That's the question I asked myself after reading Art Caplan's piece in Newsday today. Art tells the tale of the recent meeting in Denver of the American Society of Concierge Physicians: "Concierge medicine is a special, high-end form of medical care that guarantees that if you need treatment you will get it, without a hassle, seven days a week-but only for an extra fee. If you can pay amounts that range from $20 to thousands of dollars a month, you can guarantee that your phone calls will be promptly returned by your doctor and that you'll get special attention whenever you're admitted to a hospital." He contrasts the "quality medicine for the rich" philosophy of the ASCP with TennCare's recent cutbacks to the state's Medicaid program:

It is making over its state Medicaid program known as TennCare. If this program gets implemented, many of the poor, elderly, children and disabled in Tennessee who rely on Medicaid will be told simply to get over it. And other hard-pressed states may well follow suit.

Gov. Phil Bredesen, a former HMO entrepreneur, sees the challenge of health care for the poor in Tennessee in very stark terms. In a speech last February, the governor described the state Medicaid program as nothing more than an open checkbook that is continuously being raided by "doctors and hospitals and advocates" who "decide what is needed."

Caplan's opening paragraph provides a fitting close, as well: "Just how bad is the state of health care in America? Well, consider two recent developments that shine a spotlight on a system that was already showing signs of severe distress, even before the Supreme Court decided to let HMOs off the legal hook. In Colorado the rich are paying what amount to bribes to make sure that they are at the head of the line when it comes to getting health care, and in Tennessee the poor are basically being told to get lost."

I've examined concierge, or "boutique," medicine in this space before, and as recently as last week reported on a hospital in the tony Hamptons on Long Island that has offered "concierge emergency care" contracts to selected (and wealthy) residents in its service area. I understand the frustration physicians feel on the daily treadmill practicing "hamster medicine," as well as the doom and gloom many state CEO's feel as they contemplate the sinking of state budgets by seemingly boundless growth in the demand for health care dollars. But neither of the developments chronicled in Caplan's piece provides a viable answer to managed care woes or the problems of the indigent and the uninsured. In fact, what they both have in common is a set of blinders that allows the concierge docs and the state to say, "Screw the consequences. We're holding on to whatever we can keep for ourselves, despite the cost to the system."

From: John H. Olsen
john.h.olsen@comcast.net

I haven't.

News
http://www.supremecourtus.gov/opinions/03pdf/02-1845.pdf

My story
http://www.healthcareproblems.org/Patients/IL/Statement10030.htm

good answer!

The net/net is that the concierge medicine / concierge physician / boutique medicine / retainer medicine model is attractive to both patients and physicians.

It provides an alternative means of accessing health care and the AMA has stated it is in support of the desire to have a multi-tiered health care system.

Jeff

See my blog on concierge medicine at http://conciergemed.blogspot.com/

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I started a concierge practice
because I want to be able to
practice the way I was taught which
is to evaluate the whole person,
not just one symptom per office
visit. In order to cover expenses,
the concierge model was the only
way to do this. I'm about having
the relationship with the patient,
not with the insurance company.
I wouldn't have problems with managed care if they would stay out of the middle in telling us what medications we can use (for their economic advantage), and would pay us the contracted rate
within 30 days. The increased
premiums are going to their management and more paperwork for
the providers, not to people that
provide the care. It is hard to
meet our rising overhead costs
without seeing too many people per day to be practicing good medicine. Medicine is based on an
economic model, no matter how you look at it. Skeptics of concierge
medicine sure don't say that we all should be able to buy Hummers - not just the rich. Concierge medicine is a choice for lifestyle. It will never be for the masses, so the indigent and Medicaid patients will always have providers as long as we have county hospitals and clinics.

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I also have started a Concierge Medicine program and intend to close my traditional practice soon. Rather than decreasing my care of the less fortunate, I have found increased time to volunteer in a community health center and we have provided (and will continue to provide) complimentary memberships for 20% of the members in our program, reserved exclusively for patients without health insurance, or with Medicare or Medicaid (who often have difficulty finding a physician). There's an interesting article about the University of Miami closing its primary care clinic because the economics have become so difficult. We are in a similar position, we either change our mode of operations or we'll be bankrupt shortly.

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I am a physician and have been in private practice for 10 years and am in the process of converting to
a "concierge" practice. I have seen the state of general Internal
Medicine deteriorate in regard to 3rd party payor reimbursement. The only way to make it work is to see 30 pts/day which means short,quick visits. If you have mult. medical problems and require more attention
you are in trouble. The change in
my practice will allow me to practice like Marcus Welby did and
actually make house calls instead of sending those patients to the ER. God Bless.

Tom:

I have great respect for your opinions and comments. However, I would suggest an additional consideration. Physicians in "concierge" practices often have MORE time to see patients in volunteer clinics (or in their own offices - as in our case) than they did when participating in the "rat race" style of care. And, our society is a free market...except in health care. Disallowing this option would simply lead to more skilled primary care physicians retiring early, subspecializing, or going to law school.