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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
There is no way the government can outlaw concierge service. Even if it gets banned here, the rich will still be able to get on a plane and go off to Bangkok and be seen there.
Advantage to being seen outside of the stateside medical program is that overseas, when a person has an undiagnosed illness, the various specialists consult with each other. Here in the USA, with an undiagnosed illness, the various specialists do not bother with such brainstorming. Instead they briefly read the notes that the other doctors have scribbled out, send the patient on to yet another round of expensive tests and let the machinery do the diagnosing.
With what many of us are paying for all the tests, which often don’t lead to any real diagnosis anyway, we probably would be better off having to pay out of pocket for concierge service to begin with.
Hopefully, Canada’s will implode before we do the same:https://hotair.com/archives/2008/06/26/father-of-candian-healthcare-system-now-disowning-it/
I think it will be a case of “If you like your concierge medicine, you can keep your concierge medicine.”
But if you want to hedge your bet even while avoiding Costa Rica, I understand that Managua, Nicaragua is a beautiful town, You buy a hacienda for a few pesos down.
And isn’t there someone here on Ricochet that owns a plantation down that-a-way?
I believe Congress is covered by the ACA. It just fudged the rules a bit to keep a subsidy it had pre-ACA.
I haven’t read any of the comments, but I did have an immediate reaction, so I thought I would just jump in. A few years back I spoke of the fact that I pay my Doctor annually a concierge fee for me and my wife. My Doctor happens to be a life long friend who has given me “concierge like” care for years without me having to pay for it and would continue to do so now, even if I didn’t pay him. So now that concierge has become a thing, and he has taken that thing on as his continuation of practice even at a relatively late age, I pay him the fee–gladly.
But, here’s the thing…medicine, as practiced today, is highly specialized. My Doc is an internist. That’s a good thing for one’s primary care physician. But just because he is my concierge Doc, doesn’t mean that any other doctor like a cardiothoracic, or an oncologist, or an orthopedic, that my concierge doc recommends, would give me that same concierge service. I’m standing in line like everyone else. My guy might have some pull with the specialist, but it’s minimal. So @drbastiat, do I have that about right?
As for down the road, when government takes over health care, everyone will take it in the shorts, because the smartest and hardest working amongst us will no longer go into medicine. It just won’t offer the rewards that correspond to the rigors of obtaining the degree. And there will be less new treatments and medicines, because the government will restrict the amount that can be charged for newly discovered medicines. Let me just say, I hope it will be another 25 years before this happens.
Yep – concierge is for primary care. There are a few vertically integrated concierge health systems in major cities, but they are few.
Right now, in England, around 80% of physicians were born outside of England. Lots of Indians, of course, but also everywhere else.
If you’re a really smart, hard working English kid, why on earth would you go into medicine? But if it will get you out of India, ok, maybe you’ll do it.
Which is ok, I suppose, but medical care is a very personal thing, and cultural differences can be a serious downside at times. Man, I could tell some stories. Maybe in another post…
Would I be rude to ask publicly, what happened to @docjay?
Really?
It costs $2,000 per year to be a member of my practice. That’s cheaper than a pack a day of cigarettes. So if you see someone smoking a cigarette in front of Walmart, they could afford concierge care if they wanted to. They may choose to spend their money on other things, but my point is, it is affordable.
If this type of practice gets banned, then you’re right, the very wealthy will fly somewhere else, I guess. But first of all, that would be only the very, very wealthy. And second, when do you call the Netjet hotline? How can you tell how serious something is? It’s nice to have a doctor down the street, that you know personally.
So I’m not nitpicking, but I think our government certainly can outlaw concierge service. Canada did.
But it was easier for Canada. They can just send their sick people 100 miles south to the USA, which has the best health care in the world. Canadian health care would cost A LOT more if they had to take care of their own sick people.
We can’t do that. So I think that the wealthy supporters of the Democrat party would stop and think about banning concierge care here.
I’m not sure President Bernie would care. But there would be push back.
Actually every year for 35 years, my wife and I have spent a week or two in Mexico during our cold, cold winters. We see both Americans and Canadians taking advantage of what, they claim, is excellent and inexpensive health care in Mexico.
If you don’t like Chevys, you might consider buying a Cadillac.
Although that’s a bad comparison, because Cadillacs are very expensive. Concierge care is not as expensive. $2,000 is not a small amount of money, and you choose to prioritize other things in your budget. Or perhaps not. Your choice.
But if you really don’t want to get stuck in one of those plastic chairs in a clinic somewhere, you do have options.
It’s good to have options.
I hope that our government does not decide that you should not have the option of avoiding plastic chairs in a clinic. You may not give a rat’s behind about my practice (I can’t imagine why you would…). But you should give a rat’s behind about our government limiting your options. Whether you choose to exercise them or not.
Amen.
At least for the foreseeable future I would expect something very much like the school system is now – public schools available to all and paid by the government, but very bad; private schools available, but very, very expensive.
Outlawing private insurance and private care won’t be taken up until the doctors working in the government clinics and hospitals unionize, and then the unions start drooling over the money that goes into private alternatives. Just as the teachers’ unions do now.
A Canadian friend called me on the phone the day after Obamacare passed. I pick up the phone, and before I can even say hello I am deafened by him screaming, “YOU STUPID F***ING AMERICANS!!!!!!!”
He announced he was going walkabout.
Probably sitting on a mountaintop somewhere knocking back a few with a guru.
I see patients in the ER all the time whining about how they can’t afford their medicine or to see a dentist or a doctor.
Then I look over their gigantic tattoo’s, and note they smoke a pack a day, drink daily and smoke “a little weed” ( and snort a few lines of coke).
Choices.
I speak to him from time to time. He stepped away from social media like this. It’s been a while. I’ll give him a call and see how he’s doing.
I’m sure not all. But nearly all.
What other choice to they have? When they get sick, they don’t have time to sit in a doctor’s office for half a day. It only makes sense.
I have several friends doing this in DC. They have lots and lots of congresshumans plus all the other various officials that you’ve heard of.
The SHOP plans are gone?
There will always be a multi-tier system of everything. Even in Communist countries, government overlords got the better housing, cars, medical care, etc.
Socialism shifts the provision of the good life from the people with money to people with government/military/police power.
In every society in every part of the world in every era, somebody gets better stuff than the “masses”. The political/economic system determines who gets it. Either the people with the money or the people with the guns.
It is. It’s called “The United States”.
Beat me to the punch here, homie.
Thanks Doc. He had said he was going to loop back around after six months or so, but it’s well past that. Mentioned something about a potential Carolinas visit, and would I be willing to hold onto his bail money while he’s in town, that kind of thing.
Tell him he’s missed here. Please.
@Dr. Bastiat: “(Ever wonder why Mayo is in Rochester, Minnesota?)”
Except that the Mayo Clinic was founded in the 1860’s.
I really don’t think that we are in much danger of losing the current health system to a socialized system. The Democratic contenders that are furthest on the fringe always talk about Universal Single Payer HC, but when it comes right down to it, once in office, they don’t push it. Which doesn’t mean that should Bernie Sanders or Liz Warren get in, we should not worry. Left to the direction of the DNC, some changes might occur that will make the current system even worse, but no way will it be socialized.
I’ll be the contrarian. For 100 years, the AMA has controlled regulation on the healthcare industry. I don’t see that changing ever. I personally don’t think any guild should have the power to control regulations of their industry. This could be the AMA, ABA, …., real estate agent guild. It makes for a lot of rent seeking and poor customer value. Our healthcare system should be a lot better for what we are paying. Any deficiencies are at the feet of the doctors, lawyers, hospitals and big pharma.
Let me know when the AMA starts backing a few million visa’s for immigrant doctors and the deregulation of self-care devices. Then I’ll know the guild cares more about the patients than the doctors.
I read an article on Mises.org that said basically the same thing. Even decades before World War II, doctors and the government were fighting over cartelizing it. They were freaked about immigrant doctors, so they created education institutions to control everything. Those became a source of rent seeking. The politicians wanted to make money off of it. Something like that.
Let’s start with your last sentence first, starting with the words “President Bernie.”
Bernie is a tool. Plain and simple. There is no there there. He says only what his handler at the DNC tells him to say. If there had ever been any there there, he would have joined the 13 activist voting groups that needed him to be part of the lawsuits to determine that the DNC stole the Primary away from Bernie and gave his victory to Hillary. But his handler told him not to. In 12 lawsuits, the judges wouldn’t let the lawsuits proceed because they deemed only Bernie to be the person with standing. In San Diego, it was determined the voters themselves were persons of standing. The matter went to court. It was proven in San Diego that Bernie won, but the DNC fraudulently gave his victory to Hillary.
Stop and think about that. If you ran as a candidate, and one third of your followers said, “Your opponent stole your Primary,” would you back down from pursuing it? I think not. So Bernie is no more real than Honey Boo Boo.
End of Part One
Part Two:
As far as how much money you do or don’t charge, I don’t care. The only problem I have with people shelling out lots of money is when the money is going straight up their noses. Health care is a need, and if people have money and want to shell it out on their health, how is that a bad thing?
People right now are flying to foreign countries because the medical systems are integrated. Here, if my spouse were found wandering the streets in a semi-near diabetic coma, & some kind stranger got him into a hospital, he might be determined to be needing insulin, but the insulin might not be available til the next Am when the pharmacies open. That’s how nuts our system is.
Specialists often do not talk to other specialists when dealing with a patient who has a serious but undiagnosed ailment. Yes they may read a note or two, but the patient goes undiagnosed in part due to lack of brain storming between the med specialists.
Here you wait months to see a specialist, and then you might need to wait two weeks to get the test that person recommends, and then if that test doesn’t show much, you start all over again. Often a person who is ill has to figure out the locations of several different clinics and medical centers to cover this ground.
When Sixty Minutes did a report on people who go off to India or Bangkok for med care, everything is taken care of at one center, in 36 to 48 hours! You see the specialist, and you get the tests and it’s done. It all happens inside one single facility as well! This happens is these third world nations, and we are supposed to believe we live in the greatest Super Power on earth, yet we don’t handle things that way. Why?
Also, Canada is not run by lobbyists. Since ObamaCare came about, the Big Insurers have even more money than before. If in 2009 their lobbyists could keep the health system we had, with the Big Obama reform basically giving a mandate that people had to give more money to Big Insurers, now that they have that money, do you think they wouldn’t fight to keep things the same?