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Politics : A US National Health Care System? -- Ignore unavailable to you. Want to Upgrade?


To: Lane3 who wrote (13037)1/13/2010 10:30:07 AM
From: Lane3  Respond to of 42652
 
Today's Post has something on concierge doctors.

Patients paying for more face time with doctors

By TOM MURPHY
The Associated Press
Tuesday, January 12, 2010; 5:09 PM

-- Over the counter cold-and-flu remedy: $5.99.

Trip to the doctor's office: $20.

Extra time to bend your doctor's ear: $1,500 a year and up.

Primary care physicians are increasingly offering exclusivity to those willing to pay for it.

These practices, known as concierge, boutique or retainer practices, typically charge annual fees that range from $1,500 to $10,000 or more. The fee allows the businesses to prosper with a far smaller roll of patients than has become the norm under the traditional system.

Patients like the extra attention and lack of crowded waiting rooms. Doctors say they need alternatives to a payment system that forces them to cram their schedule with appointments.

But the growth comes with concerns about doctor access, particularly since a bill moving through Congress could cover millions of uninsured people and flood doctor offices with new primary care patients.

Heidi Berman pays $1,500 annually to see Dr. Stephen Glasser in Baltimore. The 38-year-old attorney said visits to her previous doctor lasted five or maybe 10 minutes.

"If you had questions, they were sort of an afterthought because the experience was so rushed," said Berman, who switched to Glasser a year ago.

Now, if she forgets to ask a question during normal office hours, she calls her doctor in the evening and he immediately calls back.

"It's personalized attention that I think ... every person is really entitled to," she said. "It's unfortunate that you have to pay for that, but for me, the $1,500 a year for that extra attention is worth every penny and then some."

The fee typically gives patients longer, more in-depth appointments with doctors as well as extras normally not covered by insurance. That can include an annual physical that delves into nutritional counseling and depression screening and provides a wider range of tests and blood work than patients usually receive. They also get after-hours access to the doctor.

Most patients still need insurance in addition to this fee, and they still pay co-pays and other coverage-related costs.

Glasser used to care for about 3,500 patients, seeing between 25 and 30 a day. He pared the total down to between 600 and 700 when he converted to a concierge practice six years ago.

He still has full days, but he traded 10-minute visits for more time with patients, including physicals that can last longer than an hour.

"Back then, you're sort of putting out the fires and treating complications and trying to keep people out of the emergency room," he said.

The number of doctors who operate a retainer-based practice is hard to pin down and is still a small slice of the roughly 326,000 U.S. primary care doctors. But organizations that help start them report brisk growth.

MDVIP Inc., based in Boca Raton, Fla., works with 340 doctors who have about 122,000 patients. It is one of the bigger firms in the business and has seen both doctor and patient totals grow by 10 percent or more every year since the company started in late 2000.

Concierge Choice Physicians in Rockville Centre, N.Y., works with 120 doctors who have converted their practices. Managing partner Wayne Lipton said there also could be a few thousand doctors who set up retainer-based practices without such help.

In contrast, a 2005 U.S. Government Accountability Office report identified only 146 concierge physicians in the entire country.

The growth in concierge care is "a reflection of the fact that we've got a very dysfunctional health care system," under which doctors are forced into a "hamster wheel" system in which they must see lots of patients just to stay afloat financially, said Dr. Lori Heim, president of the American Academy of Family Physicians, which is neutral on the subject.

But Harvard Medical School professor Dr. Stephanie Woolhandler said concierge practices are "absolutely the wrong solution," one that leaves behind people who can't afford better care.

Woolhandler, who still sees patients, says the entire system must be fixed to place more value on a doctor's time.

Some doctors try to juggle the two systems and operate only part of their business under a concierge model. Others may waive fees for needy patients. MDVIP works with physicians to find new doctors if patients can't pay the fee when a doctor converts.

Despite these options, some patients are still left with a tough search for affordable care.

Florence Day, of Sandy Spring, Ga., had a hard time getting her blood pressure under control after she lost her doctor a couple of years ago. He switched to a concierge practice and she declined to pay the $1,500 fee to stay with him.

Day, 90, lives on a fixed income and is covered by Medicare. Her daughter helped her eventually find a doctor she likes. But she's not thrilled with a system that charges an annual fee on top of the payment she's always made at the doctor's office.

"That's like putting up a deposit, you know, and I don't think that's right," she said.



To: Lane3 who wrote (13037)1/13/2010 11:50:17 AM
From: TimF  Read Replies (1) | Respond to of 42652
 
Some people have plans that are more generous than Federal Blue Cross, real "gold plated" plans. Often these people are quite wealthy, but they may have the great plans through their union contract.

The more serious issue is that the level is not (at least as part of this bill) adjusted for inflation, so eventually a large percentage of plans could be covered by this tax.

More -

------

...Who has high-premium plans?

In the health bill passed by the Senate, a high-premium health plan is defined as costing more than $8,500 for an individual or $23,000 for a family. The cost includes health and dental benefits, along with worker and employer contributions to flexible spending or health savings accounts. In an analysis released Nov. 30, the Congressional Budget Office predicts that in 2016, 19 percent of workers who have insurance through the workplace would fall under that category...

kaiserhealthnews.org

----

...As it turns out, though, many smaller fish would get caught in Mr. Baucus’s tax net. The supposedly Cadillac insurance policies include ones that cover many of the nation’s firefighters and coal miners, older employees at small businesses — a whole gamut that runs from union shops to Main Street entrepreneurs.

Under the Baucus plan, insurers selling a plan costing more than $8,000 for an individual and $21,000 for a family would have to pay a 35 percent excise tax on the excess amount.

Although the national average premium is currently $13,375 for a family policy, according to the Kaiser Family Foundation, many are much higher than that — particularly in high-cost parts of the country.

Nationwide, about one in 10 family insurance plans would be subject to the new excise tax, according to the Center on Budget and Policy Priorities, a liberal-leaning policy and research group.

The tax would be levied on insurers — or on employers that act as their own insurers. Either way, the tax would very likely be passed along to workers in even higher premiums than they pay now. But if insurance premiums continue to rise faster than inflation, as they have for years, many more people’s policies could end up setting off the luxury tax in coming years.

“It puts a bigger tax on middle-income Americans who are already paying enough,” said Harold A. Schaitberger, the general president of the International Association of Fire Fighters. The union says some of its members around the country are in plans that would be subject to the tax.

People who live in high-cost areas, like the Northeast or California, would also have a greater risk that their insurance plans would set off the excise tax — not because the coverage is particularly generous, but because the price of their policies reflects the higher medical costs where they live. Massachusetts residents, for example, tend to pay more than a quarter more in premiums, on average, than people living in Idaho...

...Proponents say the tax is squarely aimed at the very richest plans — like the family coverage offered to the 400 or so managing directors at Goldman Sachs and its top executive officers. It carries a premium of around $40,000 a year. The Goldman plan would be subject to nearly $7,000 in taxes. Goldman Sachs declined to comment.

Even if most employees around the nation might initially escape, experts say more people’s insurance plans would cross into the taxable range in future years. If the inflation rate in premiums continues its pace of the last 10 years, even the average cost of family coverage would probably cross the threshold within a few years of the tax’s going into effect.

“That number is going to grow and grow and grow,” said Marissa Milton, a health care policy analyst for the HR Policy Association, which represents large employers’ benefit managers.

Ms. Milton drew a comparison to the alternative minimum tax — a tax modified in 1986, supposedly as a way to keep affluent people from using deductions to avoid paying taxes. In reality, it has ended up capturing more and more middle-class taxpayers, Ms. Milton said. Likewise, the insurance excise tax “is going to affect a lot of families,” she said.

By his own calculation, Robert G. Hansen, a business professor at Dartmouth, is one of the Americans who might be considered to have luxurious coverage, because the cost of his benefits could easily top $25,000.

But that supposedly “gold-plated coverage,” he said, includes the cost of related benefits, like dental coverage and the money in his flexible spending account — all of which would be subject to the excise tax.

And who will pay the $1,450 in additional taxes Mr. Hansen would incur? “In the end, look in the mirror,” he said.

“It’s the worst kind of economic engineering,” he said. “You end up with something that looks like the I.R.S. code.”

Small employers would also probably be hit by the taxes — and, again, not because they offer overly generous coverage. Instead, small businesses tend to pay more for their insurance than bigger employers that can negotiate better premiums. And because they do not have large pools of workers to help spread the risk, small employers tend to pay even higher amounts if they have older or sicker workers.

About 14 percent of small employers, counted as those with fewer than 500 workers, now offer policies that would be subject to the excise tax, said Beth Umland, director of research for Mercer, a consulting firm that conducts an annual survey of employee benefits. That compares with just 5 percent of large employers with 500 or more workers.

“That is a very heavy hammer on the cost of your premiums,” said Donna Marshall, the executive director of the Colorado Business Group on Health, which represents employers of all sizes in that state. “You don’t want to cause a chilling effect on the employers who are trying to do the right thing.”

Even union plans, which tend to offer the most generous coverage, are expensive because they frequently cover a number of older workers or some who retired early and have not yet reached Medicare age. Jim Hoffa, president of the Teamsters union, warned that the middle class, not the rich, would bear the brunt. “It taxes the wrong people.”

nytimes.com