A Surreal Scene from American Healthcare
February 6, 2018
By Mencken's Ghost
Scene: A luncheon on Superbowl weekend at a resort in the foothills of the Catalina Mountains in metro Tucson, Ariz. In attendance were about 200 patients of a local family physician, who hosted the luncheon to show his appreciation to his patients.
I'm not hallucinating. This actually happened. The doctor indeed thanked his patients with a luncheon. I know, because my wife and I were there.
The physician was trim, fit, personable, gracious, and funny. A transplanted Canadian, he joked that the reason he had become a doctor was that he wasn't good enough at hockey to play the sport for a living.
The attendees also showed their appreciation to the doc. Some stood up and recounted how he had saved their lives with his focus on wellness and the special care and time that he gives them. It was quite moving.
A couple of attendees who knew that his birthday was the next day had arranged for a surprise birthday cake. Everyone enthusiastically sang "Happy Birthday."
As new patients, my wife and I had a delightful time at the luncheon and met some very interesting people, including a musician and his wife, who, along with their three children, had been seeing the doc for years and spoke very highly of him.
Attendees weren't required to complete those ubiquitous and utterly useless and silly HIPPA forms before having lunch with the doc. If the feds read this, he'll probably be sued or lose his medical license.
What accounts for the mutual admiration between the doc and his patients? A free market—or more accurately, a flicker of a market that hasn't yet been extinguished by the government.
You see, the doc's patients pay an annual fee to him for what is known as "concierge care." In return, they can get same-day appointments, have quality time with him during office visits, and get very thorough physicals and wellness advice. It's kind of like having a service contract with a HVAC company to maintain your air-conditioners, so that if they stop operating on a hot summer day, the company puts you at the front of the queue.
The concierge fee is in addition to what is paid to the doctor by third parties; that is, by insurance companies, employers, and the government. The problem with these third-party payments throughout the medical industry is that they are counter to a true consumer market, where the consumer is king and businesses compete vigorously for the consumer's business. They are counter to a true consumer market because someone other than the patient pays the bill.
This situation is upside-down. Medical care is much more important, personal, and intimate than, let's say, car care, but there is a consumer market in car care but not medical care. Car owners have considerable options for getting their car serviced. They can go to place that does quick oil changes, or, as I do, pay more at a dealership that has a comfortable waiting room, refreshments, and a loaner car if needed.
Is concierge care only for the rich? Hardly. It's also for those of modest income who put a higher priority on medical care than on other purchases. They'd rather forgo spending six bucks everyday at Starbucks or subscribing to a premium cable package than forgo getting personalized medical care.
What about the poor? Isn't it unfair that they can't get concierge care? Well, there is no reason that the poor couldn't get concierge care, but this would take a complete revamp of the social-welfare system and conventional thinking. First, it would require restricting public aid to the truly indigent or disabled; second, it would enable recipients of the aid to pay physicians directly with vouchers; third, it would remove government quotas on medical school admissions, so that the supply of docs would increase; and fourth, it would change the mindset about the use of coercion in America.
Regarding the fourth point, an elaboration: The first impulse nowadays by those in government, academia, the media, and much of the public is to solve a social problem with government force. The first impulse is not to ask how the problem might be solved without the use of force. In healthcare this means that the first solution to the problem of the uninsured is to force everyone into a "same size fits all" program that is controlled directly or indirectly by the state through market-destroying regulations, tax policies, subsidies, and eavesdropping on what goes on between docs and patients.
Of course, I'm hallucinating to think that this will ever change.