Something wrong?

There was an extraordinary hearing today at the bipartisan commission established to examine the causes of the current financial crisis. Jamie Dimon, CEO of JPMorgan Chase and commonly acknowledged as one of America’s most powerful and outspoken bankers, said this:

“Regulators simply didn’t have the visibility, tools or authority to protect the stability of the financial system as a whole.” ”

Why not?

Market Failure II

Do rural communities deserve a lower standard of health care? According to the Missoulian (1/25/2009), they do. In an article written by David Brown of the Washington Post, the backbone of rural medicine is disappearing. Young surgeons are in great demand and rural hospitals and health clinics can’t afford to pay for them. Its simple economics – the result is that rural communities don’t have access to general surgeons. And that means family practitioners in those communities “can’t deliver babies, emergency rooms can’t take trauma cases, and most internists won’t do complicated procedures such as colonoscopies.”

You can’t blame the surgeons. After they have labored through years of medical school and more years as a resident, they have chalked up hundreds of thousands of dollars of debt. They simply can’t afford to work in a rural community.

You can’t blame the rural hospitals. They don’t have the population to be able to pay the same salary that the big city, billion dollar, non-profit hospitals are able to offer.

You can’t blame the current general surgeons. With the advent of HMO’s we have seen them spending less and less time with more and more patients in order to achieve the ‘efficiencies’ that the insurance companies insist on. There is no reason why they would encourage young medical students to follow in their footsteps and practice the craft of general practice. The non-surgical specialities such as radiology or cardiology pay about the same without the intense workload and scheduling.

Of course, there are some sensible solutions. We could make medical school free. Students would still have to cover their living expenses and pay for books, but tuition and fees could be paid for by the public. Or, we could pay all general surgeons the same amount, regardless of the location of their practice. Or, we could make every hospital that wishes to be considered a non-profit (and therefore doesn’t pay tax on their profits) to provide equal coverage to urban, suburban, and rural areas in a surrounding region. Surgeons could take a rotation across the different campuses of the same hospital.

All of those solutions are perceived to be anti-free enterprise. We would lose the brilliance of the marketplace, in deciding who can afford to go to medical school, where the best surgeons should work, how much they should get paid, and how to more efficiently provide the highest standard of health care to those willing to pay for it.

But, that free market fails the rural community. They don’t deserve equal treatment. Or if they did then they would have to move to the city. Living on the backroads of Montana comes at a cost. Is it your health?