The outbreak of doctors’ strikes in America is spreading. So far, doctors in West Virginia, Pennsylvania, Florida and New Jersey have held temporary strikes to protest the prohibitive cost of medical malpractice insurance. Now, doctors in Illinois have announced plans for a one-day strike next week. These strikes, so unusual in the United States, are an early symptom of the spread to this country of a worldwide epidemic.
Doctors’ strikes have become a commonplace occurrence outside the United States. A few weeks ago, French doctors briefly went on strike to protest the low price fixed by the government for consultations, as well as limits on the working hours (and therefore the wages) of hospital personnel. In Croatia, doctors have just ended a month-long strike to protest low salaries offered by that country’s nationalized medical service. At a major hospital in New Zealand, senior doctors have struck one day a week for the past three weeks and plan to keep doing so for another three weeks, also in protest against low government salaries. In Nigeria, junior doctors have gone on strike to protest the government’s failure to pay a promised wage increase, while doctors in Ghana are striking for better working conditions at state-run hospitals.
If you haven’t heard about any of these cases, you are not alone. Doctors’ strikes outside the United States have apparently become so frequent that they are no longer regarded as newsworthy.
Yet there is something shocking and dangerous in the idea of a doctors’ strike. In the industrialized world, we are blithely accustomed to the fact that when an emergency strikes, when we fall seriously ill, or even when we suffer from minor aches and pains, a doctor will be there to diagnose the problem and solve it. We take our doctors — and the instant availability of their life-saving knowledge and skills — for granted.
If there is a worldwide scourge that is prompting these people to walk off the job, it is crucially important to discover the cause. A physician investigating the cause of a disease would begin by looking for a common element, a risk factor that is present in all cases. In the doctors’ strikes across the world, there is one factor that is omnipresent: government controls. All of the overseas doctors are striking against socialized medical systems in which doctors’ fees and work procedures are set, in minute detail, by the government. When the government is short on money or wants more services, its first step is always to squeeze the doctors — restricting their fees, regulating their services or just plain refusing to pay them. The doctors are left with only one recourse: to go on strike.
We are not used to seeing doctors go on strike — indeed, they are the last kind of person who does so. That is because doctors have traditionally been independent entrepreneurs. Possessing rare skills that are always on demand, they have been free to negotiate the terms on which they choose to work.
That is why the doctors’ strikes are so ominous. In most countries, doctors are no longer entrepreneurs. Over the past 50 years, in one country after another, doctors have been transformed into small-time bureaucrats. The principle behind socialized medicine is stated by a Croatian government official who condemned the doctors’ strike in his country: “To strike is everyone’s constitutional right, but the people’s right to health and a regular health service is even greater.” Under socialized medicine, the doctors are always presumed to have no rights, while all comers are presumed to have a “right” to the doctors’ unrewarded services. This transformation of doctors into servants of the state — whose only bargaining tool is the mass withholding of their services — is the cause of the rash of doctors’ strikes.
The recent strikes here are faint echoes of this worldwide trend. The immediate complaint in America stems from this same hostility to the rights of doctors — in this case, our government’s refusal to protect them from arbitrary medical malpractice awards that amount to legalized looting. And now, both Congress and the Bush administration want to expand Medicare, which has been the leading edge of socialized medicine in America, imposing the kind of controls on doctors’ fees and regulation of their practices that is endemic in the rest of the world.
We have to learn the lesson of the worldwide epidemic of doctors’ strikes. If we make war on the rights of our doctors, we have no right to rely on them to keep working.
