CT Blue

I’m a big fan of Dean Baker, but there’s one point he makes repeatedly upon which I beg to differ somewhat. His post today alludes to the issue:

Hey, can an experienced doctor from Germany show up and start practicing in New York next week? Since the answer is no, we can say that we don’t have free trade. It’s not an immigration issue, if the doctor wants to work in a restaurant kitchen, she would probably get away with it. We have protectionist measures that limit the number of foreign doctors in order to keep their pay high. These protectionist measures have actually been strengthened in the last two decades.

We also have strengthened patent and copyright protections, making drugs and other affected items far more expensive. These protections are also forms of protectionism.

via Beat the Press

Dean frequently makes the point that foreign doctors and lawyers can’t freely compete here in the states, and that this represents a form of protectionism. I don’t disagree with his premise all that much; it probably is a form of protectionism, particularly in the case of doctors, for the human body is pretty much the same everywhere. Lawyers could argue that a lawyer from India would not know the law here in the states, but that’s a pretty hollow argument when all is said and done.

My dispute with Dean has more to do with his categorization of these professions as high earners that we should count among the 1% that controls the economy. First, we have to bear in mind that it’s really the .001 percent that is running things. It’s quite likely that I’m in the lower reaches of the 1%, or close enough to to it that it makes no difference, but there’s a distance between me and the Koch Brothers that dwarfs the distance between me and the bottom 25%. The same goes for doctors (who by and large presently make more than lawyers). But the larger point is that, doctors especially, are facing a future in which their own economic destinies will largely be in the hands of others. I’ve observed it second hand, so to speak. I’ve been doing disability work for about 25 years now so I see a lot of medical records, and I’ve seen things change. In the early days most doctors worked out of their own offices or groups. That’s changing dramatically now. More and more, they are affiliated with hospitals and are salaried employees. They are also being replaced, to a great extent, by lower paid APRNs. Most of my clients never see a physician. There will doubtless come a time when doctors will find that they have lost bargaining power to the hospitals, which are themselves becoming mega corporations. Here in the New London area, for instance, the hospitals in Westerly and New London merged some time ago, and Yale-New Haven is now swallowing that combination whole. Hospitals, when not openly for-profit institutions, are non-profit in name only. CEO salaries are swelling, and the money to pay them has to come from somewhere. As in other fields, it will need to come from the workers; not just the nurses and the orderlies, but sooner or later from the doctors. I look forward with some pleasure to the prospect of doctors attempting to unionize in the coming years, as they realize they are being screwed. Good luck with that, by the way, as the right wing courts will no doubt find them to be supervisors and therefore not entitled to unionize. My point is, Dean, that we don’t need foreign competition to depress the incomes of doctors. That will be the inevitable result of the corporatization of the health care industry. There are similar forces at work in the legal industry. Witness the fact that it’s harder and harder for law school graduates to even get a job.

This is an equal non-opportunity country. The oligarchs are screwing us all, and that includes the so called professional class.

Afterthought: After I wrote this, it occurred to me that there is another “profession” that has been nearly ruined by the corporatization of America. Consider teachers at universities. For example, it costs about 60 grand or more to attend NYU these days, where you are likely to be taught by an adjunct making half that much in the entire year. The administrators and celebrity professors (who don’t actually teach) are making big bucks, but more and more the folks in the trenches are working for peanuts. There are still tenured professors, but those positions are disappearing fast. Now, it’s true that there’s no bar to recruiting foreigners to teach in our universities, but that’s not really a factor in driving down the pay of the people doing the actual teaching.