Free Trade Agreements; More on Doctor Salaries …

by on September 22, 2011

To the Editor:

Looked at another way, Free Trade Agreements (FTAs) are nothing more than dollar imperialism. That is, a major economic power — the U.S. — taking unfair advantage of a weaker economy. For example, the U.S.-Colombia FTA will give market access for U.S. agricultural, consumer, and industrial products, and will immediately remove all tariffs on about 80 percent of U.S. goods entering Colombia.

This includes immediate duty-free treatment of beef, cotton, wheat, soybeans, many fruits, and other agricultural products. The remaining 20 percent of tariffs will be phased out over a period of 10 years for both agricultural products and industrial products. In addition, the agreement provides protections for U.S. investors that will be enforced through a binding international arbitration program. The U.S.-Colombia FTA will hurt small peasant farmers in Colombia, who will be forced out of business because they cannot compete with cheap imports of food from the U.S., which subsidizes its farmers.

This has happened in other developing countries that have entered trade agreements with the U.S. For example, low priced corn (subsidized by the U.S. government) has forced over a million small Mexican farmers out of business since 1994 when the North American Free Trade Agreement took effect. And how will non-agro Colombia businesses fare when faced with competition from multi-million dollar U.S. corporations? FTAs favor the U.S. at the expense of Colombians.

That’s why U.S. business favors them. It is dollar imperialism at its worst. What we need is for the Obama administration to develop a trade policy that does not rely on bilateral free trade agreements. Instead, the U.S. should seek a multinational approach through the World Trade Organization. A broader international approach will promote trade that is perceived as fairer to all concerned and will improve the international business climate.

Ralph E. Stone
San Francisco

To the Editor:

I’ve never believed that the medical school costs argument holds much water. Doctors demand high incomes because they can, not because they have an argument for why they ought to be paid a lot for one reason or another.

Despite the relatively high earning power of primary care doctors, for example, I (I am a primary care doctor and owner of a small private practice) find it next to impossible to find docs to staff my office along with me because I simply don’t have enough money coming in to pay what they “demand.” Pay me less, and I won’t even be able to pay myself enough (now I earn considerably less than the median) to justify my continued work in my chosen field. Instead, because I am smart and capable of doing a variety of other possible jobs (as are most docs) I could easily seek out other employment which is less demanding and more remunerative.

Even from the perspective of a primary care practice (and we are the cheap providers not just with respect to our own earnings but with respect to the costs of the various tests we order) it is so clear that the driver of costs is the tests and procedures which we order based upon the technological abilities of medicine and the demands of our patients. Typically mundane is the patient who leaves after a perfectly ordinary follow-up visit for diabetes, for which I might have charged $120 and received $80, with orders for lab tests for which the lab will charge $600, a set of prescriptions for $500 of medication, and an order for a procedure that might add anywhere from $100 – $3000 to the health care bill.

To control health care costs we need to go to where the money is and there it certainly ain\’t in primary care docs earnings. Control of costs must come from elimination of administrative waste (read: “we need single payer care now”), from adoption of sensible evidence-based guideline for appropriate care, and from using the power of the single payer to drive down costs for medical technology and pharmaceuticals, (and doctors’ earnings where they are based upon inappropriate use of the above).

Aaron Roland
San Francisco

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