Editor's Memo

If Doctors Practice Gouging, What Does It Mean for Society?

John Marcille

Competition to get into such institutions as Princeton, Harvard, and Yale is, as you might imagine, stiff. So stiff, in fact, that many of us believe that the Ivy League universities are the most selective in the country. Yet it has been argued that the military institutions, places like West Point or the Citadel, are even more difficult to get into. For one thing, you can’t just be brilliant; you need to pass a physical and have demonstrated leadership ability.

I thought of these schools while we worked on this issue of MANAGED CARE because our cover story deals with doctors who shamelessly gouge the system by charging exorbitant fees. The connection is that the military academies have something else that other schools either lack or merely pay lip service to: They have honor codes.

Not only are the students expected to not cheat, but they must report others they discover to be cheating. In other words, it is the opposite of the so-called “don’t snitch” code that dogs many institutions and some social strata.

This don’t-snitch mindset is not so alien to us as we might like to think. Most of us were taught early, probably by our parents, to not be a tattletale. But how does that work in adult life? If we witnessed a murder, we would go to the authorities. But what if we witnessed somebody shoplifting?

Are the doctors who gouge operating in a vacuum? Must it only be the insurance companies on the lookout for those who want to extort? How about some peer pressure from straight-arrow physicians, surgery centers, and other providers?

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