<p>I don’t really see what’s bad about concierge medicine - it’s just free-market practice for services. We have that for all kinds of services. If there is no demand, then these practices go away.</p>
<p>It’s never been ILLEGAL anyway, but it makes it more apparent to folks that there is a clearly a difference between those who have means and others. It also puts a heavier burden on the docs who DON’T do concierge medicine & don’t cherry-pick only the healthiest patients.</p>
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<p>Well, this is a college forum and having money or other resources is almost always an advantage. It’s like that in many areas of life.</p>
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<p>Also pretty natural. People want the best attributes that they can get in their spouses too. We don’t force people to marry people that they don’t like - for whatever reason. Cherry-picking is nature - natural selection.</p>
<p>Many things are “natural” but that doesn’t make them necessarily “right” or “ideal.” It is harder and harder for docs to practice medicine the way most of them want to & why most of them entered medicine to do between the demands of the insurers & system and the constraints that these systems impose on everyone to see more folks in shorter & shorter periods of time with more & more paperwork to get them the Rx and other treatment that is appropriate. Many, many of the medical professionals I know actively discourage their kids & loved ones from going into the field because of all of these forces that make the field so discouraging. This may be one more of those forces.</p>
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<p>That’s imposing a value judgement on nature.</p>
<p>Tornadoes are not right or ideal but they happen and we really can’t
do much about them. So are floods, hurricanes, ice storms, etc.</p>
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<p>The overall pie is shrinking from foreign competition in markets that
formerly provided good jobs in the US.</p>
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<p>You can say that about manufacturing, law, and a bunch of other fields
too. Pretty soon we’ll have nothing left.</p>
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<p>If some doctors can make a nice living doing what they love, why not
just let them?</p>
<p>We don’t need to let them, since that’s what they’re doing. We don’t have to find concierge practices admirable, though. My dh is not a Pollyanna type by any means, but he feels that medicine is a calling and that, since illness is an equal opportunity malady, it’s unethical to cater to the wealthiest, healthiest patients for the physician’s own financial gain and comfort level, without consideration of the medical needs of the neediest patients. Sure, docs can do it, and many do.</p>
<p>Maybe these guys will donate a few weeks a year to local free clinics or similar programs, or retain a number of poorer patients who can’t afford to go to the concierge level. It’s devastating for frail seniors to have to change physicians after many years.</p>
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<p>It’s a business with a profit model that provides needed services and
provide employment for others. That’s certainly admirable to me at
current levels of unemployment.</p>
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<p>That’s a fairly vague term that has a wide variety of interpretations.</p>
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<p>Same thing with food. But we have a relatively free market there.</p>
<p>Is being a farmer a calling? A grocery store clerk? A butcher or
baker? A high-end restaurant at the Waldorf in NY?</p>
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<p>Money is fungible and if you make the rewards sufficient, you’ll draw
in labor supplies. If you treat your labor like crap, your supply will
dwindle. Companies do figure out how to serve different types of
customers with different abilities to pay.</p>
<p>Apple certainly operates in the mode of going after customers that can
pay premium prices for premium products and they are a well-admired
company.</p>
<p>^ Do you see no moral difference between computers and health care?</p>
<p>As a practical matter, our sickest, most neglected patients will cost us as a society the most. It is said that the sickest 5-10% of the patients are responsible for the large bulk of healthcare costs & I believe it. They are hospitalized more frequently & stay in the hospital & other high cost settings for longer. Lung transplants can cost up to $1 million and then more for follow up care & all the many drugs they need to stay alive! Preemies and others who are medically fragile are a huge expense to our healthcare system, gobbling resources, as does a lot of end of life care that may not even prolong life or its quality.</p>
<p>Perhaps there are some docs who would not practice medicine at all if they are not allowed to have a concierge practice. Should we as a society be subsidizing the medical educations of those who are going to “cherry pick” only the healthiest patients? Our state heavily subsidizes our state medical school, as do many other state medical schools. I don’t want my tax dollars providing such a subsidy.</p>
<p>Apple does not yet provide lifesaving & life sustaining services, at least in our household.</p>
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<p>Do you understand fungible?</p>
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Certainly, any of these professions might be a calling (except the restaurant, of course - maybe a restaurateur?). No one’s going to die without the services of a butcher or a grocery clerk, of course, or without the latest premium Apple product, either.</p>
<p>By saying that “we” don’t “have to” find concierge medical practices admirable, I didn’t mean to imply that you and others can’t find them not only admirable, but splendid.</p>
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<p>This is a societal issue. Do we saddle doctors with the problems of
society?</p>
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<p>Individual citizens disagree with various areas of funding. We elect
legislators and others to make decisions for us. That you don’t want
your tax dollars going in one direction is merely one voice of many.</p>
<p>Our state schools subsidize all kinds of majors. Graduates will
hopefully find work or start their own businesses thereby paying taxes
to the state.</p>
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<p>Take a look at Steve Jobs’ presentation on the iPad 2. They have some
remarkable applications in hospitals. I’ve heard that Macs are pretty
commonly used in biomedical research.</p>
<p>Apple also makes a ton of money and creates lots of jobs and pays lots
of money in taxes - money that can be used to pay for social medical
services.</p>
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<p>It must be nice to be able to assume lasting prosperity for the
foreseeable centuries.</p>
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<p>I’d guess that tax collectors would be happy with concierge medical
practices.</p>
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I’ll admit that I’m not quite connecting with you on this thread, BC. Did I do that? Since you’re quoting my post, I presume you think I did. But I didn’t, and I don’t know where this comment came from.</p>
<p>Most in the US take food prosperity for granted. You seem to fall into that category.</p>
<p>… because I said that no one would die without the services of a butcher or grocery clerk? That’s a rather sweeping conclusion, to decide what I think about food prosperity based on a short phrase. There are other means of obtaining food than from a butcher or at a grocery store that employs clerks. There’s only one profession that’s going to provide a cardiac catheterization.</p>
<p>While much as BCE’s arguments may sound unfair, I have to say I’m firmly in his camp. More often than not evening out the playing field is usually accomplished by pulling everyone down. </p>
<p>If a doc A sees patients who are not too sick, while doc B sees the sick ones, it’s quite possible A cannot bill that much for his services as B can. “Sickest” and “most neglected” aren’t necessarily the same set - with the right insurance, the doc who “cherry picks” the sickest patient can make a lot more revenue because of over-treatment.</p>
<p>The average doctor undergoes a tremendous number of years in education, much of which is full-pay education, for which they take out massive loans. It is disingenious to ask doctors who can’t make a living until 30, who are in 300,000 dollars of debt before they write their first bill to medicare, to continue to practice for less money.</p>
<p>So, insurance premiums have gone up, for the docs. Cost of an education has gone up for the docs. Reimbursement from insurance companies has gone DOWN, to the docs, and the government does not want to pay them and wants to make them the “bad guy” in all of this? </p>
<p>I don’t think the doctors are the problem, at this point. Should they work for free? Do you WANT a doctor who is willing to work for free? Do you believe we will get the best and brightest as doctors if they are asked to live on what we say they can charge and force them to take on patients they have no interest in treating?</p>
<p>I don’t.</p>
<p>The docs in the concierge practice we use are really great. They do a lot of pro-bono work. They also work with alternative medical professionals like accupuncture and such for pain management. They opted out of the pharma-insurance industrial complex, but it doesn’t mean they don’t practice ethical medicine and don’t work at county to do their fair share.</p>
<p>The problem is the either/or thinking. Either you practice concierge medicine and you are an evil cherry picker, or you take what you are given by medicare and you are a benevolent doc with a calling. In general, things tend to be much more complex.</p>
<p>For the record: I’m with LASMA on the Public Option issue. We need a public option. I would also say we need MUCH less expensive medical schooling, and we need more doctors, above all. My Gyne thinks the best system would be one where the docs get a heavily subsidized education and then work a mandatory number of years/hours in the public system and then are allowed to create their own practice. I think this might be a good solution, personally.</p>
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<p>There used to be a lot of secretaries.</p>
<p>There used to be a lot of people that maintained ledgers.</p>
<p>There used to be a lot of switchboard operators.</p>
<p>If you want more people or more professions or even robots or
nanobots to do more work, then train, hire or invent them.</p>
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<p>Economics and nature are incredibly unfair.</p>
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<p>I take your point, BCEagle. But here’s the thing: the AMA has not permitted the formation or credentialling of a new medical school for years and years. They have limited competition by restricting the number of graduates from the finite and small number of med schools. There are some docs who end up in Grenada or other off-shore locations, but we just don’t have the spots.</p>
<p>Regarding the health care systems of other countries, specifically Canada, I can’t speak to personal experience. But I can say that time and time again the literature refers to the nightmares of Canadian healthcare as being stories from the distant past. They had a hard time birthing the system, but it’s vastly improved. Current medical writing says that the wait times for surgeries at all levels from acute to tertiary are less than wait times in the US. Most of the horror stories people hear are from the decade after it began, and the US insurance industry just keeps recycling them. Again, I don’t know that from personal experience, only from reading industry articles from all sides of the heatlhcare spectrum.</p>