There are times when some things just don't look good.
Conspicuous consumption in hard times is one of them. Using money to muscle ahead of the common folk for services is another.
Along those lines, the "concierge" physician practices described in an Oct. 22 special report (p. 38) by reporters Michael Romano and Laura B. Benko are likely to tarnish the image of the medical community. Under these arrangements, affluent people can pay a steep annual retainer for preferred services and special attention. Those wealthy patients like the ability to see doctors whenever they want and to avoid the unpleasantness that ordinary people endure. Participating physicians say the "boutique" practices spare them payment hassles and ensure that they don't have to rush their patients.
This white-glove treatment would raise fewer eyebrows if this country could provide minimal healthcare coverage to all our citizens. Bioethicist Arthur Caplan of the University of Pennsylvania says it is morally objectionable to direct resources to the prosperous while nearly 40 million Americans can't pay for basic insurance. "I think the healthcare system is teetering toward intolerable stratification," Caplan says.
Americans have always lived with economic stratification, with the wealthy getting a bigger piece of the pie. But when some people get no piece at all, trouble can ensue. Lawmakers, government agencies and medical associations are understandably beginning to take a long look at concierge practices.
Many people also will find it galling to contemplate the assertion that these practices allow doctors to spend more time with patients. The implication is that physicians will lavish their attention on people who shell out the most dollars. And consumers will reason, correctly, that if these doctors were willing to make less money, they could devote all the time they wanted to their patients.
Concierge physician practices are completely legal and, with proper regulation and restrictions, should be allowed in a free-market society. But that doesn't mean these physicians are doing anything good for the profession.