Concierge medicine has the potential to provide the two essential elements missing in our health care system, that is, a way to hold down costs and a way to get people to pay it forward instead of waiting until they need it.
The idea is simple and it leverages capitalism, the engine of economic success. An AP article in today’s Globe describes it.
Every year, thousands of people make a deal with their doctor: I’ll pay you a fixed annual fee, whether or not I need your services, and in return you’ll see me the day I call, remember who I am and what ails me, and give me your undivided attention.
The problem highlighted in the article is that concierge medicine could lead to a system that treats people with more money better than people with less:
“What we are looking at is the prospect of a more explicitly tiered system where people with money have a different kind of insurance relationship than most of the middle class, and where Medicare is no longer as universal as we would like it to be,” said John Rother, policy director for AARP.
But if we discard the idea for this reason we are in effect admitting that we have no answer to the core problem, cost.
The concierge system is excellent because:
- It cuts red tape and administrative costs. Record-keeping is simplified.
- It relieves doctors of through-put pressures.
- It reduces waiting time for patients.
- It gives doctors more incentive to practice preventive medicine.
- It puts medical practice on a personal basis for both doctor and patient, more satisfying for both.
- It incentivizes patients to use what they are paying for, thus promoting preventive care.
- It minimizes errors and improves quality because doctor and patient are familiar with each other.
- It potentially encourages competition among doctors.
Now, rather than run scared from this system because the poor can’t afford it, why not look at the problem differently? Why not ask, “How can we fund access by everyone to this excellent system?” That would separate the cost issue from the system structure, and that is as it should be.
I see the principal problem now, as with the Affordable Care Act, as being chaotic for just that reason – the cost problem is not politically solvable. The same is true of the effort in Vermont where their House has passed a single payer bill that contains no plan for how to contain costs. Why not let the market do it?
Critics will argue for a government system like Canada’s, but I do not think that will work in America. Ask any Tea Party member. In this culture we hate taxes and we don’t want to be told what to do. But we as a people are OK if we get something when we pay for it, or when the cost is hidden, as with sales taxes. That’s just the way we are and it’s time we faced up to it politically.
I am inspired by the awesome potential of this idea and I see it as an opportunity to think outside the box. How about encouraging reduced fees for Medicare patients? How about adding a small co-pay for each visit, simply to discourage those who might be inclined to abuse a pre-paid plan? How about Medicaid dropping bureaucratic form-filling in favor of a direct subsidy to enroll needy patients in concierge plans? And I would love to hear ideas about how more competition among doctors could be encouraged with a concierge system.