Concierge Medicine, the Ritzy Repeal and Replace of Obamacare

Since my early days as a doctor, I was taught about the three As governing doctor-patient relationship: Availability, Affability, Ability. You can imagine my surprise when I was told the relative weights the patients gave those traits: 60%, 39% and 1% respectively! More recently Affordability joined the group and must have altered those weights a bit but Availability of the physician is still the champion.

Henceforth it is no surprise that concierge medicine, that gives patients up to 24/7 access to their doctor in some groups, is gaining so much popularity. This unbridled access will cost you an average of $100 per month per adult ($50 – $300, depending on the area), payable as a subscription. Your physician will spend his time knowing you medically inside out instead of wasting it on billing and insurance paperwork. Physicians in these cooperatives that are mushrooming nationwide will not take on more than 600 patients in their care. They are more relaxed and devoted to their task, since they are making a predictable and fair living, independent of the whims of the insurance carriers, saving on having to hire a clerical army of billers. They can sharpen their Ability and hone in on prevention. Indeed, their incentive would be to keep their patient cohorts as healthy and stable as possible, so that caring for them is but a breeze.

Affordability does ensue since $1200 per annum for this kind of intensive coverage is a very reasonable cost in this day and age. The majority of patients will not need much more and should not be forced into government mandated plans that would cover prostate exams for women and pregnancy care for men, and other non-sensical features! Moreover, it does solidify the doctor-patient relationship, remove the middlemen, and keep a lid on costs as they are fixed and visible.

Armed by their swelling patient numbers, these concierge doctors gain increasing negotiating power with diagnostic laboratories and imaging centers, hospitals and pharmaceuticals companies. These patient pools can also negotiate with carriers for catastrophic insurance to cover diseases and injuries that require hospitalization. There is force in numbers. The carriers would have a full gamut of such policies that patients could choose from.

The entire system will be driven by patients and their doctors for a change. Healthcare is uniquely about them after all. The government will be very hands-off with its punitive taxes and mandates, even for patients with pre-existing conditions. Indeed, these concierge practices with their cooperative purchase power can absorb the care of a variety of patients with chronic diseases, such as diabetes and cancer, and even the elderly.

A practice with 10 physicians covering 6,000 patients can behave such as a self-insured large employer in the market place, except that it would be more astute to negotiate from within, because of the intimate knowledge they have of the disease processes and the patients. Three-quarter of those practices are primary care but some are starting with specialist physicians as well: cardiology, orthopedics, neurology and others.

Hospitals can potentially behave as their own concierge practices, since a 300-400 bed hospital has more than 2,000 employees. Many do that already, i.e. self-insure their staff.

Other A words are brought to fore with this model. One is Accountability will emerge automatically from such an intensive doctor-patient relationship which enhances mutual sense of responsibility between the two. Malpractice law suits will plummet. The patient, not being bound by some carrier network, could always switch doctors ad lib if Affability is failing his provider.

Another very important A word is Addiction Prevention. Indeed, one of the surest way to make an addict of a patient is to give him a month prescription of Percocet, for example, for back pain. That provider will have no control whatsoever over the patient taking a month worth of pills in one swallow, selling them, giving them away, etc. A more frequent visit to the doctor, along with frequent phone and email contact, is the best protection against this kind of abuse. For example, the pills could be administered a few days at a time by the provider himself if he detects a high-risk patient. Keeping close tabs is the best tool doctors have for this plague, and the concierge format seems to have a built-in safeguard.

In summary, the concierge-type medical cooperative thrives on Availability and Affability, sharpens Ability, drives Accountability, fosters Affordability, enables Addiction avoidance, and hones in on prevention.

Encouraging formation of these concierge practices, city by city, state by state or even across state lines, could be the extent of the US government intervention, combined with health savings accounts to pay the nominal fees and perhaps some capped tax rebates for insurance purchased, e.g. catastrophic, to even the playing field between those insured by their employers and those who are not. Carriers could reinsure their claims (beyond a certain threshold) just like workers’ compensation self-insureds have been doing for years, to minimize their risk. The government should open state lines to foster competition; as well as reign on medical device manufacturers and big pharma to drop their prices overall, which President Trump has started to do.

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