Clinic with two doors, a symbol of two-tier care:
On Manhattan's fashionable Upper East Side, the door on 77th Street says Lenox Hill Radiology. It's a busy place, with 20 or 30 people typically waiting in chairs. It takes insurance.
But if you walk a few steps down the block to Madison Avenue, and one block up to 78th Street, you'll walk through the door of New York Private Medical Imaging. The waiting room has only four chairs, usually empty. It takes cash, checks and credit cards. You can try to recoup some of your money later if you have insurance.
Both doors ultimately lead to the same area of changing rooms and scanning equipment. The same technicians perform PET scans and MRIs on the same machines. The employees are warned, in a written policy, not to tell the patients about the other door.
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To see how it works, msnbc.com sent two reporters, Linda Carroll and Helen Popkin, for their routine mammograms on the same afternoon to document their experiences. And later we returned to interview doctors on both sides.
The purpose: to determine if both women received the same care. And if there were any differences, were they meaningful or superficial?
At the Lenox Hill clinic, on the insurance side, Helen waited 15 days to get an appointment. On the day of her mammogram, she stood in line at the reception desk in a crowded waiting room.
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The technician was friendly and efficient, though Helen didn't see a doctor. She went home not knowing whether she was healthy or not, and waited nine days for her results. But it was good news, a clean bill of health. Though the list price was $350, Helen's insurance paid the clinic $140 and she paid nothing, because her health insurance covers preventive care such as mammography.
At the Private Imaging clinic — the boutique side — Linda was able to get an appointment in two days. She was greeted immediately in the private reception area. She changed into a comfy spa robe. Her technician was also friendly and efficient, then the doctor read the scan after a few minutes, reassuring her, “Your mammogram's negative. Nothing to worry about. See you next year.” Linda walked out carrying a copy of her X-rays. Linda wrote a check to the clinic for $350; if she'd had the same insurance plan as Helen, Linda's net cost would have been $210.
Premium-pay medical practices grow as doctors seek more control, cash:
The result, critics say, is a segregated system that offers extra access for extra cash, even as it escalates a looming health care crisis for everyone else. And there’s nothing in the current health reform bills being considered in Congress to stop it.
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Here’s how concierge medicine works: Doctors charge anywhere from $1,500 per person per year up to $25,000 or more for a family. This fee acts as a retainer on top of all the insurance-covered services.
In some programs, those who don’t pay are forced to leave the practice. In others, they’re likely to see a nurse practitioner, a physician assistant or a newer, different doctor hired to handle the traditional patients.
The move to smaller, premium practices will worsen an already dire shortage of primary care doctors, creating an elite group of well-compensated physicians who see fewer and fewer upscale patients, dumping the rest on their increasingly harried colleagues, critics contend.
The U.S. is short by between 40,000 and 50,000 primary care doctors now, a figure that’s expected to top 125,000 by 2020, according to the American Academy of Family Physicians. That means people who don’t want or can’t afford concierge plans will have a harder time than ever finding a doctor.
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The movement toward concierge care has exploded in recent years. Five years ago, there were 250 concierge doctors in the nation, serving perhaps 100,000 patients. Today, more than 5,000 primary care doctors run retainer practices serving 500,000 patients, according to the Society for Innovative Medical Practice Design, a concierge association.
The rich have always (and will always be able to) pay for better health-care. In the UK the rich pay for the NHS through their taxes but they don't use it and then pay for treatment by private practices. Private practices are illegal in Canada so the rich have to come to the USA for better treatment.
It isn't fair but that's the price that you pay for freedom. The way I see it is that there are obviously two levels of health-care. There's standard health-care which treats standard problems and there's fancy health-care which treats more complicated problems. Both aim to avoid death. The rich can afford to postpone (but not altogether avoid) death.
There is no way of getting around the "unfairness." It will always be with us. "Universal" health-care in theory means that everyone can get every type of treatment. In practice it will mean rationing of the limited resources available. So the rich will buy extra treatment on top of paying taxes for "universal" health-care. Is that fair?
I can't afford really "fancy" health-care. My insurance premiums cost $5,000 a year. I also have to pay a $1,800 annual deductible before insurance kicks in. Then I have to pay 20% of everything after that. I figure my insurance is there for emergencies like if I end up with a hospital bill of more than $6,800.
That happened to me once when I had to have emergency surgery and the bill came to $126,000. I didn't have insurance and it nearly ruined me. I figured that paying about $7,000 a year in insurance was a good investment. And paying 20% (about $25,000) beats facing bankruptcy to pay $126,000.
I would not mind paying taxes so that everyone could have access to limited "standard" health-care and then pay whatever I can for "fancy" health-care. But the "standard" health-care would have to be limited and rationed. And that's not something that Democrats are not willing to admit must happen. But I have to limit and ration my own health-care by not buying a "Cadillac" insurance plan which I can't afford.
I know that if my insurance company decides not to cover some fancy procedure that may be able to save my life, I will have to accept death. I don't expect the Rockefellers to pay for me. And I don't like having to pay for a fancy procedure for someone else who can't afford it. In a free society you get what you pay for. And these two-tier practices will increase even more under the Democrats' plans. There is no way to make it fair.
The only thing about human life that is fair is death. As James Shirley wrote in 1640:
The glories of our blood and state
Are shadows, not substantial things;
There is no armour against Fate;
Death lays his icy hand on kings:
Sceptre and Crown
Must tumble down,
And in the dust be equal made
With the poor crookèd scythe and spade.
Some men with swords may reap the field,
And plant fresh laurels where they kill:
But their strong nerves at last must yield;
They tame but one another still:
Early or late
They stoop to fate,
And must give up their murmuring breath
When they, pale captives, creep to death.
The garlands wither on your brow,
Then boast no more your mighty deeds!
Upon Death's purple altar now
See where the victor-victim bleeds.
Your heads must come
To the cold tomb:
Only the actions of the just
Smell sweet and blossom in their dust.
Labels: health-care insurance, medicine
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