In practice for 20 years, Dr. Derm sees a large number of skin cancer patients. He is recognized as being one of the best oncologic dermatologists in his state. Over the course of the last 10 years, he has seen Mr. Skin for multiple skin cancers. The last time Mr. Skin was seen in the office was three years ago. After that visit, Mr. Skin was “discharged” from the practice for not showing up for numerous visits, as well as refusing to pay either insurance deductibles or co-pays on three different occasions over the course of two years. Since that time, Mr. Skin has found a different dermatologist. The new dermatologist recently biopsied a lesion on Mr. Skin that proved to be early invasive melanoma. Mr. Skin, understandably anxious, seeks an appointment with the “skin cancer expert,” Dr. Derm.
Mr. Skin is given an appointment to see Dr. Derm. However, when Dr. Derm sees Mr. Skin in the waiting room, he refuses to see him. Mr. Skin is fuming and seeks to sue Dr. Derm for not seeing him. A law student friend tells Mr. Skin that, increasingly, legal experts have re-explored the notion that patients seeking medical care may have a “property right” to that care. He cites the fact that as the 2020 presidential race nears, this is an increasingly discussed issue. What is this property right? Does it exist?
Medical education is an extraordinarily expensive enterprise. It is heavily dependant on public funding. The total educational costs for an MD degree have increased every decade. New physicians, in general, often carry enormous debt once they have graduated (there are some exceptions such as the tuition free medical school education at NYU). Yet, physicians entering into practice are felt to have paid only 2.3% to 21% of the total direct costs of their own education. The rest of the funds, in fact, come from a variety of sources. The public contribution to these funds varies tremendously from school to school. On the average, though, direct state and federal government appropriations and government funded grants and contracts constitute about 38% of total revenue.
For graduate medical education (GME), the taxpayer funds an even greater proportion of physician training. Almost 20 years ago, Medicare was contributing $76,530 per resident. That number has increased tremendously
since then. Clearly, the American taxpayer does underwrite a substantial share of physician training. With that, increasingly, patients as well as some legislators feel strongly that Americans have a right to healthcare and to see the physician of their choice. This would include Mr. Skin’s right to see Dr. Derm.
Financial support for medical research has also evolved into a publicly funded model. Almost 83% of biomedical research articles and 80% of clinical research articles come from either government sources or academic institutions for which public money pays the majority of research costs.