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By Jerold J. Kreisman, M.D.
It was, after all, the 10th and final commandment-"Thou shalt not covet . . ."-so maybe God just stuck it in as an afterthought. In a species that lists more commandments than sins, it is one of those seven deadly ones. Dante visited Avarice on his descent through Hell, pausing there momentarily as he passed through Gluttony on his tour to Wrath and beyond. Greed has always infiltrated humankind. Perhaps it is fueled by an arrogance that can never feel full. But for many of us, it is hard to understand fully.
Recent news articles have described the unfathomable greed of trial attorneys involved in tobacco lawsuits. Contingency settlements could result in windfall payments to lawyers of $92,000 an hour. In rejecting a motion to cap these fees, the U.S. Senate reflected its own greed-this time for campaign contributions-in gutlessly refusing to challenge the powerful trial lawyers lobby.
What is most macabre in this absurdist theater is how the players defend greed as "free enterprise." Rather than accept a policy of enough is enough, the goal is to get all you can.
What is personally ironic is that Rich Hailey, the president of the Association of Trial Lawyers of America, supports his position against contingency fee limits by arguing, "The federal government does not regulate the fees charged by doctors, accountants, or plumbers."
While I am honored as a physician to be listed in the company of other professionals who are paid according to their work, expertise, and skills, I am amused that Mr. Hailey has never heard of Medicaid or Medicare.
Uniform, imposed fee structures have deeply wounded medical excellence by rewarding all physicians equally. Now that managed care organizations have followed the government's lead, all physicians are paid the same regardless of their skill level or experience.
Psychiatric care has suffered the greatest impact, having been forced to endure the largest cutbacks. How I envy my brethren in other professions who are truly allowed to work within a free marketplace in which the consumer (and not some bogus outside "quality assurance" entity) can judge quality and determine if the lawyer, accountant, or plumber is worth their freely determined fees. Such a system also reasonably rewards the professional for actually logging the hours, rather than for just snagging a propitious largess. Unlike corporate America, the accountant, the plumber, and the doctor don't get obscene bonuses if the books balance, the toilet flushes, or the patient lives.
Although greed surely permeates our profession as well, in general most physicians did not enter medicine to become excessively rich. Indeed, doctors are notorious for being both ignorant of and disinterested in business matters, a primary cause for the profession's exploitation by profit-driven industries. Most of us expected a comfortable living in exchange for long years of study and a quest for excellence, which would be rewarded by the honor of working long hours, continuing a lifelong commitment to constant education, and caring for patients who entrust us with their lives.
The chief executive officers of major managed care firms receive an average income package of $6 million a year. Surely, millions of health care dollars should not be going to individual administrators, physicians, or institutions. They should be spent on rendering health care to millions of people.
It is time to rein in uncontrolled greed. The federal government needs to reconsider capping windfall profits from all sources. Reasonable rewards for entrepreneurial and contingency risk taking should be preserved. But it is offensive to those of us who make a living based on payment for time spent to be confronted with such quirkish and vulgar enrichment. Specious arguments invoking "free enterprise" to justify unconscionable money and power grabs should be considered stand-up comedy, not stand-tall capitalism.
Dr. Kreisman is in private practice and is medical director of adult psychiatry at DePaul Health Center in St. Louis.