<p>^^ Canada’s outcomes are better, too.</p>
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<p>Many monopolies or multiopolies have fallen in the last two decades due to technology and cheap, foreign labor. Perhaps that trend will continue with medicine.</p>
<p>There are many people that ask me about injuries at the office as I have a reputation for knowing what to do with many injuries. With information technology the way it is, perhaps we could greatly reduce costs with education of the general populace so that they can handle far more problems - those which people go to emergency rooms and doctors for currently.</p>
<p>Take a look at the diet and exercise thread and see the people over there taking control of their health using information technology.</p>
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<p>Ya know, I’ve been married to a doctor for more than 30 years and I’m all in favor of MDs being fairly paid. No one needs to educate me on the squeeze MDs find themselves in today, because I am more familiar with it than I ever wanted to be. No one works for free, and I certainly never suggested it. :rolleyes: And on re-reading my posts, I don’t see an inability to recognize the complexities of this debate. I haven’t said that concierge docs shouldn’t be allowed to apply the principles of unrestricted self-interest to medicine. I’ve quoted my husband as thinking it’s unethical, as do I. And I’ve said I don’t admire it. I don’t.</p>
<p>I do think it is unethical for a doctor to have “no interest in treating” people who can’t afford to pay a $1,500 bonus, which the first concierge doc in our area is charging (I’m sure more affluent areas would justify charging far more), or who aren’t in a financial position to pay in full up front and be reimbursed by their insurance plan later. I do think it’s unethical when doctors have “no interest in treating” the sickest patients because of what those outcomes might do to their bottom line or call schedule. Sure, it’s legal, and it’s capitalism, and they should be allowed to pursue their careers in any way that they find most personally fulfilling. This is America, after all. Just don’t ask me to applaud. And then there’s that nagging question - what about the poorest and/or sickest patients?</p>
<p>FWIW, I never said that concierge docs are “evil” cherry pickers, nor that MDs who consider their profession to be a calling are “benevolent.” Many of them are crabby - spending every 4th night on call when you’re approaching age 60 will do that to you, as will arguing with insurance plan administrators.</p>
<p>If my husband and his colleagues, who trained 6 years after medical school for their field, decided to put their financial well-being ahead of the physical well-being of the kids in this community, there would be a lot of grieving families. I’ll grant that there’s a place for concierge docs - I think those of us who can’t, or won’t, obtain our health care that way can see the place for docs with a calling, as well.</p>
<p>I’m not lecturing you, simply seeing the other side of the issue. The main thing the docs I know want to get away from are the insurance companies. For this group, this was one way. As I said, they do plenty of pro-bono work. I don’t applaud either group. I think the system is broken, starting with the fact that the medical schools aren’t educating enough doctors in this country, all the way to managed care and the lack of tort reform.</p>
<p>Good luck to you and your husband.</p>
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A lot of the basic treatement is now being handled by NPs and PAs, even in the ERs and specialty offices for that matter, so it’s not strictly true that the supply/demand situation is being completely manipulated by AMA.</p>
<p>The number of years of education and all of that isn’t what is going to be what gives the doctors clout to charge what a given amount. It is demand. Concierge medicine occurs when there is a market where there are enough people out there will and able to pay for the services of doctors. Right now, the way I see it in my comfortable world where most people are insured, is that insurance dictates a lot of medical care. Want to see a doctor that’s covered by your plan? You gotta wait. If the plan won’t cover certain things or has stipulations most people do what is told rather than pay to do it the way it is recommended. I’ve had people tell me straight to my face how they won’t/can’t get something that is clearly better for a family member because the insurance won’t pay. As someone who pays a premium to get what is the best for the family, I don’t get it. </p>
<p>I would pay for concierge doctors and services when they clearly give a medical/health benefit and if I can afford them. I also will tend to put health services high on my priority and will cut in other areas to bet the best medical care, especially for what I see as serious issues.</p>
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<p>Excellent summary of the moral problems with this new service. </p>
<p>Regarding your last point about the poorest/sickest, I think there’s at least one poster on the thread who would respond that that’s how natural selection works. Wealthier people deserve life and health more than poor people do.</p>
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<p>Poor people can show up at the ER just like they do now. How would that change? Sorry, poor argument…</p>
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<p>You’re kidding, right? Even our former president realized that that argument is bogus (after he tried to make it – once). Good medical care means consistent, long-term, individualized care. An ER cannot provide this. And BTW, it’s not supposed to. Have you been to an ER lately? They overflow with people who don’t have life-threatening needs, but who do not have insurance and cannot afford a doctor. Withholding insurance means a huge strain on a system which we all must use, and it also means that *YOU pay for that ER visit *rather than an office visit. Even if the ethical/moral dilemma means nothing to you, it isn’t very smart financially, is it?</p>
<p>It simply cannot be argued that poor people have access to equivalent health services, even before the concierge service came along. It is well-established that wealth and health are strongly correlated. The question is, do we resist that trend and try to minimize it, or do we sanction it and allow it to maximize?</p>
<p><a href=“The Reporter Archives | NBER”>The Reporter Archives | NBER;
<p>As a healthcare professional, I recognize and realize that the ER is not the ideal place to receive medical care. My experience has been that many people go to the ER for things that the staff at the ER are unable to properly manage. Their job is not to provide the regular healthcare and frankly they are not very good at providing care for anything less than emergencies. </p>
<p>I have had poor experiences with the emergency rooms in three different states and of different sizes. For me to make the suggestion that an individual go to the ER, he or she is likely going to be transported by ambulance. </p>
<p>I also recognize that the insurance system in the United States is more than screwed up. Major changes need to be made, but I absolutely do not believe that the government should be put in charge of healthcare. They fail at the healthcare services they currently provide (Medicare, Medicaid, etc) and I definitely do not want them in charge of everything.</p>
<p>It is scary to be in the ER (I have been there on several separate occasions). While I was there, I rarely saw folks moving out of the waiting room unless they arrive by ambulance, are clutching their chest or obviously having EXTREME difficulty breathing. The room is overflowing with folks waiting to be seen, most of whom I believe don’t have insurance. This is one of the reasons my dad was told by his internist when he was having tightness in his chest & only a few blocks from the ER to get an ambulance or he wouldn’t be seen.</p>
<p>ERs are among the few places that have to take whomever comes in the door, even tho the can & often seem to take hours before they see those waiting. It is definitely a poor place for people to get on-going care, tho that appears to be what some of those in the waiting room are trying to get.</p>
<p>I am glad that to my knowledge there is no concierge medicine in our state, yet. Unfortunately, many of my docs are no longer accepting new patients except by referral (e.g. relatives of existing patients or as a favor to referring docs); they have reached the limit of the # of patients they can handle.</p>
<p>The #1 respiratory hospital I go to in Denver also does not offer concierge DOES service & participate with many/most insurers as well as treating some unable to pay. Those with state paid insurance because of low/no income can have their travel & lodging expenses paid if they need to go out of state for care at a place like the Denver respiratory hospital. They see many of the sickest patients in the world.</p>
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<p>I can confirm this by virtue of personal experience. I’ve lived most of my adult life on the northern side of the border, with a few years here and there of stints in the U.S., where we had topnotch golden health insurance coverage, so I have some basis for comparison. The care here is very good. I’ve never had a problem, ever, getting a same day appointment with my doctor. There are no controls on what doctor I can see. No co-pays. No deductibles. No arguments with an insurance company about what they will or will not pay (for either me or my doc). No previous condition concerns. No worry about being dropped or cancelled. No exorbitant premiums. No worrying about finding coverage for my children when they finish college. None of the long waits for tests that some like to claim. The one time I can think of that we utilized a service in the U.S. rather than wait was for an MRI that my H needed and he preferred the open MRI, which would have meant waiting a week. Because he had a business trip planned, he wanted it done sooner so drove to Buffalo and had it done next day. We’ve had the unfortunate occasion to have to utilize healthcare services for a serious illness for one of our Ds and that treatment was handled in a timely manner, too. There may be outlier cases, which are the ones that the U.S. press seems to latch onto, and I’m not saying that the system is perfect, it’s not, but it beats the one in the U.S. by almost any possible measure, when you look at the two systems in their totality.</p>
<p>both i and my H are physicians- we went into it as a calling almost 30 years ago. i have spent most of my time in public medicine and made a decent living with plenty of oncall work. H spent most of his in the private sector made increasingly less decent living with much more oncall work. both our D’s and their friends chose not to go into medicine. their friends who did went into the PhD/MD programs as primarily researchers. so, when we went into it, it was a calling- it is now a job and it feels that way. yes maybe my age is a factor but i doubt if it is that much. bottom line- the attitude of the public towards physicians has changed and the calling has gone away- this has happened in plenty of other fields like teaching and ministry. when i asked my D why she did not want medicine she told me that ‘people don’t like doctors and have no respect for them. it hurts me to hear what others say. they do not realize what doctors do’</p>
<p>I am hoping my docs will give me a heads up if and when they plan to retire and help me find a replacement. I am concerned as many of my docs are my age or older and I don’t expect them to work forever, tho some have said they plan to. Only one of my docs is younger than me, by about 10+ years and I expect that he will continue working. My Denver doc will likely continue to help me manage my health via email as long as he decides he wants to practice and hopefully pass me on to a colleague if he decides to stop practicing.</p>
<p>Yes, I wish our healthcare system was different from what it is but have no idea what to do about getting it reformed. I believe it IS broken but no one I have spoken with has any good ideas about how it should be fixed. So much money & structure is invested in how to deny claims.</p>
<p>I am glad that healthcare reform passed and believe it needs to help us move toward a better system than we currently have. Medical premiums are crushing expenses, especially for those with illnesses who have to purchase individual or small business policies. It is causing our businesses to be less competitive on the world stage. Part of the premiums are paying for the bloated bureaucracies that are set up to deny claims and make folks jump through all hoops to get appropriate treatment & care.</p>
<p>Alwaysamom, I am a proponent of a system similar to what Canada has, but as a mom who spent a lot of time at Memorial Sloan Kettering with a kid with cancer, I can tell you that there are a lot of Canadians here that have been given the boot in terms of care over the border. Certain things are just not avaliable there under the social medicine structure. I have a book full of names of families with kids from Canada who would get their treatment here because there is no available treatment there. So in terms of broad coverage for most maladies, the system there works. But there is that fear that certain orphan diseases and conditions will not get the attention that our system can give them.</p>
<p>I am particularly involved with kids with neuroblastoma which is the most common soft tumor cancer in young kids Relapsed neuroblastoma is an automatic death sentence in Canada. And about 2/3 of kids who are over 16 months when so diagnosed will relapse. This is just one small example of what happens under socialized medicine. </p>
<p>In ANY medical system, the most important thing is for someone to be able to navigate the possibilities when a medical situation occurs. I was appalled when a friend here was told to wait 6 weeks for a lump on the breast to be checked out. Aggressive phone calling and work got her an appointment immediately. I assume the same can occur in the social medicine setting too, but it seems to me that many there are complacent in accepting the long waits and lines that come with the system. </p>
<p>My MIL comes from an area that has no local hospital anymore and not enough doctors. Gotta go at least a good 45 minutes for a certified hospital and the choice of doctors is abysmal. No ob/gyns there. We had thought about retiring there as it is beautiful country, but the combination of old age and bad medical care does not work. Though only 100 miles from one of the best med schools/hospitals in the country, the area is substandard in every area of medical treatment. The reason? No money there. I would think socialized medicine would make a big difference in such areas as doctors could then make a living there since they could get paid. But the funny thing is that most of the folks there are dead set against it. They are as Republican as can be and are against Obamacare and any other government coverage even though they would be major beneficiaries of it.</p>
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<p>Neither do I, and in fact, that has not been proposed by anyone credible, no matter what the radio talkers say. But this is another great example of how Big Insurance has staved off reform all these years. They have managed to frame the debate as an argument about health care, when in fact the issue is health insurance. </p>
<p>Because medical care has the potential for being ruinously expensive, we need insurance. The question is who will provide the insurance. Big Insurance has a profit motive, universal insurance doesn’t. Big Insurance pays its CEOs obscene amounts of money; universal insurance doesn’t. Big Insurance must advertise to stay competitive, a cost that’s rolled into premiums; universal insurance doesn’t. Big Insurance can discriminate against pre-existing conditions, universal insurance can’t. Big Insurance raises premiums 15-30% every year, forcing me to step down my coverage to afford it; universal insurance doesn’t.</p>
<p>In HI, there are very few specialists on most of the outer islands and the specialists have to fly from Oahu to provide care (and/or patients have to fly to Oahu). There are long waits, even if you have insurance & get referrals unless you have a persistent advocate & are able to penetrate the system.</p>
<p>I just attended a meeting in Bethesda, where we heard about the Office of Rare Diseases at our National Institutes of Health. It was fascinating what they do and are exploring, but it IS expensive and time-consuming. It does have implications for other disease and broader health, but funding is threatened with the broad cuts being proposed everywhere.</p>
<p>One of the things we think about when we think where we will live and travel is the availability of quality medical care, as I have some health issues, as do our kids. These issues affect all those who live in the community.</p>
<p>We do outreach clinics but have no resources to provide needed follow up care and try to connect patients with resources that can provide it. It is a great challenge, on Oahu and especially on our outer islands.</p>
<p>Some of us have lived “good and healthy” lives but still are mysteriously diagnosed after a prolonged medical quest with problematic chronic conditions that will require us to have more medical care than we ever anticipated. I know many who have fallen into this situation. What should happen to these folks?</p>
<p>Should there be some blame index to decide who gets care & the cost of care? What happens to infants and children in need of intensive chronic healthcare? Yes, it’s great when folks do everything right and are able to enjoy great health. Some folks break every rule and still enjoy enviable health. What about those of us in the opposite category? Those whom no doc or healthcare provider can suggest any lifestyle change to improve upon what the patient and family are already doing for themselves but the patient still have severe lifetime chronic health issues? These conditions do exist and can be devastating, very expensive and require a lot of medical & other resources.</p>
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<p>As did I, cptofthehouse, as I alluded to in my previous post. Not neuroblastoma, but a 6 year battle nonetheless. She was actually first diagnosed just prior to a move to NYC so through those years, we experienced treatment and care on both sides of the border, first here, then there, then back here when we returned. Both were excellent. I can’t speak specifically to those who had difficulty getting treatment here for neuroblastoma but I can say that we have opened our home on many occasions to families in town for treatment when the Ronald McDonald house is full, so with that and in the course of years of treatment, we have met many, many families. We have a large home and it’s been one of the joys of maintaining this large place now that most of our Ds have homes of their own. I haven’t seen or heard of any families who had to travel to the U.S. because of limitations in treatment here for childhood cancer. Are these experimental trials that they’re participating in? I’m curious as to what it is that is not available here. I have met a neighbour of my sister and brother-in-law who are both physicians, who is the head of cancer research at the Hospital for Sick Children in Toronto, as well as a prof at U of T, and, if I’m not mistaken, one of his research studies has been on neuroblastoma. I’ll have to look him up and see. I seem to remember him talking about that several years ago.</p>
<p>I agree with you that people need to be advocates for their medical care. I think that more and more people are doing that these days. Hospitals have patient advocate departments now so I think there’s a greater awareness now than there was even 10-15 years ago.</p>
<p>I am glad that you have always gotten timely and excellent treatment for you and your family, Alwaysamom. That is not always the case for many people on both sides of the border. Our family has also been fortunate in this regard. I do believe that what makes the most difference is having someone who is knowledgeable and willing to do the research and work with the insurance. </p>
<p>I have heard a lot of complaints about the Canadian system and the wait for tests, treatments, surgeries there which can be a serious issue for those who are cancer patients. In all fairness, manage care American patients can run into the same problems. What I see as an issue is that we do have clinical trials and other treatments that are simply not available in Canada and a number of other countries. We get ever so many coming here from these countries tor this treatment, this chance for life. You get the flocking to Canada, mainly for less expensive treatment for the more routine things and meds that cost too much here in the US. Specialty care is a whole other story. </p>
<p>While at MSK, I was talking to a family that was amazed that my MIL got her double knee replacement done, 1,2, 3, as we scheduled it and she was 83 years old. Apparently they have a grandmother who has been on the waitlist for such a surgery for a year and a half now, and they say this is typical. They are here for treatment for their little one that is simply not available in Canada. It is not available in most parts of the US either, and we get many Americans here at the Ronald McDonald House. The doctors I talk to here at MSK, are able to offer many of these treatments which are regarded as experimental but have prolonged life for many years because of our system of medicine that still allows this sort research and treatment. It is rare that a New Yorker with a serious cancer situation will go to Canada for his/her treatment. The roster is filled with Canadians and others from all over the world that are here to get what is not available. That it is deemed experimental is the case for the neuroblastoma, but there are other drugs and protocols that are standard at MSK that are not approved in CAnada.</p>
<p>My elderly mother is living with us now and her treatment is more expensive for her COPD here than it is under Japan’s social medicine. Being here in NYC, she is fortunate to be able to see a Japanese medical group which makes the difference much easier for her. Though her meds are more expensive under US insurance plans including Medicare, the doctors tell us that she is far better off here if she has any complications, because the system in Japan is highly unlikely to be able to accommodate her as quickly. Some of what we consider regular care is considered exceptional and drastic over there. </p>
<p>Having heard every kind of sad story and failing of our system here from those who are the neediest in care as their lives hang in need for it, it would be a travesty to lose what we have in care, small though that group of folks are. My son had some very specialized tweaks in protocol for his treatment that would be highly unlikely to be approved in most countries including Canada. Though in his case, his prognosis would have been excellent in either country, the fact that he was treated with 48 hour infusions which necessitated hospital stays when getting anthracyclines has reduced his chances of heart problems which come hand in hand with those drugs. Many US hospitals will not permit this treatment, and go with a quick and less costly push instead, but here the option to get the long term infusion is at least a possibility. Again, getting the best of our system requires a lot of time, research and persistance. But in my research, I could not find a lot of the options available anywhere but in our country. I would have been across the border in an instant if that were the case. But we get many Canadians here who have done this research and cannot get what they want there.</p>
<p>I don’t know if concierge treatment is permitted in Canada. I truly don’t see a problem with it. If someone is willing and able to pay for certain amenties in healthcare, they certainly should be free to do so. It becomes a problem only if the services provided are drying up the regular market. The concierge services I have seen (and they are not termed as “Concierge” services) are certainly not essential services. What they do is provide amenities that are not covered in many managed care plans. I’m not even sure they do that. They tend to be doctors that can command more money than what the insurance is willing to pay and who can get paying patients so that these doctors do not have to deal with the bureaucracy of dealing with insurance. As someone who does not hesitate to go out of the preferred provider loop anytime I want more immediate or other services, I don’t see an issue with this. In a sense, Canadians who come to the US for treatment are getting "concierge "treatment</p>