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不久前，我读到一篇文章说，一位在美国做护理工作的中国女孩，拒收美国富翁十万美金的红包。这个故事不禁让我想起了和美国医院红包有关的话题。
众所周知，国内的医生以各种各样的方式收红包，这依然是各大医院医生们心照不宣的秘密吧。按理说，医生和白衣天使对患者救死扶伤，病人家属有所表示，本是件可以理解的事情。可老百姓怕就怕送红包这事越走越邪。换句话说，假如不送红包，医疗质量就要打折扣，这样可就不好了。记得当年，我在国内就医时，不仅主刀医生咱要孝敬，麻醉师要打理，就连护士也不能忘了。但愿这样的状况现在已经有所改变。
在美国，医生的头上压着保险公司，律师和力保饭碗这几座大山。要是哪位医生稍不留神出了严重的医疗事故，那麻烦可就大了。所以，即使没有患者的红包，美国医生也得鞠躬尽瘁死而后已地为病人服务。当然，美国医生们的道德素质及其每月的进账额，大概也是让他们视红包为身外之物的理由之一。
虽然美国医生没指望把红包当作自己的灰色收入来源，但这不意味着他们不能拿红包。而且，美国医生拿红包就和餐馆里的服务员拿小费一样，完全是个人的事情，组织上没必要和理由干涉。
话说有一位住院医段誉，他不仅心眼好，人长得也贼帅。最难得可贵的是，这位段医生不仅只爱美女，他对年老体弱的病人也是照顾有加。有一天，段医生收治了一位白发苍苍的名为童姥姥的美国老太太。这位童姥姥年过八旬，膝下无儿无女，她瘦瘦小小的身材和那副随时都可能被风吹倒的病态，让段医生大动恻隐之心。
在童姥姥随后就医的日子里，段医生无微不至的人道主义关怀和精湛的专业治疗，让这位美国老人深受感动。有一天，前来复查的童姥姥悄悄地把一个粉红色的信封递到段医生的手中说，这里面装着她的由衷谢意。
段医生先是楞了一下，再转念一想，这信封里面会装着什么呢？也许，只是个感谢卡片而已吧。在美国，人与人之间因为某种因缘互送感谢卡挺常见的，患者给医生写感谢卡也不稀奇。虽然感谢信里写的都是些常规的那几句话，但读着那些温暖人心的字句，收卡人的心里还是挺烫贴的。于是，段医生高高兴兴地收下了这个信封，并和童姥姥挥手话别，期待下一次老太太复诊时再见。
段医生下班回家后，向妻子语嫣无意中提及此事。语嫣道，何不拿出来看看那封感谢信呢。段医生这才恍然大悟，对呀，谁说不是呢，忙碌一天，还没来得及看看里面写的是什么呢。于是，段医生随手把那个信封交给了语嫣，让太太先过目看看，来满足一下女人的好奇心再说。不出几秒钟，段医生便听到了语嫣的惊叫：“这里有张支票啊，三万多的支票哪。”段医生听了之后，先喜，再惊，后怕：“我怎么把这么大的糖衣炮弹带回了家。这要是让医院领导知道了，我还不得被抓典型？”
段医生来自中国大陆，他这样的思维绝对和咱中国的习俗和国情密切保持一致。所以，第二天上班的第一件事，段医生便找到了他的上级医生，向领导严肃认真地汇报了他这次无意中受“腐蚀”的经过。
哪料到，美国上级医生听了他的汇报后，轻松一笑：“这是你和病人之间的私事，只要你们之间没问题，你拿多少红包，医院是不管的” 。
即便如此，听了领导的话，段医生的心里还是七上八下的。他当住院医快三年了，还从来没收过病人的红包呢。没想到，这第一个红包就数额不小.这事一定得谨慎处理才好。假如以后童姥姥的律师和他较劲，他可不愿意惹上民事纠纷。
终于盼到了童姥姥复诊的那天。段医生决定要把这个大红包退给美国老人。童姥姥一看这架势，真的急了，老人的话显得有些语无伦次又格外坚决：“我无儿无女又来日不多，我正在慢慢处理自己的财产呢。你对我这么好，我不给你，给谁呀。你，你就收下吧。你要是真不放心，可以和我的律师联系。”看到眼前如此诚恳的美国老人，再想想上级医生对他的那番教诲，段医生心里想道“那，我就先拿着，就算满足一下老人家诚挚的心理需要吧。” 。
就这样，段医生家里的账面上平添了三万多的现金收入。在美国，要想在纳税后攒出三万多美金的现金，那可得费牛劲了。
虽然银子已经入账，语嫣还是谨慎地把这笔钱束之高阁“咱先收着，就算替老人暂存。要是老人哪天反悔了，咱再还给她。”是啊，谁敢肯定八十多岁的老人不犯糊涂呢，童姥姥虽然送红包时态度十分诚恳，但也不能排除她是一时的感情冲动呢。做事冲动基本属于个人素质问题，和年龄是没有太大关系的。语嫣继续筹划着“咱先开个独立帐户，把这三万多存进去。如果事情有变，童姥姥反悔，大不了咱连本带利地再还给她。要是童姥姥百年千岁之后，还没有人找到咱头上，到那时，再花也不迟。咱也可以把这钱捐出去，赞助几个希望工程什么的。” 。
在美国，普通的朋友之间是不怎么讨论年龄和收入的。有一天，当挚友语嫣坐在我面前，和我谈起这个红包事件时，我不禁庸俗地感叹道：“俺家的那位医生怎么就从来没遇到过这样的美事呢？”。呵，话虽这么说，依我看，这红包，特别是大红包，还真有点儿像男人们身边的二奶或者情人啥的。没它的时候，难免会憧憬一下。一旦得到它，这东西还挺烫手的。而且，还只能先暗地里藏着，最终能否公开消费，只有天知道。
The best way to choose Drs is in their practice. Not by test, or residency position interviews. In free market, Drs have to compete with other Drs, they have to provide good service at reasonable price to stay in the business. Because currently Drs’ organization artificially makes shortage of Drs, their job is guaranteed and price is inflated, or they do not have to provide good service to stay in business, because we have nowhere else to go.
Without addressing free market production of Drs, the healthcare reform will get nowhere.
“the residency training in US has strict standards -- this is one of the reasons foreign doctors may (not all of them) need to redo their training, to ensure the quality of care.”
The problem is that, by limiting number of residency slots, Drs’ organization artificially make shortage of Drs allowed practice in US. The shortage breaks the balance of supply and demand that the Drs can artificially maintain their high salary. This is like you open a store, then you limit the number of stores of this kind allowed to be opened. This is monopoly.
“Also pls keep in mind that doctors in US pay very high tuitions for medical school, and get paid very little during their long residency training.”
How much is the tuition? It is just about college tuition of Ivy schools ($150k for 4 years). A specialist can pay off the tuition in 2-3 years, then enjoy the inflated salary for another 30 years. “paid very little during their long residency” How much those guys paid in PostDoc? BTW, there is no excuse for monopoly for anybody.
“if you lower their salary, then you will not be able to attract the bright students to the field of medicine. right now medical schools are very difficult to get into, and often attracts best students from collage.”
I am not talking about lowering their salary, their salary would never be there if determined by free market. “attract the bright students,” Do you think tests can select the best students, tests can only choose good students. We have plenty of good students. Most Drs’ work are routine work, they needs to be careful and responsible persons, a few positions need to brilliant but so is other professions. Real advancement of medicine depends on the ones developed MRI, CT and those magic drugs, we need brilliant people to be there.
the residency training in US has strict standards -- this is one of the reasons foreign doctors may (not all of them) need to redo their training, to ensure the quality of care.
Also pls keep in mind that doctors in US pay very high tuitions for medical school, and get paid very little during their long residency training. if you lower their salary, then you will not be able to attract the bright students to the field of medicine. right now medical schools are very difficult to get into, and often attracts best students from collage.
Why you allow so many "江湖 airline companie exist," you are not afraid of this many "江湖 airline companies" to "摔死" you. Why not kill all the 江湖 airlines and allow only Ameriacan Airlines to fly?
Why you do not allow Homedepot to merge with Lowes? You are not afraid being killed by a falling house built with 江湖 building materials from "江湖 stores?"
Why you do not allow GE to merge with Honeywell, you are not afraid "江湖 engines made by so many 江湖 companies" send you to the bottom of the sea in no time?
Why you allow so many "江湖 airline companie exist," you are not afraid of this many "江湖 airline companies" to "摔死" you. Why you do not allow Homedepot to merge with Lowes? You are not afraid being killed by a falling house built with 江湖 building materials from "江湖 stores."
Why you do not allow GE to merge with Honeywell, you are not afraid "江湖 engines made by so many 江湖 companies" send you to the bottom of the sea in no time.
Yes, How do you know in the current monoply system, those Drs are not "江湖医生." In the free market, at least I have choice not see those "江湖医生." In the current system, those are the only Drs. we have.
free-market 医生。罢了，江湖医生多得是，您老先去试试看。
This problem primarily attributes to the AMA (American Medical Association), an institution which effectively enforces a chronic supply shortage of drs. The production system of Dr is strangled by the withholding nature of the AMA, which requires every dr practices in US to have residency in US (even for well experienced froeign Drs). On the other hand, the AMA restricted number of residency slots available. This environment prevents equilibrium of supply-demand from occurring, or the AMA effectively enforces a chronic supply shortage of Dr to the increasing demand. By eliminating competition, Drs can maintain high salary.
AMA’s monopoly on the production of Drs has to be removed. Let the free market decide the price. Capitalism is best at determining fair value when you don't have unions controlling supply of labor or politicians picking winners or greedy monopolies eliminating competition. In the free market environment, the Drs have to provide good service at reasonable price to stay in the market in which the consumer will benefit.
Without free market in the production of Dr, the country will be dragged deep to the sea. Any reform without changing current monopoly in production of Drs will not work.