We Liked Our Doctor


We liked our doctor. A lot. We invested time and effort in finding him. He spent time getting to know his patients.  And when our health insurance premiums skyrocketed not so long ago -- and, yes, they soared -- we told ourselves that at least, when we need medical care, we have a good doctor.

But here it is. A letter arrived. As the perspicacious predicted (though not as the American public was promised), we are losing our doctor. Oh, he is not yet entirely unavailable -- there are physician's assistants in his old office who may still be able to see us, for at least a little longer, and if necessary consult with him by phone. But he has moved to a different job, in which he may be better able to surmount the paperwork and continue to support his family.

No surprise. Apart from physicians who cater to Hollywood-celebrity levels of wealth or Washington-elite levels of power, how can any doctor with a private practice find time to deal with individual patients? The new prime imperative imposed by law requires that a doctor spend most of his or her time and energy toiling to comply with a regulatory burden so titanic that even those who issue it can't keep track of it. I have no criticism of our (former) doctor, who invested years in mastering his profession, but has now been effectively commandeered as a serf of the federal bureaucracy. He is behaving pretty much the way Obamacare (dis)incentives would have him do.

It makes me sad. Not only because I really did like our doctor, and what clearly lies ahead is a path of rising costs, dwindling choice and lengthening queues. But because what lies ahead for this country is not good medical care for all, but gray standardization in which we are not only forced to pay for things we don't need, but deprived in a crisis of the medical care that we really do need. Federal regulators, not doctors and patients, will make the decisions.

And somewhere in all the public debate -- amid the gibberish about  Websites and "mandates" -- there is a basic idea that's gone missing. When people are forcibly deprived of the opportunity to engage in voluntary transactions with each other -- when you and your doctor are kept apart by a minefield of impassable regulation (dolled up under the ersatz label of a "marketplace") -- the result is the destruction of potential wealth. No, I am not talking solely about money, but about the many dimensions of health, wealth and satisfaction, as in, The Wealth of Nations; the inalienable right to life, liberty and the pursuit of happiness.

Economists have a term for this kind of destruction, now being visited on American medicine. They call it deadweight loss. The nullity, the non-creation of prosperity, the absence of mutual benefit, the empty triangle on the supply-demand chart, where a free market would have allowed gains from trade -- from which both parties emerge better off than before. At the extremes, the Soviet Union with its repression and its warped and beggared economy was a colossal exercise in blocking markets and enforcing a nightmare of deadweight loss -- to the huge detriment of all but the exempt elite. The United States, with its astounding prosperity, and its much-envied and innovative medical industry, was a testament to the power of markets. (No, the markets in medicine were not entirely free; there was a big regulatory web, there were huge legal tangles; but the choices, and freedom, were far greater than what's happening now).