How do we want to deal with doctors going on strike?

by · January 27, 2015

Jaybird

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50 Responses

  1. Russell Saunders says:
    January 27, 2015 at 5:38 pm

    Can’t really know what to say about this without more information than is provided in the article.

    I am broadly against doctors striking unless their work conditions are egregiously bad and there is no other remedy available.Report

    • Jaybird in reply to Russell Saunders says:
      January 27, 2015 at 5:45 pm

      Ah, very good to see you, @russell-saunders. Here is the story as covered by the SF Gate.

      Though I can’t say that *I* felt any more enlightened after reading it than I did after reading the press release…Report

      • Mike Schilling in reply to Jaybird says:
        January 27, 2015 at 10:59 pm

        sfgate.com is, by the way, the web site of the San Francisco Chronicle, which was famous for literally decades as one of the worst large-circulation newspapers is the country.

        That’s changed now. Its circulation is way down.Report

  2. Saul Degraw says:
    January 27, 2015 at 5:51 pm

    1. I will note that these are doctors at student health centers and not full hospitals. Most student health centers are not really trained to deal with emergencies anyway. So this is not a case of someone dying because the ER doctor was on strike while they had a massive heart attack or were in a serious car crash. UCSF is a major medical school and hospital but it does not seem clear from this article that regular UCSF doctors are going on strike. The article specifically mentions health centers.

    2. I am not sure if we will be seeing more of this. It is true that doctors are more likely to become employees instead of owning their own practices but they are still professionals. Lawyers don’t generally strike and they are largely employees of other people.Report

    • Kolohe in reply to Saul Degraw says:
      January 27, 2015 at 5:59 pm

      I also presume that if someone had an urgent medical issue in sight of the picket line, one or more doctors would drop the signs and render aid. Because it would be right thing to do, and also because I’m pretty sure they would lose their medical license(s) if they didn’t.Report

      • Michael Drew in reply to Kolohe says:
        January 27, 2015 at 6:07 pm

        I doubt they would lose their licenses but I’m sure they would give treatment, as their quarrel is not with the person who collapsed on the picket line, and they wouldn’t be acting as an employee in doing so anyway. They’d honor their profession’s commitments regardless of employment just because they believe in them.Report

      • Patrick in reply to Kolohe says:
        January 27, 2015 at 7:10 pm

        I’m not familiar with all state laws in all states, but in California at least if you are a licensed *emergency* medical practitioner you are legally required to deliver care… or rather, you can be held liable if you do not. See here:

        1799.108. Any person who has a certificate issued pursuant to this division from a certifying agency to provide prehospital emergency field care treatment at the scene of an emergency, as defined in Section 1799.102, shall be liable for civil damages only for acts or omissions performed in a grossly negligent manner or acts or omissions not performed in good faith.Report

      • zic in reply to Kolohe says:
        January 27, 2015 at 7:25 pm

        Same here in ME. When my younger kid was certified in outdoor emergency medicine, part of that responsibility was that he had to provide emergency care; couldn’t drive by the accident, etc.; something I actually had some concerns about for 16 year olds; but age, once certified, was not a relief of that responsibility.Report

      • Kazzy in reply to Kolohe says:
        January 27, 2015 at 9:46 pm

        I might be mistaken, but I believe this even extends to CPR-certified individuals in some states. I know some people who refused to carry their certification cards (which was usually the only way to determine whether someone was or was not certified) in the unlikely event they did not render support and were found to have been required to. Seemed real screwy…Report

    • Tod Kelly in reply to Saul Degraw says:
      January 27, 2015 at 7:55 pm

      ” I will note that these are doctors at student health centers and not full hospitals. Most student health centers are not really trained to deal with emergencies anyway. ”

      If the UC system is set up like the Oregon system, than the student health center isn’t for students in general; it’s for students who are kids of low-income parents. (Students that don’t qualify have to pay exorbitant fees to use the system.) If that’s the case here, than I can see some bad outcomes for a certain class of student, depending upon how long the strike might last.Report

      • Kolohe in reply to Tod Kelly says:
        January 28, 2015 at 2:41 pm

        Based on this UCLA page, everyone is treated, but everyone has health insurance with automatic, mandatory enrollment at the cost of about a 2000 dollars per academic year – with subsidies available based on state and federal guidelines for health insurance subsidies.

        In Virginia public universities, (in the last century), there was also a ‘health center’ that served all with a fee that got rolled into the rest of the student fees, and thus was mostly invisible. I do not remember it being nearly as much as UCLA is charging now – as the total student fees amounted to some 1000 dollars for the entire year back then.

        University student health centers should be just about the cheapest health care system to run – a young population where the persons from the lowest socioeconomic are mostly excluded. Just based on number of undergrads x yearly fee, they’re running a 50 plus million dollar a year system. And likely have a good deal of capital costs, like physical infrastructure, paid for from other university budget sources.Report

    • Tod Kelly in reply to Saul Degraw says:
      January 27, 2015 at 8:02 pm

      “I am not sure if we will be seeing more of this. It is true that doctors are more likely to become employees instead of owning their own practices but they are still professionals. ”

      In a way, this happened all the time pre-ACA. (And in fact may still happen now. I’m out, so I don’t know.)

      Private practice doctors used to bundle together into consortiums to negotiate contracts with insurance providers. If they couldn’t get the price they wanted, they refused to sign the contracts. In areas like Bend, Oregon which is a small market and where everyone was part of one consortium, there were times where they threatened to use no carriers in order to negotiate higher prices.

      Since they could have conceivably still worked for people who would just pay out of pocket and since they were not employers of the insurers, this wasn’t really threatening a strike. But in the world of walks like a duck talks like a duck, it wasn’t far off from being essentially the same thing.Report

      • Saul Degraw in reply to Tod Kelly says:
        January 27, 2015 at 8:09 pm

        Didn’t it also happened with HMOs? Weren’t HMOs the first place that doctors became more like employees?

        Kaiser was around long before the ACA and they always treated doctors as employees as far as I can tell.Report

      • Tod Kelly in reply to Tod Kelly says:
        January 27, 2015 at 8:38 pm

        I’m not talking about being employers or employees as much as I am doctors saying, “we collectively have decided that if you don’t pay us more we are going to stop working and if you need our services you will be SOL.”

        Which probably doesn’t meet the legal definition of a strike, but really feels like one for all intents and purposes.Report

  3. LeeEsq says:
    January 27, 2015 at 6:16 pm

    The corporate powers that be should realize that there are some employees you just can’t screw with.Report

  4. LWA says:
    January 27, 2015 at 6:37 pm

    I don’t have a strong opinion one way or the other as to whether their contract is fair or not.

    But I think its noteworthy that in discussions about healthcare, we always hear about how much it does or should behave like a marketplace- pricing signals, cost conscious consumers, etc.

    In other words, healthcare is a consumer good like a toaster.

    Yet here in these comments we see concern about emergency services- Replacing “Doctor” with “Nail Salon Technician”-

    “I also presume that if someone had an urgent cuticle issue in sight of the picket line, one or more Nail Salon Technicians would drop the signs and render aid.”

    Really? Would we even expect them to?

    I’m not picking on anyone’s comments here- I actually agree with them.
    Its just that we should recognize that health care isn’t a toaster- it may operate in the realm of markets, but it can’t and shouldn’t be bound by market pressure.Report

    • Jaybird in reply to LWA says:
      January 27, 2015 at 6:41 pm

      Stuff that I need that someone else has can’t and shouldn’t be bound by market pressure?Report

    • j r in reply to LWA says:
      January 28, 2015 at 11:04 am

      Its just that we should recognize that health care isn’t a toaster- it may operate in the realm of markets, but it can’t and shouldn’t be bound by market pressure.

      You can pretend that once something has been subsumed into the world of government-provided goods and services that it is no longer operates in “the realm of markets,” but that don’t make it so.Report

      • LWA in reply to j r says:
        January 28, 2015 at 11:40 am

        I agree they operate in the realm of markets.
        Its just that we whether we allow market forces to be the driver of them is optional.

        For instance, we can provide unprofitable services to people who can’t pay by simply paying for them collectively.
        Inefficient, but it gets the job done.

        My “everything is not a toaster” argument is just saying that the market doesn’t always return the outcome we want, no matter how free we make it.Report

      • James Hanley in reply to j r says:
        January 28, 2015 at 11:48 am

        Its just that we whether we allow market forces to be the driver of them is optional.

        What do you mean by “the driver” exactly? Do you mean with the emphasis on “the” as in “the sole, only, and exclusive driver?” Or is it meant less stringently, as in “a driver, but not the only one?”

        I don’t meant that snarkily or contentiously, but for clarification. I either agree or disagree, depending on I understand it.Report

      • LWA in reply to j r says:
        January 28, 2015 at 2:28 pm

        I mean it in the second sense, that market forces and economics can inform, but not dictate our choices.
        An economist may inform us of the possible ramifications to a certain policy, and we balance that against other considerations in making a choice.Report

      • Kimmi in reply to j r says:
        January 28, 2015 at 2:34 pm

        LWA,
        yeah, and then we go and make the cussed stupidest choice for the damnedest reasons!
        Ascribing to humans writ large more rationality than man writ small is a liberal failing.

        Can we do so? Yes, it is possible — but so very, very often unlikely.

        You’ll hear scads of folks around here talking about rent control — which is missing the forest for the trees. The real issue is building codes, and the costs of building a new building to house the poor, which is so ridiculous that it doesn’t even come into political discussions. In this country. Elsewhere and elsewise, it’s a part of most solutions.Report

      • James Hanley in reply to j r says:
        January 28, 2015 at 3:18 pm

        I mean it in the second sense, that market forces and economics can inform, but not dictate our choices.

        Oh, in that case I half-disagree. Sure, we can respond to a shortage of apples that drives up the price by paying more for apples or having government set up a price ceiling on apples. In that sense our choices are informed by market forces, but not dictated, since we have alternative responses among which we can choose.

        But having the government set up a price ceiling does nothing to eliminate market forces. It just means the apples get bought out more quickly, possibly hoarded, and possibly resold for higher prices on the black market. The market forces are just as much in play; they’re just playing on a different situational structure and so they produce a somewhat different outcome.

        You can’t actually escape market forces by putting something into government’s hands. You can reshape them (but generally not with enough fine-tuned control to prevent unwanted/unintentional forces from coming into play), but you’re not going to negate them or make their effects insignificant.Report

      • Jaybird in reply to j r says:
        January 28, 2015 at 3:26 pm

        possibly resold for higher prices on the black market

        This remains my measurement of failure for the PPACA. If/when the black market of medical care becomes a growth industry, *THAT* is what tells me it has failed.

        If we don’t have one by, oh, 10 years after passage? That’s when I will consider myself to either have been right or have been wrong.

        (I admit to seeing striking doctors as a harbinger.)Report

      • James Hanley in reply to j r says:
        January 28, 2015 at 3:34 pm

        Jaybird,

        It may not count as black market, but medical tourism is already a thing, all around the world. Various reasons drive different people to travel for medical care. Tens of thousands of people visit the U.S. for medical care each year to access advanced technology; hundreds of thousands of Americans travel elsewhere each year to access lower costs.Report

      • Jaybird in reply to j r says:
        January 28, 2015 at 3:42 pm

        I kinda have that baked into the cake. It existed prior to the PPACA, it’d be cheating somewhat to use that as the measure afterwards.

        Ah, but if the rate of growth for such starts seriously outpacing inflation/population growth? I don’t know how to define “seriously” quite yet but maybe I’ll use prominent pundits saying something to the effect of “Something Ought To Be Done” as the measure.

        Of course, that brings us to defining “prominent”…Report

      • DavidTC in reply to j r says:
        January 28, 2015 at 4:15 pm

        There actually was a bit of a ‘black market’ pre-ACA at communities near the Canadian border, where people living in the US, who didn’t have insurance, would pretend to be Canadians (usually using Canadian IDs or fake Canadian spouses) and steal health care using an accomplice’s Canadian health insurance.

        Granted, that’s not normally how a black market works, but I’m not sure you can have a black market in *legal services*. (If you buy it legally, and it’s a service so you can’t resell it, there is no black market?) This was really just people *stealing* the legal service because they were unable to purchase them at reasonable prices a mere ten miles away.

        This, presumably, has mostly stopped, now that those people can get health insurance. So, if anything, the ACA reduced the ‘black market’ in health care, if we want to call that a ‘black market’.

        And that’s as close a ‘black market’ I can see showing up in health care, unless you’re expecting actual unlicensed doctors to show up or something. Which is a pretty strict standard for ‘failure’. I mean, I’m probably biased because I like the ACA, but I’m having trouble figuring out how unlicensed doctors could happen as a consequence of the ACA *even if* it completely failed. There are a lot of ways even I would admit the ACA had failed that don’t result in that, like insurance companies starting to withdraw from the market in large numbers.Report

      • zic in reply to j r says:
        January 28, 2015 at 4:17 pm

        Sen. Susan Collins one introduced a bill to allow re-importation of prescriptions from Canada because they were cheaper. Note the ‘re-importing’ bit there; bringing them back across the border. Says something about the costs of them here when they’ve never crossed it in the first place.

        I know a lot of people who go to Canada for medical care; they say it’s better and it’s cheaper, even when they have to pay out-of-pocket for it.Report

      • Jaybird in reply to j r says:
        January 28, 2015 at 5:06 pm

        David, I’m just using “black market” as shorthand for “market outside of the legal ones”. If pundits start screaming for doctors to be arrested (or, worse, doctors actually do start getting arrested?), then that’s what I’m talking about.

        (Yes, I know, that covers “grey markets” too.)Report

    • James Hanley in reply to LWA says:
      January 28, 2015 at 11:36 am

      it can’t and shouldn’t be bound by market pressure.

      It not only can, but will be. Period. The particular pressure may change depending on what government policies are involved, but market pressures will not go away.

      If doctors are not compensated at a level that attracts as many would-be doctors, market pressures will result in their being fewer doctors. If there are fewer doctors, and price increases are forbidden, market pressure will result in patients paying their medical costs in part via queuing.

      If we pay doctors a lot, don’t work them too hard, don’t make them put up with too much administrivia, and make medical schools free, then market pressures will result in there being more doctors. Etc., etc. through infinite permutations.

      I imagine some will think those aren’t actually market pressures then. But they are. We only use the term markets to refer exclusively to private arenas of exchange as a matter of convenience in every day language. But the pressures at the core of those markets are the same pressures that are at the core of any government-run program; they are, collectively, market pressures.Report

      • LWA in reply to James Hanley says:
        January 28, 2015 at 11:45 am

        Well, that’s all true- We can simply choose to accept the various permutations.

        Its a bit like saying the law of gravity dictates that water flows downhill. But a combination of other laws of physics allows us to make it flow uphill. Gravity is still present and hasn’t been changed, its just the outcome has been changed.

        We just have to be willing to invest the energy to do it, and accept the consequences.

        Right now, health care is largely rationed through prices; in a socialized scenario like the NHS, it is rationed by other means.

        We can choose which outcome we prefer.Report

      • James Hanley in reply to James Hanley says:
        January 28, 2015 at 11:49 am

        Gravity is still present and hasn’t been changed, its just the outcome has been changed.

        Oh, no, the outcome has not been changed. Only the particulars of the path, the mechanisms, and the time frame. That water will eventually flow downhill. 😉Report

  5. Damon says:
    January 27, 2015 at 7:31 pm

    Don’t worry about this. Once we switch to a single payer system, doctors and medical staff will be prevented by law from striking and they will have no legal recourse.

    OR they will become part of the gov’t services union and the quality of healthcare will go down as, well, hell, it’s a union biatches.Report

  6. Mike Schilling says:
    January 27, 2015 at 11:03 pm

    Note that (as it says in the linked article) this is a one-day demonstration strike, and the student health centers will be staffed with management and non-union health workers. The main impact is that some appointments will need to be rescheduled.Report

  7. Brian Murphy says:
    January 28, 2015 at 2:37 am

    One incident in 25 years definitely constitutes a trend…Report

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