Jen Wieczner published her article “The Pros and Cons of Concierge Medicine” in the Wall Street Journal on November 11, 2013. Concierge medicine doctors are “on retainer” much like some lawyers. They made a certain reputation as doctors for the rich and famous charging $500 dollars a visit on top of a $30,000 per month retainer. The above Cartier watch ($61,000) was just what they needed to take the patient’s pulse.
Ms. Wieczner now informs us the conciergierie has found a new way to tap into wealth, a patient’s insurance deductible. As it turns out, there are a lot more people trying to be frugal with their health care costs than trying to be extravagant. Those frugal masses are trying to avoid the high out-of-pocket costs for medical exams and tests . In essence, the profitable concierge doctor finds a way to provide less expensive, but very personal care for cash (not insurance) in the environment below the deductible level found in that silver insurance plan. And, as P.T. Barnum said, “there’s a sucker born every minute“.
If it were true concierge medicine has some medical skill not provided by most primary care doctors it would be a wonderful development. But, according the article the wonderful services include PSA testing (not needed), routine blood tests (not advised), testosterone tests (leading to unnecessary and dangerous treatment), x-rays (never an advised screening), PAP smears (really only needed every 3 years), CAT scans (lots of false positives that require more testing), and MRI scans of the brain (for no known reason except the irrational fear of dementia). The claim they can do a colonoscopy for $400 dollars is probably true, the same price as in Europe — perhaps mainstream medicine should take note.
The Wall Street Journal is a forum for capitalist ideas. The notion there is profit to be made in this high deductible world is likely true. Competition to provide low cost care is clearly needed. But, that low cost must be coupled with reasonable, evidence based, coordinated, and quality care. The Timex watch might be a better model for US healthcare than the Cartier watch.