In the face of undeniable proof that the concierge medical practice model, particularly when combined with the use of Health Saving Accounts, is an innovative market force that is addressing finance problems for a substantial portion of the health care market, this New York Times grudgingly acknowledges that concierge medicine may be a viable way to control health care costs at least for a substantial portion of health care consumers.
But on the other hand, the Times doesn’t want you to forget that HSA’s don’t work for everybody:
Critics have been less enthusiastic about H.S.A.’s, worrying that high-deductible plans work only for young, relatively healthy people who do not spend a lot on health care anyway. When sick people are faced with paying high out-of-pocket costs for medical bills, they simply go without the care they need, experts note.
As Arnold Kling has observed, why does the Times think that that we cannot possibly afford health care if we have to pay for it individually, but we can afford it if we pay for it collectively?
tom,
i believe concierge is ethical, as is a two-tiered system-no problem.
however, i fail to see the cost savings. concierge could be fine for those who do not find the incremental increase in cost to be an issue.
a far more viable approach is that of my practice-not on insurance, charge and collect good fee for services rendered, agree to cap costs at 750 dollars per year and offer all but the juvenile aspects of “concierge”.
yes, same day appointments, unhurried visits, phones answered, great staff who know their patients and their business, my personal attendance in the hospital and talking with other physicians–solid, personal care.
no to going with patients to specialists–they are grown-ups. too few patients can allow skills to atrophy and too much of a physician being financially beholden could lead some physicians to lose sight of their duty to say, “no” when that is the right answer. (ask michael jackson or elvis how their concierge experience is going?)
similarly, paying a larger fee can lead some patients to an unhealthy, excess focus on their health that will almost certainly be indulged–that healthy doctor-patient relationship that has the doctor balancing things well WILL be eroded in such cases–the patient has paid for that “extra” attention.
in upcoming years, look for more internists to do as i described, higher-than-insurance fees for better medical care and service, FAR cheaper and, persuasively, more appropriate than concierge.
The concierge approach combined with HSAs is providing an interesting experiment for a very small part of the health care market, at least in the real world.
Let’s not get too excited about a very limited approach serving a very limited market segment.
Agreed that the model addresses a limited market segment. But the more important point is that it’s a market innovation that has successfully addressed problems and, at least to date, effectively resolved them. The increasing use of the model hopefully will generate other models to deal with other portions of this very big and diverse market.