Category: Healthcare

My roommate was surprised by a card he received from his doctor this week. The doctor stated he was changing the way his practice worked, in order to provide a more “personalized approach”. There will be time to really discuss medical needs, the card noted. The appointments will be unhurried and quickly obtained.

“To achieve these goals, my practice size will be smaller and there will be an annual fee.”

The return address listed a Specialdocs Consultants. A quick look up on Google told us all we needed to know: Roomie’s doctor is going concierge. Going concierge just in time to avoid the unwashed masses who promise to invade medical offices next year thanks to the Affordable Care Act.

The unwashed masses…that’s folks like you and me who for whatever reason, don’t currently have medical insurance. For all the lofty rants about freedom and liberty echoed by those who fought against Obamacare the last few years, bottom line is much of the pushback is coming from folks who don’t want to have to compete for medical care with the additional 10-15% more of Americans who will soon be able to get healthcare when they need it. And compete we all will, if the medical profession meets the newly insured by fleeing to walled practices, doors open only at the ka-ching of a dropped coin.

What can we expect from these new, walled practices?

Lest you’re thinking Royal Pains, and doctors that come to your home (and who also donate much of their free time to treating those who can’t afford their services), the reality is that you’ll still need to visit the doctor in his or her office. However, you will most likely be able to get an appointment more quickly, and yes, the doctor will be able to spend more time discussing your health issues with you. But you’ll get all of this only after you pay a hefty premium. In the St. Louis area, average concierge fees run between $1500.00 and $2000.00 a year.

In a glowing opinion piece on concierge medicine, a doctor writing for Forbes magazine implied that the fees paid are “within the means of most middle class families”. However, there are few families I know that can quickly and easily absorb an extra $150 or more a month, just for the honor of being able to call in for an appointment. For all that doctors bitch about receiving less money from Medicare, they still are doing much better than the average middle class family, whose income has remained fixed as grocery and other costs have increased.

What we’re seeing is the beginning of a class system within the medical industry, with the wealthier having quick access to medical care, while the rest of us scrape by, getting whatever we can get. Of course, there’s always been a class system in the medical industry, but now it’s more obvious.

In the Forbes piece, the doctor wrote:

Over the next decade, we will likely see the evolution of primary care delivery into two tracks. Some patients receive high-quality care from happy, motivated concierge doctors, whereas others will have to make do with rushed “assembly line” care from overworked providers trying to get their patients in and out the door as quickly as possible.

Over the next decade what we’ll see is a different attitude towards the medical community, thanks in part to these new walled off medical practices. Gone will be the days when doctors are treated like Gods. More people will get their medical advice from Dr. Google, than from Dr. Baker or Dr. Hsieh. We’ll also be seeing more of nurse practitioners and physician assistants than doctors, which is a trend we should encourage. Gone, too, are the days when we just accept whatever the doctor says—whether she says it in 10 minutes or 30.

We’re already seeing a change in how we view medicine. Rather than rush in and get antibiotics any time we or our kids get a sniffle, we suck it up and drink our orange juice. We’ve found that antibiotics have been over-prescribed in the last few decades, leading to antibiotic resistant infections that, unlike the common cold, can kill us.

We’re discovering that many of those medical tests our doctors want us to take are unnecessary, or could be replaced by less expensive alternatives. We’re even discovering that the annual physical that we’ve been told is absolutely necessary for good health may not be necessary after all for many of us. As for treating the measles or the mumps, most parents get their kids immunized, and do so at the local school or pharmacy, not the doctor’s office.

(Well, most parents that don’t belong to certain churches. that is.)

We already know what we need to do to be healthier in this country. We need to eat less processed, fat and sugar laden foods We need to lose weight. We need to quit smoking, and not drink so much. We certainly shouldn’t take Molly, or whatever “kill me” drug is currently popular.

We need to get off the couch and walk. And when we walk, we need to turn off the damn phones. We’d do better spending that $2000 on a relaxing vacation or fun new hobby than paying a concierge fee.

In other words, we need to practice common sense when it comes to our health. We don’t need a doctor telling us what we already know if we’d only be honest with ourselves.

So, we need our doctors, true, but we need to work on needing them a lot less. Maybe then the doctors won’t flee from us in terror.

Is roomie going to pay the fee? He visits the doctor once a year. He isn’t particularly fond of him. He certainly doesn’t like him well enough to pay for the privilege of just being his patient.

aroli was talking about an incident in her neighborhood via Twitter that I later found out to have been at a Healthcare reform protest put on by MoveOn. Karoli recounts the pro-reformer’s side of the event, and there seems to be any number of people wanting to jump on that particular wagon. I’m not one of them.

The facts, if I understand them correctly, are that a group of about 150 pro-reform protestors showed up for a rally, and a much smaller anti-reform group formed across the street. Everything should have been fine if this state had been maintained. The worst that could happen is people going hoarse yelling at each other.

It didn’t remain the same though. Karoli writes that the anti-reform protestors were blocking access to the protest side, but her photo shows no one was blocked, and the anti-reform protest was too small to physically block anyone’s access to the cross walk. More importantly, the anti-reform people stayed on their side of the street. It was the pro-reform person who started this brouhaha, because they were the ones to cross the street, effectively busting into the other side’s territory. In Karoli’s words:

Several minutes later, there was another altercation. My best recollection is that this man saw what happened to the woman and reacted to it. I cannot say with certainty where he was when he saw it — he may have arrived and was navigating his way through that group, or he may have crossed the street to defend her. He was confronted by the same man. I could tell from where I was that the man was belligerent, angry, and confrontational.

The man in the orange shirt hit the pro-reform guy (I’m going to call him PR Guy just to keep the players straight). Hard. ( tweeted in real time) He punched him in the face, knocked him to the ground and into that thruway. As you can see from the photo, cars drive straight through that without stopping. The pro-reform guy could have been run over. He got up, tried to get back up on the curb, but Orange Shirt guy was in his face. Finger in his face, PR Guy standing, steps up to the curb, and there’s a scuffle. Orange shirt seemed to have PR Guy in a hold, but again, I was across the street, so won’t state that as absolute fact. Next thing I see is PR Guy’s hat being tossed into the street, both yelling at one another, then Orange shirt walks away, PR Guy picks up hat and crosses to our side.

When he gets to our side, he tells a story in one sentence: “He punched me hard, straight in the face, so I bit his finger off.”

The woman that Karoli references was someone handing out flyers, who went across the street for some reason. Supposedly while on the other side of the street the man in the orange shirt, whose finger was later bit off, shooed her back across the street, doing so in what Karoli calls an aggressive manner.

Fine. Dandy. If the woman felt threatened, she should have called the police. However, if the woman was across the street trying to hand out flyers to these people, which my spider sense tells me could have been a very real possibility, then it’s not surprising she triggered an angry response. You don’t bait people when emotions are high.

Regardless of why she was on the other side, the woman crossed back and she was in no danger. It was inappropriate for any other pro-reform protestor to cross back over, regardless of reason. This put the pro-reform movement squarely into acting as the aggressor in this event.

Regardless of who did what, the pro-reform movement was in the wrong. Worse, they allowed themselves to be set up in such a way that it could potentially help discredit what they’re supposedly protesting for.

I have to wonder what’s more important to the pro-reform movement at this time: the healthcare reform? Or the healthcare reform protests? Because from my seat, the latter has real potential to hurt the former, if more incidents like this occur.

Shame.

update More information on the incident. It sounds like this was more of an altercation that came about because Code Pink also attended the protest. Why Code Pink felt they had to be there is anyone’s guess.

last update Corrections: the person who lost part of his finger was the first to actually cross the street and confront a pro-reform protestor, before crossing back over to his side. He was the man wearing Khaki, not the orange shirt guy. He also threw two punches at the guy who bit him, not one. The police are not actively looking for the guy who did the biting, probably because Khaki was the one to throw the first punch.

Frankly, no one was an innocent bystander in this. Time to move on to what really matters: healthcare reform.

I find it fascinating to watch what happens when progressives discover what kind of a person the CEO of Whole Foods, John Mackey, is. Because his stores sell organic and healthy products, people automatically assumed he was a progressive like themselves. However, Mackey is the worst of fanatical libertarians, though it was only with the recent Wall Street Journal OpEd he wrote that people discovered this for themselves.

In the OpEd, Mackey came out against anything but a free market healthcare system. He states, unequivocally, that in his opinion, healthcare is not a right.

Health care is a service that we all need, but just like food and shelter it is best provided through voluntary and mutually beneficial market exchanges. A careful reading of both the Declaration of Independence and the Constitution will not reveal any intrinsic right to health care, food or shelter. That’s because there isn’t any. This “right” has never existed in America.

Even in countries like Canada and the U.K., there is no intrinsic right to health care. Rather, citizens in these countries are told by government bureaucrats what health-care treatments they are eligible to receive and when they can receive them. All countries with socialized medicine ration health care by forcing their citizens to wait in lines to receive scarce treatments.

I leave those in other countries to respond to what Mackey says about your countries, and focus on what he said about this country.

Mackey lists changes he believes will solve the healthcare problems, including removing items that insurance companies are mandated to provide, allowing cross-state insurance sales, as well as tort reform.

However, as articles, such as this excellent article on healthcare costs in the New Yorker detail, healthcare costs are not driven by malpractice lawsuits, or government mandated health care coverage. If anything, the only thing has kept some small control over the healthcare companies are the state laws that don’t allow them to arbitrarily cancel healthcare coverage for the sick, and those who need care—that demand a minimum of responsibility from these companies.

Healthcare in the US has become nothing more than an exercise in earning profits. Until it’s redefined to what it should be, the care of people, costs will continue to increase exponentially, until eventually only the wealthy will be able to afford truly decent health care. The free market fails when it comes to basic humanity.

According to Mackey, if you’re sick and you can’t afford healthcare, why you should just die. I don’t know about any of you, but I have no interest in giving a man like this the time of day, much less my money. I have disliked Whole Foods with a passion for many years, both because of Mackey’s attitude, and the fact that the company grossly overcharges for its goods. To Mackey, organic and healthy are green marketing, a way to make lots of money.

Now others are discovering the truth of Whole Foods and Mackey, and have started a boycotting campaign, though how well it will do, is anyone’s guess. People have to make choices if they want to live what they believe, and that includes choosing where they spend their money. I can do without the “progressive” whose beliefs are nothing more than Twitter tweets and social media bon mots, and who isn’t willing to put their buying choices behind their beliefs.

But this is an easy one for me, because I’ve been boycotting Whole Foods for years.

update Good Good OpEd piece on this discussion at the NY Times. There are a lot of folks saying, but he’s so environmentally helpful, and has led the green revolution, and so on. Well, I look at it this way: he’s been amply rewarded for this effort. From now on, any money I give the store is payment for his latest efforts, and they have been both anti-union and now anti-healthcare. Whole Foods is not the only game in town when it comes to the environment. Not anymore.

Now this is damn clever: using Google searches to trend flu outbreaks. Google is aggregating flu-related searches into trending where flu outbreaks might be occurring, or about to occur.

So far, knock on wood, the flu trend graph shows low activity for Missouri.

Susan Blumenthal provided one of the best in-depth analysis of Presidential candidates health care plans, in objective, side-by-side comparison of all the candidates: Republican and Democrat.

In explaining the charts, she wrote:

With our current sick care system, Americans cannot afford — socially, politically, economically, or otherwise — to remain on the sidelines. We have a window of opportunity to establish a real health care system with the upcoming 2008 presidential election. It is up to the presidential candidates and the American public to bring health care concerns to the forefront, and engage in meaningful dialogue about various proposals to provide quality health care to all Americans. And then it is up to us to vote.

I’m not writing with either bias or bigotry when I describe the Republican plans as being almost completely non-existent. Most of the candidates vaguely mention something about working with the health care industry to ‘make it better’. Few see the need for universal care for all. Many emphasize how people need to take care of themselves. If a Republican is elected president, it is very doubtful that we’ll see any change–either moderate or meaningful–in health care or coverage.

Of the Democratic candidates, Hillary Clinton has done the poorest job of addressing this issue, and I’ve reluctantly have had to drop support for her candidacy because of this. I’ve had to also re-think some of my ideas of a general single-payer universal health care plan, as supported by Dodd and Kucinich. Both provide no effective way to implement such, other than taxing the rich more.

Barak Obama and John Edwards really have done the best job of providing a fairly detailed description of what they would do, how they would do it, and how much it would cost. I respect what both have done in this regard, and their innovative plans.

However, I believe that John Edwards has the most effective plan. His concept of a state and federal Health Market to provide coverage for those who may not have it, or for those who do and believe such is better, is an effective way to begin easing this country into a true universal health care, single-payer system. It doesn’t eliminate all of the problems, true. For instance, doctors and hospitals have to maintain staff just to be able to figure out how each health care provider does their paperwork, and understanding what is, or isn’t, covered. In addition, there will be providers who integrate profit into their business model, and all profit that goes into the concept of providing insurance rather than care is ultimately not beneficial to the American people.

Still, the people of this country will not vote to federalize any private industry, even one most hold in disdain like the Health Insurance industry. We’ve been too deeply ingrained against such. By providing a competitive system where the need for profits for shareholders is removed from the business model, such plans should end up being ‘better’ than anything provided by anyone else. Allowing employers, employees, the self-employed, virtually anyone, access to Health Markets either will force the for-profit organizations into doing better, or eventually, gradually, ease them out of business.

As for the cost, what Edwards quotes does seem reasonable. Considering that we’re spending 120 billion a year in Iraq, once we pull out of that country, we could effectively transfer those funds over to health care and see few tax increases for the middle class, or loss of services in other areas of the government. Even the wealthier won’t have to give up their third homes, or fourth cars.

Susan J. Blumenthal, M.D., Jessica B. Rubin, Michelle E. Treseler, Jefferson Lin, and David Mattos. U.S. Presidential Candidates’ Prescriptions for a Healthier Future: A Side-by-Side Comparison. Huffington Post 9 July 2007.