Doctors in the US inevitably become capitalists appropriating working class aesthetic but have much better material conditions within the societies they live.
They actually enjoy how the elites of society have ordered their way of living. They enjoy the pay, the ability to deny service, the mill of getting easy patients and accruing large sums from them.
But they want to complain from a position of moral righteousness. So they (poorly) frame their arguments as fighting against hordes of rogue patients just looking for their own preselected drugs and treatments, angry at being told no. They declare, "you pay me for MY time because of MY expertise! Not to prescribe x drugs!".
But in this, you see the class dynamic re-emerge.
Workers without the ownership of their means of production, forced into the labor market, will inevitably fall ill, and then need to seek medical service. Everyone in society falls ill. But depending on how much you can rightfully extract from the value of your labor time, you are forced to exchange that time for medical service. And then society is ordered in such a way to lock you out of the process of getting the best pharmaceuticals and technology to aid yourself, you must go through a gatekeeper. And then these individuals have an unequal advantage against patients, given to them by the society they live within.
And this re-formats the role of those who are supposed to be socially aligned with the working class to be servants of the ruling class. They believe they are reaching independence each cash infusion. They are faux-independent.
The doctor becomes conditioned to view patients that want more of their labor time as being overbearing. The doctor views patients who want particular treatments or aid as problematic. Doctors then use statistical data sans the socioeconomic factors reinforcing that data, to create narratives around persistent patients.
In a "liberal" society, see how this develops "illiberal" tendencies. How the system works in reverse when tested. How capitalism itself combats liberalism when at odds.
The more a patient wants to take ownership of their bodies, the more they want to learn what the doctor knows without going to medical school, gain more for the money the doctor receives from insurance, they are obstructed.
The doctor then appropriates more working class rhetoric AGAINST the working class. Speaking about how insurance companies make their lives difficult as well. How they must deal with people who do not listen to them despite having experience. How they are overworked and have tough peers and bosses. But in reality this is not the case. As their relation to each of these issues is distinctly different than that of non-doctors receiving care themselves.
And then this relationship is built and reinforced. The one that has been ordered in this way by the owners of society. These doctors over months, years, decades become transformed into agents of the elites.
They want to spend less time with less wealthy patients or those not in their social and/or family sphere. They bring Fordification into their practices. Establishing medical assembly lines and a medical factory process. They become increasingly identical services. And as this occurs, the same doctor feels liberated by reducing their workload, as their practices begin to run off their name and everyone else is paid off this guild arrangement. They want to build a fiefdom within the capitalist system. But what they are truly ushering in is their standardization. They become more replaceable and their labor time becomes less valuable the more "liberated" they feel through cash infusions.
Doctor shopping becomes more common because many doctors become near-substitute services the more wealth they accumulate.
And who is exempt from this? The patients with the most capital. They can get the best doctors, the best service, the most time, etc. The gatekeeper of prescriptions and procedures is non-existent to the wealthiest.
The shortsighted part of this is that doctors then put their faith in those that order the society we live under.
And this puts the stock in the capitalists. The business owners.
The more streamlined and quick your service is. The more identical you become. The more numerous you become. The more replaceable you are. And when the AMA and the associations that help keep doctors in the positions they are in begin to falter with economic woes, the capitalists will betray the doctors to feed industry. They will usher in universal healthcare to lower their own costs and ease working conditions.
A universal healthcare system will crush doctors who have built themselves into insurance thieves and shorten time with patients. It will build off the standardization and streamlined approach of facilities. And under a capitalist nation, it will pressure crunch on doctors. And the perspective of patients will largely be that of how they feel about Amazon. As long as the wait times are not bad, the service is reliable, and the price is cheap, then they disregard the worker providing the service.
Insurance serves a role of minimizing the worker's ownership. The worker leases a policy which is in turn used by doctors to profit off the patient. This relationship is fostered as independently from the patient as possible for the doctor. And so the doctor sees the patient as the gatekeeper of insurance, which they view as their real patient. Whereas the patient views the doctor as their gatekeeper of the drugs and services they need. And this pushes the doctor to view the patient as one who offers consent to this extraction and little else, but not insurance, as the cost of services goes up and healthcare costs expand.
As insurance costs rise and doctors make a fraction of this, this depresses the offering of un-insured patients. This limits their leverage over doctors and makes them less desirable as patients unless they can pay a good portion of the sum up front.
This benefits the wealthy, who can pay out of pocket if they want.
As the doctors become conditioned to feed off insurance and commit insurance theft over patients, THIS is the mechanism that reorders the private practice.
Insurance companies, become cartels in each state, finding whichever means to take over state programs and institutions to weed out other insurance companies. So that via economies of scale, only a limited amount of insurance companies carry the majority of policies in the state.
Then these insurance companies THEMSELVES are subjects to the capitalists that order society. They are ordered to accept particular pharmaceuticals and particular procedures etc. And they are ordered to follow particular protocols. And this is then made out to be competition, but this is actually just oligopoly. Insurance companies in agreement. And if possible, this is then extended to the state, to mandate policies, removing the idea of the oligopoly and placing the burden on "state or city regulations".
These insurance companies then use their wealth to flood patients into doctors' offices and "order" doctors into a particular model. They outbid the uninsured patients and then become a larger and larger share of the doctors' wages. Then they condition the doctor based on denials and approvals to condition their labor to the institution of insurance within the region they work in.
This puts the doctors at risk when the insurance industry eventually gets betrayed by the capitalists.
Once a faction of the capitalists that is indifferent to insurance, gains enough control of government, they will be posed to lower healthcare costs, if it lowers the cost of their industries, in order to feed their industries.
And upon instituting a universal healthcare program, this faction of capitalists that own the government, will be able to negotiate directly with the doctors through the government. Essentially negotiating how much doctors will onboard this portion of wages. Depressing the doctors' wages.
(4/22/2025)