At the end of this basketball season, one of the most exciting things to hit the NBA in a long time will get started.  That is the bidding war for LeBron James.  With his rookie contract expiring and his celebrity status firmly established, there is much anticipation about which team will be able to offer him deal worth approximately the entire GDP of Italy.

Or, will someone in Washington, DC decide what he should be paid?

Of all the czars appointed by the Obama administration, none has gotten more attention than the pay czar.  This began as the quid pro quo, in that if your company took federal bailout money, then the czar would set the pay for its top executives.  Taxpayers and reasonable people everywhere believed that was a fair trade, and hopefully a disincentive to come to Washington with outstretched hand, either by private jet or hyrbid car, asking for money.  Fair enough.

Then the pay czar decided to rule on what would constitute 'reasonable pay' for other bank executives, even those who did not take federal money.  Some people began to get nervous.

Now you wonder if the pay czar has set up a second office in the healthcare reform camp.  At least philosophically so.  Implicit in the discussion, or at times more direct, is the question of how much money physicians should make.  More than a kid flipping burgers, for sure, and probably more than a third grade teacher in most cases, but clearly not as much as a basketball player.

When politicians and even real people talk about reducing healthcare costs or 'bending the curve,' we all generally agree in concept.  The cost is hampering our economy and at least aiding in the slowness of business to add those critically needed jobs.  However,  every one of those two trillion or so dollars goes to someone.  So bending the curve, while euphemistically soothing, means someone's ox is getting gored.

Of course the greedy healthplan CEO's ox needs some goring, and probably some big shot pharma execs as well, but there are only a few of them.  It makes for a good, safe sound bite for the voters back home, but the math is insignificant.  There are a few hundred thousand physicians, so if you want to save some real money, take a bite there.

For policy makers to pretend that they are not looking at average income for physicians in this specialty, or that specialty, with an eye toward what is a 'fair' level of compensation is disingenuous.  Clearly, inherent in the policy discussions are assumptions, be they stated or hidden, about how much money a physician should make.  It is hard to know whether the discussions have contemplated how the 'target' physician compensation should account for the cost and effort of a medical education, the time demands, the legal liabilities, or the unique moral and ethical obligations the physician to the patient.

Physicians, particularly independent physicians, are both doctor and entrepreneur.  Yes, they care for patients, but they also started a business, put up captial, hired employees, and took financial risks.  Clearly, I am a free market guy.  I believe that if physicians have the right to fail, and some do, then like other entrepreneurs, they have the right to the upside as well.

Maybe in some twisted Beltway logic, getting paid by Medicare or Medicaid for some portion of your business constitutes a bailout which subjects you to compensation regulation, but delivering a service to a patient who happens to be a senior seems a little different than asking for a few billion for your failed hedge fund.

Tim Coan