<p>As a dentist who has “managed” to avoid mangled care up to this point, I’d like to add my admittedly subjective take on it as a more than casual observer:</p>
<p>Up until widespread insurance, routine MD visits were fairly affordable and could be paid for out of pocket with minimal hardship for most working class Americans. With the rise of traditional indemnity insurance, MDs learned how to game the insurance and fees were suddenly “unbundled”. So you would see your physician for 5 or 10 minutes and there would be four or more separate itemized charges totaling in the hundreds. The patient didn’t care…as long as insurance covered it. Utilization also greatly increased. Since the care was now “free” ; every illness: minor, major, real or imagined warranted a visit to the doctor’s office or emergency room. The physicians really rode this gravy train and their high incomes reflected it.</p>
<p>Insurance company execs eventually caught wise to this, and decided they wanted more of a piece of the pie. They slowly lowered reimbursement levels and took more for themselves. Just like the parable of the frog in boiling water which was heated up gradually, the doctors (soon to be renamed “providers”) were still doing fairly well, so didn’t protest all that much.</p>
<p>Fast forward to the current situation: Doctors became so beholden to insurance companies for their income that a physician with four years of medical training, three years of residency and ? yrs of a fellowship or specialty training now have to answer to an MBA or sometimes even an insurance clerk before they can exercise their medical judgment. And their income has now plummeted since the “middle man” is now getting a huge piece of it.</p>
<p>Although I feel “they have made their own bed” as a profession, I do feel sorry for MDs and sad about the current situation. The “best and the brightest” of the new generation are aspiring to be “middle men” (just read the top students posting here if you need any proof) such as investment bankers and corporate lawyers. There, the hedge fund managers and senior law partners routinely make seven figures, whereas primary care docs seem to struggle to make more than $200K im many areas of the country. The net effect of paying less per procedure is that they have to see more patients to make the same income and quality undoubtedly suffers.</p>
<p>So what does that have to do with “concierge care”? That is the justifiable response of good doctors who have a nice following to be able to practice medicine the way they used to before managed care…and still make a decent living. And it is a way for patients who want to be looked at as more than a number and can afford it to get quality care and be treated respectfully. And if you are paying extra, you don’t want a new doc, you want one who already has established practice and reputation. I know I would.</p>
<p>I don’t believe that government will do any better at “managing” care than insurance companies, and will probably be worse and even less efficient. More and more doctors are already “opting out” of Medicare, rather than continue to accept lower and lower reimbursements. A two tiered system, public and private will undoubtedly be the result, with the less experienced and overworked MDs serving the masses and the best practitioners doing elective care and catering to the wealthy. And the real top young minds won’t be going into medicine at all.</p>
<p>I’m drained and discouraged after posting those thoughts. I’ll leave it the smarter people here to figure out a good solution. Although I can’t think of one, I am fairly certain it is not a government takeover.</p>