You can thank Ronald Reagan for it, but everyone knew it would end up like this:
Diana Moore learned the news through the neighborhood grapevine. Her family's primary-care physician of seven years would no longer accept Moore, her husband and daughter as patients - unless the family paid a $4,500 annual fee.
The physicians at Charter Internal Medicine in Columbia are overhauling the practice, ditching the insurance-dependent model and instead charging a flat yearlyfee in exchange for the promise of 24-hour access to doctors, unhurried appointments, home visits and state-of-the-art annual physicals.
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I was working as a mechanic in a body shop when the body repair industry was being pressured into becoming 'pro shops', working for agreed prices with insurance companies in return for the insurance companies directing work to the shops. 20 years later, if you're a body shop, you can't stay in business without insurance work (unless you're a specialty resto place and different rules apply).
And don't get me wrong, I'm not shedding any tears for doctors (who, for the majority, lead the lifestyle mortgage bankers used to) but, like the body shops, they have to rely on volume to cover costs. When the profit - cost margin gets too low, the first thing that suffers is quality. A fucked up paint job on a fender is one thing, with health care, lives are at stake.
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Known as "boutique" medicine or "concierge" care, the national trend appears to be sweeping across Maryland as primary-care doctors feel the financial crush of rising costs and low insurance reimbursement rates. Physicians say the model allows them to trim their patient loads and give patients quality care without worrying whether insurance will cover it.
"Primary-care doctors are seeing 30 to 40 patients a day - that's too many," said Dr. Harry A. Oken, who has been with Charter Internal Medicine for more than 20 years. "It's not about the money. It's about having the time to spend with your patients to keep them healthy."
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Once upon a time, I remember when it wasn't a necessity to have health insurance. The first time I broke a bone (1967; I was 5) my dad paid cash for my emergency room visit, not wanting to go through insurance for fear his permiums would go up (he'd started his own business a few years before and things were tight). Nowadays, you can't walk into an emergency room without a $1000 bill.
The U.S. health care and insurance industries need an overhaul, some serious regulation, and a rethinking of the way the health of the nation should be addressed. Hopefully, President Obama (fingers crossed, knock on wood) will live up to his campaign promises.
Going to work ...
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