Dr Sidney Wolfe, director of consumer organisation Public Citizen's health research group in Washington, DC, said, “Boutique medicine is a predictable consequence of how badly our healthcare system is functioning.”In my case, I received a letter that informed me unless I paid a thousand dollars a year, on top of what Blue Cross provided for office visits, my doctor would no longer see me.
The American Medical Association has not taken an official position on the issue. But Dr Richard Roberts, chairman of the American Academy of Family Physicians, said, “If you have a substantial portion of America's doctors doing this, who's going to take care of everybody else? We've got over 40 million people in this country without health insurance, and another 20 million who are underinsured. What's wrong with this picture?”"
Instead, I could go see someone from a list of doctors who had agreed to accept his patients for "continuity of care." Well, I thought to myself. If my doctor doesn't want to see me, I don't want to see him. Another doctor told me, "he's good, but he's not that good." So I checked the list. Only one doctor had a medical degree from an American medical school. Some "choice." I called and was accepted as a patient.
Then, a few months later, a new letter arrived, from the new doctor. He was going into a modified boutique system himself, he said, called MDVIP. (The company is owned by Proctor and Gamble, makes of Tide Detergent, by the way.) He would still agree to see me, but only for a short 15-minute appointment. For longer appointments, 30-minutes or more, I would have to pay him an extra fee, as well.
Both of these doctors had invited me to sales seminars at local hotels before they switched to the new system--just the kind of things condo salesmen or hedge fund operators tended to run, before the recent Wall Street collapse.
Well, I talked to yet another doctor, who said that the two-tier practice sounded unethical on its face, that it was wrong to treat patients differently based upon their ability to pay. Apparently, this idea has occured to some lawyers, even Members of Congress, but so far no one has acted upon it. You can find out more about the legal problems with boutique practices, on attorney Steven M. Goldstein's webpage. Apparently, there have been questions from members of Congress:
These practices have not slipped under the radar screen of government officials, as numerous investigations and other efforts to stop this movement have begun. The most visible action was a letter sent in March of this year to the Inspector General for the Department of Health and Human Services by five members of Congress, including Representative Henry Waxman from California and Representative Pete Stark, the author of the Stark self-referral law. In their letter, the Congressmen raise several concerns that the boutique practices are violating federal laws, and they asked the Inspector General to take "rapid action" against these practices. Last year, Senator Bill Nelson of Florida introduced a bill in Congress to prohibit physicians from charging additional fees to Medicare patients. In addition, various state agencies have begun their own investigations. Departments of Insurance in the states of Massachusetts and Florida are reviewing the practice.Nevertheless, little has been done to stop a questionable practice that results in fewer doctors being available to see patients--at a time of crisis in national health care.
Laura Newman cited the "boutique" phenomenon as a horrifying symptom of a developing American class system in health care, one that harms public health directly by rationing care on the basis of ability to pay in the British Medical Journal:
Charatan points out that the rise of boutique medicine means that more doctors can cream from the top, picking those who pay the most. Unsettling questions remain: are American doctors and insurers in their silence building a system that is eroding the public's health? In the past, doctors' leaders and researchers have waged a successful battle in the United States to allow specialty referrals, taking their battle to the press, Capitol Hill, and state legislatures. But they have become eerily quiet on this issue. It is high time for those claiming interest in the public's health to publicise the situation and document the harm.
I haven't seen too many articles about the phenomenon in the media. My guess is that all too many writers, editors, producers, and the like are happy to pay the extra fees for VIP treatment, and haven't spent much time thinking about the ethical or public health considerations. There's a term for this mentality: "Public be damned."
The thought occurs: Perhaps this discouraging phenomenon might be added to the anti-elitist agenda of the Tea Party Republicans when they enter Congress as part of the effort to "repeal and replace Obamacare?"
