Delicious Tiers by Pat Conrad MD
Oh Blessed Irony, you are the Muse with which the cosmos showers bad ideas with derisive sarcasm. In short, this cracks me up.
Our transatlantic cousins and their pious preening over compassionate, nationalized health care are letting their slip show just a little. The British National Health System was supposed to cover everybody. It doesn’t. It was supposed to be a more efficient allocation of resources. It isn’t. It was supposed to avoid the moral evils of a dreaded “two-tier” system, which of course has been in place for decades for those with the ready cash.
So now “GPs in London and Hertfordshire join scheme (note the pejorative tone) offering same-day appointments for £1,200 a year.”
Family docs in these select areas are signing on to a concierge system that sells better service for – TAH DAH! – extra money. The fee covers an annual physical, some labs, and maybe even house calls. And like some DPC docs I could name, there are family discounts. The hiring corporation limits each doc’s panel, and patients will have their physician’s email and cell number.
There are plenty of fairness police who think NHS doctors should not be allowed to do anything but government medicine and Concierge Choice is rightly wary of the government hammer: “The GP will still be spending 90 per cent of their time on NHS work. We want to work in a complementary way with the NHS. We will be recommending that patients remain registered with their NHS GP,” says founder Dr. Mark Sweeney. And he is selling this as a service that will help more complicated patients with more chronic problems, a relief to the harried resources of the NHS that allow about 10 minutes per visit.
I think this is a great development, and pretty funny. The nationalized care that we are hurtling toward just doesn’t work, and will end up in a lot of very expensive, widespread dissatisfaction. The worsening shortages that are daily headlines with the NHS, and the significantly increased disinterest among British physicians in being simultaneously worked to death and impoverished are encouraging some to find an out. This has a lot of DPC earmarks, but of course the U.K. doctors are on a much tighter leash, and the pushback in the event of a successful outing is likely to be much more harsh. Maybe there will be a race toward DPC on both sides of the pond. More likely, there will be international cooperation towards discouraging private contracting as a way to keep government systems solvent and “fair.” Certainly, this “problem” will worsen as more patients see how great free health care really is.
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I have reluctantly concluded that the best way forward for the US is a variation on the U.K. system.
The catalyst for this change of heart was the failure of the GOP to repeal, much less replace, Obamacare. After that, it is unimaginable that Medicate and Medicaid are revocable.
That leaves us with the choice of sticking with some variation of the current patchwork system and its inefficiencies and ineffectiveness, or spending the 60% of the US healthcare budget accounted for by the public sector more wisely.
The latter involves pooling all public budgets into Medicare, which would pay for a baseline level of care for all citizens. The spend would be maintained at the current percentage of GDP/federal budget. Any care not covered within that budget would be freely available from the private sector either by self pay or third party.
Care would be provided by the private sector, including DPC practices, contracting with CMS, individuals, and third parties.
I call this the All American Health Plan. Everybody pays. Everybody benefits.
Of course, the NHS and etc., will destroy it by assimilation. The “free-lance” doctors will be ruled to death until the “private customer ” receives just corporate & government CrapCare- and the media will strike down Greedy Doctors. The plan is made already.