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Definitions

By Dr. Jim Ferguson

Do you remember the days of HMOs?  Back in the 1990s health maintenance organizations were ballyhooed as the way to reduce medical costs.  Basically, this was accomplished by limiting medical services.  The justification for restricting care was to limit waste and unnecessary testing, procedures, etc.  It didn’t work, and HMOs are a thing of the past.  My former medical group had an HMO, and we figuratively lost our shirts as we attempted to manage patients’ behavior and ER utilization.

We are now in another round of medical alphabet soup, again with the hope of reducing healthcare costs.  I’m sure you’ve heard of the ACA.  Nancy Pelosi insists on calling Obama-care, the Affordable Care Act (ACA), though this is an oxymoron because the law, passed solely by Democrats, is not affordable.  I do agree with the President who says he “likes the term Obama-care”; make no mistake, it is his legislation.

Socrates believed that any discussion must begin with a definition of terms.  Someone should ask the question, what is affordable, and affordable to whom?  By expanding Medicaid, historically a program for the poor, Obama-care will force taxpayers to pay more for those who have less.  Much is heard about government subsidies to help people attain medical insurance through Obama-care’s insurance exchanges.  I think I understand the term subsidy, but who pays the subsidies?  We the taxpayers do, because the Government provides these subsidies with money it extracts from citizens through taxes, borrowing from the Chinese, or by “printing” money, thereby devaluing every dollar in your pocket.

The stated goal of Obama-care was to coerce citizens to purchase medical insurance.  As a theist and a conservative I agree with the Apostle Paul.  In his letter to the Galatians he said we should “help others with a burden,” but each of us should “carry our own load.”  The problem is that many refuse to take responsibility for their choices and then cry out for others (and the government) to forgive and fix their mess.  Now, before big government progressives and liberals start screaming, let me say that I believe in a social safety net for those who are incapable of taking care of themselves.  Again, the issue is defining incapable.  The philosopher Jean Jacques Rousseau said that a utopia can be produced if society just provides enough food and education for the masses.  The Great Society philosophy has promoted this for fifty years and is a dismal failure.

The latest medical acronym is the ACO or accountable care organization.  The  goal of this collaboration between government, hospitals, and doctors is to hold down costs, all the while promoting good medical care.  The latter is in large part determined by so-called metrics (measures) of care purporting to identify best medical practices.  Unfortunately for the bean counters, the fact remains that patients and doctors are unique, and a cookie-cutter approach has not been shown to lower costs or improve care.  The experts say we have to do something, even financially reward doctors for doing more screening tests which will hopefully translate into lower healthcare costs in the long term.  This Kierkegaardian leap of faith is strangely similar to the passionate belief in the global warming computer models that purport to predict the climate twenty, fifty and a hundred years from now.  Over the last twenty years these computer models have been even less reliable than the weatherman’s next day forecast, and transferring our healthcare to the government to manage is foolish given their track record.

Definitions of words do change over time because we have a living language.  If I had mentioned to you a mouse thirty years ago you would have pictured a furry rodent scurrying in the basement shadows.  Today, we would envision a device which orients the cursor on your computer screen.  I learned the term concierge on my travels in Europe, but today there is a new meaning.

A hotel concierge facilitates the needs of the guests.  Apparently, Mr. Webster is unaware of a new definition.  Concierge medicine is a new non-traditional type of medical care.  It is less commonly referred to as boutique medicine.  In 2005 there were approximately 500 concierge medical practices in the United States.  A more recent survey counted more than 5000 such practices in America.  I’m told there’s even a TV show called Royal Pains which depicts a concierge medical practice among the wealthy in the Hamptons.

A concierge doctor is best described as a patient’s personal advocate.  The concierge doctor is on a retainer, as you might retain the services of a lawyer.  Because he is employed/retained by you instead of a medical group, a healthcare system or the government, his allegiance is clear.  Furthermore, he is not obligated to insurance companies or any metrics of care, and therefore his advice is less conflicted.

I became dissatisfied with the medical system several years ago, but this came to a head last spring.  I concluded that I could not continue in my practice and maintain my principles.  Therefore, after long and prayerful consideration I left my medical practice of thirty-five years; it was the hardest decision I’ve ever made.

In my “retirement” I finally concluded that I wasn’t retired, but on sabbatical, and this month I began a small concierge medical practice.  My focus is to provide medical guidance and advocacy for a few instead of treating the thousands of patients I once had.  This may sound elitist to some and challenge others, but it is a way for me continue and not bury my talents in the ground.

John Wesley, the founder of Methodism once said (and I paraphrase) “Do all you can, everywhere you can, with everyone you can, as long as you ever can.”  Good advice, even if your horizons become limited.

 

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