<p>The larger problem here is pretty simple. We have too many people paying nothing. Noticing that very obvious fact does not make one cold and callous. Actually, it could easily be argued that it is much less empathetic to keep expanding the poverty pool for political reasons. Even with Medicaid and food stamps and housing subsidies and tax credits for existing and doing nothing, poverty is still unpleasant. It’s also notable how little the so-called caring posters care about the real working people getting punished for the “greater good”.</p>
<p>The interesting thing to me about Blue Collar concierge is the business model… which I think won’t work. Do they get to pick and choose their patients? </p>
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<p>That. Thank you.</p>
<p>All PC docs get to pick and choose their patients. If a doc just doesn’t want to care for a patient any longer so longer, they refer them to others. Not in an emergency situation, of course, but for non emergency care. </p>
<p>act-</p>
<p>I would be really careful about that, the whole 47% don’t pay taxes, etc, is in reality not true, it is a sound bite for certain political philosophy but it doesn’t bear up. A lot of that 47% don’t pay any federal taxes because they make so little money, that they get it back with the earned income credit. Those people do pay into SS and Medicare, though, so they do pay federal taxes. They pay federal excise taxes on goods and services, they pay sales taxes and local income taxes, so it isn’t they are ‘freeloaders’ paying nothing. </p>
<p>And if we are going to go there, how about corporations making billions of dollars in profits and paying no taxes, are they included (somehow, mysteriously, when the Ayn Rand supporters get going, they don’t cover companies, and say “I am talking people”…well, SCOTUS has said corporations are people, too). Farmers are some of the biggest group of ‘real people’ claiming how they get nothing, yet the reality of their lives is the federal government is all over them (anyone notice how much outrage there is when they discuss cutting back farm subsidies, or gutting programs like the ethanol boondoggle and the like?). The ‘real people’ who complain about paying for those who pay nothing are often big beneficiaries of the government, the only difference is their stuff is hidden). </p>
<p>There is a quote of Mencken’s that often comes to bear here, when I hear the word ‘simple’ I think of it" To every problem, there is an answer, so simple, so straightforward, that it seems the most obvious answer…and it is dead wrong". That “obvious fact” isn’t so obvious when you get beyond sound bites and talking points on talk radio, it is very easy to sit back and say “I am paying a lot of taxes because so many people are lazy and pay nothing”, or see those poorer than us as ‘parasites’ (to quote Ayn Rand, who seems to be influencing another generation of disciples), rather than look at the reality of things, dig in and see what exactly the reality is. By the way, those people who ‘don’t pay anything’ are also real people, with families, lives, hopes, dreams and whatnot, and characterizing them as the ‘other’ from ‘real’ people is part of the problem IMO. </p>
<p>musicprint - Never did I suggest they weren’t real people. But, unfortunately they are being told that their unfortunate circumstances are someone else’s fault so hopes and dreams frequently turn to anger and unproductivity. The lower middle class is disappearing because it’s no better than poverty anymore and people are waiting for the government to fix it. That won’t happen. It’s sad. </p>
<p>So then the Blue Collar concierge system isn’t for sick people? So if a family shows up that has two severely asthmatic kids who get seen by the doctor once a week, or a person with COPD, or a diabetic who needs a lot of monitoring shows up, the doctor says, “This model of free access to doctors is not for people who need a lot of access to doctors,” and shows them the door, then?</p>
<p>That business model doesn’t solve any problems I care about solving. Also, I suspect that it is not going to be serving people who are in fact blue collar, because they won’t be able to afford it.</p>
<p>Most doctors care about their patients. The concierge practice may care more about their patients because they have to do their own marketing and word of mouth is the best form. So they won’t be turning away the asthmatic kids, that wouldn’t be good for growing the business if word got around. In fact, because they aren’t relying on being in the insurance companies network, keeping their patients happy is even more important. Cases I’ve heard of in which doctors have refused to see patients again happened if a patient was verbally abusive to the staff or the doctor or patients who don’t pay their bills. </p>
<p>If Obamacare ends up imposing the same restraints on group insurance or if I lose my group policy sometime in the future, I will be one of those people using a concierge practice. No way I am going to wait months for healthcare or get caught up in the govt bureaucracy fighting for access to providers of my choosing. </p>
<p>The cheerleaders can’t seem to get their heads around the fact that having insurance does not mean you will have access to the healthcare you may need if you get sick. </p>
<p>Let me say to those who think I am just critical of govt inefficiency and incompetence…I also detest it when I see it in the private sector, which is why I oppose the merger of Comcast and Time Warner Cable or where you have private entities that approach the bureaucratic nightmare that is govt at almost any level. This is where our health care system is going with the demise of the independent practice and a few mega insurance companies conspiring with a few monopolistic hospitals to control access to healthcare for their customers. For consumers this will be a nightmare.</p>
<p>Oh, silly, make the best decisions you can. If that means choosing because some docs in Erie are trying it, be my guest. I’ll want to know how things back up for appts in flu season, when demand is high, what happens when too many in the that concierge’s pool are too sick. It’s not enough for me to decide based on an article, doc discounts for Prilosec (which is available OTC and in generic. And what bulk pricing for lower demand, expensive Rx?) How will we cover those lab tests and specialists?</p>
<p>I do think some here only took a cursory look at ACA or the exchange- with an eye to setting a few wildfires. We don’t know if others on this thread who don’t have exchange coverage priced their plan options accurately or if they are just trying to make a point. What makes you think a quick look at concierge is enough? Conceirge is nothing more than it is. You’ll still have to deal with hospital choices and coverage, all the rest.</p>
<p>How does the Picasso hospital fit into the concierge concept? </p>
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<p>I’m thinking that they are on only covering basic, preventive and routine health care services – anything complicated probably gets referred out to a specialist. So basically they are charging a monthly fee for much of the stuff that should be free under ACA — routine checkups, well baby care – plus the small stuff (kids with earaches and sore throats, etc.). As soon as the care gets complicated, the patient is probably referred out to a specialist. The concierge doctors probably don’t do surgery, they don’t deliver babies, they don’t treat cancer.</p>
<p>“The concierge doctors probably don’t do surgery, they don’t deliver babies, they don’t treat cancer.”</p>
<p>That’s coming. In a way it is happening now since many of those specialists won’t take Obamacare patients in the individual market.</p>
<p>Concierge practice may make primary care more attractive to medical school graduates and thereby increase the number of physicians going into primary care. It reduces overhead by reducing the need for office staff to deal with the insurance companies. The doctors don’t have to fill out forms or be on the phone with claims people, all of which is not reimbursed. They have control over their pricing. They can spend time with their patients. </p>
<p>I keep hearing how good the Covered Ca. site is working; then I take a look a these reviews from Yelp for only Sacramento residents and one has to wonder.</p>
<p><a href=“http://www.yelp.com/biz/covered-california-sacramento”>http://www.yelp.com/biz/covered-california-sacramento</a></p>
<p>One example:</p>
<p>"The most incompetent, broken, screwed up thing I have ever come across.
It is unusable AND they are going to charge you 1% of your income from not being able to use it by a certain deadline?</p>
<p>It seems like a bad dream except that it is real."</p>
<p>One more (I have severely edited it).</p>
<p>“As a certified agent for CoveredCa I have pretty much nothing good to say about this website and customer service. I am happy to be able to help people sign up for coverage that they could not afford before but the whole system and experience has been terrifying and frustrating and just downright SAD.”</p>
<p>There’s already an effort to make primary care more attractive, separate from concierge. The trend I see, in the med program I know, is a desire to work in more complex fields, for a variety of reasons. </p>
<p>I’m not sure folks would want a surgeon on retainer, unless they were old enough or at-risk enough (oops) that something was looming. Multiple somethings. It won’t be $75/month to cover the possibility of an expensive surgical procedure. And how do you get around facility and more sophisticated diagnostic costs? </p>
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Fang: can we agree to the fact that maternal mortality stats don’t mean much unless normalized for demographics?</p>
<p>" And how do you get around facility and more sophisticated diagnostic costs?" </p>
<p>You buy a supplemental policy. Did you read the article? I’m seeing a lot more of these practices popping up around here. For most people it’s a great idea and makes a lot of sense. It’s personal.</p>
<p>But the “supplemental” policy has to be ACA compliant - and ACA mandates that the preventive services be provided without cost - so the concierge buyer potentially ends up paying more – they are essentially paying a surcharge for convenience and choice – but that is an amount that will not be applied to their insurance deductible and is often in lieu of services they could receive for free even with a high deductible ACA-compliant policy.</p>
<p>I can see why wealthier people would go for that – people with money routinely pay more in order to secure comfort and convenience. </p>
<p>I"m just not so sure it benefits the patients of the “blue collar” concierge. </p>
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<p>I’d agree to normalize for maternal age, certainly, which would maybe make the US look a trifle less bad. Normalizing for socio-economic status isn’t going to help, I’m afraid. The other countries with numbers near ours, countries like Iran and Hungary, aren’t filled to the brim with rich people.</p>