December 3, 2009

Your money for nothing and your health care for free

Everyone likes to dump on lawyers. Often it's for obvious reasons.  But there are some lessons that can be learned from lawyers.  Specifically there is one lesson for health care that deserves some attention.  It can be summed up in two words: pro bono.

Most if not all state bar associations have strong recommendations that members provide some level of free service for the public good. Often the work is provided to the underprivileged or those who cannot afford legal costs, hence the free service.  It's charitable. A common recommendation seems to be 50 hours per year of pro bono work.  If a typical work year is in the neighborhood of 2100 hours that means that a lawyer is contributing less than 2.5% of their time to pro bono work.  That's not an unreasonable strain.

If we apply that same logic to doctors, based on the assumption that there are 846,000 doctors in the United States (2005), then we have 42.3 million hours of pro bono medical work available.  Never mind that there is a doctor shortage in the country, or that it would take 2.5% of the available surgery away from paid health care for now. And ignore the fact that doctors work on average more than 40 hours per week.  And ignore for now the fact that it would require hospitals give up some facilities and medical supplies, likely in the same 2.5% ration, thereby cutting into profit margins.

The last number the President associated with uninsured Americans was 30 million, and the average number of visits per person per year in the United States is 8.9.  That would mean an additional 267 million doctor visits of say an average 30 minute span (that part is pure conjecture) for a total of  8 billion  minutes of doctor time required or 133.3 million hours of visits.

Ooops! That's three times the number of pro bono hours we caculated as available. And it still doesn't factor in the shrinking size of the doctor supply.  So if we bumped the pro bono to 7.5% of all doctor's time we could roughly cover our goal of providing pro bono health care for the uninsured. As a doctor would you give up 7.5% of your income for charitable reasons? Maybe.  Maybe not.  As a hospital would you give up that percentage of your facilities and supplies - and therefore profits - for the same charitable reasons? Maybe, but probably not.

Now consider all those caveats that further complicate the issue.  The problem, could be minimized though.  If you increased the number of physicians (which is already a problem that needs to be addressed anyway) significantly, say by 50%, the pro bono per doctor goes down to 5%.  Is 5% of a doctor's time for free feasible?  Yeah it is feasible, especially when compared to the alternative - ultimately price controls and salary caps.  I'm sure doctors would rather give up 5% for free than be capped and also have to pay a tax as a likely user of a premium health care plan themselves.

This is fundamentally an issue of supply more doctors not only would allow for some sort of pro bono work, it could ease accessibility and availability issues.  Further, it would negate the need for a trillion dollar supposedly revenue neutral plan by the government and it would keep the government out of the medical business.

There, yet another alternative to Obamacare.  It may not be the greatest or well thought out solution since I came up with it in 30 minutes, but the same can likely be said for the Senate health care bill.....

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