CASH ONLY, PLEASE

Physicians Practice ^ | July/August 2006 | Nancy J. Morgan MD

[Hostage]

Nearly five years ago, my husband and I left a university clinic practice to explore ways to spend more time with our patients. Denied the right to provide services to my patients because the patients' insurer did not deem it necessary, we felt we were losing personal control of the practice of medicine.

Much of my practice was women's care, and the idea of providing comprehensive women's care in 12-minute visits was absurd. Furthermore, to maintain an "efficient" patient flow, my schedule was typically filled weeks in advance with physicals and Pap smears, so that acute care was frequently shunted to one of my colleagues; any possibility of continutity of care was totally lost. Believe me, when a patient is acutely ill, frightened, or in pain, there is nothing "kind" about forcing her to see a total stranger for her care.

We moved to a completely new area and started a retainer-fee practice from scratch. Unlike many retainer practices which cover "extra" sevices while charging insurance and/or Medicare for the usual covered services, our fees cover the entire cost of the medical care.

We are not on contract with Medicare, Medicaid, or any insurance company, although many of our patients still retain traditional insurance coverage for secondary services, hospitalization, medication, etc. However, they pay us out of pocket for the personalized care we provide them.

Ironically, our monthly care fees are considerable lower than the "access fees" that insurance e-based retainer practices charge for the "extra" services.

The bottom line is that we are very affordable.

Two years ago, our state insurance commissioner decided that he did not approve of the concept of "concierge" medicine and announced that he would shut us down. We pointed out that, far from serving only the wealthy, we in fact provide care for many groups of people who could not otherwise afford care of any kind, or might otherwise abuse emergency rooms for outpatient care. Even our maximum monthly charge (which is for housebound adults who require in-home care) is only $100 a month, regardless of utilization.

So, yes -- retainer-based medical care can be kind. But perhaps you can see why we take exception to the term "concierge".

[Pine Mtn. Maverick]

Sounds like he had a glorious time and helped many people along the way. He loved his work and liked to have the kind of relationship with his patients that creates a very rewarding experience all the way around! His poor wife though....I bet some of his house calls lasted 3 hours! LOL!

[defenderSD]

I don't want to keep bugging you, but I cannot find the editorial section or any articles by this name at this website. How do you navigate to this editorial?

[rightinthemiddle]

Health care has become a vicious cycle involving everyone:

Patients who want everything for free and use health care too much, which in turn makes health care too expensive for those really needing it.

Physicians, saddled with high student loan debt, who think they should by millionaires before they are 28.

Health insurance companies determined to make huge profits.

Hospitals/Health Systems bloated with expensive and inefficient bureaucracies.

Medical schools charging students outrageous tuition.

Politicians promising benefits to the voters while under the influence of lobbyists at every turn.

Lawyers/patients pushing incredible and frivolous medical liability lawsuits.

Medical liability insurance companies determined to make profits.

Parts of the cycle have begun to crack; many medical liability companies are hurting. Physicians can't afford the liability insurance, so they won't see some patients. As usual, the problems start with lawyers, lazy consumers and bureaucracies. Those will be the last to give in to solve the problem.

Still, with all the mess, we have the best system in the world.

[Hostage]

You can't. I also tried to find so that I could cut and paste it but editorials aren't on the website. So I typed it in by hand.

I have the editorial in front of me. It's on page 14 of the current July/August issue. If you like I could scan it and maybe display it but it would take time for me to remember how to do that on FR. Or otherwise I can email it to you.

So sorry otherwise.

[Extremely Extreme Extremist]

Dude...

[defenderSD]

We don't mind if you type it in by hand, that's fine. But this article as posted doesn't appear to be the complete editorial. Is that the entire editorial? She never explains why the insurance commissioner tried to shut down her practice, or what happened after that. You can take your time posting it, but I think you want to post the entire editorial (unless that is the whole thing.)

[Hostage]

we have the best system in the world

This is what the Soviets used to say, I kid you not.

And don't get me wrong, I am not a communist sympathizer. Far from it, I am a hardcore Reaganite for life.

But whether we have the best is debatable. Many will say that other societies are far more advanced in healthcare. One example that is touted is Iceland.

Or put it this way, if you are rich you will have access to the best. And it was the same under the Soviet system, if you were affiliated with a high ranking party member, you had the best.

[Pine Mtn. Maverick]

I agree that's not socialism and anything that cuts down on bureaucratic costs cannot be deemed socialist. The only thing is that procedures like by-pass surgery, which is being done now with regularity even on very elderly patients, ends up costing over 100,000-150,000 when you add in all costs. America is getting "Grey"....baby boomers are going to become retirees and health costs are going to sky-rocket. The government, if it does adopt a socialized health care system, will have to become "Rationed Healthcare". Life extending procedures for those over a certain age or health status could get clipped in favor of funding "curable conditions".

[Hostage]

No, it's the entire letter that she wrote or that was published. She may have written more but that is all that was published.

I just did a Google search of:

washington state concierge medicine

and it came up with alot of sites that discuss the politics behind her editorial letter.

Thanks for being concerned.

[djf]

I tend to think it's the governments involvement that screwed things up from the start.

If it is the governments responsibility to make sure everyone is taken care of, then the providers and the insurance companies can AND WILL charge whatever they damn well please, because they know the government can just print whatever dollars or checks it takes to get the job done.

This is not "free market economics" in any sense of the phrase.

[somemoreequalthanothers]

Or put it this way, if you are rich you will have access to the best.

I think that's going to be the case no matter what system is used. That's the way of the world. It applies to justice too.

[Pine Mtn. Maverick]

I agree with you. Fat government "Hogs" are hard to feed.
And what people don't realize is that during the "Clinton" era, many health procedures covered by medicare were cut, yet premiums increased.

[carmenbmw]

I seriously considered medical school some time ago but decided against it because I had seen, as a R.N., that it would be the insurance companies that would be deciding the care for the patients, not me.
Where I live there is one organization that CONTROLS the health care. You are either with them, or you you dont work.
Talk about bloated! We have a prime example of it here.

[djf]

And there is another factor to be considered:

Even though FR has tons of naysayers, even they have to admit that the bulk of the SS baby boomer money has yet to be printed.
We're talking about HUNDREDS OF BILLIONS, if not TRILLIONS of dollars that will hit the streets.

And when you have way, way more dollars chasing the same amount of goods and services, the result is ALWAYS the same.

Inflation.
On a massive scale.

[conservatism_IS_compassion]

the bulk of the SS baby boomer money has yet to be printed.

Oh, it's printed all right - but it's sitting in the "Social Security Trust Fund" in the form of huge government bonds which by law can't be let out to the public. It constitutes an IOU the government has written to itself - and it has the same effect as an IOU for a billion dollars would have if you wrote to yourself.

There is however a hole card - the tax liability of the baby boomers' IRAs and 401(k)s. A baby boomer who retires and draws Social Security will use a nontrivial fraction of that money to pay the income tax on his IRA distributions. So it isn't quite as bad as face value would have it - given a good stock market.

The idea which the Democrats boast of having defeated - "privatizing social security" by investing payroll tax money in stocks and bonds - would not cost the government any money. It would recognize costs that already exist and are kept off the books now, but that is not the same as actually costing the government money. To the extent that it improved the stock market it would actually help bail the government (read, our grandchildren as taxpayers) out of this ghastly problem.

[arjay]

I have had United Health Care for years and have only one or two disagreements with them about care.

They have paid tens of thousands of dollars for my chronic health problems and I have been very happy with them.

I thought someone should know that they are not always bad.

[djf]

It's not printed. If there is such a thing as the "Trust Fund", it's in the form of bonds and T-bills. It has yet to become physical greenbacks.

Let me get this straight. Even if I am somewhat charitable and conjecture that the government did not force folks to give their money to Social Security (at gunpoint), you are actually saying it's a good thing that they are now forced to pay taxes on their donations to get it back?

What a freakin racket...
not only will their money end up buying far less than a couple decades ago, they have to pay taxes on it!!!

[dawn53]

There was, up until a few years ago, a pediatrician, north of Atlanta, who practiced well into her 90's.

She saw patients on a first come, first served basis, and charged around $10 per visit...and she spent as much time as she needed with the patient (sometimes 45 minutes.) She didn't have to maintain an office, but practiced out of an outbuilding on her own property. She didn't use staff, so she really had no overhead.

I had many friends that used her as a doctor for their kids for years and years, and she was always "right on" in her diagnosis'. We saw her once when we were visiting our friends and my son became ill. She was (and if I'm not mistaken she's still living and well past her 100th birthday) a breath of fresh air!

[capitalist229]

Implosion due in 20 years when 85,000,000 baby boomers are on Medicare consuming a projected 78% of the federal budget.

Congress will be impotent, controlled by an unstoppable AARP.

BUMP

[conservatism_IS_compassion]

if you are rich you will have access to the best [ . . . and if you are not rich you will not have access to the best].

There is a minor factor that you are not considering in that formulation: What is "the best," when? The difference in the state of the art in medicine now and a century ago is the difference between life and death for a lot of seniors, myself included. I went to the hospital a hurting puppy a couple of years ago, and the Dr. diagnosed it and readily treated it.

He remarked that the procedure - with which I happened to be intimately familiar, but not as a patient 'til then - was invented 100 years ago. Before that, if you got that problem, you just died of it. Whether or not you were royalty, never mind merely being "rich." The temporal improvement in the SOtA in medicine - and much else - has been such that an American secretary today wouldn't be better off trading circumstances with Queen Victoria.

And of all the fraudulent claims of socialism, being "progressive" is one of the most egregious. Equality by diktat is easy, but unattractive. Bait the boobs with equality with the rich, but give them the only equality possible - making the rich equal to everyone else. But having done so, you have eliminated the incentive to rapidly improve the SOtA in medicine or anything else. And over any length of time at all, that translates into significantly poorer medicine for everyone.

And it was the same under the Soviet system, if you were affiliated with a high ranking party member, you had the best.

Sure - the best in the USSR. But since they would always be in the process of learning from the West rather than innovating, even with all special provisions for the nomenklatura they couldn't actually have care equal to the best in the West without going to the West.