The unnecessary vilification of greed

October 9, 2008 at 8:28 pm (Uncategorized)

In the movie It’s a Wonderful Life we learned that every time a bell rings, an angel gets his wings. This simple chime of a bell can somehow confer morphological changes to a mystical being. The opposite seems to hold true for politicians. Whenever Barack Obama begins to speak of insurance companies, a little bit of truth dies. In the most recent debate I heard him say that insurance companies are greedy as if to imply they are unethical and have the sole purpose of trying to make Americans’ lives miserable. This rhetoric of greed as applied to Wall Street, insurance companies, big businesses, hospitals, and doctors is a bit off the mark.

Greed is a good thing. The knowledge that harder work leads to more money causes men to put in more hours and complete more goals. Obtaining more wealth is a seemingly reachable prize that can be obtained by creating better products, by developing more efficient methods, and by taking new risks. Greed is the invisible hand that runs the United States. Its roots span back as far as the Declaration of Independence. Our forefathers were not seeking religious freedoms when they broke away from Britain; they wanted lower taxes. It’s the reason the Spanish-American war was fought. It’s the reason Henry Ford developed the Model T. And it’s the reason that doctors are willing to work 80 hours a week.

Whenever an applicant applies for medical school he has to come up with a convoluted explanation as to why he wishes to become a physician. Many of the personal statements I have read in recent years center on helping other people, delivering health care to those in need, and providing access to those who cannot reach. In reality, many people are seeking a $200,000 a year job. An applicant who can say, “There’s no way I would do this for $30,000,” is much more honest. And yes, while there are some people who would deliver healthcare for free out of the goodness of their hearts, enrollment in medical schools would significantly drop, and the number of physicians in the nation would be at a critical shortage if greed were taken out of the equation.

Greed is a wonderful thing. We should embrace it and get people to work harder and more efficiently by dangling this prize in front of them. I know what you’re thinking. “Have you bothered to read the news, Half MD? The whole reason we’re in this economic mess is because of the predatory lenders and the greedy people on Wall Street!” I would counter that by saying the whole reason we’re in this mess is because of unethical behavior and stupidity. Greed did not cause banks to dole out $300,000 mortgage loans to persons making $40,000 a year—but stupidity did. Greed did not cause banks to sell unfunded insurance plans to each other—but unethical behavior did. On the other hand, when greed is contained within ethical boundaries and wise decision-making, it can be a force for good and for change.

Medicare could use its dollars to influence physician behavior for the better. It could offer higher payouts to those doctors that use a centralized electronic medical record system. It could grant bonus money to the lowest 20% of hospitals with nosocomial infection rates. Someone will counter by saying, “But then greedy hospitals will simply not report their nosocomial infection rates so that they can earn bonus money.” And I will respond by saying, “No, unethical hospitals will not report such embarrassing data.” A greedy, honest hospital will develop more safety barriers to prevent the spread of infection.

The next time someone says to you, “Those insurance companies sure are greedy,” usually counter back with, “I hope they are.”

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  1. AB said,

    Your argument places the outcome before the cause. Is greed not the root of unethical behavior and stupidity? It is defined as a “selfish and excessive desire to want more of something than is needed.” When contained within ethical boundaries and wise decision making, greed becomes an oxymoron. The ruthless, maniacal focus on profit at the expense of positive patient outcome that typifies the behavior of our insurance companies is indeed greedy, and cannot be reconciled with the provision of quality, comprehensive healthcare. And I wouldn’t characterize us medical students as greedy, but as requiring fair compensation for hard work.

  2. RAG said,

    I agree. Greed is good because it motivates. We can be greedy for other things as well, beyond financial incentives. The difference between Democrats and Repulbicans (very simplistically put) is that the Dems focus on making the poor believe it’s the rich (anyone making more than them it seems) who make their lives miserable (despite dropping out, doign drugs, performing crimes, etc.) while the Repubs want to ensure financial success for those willing to work (and cheat) to get it.

  3. marcia (2) said,

    No, the difference is the Dems want to ensure everyone has the basic necessities of life; success is up to the individual. The Republicans do indeed want to rationalize greed as a good thing, to avoid feeling guilty about their disordered values.

  4. Tea said,

    You are speaking of good greedy people, not the unethical greedy ones.

    The Democrats want to give health care to everyone so everyone can at the very least get basic care. It will cost us dearly, but it may work. What we have been doing hasn’t worked.

    If RePUGlick’in Palin (pug with lipstick!) makes it into the White House as prez if McOld wins, she will ignore the health care crises and talk about how great it is that everyone has health care. (Oh, and “Maverick! Maverick! Maverick! What were we talking about again?”)

  5. me, myself and I said,

    Greed is greed: anytime someone desires and attempts to obtain substantially more than they need (and usually at the expense of others), it’s bad for someone. Last I checked, avarice was still considered a vice.

    Medicaid patients who show up at the ER 20 times a month for minor ailments (or drugs), at $1.00 a pop are greedy, too.

  6. Open Source Doc said,

    I think instead of using greed, the term market economy would be better. It’s what makes companies efficient and productive. Having competition is good, but greed leads to irrational decisions.

  7. Miami_med said,

    Perhaps we would benefit by holding all of those people who bought million dollar homes on middle class salaries responisble for their own mistakes. Instead of complaining about people “losing their homes,” we should hold them responsible for their poor decision making. As far as the “unethical” behavior, it only works in an environment where people are bailed out. Everyone in the big banks on Wall Street functions like they get bailed out every time they lose money. Oh wait, THEY DO. No one would lend out $300k to someone making $40k/year in a sane lending environment. I think you’ll find government bailouts and the ever present influence of Fannie Mae and Freddie Mac distorting the markets.

    In a sane market greed CAUSES good decision making. Responsible lending is the only way to make money long term. In fact, the “credit crisis.” is largely a return to sane lending. People with good credit can still get a loan. Repeated government bailouts and Fed rate cuts are simply new ways to distort the market in order to cause the same problem again which will be blamed on “greed” again when it blows up in the next few years.

    P.S. I don’t believe that Half MD ever mentioned being a republican or wanting to vote for McCain, which really makes this thread an interesting case study in gut reactions. Both Obama and McCain supported the Wall Street Bailout, which was championed by Nancy Pelosi (a democrat). Both parties are proposing poor excuses for healthcare “policy.” The only state to attempt Universal Healthcare coverage was Massachussetts under a Republican. Just some food for though.

  8. Double Dizzle said,

    I think you are confusing “greed” with more positive things like ambition, etc. According to Wikipedia (as good a source as any), Greed denotes desire to acquire wealth or possessions beyond the needs of the individual, especially when this accumulation of possession denies others legitimate needs or access to those or other resources.
    If you really believe greed is good, you will end up very frustrate in healthcare. The very framework of our current system, particularly with regard to reimbursement (e.g. getting paid), is based on the principle of spreading the wealth and increasing access to the elderly, the indigent, etc. Outside of a few very small areas of elective procedures in derm, ophtho, plastics, you ultimately wind up working a longer and harder day because poor people need care and cannot pay you. Even if you do not care for them directly, your practice will be reimbursed at lower rates because of their impact on the risk pooling system.
    Medicine is a public trust and it is increasingly run like one. The tremendous job security that physicians enjoys is based on this trust and greed – perhaps not as your define it, but true greed as defined above – is implicitly forbidden by the Classical and Modern versions of the Hippocratic Oath (which you’ve not yet taken):


    This is classically understood as an admonition that we are supposed to keep the good of our patient as our highest priority. Such “mischief” includes the human frailty of greed as well as lust (which is explicityly mentioned).

    HalfMD if you really are such a fan of greed, it is not too late for you to be happy in life. I strongly suggest skipping residency and getting an MBA. I am not being facetious here. Medicine is a very morally and legally perilous field to be greedy in, because there is a constant tension between what is best for “society” or “the healthcare system” or certainly “the bottom line” and your patient. There are many, many fields where properly placed incentives can make a greedy person indistinguishable from a genuinely good person. I suggest you try to find one.

  9. Owatana Siam said,

    Your posts are very perceptive, and I enjoy reading them. But this one sounds like a parody of Gordon Gecko. I think you have been working too hard and are losing your perspective. It is hard to keep your perspective when the patients and families you work the hardest to help are often the least appreciative. Disillusionment is the greatest occupational hazard of medicine. If greed was your main motivation you would have become a lawyer or an MBA. Take some time off where you can push medicine completely out of your mind and see if you still feel this way. Good luck to you.

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