Yesterday, Jeffrey Goldberg, in the midst of a reasonable post suggesting there are multiple pathways we might take to improve our healthcare system and taking issue with a letter insisting Jews should support the current healthcare plan in the Congress and attack Senator Joe Lieberman for his opposition, tossed off an aside that requires some remonstrance:
I don't agree with Lieberman at all -- I would like to see the profit motive completely removed from health care in this country -- but I don't think Lieberman is betraying his religion by taking the position he takes.
This morning, Jefferey Goldberg posted a response from a reader taking issue with his wish:
Removing the Profit Motive from Health Care
(sic) spent years publicizing the work of brilliant scientists and physicians at two Ivy League medical centers. They are incentivized both by an altruistic desire to eradicate disease and by the prospect of seeing some financial reward for their labors, even when it is postponed for years while they toil in their laboratories, working for subsistence wages, until, with luck, they have a breakthrough or discovery. When a new drug, or treatment, or scientific technique does come to market, it's also a great boon for the university where the work is likely to have taken place, when they start to see an income stream from licensing their patent. Take a look at any university with a large scientific research enterprise, and then look at their budget. It's likely they are reaping significant revenue from intellectual property. So it's a pillar of our educational establishment. These discoveries don't come out of a vacuum; scientists are just like anyone else, with families to support and expenses to be paid.
The letter writer adds that Doctors also have an interest in supporting their families and paying their bills. Once upon a time, when in college, I was a confirmed liberal/leftist and accepted without question that the profit motive was immoral and unethical. The finest organizations were non-profits run by altruistic people who lived on a pittance, supported primarily by the warm feeling engendered by helping those less fortunate and by the approval of all right-minded people. It was axiomatic that liberals were good (better) people and that those who worked at places like NPR eschewed the profit motive as beneath them. (Imagine my shock and surprise to learn several years ago that so many NPR "talents" made incomes well into the high 6 figures.) Corporations were evil in direct proportion to their profitability. It is easy to be a liberal when you are not supporting yourself, paying your own taxes and bills, and enjoying all the comforts that our society has to offer.
With entry into adulthood, things change. First of all, "non-profit" is a meaningless term. Any viable organization (except the government, of course, which can simply print money ... for a time) needs to bring in as much money as it spends or it will soon fail to be a functional entity. Everything in excess of expenses therefore is profit. Non-profits convince the gullible that they are not motivated by profits, by which they mean some surfeit of profit above what they deem reasonable. They do this by offering their services for less than their competitors. They manage this neat trick by either getting (evil) corporations and/or wealthy individuals (no longer evil capitalists once they donate money to liberal causes) to subsidize their services or getting the government (ie, the taxpayers who pay a percentage of their profit for the privilege of living in this country) to subsidize their services. Others who engage in non-profit activities are able to do so because they were lucky enough to have wealthy parents, or have found a wealthy spouse, who enable them to offer their services at below market rates while subsidizing the life style to which they have become accustomed.
There are only a limited number of ways to see the "profit motive completely removed from health care in this country"or any human activity, for that matter. We could expect, or compel, all the scientists and healthcare professionals in this country to donate some fraction of their income to others by essentially working for below market wages. Doctors and researchers who currently spend 50-70 hours a week on research and/or patient care would then donate their time, energy, and services for compensation deemed fair by those who would adjudicate what profit actually means in this setting. (Should a Neurosurgeon clear $100,000 after expenses? $200,000? $500,000? More? Should the developer of a new drug that saves 50,000 lives a year be compensated with $100,000? $200,000? $500,000? More?)
People like Jeffery Goldberg misunderstand a fundamental about how the world operates when they dream of a world without a profit motive. Please note, I am a great admirer of Jeffrey Goldberg's writing. Though I often disagree with his point of view, I thoroughly enjoy his writing, which often is very incisive and well reasonsed. He is entitled to Imagine a world where healthcare is offered without any desire for profit, yet he does not apply the same desire to himself and his field of endeavor. He often exhorts his readers to purchase a subscription to the Atlantic. Presumably if more people pay to read the magazine he writes for, he will be able to have a more assured income and gain a raise in his compensation. At what point does his compensation become excessive? Who should determine what constitutes profit and how much profit is acceptable?
It is unseemly to be greedy. It is also, for many liberals, a difficult to digest fact that some people are endowed with greater abilities than others and that society, via the market, rewards some people, occasionally exorbitantly (and who wants to define exorbitantly?) while rewarding others far less than they feel they deserve. Yet, up until this time, there is no better way to discover value than through markets. And the reason markets function is that people want to, in fact need to, earn a profit. Profit, ultimately, is simply any excess over subsistence. Without a profit motive we would still be living in caves, in a more egalitarian Hobbesian world where we would have no worries about healthcare profits.
Recent Comments