It's called Boutique, or Retainer based Medical Practice.
Let's talk about the principle that medical care should be a public service that is not dependent on wealth, but available to all citizens. Medicare is often cited as an example of the ideal of publicly funded single payer system that works.
First of all, let me squelch the thought that this diary is for a continuation of private insurance based medical industry, the defects of which were well stated in this recommended diary.
I have been on Medicare for going on five years now. After moving to coastal Southern California, a decade ago, only after being assured that my wife and I could get private insurance........(a close call since once I had taken Valium!) we found a GP that we both liked.
It was not to last. Soon after we started seeing him he sent out what he called a questionnaire, really a push poll to soften up his client for what to come. In order to ensure that each person get the attention they deserve he was going to limit his number of patients to one thousand. And to be among the lucky ones, all that is required is an annual fee of $1,800.
And for this, you get a guarantee of next day appointments, and an annual examination. Now here's the crucial point that is rarely made clear when describing similar set ups. There are groups of doctors that set up their own comprehensive practice, that includes general treatment along with some specialists for a fixed fee. That is NOT boutique Medicine.
Boutique practices act as a conduit and an interface with insurance entities, both private and public(medicare). So, even though you have spent the $1800 fee, when you see your doctor for anything, he will bill medicare the regular fee.
Actually, this is only marginally legal under medicare regulations which state that any doctor who accepts medicare must not charge any additional fee for covered services. So, a doctor in an expensive area, may not bill the $100 for a short exam, and require the patient pay additional. (This gets tricky to explain, since there are two parts in Medicare billing, but Boutique Practices means additional fees after both parts.)
If there were unlimited funds available for medical care, and a surplus of primary physicians, this could be a great idea. But there are not. With the extra attention that comes with boutique care, there are more referrals, more desire to get all of the emotional along with therapeutic benefits of modern science.
But it's only the wealthy who can afford this first class passage. And they will be vying for limited resources with those who could never afford the added cost. Or if more people decided this practice was for them, well the retainer could just be raised until the boutique physician has that ideal number.
I write about this, not because its a simple case of the doctors who do this being greedy. That could be, but they may also want to provide better care-(and making an extra few hundred thousand doesn't hurt.)
These are the type of issues that should be out in the open right now. Our elected officials should be examining the unique aspect of medical care, the only service where eventually your client dies under your ministrations. And if the system built on private insurance is found to be non functional, it should be eliminated.
This is certainly a confiscation of financial property as the assets and good will of the insurance corporation would be made worthless. It's not a trivial thing to do, and reminds me of the last time an entire class of owners had their property confiscated....I believe it was in 1865
Obama has said that if we were starting from scratch he would support single payer, but that he must accept the structure that exists as a starting point for change. Well, not so if it is not a starting point, but rather a solidification of the existing process, giving insurers even more political clout, since now everyone must give them revenue by government edict.
With the increase, and tacit acceptance of Boutique medical practice, Medicare has started to become stratified into luxury and basic care. This exact process, if continues, is certain to be a part of any single payer universal plan. Unlike deciding to buy a Lexus or a Toyota, something that should be an individual free market decision, in this case the bulk of the purchase, the medical service, is not paid by the individual, but by public funds.
This is a perverse, regressive practice.....that ironically may also provide better medical care, but to the few at the top of the income scale. It is only one of so many issues that should be discussed in the open as we decide the future of this vital part of our lives and or our economy.