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My thinking on this link is more about seniors but I realize it impacts folks across the age spectrum. It is not about political division but the reality that in a free market based economy it will often be market forces and not public policy that creates outcomes intended or otherwise.
Frustrated with a changing healthcare system that has resulted in longer work days and less time with patients, a growing number of doctors in California and across the nation are turning to a new type of practice — concierge medicine.
The model is simple: Doctors charge their patients an annual fee and in turn, give them more time and attention.
Rising costs and shrinking insurance reimbursements have prompted doctors to search for innovative ways to keep their solo practices afloat. Concierge medicine, practiced by more than 5,000 physicians nationwide, provides them with extra income and allows them to limit their patient rolls.
Michael T. Duffy, a physician in Beverly Hills, recently made the decision to switch from traditional private practice to concierge medicine. He hopes to reduce his patient load from 2,000 to about 400.
As we know many doctors are declining to accept Medicare patients and this might be away to induce many of them to continue accepting seniors on Medicare. The reality is that the demand for medical services far exceeds our ablility to provide them in a timely and well practiced manner. Will it be government or the normal free market forces that eventually decides?
Would you prefer the opportunity for a concierge based system providing you the benefits in exchange for the reported going rate? Would you prefer it even if improved health care for you was at the disadvantage of someone else?
I don't live in a high-priced spread part of the US. But my current PCP doesn't accept new Medicare patients (although she will keep existing patients when they go on Medicare - and will also accept family members of existing patients who are on Medicare - like my father when he moved here). Were we to lose her - for whatever reason (like she decided to move to Seattle) - we would have had to think quite seriously about going to a concierge practice. Not that there are many of them here now. OTOH - there are aren't many good PCPs here either. I can count the number of PCPs within 10 miles of me on one hand. OTOH - there are probably 30+ dermatologists. Like Willie Sutton said - he robbed banks because that's where the money was.
To answer your last 2 questions with specificity. I want the right to decide between a "Medicare doctor" - and a doctor I pay for totally out of my own pocket - a concierge doctor (or - maybe in a rural area - it's a doctor who gets paid in beef or chickens or organic eggs). And how would I disadvantage someone else by doing that - as long as I paid my taxes for people who can't afford to pay for their own health care (whether they're simply unfortunate - or total deadbeats)? Unless you think this latter group will wind up with health care that is worse than mine?
Which is entirely possible. I know we as seniors tend to focus on seniors. But I was reading a little about the costs of AIDS patients these days. It's huge now that it's a chronic and not necessarily kill you off fast disease. How many of you seniors are willing to pay a ton of money to keep IV drug users with AIDS alive? Or to give them liver transplants for that matter (when they have HEP C)? Robyn
I don't live in a high-priced spread part of the US. But my current PCP doesn't accept new Medicare patients (although she will keep existing patients when they go on Medicare - and will also accept family members of existing patients who are on Medicare - like my father when he moved here). Were we to lose her - for whatever reason (like she decided to move to Seattle) - we would have had to think quite seriously about going to a concierge practice. Not that there are many of them here now. OTOH - there are aren't many good PCPs here either. I can count the number of PCPs within 10 miles of me on one hand. OTOH - there are probably 30+ dermatologists. Like Willie Sutton said - he robbed banks because that's where the money was.
To answer your last 2 questions with specificity. I want the right to decide between a "Medicare doctor" - and a doctor I pay for totally out of my own pocket - a concierge doctor (or - maybe in a rural area - it's a doctor who gets paid in beef or chickens or organic eggs). And how would I disadvantage someone else by doing that - as long as I paid my taxes for people who can't afford to pay for their own health care (whether they're simply unfortunate - or total deadbeats)? Unless you think this latter group will wind up with health care that is worse than mine?
Which is entirely possible. I know we as seniors tend to focus on seniors. But I was reading a little about the costs of AIDS patients these days. It's huge now that it's a chronic and not necessarily kill you off fast disease. How many of you seniors are willing to pay a ton of money to keep IV drug users with AIDS alive? Or to give them liver transplants for that matter (when they have HEP C)? Robyn
Location: ๏̯͡๏﴿ Gwinnett-That's a Civil Matter-County
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Originally Posted by TuborgP
Would you prefer the opportunity for a concierge based system providing you the benefits in exchange for the reported going rate? Would you prefer it even if improved health care for you was at the disadvantage of someone else?
The concept sounds like something that should be illegal and carry stiff penalties.
Either someone needs care or they don't.
Why should someone have to pay more to get care they need? They've already paid into the system and are entitled to receive the care they need and nothing more, nothing less.
If you're Conrad Murray and want to run your own private pain pill mill to the highest bidder then that's fine by me but if thats the case, there should be no taking medicare patients at all. Either you're in it to provide an essential service to patients who have already paid for it or you're providing services to the highest bidder. There should be a clear distinction and separation of these two different kinds of providers.
if thats the case, there should be no taking medicare patients at all. Either you're in it to provide an essential service to patients who have already paid for it or you're providing services to the highest bidder. There should be a clear distinction and separation of these two different kinds of providers.
There is. Concierge practices have been around for quite a while now. Concierge doctors don't want Medicare patients - reimbursement rates are atrocious. That's the point of being concierge. These docs establish a practice comprised of well-heeled patients who are willing to put the doc on retainer, just like a lawyer, and patients pay out of their own pocket. The only time Medicare might enter into it would be for hospital, lab, etc. Of course, whatever Medicare won't pay for, the patient will. But the doctor himself charges what he wants in return for what the patients want which is more personal attention and better care.
Don't forget- the conciege practices provide primary care only. Not specialists, not hospital care. (Although some say they will check in with you in the hospital).
Will it be government or the normal free market forces that eventually decides?
We should first establish the fact that healthcare is and has been an outlier within a market economy and outside of some elective procedures is and has never operated within an principles associated with a market economy.
Small examples:
In the case of an a medical emergency when one calls 911 one isn't provided with a list of optional ambulance services from which to choose from.
When the ambulance comes, generally the hospital that you are transported to is based upon geography not a choice based upon price of services.
When you are admitted to the emergency room, you don't get to pick and choose which procedures that you agree to much less the price that is being charged. (as a joke I recently tried asking for the price of individual tests and procedures, it doesn't work).
Even when you have time to "shop around" you are required to pay for the evaluation.
In the case of those who have medical insurance, the market price of services isn't determined by you the consumer but rather the relationship between medical providers and the insurance company and while there are market forces involved in those negotiations, I would be hard pressed to argue that is a ideal free market transaction depending upon the relative negotiating powers of the either the medical providers or the insurer.
Don't forget- the conciege practices provide primary care only. Not specialists, not hospital care. (Although some say they will check in with you in the hospital).
Most patients see to it their concierge at least has privileges at the hospital of their choice. I chose a PCP based on his hospital affiliation. (Disclaimer: I'm not in a concierge, of course). He no longer has privileges at that hospital, and I have since changed my PCP. For me, hospital affiliation is paramount. I seriously doubt any well-to-do patient would leave hospital affiliation to chance. These types of people don't function that way. They control as much as they can at all times. I saw NYT article about five years ago on concierge trends. Their PCP doing hospital visits was all part of the agreement. As far as I understand it, you pay an annual fee for the privilege of personal attention, and then pay in addition for any office visits, hospital visits, home visits, whatever.
Excuse me, but I am one of the great unwashed and outside of Royal Pains, I've never encountered the concept despite the fact of having an ungodly number of physicians in my immediate family. So what is a conciege practice?
Excuse me, but I am one of the great unwashed and outside of Royal Pains, I've never encountered the concept despite the fact of having an ungodly number of physicians in my immediate family. So what is a conciege practice?
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