Concierge medicine and goverment run healthcare

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kiryan
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Concierge medicine and goverment run healthcare

Postby kiryan » Fri Aug 28, 2009 5:22 pm

I caught part of a radio program on healthcare yesterday. Specifically discusisng "concierge medicine". Basically, a doctor will decide he wants to have a certain # of clients and they will pay a certain amount of money (say $6,000 a year). The doctor will then basically see them whenever they want, at home or in the office or in the middle of the night. He takes responsibility for their healthcare.

So they had 3 doctors discussing it. The first was a very high end concierge service (they wouldn't say how much it cost but she serves rich people), the 2nd was a doctor in charge of some physicians for single payer (government plan) health insurance. The third was a lower end doctor running a concierge practice (6,000 a year). All 3 were bemoaning how meidciare / medicaid don't pay general physicians well enough and how the entire system (with influence from drug companies) pushes people into specialities.

It was obviously a bit of a heated discussion and it was interesting to hear it from the doctor's perspecitves. The single payer doctor basically called concierge practices immoral and that the doctors were failing to meet their social obligations. The low end concierge doctor was particularly eloquent and said several things, first its injustice to enslave a group of people (doctors) to artificially low wages so that the greater good can be served as determined by government (like in a single payer scenario).

Second, he said his concierge practice frees him to decide who is worthy to receive his care. He went on to explain that he used to see 40-60 patients a day, 90% or more of whom were poor and 70% of whom basically were not trying to be healthier. Overweight patients with type 2 diabetes who refuse to exercise and put down the twinkies. Smokers with advanced cases of emphysema who wouldn't stop smoking. ect ect ect.. He said he felt like he was wasting his time treating these people because they weren't following his advice. So he started a concierge practice.

In his current practice, he said that he gives away more charity care now than he did before, but he decides who is worthy. If your poor and want better health, he'll see you. If you are poor and refuse to follow doctor's orders for getting healthier, you won't get any more free care from him. he's not going to waste his time. The doctor to the rich also said she gave away more truly free care than she did when she was a regular private practice.

The doctor for single payer was not very well put together... she looked like a fool repeating a bunch of talking points especially when she got into the morality of taking care of everyone debate. I don't know if this was organized to be some sort of lopsided sham discussion, but I found the concierge doctors' points moving. I'd read about concierge practices 5+ years ago, and it sounded gimmicky to me, obviously bad public policy when we are facing a shortage of primary care physicians and even a bit wrong morally.

However, I can see the validity of the doctors' points especially in choosing who gets their free care. Its certainly not fair if you believe healthcare is a right and should be applied evenly across the board, but practically speaking if you don't have enough healthcare supply to meet demand, wouldn't you provide for those that use it most effectively? I'm starting to become a fan of the concierge medicine model.

If you were running healthcare isn't this how you would do it? provide care to people who are trying to get healthier, stop wasting care on people who continuously make bad health decisions no matter how much education you give them?
Yayaril
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Re: Concierge medicine and goverment run healthcare

Postby Yayaril » Fri Aug 28, 2009 10:58 pm

I believe health care is a right and everyone has the right to live a healthy life.

Perhaps the government should step up that tax on unhealthy consumables and apply the funds to the treatment of the unhealthy.

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