What’s Wrong with Insurance Commissioners Regulating Concierge Doctors?

February 5th, 2009 By Steven Knope, MD

So what was wrong with the Maryland state insurance commissioner getting involved as the self-appointed regulator of concierge medicine? It has been suggested that his hearing may be “helpful” to physicians – to give guidance to concierge doctors so that they don’t run afoul with insurance law. Really?!

I spent a decade of my life fighting corrupt insurance companies, ultimately opting out of the third-party system because I could not reform it. I opted for a private practice model so that I would not be subject to the corruption of big insurance or the U.S. Government. After ridding myself of insurance companies and Medicare, I find it difficult to believe that an insurance bureaucrat could or should regulate my private business. Since insurance commissioners have obviously not carried out their duty to reform their own industry, why do they want to regulate mine? Don’t they have enough problems?

The purpose of the concierge movement is to allow doctors and patients to develop direct financial relationships, outside of the confines of insurance companies or bureaucrats. Before the hostile takeover of our profession, this is just what private doctors did for decades. Doctors didn’t have to answer to insurance companies or commissioners.
 Were doctors like Marcus Welby operating “insurance companies” because they had direct financial relationships with their patients and provided unlimited care and access to their patients? Of course not; and neither are present day concierge doctors. The idea that private doctors are operating insurance companies because of a few theoretical similarities between the two is absurd. This position is not motivated by fact, but by a grab for power.

The fact is that concierge doctors are private physicians operating private businesses. To be under the commissioner’s jurisdiction, Tyler would have to prove that concierge doctors meet the criteria for insurance companies.  He has not even come close to doing this in his report.  He uses words like “may” to describe whether “some” concierge doctors “might” be practicing insurance. However, the failure to substantiate his position did not stop him from overstepping his bounds.

We all know what insurance companies are and what they are not. Since doctors do not engage in
managing large risk pools of customers for unforeseen medical catastrophes – such as car accidents and bypass operations, paying for their drugs, their chemotherapy and their surgical procedures – it is very clear that primary care doctors are not acting as insurance companies.
 Part of the problem, however, stems from the fact that what is now called “health insurance” is not insurance at all. Healthcare insurance has become a bastardized form of pre-paid medical care. Care to investigate this problem with your industry, Commissioner Tyler?

The response by different physicians to bureaucrats like Tyler depends largely on your political stripe. If you are a liberal, or support nationalized healthcare, all government oversight and intervention is good. Business is bad. Government is here to help people – to save them from their own weaknesses, stupidity, limited abilities and incompetence – to promote the collective good by making sure that all human beings are guaranteed the same outcome in life. As some psychiatrists have proposed, liberalism of this kind is a delusion, by definition. Interestingly, many of the my patients who hold liberal views in other areas of politics still recognize the importance of freedom of choice in medicine.  They understand that never during the history of man have all people lived the same lifestyle with the same resources and had the same outcome. They never will.

If you are a libertarian, excessive governmental intervention is bad news. Libertarians believe that government’s sole mission is to preserve the liberty and individual rights of American citizens.  Libertarians do not believe that people need to be saved – from themselves or from each other – by governmental oversight and regulation. To the contrary, Libertarians believe that people need to be saved from big government, by limiting the size and scope of government.

Libertarian doctors do not want to see medicine run like the DMV, the U.S. Postal Service or those who managed Hurricane Katrina.  They do not believe that government is benign and compassionate. They believe it is largely incompetent and expensive. Liberal physicians advocate for a single-payer system, which they trumpet as more “ethical” than a market-driven system.

Commissioner Tyler’s actions were typically bureaucratic. They were presumptuous.  There are several problems with his appointing himself Grand Pooba of private medicine:

1) There was not a single complaint from a citizen in Maryland about a concierge doctor to trigger this “investigation.”
2) There was not a single documented violation of insurance law by a concierge doctor that would justify his hearing.
3) Without any legislative action, he has written a position statement on concierge medicine and sent out letters to private concierge doctors in Maryland asking them to consult with his office – just to make sure that no one is coloring outside the lines; lines that he alone has defined.

Stated simply, what commissioner Tyler did was overreaching. When politicians overreach, there is always – not sometimes – ALWAYS a hidden agenda. I would ask if the good commissioner was perhaps acting on behalf of big insurance, big government, or both. Both big insurance and big government are threatened by primary doctors leaving the burning ship of third-party payer medicine. Their concern centers on what the primary care physician shortage will do to their own self interests. As the doctor shortage worsens, it will result in an inability of both insurance
companies and government to control medicine. Without enough primary care doctors, insurance companies cannot sell new policies. They cannot maintain the policies that they already have. Government cannot grow and expand without primary care slaves to work in the cotton fields.

Instead of reforming the broken healthcare system, Commissioner Tyler and his ilk would rather take aim at those physicians who are smart enough and strong enough to jump off the burning ship and swim to shore with their patients.  This intimidation tactic will not save the ship afire, nor will it prevent those weaker passengers on board from drowning. Promoting fear is not a good strategy on a burning ship. It is frankly suicidal.

I am not personally worried about politicians such as the commissioner and what they might do to me and my practice.  I am delusional enough and arrogant enough to fight those who threaten what I value.  I believe that the way to control overreaching is to confront it. I believe that concierge doctors will fight for their liberty and that they will prevail.
We are far more motivated than insurance commissioners.  We have patients who will fight along side us to maintain their right to see the doctor of their choice; to purchase the kind of medical care that they feel best meets their needs. We also have the U.S. Constitution on our side.  Finally, we have a much greater investment in our profession than bureaucrats have in this issue. In battle, motivation is everything.

To those who say we must “compromise” on the issue of governmental regulation of medicine, I disagree. Regulating private practice through governmental agencies transcends even the traditional differences that exist between liberal Democrats and far-right Republicans. Concierge doctors, by the very fact that they practice concierge medicine, are taking a libertarian position in medicine, whether they realize it or not.  Patients who see a concierge doctor are also behaving as libertarians, at least in the area of their own health care. Though most people don’t truly understand what a libertarian is, they at least know that the founding fathers of this country were libertarian in their beliefs.

They were willing to fight for liberty and freedom. If we wish to see medical freedom survive, we will have to be willing to pay the price as well; which means we will have to continue to fight for that right; not play nice with those who would take our freedoms from us.


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