When Your Work Spirals Out of Control …

It’s time to change your business model

When Peggy and I moved to Philadelphia 20 years ago and were looking for a doctor, someone recommended “Dr. Tom Harrow” (not his actual name), with a practice five blocks from our home across the street from the teaching hospital where he’s clinical assistant professor of medicine.

I went to see him for a physical and he was (and is) terrific. Soft spoken, he asked a lot of questions, listened to my replies and took extensive notes. And he examined me expertly from toes to nose.

Peggy and I have since been back to him numerous times and he has been simply great—thorough, meticulous and a diligent note-taker. The specialists he has referred us to are the top people in the Philadelphia area.

On the wall of the little examining room is a huge framed montage of sports photographs along with badges, sideline permits and tickets. I discovered he was not only head team physician for one of Philadelphia’s major sports teams, but also lead internist for another. We see him sometimes on TV ministering banged-up athletes.

With the combined salaries of these two teams being roughly $200 million a year, the owners would be nuts to entrust their precious assets to anything less than a world-class physician. From first-hand experience, I can testify that Dr. Harrow is world-class.

When I turned 65, I went to see Dr. Harrow for something or other and we talked Medicare. I said I assumed that the federal government’s Medicare reimbursement payments were lousy and that if there were any tests or treatments he wanted to perform that he would lose money on, I would gladly make up the difference.

His icy response: “Under Medicare, it would be illegal for me to take extra money from you. I could lose my license to practice.”

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Comments
  • Peter Hochstein

    Unfortunately, Denny, you’ve put your finger on what is about to emerge as a major healthcare problem: concierge medicine for those who can afford it, second class medicine for everyone else.

    One of the reasons it’s foolish to cut Medicare reimbursements is that low medicare and other insurance reimbursements drive doctors out of the Medicare orbit, or forces them to take so many patients that they can’t provide first class medicine. If anything, reimbursements to physicians and certain other providers should be increased. Funding this is problematical unless we accepted that higher taxes replace expensive out-of-pocket costs and insurance costs for healthcare – for patients and their employers alike.

    Another thing we ought to be doing is encouraging more bright young people to enter the medical profession, rather than spending their lives moving money around to make a living. Too many young people go into banking only because it’s the surest way to know they’ll be able to pay off their huge college loans quickly .

    In countries where university tuition is free, or close to it, there are fewer problems turning out the doctors, scientists and great teachers they need in adequate numbers. Meanwhile, our nation grumps about taxes and slides ever more quickly toward third world status. In fact, in some respects we’re there already.

    Sorry to go off on this rant. But concierge medicine isn’t just a marketing invention. It’s a response to a system that doesn’t reimburse its doctors fairly, and that plunges young people into decades of debt before they ever emerge with their degrees.

  • Scott Wheatley

    I’m Canadian, and though our system is not perfect I know that if I were to have a heart attack right now that within minutes I would have paramedics, a firetruck manned by trained first responders plus our office first aid attendant(certified first aid attendant) at my side.

    I would be rushed to emergancy, be served by a team of er physcians, state of the art equipment and would have a bed and 24 hour assistance by a team of well trained doctors and nurses.

    I have seen our system in action and although it isn’t perfect, I have never seen it fail in a time of extreme need.

    My cost? Between my work and my wifes it is 100% covered. If I was paying myself for a family of four it is about $200 per month. In my youth when I was to busy having fun to worry about paying provincial health premiums I was still covered.

    When I hear about some of the horror stories south of the border I can only be thankful for our system.

  • Peter

    To add to Scott’s praise for the Canadian (single-payer) system, Canadians enjoy longer life-spans (in comparison with the States), lower infant mortality, and other medical advantages … all for a fraction of the percent of GDP that Americans pay. And no one loses their home to pay for medical care.

    It’s no wonder that Ontario had to go to a higher-tech health card: It was discovered that thousands more cards had been issued than the population of the province at the time. (The extra cards were all in the hands of folks who lived in places like Buffalo and Detroit, and were happy to take advantage of Canadian healthcare: The bogus cards were said to have a "street value" of $5,000!)

    One other benefit of a single-payer system: Much lower administration costs for the doctors. The clinic where my doctor practices boasts 4 physicians. They have a grand total of 2 admin staff, to answer phones, make appointments, handle referrals, and perform all "billing"-related tasks

    As Scott says, the system isn’t perfect, but I don’t know a single Canadian who’d prefer the U.S. medical system..

  • jonathanblaine

    As a dual-citizen, born in Canada but with 20 years of navigating the wonders of the US healthcare system under my belt, here are my my 2 kopeks worth concerning US healthcare and how it measures up with other countries’ offerings.

    I address much of this in July’s "Single Payer: A $1 Trillion-savings US Health Care Pipe Dream?"
    http://jonathanblaine.com/wpress/2012/07/single-payer-healthcare-pipe-dream/

    Economically, ‘ObamaCare’ must be just the beginning. Healthcare is a necessary service, rather than a free market product consumers like Denny should be agonizing over as a consumer… not only for the reasons Peter and Scott mention. America’s current track, even with the ACA, is going to bankrupt the country.

    There are more basic have / have-not questions at stake. As I quote one Canadian who put it quite succinctly: "Do poor children have the right to the same standard of medical care as rich children? Yes or no? Instead, the debate has become about ‘liberties.’ If the consensus answer is ‘No,’ fair enough, continue as is."