THE CASTE SYSTEM

Life interfered with my ability to post a rant last week, but for better or worse, I’m back.

An Associated Press article that appeared in my local newspaper today expressed concerns about “concierge medicine.” This is a practice paradigm that has been around for a number of years in which a physician, usually practicing primary care, for a yearly retainer of about $1500 to $1800, provides a higher level of service. Typically, what the patient buys is same-day service and more face-time with the doctor. The article states that the spread of the practice “could drive a wedge among the insured,” with people unable to afford the retainer finding themselves “stuck on a lower tier, facing less time with doctors and longer waits.” Furthermore, if the practice becomes more prevalent, “it could lead to a kind of insurance caste system.” For their part, the doctors argue that they’re trying to “recapture the personal connection,” but the article does report there are economic benefits for the health care provider and the ability to have smaller patient panels. Also, many of the doctors apparently bill Medicare and private insurance for services outside the retainer coverage limits. At this time, it is reported, there are less than 2,000 physicians in retainer-based practices.

The truth is, we’ve always had a “caste system.” Does anyone really believe the very wealthy get the exact same care as everyone else? They can, and do, even hire personal physicians (sometimes this works to their detriment; witness the Michael Jackson fiasco). The new paradigm just brings an element of this special treatment to the less affluent. The more libertarian among us would say, why shouldn’t these people be able to spend their money the way they want? The more liberal or progressive would decry the “inequality” in the system (ironically, some of the most liberal are celebrities that are the worst “offenders”). And I don’t have a great deal of confidence that the ruling class wouldn’t exclude themselves from any regulations they concoct; there is ample precedence for that.

Even if you don’t have an objection to the right of physicians to choose to practice, and the patient to elect to buy, concierge medicine, it will be a symptom of the coming storm. It will add to physician shortages and provide an alternative scheme for care rationing— both inevitable for reasons I’ve laid out in previous posts.

The answer is to deal with the root causes: To truly modify health care delivery, get rid of as much waste and fraud as possible, and provide rational means for rationing. This will reduce the gap separating the level of care received by the “haves” and “have-nots.” But I’ve belabored that point in the past. What I predict the government will do is attempt to enact some laws to limit the new business model, such as disallowing or restricting Medicare participation by “offending” physicians, or levying some extra “fees,” (so as not to increase taxes; forgive me, I couldn’t suppress the dig). As usual, this will be inappropriate and reactive, with unintended consequences.

When you try to control the twin dragons of supply and demand by clamping their jaws shut, you’ll always get whipped by the tail.

Advertisements

Tags: , , , ,

Leave a Reply

Fill in your details below or click an icon to log in:

WordPress.com Logo

You are commenting using your WordPress.com account. Log Out / Change )

Twitter picture

You are commenting using your Twitter account. Log Out / Change )

Facebook photo

You are commenting using your Facebook account. Log Out / Change )

Google+ photo

You are commenting using your Google+ account. Log Out / Change )

Connecting to %s


%d bloggers like this: