On the other hand, if the goal is to obtain the best attainable health care for everyone, while adjusting incomes to reinforce the primary care infrastructure and to provide fair but not excessive compensation for procedure-oriented specialists, then practicing medicine in a single payer environment is just what the compassionate doctor ordered.