A Simple Plan to Reform Healthcare
Published by Ted Almon October 18th, 2006 in Articles.
I have been reading about some primary care physicians who are now charging a retainer for their patients to be part of what they are calling a "concierge" medical practice. In return, the patients get near-immediate, full-time access to the physician and a more thorough examination upon their visits.

I decided that sounded good to me. Now if only I could convince my long-time physician to start a practice like that. Let's call him Charlie (because that is his name) and follow me on a hypothetical meeting with him (note: my company sells medical equipment).

Charles is a wonderful PCP, and I would not consider leaving him after all these years. But I also hold no illusion that he cares any more about me than any of his other patients, even those with inadequate or even no health insurance coverage. After all, in order for him to achieve the lifestyle he appears to have, he could have as many as 3,000 patients.

And even though I am perfectly happy with the service he provides now, and I am in good health and very seldom call outside my regular check-ups, why would I not want to be part of a more exclusive, say 500-to 600-patient group?

I can afford the $1,500 or so it would cost beyond my current outlay, and if my health status ever takes a turn for the worse, it could come in handy. How is it different from flying first class, staying on the concierge floor at my favorite hotels, or hiring a driver to take me to special events?

More puzzling, however, is why Charles will not do it. The math seems simple to me, and the lifestyle choice should be an even bigger no-brainer. I decided to ask him.

"Health care is not like the car you drive," he told me. "Everyone should be entitled to the best I can provide. If I open a boutique for successful guys like you, what will become of all my other patients? There are already too few young doctors entering my field. Is it fair to send them all the poor people?"

"The whole system needs to be changed," he went on. " You can't just put a Band-Aid on it, making sure the affluent have access until you figure out what to do about everyone else."

I felt admonished. In business, your can always get what you are willing to pay for. What's wrong with that?

Then Charles became more reflective. "You know...concierge medicine might actually serve both our purpose in a perverse way." Now, more animated and engaged, he went on.

I have been involved for more than 20 years in the debate over how to rein in health care costs. You know that, as an employer, you have been in many of those same discussions. You want lower - or at least more stable premiums, and I want fair reimbursement. And essentially we agree about what needs to be done. It's the most frustrating thing I've ever tried to do.

I had to concur. Never in business have I encountered a problem so resistant to agreeable consensus.

I offered that health care reform follows Sinclair's Principle.

He furrowed his brow so I explained the novelist's maxim: It is difficult to get a man to understand something when his salary depends on his not understanding it.

I went on.

"Thousands of completely independent entrepreneurs - none of them connected to the rest of the provider network- all duplicating back-office overhead that could be consolidated and automated in a lager practice."

"There is plenty of blame to go around. All of the obvious waste and inefficiency ends up as income for someone, and that guy will fight to make sure that part of the system doesn't get reformed."

"Well hell!" he stormed. "At least you and I do something essential to the care of the patient. What about those insurance companies and broker guys, and my favorites, the administrators, those working in health care who have nothing to do with patient care who are coding, denying and suspending claims, negotiating contracts, conducting reimbursement audits, all of it. The reimbursement system is a quagmire of unproductive activity and cost."

Now he was on a roll.

"You see," he said, "this is why I say no incremental fixes are possible. We need a master plan at least for Rhode Island. But what would it take to make that happen?"

"A crisis!" we both spurted.

"And what could precipitate a true crisis?" he asked. "I mean hordes of people marching on the State House? How about a broad adoption of ..." He paused. "Yeah, concierge medicine. Thousands of people being dumped by their doctors because they can't afford the retainer. That might just do it."

And so I am back to joining a concierge medical practice, but for very different reasons than I had at first. Now I see it as a precipitating cause for a war that needs to be fought. Funny how sometimes spending just a little more money can end up saving a whole lot more.

Ted Almon
President/CEO
Claflin Co.