Concierge Medicine

Sunday, September 02, 2007

Note: The Houston Chronicle tends to pull stories off the web quickly. Read this one sooner rather than later if it sounds interesting to you.

Thanks to the small sliver of the free market still left in medicine, we in Texas are finally seeing the return of something that sounds more like the subject of a Norman Rockwell painting than a viable business practice: the physician house call.

At the Sugar Land practice of Frank Mazza and Kirk Lee, the doctor is always in.

Patients enjoy same-day scheduling, routinely empty waiting rooms, appointments that linger as long as it takes to unhurriedly answer questions and access to doctors via phone and e-mail during non-office hours.

If the patient is unable to come in, Dr. Mazza or Dr. Lee even make house calls.

"It's wonderful," said Laura Konrad, a 73-year-old patient in last week to have some moles checked out. "It gives you such a sense of security, a feeling that you can always get to your doctor and talk to him. I can't say enough about it."

There is a catch: It costs $1,800 a year out of the patient's own pocket.

It is known as concierge medicine, a revolt against what many doctors consider the McDonaldsization of contemporary health care. The premise is simple: Fees collected from patients allow the doctors to slash their caseloads and spend more time on those who remain. It also allows them to increase their income.
So it's a "catch" to pay someone for services rendered? And we're blaming the declining amount of time physicians spend with patients on capitalism? On those counts, this article is both immoral and incorrect.

Our medical sector is anything but "McDonaldized". Rather, we can thank our federal government's hiding medical insurance costs through the tax code and outright subsidies for the fact that most people see paying for medical care as a "drawback" -- while cheerfully paying for other life necessities and even luxuries. In fact, I wouldn't be surprised to learn that most people spend far more than $1800 per annum on vacations and other forms of recreation each year.

Even the charge that physicians who opt for small practices like the ones described are de facto unavailable is seen to be bunk late in the article when it is mentioned that some physicians would rather abandon primary care altogether than practice in the mill-like environments that the prevalence of managed care -- for which we can also thank government meddling -- has helped to make so common.

Would I necessarily opt for concierge medicine? Probably not, but its existence both indicts our current government-micromanaged health care system and points the way towards a solution. The government helped create the need for such practices in the first place -- and doctors are free (so far) to fill that need. Unfortunately, with so many journalists and intellectuals damning the notion of payment for services as "elitism" (as we see in this article), Americans sound ready to stampede in the wrong direction, trampling the rights of physicians and patients alike in a new quest to extirpate what little capitalism is left in a vital industry.

If we want to continue to have access to the best medicine in the world, we should embrace what makes it possible: Capitalism.

-- CAV


: Corrected a typo.


Mike said...

My own doctor just closed his practice. A year ago, he finally ran out of tolerance for Medicare and Medicaid bureaucracy, and in the year that followed, he found "a whole new hatred for the rest of the equation." It's a shame, because there's a retired doc who had patients who trusted him and employed a dozen people who definitely were topping out their income-skill brackets... non-degree-holding single moms and the like working as receptionists and medical techs. All of it collapsing because the man decided he'd rather run out the clock with the pile of money he has than fight the red tape to make any more. As a capitalist, I hang my head in shame to think of it. Also, props for your canny use of the word "extirpate."

Gus Van Horn said...

I appreciate your example of an Atlas shrugging but for one detail:

You shouldn't hang your head in shame, particularly as a capitalist. The state's interference artificially made this man's job harder for him intellectually and psychologically. He was entitled, as owner of his own life and work, to decide when enough was enough.

It is the statists who support your former doctor's enslavement who should hang their heads in shame. We have only to shake our heads sadly at the fact that what this man got for all his hard work was hassling and endless claims to entitlement. What a sad end to a productive career!

Inspector said...

Gus, I was wondering if you saw this thread on in response to your "fair" tax critique? I actually think it may be a pretty good defense.

Consider this example of medicine: the keystone for what is screwing up a lot of medicine in this country is the screwed up tax code which uses payroll subsidies to strangle the normal business model for medicine. Remove the payroll tax system and its subsidies and you completely undercut a major government interference into medicine.

Just a thought. I'd like to hear your take on it.


And Mike: if you think that your doctor has anything to be ashamed about for not tolerating the government's chains on him, then I think you have no idea how bad it is to deal with the Medicare and Medicaid bureaucracy.

"Completely F***ing Insane" doesn't even begin to describe it. It's not just a question of money (although I, as a capitalist, find your disdain for "piles" of distasteful); it's a question of being completely unable to do the work you love in a way you love to do it. It turns it into drudgery.

At that point, it really does become an exercise in punching a clock for money, and that's not good for the spirit. If a man has enough to retire and doesn't want to spend the rest of his days on a hamster wheel, then I don't blame him.

Imagine your job, with all those petty socialists you work with (yes I read your blog)... now imagine that they have complete power over you and all you can ever do is operate their machinery - without any hope of changing the system. You're no longer a participant in the system who can fight their inanity, but are on the receiving end of it.

Imagine further that you had enough money to retire. Would you spend the rest of your days punching a clock and working as an impotent cog in some horrible, nightmarish leviathan of socialism?

Looking at it like that, what would you say to a man who said that he "hangs his head in shame" for your refusal to "fight the red tape?"

I think you owe that doctor an apology, Mike. You should thank your lucky stars that anyone is willing to work at all under such horrid conditions, let alone the best and brightest.

Gus Van Horn said...

Thanks for pointing out that thread and for adding this thought as an implication of passage of the Fair Tax.

My further thoughts:

(1) The commenter who noted my confusion on how the "prebate" was calculated is correct. I have noted that already (but not at the post itself or at, which I rarely have time to go through), so I figured I'd reiterate it here.

(2) Given the various points other commenters brought up, the Fair Tax might be worth support from capitalists IF enacted as advertised AND supporters explained why they support it.

(3) I very rarely have the time to go through long threads like those at, so thanks for pointing this out. I otherwise wouldn't have necessarily known about this very interesting discussion.

Mike said...

Inspector -- I see that I chose my words sub-optimally. I am not at all ashamed of my doc; he's a stand-up guy and the first doc I've ever had that I would trust with ANY medical issue, no matter how sensitive. Also, I did not mean it pejoratively when I referred to his "piles" of money. He has earned it fair and square, and then some. It's just a tragedy to me that a man who is clearly capable of generating that kind of wealth would find the lay of the land so barren that he opts no longer to do so.

I was ashamed for myself because I'm looking at a clear example of what capitalism is supposed to be (skilled professional, runs own business, employs others who might not earn nearly as much elsewhere, customers happy, everyone gets paid, winners all around) and yet here I am discussing his close-up-shop with him and I know he's entirely right that the system is broken. And the next day I go into work and struggle again with the latest red tape out of CMS preventing me from making any progress at the opposite end. There are days when I honestly believe today's America cannot be fixed until we allow the break to complete instead of holding it all together with duct-tape and band-aids.

Also, thanks for the note that you've read my blog... sometimes I don't post much Objectivist-relevant content because I don't know if there's an audience for it, but I'm finding out that there is and I should. I'm sure the day-to-day stuff is terribly tedious for some.

Inspector said...

So, Mike, you meant it more in the way of the Indian standing by the side of the road, shedding a single tear?