
Boutique medical services offer wealthy Americans the chance to cut the line - paulsutter
https://mobile.nytimes.com/2017/06/03/business/economy/high-end-medical-care.html
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pyrophane
My concern is that this sort of approach to medicine is going to result is the
"top specialist" tier of doctors spending more time treating complaints that
don't really require their particular level of expertise. You probably don't
need to see the world's best cardiologist if you just have high blood
pressure, but if you are paying 40k a year for a concierge medical service
they might feel that the need to get you in front of him or her in order to
justify their fee. Otherwise what are you paying for? Consequently this
amazing heart doctor spends an hour telling you to eat better and exercise
rather than evaluating someone's complicated and life threatening condition.

~~~
Deregibus
In theory though, the market should address that right? e.g. a version of this
that's $10k a year but can handle 10x the volume because you triage patients
with competent nurses and PAs and save the expert's time for the cases where
they can actually make a difference.

~~~
rev_bird
Starting to sound an awful lot like the U.S. health care system...

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Deregibus
Yeah, I had the same thoughts when I was writing that. The key difference is
that the current system is so convoluted that there is almost no meaningful
market for consumers on the actual care side of things.

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sbierwagen
I like how the article says Private Medical "does not advertise", then
immediately follows that with some glossy, staged press shots. They don't
advertise, except for the advertisement they just ran in the New York Times.

~~~
atemerev
The NYT, with advertisement slogans like "Truth. It has no alternatives."
(When I first saw it, I had to double-check whether I am reading some English
translation of one of the "Pravda" issues in the USSR -- no, it was still
NYT), -- well, despite such bold claims, they often act as the principal venue
for top-level PR firms. Increasingly so in the last few years -- I understand
that newspaper business is in deep trouble, and I understand their envy to
Facebook and Twitter, but this sounds just a teeny tiny bit unethical to me.

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dsr_
This is the sort of thing that ends up with rich people swinging from lamp
posts.

Not the fact that you can hire a private doctor. Taking one doctor out of
circulation, more or less, doesn't enrage people.

No, the offensive thing is that John Battelle's kid's broken leg is too
important to be seen by a mere ER doctor, and instead the very senior
orthopedics doctor is summoned away from dealing with serious problems to deal
with a broken leg.

How does the head of orthopedics live with himself? I'm sure he comforts
himself with money.

Battelle made his money by doing things, and hardly anyone begrudges him that.
But his son now knows that his broken leg is more important than some
grandmother's shattered hip, and is likely to keep that attitude as he rises
to adulthood.

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ice109
>This is the sort of thing that ends up with rich people swinging from lamp
posts.

i don't understand why smart-ish people keep repeating this. there will never
be another revolution in a first-world (western) nation. it's just not
happening.

~~~
djohnston
why do you think so? i don't have strong convictions either way, but i don't
think i'd count it out as an impossibility.

~~~
icelancer
A lot of reasons, but one solid one is that there is a pretty strong anti-
pattern in that the ones that desire wealth redistribution the most are the
most likely to support gun control and/or the banning of private ownership of
weapons.

~~~
atemerev
Wealth inequality is not the only reason for revolutions. There are also
dictatorships, human rights abuse, corruption, disregard of laws for the
elite, and other fine things that might warrant the direct action.

~~~
icelancer
While true, those values are highly correlated - at least in Americans, and
most of the developed world - with people desiring lower access to guns for
the private citizenship. Low access to force multipliers makes it much harder
to spark and win a revolution against the state.

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dr_
I don't personally have a problem with people paying extra to receive what
they perceive to better care. But I think if you look at outcomes, I doubt you
will find that they have received better care by paying the extra 40k or
whatever it is a year. It's great that the kid in the story was able to be
seen by a established orthopedist in a city hospital - but most general
orthopedists know how to set a kids leg, and I doubt the outcome would have
been much different if they had gone to the originally intended ER.

It's certainly a good gig for the family practitioner, but I think the
following quote at the end of the article:

"“The traditional model of having a good internist is dying,” said Mr. Traina,
a scion of a prominent family here that arrived with the California Gold Rush.

will apply to the concierge doc in the longer run as well. If you are
reasonably healthy, checking your blood work once a year and your blood
pressure every so often, you don't have much need for a family doc. If
catastrophe strikes, then you will probably need a specialist - and if you're
willing to spend the money, it's best to save it for these times - yes your
cash will get you in as easily as a concierge doctor can - rather than dishing
out 40k annually.

I recently chose a medical clinic that's part of a university system for my
own healthcare, as opposed to a family doc who charges $1400 for an initial
exam and $400 for follow ups. Do they spend as much time with me? No, I'm in
quick and out quick. I get my shots and blood work and I'm out the door. Since
I'm pretty healthy, that's the way I want it.

~~~
atemerev
It is the most rational model. Unfortunately, like mentioned in other threads
here, fully private, cash-to-hands medical practice is prohibited in many
countries.

I have to travel to Spain for my medical tourism needs. However, it is mighty
inconvenient.

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bmmayer1
It's unclear what the point of this article is supposed to be other than to
stoke outrage at the 1% who get premium treatment while the rest of us proles
suffer 'normal' healthcare. It's almost as if all of a sudden having money
buys you nicer things, as it always has for all of history, including in the
healthcare systems of every other nation.

In developing countries like China, Russia, India, Saudi Arabia, there are
entire parallel healthcare systems for the wealthy and connected to get high
quality care and when such care isn't available, they travel to richer
countries or hospitals that cater to foreigners in Bangkok, Seoul, Cleveland,
Medellin, and any number of medical tourism destinations that have popped up.
I've been to several of these hospitals and they are _nice_. In Seoul, at the
Samsung Medical Center, hospital rooms for foreigners have one bed each, as
opposed to four beds each for Korean nationals. Why? Koreans are paying less
via subsidies and rich foreigners with weaker currencies are paying full fare.

In universal healthcare countries with market economies like the UK and
Canada, private clinics are the only way patients with money who want to avoid
the limitations imposed by rationed care can get access. In Canada, instead of
waiting an average 9.5 months(!) to replace a painful knee, you can go to
Duval Orthopedic Clinic in Montreal to get a knee replacement for under
$14,000 USD (compared to $49,000 in the US). In Hungary--this is a fun one--
you can go to a terrible state doctor for free or pony up $50 US for a private
doctor. Most Hungarians who can afford it pay the cash, because they know they
will get the quality for it. Even in the so-called universal medical system of
Cuba, the political elite and their relatives have their own private hospital,
whereas the rest of the population suffer substandard equipment, years-long
wait lists, lack of medication and outdated facilities, and worst of all,
doctors who spend half their time working side jobs as taxi drivers to pay the
bills.

The point is, markets will always step in to fill needs that aren't being met
by state-run care--it's as predictable as the sun coming up. Often, the gap
between rich and poor is worse in systems that try to do the most to eliminate
it--Cuba being a prime example.

What I found most interesting about this article--most likely unintentionally-
was the hypocrisy of the Bay Area, the liberal mecca of the country, that
would vote for universal healthcare in a landslide, also being the main
drivers of demand in premium private service, widening the gap between the
rich and the poor such a healthcare policy is bound to exasperate.

~~~
blendo
_In Canada, instead of waiting an average 9.5 months(!) to replace a painful
knee, you can go to Duval Orthopedic Clinic in Montreal to get a knee
replacement for under $14,000 USD (compared to $49,000 in the US)._

In the US, your _charge_ is likely to be $49,000, but I think many insurers
have agreements to only pay 20-40% of that.

Woe to you if uninsured in the US, though: they'll expect the full $49K. See
David Belk's
[http://truecostofhealthcare.net/](http://truecostofhealthcare.net/)

~~~
bmmayer1
True, and it also varies widely by region.

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hn_throwaway_99
I think a fair question is whether all that additional expense results in
better outcomes. I certainly understand the experience is better for patients,
and there is little or no wait time, but is there evidence that health
outcomes are actually better?

I wonder if it's like the difference between taking coach vs. a private jet.
The private jet is more convenient and comfortable, but safety ratings are
considerably better on major airlines.

~~~
sologoub
I think another way to look at this is minimizing risk/resulting guilt. The
broken leg example seems to support that - the father is paying for the best
possible care for his son, even if the outcome is the same (leg heals
properly) as the ER doctor, the father has obsolved himself of the risk that
he didn't do enough and allowed the leg not to heal properly.

In other words, the (I'm guessing) relatively slim chance there is a
complication with the broken leg is not worth it to the wealthy father to
take.

~~~
hn_throwaway_99
> In other words, the (I'm guessing) relatively slim chance there is a
> complication with the broken leg is not worth it to the wealthy father to
> take.

In medicine, though, there have been a lot of recent studies recently that
have shown that too much care can be harmful (especially in the orthopedic
realm). Sometimes the best thing to do really is nothing, but when you're
paying 40k a year, my guess is you, and more importantly your doctors, would
rarely take that point of view.

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skolos
Doesn't this exist in almost every country? There is always market for rich to
get better health care.

~~~
ThomPete
No. It's really as simple as that. only the US allow for this.

Edit: To all the down-voters. The article isn't about private healthcare which
in the US is more the rule than the exception. It's about a layer on top of
private healthcare.

Of course private healthcare exist in other countries. But this concierge
layer for "normal" rich people you will be hard pressed to find many other
places I ma pretty sure off (but could be wrong of course). Unless you are a
politician or royal or something.

~~~
kcorbitt
While there may be some countries that disallow private healthcare entirely,
the international situation is far more nuanced than your comment implies. For
example, I lived in Spain, where most people use the highly functional public
health system but there is a parallel private healthcare industry that is also
very effective (and still reasonably priced, compared to private healthcare in
the US).

~~~
ThomPete
Yes private healthcare systems of course they exist in other countries. But
the article is as far as I understand it about something else. It's about a
layer on top of the already existing private healthcare system in the US.

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jbandela1
What is interesting is that anecdotally in my experience and those I talked to
the VIP patients in VIP rooms tend to have worse outcomes.

It may be because there is a tendency for VIP to demand that something be done
and it not be uncomfortable. So they may go through more tests and procedures
for every little complaint and maybe get more pain meds which ends up
contributing to worse outcomes.

In addition, the doctor may be reluctant to say "no". For the ultimate example
of this, see Michael Jackson.

Finally, teaching hospitals provide some of the best care in the country. So
because of that, a VIP may go there. However, many of them don't want to be
seen by residents and medical students and residents. They want to be seen by
the famous department chair. Well, in many cases the department chair may be
good at research and politics and fundraising, but may not be the best actual
doctor. In addition, they may be years removed from actual day to day patient
management, relying on the residents to manage the details. You can imagine
how things can go wrong.

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paulddraper
And?

You can always get better faster service if you pay more.

Disney World, health care, cars, political favors, nutrition, hospice,
climbing Everest, prosthetics, cleaning staff, coaches, going to outer space,
etc.

I wouldn't expect Health Care for the proletariat to be somehow different from
the rest of our brief mortal existence. Somehow, it has seemed recently to
gain a special status all to itself.

\---

"Wish not so much to live long as to live well."

\- Benjamin Franklin

~~~
backtoyoujim
You are equating health care with going to Disney World ?

~~~
fsckin
Pay more and cut the line all day long, access to exclusive restaurants,
private meet and greets with characters, etc.

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brightball
MDVIP. Pay an annual fee in exchange for the doctor keeping a reduced patient
load.

It's reasonably affordable without being velvet rope wealthy and gives you a
much more streamlined care experience.

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watertorock
As usual the elite can afford the best and will get it.

