I’m going off topic today to write about something that really makes me angry. My doctors here in Long Beach – a long-established practice near Memorial Medical Center – are changing their practice to a model known as “concierge medicine.” I first heard about it within the last six months, and already it’s coming to a practice near me – maybe a little too near.
Under the concierge model, doctors will provide much more extensive, personalized care to their patients. Of course this sounds attractive to patients: who wouldn’t want 24-hour access to their doctor, next-day appointments, computerized records, a preventive approach, an exhaustive annual physical, less time in the waiting room and a more prompt, attentive, and less rushed physician? The doctors find the idea attractive because it allows them to practice medicine in the way they were trained to do: considering the whole patient and the whole medical history while having enough time and enough income to do so. Our health care system has driven many physicians to consider this model.
The catch is that to achieve these goals, my doctors will each be “laying off” (my term) roughly three-quarters of their patients. Each will see just six hundred patients in the new model; the rest of us must find other doctors. All in Long Beach. All at the same time. And the six hundred are to be signed up first-come, first-served.
I learned that last fact, though precious little else, at a crowded informational session at a Long Beach hotel earlier this week. The program consisted mainly of material provided by the private concierge-medicine company and designed to explain how excellent the doctors are (not in question) and how great the care will be under the new system. In other words, it was an extended sales pitch for signing up with the new service. I could not stay until the last fifteen minutes, which was the only time allocated for questions and answers from the audience of several hundred people.
Therefore, I don’t know how the extra cost of this new practice – $1800 per year on top of all other doctor’s fees – will be handled, if at all, by my health insurer. I don’t know how easy it will be to find a new doctor (though the presentation said that patients leaving the practice will receive help with this).
Mainly, I’m troubled because this feels like a very tangible step towards a two-tiered health care system: one for the wealthy, and one for everyone else. There will always be high-end medical care available and those who are willing to pay for it, and there’s nothing wrong with that. But in the absence of a universal health care system, or, frankly, even a functional health care system in this country, there’s no safety net for everyone else. Wealthier people tend to be healthier anyway; poorer people tend to be less healthy, for a variety of reasons, and here in Long Beach, their health care options just got substantially narrower and, I fear, lower in quality.