Early Casualties in the War on Concierge Medicine

National attention has been drawn to recent hearings held by the Maryland insurance commissioner regarding whether or not concierge doctors in that state are, in effect, operating insurance companies without a license. Md. Ponders Regulation of ‘Concierge’ Medicine. If this were “found” to be the case, the insurance commissioner in Maryland, along with the state, could then regulate and control private doctors offering concierge care. What a great way to nip any physician independence in the bud!

Let’s take a look behind the scenes and examine what has really been going on in Maryland. During a recent trip to Washington, D.C., I met a well-known internist from Maryland who is a member of a practice with five other internists. This group of doctors had planned to convert their practice to a concierge model two months ago. However, word of this move touched off a storm of public criticism, which generated considerable media attention (all negative, some quite vehement). This criticism ultimately led to this hearing by the insurance commissioner.These events resulted in a reversal of the doctors’ decision to open their concierge practice. Fortunately, at least one concierge physician in Maryland, Dr. Tom Lansdale, stepped up to the plate and wrote an op-ed piece, In Defense of So-called Concierge Medicine, for the Baltimore Sun, which though cut and “edited” down to almost nothing, was nevertheless a voice of reason.  

Disturbing, though not surprisingly, the Maryland internal medicine group caved into public criticism and dropped their plans to open a concierge practice at this first sign of resistance. I say “not surprisingly,” because doctors are often unable to confront criticism, even if it means standing for their deeply-held principles. Having met the head of this physician group personally, and knowing him to be a good doctor, I have no doubt that he felt concierge medicine was a better medical model for his patients. So it wasn’t as if the insurance commissioner or the public pointed out some criticisms of concierge medicine that he had not previously considered. He simply got scared! He gave in to pressure. This is just what those who oppose any form of private medicine wanted. They rattled their saber to see if the doctors had any balls and they got their answer; NO BALLS here! Can you imagine a group of lawyers or dentists acquiescing in such a manner? It would never happen. This kind of resignation only happens with doctors.

When I opened the first concierge practice in Tucson eight years ago, there was a quote on the front page of the Arizona Daily Star from a University of Arizona School of Medicine professor which read: “This is boutique medicine at its mercenary worst.” Being on the cutting edge of change involves taking a little heat and a little risk. Eight years after this scathing criticism, the Director of the University of Arizona Cancer Center, Dr. David Alberts endorsed the back of my book Concierge Medicine; A New System to Get the Best Healthcare (Greenwood/Praeger, 2008) with the following comment: “I call him, ‘The Answer’ — i.e. the answer to our dysfunctional, impersonal healthcare system.” Dr. Alberts not only endorsed my book, he is one of my concierge patients. As a leading academic physician, he is a strong supporter of concierge medicine. He knows that our current third-party system is broken and that patients in this system often get suboptimal care.

Those who wish to continue to enslave primary care doctors in third-party payer relationships are watching to see how concierge doctors and their patients will respond to these early shots across their bows. The Maryland experience is one of their first salvos and it is a win for the bureaucrats, simply because these doctors went down without a fight. This little hearing by the insurance commissioner also sends a clear message to other doctors contemplating opening a concierge practice in Maryland.

Let’s look at the insurance commission’s inquiry objectively: Does anybody, for a single moment, believe that concierge doctors are trying to emulate insurance companies by using a retainer model? The fact is that we are doing just the opposite. Most concierge doctors want nothing to do with insurance, which is why we opted out of the system in the first place. ALL of us explain to prospective patients that we are not insurance companies and that they must have – at a minimum – catastrophic health insurance to cover medical expenses outside of our professional services. Our written contracts document all of this in detail so that there is no ambiguity.

It is a frequently quoted truism for patriots in this country that “Freedom is not free.” We have the freedoms that we enjoy only because those who preceded us were willing to go to war to preserve those freedoms. The same is true in the practice of medicine. If doctors want to preserve the right to deliver the kind of care that they feel is best for their patients, they are going to have to go to war with the insurance companies and politicians who would prefer to enslave them. Make no mistake about it, this is war. We are fighting over our freedom to practice medicine on our own terms. The patients who flank us will be fighting for their freedom to use their own money to purchase the kind of healthcare which is best for them. On the opposing side, the insurance industry will be fighting to maintain their huge corporate profits, their exorbitant CEO salaries and their shareholders’ dividends. There is much at stake on both sides.

The real issue in this drama is that concierge medicine is a major threat to the big insurance companies, along with those politicians who support a nationalized healthcare system. Both big insurance and big government are now aware that there is a serious shortage of primary care doctors in this country. Without large numbers of primary care doctors under their control, they will not be able to implement their plans to control the flow of the healthcare dollar. This is what motivates these early attacks on concierge medicine. Follow the dollar and you will understand the motivation of the inquirers. This is all about big insurance and big government trying to control the healthcare dollar.

Before the insurance companies get too cocky about this recent victory, they should realize that all concierge doctors and patients will not respond the way that the Maryland group of internists responded. I am a board member of SIMPD, the national concierge physicians’ organization that represents private doctors across the country. We are fiercely independent professionals. We are strong patient advocates. We will not relinquish our hard-won right to control the way that we practice medicine. All of us in this organization have fought many fierce battles with the insurance industry and we are not only surviving, but thriving. We have thousands of loyal patients who will never return to the kind of fast-food medicine that is dished out by HMOs and big insurance companies. Freedom to deliver and receive the kind of medical care that citizens in our country deserve is a right worth fighting for and I encourage like-minded doctors to fight along with us to preserve that right.

Can you imagine a group of lawyers or dentists acquiescing in such a manner? It would never happen. This kind of resignation only happens with doctors. 

When I opened the first concierge practice in Tucson eight years ago, there was a quote on the front page of the Arizona Daily Star from a University of Arizona School of Medicine professor which read: “This is boutique medicine at its mercenary worst.” Being on the cutting edge of change involves taking a little heat and a little risk. Eight years after this scathing criticism, the Director of the University of Arizona Cancer Center, Dr. David Alberts endorsed the back of my book Concierge Medicine; A New System to Get the Best Healthcare (Greenwood/Praeger, 2008) with the following comment: “I call him, ‘The Answer’ — i.e. the answer to our dysfunctional, impersonal healthcare system.” Dr. Alberts not only endorsed my book, he is one of my concierge patients. As a leading academic physician, he is a strong supporter of concierge medicine. He knows that our current third-party system is broken and that patients in this system often get suboptimal care. 

Those who wish to continue to enslave primary care doctors in third-party payer relationships are watching to see how concierge doctors and their patients will respond to these early shots across their bows. The Maryland experience is one of their first salvos and it is a win for the bureaucrats, simply because these doctors went down without a fight. This little hearing by the insurance commissioner also sends a clear message to other doctors contemplating opening a concierge practice in Maryland. 

Let’s look at the insurance commission’s inquiry objectively: Does anybody, for a single moment, believe that concierge doctors are trying to emulate insurance companies by using a retainer model? The fact is that we are doing just the opposite. Most concierge doctors want nothing to do with insurance, which is why we opted out of the system in the first place. ALL of us explain to prospective patients that we are not insurance companies and that they must have – at a minimum – catastrophic health insurance to cover medical expenses outside of our professional services. Our written contracts document all of this in detail so that there is no ambiguity.

It is a frequently quoted truism for patriots in this country that “Freedom is not free.” We have the freedoms that we enjoy only because those who preceded us were willing to go to war to preserve those freedoms. The same is true in the practice of medicine. If doctors want to preserve the right to deliver the kind of care that they feel is best for their patients, they are going to have to go to war with the insurance companies and politicians who would prefer to enslave them. Make no mistake about it, this is war. We are fighting over our freedom to practice medicine on our own terms. The patients who flank us will be fighting for their freedom to use their own money to purchase the kind of healthcare which is best for them. On the opposing side, the insurance industry will be fighting to maintain their huge corporate profits, their exorbitant CEO salaries and their shareholders’ dividends. There is much at stake on both sides. 

The real issue in this drama is that concierge medicine is a major threat to the big insurance companies, along with those politicians who support a nationalized healthcare system. Both big insurance and big government are now aware that there is a serious shortage of primary care doctors in this country. Without large numbers of primary care doctors under their control, they will not be able to implement their plans to control the flow of the healthcare dollar. This is what motivates these early attacks on concierge medicine. Follow the dollar and you will understand the motivation of the inquirers. This is all about big insurance and big government trying to control the healthcare dollar. 

Before the insurance companies get too cocky about this recent victory, they should realize that all concierge doctors and patients will not respond the way that the Maryland group of internists responded. I am a board member of SIMPD, the national concierge physicians’ organization that represents private doctors across the country. We are fiercely independent professionals. We are strong patient advocates. We will not relinquish our hard-won right to control the way that we practice medicine. All of us in this organization have fought many fierce battles with the insurance industry and we are not only surviving, but thriving. We have thousands of loyal patients who will never return to the kind of fast-food medicine that is dished out by HMOs and big insurance companies. Freedom to deliver and receive the kind of medical care that citizens in our country deserve is a right worth fighting for and I encourage like-minded doctors to fight along with us to preserve that right.