There is trouble getting healthcare in America. 28 million lack coverage for healthcare and current pending legislation, that seems likely to pass (probably after some modifications) plans to add another 24 million to that. If you recognize this as a problem, the next step is to find a solution.
Some blame the government for being involved where the free market fails. Others blame the market for being involved where the government fails. It's also easy to shake a stick and find people who blame insurance, or pharmaceutical companies, and other elements.
But you know who never gets blamed? The doctors. We can't seem to find a solution so far, so let's examine the one element always overlooked: the doctors themselves.
"But the doctors are the ones fixing things." Depends on how you define fix. If you added more doctors to take care of shortages, then yes, that may mitigate and temporarily salve our predicament. Health professional shortage areas are defined as an area with at least 3,500 individuals in need of a primary care physician, and in 2014 there was a deficit of 8,200 primary care physicians across 6,100 shortage ageas. Similarly, a shortage area for mental health is defined as an area with at least 30,000 individuals in need of mental health care and in 2014 there was a deficit of 2,800 mental health providers across over 4,000 shortage areas. The extent of the problem is estimated to be a shortage of 45,000 primary care physicians by 2020 and a shortage of 130,000 by 2025. While there is currently a greater number of physicians graduating from newer medical schools, this will still ultimately be insufficient since it will lead to an increase of only 11% in the physician workforce by 2025. And while the number of residency positions have increased, the total number is still a decrease in comparison to the total population, viz. 15% and 6%.
So the shortages and failure to have sufficient practitioners are projected to persist for the foreseeable future. That's because another word for "insufficient" is "lack of supply" in economics. That's bad for the buyers of medical care, and good for the sellers, viz. physicians. Despite the fact that 52% of physicians over 50-years-old, which constitute one third of clinicians, plan to stop practicing within 5 years it is not in the interest of MD's to see more enter their field.
1847-1901: The AMA develops as a body of physicians that had "the more decided views about the importance of diplomas." In short, they wanted to raise standards for medical school admissions (ie. bottleneck inputs into the system) and they wanted to do it nationally because if it was implemented on just the state level then labor markets could move.
1904: The AMA establishes Council on Medical Education, calling for 4 years high school + 5 years medical training + 1 year internship + licensing. This means of the 160 existing medical schools examined, they approved of only 82 and claimed 32 were beyond repair. Many reports and investigations, some more famous than others, were launched after this. The results showed that if the AMA had their way 20 states would have been left without any medical schools. Local legislatures intervened at this point and maintained the current supply of medical schools.
1929: The AMA called the Sheppard-Towner Act (which provided matching funds to states for prenatal and child health centers) an "imported socialist scheme" and has it repealed. This leads to righteous indignation on the part of some physicians who form the American Academy of Pediatrics in 1930.
1937: The AMA denounces the Committee of Physicians for the Improvement of Medicine (who advocated on behalf of the "medically indigent") by "insinuating that they had obtained signatures by devious and deceptive means". Too bad twitter wasn't around back then.
1962: JFK tries to pass the King-Anderson bill but is defeated by the AMA and their Operation Coffee Cup.
1979: Congressional Office of Technology Assessment calculates, somehow, an estimated 185,000 surplus physicians by the year 1990. So, predictably, the answer was to place a moratorium on new medical schools, which has only recently been modified.
There were more failed attempts at healthcare reform to follow, and even now Trump is not immune to be obstructed. The AMA truly are bipartisan in their hatred. And not merely on ideological grounds: HMOs were considered "socialistic" when proposed by Nixon, and even the consideration of disability insurance in 1950 was called "another step toward wholesale nationalization of medical care and the socialization of the practice of medicine." Basically, everything they don't like is socialist, regardless of how free the market it is. Until it is THEIR market.
A good example of this is Leonard Peikoff making a slippery slope argument of barbers and regulations, which you can view here. By their actions, it's clear that physicians are not opposed to regulation per se, they're just opposed to regulations they don't like. But if you watch the video, the mentality is such that you'll notice the physicians clapping at the prospect of you not getting healthcare and somehow applauding against the same type of regulations that the AMA and similar groups have been implementing for them. I've talked about the denial of ideology before, but this is still an impressive moment to capture on video.
If physicians, and their lobbying associations, are creating the situations that underlie the current medical predicament then they can't claim to be hapless victims. In approximately a century and a half they have constructed a system carefully designed to benefit exactly who you think it would instead of who you think it should.
"But they're just looking out for their own self-interest." Maybe, but that's not what they signed up for. However much you want to plead the Yuppie Nuremberg Defense ("I don't really want to make the money, paying off my loans forced me to…"), clinicians are entrusted with the health of their patients. They're granted their status, and your tacit approval when you receive their services, on the predication that they are actually going to do right by you and your interests.
"Well, at least they provide a good service that helps one's health and makes us feel better". So do vendors of cheese and alcohol. If the best reasoning you have for the kindness of the medical profession is that "a service was provided," go re-read your Fountainhead and call me in the morning. If we're going so far as to reduce ethics to transactions and utility calculus, then we should also declare that all the good acts stem from professional assertiveness thus making them fall under circumstantial moral luck – this reduces their ethical standing to a nullity and they deserve no praise as they are part of a causal chain but have demonstrated no moral responsibility.
Will a doctor keep your information confidential? That's what they say anyway. But the reality is that they have loose lips concerning patients who are drug seeking, when insurance or employer wants the records, when the law wants the records, or just when you are a patient that has a certain disease. How much trust does that warrant?
This is not just found in psychiatry. A significant portion, 30%, of the most influential medical research is wrong. Only an average of 10-25% of medical studies are reproducible, with specific fields, such as cancer research, having as much as 89% of landmark research findings for drug targets being unreproducible. Also, the current research paradigm is such that the age of cited articles cluster around the past 10 months and reference rot means that 13-25% of hyperlinks cited are broken and therefore unusable. EVEN IF all these obstacles are surmounted, we'd still have to grapple with the fact that 85% of global research spending is wasted on poorly designed studies.
Well, nothing may be a stretch. There has been some very notable research done by Max Clara, Friedrich Wegener, Claus Schilling, Josef Mengele, Herta Oberheuser…in concentration camps in Germany. Or by Shiro Ishii if you want to visit Japan instead. Or Henry Heimlich if you prefer China. Or Marko Turina in Switzerland. Then again, you needn't leave the USA if so desired.
The combination of power seeking and high intelligence tends to bring about situations of arrogance and danger more so than we would like to admit. You don't have to go as far as Michel Foucault or the anti-psychiatrists of Italy to see this. Look at physicians overseeing torture in Uruguay in the 1980s, or psychologists being complicit with CIA torture in Abu Ghraib.
You could also just directly murder people, if these other methods are too roundabout. You could be a psychiatrist like Nidal Hasan or Radovan Karadzic, a surgeon like Ayman al-Zawahiri, or an opthamologist like Bashar al-Assad. The specialties don't discriminate.
"You're just pointing to a few bad apples", you may say. And you conspicuously forgot the rest of that phrase: "a few bad apples spoil the whole bunch." What part of "first do no harm" doesn't make sense to you? Didn't I just mention how they're not blameless above? Are we on repeat? Is the eternal recurrence here already?
The history of medicine in America extends back to brilliant minds like Benjamin Rush. In 1819, he said American physicians should reject the aristocratic tendencies of European physicians since "they are incompatible with the simplicity of science, and the real dignity of the physic". This slowly degraded until 1974, when Russell Roth, president of the AMA declared: "Of the consumers' role, passengers who insist on flying the airplane are called hijackers!" Your role as a patient has gone from deserving dignity to collusion with plane hijackers. Their words, not mine, just put on your glasses.
I know you want to think there are objective healers out there who are perfectly humanistic, ethical, and know it all. The idea that the people caring for your very life are going to be just as selfish and (almost) as ignorant as you is a terrifying prospect. But the vast majority, like in most things, are not the ideal. Hell, they're probably not even good. They're "human, all too human" as a famous German used to say.
If you're rushing to defend your favorite health practitioner, or you're in healthcare, then this is a warning sign that you should stop refusing to hear this. If you're skeptical of all of this, that means you haven't learned the lesson. If you remain skeptical, that means your impulse wasn't to say "Am I/they doing this?" or "How should I/they act differently?". Instead, your reaction was to rationalize as to why you/they are the exception, and in that case it most definitely applies. "Physician heal thyself" before you get defensive.
The power players, those with privilege, those who control the levers determining distribution of healthcare, have a special role to play. Things likely won't get better until the privileged in medicine decide to change. But before you can even contemplate change, the first step is to correctly recognize the problem.