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不久前，我讀到一篇文章說，一位在美國做護理工作的中國女孩，拒收美國富翁十萬美金的紅包。這個故事不禁讓我想起了和美國醫院紅包有關的話題。
眾所周知，國內的醫生以各種各樣的方式收紅包，這依然是各大醫院醫生們心照不宣的秘密吧。按理說，醫生和白衣天使對患者救死扶傷，病人家屬有所表示，本是件可以理解的事情。可老百姓怕就怕送紅包這事越走越邪。換句話說，假如不送紅包，醫療質量就要打折扣，這樣可就不好了。記得當年，我在國內就醫時，不僅主刀醫生咱要孝敬，麻醉師要打理，就連護士也不能忘了。但願這樣的狀況現在已經有所改變。
在美國，醫生的頭上壓著保險公司，律師和力保飯碗這幾座大山。要是哪位醫生稍不留神出了嚴重的醫療事故，那麻煩可就大了。所以，即使沒有患者的紅包，美國醫生也得鞠躬盡瘁死而後已地為病人服務。當然，美國醫生們的道德素質及其每月的進賬額，大概也是讓他們視紅包為身外之物的理由之一。
雖然美國醫生沒指望把紅包當作自己的灰色收入來源，但這不意味著他們不能拿紅包。而且，美國醫生拿紅包就和餐館裏的服務員拿小費一樣，完全是個人的事情，組織上沒必要和理由幹涉。
話說有一位住院醫段譽，他不僅心眼好，人長得也賊帥。最難得可貴的是，這位段醫生不僅隻愛美女，他對年老體弱的病人也是照顧有加。有一天，段醫生收治了一位白發蒼蒼的名為童姥姥的美國老太太。這位童姥姥年過八旬，膝下無兒無女，她瘦瘦小小的身材和那副隨時都可能被風吹倒的病態，讓段醫生大動惻隱之心。
在童姥姥隨後就醫的日子裏，段醫生無微不至的人道主義關懷和精湛的專業治療，讓這位美國老人深受感動。有一天，前來複查的童姥姥悄悄地把一個粉紅色的信封遞到段醫生的手中說，這裏麵裝著她的由衷謝意。
段醫生先是楞了一下，再轉念一想，這信封裏麵會裝著什麽呢？也許，隻是個感謝卡片而已吧。在美國，人與人之間因為某種因緣互送感謝卡挺常見的，患者給醫生寫感謝卡也不稀奇。雖然感謝信裏寫的都是些常規的那幾句話，但讀著那些溫暖人心的字句，收卡人的心裏還是挺燙貼的。於是，段醫生高高興興地收下了這個信封，並和童姥姥揮手話別，期待下一次老太太複診時再見。
段醫生下班回家後，向妻子語嫣無意中提及此事。語嫣道，何不拿出來看看那封感謝信呢。段醫生這才恍然大悟，對呀，誰說不是呢，忙碌一天，還沒來得及看看裏麵寫的是什麽呢。於是，段醫生隨手把那個信封交給了語嫣，讓太太先過目看看，來滿足一下女人的好奇心再說。不出幾秒鍾，段醫生便聽到了語嫣的驚叫：“這裏有張支票啊，三萬多的支票哪。”段醫生聽了之後，先喜，再驚，後怕：“我怎麽把這麽大的糖衣炮彈帶回了家。這要是讓醫院領導知道了，我還不得被抓典型？”
段醫生來自中國大陸，他這樣的思維絕對和咱中國的習俗和國情密切保持一致。所以，第二天上班的第一件事，段醫生便找到了他的上級醫生，向領導嚴肅認真地匯報了他這次無意中受“腐蝕”的經過。
哪料到，美國上級醫生聽了他的匯報後，輕鬆一笑：“這是你和病人之間的私事，隻要你們之間沒問題，你拿多少紅包，醫院是不管的” 。
即便如此，聽了領導的話，段醫生的心裏還是七上八下的。他當住院醫快三年了，還從來沒收過病人的紅包呢。沒想到，這第一個紅包就數額不小.這事一定得謹慎處理才好。假如以後童姥姥的律師和他較勁，他可不願意惹上民事糾紛。
終於盼到了童姥姥複診的那天。段醫生決定要把這個大紅包退給美國老人。童姥姥一看這架勢，真的急了，老人的話顯得有些語無倫次又格外堅決：“我無兒無女又來日不多，我正在慢慢處理自己的財產呢。你對我這麽好，我不給你，給誰呀。你，你就收下吧。你要是真不放心，可以和我的律師聯係。”看到眼前如此誠懇的美國老人，再想想上級醫生對他的那番教誨，段醫生心裏想道“那，我就先拿著，就算滿足一下老人家誠摯的心理需要吧。” 。
就這樣，段醫生家裏的賬麵上平添了三萬多的現金收入。在美國，要想在納稅後攢出三萬多美金的現金，那可得費牛勁了。
雖然銀子已經入賬，語嫣還是謹慎地把這筆錢束之高閣“咱先收著，就算替老人暫存。要是老人哪天反悔了，咱再還給她。”是啊，誰敢肯定八十多歲的老人不犯糊塗呢，童姥姥雖然送紅包時態度十分誠懇，但也不能排除她是一時的感情衝動呢。做事衝動基本屬於個人素質問題，和年齡是沒有太大關係的。語嫣繼續籌劃著“咱先開個獨立帳戶，把這三萬多存進去。如果事情有變，童姥姥反悔，大不了咱連本帶利地再還給她。要是童姥姥百年千歲之後，還沒有人找到咱頭上，到那時，再花也不遲。咱也可以把這錢捐出去，讚助幾個希望工程什麽的。” 。
在美國，普通的朋友之間是不怎麽討論年齡和收入的。有一天，當摯友語嫣坐在我麵前，和我談起這個紅包事件時，我不禁庸俗地感歎道：“俺家的那位醫生怎麽就從來沒遇到過這樣的美事呢？”。嗬，話雖這麽說，依我看，這紅包，特別是大紅包，還真有點兒像男人們身邊的二奶或者情人啥的。沒它的時候，難免會憧憬一下。一旦得到它，這東西還挺燙手的。而且，還隻能先暗地裏藏著，最終能否公開消費，隻有天知道。
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 "江湖醫生." In the free market, at least I have choice not see those "江湖醫生." In the current system, those are the only Drs. we have.
free-market 醫生。罷了，江湖醫生多得是，您老先去試試看。
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.