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Wall Street-types in Manhattan now think that doctors who accept private insurance are inadequate for their gilded bodies. Welcome to the world of concierge medicine on steroids:

The health care market in New York is sufficiently unusual that members of the affluent classes routinely question the merits of doctors who do take insurance. How could the doctor satisfied to receive a $20 co-pay also be the doctor skilled enough to know that your palm’s itch is really the early sign of something rare and disfiguring?

...

It is not simply that check-ups will be offered and ailments tended to in the way of standard concierge practices, where the average annual fees run $1,400 to $1,700 a year nationally; the practice will take a comprehensive, methodical approach to life extension. Dr. Yadegar envisions administering state-of-the-art screenings that use biochemical markers to identify potential predictors of cancer; consulting on limiting exposure to toxins; and networking with personal trainers. Dr. Yadegar will also offer dermatological fillers — come for the stress test, stay for the collagen.

In New York it is impossible not to notice that the wealthy will pay dearly for things, and they will pay especially high sums for those things they believe other wealthy people don’t have. Similarly it is hard not to notice the alienation felt by those in the highly educated professional class who have been forced to concede so much of their status to friends and acquaintances who have elected to make 200 times as much money on Wall Street, providing one one-hundredth the social utility. The arrival of a kind of Goldman Sachs of family practices was in some sense inevitable.

How much extra will these titans of Wall Street pay for doctors not exposed to the disgusting bodies of lawyers and professors (not to mention the filthy wretched masses who dispose of their toxic medical supplies)?
All of this led him and a new partner, Daniel Yadegar, a cardiologist and specialist in integrative and anti-aging medicine, educated at Harvard and Cornell, to embark on a whole new kind of practice, one in which patients — and there will be no more than 400 — will pay $25,000 a year for unfettered access to the doctors. Patients will be able to call and see and text the doctors whenever they want; they will be able to receive home visits, though those will cost extra (and so will lab work). They will be able to ask their doctors to travel to them should they suspect the onset of illness in June in Umbria. Various young Internet moguls have already expressed interest in becoming patients of the practice, which will start next month, Dr. Goldberg said.
On a superficial level, it looks like these doctors are bringing Elysium to the United States -- the (super) rich will have have healthy, painless lives exceeding those of the masses, while anyone not predisposed to spending his or her days rent-seeking in a Financial District tower will have to accept living just an ordinary life.

The irony is, of course, that Americans (Manhattan billionaires, included) already live shorter lives than many poorer people in the world: including those wretched non-billionaires languishing in squalid places like Greece, Southern Italy and Costa Rica.

It's tough not to laugh at the naive thinking of these individuals: cancer doesn't discriminate between the banker and the pauper, nor does the heart attack or the stroke. Instead, these new patients of Doctors Yadegar and Goldberg will just be purchasing the illusion of longevity and good health.

Before leaving you at liberty to read the article in full, though, let's also put these practices into the bigger context of American social policy: almost 100 million Americans are un- or underinsured in this country, meaning they risk death for lack of access to basic medical care. All the while, the titans of Wall Street and the #FixTheDebt crowd tell us Medicare must be cut, Obamacare is too expensive and folks just need to figure out their medical care by trading chickens. We are literally a society that is unwilling to ask our billionaires to pay just a little bit more money so everyone can have a a basic level of social protection; no other rich country on Earth has such a perverted social contract. Free-at-point-of-use health care for everyone is most certainly achievable, but this billionaire class would need to pay a tiny bit more.

Whatever, though, who cares if we have the rich world's highest infant mortality rate? Some asshole is afraid of loud noises in the dark and needs his or her toe held by a doctor:

In recent years, some of Dr. Goldberg’s patients have made unusual requests that he has obliged. In one instance, when a patient didn’t want to be seen having a colonoscopy, Dr. Goldberg closed his office for four hours to grant her more privacy. Another requested allergy shots at home and another his accompaniment to a stressful M.R.I. where Dr. Goldberg held the patient’s toe to supply comfort.
Paging Dr. DeBlasio, expert in socio-economic inequality...STAT.

9:04 AM PT: Kossack 'fugwb' in the comments brings up an important point. Total health spending in the UK is about $3,500/person. The $25,000 spent on these 'life-extension' doctors could finance the care for over five patients in your average European, Canadian, Australian single-payer system.


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Comment Preferences

  •  We've had plastic surgery (40+ / 0-)

    targeted at "imperfect" women for years. But these days a lie wealthy, affluent MEN in high-stress occupations (such as insider trading) fall for, is that testosterone supplements will make them younger. Compete with the younger guys coming up, they hear. Cut out on your dumpy wife. Get a racy model, you know, for your garage.

    Important diary. Thanks for mentioning the intriguing statistic of mortality rates for wealthy, affluent professionals in America, relative to mortality rates elsewhere in the world, for other classes of people. They aren't as stellar as you'd think.

    Important discussion. Tipped and recommended.

    It's here they got the range/ and the machinery for change/ and it's here they got the spiritual thirst. --Leonard Cohen

    by karmsy on Sun Dec 08, 2013 at 08:51:54 AM PST

  •  Concierge medicine is inevitable, it seems. (24+ / 0-)

    And it has been here, even on a lesser scale.  I've heard of a number of doctors seeking something like $1200 up front for the right to see a certain doctor.  This guarantees the patient things like an hour long consultation when you come in for your annual checkup, the ability to schedule appointments quickly, that kind of thing.  

    This, like many of the other things  happening, is a predictable outcome of where we have been going in health care.  Both government (Medicare, Medicaid), and insurance companies (networks), have attempted to keep costs down by limiting what providers are paid.  In Medicaid and Medicare, the limits on provider reimbursements are making more doctors decide not to take Medicare or Medicaid patients.   For private insurance, there's an attempt to limit the more affordable plans to those doctors and hospitals willing to accept lower reimbursements.) This morning, Ezekiel Emmanual was on one of the Sunday shows making the point that the President's promise that "If you like your doctor, you can keep your doctor" was correct IF you were willing to pay more to keep your doctor, meaning the most expensive insurance plans.  

    I suspect that were are moving into a two, or maybe three, tier system.  Tier 1 will be the millionaires and billionaires, and the top doctors in the country, like the article seems to indicate.  Tier 2 will be the "better" doctors and hospitals that will only be available to those people who can pay the premiums for the best plans or who can afford to pay a few extra thousand a year for access. Tier 3 will be the "masses" who will have access to those doctors willing to accept low reimbursements, who spend only a few minutes per patient, and for whom it takes weeks (or more) to get an appointment.

    I am concerned that the days of the middle class thinking that they have access to what they perceive as "the best" in healthcare (for example, here in New Orleans, people have assumed that when you get a serious cancer diagnosis, and you have insurance, you can go to MD Anderson in Houston) are coming to an end.

    •  Exactly -- we have two-tier medicine already and (16+ / 0-)

      many middle-class folks don't realize that they'd be better off on the single-payer tier than the private, crap insurance tier.

      •  Actually, there probably wouldn't be a difference (8+ / 0-)

        There may be a slight pay off in terms of savings once the price controlling effect of single player comes into play, but the benefits of single payer really skew towards the low end of the income scale.  That in itself does all sort of public good (reduces crime, increases lower income buying power, etc.), but you won't really see it reflected the quality of medical care for at least half of Americans.

        •  I think middle class will benefit. Take mammograms (0+ / 0-)

          for example. How many women with junk insurance ignore them? ACA mandates they're part of policy.

          This health care system is a moral atrocity. Dr. Ralphdog

          by AllisonInSeattle on Sun Dec 08, 2013 at 01:25:39 PM PST

          [ Parent ]

          •  Not as many as you'd think (0+ / 0-)

            67 percent of women over 40 have had a mammogram in the past two years.

            We're still dealing with millions--even tens of millions--when we talk about specific break downs, but we're also talking about the margins.  In fact, the vast majority of the healthcare debate lives in the 15 percent margin where those of us on individual plans, or the uninsured, live.  That's why the GOP works so hard to portray ACA now and our proposals later as threatening what the 85 percent already have.

    •  My doctor offers some kind of concierge option (6+ / 0-)

      For a grand or so, they will fill out your kid's health forms, give you longer appointments, etc.  I just ignored the solicitations, and I seem to get pretty much the same care that I always have.

      "We *can* go back to the Dark Ages! The crust of learning and good manners and tolerance is so thin!" -- Sinclair Lewis

      by Nespolo on Sun Dec 08, 2013 at 09:03:59 AM PST

      [ Parent ]

      •  It seems to me that this is only necessary (4+ / 0-)

        if the practice is managed so poorly that the need is created.

        If you pay more the doctor will call you back? Why doesn't the doctor call everyone back. Same day appts? Why aren't they already available?

        It's a symptom of poorly managed medical practices that this is even necessary.

        "There is no expedient to which man will not resort to avoid the true labor of thinking." -Sir Joshua Reynolds

        by New Jersey Boy on Sun Dec 08, 2013 at 11:46:37 AM PST

        [ Parent ]

      •  Nespolo - that may change if more patients (2+ / 0-)
        Recommended by:
        coffeetalk, leevank

        sign up for the concierge option. The method that your physician is using is a very safe way for him to test his patient population and determine if they will support a transition to a full time concierge practice.  

        "let's talk about that"

        by VClib on Sun Dec 08, 2013 at 01:56:01 PM PST

        [ Parent ]

        •  you'd like that, wouldn't you? (0+ / 0-)

          “Vote for the party closest to you, but work for the movement you love.” ~ Thom Hartmann 6/12/13

          by ozsea1 on Sun Dec 08, 2013 at 02:11:10 PM PST

          [ Parent ]

          •  oz - the concierge practice is particularly good (4+ / 0-)
            Recommended by:
            valion, coffeetalk, ozsea1, Lying eyes

            for that mid 50s physician, who has a large practice that includes a subset of patients who will pay for a higher level of service, and doesn't want to be in the business of assembly line medicine. Independent physicians are small business owners and I have no issues with any of them deciding to change their business model if that allows them a better work environment and improves their quality of life.  

            Personally I am very grateful that my primary care physician will continue to see patients who turn 65 and are on Medicare. He is one of the premier internal medicine diagnosticians in my area. He hasn't taken a new Medicare patient in more than a decade. He doesn't practice assembly line medicine, at least not with me.

            "let's talk about that"

            by VClib on Sun Dec 08, 2013 at 02:19:13 PM PST

            [ Parent ]

    •  Mostly agree, but (25+ / 0-)

      I want to partially take issue with your characterization of the "top doctors" as those who will be in your Tier 1.  I don't think it is fair to equate best with most money hungry.  There are doctors who really did go into medicine to try to improve the health and life of their patients and community.

      Small warning to those concierge doctors promising to extend life and provide always perfect care.  There are lawyers who are going to be happy to present your promise versus the untimely death of Mr. Moneybags to a jury.  Be very well insured.

      •  Best bedside manner. (5+ / 0-)

        Why is it easier to buy a gun than it is to register to vote in most states?

        by 88kathy on Sun Dec 08, 2013 at 09:32:02 AM PST

        [ Parent ]

      •  In my experience it's the contrary. (21+ / 0-)

        Docs who actively solicit concierge practices are a blight on our profession IMHO.

        The finest physicians I have known in my career have almost without exception been willing to see patients regardless of insurance. And the docs who refuse to see my Medicaid patients tend to be less admirable in other domains as well.

        Just sayin.

        •  Exactly! (16+ / 0-)

          The concierge clientele is VERY susceptible to quacks and charlatans.  If you don't go along with whatever nutcase idea these prima donnas have for their treatment then you're out.

          My field of Molecular Medicine is ripe for the picking of physicians ordering very expensive and completely unnecessary testing.  Want your whole genome sequenced so you can see your genetic susceptibility to disease?  Sure you can have it done for a high price but no one knows what those results actually mean…yet.

        •  Medicaid doctor shortage will be acute. (4+ / 0-)

          Doctors can actually lose money on Medicaid patients.  It depends on the overhead costs (the doctors with the latest technology, for example, are going to have higher overhead) the doctor has as well as the reimbursement levels for particular service.  Doctors who accept Medicaid patients -- and Medicare, for that matter -- often don't make any money at all on Medicaid/Medicare patients when you take into account the overhead and cots they deal with.  They make up for it with privately insured patients.  

          There's a temporary bump in Medicaid reimbursement rates that expires at the end of 2014.  Given that (as that article says) doctors are not going to take on a lot of Medicaid patients this year (a doctor is not going to take a new patient this year if he/she is going to have to stop seeing him/her next year) and it will be even worse in 2015.  

          Medicaid expansion is getting health care coverage to millions of additional people.  But that is not going to mean more doctors will be available for those additional people.  

          •  Medicare and Medicaid completely different (17+ / 0-)

            Yes, Medicaid in many locations won't cover costs. Cry me a river, most of us doctors are more than well paid enough to eat the cost of providing some under-reimbursed care to Medicaid patients. Given what doctors are paid, I would be cool with Medicaid acceptance being a condition of state licensure. Medicare is a completely different issue. Medicare pays promptly, the paperwork is simple, criteria for payment transparent, and denials rare. If you're a doctor who can't make ends meet with Medicare, ur doin it wrong.

            Now, the structural bias in Medicare against primary care and in favor of highly reimbursed procedural subspecialties is a whole 'nuther thing. As a family doctor for almost 30 years I am intimately aware of this problem.
            Here in the U.S. we have way too many interventional cardiologists and radiologists orbiting around affluent fee-for-service locations. The result is the gross over-utilization of coronary angiograms in places like Miami where specialists are chasing patients, while primary care docs in poor rural locations like mine can't meet the demand for service because we're so overworked.

            •  I thought ACA was raising Medicaid reimbursement? (1+ / 0-)
              Recommended by:
              AllisonInSeattle
            •  Cry a river, indeed. (3+ / 0-)
              Recommended by:
              coffeetalk, valion, leevank

              The ethics and the optics of accepting Medicaid are good. An editorial this fall in the New England Journal of Medicine addressed this with a compelling argument why doctors should enroll.  Nevertheless (sigh) it is bad business, unless your patients have Medicaid as a secondary insurance with Medicare as a primary; then it makes more sense.  We take Medicaid, BTW.

              Treating the needy and uninsured is noble, and we do it , but we wouldn't survive if we operated at a net loss.  Doctors have overhead (rent or mortgage payments, utilities, staff wages and benefits, diagnostic equipment, the mandatory shift to EMR).  I'm about to say some very negative things, so don't get me wrong, I like practicing medicine.  But after all the years of training, student loans, administrative headaches (and fear), unreimbursed call, regulatory swords of Damocles, the psychological trauma of managing illness, I don't particularly care for people telling me that I should make less, because they don't know what they are talking about.  My skills and how I use them are worth a hell of a lot.  

              Personally, I don't want to go to a doctor who is a low bidder.

              I write off charges for uninsured patients weekly because I don't want them to let finance get in the way of their health. That's not 'free money.' That comes out of my pocket. At the same time, I don't sign on to shitty insurance plans because I can 'eat the cost.'  I can't and I won't.

              •  I hear you, but have to politely disagree. (3+ / 0-)
                Recommended by:
                kathny, eleaba, nchristine

                Yes, we physicians have lots of overhead and all. But as one family medicine journal memorably put it, "still beats being a hot-tar roofer in July".

                No doubt medicine is very demanding. But "unreimbursed" call is incorrect. That's why we're pretty darn well paid compared to entry level engineers or junior attorneys. Sure, I'd love to be paid just to wait for the phone to ring, but that's not the deal. And if you think doctors are 'regulated', just see what plumbers and home builders have to deal with.

                It's not for everyone, and for sure it's stressful. But the degree of gratitude and respect we get from our patients still boggles my mind after 30 years.

      •  I think it will be a very big issue. (7+ / 0-)

        I agree that there are some doctors who are "top" in terms of knowledge and skills who may continue to operate on those very low reimbursement rates.  But those low rates mean that to make any money, doctors have to limit the amount of time they will spend with each patient.  I know some doctors who are in it to help patients, but they also want to make a decent living (for having invested years of their lives and zillions of dollars in student loans to become a doctor).  And with some of the low reimbursement rates, doctors simply can't do that without getting patients in and out very very quickly, and many of the best doctors resent having to do that.  So the most "in demand" doctors, who can get those "concierge" rates (the extra couple of thousand a year from patients of a PCP, for example) are going to opt more and more for that, not only for the money, but also because it will continue to let them spend time with patients, which is going to become less and less feasible as more reimbursement rates are cut.  

        The other problem is that many doctors who accept Medicaid and Medicare are close to not making any money on those (given the reimbursement rates) and have to make it up on insured patients.  That option will be taken away for those doctors on the most affordable plans.

        I think it's more of an issue with what I called "tier 2."  That's a lot of the doctors and hospitals who until now had served the insured middle class, but who won't be on the networks of the most affordable plans because they aren't willing to to to the "very low reimbursements, get patients in and out quickly."  

        And, like I said, I think some people are gong to be VERY VERY unhappy to learn, after for example a devastating cancer diagnosis, that places like MD Anderson are not in their network and are not an option.  That's going to be a huge issue, I think.

        •  What's the definition of "any money" here? (2+ / 0-)
          Recommended by:
          Most Awesome Nana, Tonedevil
          But those low rates mean that to make any money, doctors have to limit the amount of time they will spend with each patient.
          (my bold)

          Are we to believe that doctors are one step from the poorhouse?

          •  Given their overhead costs, doctors can (5+ / 0-)

            lose money on Medicaid patients. The reimbursements are less than Medicare, which is why there is a temporary bump in reimbursements (expires at the end of 2014).  See also here and here and here.

            •  Keeping in mind that the Dr's pay is part (1+ / 0-)
              Recommended by:
              Tonedevil

              of the overhead.  I assume that if they are small businessmen that the owners draw (sole Proprietor) or salary is counted into the overhead costs.

              The Medicaid, Medicare reimbursements must make  getting that third home in Aspen much harder.

              There are just way too many Doctors who are in the field for the sole purpose of making money. This isn't recent either. It was going on with a few of my friends who became Doctors starting in the 70. They just didn't know how to answer the question honestly that came on their Med School application: "Why do you want to be a Doctor?"

              I doubt that question is on those applications any more. That's not to say there are all bad doctors...as bad doctors won't earn much if they get a rep for their patients dying.

              But it also doesn't stop Doctors who are strong advocates for unnecessary surgery and devices, not to mention heavy users of their  leased diagnostic machines. It also doesn't stop Pharmaceutical sponsored research, kickbacks, and bribes that can drive a influential Doctor's annual compensation into the millions.

              In my mind, not taking on Medicare or Medicaid patients is more of a personal lifestyle choice for a certain class of Doctors.

              “ Success has a great tendency to conceal and throw a veil over the evil of men. ” — Demosthenes

              by Dburn on Sun Dec 08, 2013 at 02:52:48 PM PST

              [ Parent ]

              •  Dburn - my primary care physician and I have a (1+ / 0-)
                Recommended by:
                coffeetalk

                very candid relationship, including about his practice economics. Even on a marginal cost basis he would lose money on Medicaid patients and Medicare is not quite a breakeven. That's why he hasn't taken a Medicaid patient in twenty years or a new Medicare patient in a decade.

                "let's talk about that"

                by VClib on Sun Dec 08, 2013 at 03:32:33 PM PST

                [ Parent ]

                •  Any Business (0+ / 0-)

                  has loss leaders. Sometimes when you treat a profession strictly by the P&L that deals with peoples health, then people die unnecessary deaths. Some very painfully.

                  At least we are engaged about the economics of providers which leads me to believe that one comment should be paraphrased. "In order to maintain certification,  x% of the Doctor's patients are on medicaid and medicare".

                  Not every invoice that a business issues has a large profit margin. Building up goodwill is part of the cost of doing business. Call it pro bono work with a small profit margin.

                  IMO , this site has purposely skipped some of the most egregious practices that come on the provider side in this multi-year health care debate.  Reforming health insurance is not even a partial reform. It's a Band-aid and they eventually fall off.

                  Not addressing the provider side's unfettered greed means the wound just festers and grows.

                  “ Success has a great tendency to conceal and throw a veil over the evil of men. ” — Demosthenes

                  by Dburn on Sun Dec 08, 2013 at 08:56:41 PM PST

                  [ Parent ]

                  •  I don't think we should mandate that physicians (0+ / 0-)

                    take Medicaid and Medicare patients. Why should government mandate that providers work at below market rates? That would seem to me to be an abuse of government powers. That fact that no provider is mandated to treat Medicaid or Medicare patients requires government to pay enough for the services to attract a sufficient number of providers that government meets its public policy objectives. Mandating treatment seems to me to be a slippery slope of transferring our responsibilities to provide specific healthcare programs to a small group of our citizens, who happen to be clinicians.

                    "let's talk about that"

                    by VClib on Sun Dec 08, 2013 at 10:31:54 PM PST

                    [ Parent ]

              •  That's ridiculous. (1+ / 0-)
                Recommended by:
                VClib
                The Medicaid, Medicare reimbursements must make  getting that third home in Aspen much harder.
                That's a really snide, unfair, and uncalled for comment.  

                I don't know about you, but I don't expect a doctor to take a LOSS on seeing patients.  And that is what Medicaid often does.  And yes, I think that anyone who has taken a decade past high school, and spent all that money on education, to become a doctor, and who works long hours and who often literally saves lives to be well paid.  I WANT the pay to be enough so as to attract the smartest people out there.  

                And no, the vast majority of doctors I know, while they are well paid, don't have a "third house in Aspen."  

              •  So it's okay to make our choices on vendors (0+ / 0-)

                contingent, inter alia, on their lifestyle choices? Or are you just shooting DKos skeet here?

                In my mind, not taking on Medicare or Medicaid patients is more of a personal lifestyle choice for a certain class of Doctors.
                •  This isn't about choosing vendors (0+ / 0-)

                  This about vendors turning away business that can mean life vs death for the customer simply because they seem unable to find the proper mix to maintain profitability which almost always means a high level of pay for the largest part of the overhead. The Doctors.

                  There is evidence that the AMA and others have worked with the schools and hospitals to ensure that Doctors always come on on top of the supply /demand equation to maintain  pricing power.

                  I don't feel like sourcing it right now as this is just a circular argument that goes nowhere.

                  “ Success has a great tendency to conceal and throw a veil over the evil of men. ” — Demosthenes

                  by Dburn on Sun Dec 08, 2013 at 09:02:10 PM PST

                  [ Parent ]

          •  Is it fair to compare to other professionals? (4+ / 0-)
            Recommended by:
            lavorare, Tonedevil, AlexDrew, valion

            No. I don't think doctors should be only one step from the poorhouse. That's not a reasonable standard to apply to someone with a secondary degree working in a professional field.

            How should a doctor's income be relative to a plumbers? That's a fair standard. Should a doctor make less, the same, or more?

            Or would it be fair to compare doctor's income to a lawyer's? Should it be lower, the same, or more?

            The poor house? No, that's not what we're talking about.

            "There is no expedient to which man will not resort to avoid the true labor of thinking." -Sir Joshua Reynolds

            by New Jersey Boy on Sun Dec 08, 2013 at 12:19:43 PM PST

            [ Parent ]

            •  Physicians should make more than lawyers (3+ / 0-)
              Recommended by:
              coffeetalk, lavorare, AlexDrew

              After three years of law school lawyers are making money. For physicians it's four years of medical school, plus four to six or more years of training. Most physicians don't start practicing until their early thirties. By the time I was 30 I was a corporate officer of a Fortune 200 company. Physicians should certainly make more than the average mid level Fortune 500 executive.

              "let's talk about that"

              by VClib on Sun Dec 08, 2013 at 02:11:49 PM PST

              [ Parent ]

      •  I get mailings regularly from a company that (1+ / 0-)
        Recommended by:
        Tonedevil

        helps doctors "transition" to a concierge model.

        The company skims off the top somehow. There's no filter for "quality providers."

        That's just the impression the model creates by artificially limiting access and then charging extra for it.

        "There is no expedient to which man will not resort to avoid the true labor of thinking." -Sir Joshua Reynolds

        by New Jersey Boy on Sun Dec 08, 2013 at 12:11:31 PM PST

        [ Parent ]

    •  Our doctor did exactly that, asks $1600 each (3+ / 0-)

      to stay on as his patient.

       Retired,  64, we declined.

       Don't blame him though making enough money to keep his practice profitable in Austin TX required several nurses, physician assistant, nurse practitioners all keeping appointments short, quick and flowing along for insurance claims.

      Found a doc that only takes Medicare. That means for some months we enroll in  Medicare will have to file our on claim paperwork on our retiree health insurance and pay the diff.
      .

      Congressman Jim McDermott talks aboutthe 'new business model' under ACA:

      SNIP
      Thanks to the Affordable Care Act, a new business model is rapidly emerging in the medical-industrial complex that, in theory, can dramatically reduce the inflated costs of healthcare while serving everyone—rich and poor, healthy and sick. But the reformed system will also still rely on the market competition of profit-making enterprises, including insurance companies. A lot of liberal Democrats, though they voted for Obama’s bill, remain skeptical.

      “In the long arc of healthcare reform, I think [the ACA] will ultimately fail, because we are trying to put business-model methods into the healthcare system,” said Washington Representative Jim McDermott. “We’re not making refrigerators. We’re dealing with human beings, who are way more complicated than refrigerators on an assembly line.” I turned to the Seattle congressman for a candid assessment because he’s the third-ranking Democrat on the House Ways and Means Committee and has been an advocate of single-payer healthcare for decades. Plus, he’s a doctor.

      The business transformation under way in healthcare involves the consolidation of hospitals, doctors and insurance companies in freestanding “integrated delivery systems”—nonprofit and profit-seeking—that will have the operating scope and power to eliminate duplications and waste and hold down costs, especially the incomes of primary-care doctors. Major hospitals are buying up other hospitals and private practices, and they’re hiring younger doctors as salaried employees. An  American Medical Association survey in 2012 found that a majority of doctors under 40 are employees, no longer independent practitioners.

      “The medical-industrial complex is putting itself together so that the docs will be the least of our problem,” McDermott said. “They will simply be serfs working for the system.”  The AMA’s market research reports that “hospitals focus on employing primary-care physicians in order to maintain a strong referral base for high-margin specialty service lines.” Big hospitals need a feeder system of salaried doctors, McDermott explained, to keep sending them patients in need of surgery or other expensive procedures.

      “It’s possible hospital groups can reduce costs,” the congressman said, “but I look at the consolidations going on and ask myself, ‘Are we going to wind up with hospitals that are too big to fail? Are we going to have hospitals so powerful that we cannot not give them what they want?’ It’s going to be the government against the medical-industrial complex, which is developing very rapidly. If the Little Sisters of Providence [his fanciful example] become a conglomerate and the government says you should close some of your hospitals, they will say, Who says?”

      Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

      by divineorder on Sun Dec 08, 2013 at 10:00:10 AM PST

      [ Parent ]

      •  I don't think this is exactly right (1+ / 0-)
        Recommended by:
        divineorder
        Don't blame him though making enough money to keep his practice profitable in Austin TX required several nurses, physician assistant, nurse practitioners all keeping appointments short, quick and flowing along for insurance claims.
        I certainly don't blame him for wanting to make more money. But he doesn't have to have PA's and NP's to keep his practice profitable. He hires them to either be more profitable or to work less.

        You want proof? Your new doc is practicing only taking medicare, and I have no doubt his practice is profitable. Your old doc has weeded out the less profitable patients (including medicare patients) in order to make more money, not in order to remain profitable.

      •  I'd guess (1+ / 0-)
        Recommended by:
        Tonedevil

        that several of the staff members do nothing but process insurance forms.

        (Is it time for the pitchforks and torches yet?)

        by PJEvans on Sun Dec 08, 2013 at 01:32:58 PM PST

        [ Parent ]

    •  There is already at least a three-tier system (1+ / 0-)
      Recommended by:
      PJEvans

      First of all, the wealthy have and will always be able to pay for perq-ier coverage.

      Then there is the vast middle--the insured, essentially.

      Finally, there is a third group of non-wealthy, non-insured who, prior to the ACA, had few options other than charity care.  This group now has improved access to health care.

      "Well, I'm sure I'd feel much worse if I weren't under such heavy sedation..."--David St. Hubbins

      by Old Left Good Left on Sun Dec 08, 2013 at 12:48:46 PM PST

      [ Parent ]

    •  I have been asking since the days of drafting (2+ / 0-)
      Recommended by:
      coffeetalk, Cassandra Waites

      the ACA, who is going to care for the expanded group of Medicaid patients? Few physicians in my area will take Medicaid patients now and those on Medicaid have a very difficult time obtaining access to care. What happens when the population of Medicaid patients dramatically expands? Who will care for them?

      "let's talk about that"

      by VClib on Sun Dec 08, 2013 at 02:07:26 PM PST

      [ Parent ]

    •  I lost my doctor to concierge medicine (2+ / 0-)
      Recommended by:
      VClib, Tonedevil

      a decade ago.  
      Fabulous doctor, loved practicing medicine, but hated...absolutely hated insurance and what it made him do.
      Unwilling to have a 1500 patient list, unwilling to negotiate every year with the various plans, unwilling to invest so much time in the games insurance companies play over getting paid, unwilling to compromise his practice of medicine as dictated by some cost accountant he found a way to practice medicine as a doctor.
      Best doctor I ever had, but I understood completely

      "Searches with nonspecific warrants were ‘the single immediate cause of the American Revolution.’” Justice Wm. Brennan, referring to the 4th Amendment

      by Nailbanger on Sun Dec 08, 2013 at 02:35:26 PM PST

      [ Parent ]

    •  Not necessarily the "top" doctors (0+ / 0-)

      The most money-hungry ones.



      Women create the entire labor force.
      ---------------------------------------------
      Sympathy is the strongest instinct in human nature. - Charles Darwin

      by splashy on Sun Dec 08, 2013 at 05:41:19 PM PST

      [ Parent ]

    •  Part of pop culture even (0+ / 0-)

      with it's own TV show - and a title quite fitting to these types - "Royal Pains" ...

      “Those who can make you believe absurdities, can make you commit atrocities.” ... Voltaire

      by RUNDOWN on Mon Dec 09, 2013 at 12:21:51 AM PST

      [ Parent ]

  •  "What Makes You Think You Can Live Forever? (12+ / 0-)

    Steve Martin - "What makes you think you can live forever?
    Lily Tomlin - "Because I'm rich."
    -All Of Me (1984)

    Men are so necessarily mad, that not to be mad would amount to another form of madness. -Pascal

    by bernardpliers on Sun Dec 08, 2013 at 08:55:09 AM PST

    •  Actually, I'm all for billionaires pursuing (10+ / 0-)

      radical life extension.  Simply because some rich rat is paying for research doesn't mean it won't benefit the masses on its own inertia, or that government intervention later on couldn't extend the benefits to those that slip through the craps.  If ConEd and Westinghouse couldn't keep electricity out of the hands of the unwashed, what makes you think Larry Ellison can deny people immortality if it's achievable?

      •  Absolutely true (9+ / 0-)

        Much of the DNA work being done for cancer treatment is, in part, funded by very wealthy folks with family who have cancer.

        •  And we needn't count on altruism (0+ / 0-)

          Even self-centered altruism.  Sheer greed and simple math will ensure that most any feasible innovation in most any area be made as widely available as possible.  You can't gouge a wage slave if he can't even bury himself in debt to buy your wares.

          •  rduran - who would pay? (1+ / 0-)
            Recommended by:
            coffeetalk

            Ninety percent of the cost of bringing a new therapy into wide practice occurs after the initial scientific discovery. And most of those discoveries fail as they are subjected to more complex human trials. Today government funds many of the inventions but private industry provides the 90% and takes the losses of the therapies that fail. Under your model where would all the risk capital come from?

            "let's talk about that"

            by VClib on Sun Dec 08, 2013 at 03:39:54 PM PST

            [ Parent ]

            •  Not sure what you're asking (1+ / 0-)
              Recommended by:
              VClib

              I'm not proposing any new model.  I'm just saying it's unlikely that a practical application in the area of life extension would result in Elysium-style hoarding by the rich.  You'd run out of customers pretty quickly.

      •  Probably the opposite (0+ / 0-)

        as wealthy customers drive up the costs of critical medical services.

        Think Organ Transplants.

        Really makes you wonder is someone like Cheney really waited "his turn" on that donor list.

        “Those who can make you believe absurdities, can make you commit atrocities.” ... Voltaire

        by RUNDOWN on Mon Dec 09, 2013 at 12:24:45 AM PST

        [ Parent ]

        •  The wealthy don't drive up the costs (0+ / 0-)

          of organ transplants.  Cost is driven by the fact that particularly donor material is scarce and the associated procedure is so rarely conducted.  Unless life extension innovation is bottlenecked by the need to acquire organ and tissue donations (which sort of defeats the purpose), then there's no reason to suspect it won't be come widely available.

  •  Thanks for the link to funding single payer (12+ / 0-)

    The spirit of liberty is the spirit which is not too sure that it is right. -- Judge Learned Hand, May 21, 1944

    by ybruti on Sun Dec 08, 2013 at 08:55:10 AM PST

    •  Yes, please share that far and wide! n/t (4+ / 0-)
      •  Yes, thanks! Would also like to suggest (2+ / 0-)
        Recommended by:
        Most Awesome Nana, barbwires
        A perspective on the relationship between national and state single-payer efforts

        By Steffie Woolhandler, M.D., and David Himmelstein, M.D.

        PNHP note: The following article was among the materials distributed to participants at PNHP’s Annual Meeting in Boston on Nov. 2, 2013.ingle-payer efforts


        Opportunities

        1. In some locales, the apparently lower bar to state single-payer legislation is facilitating mobilization of activists who might be daunted by the scale and seemingly dim prospects for congressional action.

        2. State-based efforts empower local leadership. Such local leadership is critical to development of a nationwide movement.

        3. Media outlets are often more willing to cover state-based efforts, both because they view such efforts as more feasible and because attention to local issues and personalities is a central focus of local media.

        4. State legislators and local politicians who become single-payer supporters influence, and sometimes themselves become, U.S. representatives and senators.

        5. State programs can be tailored to address local problems, e.g. thorny rural health issues.

        6. Some feel that a state program may avoid some of baggage of Washington-based lobbying and rule making. The Affordable Care Act, flawed from the outset, has been further compromised in HHS’ rule-making process, which has bent to corporate pressures.

        7. Many point to the Saskatchewan example of state- (or province-) level reform that served as a springboard to national legislation.

        Move Single Payer Forward? Join 18,000 Doctors of PNHP and 185,000 member National Nurses United

        by divineorder on Sun Dec 08, 2013 at 10:06:17 AM PST

        [ Parent ]

  •  I never expect to see Paris Hilton or Donald Trump (5+ / 0-)

    at my clinic.

    I'll tell you right out, I am a man who likes talking to a man who likes to talk. - Kasper Gutman

    by rasbobbo on Sun Dec 08, 2013 at 08:57:47 AM PST

  •  The money (11+ / 0-)

    spent by one of the wealthy using these doctors would pay the medical for how many of us commoners? It's amazing how so much of this country thinks our wealth disparity is OK. The propagandists have done their jobs well.  

    "If fighting for a more equal and equitable distribution of the wealth of this country is socialistic, I stand guilty of being a socialist." Walter Reuther

    by fugwb on Sun Dec 08, 2013 at 08:58:31 AM PST

  •  My PCP just flitted off to one of these (6+ / 0-)

    apparently the up and coming thing among specialists in Internal medicine. I think the annual fee is $5000.

  •  I'm sure the wealthy in the US live longer (9+ / 0-)

    than poorer people elsewhere.

    •  Doubtful that wealthy in US live longer than (9+ / 0-)

      many in 'blue zones' who live low-stress lives in warm climates with healthier diets and have access to basic health care from birth to grave. Yes, it's possible, but not necessarily guaranteed.

      •  Well off, educated people have healthy diets, (6+ / 0-)

        exercise, have access to healthcare, don't face the biggest stressor, which is financial problems. I am pretty sure that for 40% of Americans, the life span is equivalent to about everywhere else in the world. Warm climate is not related to life expectancy. That is an easy one to check out: http://en.wikipedia.org/...
        And the most "stressed out" country of all, Japan, has the longest life span.

        "You can die for Freedom, you just can't exercise it"

        by shmuelman on Sun Dec 08, 2013 at 09:22:09 AM PST

        [ Parent ]

        •  True, but Japanese still work fewer hours than (4+ / 0-)

          us..

        •  Ironically, Nelson Mandela spent (5+ / 0-)

          27 years in prison, much of it at hard labor, and still lived to 95 1/2.  

          I was wise enough to never grow up while fooling most people into believing I had. - Margaret Mead

          by fayea on Sun Dec 08, 2013 at 09:32:48 AM PST

          [ Parent ]

        •  That's a pretty large blanket you just threw. (1+ / 0-)
          Recommended by:
          nancyjones

          That isn't necessarily true. Predators are under a lot of stress to stay predators so they won't become prey.

          Example: There was a recent article that financial professionals are starting to kick off at startling low ages from their late 20s to the early 40s from coronary problems because the jobs are pressure cookers,.  

          The idea that money guarantees long life , healthy eating , fresher breath , and whiter teeth isn't a given. It may have been in the past,  but these days those with large a net worth may have liquidity problems that are unfathomable to the unwashed masses who are called broke deadbeats when they can't pay their bills and the wealthy broke are referred to as "good people with a small liquidity problem".  Why? Even Forbes magazine acknowledged those high net worth individuals have put on a large amount of leverage to reach a certain level of paper wealth.

           It can actually be more stressful for people who have more wealth on paper than they do actual liquidity, than people who have less or none.

          Getting  margin calls that can't be paid from their brokers or losing their 5-50 million dollar house to foreclosure may not happen as often until we have another  down market, but that doesn't mean the stress levels are any less . The biggest worry people who show  loads of wealth is having to live like the the bottom earners of society.

          That's why people who have money are starting to quietly kick the bucket at ages most lives are just getting started. With great deal of stress comes death regardless of what one is eating.

          We are now living in a society of predators and prey. A predator is always worried he or she may become prey  as they take wild chances to keep up with their peer groups.

          If or when a fed chairman comes out and says very specifically they are not going to prop the markets any more as their balance sheet has grown uncomfortably large with way too much shaky collateral, (or they can no longer hide the fact that inflation is far more than what they have stated) high net worth highly leveraged households will come up apart like a cheap suit.  

          People worry about that. At the same time they worry about keeping their place and moving up in the pecking order. Those wishes are at odds with each other and cause massive stress levels.  There is danger  in never finding satisfaction based on the acquisition of material wealth.

          Once stress levels reach certain levels, particularly negative stress, there isn't much of a money cushion between life and death as money really won't have much say in the matter.

          Death come for everybody. It's very random at first, then when it goes from an abstract concept to a very big reality it rarely distinguishes between those who have money and those who don't.  But the wealthy will always pay through the nose because they believe with all they have that money equals longevity.

          “ Success has a great tendency to conceal and throw a veil over the evil of men. ” — Demosthenes

          by Dburn on Sun Dec 08, 2013 at 03:45:37 PM PST

          [ Parent ]

      •  As a group, they definitely do. (4+ / 0-)

        As has been noted here many times, almost all of the gains in US life expectancy in the past century come from two sources: lower infant mortality, which at least has some reach across the income spectrum, and the healthier lifestyles of the upper classes.

        While I am sure that people who live in "blue zones" have a much longer life expectancy than average Americans, I am willing to bet that they do no better than the top quintile of Americans. And that's not even that wealthy, but it's wealthy enough to buy a decent diet, time and opportunity for exercise and leisure, and health insurance that affords decent care and some choice of doctors.

        "The only thing we have to fear is fear itself."........ "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." (yeah, same guy.)

        by sidnora on Sun Dec 08, 2013 at 09:31:50 AM PST

        [ Parent ]

  •  Well it costs to have your doc pretend to be your (13+ / 0-)

    best friend, shrink, priest or Rabbi, and Mom too. What do you expect?

  •  Billionaire life expectancy (10+ / 0-)

    I sincerely doubt the poor in most any country are statistically likely to outlive billionaires in this one, not when there is so much research confirming what we already know: the wealthy live longer and healthier.

    American life expectancy compares so unfavorably precisely because this country abandons the poor to crappy living conditions and denies them access to health care.  And this state of affairs persists because for at least 50+1 out of a 100 Americans, the system actually works (in the crudest sense, at least).

    •  Interesting chart! n/t (2+ / 0-)
      Recommended by:
      rduran, Most Awesome Nana
    •  Thanks for some intelligence. I am shocked that (4+ / 0-)

      some people at DailyKos do not actually understand the true enormity of the bifurcation of wealth in the US, which has an embedded third world country in its midst. Some of the the largest factors that affect life expectancy, like teen suicide, violent death, morbid obesity, poor nutrition and child mortality are wildly disproportionate for the poor in this country. You really don't want to be in the bottom economic 40% in America, you literally pay with your life.

      "You can die for Freedom, you just can't exercise it"

      by shmuelman on Sun Dec 08, 2013 at 10:10:24 AM PST

      [ Parent ]

      •  I suspect the numbers are dragged even (2+ / 0-)
        Recommended by:
        shmuelman, Cassandra Waites

        lower by the bottom twenty percent.  While there is likely some noticeable difference in health outcomes between folks living 150 percent above poverty and those right on the median income line, it probably pales in comparison to those living in poverty and below.  This is why selling any one step to better health outcomes is hard; it's so easy to play divide and conquer when each is tailored to improve conditions for only a small slice of the situation.  So we reach for omnibus solutions which we hope will gain enough support to outstrip the opposition.  It's not a terribly elegant way of doing business, but it's a political fact of life.

    •  I think more to do with average American's habits. (2+ / 0-)
      Recommended by:
      rduran, mattc129

      Just look at any crowd of people...malls, on the street, airports, etc.

      Our weight is a major health problem. All the high fat, fried foods and extra large portions cause many of our health problems.

      While many poor may not have access to fresh fruits and veggies, the majority of us do, but don't take advantage.  

      I  do not think McDonalds and Burger King have much to worry about. Nothing like a double bacon cheeseburger. Oh yes, and don't forget the large fries and big gulp.

      This is the diet of middle class America.

      It’s the Supreme Court, stupid! Followed by: It's always the Supreme Court! Progressives will win only when we convince a majority that they, too, are Progressive.

      by auapplemac on Sun Dec 08, 2013 at 12:17:38 PM PST

      [ Parent ]

      •  Also agreed (0+ / 0-)

        And while there is a significant relationship between the bifurcation of wealth and obesity, race is a stronger correlate and even then white, upper income, and male obesity in the US outpaces the average in other OECD countries.  However, the wealthier half of our population still enjoys comparable life expectancy to the typical resident of comparably rich countries.  

        America faces more than one problem--obesity is a product of our choices concerning agricultural industrialization as well as eating habits--but income inequality still plays a major role.

  •  Hopefully Pathological Rich Grow More Paranoid (3+ / 0-)
    Recommended by:
    james321, 88kathy, Most Awesome Nana

    and distrust even the elite medical system they have set up.

     Of course this is just before all the pathological gun owners figure out that the other gun owners are out to get them and blast each other away at gun conventions.  

    While we are at it, would be nice to see senior Waltons and Kochs prematurely declared incompetent by their children and taking all their money to return it to the poor and deserving.

  •  That reminds me. I saw my old copy of the (2+ / 0-)
    Recommended by:
    james321, Most Awesome Nana

    "Russian Reader" the other day, when I was moving stuff around. I need to bring that out for a little light reading.

    You can't make this stuff up.

    by David54 on Sun Dec 08, 2013 at 09:14:02 AM PST

  •  Two advantages of this system (5+ / 0-)

    1. Money fleeced from the working people by the wealthy is fleeced back from them by working people. In this case, medical workers.

    2. Any medical advances discovered by this high-end treatment will most definitely work its way down to the masses -- much like combustion engine technology was driven by race cars.

    The wealthy will always have their advantages. It's the point of being wealthy. We just have to make sure that there is sufficiently mobility upwards for those who are not wealthy

    •  Sounds a bit like trickle down theory? ;) (3+ / 0-)
    •  Exactly-- this is a story of how the wealthy... (6+ / 0-)

      ...waste their money.  I don't see anything that terrible about it.

      It's not the side effects of the cocaine/I'm thinking that it must be love

      by Rich in PA on Sun Dec 08, 2013 at 09:28:28 AM PST

      [ Parent ]

    •  I doubt there will be discoveries (8+ / 0-)

      resultant from this high-end treatment.  These doctors will not be running double blinded controlled studies.  They may produce a few anecdotes, but anecdotes don't advance medicine much, if at all.

      I was wise enough to never grow up while fooling most people into believing I had. - Margaret Mead

      by fayea on Sun Dec 08, 2013 at 09:36:28 AM PST

      [ Parent ]

    •  I wish I were as optimistic (6+ / 0-)

      about both your points.

      On point one, doctors who take this career path see themselves as members of the class they'll be serving, not clever workers fleecing the rich.
      This is based on greed. My PCP, who is an interesting guy, a self-described "independent" who loves to talk politics with me, who treats both Medicaid and Medicare patients (like me), and who believes we should have single-payer, tells me that most doctors are Republicans. By which I assume that most doctors of his lifestyle and acquaintance, who are not young and live in the nicer NYC suburbs, are Republicans.

      On point two, treatment advances are often obscenely profitable for the businesses that develop them. There are cancer drugs that cost tens of thousands of dollars for each individual treatment. I don't think Big pHarma is about to make that available to the masses, unless they are forced to do so. And by the time they do, they'll have already come up with a newer, more effective treatment they can charge a lifetime's earnings for.

      "The only thing we have to fear is fear itself."........ "The test of our progress is not whether we add more to the abundance of those who have much; it is whether we provide enough for those who have too little." (yeah, same guy.)

      by sidnora on Sun Dec 08, 2013 at 09:42:44 AM PST

      [ Parent ]

  •  Elvis and Michael both had personal DRs. Having (10+ / 0-)

    a DR paid to say what you want to hear isn't much better than not having a DR at all.

    However, there are probably people alive today who will never die.

    Why is it easier to buy a gun than it is to register to vote in most states?

    by 88kathy on Sun Dec 08, 2013 at 09:30:15 AM PST

  •  Let them spend their money (5+ / 0-)

    on this.  They're gonna spend it on something, why not concierge doctors?  They already they do, so it should not come as a surprise.

    Who care???

    11:11 being mindful and keepin' it real

    by Raggedy Ann on Sun Dec 08, 2013 at 09:34:54 AM PST

  •  Majority of physicians under 40 are employees (7+ / 0-)
    The business transformation under way in healthcare involves the consolidation of hospitals, doctors and insurance companies in freestanding “integrated delivery systems”—nonprofit and profit-seeking—that will have the operating scope and power to eliminate duplications and waste and hold down costs, especially the incomes of primary-care doctors. Major hospitals are buying up other hospitals and private practices, and they’re hiring younger doctors as salaried employees. An  American Medical Association survey in 2012 found that a majority of doctors under 40 are employees, no longer independent practitioners.

    “The medical-industrial complex is putting itself together so that the docs will be the least of our problem,” McDermott said. “They will simply be serfs working for the system.”  The AMA’s market research reports that “hospitals focus on employing primary-care physicians in order to maintain a strong referral base for high-margin specialty service lines.” Big hospitals need a feeder system of salaried doctors, McDermott explained, to keep sending them patients in need of surgery or other expensive procedures.

    The Nation: How to Revive the Fight for Single Payer

    This is obviously separate and apart from the Concierge Medicine on Steroids that is the focus of this diary, but it does have implications. The "employee doctors" are going to have more opportunities to compare notes and develop "best practices." The Concierge doctors obviously won't allow themselves to be left behind and comparatively appear to be applying leaches and reading entrails, but for some people it may call into question just who the "best" doctors are.

    Change does not roll in on the wheels of inevitability, but comes through continuous struggle. --Martin Luther King Jr.

    by Egalitare on Sun Dec 08, 2013 at 09:35:25 AM PST

  •  Pretty funny... (7+ / 0-)

    $25,000/year isn't  much more than I was paying for health insurance a couple of years ago.

  •  Rich pricks all need a good dose of the clap (1+ / 0-)
    Recommended by:
    james321

    and the flu.  Dripping from all orifices would be my order of the day for them.  Disgusting and immoral junk the whole lot of them.

  •  As a family doc, I can tell you that this kind... (25+ / 0-)

    ..of obscenely expensive 'concierge medicine' is not only a moral abomination (seeing as how working poor taxpayers heavily subsidized the education of the shameless physicians catering to the whims of the rich);

    ...it's not only hugely wasteful of resources;

    ...it's not only very unlikely to extend the life expectancy of these anxious plutocrats much at all;

    ...but it's potentially dangerous to the wealthy subjects of this pampering!

    It's like this: the science of medicine is pretty straightforward. Some interventions (like immunizations, or antibiotics for pneumonia, or controlling blood pressure to prevent strokes) have been proven to be highly effective at prolonging life expectancy and preventing premature death. And we do our best to make such things available to everyone, within the egregious shortcomings of American's healthcare system.

    Some interventions, like PSA screening for prostate cancer, are of questionable benefit if any.

    And a surprising number of interventions are actively harmful. For example, screening for ovarian cancer in low risk women with ultrasound and CA-125 blood testing is actually hazardous, leading to many unnecessary biopsies and risky operations without any reduction in the death rate from ovarian cancer.

    Many if not all of the costly non-standard interventions offered by concierge physicians, and in particular the numerous 'anti-aging' treatments (growth hormone supplements, androgen replacement, etc.) are in fact more likely to cause harm than benefit. They may increase the risk of cancers. "Screening" CT scans expose patients to hazardous radiation doses without commensurate benefit. MRI's frequently find trivial age-related abnormalities whose diagnosis is not just irrelevant to longevity but actively hazardous, because it tempts physicians and patients to embark on therapies with risks and side effects for little if any benefit.

    So, concierge medicine is lose/lose/lose: it is morally squalid, wasteful of resources, and ineffective.

    •  I really wish you had your own fucking forum (5+ / 0-)

      on this site, your posts make that much sense.

      Agree with you 1000% about the 'moral abomination' aspect of this and defer gladly to you on the science and mortality statistics.

    •  Well put, Doc. n/t (4+ / 0-)

      "May the forces of evil become confused on the way to your house." - George Carlin

      by Most Awesome Nana on Sun Dec 08, 2013 at 10:55:57 AM PST

      [ Parent ]

    •  I wondered about effectiveness (1+ / 0-)
      Recommended by:
      Egalitare

      There does seem to be a point of diminishing returns, where "more health care" does not equate to "better health." I suppose if you have way too much money, you'd be tempted to use it to try to buy immortality, or at least pain-free living, as Michael Jackson so tragically did. But judging by the appearance and tragic deaths of so many rich people, it doesn't seem very effective.

      •  That is precisely correct. (3+ / 0-)
        Recommended by:
        nancyjones, leevank, Egalitare

        "More care" is absolutely not equivalent to "better care". Quite the contrary; past the point of 'enough', medical care very quickly becomes counter-productive. The more testing you do, the more trivial abnormalities you find that compel you do do even more testing to run that abnormality down, finding even more trivial abnormalities that persuade you to fix that hiatal hernia and start medication for the resulting chronic pain, which causes some kidney damage, which....

        True factoid: doctors in Israel went on strike about 25 years back. And the mortality rate promptly dropped by a measurable amount. This was presumably because of the sudden absence of elective surgeries and complications, but still.

    •  How many concierge doctors can make a living? (0+ / 0-)

      At $25,000 a year, only one percent of the population could afford it and not all of them would want it.  It seems to me that the vast majority of doctors would have a really tiny patient load if they tried to go for this model. They would  not make enough  to pay for office space and staff.

  •  The assumptions in this article are off target. (3+ / 0-)
    Recommended by:
    misslegalbeagle, Hope08, VClib
    The irony is, of course, that Americans (Manhattan billionaires, included) already live shorter lives than many poorer people in the world
    First of all, I would like to see some proof that the wealthy or well-off in America have decreased life expectancy compared to anywhere in the world. It shouldn't take much research. Same for the abysmal child mortality rates in America. It doesn't apply to people who are educated and have access to healthcare. My daughter's complicated pregnancy and birth cost nearly $40K and resulted in a healthy mother and child.
    It's tough not to laugh at the naive thinking of these individuals: cancer doesn't discriminate between the banker and the pauper, nor does the heart attack or the stroke.
    Anyone can get cancer or a heart attack, obviously. But inferring that being obese because of high carb/sugar diets, or opting to eat McDonalds rather than fresh fruits and vegetables because you have $2 for dinner, not having access to routine screening like PAP smears, prostate exams, etc, and taking early intervention before you are at Stage IV are not critical factors that separate the well-off/educated from the poor is wrong.

    In fact, the implication that rich people are like poor people except more foolish and narcissistic is absurd. People are wealthier, by and large, because they are more educated, grew up in more educated environment, are able to deal with complexity and life in a more methodical fashion. It helps if your parents made the money for you, but still, growing up around wealth means you have a much better understanding of how  how the world works and what money can and cannot buy. Maybe someone is delusional and thinks they can beat The Reaper, but if you can afford $125,000 to buy a healthy kidney (not related to concierge practice) maybe you can put the inevitable off.

    The doctors I know who have moved into a concierge practice, who are charging say $1800 - $2500 / year have done it because they are burned out on the third-party insurance system and the cost and time of doing paperwork, as well as having large patient loads (they are closer to retirement). Remember, this amount is less than you pay for private insurance, which you need anyway to cover hospitalization, and assures you both convenience and being able to attend a much smaller practice.

    "You can die for Freedom, you just can't exercise it"

    by shmuelman on Sun Dec 08, 2013 at 10:00:45 AM PST

    •  how do "the doctors you know" generally feel (0+ / 0-)

      about health care reform or single payer?

      Through early morning fog I see visions of the things to be the pains that are withheld for me I realize and I can see...

      by Keith930 on Sun Dec 08, 2013 at 10:15:47 AM PST

      [ Parent ]

      •  I couldn't say. (0+ / 0-)

        The doctors I know now are specialists in the hospital and I need to avoid conversations that may get "political." I know they are working their butts off, but they do make big money.

        "You can die for Freedom, you just can't exercise it"

        by shmuelman on Sun Dec 08, 2013 at 10:39:54 AM PST

        [ Parent ]

  •  Longer lives (2+ / 0-)
    Recommended by:
    Nattiq, Pablo Bocanegra

    if they survive the revolution, that is.

    The only meaning you get from much of what you read is what you read between the lines.

    by Publius2008 on Sun Dec 08, 2013 at 10:18:29 AM PST

  •  Save some money (6+ / 0-)

    and just follow the research that the Internet has done a good job of publicizing over the last decade:

    1.  Maintain a healthy weight.  BMI measures are overrated;  you know what a healthy weight for your body type is.

    2.  Eat healthy foods; you know what they are.

    3.  Don't use tobacco.

    4.  Get some exercise every day.  Doesn't really matter what it is as long as it gets you moving and gets your heart rate up.

    5.  Find ways that work for you to control your stress.

    Then just use your doctor to help with the much smaller set of problems that are left over.

    •  6. Advocate for good public health measures (3+ / 0-)

      like not allowing fracking near drinking water supplies, labelling GMO food (or outlawing it altogether), eliminating government subsidies to meat and junk food producers, etc. We can't achieve good health entirely on an individual basis, because the ecosystem we live in flows through our veins and organs.

      and 7. Wear your seatbelt every single time, and if you bike or ride a motorcycle or ATV, wear a helmet every single time.

      and 8. Don't drink more than "in moderation" (which is a lot less than many people think it is), and don't ever get into a car when the driver has been drinking.

      and 9. Do not have a gun in your house, unless it is unloaded in a double-locked cabinet with the ammunition stored off-site.

  •  I don't think we should stop this. (3+ / 0-)

    I think, like the diarist seems to, it just further brightens the glare of inadequate care for all citizens.

    We really don't need to see a doc all the time anyway...widespread access to NP's or PA's that can Dx and prescribe medicines would be a huge help.

    While you dream of Utopia, we're here on Earth, getting things done.

    by GoGoGoEverton on Sun Dec 08, 2013 at 10:32:27 AM PST

    •  Totally agree. (3+ / 0-)

      I have two chronic conditions - high blood pressure and hypothyroidism - that I have been controlling for 50 years. I almost never seen my doctor. She has an extremely competent PA whom I trust.

      If anything else happens, then I can see the doc (which hasn't happened in more than 2 years!).

      I believe that if you are reasonably healthy, know your own body and how it reacts, you have no need of a doctor. They will only want lots of tests and look for something else to treat.

      Use the KISS system and life gets easier.

      BTW - excellent and necessary diary. Thanks.

      "May the forces of evil become confused on the way to your house." - George Carlin

      by Most Awesome Nana on Sun Dec 08, 2013 at 11:05:33 AM PST

      [ Parent ]

  •  Some stories make me ashamed to be (1+ / 0-)
    Recommended by:
    greengemini

    a Californian, some ashamed to be an American and some ashamed to call myself a member of the human race. This story, I fear, falls into the latter category.

    How sad is it that health care providers are trapped in a system where they feel they can make their greatest contribution and reap the greatest rewards by providing aid and comfort to the parasite class at the expense of producers?

    No offense to parasites in the lower biological realms, as they actually perform a very important function, unlike their hominid variants.

  •  My former internist was going to go concierge (5+ / 0-)

    His entire group was going to charge $2,000 per patient per year to provide pretty much unlimited primary care.  Of course, you'd still need insurance in the event you had to be hospitalized or needed care from a specialist, so my wife and I (and a lot of other patients) left the practice.  Eventually, so did several other patients.  The irony is that after seeing the reaction among their patients, and seeing legal questions being asked about whether this was really a form of insurance that was subject to regulation by the Insurance Commissioner, most of them decided not to go the concierge medicine route after all.

    It seems to me that the only patients this would be good for are wealthy hypochondriacs who think they need to see the doctor every time they get a cold, or mildly twist their ankle, or have indigestion.  

    Bin Laden is dead. GM and Chrysler are alive.

    by leevank on Sun Dec 08, 2013 at 10:35:58 AM PST

  •  I think we're approaching pitchforks (3+ / 0-)

    At least at a faster pace than before I read this diary.

    May they all reap what they are all sowing.

    'snakes as you know have a mortal fear of.........tile'

    by OneCharmingBastard on Sun Dec 08, 2013 at 10:42:00 AM PST

  •  As a medical technologist (ret) (4+ / 0-)

      The catch comes when these folks need something more than an office visit.   Sure some hospitals have VIP beds / floors, but that doesn't mean that hospital services are any better or worse than elsewhere in the facility.

       If these folks need a transfusion, no one in the transfusion lab gives a darn about who they are.   The last hospital I worked for had the typical problem of some nursing units ordered everything STAT.  

       The hospital finally came up with a process for "super stat" in which if the results were that critical, then a person had to hand deliver the specimen / request to the lab, wait for it to be processed, deliver it to the lab section for actual analysis and wait for the results.  While that may sound like no-big-deal, my hospital wouldn't overstaff for folks to be off the nursing unit for this process.

        For technical reasons ( one can't make a clock go faster on demand)  that process doesn't work in a Transfusion Laboratory but we were pretty amused when we received such a request.

        So while concierge medicine may see a temporary boom, once these wealthy folks need additional medical treatment, they may be disappointed.

       

  •  What is the real quality of this care? (3+ / 0-)

    I think the real irony here is that there is no evidence concierge medicine actually is of higher quality. Just because a doctor went to Harvard and Cornell tells you nothing. I had a colleague being treated for aggressive breast cancer 12 years ago at Johns Hopkins. She was 29 and the allegedly qualified physicians there not only failed to diagnose her pregnancy, they sent her to a psychiatrist for the "phantom" symptoms, because they were certain the chemotherapy had caused early menopause. The psychiatrist finally sent his receptionist out for an over-the-counter pregnancy test and correctly concluded the doctors were full of it.

    A government that denies gay men the right to bridal registry is a fascist state - Margaret Cho

    by CPT Doom on Sun Dec 08, 2013 at 11:19:36 AM PST

  •  palm itch (6+ / 0-)
     your palm’s itch is really the early sign of something rare and disfiguring?
     An old jewish superstition is that any itchy palm means you are coming into money.
      And for those Wall Street types it is disfiguring, but not rare.

    None are so hopelessly enslaved, as those who falsely believe they are free. The truth has been kept from the depth of their minds by masters who rule them with lies. -Johann von Goethe

    by gjohnsit on Sun Dec 08, 2013 at 11:23:55 AM PST

    •  WOW. Great pick up. Think that was intentional? (1+ / 0-)
      Recommended by:
      james321

      "There is no expedient to which man will not resort to avoid the true labor of thinking." -Sir Joshua Reynolds

      by New Jersey Boy on Sun Dec 08, 2013 at 12:39:13 PM PST

      [ Parent ]

    •  Not only an old Jewish superstition (0+ / 0-)

      My very gentile grandmother had superstitions about what it meant when just about anyplace on your body itched.  There was that one, and if your nose itched, it meant somebody was coming to visit.  Those are the only two I remember, but there were others.

      Right now, my lower legs itch, which means nothing more than we really need to get a humidifier.

      Bin Laden is dead. GM and Chrysler are alive.

      by leevank on Sun Dec 08, 2013 at 09:06:17 PM PST

      [ Parent ]

  •  Outside of lower Manhattan (3+ / 0-)
    Recommended by:
    james321, PJEvans, Cassandra Waites

    are there really enough of this clientele to support doctors opting out of insurance?

    Well, Washington, perhaps -- but the biggest likely offenders there are Congresscritters, who already have their own version of concierge service via the doc in the Capital plus Walter Reed Medical Center. Not sure what is going to happen to all that under the ACA mandate, but I assume they'll find some way to keep themselves from having to ever sit in a doctor's waiting room reading two-year-old magazines for two hours to get a ten-minute consult.

    •  Concord, Mass. (1+ / 0-)
      Recommended by:
      VClib

      It wasn't exactly a concierge practice, but it was the same general idea.

      Almost 20 years ago our favorite doctor left the joint practice that we still use and went out on his own. At my last physical with him he told me that he was tired of feeling pressure to keep appointments short. His plan was cash patients only so that he could have a simple doctor-patient relationship. He realized that this would pretty much mean only the "well-off" as patients. He was somewhat uncomfortable with that, but decided he needed to relax and practice medicine the way he thought he should.

  •  Diseases of the ... rich. (1+ / 0-)
    Recommended by:
    leevank

    In the introduction to his song In Old Mexico (1959), Tom Lehrer talks about a college friend who "majored in Animal Husbandry until they caught him at it, at which point he transferred to Medical School where he specialized in "diseases of the ... rich".  This allowed him to retire young."

    Better to hide your tax returns and be thought a crook than to release them and remove all doubt. [Adapted from Abraham Lincoln]

    by Caelian on Sun Dec 08, 2013 at 12:49:12 PM PST

  •  As long as these people pay for their private (2+ / 0-)
    Recommended by:
    james321, VClib

    doctors out of pocket, why does it matter for the rest of us?

    •  One reason it matters is that there is already ... (0+ / 0-)

      a shortage of primary care doctors, and every one of them who opts for a concierge practice reduces the number of them available to treat the majority of the population.

      Bin Laden is dead. GM and Chrysler are alive.

      by leevank on Sun Dec 08, 2013 at 09:08:31 PM PST

      [ Parent ]

      •  Not in NYC. There is shortage in rural areas. (0+ / 0-)

        And I don't see how we can force doctors to practice in a certain way. If we want more primary care doctors, we need to change how we pay doctors so a salary differential between a primary care doctor and an specialist becomes smaller.

        •  I agree with that, but I also think we should ... (1+ / 0-)
          Recommended by:
          FG

          consider conditioning a license to practice medicine upon accepting some percentage of non-rich patients into a practice.  I would suggest that a doctor licensed to practice not be permitted to refuse new Medicare or Medicaid patients until the constituted, for example, 10% of that doctor's practice.

          The problem with some doctors opting out of participating in these programs is that it forces all of the other docs to take a higher percentage of these patients, which puts even more pressure on the other docs.  And FWIW, I'd also require lawyers and other licensed professionals to take a certain number of non-paying, or low-paying clients or patients.

          Bin Laden is dead. GM and Chrysler are alive.

          by leevank on Sun Dec 08, 2013 at 10:46:21 PM PST

          [ Parent ]

          •  With lawyers it's a bit of a different story since (0+ / 0-)

            we are talking about pro bono cases. You could mandate a small percentage of hours (e.g. 5-10%) to be spent on pro bono cases. Doctors, however, are paid. While Medicaid pays worse than private insurance, the difference is not that huge. It's probably more productive to use economic measures rather than mandates to make sure enough doctors accept Medicaid. With Medicare it's usually not a huge issue as it pays better and there are more people using it.

  •  One big problem we have in medicine in the US is (4+ / 0-)

    the artificial limitations placed on the numbers of physicians.  Sure, we do allow a few in from outside the US, but access is generally very, very restricted and we have high limits to the number of spots in US med schools.  Meanwhile, we have more lawyers than anyone knows what to do with.

    This needs to be opened up.  There are thousands of qualified applicants out there.

    •  Amen! nt (0+ / 0-)

      "The object of persecution is persecution. The object of torture is torture. The object of power is power. Now do you begin to understand me?" ~Orwell, "1984"

      by Lily O Lady on Sun Dec 08, 2013 at 02:27:03 PM PST

      [ Parent ]

    •  And the process is EXTREMELY onerous ... (0+ / 0-)

      for docs who are already specialty-trained.  I had the world's best-trained ophthalmology technician recently at a major teaching hospital.  She had gone all the way through medical school and an ophthalmology residency in her country, and had practiced ophthalmology there for several years, but to be an ophthalmologist here, she's got to not only pass the medical licensing examinations, but also do another complete internship and residency.  I don't question but that our training is probably better here than in most developing countries (which is where she was from), but  it seems that the process could be shortened at least somewhat.

      Bin Laden is dead. GM and Chrysler are alive.

      by leevank on Sun Dec 08, 2013 at 09:15:10 PM PST

      [ Parent ]

  •  but how does sharing a few doctors work? (4+ / 0-)

    How many doctors are splitting the $10,000,000 from the 400 patients paying $25,000 each? Maybe 5? Who will pay $25,000 a year but wealthy hypochondriacs? I bet a lot of them will end up being disappointed. For that kind of money they will expect a doctor to make a house call within 20 minutes for a cough. If even 5%  of their patients feel sick on the same day, there won't be time for hour long house calls.

  •  No one has mentioned "fools and their money..." (1+ / 0-)
    Recommended by:
    leevank

    yet?

  •  those doctors better get after it (0+ / 0-)

    It's gonna take a WHOLE LOTTA research to find a cure for torches and pitchforks.

    "Some of you are going to die... martyrs, of course, to the Freedom that I will provide!"

    by emperor nobody on Sun Dec 08, 2013 at 03:40:37 PM PST

  •  The weird thing is (0+ / 0-)

    They don't seem to realize that having healthy people around them is the best thing they can do. Making sure that everyone in the city and country is as healthy as possible makes their health better, because they will be exposed to far less disease and unhappiness in their world.

    They don't get that we are all in this together, and that's the problem.



    Women create the entire labor force.
    ---------------------------------------------
    Sympathy is the strongest instinct in human nature. - Charles Darwin

    by splashy on Sun Dec 08, 2013 at 05:35:58 PM PST

  •  Plutocrat investment in cryonics/life extension (0+ / 0-)

    Very good post, with the exception of the author's assertion about billionaire life spans.  The author really should back that up with some data, if such data exist.

    One thing that has puzzled me is why so few of the major plutocrats in our country have invested resources in cryonics or life extension technology.  Cryonics aims to preserve the information that makes us what we are after bodily death, in the hope that it may later be restored to either a repaired body or a new vessel.  Life extension tech aims to keep people alive much longer than is now considered possible.  

    If there is one generalization that can be made about the .1%, it is that they think very highly of themselves.  It must be fairly absurd for them to realize that everything that they are - decades of knowledge and experience and business acumen and drive - will vanish when a lowly blood vessel ruptures or when the heart fails to pump properly.  It must strike them as even more absurd to consider that this is certain to happen, even though they have advance notice of the various potential causes of "hardware" failure.

    So why hasn't Bill Gates or Paul Allen or Donald Trump or the octogenarian Sheldon Adelson or the Koch Brothers invested a billion in these fields?  For the most part, these greying men aren't religious.  They probably don't believe that they will be shuttled off to an afterlife.  So these technologies might be the only chance they have to perpetuate themselves.  So you would think that the egos of these men alone would drive a major investment.  

    But it really hasn't worked out that way.  They spend vast amounts on gold-plated health care for themselves and their families, but they seem resigned to perishing after 70-90 years.  To my knowledge, the only billionaire who has invested in this area is Peter Thiel.  

  •  concierge medicine has been in Boston a long time (0+ / 0-)

    a group called Health Care For All was protesting concierge medicine ten years ago

    hmmm... I just realized the word concierge breaks the "i before e except after c" rule

    Politics is like driving. To go backward put it in R. To go forward put it in D.
    Drop by The Grieving Room on Monday nights for support in dealing with grief.

    by TrueBlueMajority on Fri Dec 13, 2013 at 08:37:12 AM PST

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