Medicare for All

If you’ve ever had an experience with the American healthcare system, you’ve probably walked away thinking, “Why can’t we have nice things? Or even basic human things??” We get stuck on gurneys sitting in ER hallways, waiting hours for care; we skip other basic needs like food and housing to pay for the healthcare we can’t skip; or we wait for months for preauthorizations from our health insurance and referrals from our doctors. Of course, for the super rich you don’t have to endure any of these humiliating experiences, and they have developed some new, expensive ways to get the healthcare they need when they need it. So put up your pinkies and throw on a monocle – today we’re doing a deep dive into the lifestyles of the rich and famous to find out: just how fancy is concierge healthcare, and can the rest of us get some?

Let’s start with concierge primary care, the latest trend in fancy healthcare! What is concierge care?

Some concierge plans (also called Direct Primary Care) work with existing insurance – those are the cheaper ones ($600-1000/year, aka Hyatt Care). Some you actually pay a flat fee that covers all your services. Those are the really expensive ones, which can run from $2400 to $30k per year!

But what do you get for your money?

• 24/7 access to doctors (some promise your physicians direct phone number)
• Coordination of care (referrals, preauthorizations if necessary)
• Extra services like a health coach!
• Some offer really crazy shit like home visits
• Physicians have fewer patients and can spend at least 30 minutes with each of them.

Now there are more than 1,500 Direct Primary Care practices across the country, and 1 in 5 of the top 1% buy concierge physician care.

We’re also seeing some hospitals, like Ben’s local mega-hospital Mass General, offering “Concierge Medicine.” They have dedicated concierge physicians who see fewer patients and are more accessible, available by phone or email 24 hours a day, seven days a week. You also get your own health coach and a dietician.

Do you need to maintain insurance? Yes. At Mass General, your $10,000 membership fee covers a high level of “service” and “access” but not the cost of the medical care you need. Your insurance plan will cover the actual services provided by the concierge physician. That means $10,000 on top of your premiums, co-pays and deductibles.

Outside of the exorbitant cost, are there downsides to concierge care? You betcha.

• It exacerbates the primary care provider shortage and creates two-tier system: direct primary care physicians have fewer patients, and also creates a two-tier system where rich people buy their way out of the physician shortage.
• Despite all the marketing claims, concierge care may not lead to better health outcomes: there is a lack of peer-reviewed studies on care outcomes in concierge practices.

But when rich people get to the hospital, don’t they get treated like the rest of us? Nope. Big hospital donors often get to skip the line in the ER and get VIP status. They get fancy luxury suites with fine gourmet dining, high thread count sheets, and suites with custom cabinetry. They also get the best nurse to patient ratios in town, with some luxury units assigning each patient their own nurse who has no other patients, 24/7.

These luxury units can be dangerous though. When the hospital is more concerned with pleasing the patient than providing the care they need, it can result in “VIP Syndrome.” There’s anecdotal evidence that because some patients want to stay in their luxury accomodations instead of being moved to a specialty or more intensive unit due to their condition, they don’t get the kind of care they need, which can lead to worse outcomes or even death. At least one study suggests that higher patient satisfaction is correlated with worse outcomes.

VIP syndrome can lead caregivers to overtreat patients with unneccesary expensive tests, or undertreat them by avoiding upsetting or painful procedures or tests. This can lead to terrible consequences. A 2016 story from the Boston Globe described a prince with “ties to Middle Eastern royalty” who was diagnosed with a drug-resistant infection, but objected to his providers wearing protective gear around him. Instead of following hospital protocols, they made an exception to make him happy, putting his and their health at risk. There was also an investigation into the amount of painkillers he was administered, and other examples of exceptions made to hospital policies to please the prince.

Another obvious downside is that this kind of VIP care is unethical to treat patients differently based on wealth or status. And treating those VIPs better takes resources away from “regular patients” who already struggle to access care and providers.

Doesn’t it seem like some of this stuff is just the kind of decent healthcare we should all have? Shouldn’t we all have access to the care we need when we need it, including providers who have time to spend with us and hear our concerns, hospitals that prioritize our comfort and treat us with respect, and the ability to get care without a health butler to handle all the complexities of referrals and prior authorizations? We at Healthcare-NOW believe we all deserve nice things, and that’s why we won’t stop pushing for Medicare for All.

Don’t forget to like this episode and subscribe to The Medicare for All Podcast on Apple Podcasts, Google Podcasts, or your favorite podcast platform! This show is a project of the Healthcare NOW Education Fund! If you want to support our work, you can donate at our website, healthcare-now.org.