Sunday, October 17, 2004

Doctor compensation: Do no harm

I was heartened to see the reporting of obstetricians’ and gynecologists’ high earnings along with the rising cost of medical malpractice insurance in your recent article on the proposed medical work slowdown in Prince George’s County (“Doctor boycott likely to be felt across PG,” Metro, Wednesday).

The article stated that the rate increase could boost annual premiums for obstetricians and gynecologists to as much as $150,000, and that the Bureau for Labor Statistics put the average annual salary of obstetricians and gynecologists in Maryland in 2003 at $197, 600.

The six-figure mean-earnings number represents compensation after all expenses, including malpractice insurance. If the 33 percent increase in malpractice insurance for the current fiscal year represents a figure of $150,000 then the cost of malpractice insurance for fiscal year 2003 for this specialty was around $100,000. The actual cash difference between the cost of malpractice for fiscal years 2003 and 2004 is somewhere around $50,000. If, for the current fiscal year, this extra expense was removed directly from the earnings of the physicians of this specialty and if the after-expense compensation remained flat without this removal, the after-expense compensation would still be around $150,000.

So the extra expense for the physician could represent the down payment on an expensive sports car. What does the loss of care over this amount mean for patients affected by the boycott? Increased risks for fetal and maternal mortality, to be sure. In the case of surgeons — supposing surgeons end such services such as biopsies and colonoscopies — the result could be failure to detect cancer early. The difference could be life or death.

More so than any other group, physicians share a responsibility to their patients that goes beyond that of the ordinary customer relationship. Purely financial reasons are behind the stoppage of service and the outright abandonment of existing patients in some cases. You quote Dr. Suresh Gupta, a physician at Prince George’s Hospital Center and former president of the medical staff, as saying that “None of us wants to bring our patients into this kind of situation.” Dr. Gupta’s colleagues have already done this by failing to provide services to their patients. One begins to wonder whether the motto “do no harm” is now extending to physicians’ collective pocketbooks from its original application to patients.


Thousand Oaks, Calif.

Social Security: Not an investment

James Campbell’s letter (“Social Security: a bad investment,” Tuesday) made some very good points if one assumes that Social Security is supposed to be an investment or a retirement plan. The only trouble is that it is neither, nor was it ever intended to be.

It is a welfare program invented as part of President Franklin D. Roosevelt’s New Deal to keep the old folks out of the poorhouse or the old folks’ home, or off the relief rolls, by providing a subsistence entitlement called social insurance. To avoid a severe budget impact, the New Deal plan enacted an adjunct to the income tax. So what is happening is that most of those who are receiving income are paying an income surtax on top of their regular income tax. The employer also pays additional tax. Politicians claim that this Social Security tax money is going into a trust fund that will keep the old folks out of the poorhouse, off the street or whatever.

This is not true. The money goes into the general fund so that the politicians can spend it any way they see fit. What goes into the trust fund is a stack of IOUs with the strength of the U.S. Treasury behind it.

The good news is that the trust fund will never go bankrupt as long as the Treasury doesn’t. The bad news is that politicians can continue to use this book-cooking system to make dire predictions, instilling fear, promoting higher taxes and currying votes.



Jobs and the presidency

John Kerry has repeatedly claimed that the U.S. economy is in its worst shape since Herbert Hoover and that millions of jobs have been lost (“Bush is no Hoover,” Commentary, Oct. 11).

Mr. Kerry’s lost-job assessment begins on Jan. 1, 2001, 20 days before George Bush’s inauguration, and nine months before the president’s first budget went into effect. Mr. Kerry focuses solely on the Bureau of Labor Statistics Current Employment Statistics survey (also known as the payroll survey), or non-farm payrolls. The CES survey does not include many small-business owners, including sole proprietors, owners of sub-chapter “S” corporations, and 1099 contractors.

That’s very important, because the largest growth in our economy lately has come from small-business owners. If we look at the BLS’ household survey, which includes the small-business owners, we see that there was an average of more than 136 million jobs in 2001 and almost 139.5 million as of September 2004, an increase of more than 3 million jobs.

Does Mr. Bush deserve the credit for the job creation? Probably very little. But surely Mr. Kerry deserves none. Our market economy is a self-correcting system. It will continue to grow barring any disastrous legislation from Congress or mismanagement from the Fed. The truth is out there, just not on the campaign trail.



Questions for Bush, Bob Schieffer

Paul Weyrich and the Rev. C. Welton Gaddy weren’t the only ones who sent faith questions to CBS’ Bob Schieffer for the third presidential debate. (“Religious groups praise faith debate,” Page 1, Friday). On Sept. 26, I sent the following questions to Mr. Schieffer:

m President Bush, you portray yourself as a person of deep religious faith. In what ways does your faith influence your foreign policy?

m President Bush has told people he believes God wanted him to run for president. Mr. Bush, how did the realization that God wanted you to run for president come about?

m President Bush, since you did not talk to your biological father, a former commander in chief, about Iraq, what part did your “higher Father” play in your decision to attack Iraq?

Mr. Bush’s hopes for re-election depend in large part on getting four million evangelical Christians who didn’t vote in 2000 to vote for him on Nov. 2. For that to happen, the country needs to know how his faith affects his views on war and peace.


Louisville, Ky.

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