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Tuesday, 06 May 2008


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Hey, good for Charlie! He's in the vanguard of an interesting health care model...which harkens back to the way family physicians operated 50+ years ago.

I did not see this particular evening's show (I watched the segment online.) but I do watch Chicago Tonight with some frequency.

Plug away, Mike! I'd be proud too.

And the family resemblance is clearly there. He's the cute one, right? ;-)

He's Paul, I'm John. [g]

Mike J.

Oh, I think we, your loyal readership, will not complain about a plug like this. We often forget in the rush towards mass-consumerism that societies depend on this kind of communal engagement. To bring this back to photography, would you not say that Robert Capa's comment on the relationship between proximity and efficacy (to paraphrase, "if you do not like your photos, get closer") applies here as well?

We have a totally different system in the UK. Pardon the pun but the idea is foreign to me, so any judgement I've made is largely based on "Ignorance". Good to see your brother is still treating some of the more vulnerable members of society.

It's obvious he's your bro. But I'd say George and Ringo :p

Interesting timing Mike. Just moments ago I returned home from my annual physical with our family physician of 30 years. This is the second such exam since he converted to a concierge practice, affiliating with a national organization that arranges them rather than designing his own from scratch. Economics dictated that he either retire or make the change since, as he put it in 2006, he wasn't young enough any more to see one patient every 8 minutes. That was the break even point for his business given insurance company reimbursement rates. And he never "did" HMOs; this was only PPOs!

We feel fortunate to have incomes that permit paying for participation in his practice. After three decades, our experiences had confirmed he was competent and trustworthy. I only wish the entire system could be reformed to become a single-payer national arrangement. If countries like France can do it with (reportedly) taxpayers footing the bill and healthcare professionals able to give adequate attention to each patient, the US should also be capable. Paying higher taxes rather than concierge fees would be a fair bargain.

As one who comes from Ireland this fills me with sadness and horror,sadness that people have been so conditioned to acceptance of a system designed to serve those fortunate enough to be able to afford the outrageous costs of health care in the USA that they believe this to be a good and fair system!
Horror because we are currently been forced along the same path in my country by an inept government and an out of control health care system.
Hopefully the day is not far away when the electorate in the USA will decide to get rid of politicions who waste the wealth of their country pursuing imaginary enemies in countries they have no right meddling in and instead look after the health and welfare of it's own citizens, all it's citizens not just the wealthy elite.
When this happens it will benefit all of us as it will hopefully help others to see a better way of dealing with health care .
Mike this is in no way is meant as a dig at you or your brother as I'm sure he is a fine man and a caring doctor, the problem is the whole system not the individuals.

"Mike this is in no way is meant as a dig at you or your brother as I'm sure he is a fine man and a caring doctor, the problem is the whole system not the individuals"

There's a confluence here with the energy thread, where we've been talking about the fallacy of expecting any one solution to be definitive. You can look at Charlie's situation from two obvious perspectives. Looking inward from the society-wide meta-perspective, no, it wouldn't be a good thing if all doctors did this. Looking at it from the perspective of one doctor looking out for himself and his patients, it makes perfect sense. The system in a sense drove him to it, as he begins to discuss in the interview. As I understand it (and I may be mis-recalling the exact figures), he had something like 12,000 patients at his last practice. It was a poor neighborhood (in the shadow of Comiskey Park), and often patients would not come to see him unless, and until, they were really sick and really needed help, which militates against being able to spend 8 minutes with each patient on average, the figure the other doctor in the piece named. Do the arithmetic and you can see that he had many patients he didn't even see once a year.

On top of that, you have the insurance company paperwork, which cost the practice a fortune, and the fact that HMOs and Medicare just plain wouldn't pay them. At one point at his old practice he and his partners went something like 8 months without taking home a dime, because Medicare just wouldn't pay up. They ended up having to stop accepting Medicare patients. Meanwhile, the patients are all getting demanding and angry, because they're "supposed" to be getting services that they aren't getting. Never mind that it's actually the fault of the HMO or Medicare, the doctor is the interface they see and that's where they lay the blame.

So what he's doing is merely reducing his patient base to 600 from 12,000 so that he can really care for the patients he has. I've been at his house for Thanksgiving and Christmas dinner and he will literally get up from a hot meal to take a call from a patient. When a patient needs to go to the hospital, he'll go meet them there, simply to advocate for them as they navigate the system. His patients love him. And he really gets to take care of them, as opposed to having to do a desperate sort of triage on a seriously ill patient he's seen once in five years--for which he will then not even be paid a nominal, insufficient fee.

The system is badly broken and desperately needs fixing, it's true. What with my socialist leanings, I tend to come down on the side of arguing that everyone in a society ought to be put into the same boat--that is, we should all educate our children in the same system, we should all serve in the army, and we should all get the same medical care--because, then, the relatively better-off people will make sure that these systems are good enough for them, and the relatively worse-off members of society will benefit accordingly. This value runs diametrically opposed to the right-wing ideologies that hold sway in America right now. "Detaching" the wealthy from the health care the rest of us get is not the way to improve the whole system, because then they tend to say "I'm fine, therefore I don't care about everybody else--and I'm certainly not going to pay for them." But on the other hand, virtually every doctor I've ever met really does want to take care of people to the best of his or her ability, and I can't blame them for trying to put themselves in a position where they can reasonably do so.

Mike J.

"He's in the vanguard of an interesting health care model...which harkens back to the way family physicians operated 50+ years ago."

It may be a bit before my time, but I don't think doctors charged a fee for "membership" back then, and I don't know what kind of fee "concierge" doctors charge for a visit. Other than that, I would agree.

Mike it's obvious you understand the failings of the current systems of health care delivery in your country, being a daily reader of TOP this doesn't surprise me, what is interesting to me as an outsider is the fact that you are almost apologetic in you putting forward your views.This is what I mean when I say the nation has been conditioned to believing the system works when it is heavily weighted in favour of the rich and powerful.Cherry picking the most wealthy in society will only weaken the entire health care system.

Hi Mike,

Have to say that "concierge" medicine doesn't seem entirely like progress to me. In Brookline MA some doctors are trying it as well. My 71 year old mother and her friends have been asked for $3000/year by their doctor to be part of his concierge system, which once they pay up will get them personal care. Some are paying up. Some are looking around for new doctors. To this doctor's credit I think he's not sending any patients away for a lack of ability to pay.

My main beef with the system is that some doctors (my mother's for example) then bill medicare for services they render to their concierge patients. I don't know whether this includes your brother but there's something not quite "kosher" about this arrangement. The taxpayer picks up the bill for care, other than the $3000 bonus the doctor gets to pocket.

No doubt the system is broken badly and we'll have to muddle through to something that works--certainly concierge has merits as well. The doctors trying to deal with government bureaucracy and insurance companies simultaneously are heroes.


I am not aware of a national health care system in which all people get the same care. The rich and powerful get special treatment no matter what the government officially says. It will always be that way. They make sure of it.

Also, I have personally never seen a patient turned away from a hospital because they couldn't pay. I sure it can happen but not anywhere I have worked in all these years. As a matter of fact it could be argued that people who don't have insurance have direct access to some of the best health care in the world at our University based health systems.

The reason some doctors are going to ideas like concierge is so they can actually make ends meet and they can take proper care of the patient instead of just looking at volume. Internists, family physicians and pediatricians are finding it harder and harder to even be able to pay the bills to properly staff an office, let alone themselves. Yes some kinds of doctors can make alot of money, (like plastic surgeons doing cosmetic surgery on a cash basis, or lasik surgery for cash) but many like your brother cannot with the current system. The practice that I work for gets paid about 29% of what is billed, I challenge anyone else to accept terms such as these in their line of work. I am not aware of any other business or service where people can expect to recieve care or the product when they have no ability to pay. That is what is done in American health care. The reason it is considered a crisis is that the companies that are left with american employees are screaming about their cost for insurance coverage (GM, Ford Etc.) which is contributing significantly to them going bankrupt. However, also remember that a well run hospital has a profit margin of about 3-5 %, again I don't think any other business would agree to such a model. Long term it is not viable.

Will a national health care system work? Only if you are willing to cut out alot of what we do to take care of people in America with expensive radiology and lab testing and you don't mind waiting months for appointments and for needed procedures. Otherwise the whole country will rapidly become much more bankrupt than it already is. A massive amount of the GNP goes into our health care and it will not be cheaper for society unless cuts in services are made.

I'm sure your brother is a wonderful doc. But the concierge medicine 'movement' is morally and ethically pernicious. It throws the greater good under the bus to serve the already well off a bit better, and to ease the workload and stress on the physician.
But here's the thing; most of us docs are already pretty fortunate financially. As a small town family doc I get paid a hell of a lot less than specialists or suburban docs catering to the affluent; but I also get paid a hell of a lot more than almost all my patients.
Furthermore, every time another good doc like your brother calls it quits and bails out for the greener pastures of "concierge medicine", the rest of us still working down in the trenches suffer the consequences. Our workload gets a bit heavier, our pay a bit lower, as a few more of the paying customers are skimmed off. We have that much less time & resources to apply to our increasingly poor and enlarging patient base.
Sure, a systematic revolution is needed. Like a rising number of docs, I think it's obvious that single payer ("Medicare for all") is the way to go. But until that happens, given the privileges society grants us as physicians, we have an obligation to serve both our individual patients and society as a whole. And concierge medicine is not ethically defensible on these grounds.

Interesting, just yesterday I watched a 60 Minutes episode that repeatedly mentions the shortage of doctors and other health professionals in the US. Then today I learn of doctors that are shutting off thousands from their care, and are being trumpeted as heros and trendsetters.

Brianq: "I have personally never seen a patient turned away from a hospital because they couldn't pay."


Not so many years back I was turned away from a hospital not just because I couldn't pay, but because I couldn't come up with a $1500 deposit. Later, after I'd found someone willing to help me out with their charge card, I was told by my surgeon just a few more hours delay would have killed me.

So there you have it. Me. Dead. If I couldn't come up with $1500. And from a hospital chain with "Christian" in their name.

I'm Doug, glad to meet you. Now you've "seen" someone.

"Then today I learn of doctors that are shutting off thousands from their care"

Point taken, Doug, but eventually, somebody's got to pay for medical care. Charlie and his partners went as long as they could at their old practice just not taking home any pay. Would you work for eight months without a paycheck? They paid their staff before themselves. Finally they got to the point where they had to lay off staff.

If the patients won't pay, and the patients' employers won't pay, and the government won't pay, and the insurance companies won't pay, then ultimately the doctor has to go find another way to make a living. It's that simple, really.

Mike J.

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