Can the Benjamin Rush Society Bring Free-Market Ideas to Medical Schools?
Avik Roy, Contributor
John J. Miller has written a lengthy piece for Philanthropy Magazine about how medical students, business school students, and foreign-policy graduate students are organizing conservative student organizations, modeled after how the Federalist Society has transformed legal education. Nearly all conservative judicial appointments today come from the Federalist Society farm team. Now, the Benjamin Rush Society aims to do the same for medical schools.
I have written in the past about the dearth of market-oriented health policy wonks. That dearth is especially problematic now, given the existential threat posed by our growing entitlement state. Unfortunately (or fortunately, depending on your perspective), to the degree medical schools focus on health policy, it’s almost always from a single-payer, anti-economic perspective.
The tension between Hippocratic medicine and economic reality
This isn’t entirely unnatural. As I wrote in a piece for National Affairs entitled “Health Care and the Profit Motive,” there is an apparent tension between the Hippocratic tradition of medicine, which strives to place the interests of the sick above all others, and the economic realities of modern health care:
The tension between the spirit of medicine and the spirit of the marketplace is hardly a new problem. In Book I of Plato’s Republic, Socrates poses the difficult question: “Is the physician a healer of the sick or a maker of money?” The answer is necessarily both, and balancing the two is not much easier in our time than it was in Plato’s.
Indeed, the ancient ethic of the medical profession — set forth by Plato’s contemporary, the physician Hippocrates of Cos — gives doctors a moral as well as a medical role in their societies. The famous Hippocratic Oath affirms that doctors should protect the sick not only from disease but also from “harm and injustice,” and instructs physicians not to prey on patients’ vulnerability for their own gain. In ancient Greece, the oath represented a minority ethic in a world where charlatans posed as physicians to rob desperate people. Later, Roman physicians found much to admire in the Hippocratic Oath and preserved it for Christian Europe, where the code’s universal moral claims found more hospitable ground. The Christianized Hippocratic Oath became the common standard by which physicians were judged. For new doctors, swearing the Hippocratic Oath became a defining rite of passage — connecting them to generations of their predecessors in an ancient, unbroken tradition that endured into the 20th century.
Today, contrary to popular perception, few medical schools require their students to take the oath; its strict injunction against “abortive remedies,” for one, would be controversial. But its broader principle of placing the “benefit of the sick” above self-interest remains at the heart of the medical profession. It is one important reason why physicians are held in high regard by society, and why so many decent and honorable people are drawn to medical careers. Insofar as the pursuit of profit is the pursuit of self-interest, it is easy to understand why many would think that the free market has no place in medicine. Treating the sick and offering relief to those who suffer are acts of compassion and benevolence that risk being corrupted by economic calculations.
Health policy education in medical schools is usually a one-sided affair
But it is precisely because so many physicians pay no attention to economics that health care is so costly, both for individuals and for the government. Those who do pay attention tend to do so from one side of the debate. “Medical school curricula are full of liberal bias,” Jason Fodeman told Miller. “Students don’t hear about competing perspectives—and it’s essential that they do because every medical issue is now becoming politicized.”
Sally Pipes thought to do something about this, and decided to see if she could start medical student organizations that would spend time debating free-market ideas for health policy:
The thought has frequently occurred to [Federalist Society Executive Director Eugene] Meyer. As the Federalist Society grew in influence, he increasingly wondered: Could it serve as a model for other groups with similar objectives in different disciplines? “If you take ideas seriously and put on debates, you’ll get the best and the brightest,” he says. “I think this applies to everybody, no matter what field they’re in.”
Sally Pipes was thinking largely along the same lines. As the Canadian-born head of the Pacific Research Institute, a free-market think tank in San Francisco, she emerged in the 1990s as one of the most powerful critics of government-run health care. Now an American citizen, she spends much of her time warning her fellow countrymen about the dangers of Canadian-style policies. In addition to giving speeches and writing op-eds, she develops institutional strategies for fighting socialized medicine—and about five years ago, she came up with the idea of a Federalist Society for medical students.
“I was having dinner in New York City with my godson, a Canadian who was studying at Columbia University to become a doctor,” says Pipes. “He complained that when his professors turned away from the science of medicine and talked about health policy, the only option they really ever discussed was the single-payer system.” Pipes has spent the bulk of her career arguing against precisely this mindset. “It occurred to me that if we’re going to defeat government-run health care, then we’re going to have to reach medical students. They hear a lot of wishful thinking about what government can do, and not much about common-sense alternatives based on individual choice.” A couple of months later, Pipes bumped into Meyer and told him about her idea. He was enthusiastic and offered to help.
By the end of 2007, the Ewing Marion Kauffman Foundation had agreed to fund an exploratory meeting. The following May, Pipes hosted a group of health-policy professionals and opinion leaders in Washington, D.C. They listened to Pipes explain her idea, heard Meyer describe the ways in which he thought the Federalist Society’s model could be adapted, and discussed whether it all made sense. “There was a feeling that the medical schools had embraced statism and were telling students that they should think of their profession not as a business but as a calling,” says Deroy Murdock, a columnist in attendance. The group was persuaded that something needed to be done.
In the weeks before the meeting, as Pipes was thinking through the concept, her husband, Claremont McKenna College professor Charles Kesler, suggested that its title refer to Benjamin Rush, a doctor who signed the Declaration of Independence and served with the army in the American Revolution. It took some convincing. (“I hadn’t heard of him before,” says Pipes. “Maybe it’s because I’m from Canada.”) Soon enough, Pipes was fully on board with the concept and the name.
Pipes formally launched the organization in 2008, which now has chapters at17 medical schools including Columbia, Harvard, and Stanford; and a budget of $450,000. (My Apothecary colleague John R. Graham, who works with Pipes at the Pacific Research Institute, is also involved in the group as its Executive Director.) Here’s betting that, with wider awareness and support, it will eventually reach every medical school in the country.