Boston, MA

Well, I didn’t mean for it to happen this way, but so far my posts this week are centering around the issue of health care and health insurance. Massachusetts, as of July 1st, is now the first state to require health insurance for all residents. The deadline came and went, however residents still have until the end of the year to show proof of insurance, so only a small percentage of the 500,000 uninsured have complied. Time will tell how successful this landmark feat is and the rest of the nation is watching closely and making mental notes.

On top of all this, I went to watch Michael Moore’s Sicko last night and it sure made me feel that all right. I’ve always felt comfortable knowing I lived in a city that was known for its high-class health care, cutting edge research and home of some of the best university teaching hospitals in the country. Imagine my disappointment that none of that matters. According to the movie, there were plenty of people who had access to quality medical care, but they were consistent DENIED by their insurance companies these “medically unnecessary” procedures. Since when is getting a bone marrow transplant to treat your kidney cancer “unnecessary?” Especially when your younger brother is a perfect donor match? It just broke my heart that this was the extremely poor state of our country. What was priceless during the movie was when Michael Moore went abroad to France and London and when he explored their hospitals and health care settings, he asked “So, where do you go to pay for your hospital visit?” EVERYONE consistently laughed at him. “No one pays for medical care here” was the answer he always got. You could tell by the look on his face, he was ready to move to France! We in the audience were also laughing, but at ourselves. That is, until the poor elderly woman was literally dumped in front of the free clinic in California when the hospital she was previously being treated at decided she couldn’t get a free treatment anymore since she had no insurance. So, still in a hospital gown and with the hospital name scratched out on her dirty medical tag bracelets, they put her in a cab and she was all but pushed out onto the curb. Yes…then we stopped laughing.

Boston, Massachusetts, free health care, universal health care, health insurance, Sicko, Michael Moore

We all know that the debate of health care in America will always be a major issue of our times. Boston is no different. When I heard about this practice of “concierge medical care” even back in 2001, I thought “this can’t be a good thing.” It describes a sad state of affairs for both doctors and patients alike. Imagine the best doctors who are fed up with being dictated (or dictatored) by insurance companies and have to work over 60, even 80, hours a week and have practices of 3,000 patients just to make a “decent” living. On the other hand, there is also the poor sick patient who legitimately needs to see his doctor and the only opening is 3 weeks from now, and even when he does get to see his physician, it’s a quick 15 minutes and back out the door.

So, the answer that some doctors have come up with is to cut their patient load significantly and charge the remaining patients a hefty annual fee (often thousands of dollars) to make up the financial deficit. While this screams of elitist, luxury benefits that only the well-to-do can afford, maybe even the wealthy are not ready for this type of health care model, nor is the service readily acceptable. Read here for more.

Or is it? Despite not enough interest and not-full-to-capacity practices, it seems that it’s still a viable and profitable enough business model for other busy Boston doctors to jump on the bandwagon. Is it fair for a doctor whom you’ve known for years to suddenly say, “Ok, if you want to keep me as your doctor, I’ll have to charge you an extra $3,600 a year”? Then, again, I’m relatively healthy and only see my primary care physician for my annual checkups. I don’t need that level of care. Is it worth it to the patient who has numerous medical issues and (unfortunately) is often elderly and on a fixed income? Can they afford it at a time in their lives when they really do need that highly attentive care, yet expect it to come from their own pocket? Is it setting up a bad precedent where a patient can “buy” his medical care in such a way he can now “order” his doctor when, where, for how long he wants to see him or what medication he wants to be on (because he did all the research on the Internet himself and that’s what he thinks he should be taking)? What do you think?

health care, concierge medicine,   Boston concierge practice, Boston doctor