Alan Scher Zagir of the AP reported last weekon groups that push for free-market medicine. At medicine, business or foreign policy schools, cohorts of young conservatives—backed by wealthy doctors—have lured new members since the passage of the Affordable Care Act (a.k.a. ObamaCare). The Benjamin Rush Society, which complains that debate among students is paltry due to “interference by the government,” is one such group that urges a robust discussion about doctors’ roles. But peek under the hood and The Rush Society looks less like a grassroots ideological movement, and more like the rich setting themselves up to profit at the expense of the nation’s poorest.
To be sure, the Society keeps a decidedly conservative agenda: executive director Dr. Beth Haynes wants “to get free market back to the point where it’s a respectable point of view.” But their practical suggestions, while colored by ideology, suggest a stealth dismantling of the safety net. High on the list of suggestions: stressing the option of “concierge medicine,” a primary care model by which patients pay an annual retainer.
This alternative to Medicare offers alluring perks like same-day appointments, 24/7 direct cell phone access, and extra preventative care. Notably, physicians enjoy lighter patient loads—300 or 400 people to the usual 2,000 to 2,500—and extra professional time that allows for the crafting of individualized care plans. Equally notable: concierge physicians receive an annual retainer, and in some cases that “membership fee” accompanies regular visit charges.
The option is hierarchical at best, elitist at worst. According to the American Academy of Private Physicians, patients pay on average between $1,612 and $1,800 annually—a price categorically beyond the means of the poor. Moreover, insurance companies will not typically reimburse patients for concierge annual fees, so unless you’re pretty well off, you’re pretty much out of luck.
It certainly is the right of the middle class to select an optimal healthcare plan. As Forbes points out, “[p]atients have the right to spend their own money for their own medical benefit.” This “silent exodus” by physicians into concierge medicine, though, does pose tangible risks for the general public.
Many doctors have reduced their hours, or even retired, since the passage of the Affordable Care Act. The Wall Street Journal estimates that we will lose 10 to 15 percent of practicing physicians by 2020, leaving millions of newly insured patients with a dearth of doctors. This supply-demand imbalance will surely make for heavy patient loads, rushed appointments and, as the concierge physicians argue, a limited practice.
Fleeing Medicare—shrinking the span of our safety net—should not be seen as a solution. With dedication, our doctors can offer their patients close attention while supporting Medicare.
Forbes has covered the Chen family, whose practice in Miami exemplifies valuable primary care. James Chen, an internist, has focused on the sick, old and poor for nearly 25 years. After he was misdiagnosed with a fatal tumor, he committed to bettering his own practice: compassion and accountability are prioritized.
Chen runs eight clinics in his Chen Medical Center, which treats Medicare patients with a level of attention comparable to concierge practices. The clinics limit patient loads to ensure that daily slots are available, and they offer specialists; chauffeur service is available for the sickest and poorest; and doctors must explain bad outcomes to the rest of the group.
The “exodus” of doctors from Medicare is not just a question of economics—it is one of public health and community. With each doctor that opts into concierge practice, the poor are left with fewer options. Access to quality health care could become, again, a matter of class.
Paul Hsieh, a doctor and co-founder of Freedom and Individual Rights in Medicine, has projected a future in which “[s]ome patients receive high-quality care from happy, motivated concierge doctors” while others (read: the poor) are left with rushed appointments from overbooked physicians. Hsieh frames this condition as a matter of choice: “Which track do you want?”
To ensure a positive future for health care, we cannot place the burden of that choice on patients. Doctors should, like Chen, challenge themselves to incorporate a philosophy of high-level care into the practical framework of Medicare.
ChenMed manages its patients’ Medicare payments, but also stays profitable due to successful preventative measures. Chen sums it up: “It’s better than concierge medicine.”