Wanted to address a few other issues:
Shadowfax comments that perhaps the retainer medicine trend will be a driver of change, saying that in order for change to happen to health care payments and financing, “physicians need to take the hard and painful step of saying, “No, I won’t see you,” to Medicare patients. And that is basically what concierge care is.”
I don’t think this approach that Shadowfax mentions is the right one. There’s a reason that every year, doctors are chosen by Americans as the most trusted profession. Despite some may think of us, they know we work our asses off to care for them. We dedicate our lives to the task. We embody the definition of the true professional: the person that puts the needs of his or her patient ahead of his or her own. We lose that trust from our patients–that we have their interests ahead of our own–and we risk losing much more than just money. (And ignoring economic theory of medical school being an investment in later higher salaries, when you look at it from the average American’s perspective, making $38,000 a year, doctors complaining about only making $150,000 a year will look pretty ridiculous to most of the US.)
I also fail to understand why physicians would be willing to “protest” by joining retainer/concierge practices yet still work within the current health care non-system than “protest” for reforming the entire health care system. Not to go all single-payer on you, but those hundreds of billions of dollars (we can argue if it’s $300B or $100B later) wasted on administrative duplication and entire billing departments in hospitals and clinics sure seem like a great pot of money that we could pay primary care physicians with. Call me crazy. Many do.
And as I’d mentioned before, Josh has been writing a lot about concierge medicine at KevinMD. One post shows a sample practice with a huge reduction in hospital admissions for concierge care-managed patients. That’s great! Fantastic! Awesome! Amazing! I have no doubt that it’s true. If you can spend more time with your patients and watch them closer, you can keep them out of the hospital. Which is good for the patients and great for our health care system. But why should we only provide this to the rich patients (yes, the overwhelming majority of these concierge patients are wealthy) that can afford it? Why not fix our whole health care system so that the diabetic gets a 45 minute visit instead of a 15 minute one?