The Threat of Concierge Medicine

02/15/2013 11:15



A two-pronged attack on Medicare is already in progress and must be stopped!

The first attack already crippling Medicare is decreased physician compensation.  Allowing  the government to continue to lower the “allowed” reimbursement fees to doctors for treating Medicare patients will create a catastrophic impact on all patient care.

At the inception of Medicare in 1966 the allowed fee was generally 100% of the bill. Today the allowed fee may be closer to 50% of your doctor’s bill. 

If any physician accepts Medicare patients he must accept the mandated fee allowance he receives from Medicare.

The “allowed” figure is an ever decreasing fraction of a doctor’s fee for services. 

Future government manipulation of the allowed reimbursement figure will threaten your access to quality medical care in this country.

For those of you who have not yet seen one, the Medicare Summary issued to patients after receiving medical care “paid” for by Medicare lists four primary categories:

1. Doctor’s Fee   2. Medicare Allows   3. Medicare Paid   4. You May Be Billed

The following example illustrates how you and your doctor are impacted.

1. Let’s assume the Doctor’s Fee is $1000. 

2. The “Medicare Allows” fee may be only $600. (That figure is an arbitrary unexplained fiction created by some Washington D.C. bureaucrat and can be decreased annually)

3.  The Medicare Paid fee (80% of the allowed number) would be in this example $480. It is imperative to understand that Medicare presently pays 80% of the “allowed” fee, not the 80 % of the “Doctor’s Fee”.

Responsibility for paying the balance has forced patients to purchase supplemental health insurance to cover the 20% difference.

4. You May Be Billed, the remaining $120, must be paid by the patient, usually through supplemental “co-pay” insurance.

Imagine for a moment that your doctor decides he can no longer accept Medicare patients. If you wish to keep your doctor you will then be billed directly for the entire medical service.  Obviously, you would have to purchase new insurance, (unrelated to the supplemental co-pay insurance required by Medicare) to cover the cost of your medical care.

Many doctors already will not accept Medicare patients because of the difference between the Doctor’s Fee and the Medicare Allows Fee. Certainly, a doctor’s revenue can be severely and arbitrarily decreased while the level of his service to the patient remains constant and his case load may be forced to increase. Much more dedicated work for much less money is hardly an incentive for entering the field of medicine and has begun to force many doctors into early retirement.

Unexplained government manipulation could arbitrarily decrease the fraction of the “allowed fee” as well as the percentage of payment of the newly adjusted fee.

Get ready for your health insurance coverage to be progressively inadequate!


The second assault on Medicare will come through the implementation of ObamaCare/The Affordable Care Act.  The new system will bring an estimated 8-12 million more patients into a Medicare like system. We know that today Medicare and Medicaid already are overloaded in terms of the doctor-patient ratio. Furthermore, the amount of money the government spends on health care could decrease.

There is a high probability that government plans for Medicare include a greater reduction in the present “allowed” Medicare reimbursements.

The reaction to date among many doctors is that they will no longer accept Medicare patients or they will retire. We are left with a decreasing number of doctors who will accept government covered patients.

 The government may attempt to force doctors to accept Medicare patients, perhaps through some new licensing requirement.   Doctors would simply retire or create a whole new system of care which I describe below. The result is more bad news for the patient: an even more disproportionate doctor to patient ratio occurs and the average patient may receive less than quality care.

The emergence of “Concierge Medical Care”.

What I foresee coming in the U.S. is the growth of a “concierge medical system”. Something akin to this has already transpired in Great Britain. With the establishment of a government health care program in Britain, physicians created private practices. The private practices were composed of recognized excellent physicians and their younger associates, all with better training, superior abilities and talents. The wealthy patients see these private physicians and pay in cash for services. Or payment can be made with private medical insurance. (Yes, despite a full government medical system in Britain there is an active and thriving private health insurance system.)

The British government health care system has certain deficiencies. The privately uninsured and those who cannot afford cash payment are left to suffer through long lines of waiting for less than the best medical care. These waiting periods can, in certain cases, of severe underlying disease, result in unnecessary deaths. The British now have a two tiered medical care system – a cash system of excellent care for the wealthy and a second system of long waits and lesser quality care for the unfortunate. The private physicians do very well financially. The government physicians receive payment dictated by diagnosis and hospital days. There is no reward for excellent results, which are quite rare in the government funded segment of the system.

In the United States I predict the rapid expansion of concierge medical care. The term concierge medical care is not one I made-up, but in fact is already well established. Concierge medical care is analogous to the duties performed by a concierge in an upper echelon hotel. You call the concierge day or night for any service, which he will immediately arrange for you.  In concierge care a doctor or group of doctors requires a base subscription fee from their patients.  Additional fees vary with the complexity of the care delivered.  In return the patient receives immediate, high quality medical care.

 The doctors in the concierge system will have superior qualifications.  Recruited from the best universities, medical schools and post graduate training, these doctors will have demonstrated excellence in each of these settings. Scrutinized throughout their training outstanding doctors will be sought after by established concierge medical groups.

Does concierge medicine sound far fetched? Hardly! There are 4400 concierge practices today in the U.S! 1000 concierge practices were added in 2012 alone, according to The number of concierge practices is expected to double in the next three years!

This could be terrific news for some people!

 But what about the majority of patients?

 The majority of patients are left with unsettling and troubling questions.

What will the qualifications be of the doctors who fill the gap left by the loss of the concierge doctors and doctors who retire from the manipulated system?

The paucity of doctors will be compounded by the increase in volume of Medicare-like patients.

We know the doctors left behind will be less than the “best”.

Beginning in the late 60s, the Government, encouraged medical schools to accept (in the name of diversity) otherwise unacceptable candidates. The medical schools altered their curriculums to allow intellectually inferior students to graduate. Throughout my training I personally witnessed these alterations and their negative effects.

In the future, in order to increase the physician count, the government will encourage even lower standards for medical students.  How low will the second tier of medical schools and post-graduate training hospitals go to fill their ranks? Curriculums will continue to be diluted. How much will these altered curriculums affect the quality of doctors? Will doctors still be qualified specialists?

President Obama has already stated that we need more doctors.  The government’s goal is to have a “white coat” available for all patients seeking government health care. Obviously, the system will require doctors who will gladly settle for lower compensation. To what degree will they still be the quality of doctor to whom we are accustomed?

 The answers to these questions are pending and frightening.

The destructive effects of Obama Care on physician compensation and the quality of medical care can only be contained by the public by communicating to their elected representatives.

Stop any alterations of Medicare that involve decreased compensation to doctors and government schemes to increase the number of doctors

Since the Congress has only partially funded Obama care there is an opportunity to halt the march towards decreased quality and diluted content of medical care for the vast majority.

Please send a copy of this article to your elected officials and please forward it to everyone you can.

 I have constructed a brief statement below that you could use to communicate with your Congressmen and Senators.


Dear Senator (-----)

I am sending you this important article written by a well known retired cardiac surgeon.

Please take the time to reflect on its points regarding the dilution of excellent medical care in this country.

It is clear from this article how Obama Care will destroy the quality of medical care for the vast majority of Americans.

Please halt the funding of The Affordable Care Act. Our only hope is your budgeting authority over this destructive act.