In an email.

I admit, it wasn't nice.

But I'm taking the gloves off.

Hell, I'm never going to be invited to the White House for dinner anyway.

and even NYC academic facility docs are moonlighting these days.

Of course, there has always been a profit motive in medicine. Doctors who own their own imaging machines order more imaging tests; to take an example from my moonlighting work, a doctor who owns a scanner is seven times as likely as other doctors to refer a patient for a scan. In regions where there are more doctors, there is more per capita use of doctors’ services and testing. Supply often dictates demand.

But financial considerations have never been as prominent as they are today, probably because so many hospitals and doctors, especially in large metropolitan areas, are in financial trouble. More and more doctors are trying to sell their practices, or are negotiating with hospitals for jobs, equipment or financial aid.

At hospitals, uncompensated care is increasing as patients suffering from the economic downturn lose health insurance. Admissions and elective procedures — big moneymakers — are declining. Hospitals are cutting administrative costs, staff and services.

“More and more you’ll see people in medicine get M.B.A.’s,” a doctor told me at a seminar, in a prediction borne out in my experience. “We are in a total crisis, and I don’t know the answer.”

My alma mater's medical school started a program several years ago that was unique in the nation at the time -- a combination MD/MBA program.

I don't begrudge the docs a good living; every laborer is worthy of his hire, after all. But note what this one says about uncompensated care. That's a bigger slice of every hospital's budget than it was five years ago -- and places like John Peter Smith and Parkland are being sucked into closing down because of it.

Single payer would stop that.

(referring to Obama's recent rhetoric on health insurance):

When Democratic leaders start borrowing right wing rhetoric, we know our activism has not been strong or progressive enough.

start borrowing???

I guess paying attention is hard.