Comments on: Business model woes traps doctors and impedes health care

By: David Allen

David Allen — Thu, 25 Mar 2010 11:46:55 +0000

H-
You don’t know that the medical advice you get from me is in your best interests, except that, on the whole, giving good advice is what makes or breaks the reputation of physicians. Physicians usually only make money from tests that are performed in their own offices. So you might be leery of physicians who seem to utilize testing in their own offices to a degree beyond the norm.

You also write: “Clearly, one who feels we should all pursue our selfish goals would have no problem recommending unnecessary treatment”

That would be a non sequitur. I believe in rational selfishness. I do not believe that dishonestly is in my long term best interests. People who are rationally selfish (which is actually the majority of Americans, although they don’t realize it) believe that character and long-term goals are important. You might wish to look more into Ayn Rand’s novels and ideas to see that there are some very logical, insightful, and practical ideas regarding what it means to be moral.

By: H

Tue, 23 Mar 2010 23:30:17 +0000

” Let’s suppose you have a 10,000 deductible for that catastrophic insurance. Then that would come out of your pocket, and anything beyond would be covered by the insurance company.”

So I make $21,000 a year and I have a $10,000 deductible. Five of the last seven years I easily surpassed $10,000 in medical fees. So during those 5 years, I am supposed to live off $11,000? Since I pay 20% of the cost of my medical care, I am very aware of how much things costs and whether they are necessary.

“Perhaps that is what you are focusing on – what will happen to you tomorrow or this year. ”

Thinking back to the situation I was in, where one of my chronic conditions took 3 years to diagnose, when the 20% was hard to deal with financially…

Of course, having a $10,000 deductible and being hospitalized for a week around New Years makes that a $20,000 episode.

Anyway, since it is in your best interest to perform a lot of procedures and you clearly are motivated by profit, how do I know the medical advice get from you is in my best interest. Clearly, one who feels we should all pursue our selfish goals would have no problem recommending unnecessary treatment. Maybe that $150 mammogram is unnecessary but my guess is if you made a profit from it, you would have no qualms using fear to get me to agree.

By: H

Tue, 23 Mar 2010 21:40:31 +0000

“Wouldn’t life be grand and the world a better place if you and I had the freedom of choice to do that in all scenarios and not just with concierge doctors!”

I have the choice of a large corporate medical center clinic, a small corporate medical clinic, a group of three independently practicing physicians taking insurance, two solo physicians taking insurance, a cash only fee for service physician, physician that has a membership fee, a nurse practitioner, and various alternate health providers ie naturpathic physicians, chiropractors, chinese medicine. We have plenty of people who can’t afford care. Wouldn’t it be great if those cash only doctors really reduced their prices instead of charging more than insurance companies.

By: IVF-MD

IVF-MD — Tue, 23 Mar 2010 20:22:21 +0000

Fair enough. Would it also be fair to suggest that with the booming economy resulting from tax relief to the economy that a lot of people who rely on being government-dependent would be able to be happily self-sufficient AND that a lot more voluntary charity would be given? (Especially when you strip away the horribly inefficient burdensome layer of bureaucracy that no doubt exists)

By: IVF-MD

IVF-MD — Tue, 23 Mar 2010 20:17:05 +0000

In some cases, so would I! Wouldn’t life be grand and the world a better place if you and I had the freedom of choice to do that in all scenarios and not just with concierge doctors!

By: David Allen, MD

David Allen, MD — Tue, 23 Mar 2010 19:20:06 +0000

H,
I think five chronic conditions (assuming you had the insurance before you got most of them) would qualify. Catastrophe might better be viewed as a number than an admission to the hospital. Let’s suppose you have a 10,000 deductible for that catastrophic insurance. Then that would come out of your pocket, and anything beyond would be covered by the insurance company.

I do think that if everyone were out there, shopping around, using their own money – that the cost of medical care would come down substantially. In addition, doctors would have to tell you that, in most cases, Plavix isn’t really all that much better than aspirin (unless you have cardiac stents placed) or that having a second MRI this year to make sure the MS hasn’t progressed may not be worth the $800 that will be charged for it. As it is, with the malpractice climate – and the lack of attention to cost on the part of the doctor and patient – people spend money very easily and do their part to increase the price of things.

I’m not saying any of this would occur overnight. Perhaps that is what you are focusing on – what will happen to you tomorrow or this year. I’m speaking about changes which, if slowly implemented, would gradually transform a marketplace for the better.

By: H

Tue, 23 Mar 2010 03:53:03 +0000

“The burden is on the concierge doctor to wow you so much with the amazing service and to get his prices down to a very competitive level so that the patient voluntarily pays a little extra for that 5 star service.”

I would rather continue to see my nurse practitioner and take that little extra cash and donate it to our local food bank.

By: H

Mon, 22 Mar 2010 23:47:30 +0000

“Would it also be fair that you give parents a choice as to whether they want to support your school system, a different school or to not participate at all?”

I am not involved in K-12. I work with nursing students who have a choice be there or not. It’s a public institution and tuition is subsidized by the state and federal government. Without public funding, many of our students would be unable to continue their education.

By: IVF-MD

IVF-MD — Mon, 22 Mar 2010 21:46:40 +0000

Mr. or Mrs. H, you are certainly entitled to your choice of choosing a physician who takes cash only, one who accepts insurance, or one who would accept a bushel of tomatoes for payment. You get to judge which of them is offering better care for a better price. The burden is on the concierge doctor to wow you so much with the amazing service and to get his prices down to a very competitive level so that the patient voluntarily pays a little extra for that 5 star service. Alternatively, some doctors can choose to have a clock-in-clock-out Collect-my-government-check-vacation-and-pension package mentality and cut a deal to be part of some public option and be guaranteed a steady stream of patients without having to be so much of a customer-service fanatic. To each his own.

Would it also be fair that you give parents a choice as to whether they want to support your school system, a different school or to not participate at all?

There’s nothing wrong with having public options as long as they are true OPTIONS and not coercive. One criticism of the public education system is that it gives people no choice to go with another system that might give them what they want (ie higher literacy rates, better vocational training, more convenient hours for parents, a curriculum more in sync with the beliefs of the family, nicer drinking fountains, whatever it is that the students and parents value) as opposed to being FORCED to pay into this one-size-fits-all system.

Social goals can best be achieved by voluntary cooperation rather than by force and coercion. I respect your right to choose to go into government-run education as you have. Can you perhaps respect our rights to choose the education that we want for our kids?

I would pledge to render the best medical care I can for you, but if you don’t like it, you have the choice to go with other private or public options.

By: David Allen, MD

David Allen, MD — Mon, 22 Mar 2010 21:32:01 +0000

H,
I don’t know what other physicians have in mind, but real reform would involve disentanglement from the entire third party payer system for non-catastrophic care. It is because so many people have insurance and Medicare that they use for routine care that you get priced out of the market. I don’t want you to be priced out of the market. I wish you were allowed (by states, for the most part) to buy catastrophic care only and save all that money you give to the insurance company so you can instead shop around and pay for what you want. That is part of the idea behind Health Savings Accounts – although they don’t really allow for catastrophic only plans (which would may them much cheaper).

If you are interested, I can direct you to multiple physicians who have up-front, low-cost pricing. There is even an insurance-free ER which posts its (rather cheap) prices right on their wall!

Regarding my supposedly hypocritical stanze, I’ll go you one better. If I were 65 years or older, I would probably sign up for Medicare! The government has effectively destroyed the private market in this segment of the population. Since I paid into the system (much more than the average person of my age, by the way) I certainly would not forgo the benefits! There actually wouldn’t be many options for me – and they are getting worse as the days go by.

I declare my right to make a profit, to keep what I’ve earned, to be proud of my labor. There can be good people in bad systems – so I don’t begrudge you your salary nor do I feel badly that my talents can provide me with a reasonable living.