Ricochet is the best place on the internet to discuss the issues of the day, either through commenting on posts or writing your own for our active and dynamic community in a fully moderated environment. In addition, the Ricochet Audio Network offers over 50 original podcasts with new episodes released every day.
Will Concierge Medicine Remain Legal?
GrannyDude had an outstanding comment on another thread which read:
I should think that when the government is in charge of healthcare, there are strong incentives to discourage any “extra” medical attention, because it will raise expectations in the client class. The National Health in Britain didn’t want to pony up for little Alfie because then all sorts of parents might expect their very-sick-child to receive potentially lifesaving care. Alfie couldn’t go outside the system (e.g. to the US) because then British parents might reasonably ask “if American babies can get that treatment, why can’t British babies?
Granny brings up a question that has crossed my mind, from time to time. As you might imagine.
There are several countries around the world with significant governmental control of medicine which do allow people to pay for better care if they want to. Those systems inevitably result in a two-tier medical system – a private system for those with some means, and a public system for those who don’t have such means. And if you get sick, you don’t want to be in the public system, as you might imagine. Canada takes a different approach. Concierge and other models, which provide better care for more money, are illegal. To get better care, you have to leave Canada. (Ever wonder why Mayo is in Rochester, Minnesota?) This is not as restrictive as it seems, because around 90 percent of the Canadian population lives within 100 miles of the US border. But the underlying point is important: The system is fair only if everyone is forced to comply with it. But you can understand my curiosity – this is what I do for a living.
I practice concierge medicine in Hilton Head. I’m good at what I do, and I earn a very good living by providing a service which is not readily available through conventional means. Which bring up Granny’s question which is of such intense interest to me:
As our government gains more and more control of healthcare, will it remain legal to seek better care outside the system?
With the remarkable failures of socialized medicine around the world, nearly the only feature that can garner support is that it is fair. So allowing people to work around it, is certain to erode much-needed support. So our legislators must vote to make concierge care illegal. It must be fair.
But then again, it’s not that simple. There are a few problems here, but this one is not insignificant:
All of our legislators are members of concierge medical practices. Along with the generous donors who don’t mind dumping a million dollars into a political campaign via systems of varying legality. Do you really think that when those people get sick, they sit in plastic chairs in a Medicaid clinic somewhere?
Of course not – these are important people. So our legislators must vote to make concierge care legal. Socialized medicine is for those people over there. It makes sense only if I can continue to get good care when I get sick. After all, I’m a very important person. A two-tier system makes sense.
It’s easy to criticize our legislators. But which would you choose? Elections are complicated. Tough call.
I’m not interested in ethics here – this is about my ability to earn a living. So what do you think is likely to happen?
What do you think? As our government gains more and more control over medicine, will higher-level care become illegal? Or just part of the system?
I value your opinion. And I don’t want to move to Costa Rica.
Thanks in advance for your advice. I really don’t know how to plan for all this….
Will my job become illegal in two years? Or will our progressive leaders build a new system which openly allows for important people like themselves to seek better care than is available to, well, to those people over there?
My wife likes our nice house. She looks forward to your reply. Is my job sustainable? What do you think?
I thank you in advance for your input.
Published in General
In really broad, general terms, this is what’s going on:
I’m sure he doesn’t remember me, but I do send my regards…as do many here at Ricochet, I am sure.
This has always been true. It is why Frank Lahey set up the Lahey Clinic in 1923. It’s why my husband and I go there if there is something seriously wrong.
I agree this is a huge problem that I have seen way too many times. I don’t understand it at all.
The Mayo Clinic is trying to use teleconferencing technology to address this problem. I believe the Cleveland Clinic is also trying to fix this problem. Everyone in medicine should be working on it.
Things aren’t handled that way for most people in Thailand of India.
And they probably are handled that way for the people in the US who can pay the equivalent mark up in country without having to buy at a discount from the Developing World.
It isn’t about the ability of people in different countries to organise things and deliver a product, that’s well documented, it’s about how much people are willing and able to pay to get that product.
In most instances two thousand dollars will buy you much better and more convenient healthcare in India than it would in the US. Just like it would buy you a better equivalent of any low to medium tech goods and services that can be and are produced in India for a lower cost.
Perhaps a better comparison would be the quality and convenience of the healthcare ordinary people can access, and at what cost, in equivalent developed countries like The Netherlands or Germany?
(Though I’m all for medical tourism to India!! My college flatmate sent her father to Bangalore from Zimbabwe for heart surgery last year – a decision based on cost and reported quality which really brought home the global competition to provide certain no longer cutting edge procedures.)
Just as a postscript to my previous comment 63: We don’t really want doctors to rely on written medical histories from other doctors. Those histories are often filled with errors and wrong turns.
And doing so goes against good medical practice. My husband’s friend is now a radiologist, but he started out in internal medicine. When he was doing his first internship, he told us that doctors are trained to “use their own hands,” not to rely on others’ diagnoses. It’s part of their training.
I don’t know how many times I have seen really good doctors go against everything everyone else has said about a patient and arrived at a good diagnosis and treatment really fast. Some doctors frankly don’t care enough to get it right. That’s why we need to protect the concierge doctors. They do care enough to get it right.
I know these things to be true: At the same time, I was told by a couple of MDs (both Brits, trained and experienced in the UK) I had occasion to meet in Singapore that they relocated – one to Thailand and another to Singapore – because they could do better financially there. They could have both been lying, I suppose.
One of our two local hospitals uses teleconferencing. The process is in its infancy and so far there are excellent results. Its main feature is to connect the local hospital doctors with a qualified neurologist trained in stroke analysis of a patient who is in the throes of a possible stroke.
But my fear is that since this is a process that has come about to save money so that, for example, most hospitals inside the Sutter franchise of hospital care can save the expense of having more neurologists at more hospitals, eventually they may not even want to really have decent doctors doing the teleconferencing. To me, it is not at all fr fetched that right now, some Sutter Exec is instructing some computer genius to have a robotics “doctor” to take over where the current neurology specialist is sitting.
In some other state, I might not have that fear. But here in Calif, where in the 1990’s they laid off LVN’s and replaced them with nursing aides who did not even speak English, it is a total possibilty.
Like Ayn Rand used to say about any argument: Check your premises. Especially unstated ones that may never reach consciousness. The unstated premise in any argument about “socialized” medicine is the assumption that there will be medical professionals who will be willing to work under such a system of government control. What if such a system were implemented, and no doctors or nurses were interested in being a government wage-slave? What if people decided in high school that the profession of medicine was not worth spending many years and dollars training for, only to earn a government salary and be subjected to long hours, much liability, and no responsibility? What would happen to medical care if the supply of medical professionals shrank dramatically? Long lines in the offices of doctors who were left, years of wait time for routine procedures, not to mention things like heart transplants , might result. Why would any doctor in private practice agree to accept very low government reimbursement rates for all of his or her patients? If there are many fewer doctors, maybe even those congress critters who made sure the rules did not apply to them, would find it hard to find medical attention.
Under socialism there are always as many doctors as the State wants to create. Look at Cuba, which has even turned doctors, who work for slave wages, into a major export, to assist other socialist dictators. There are enough who stay in Cuba to give good medical care to the Party elite, in clinics protected from the masses by armed guards. There are enough to give lousy care to the masses, which is all the Party chooses to give them.
Doctors are a component of the means of production, like bus drivers, iron mines, and farms. Socialism is the ownership of the means of production by the State. Doctors are produced by the State and used by the State to satisfy its needs.
In every society, people who have property rights pursue their self-interest, as Adam Smith said. As Mises expressed it, acting humans act purposefully to pursue their goals. In socialism, all property is owned by the State. By law, the only acting humans–biological humans who are free to act–are the members of the ruling elite.
It would be interesting to see their patient profile. Ordinary people? Very rich people? Medical tourists?
“It costs $2,000 per year to be a member of my practice.“
The cheapest I’ve heard about in our area (Denver metro) for membership in a concierge practice is $6000 a year, and that was a few years ago. And then there’s two of us. And you also have to have other insurance to cover lab services, xrays, other testing, and possible hospitalization, etc. Its not as easy a decision as it seems. Of course if “Medicaid for All” comes to pass, it might be more attractive. If they’re still allowed.
My doctor’s published fee is $1200 per person, I believe. We pay $1800 for our family of two. Prices seem to be all over the place. If it stays around, concierge medicine, like lasik eye surgery, will become more competitive.
The world would be such a better place if we were all on concierge medicine + straight indemnity catastrophic insurance + a tax free savings vehicle or two. Then you could be honest and transparent about what you need to socialize. Wipe out all of the cartels.
Good question, I don’t know the answer. The latter I met because an expatriate (Dutch) friend living in Bangkok had heart problems and eventually valve replacement there.
The other Singapore, I was working there and the hotel where I had been staying for some months recommended him. Visited him several times over the course of I suppose two years. I could look around the waiting room and I remember seeing Chinese and Malaysians and Europeans but this was Singapore – they were none of them grubby as I remember but who knows, may have been wearing their Sunday best. But from the local papers, the news and discussions with locals I knew, I got the impression that medical in Singapore was just generally good. I doubt, however, that either Bangkok or Singapore are typical of say Malaysia or broader Thailand, Viet Nam…