I would love to have this kind of coverage, but I think Dr knope is severely mistaken about what income level constitutes “middle class” If I were to pay $6k a year (assuming that is per-family), then I would be spending about 20% of my after tax income on medical care.. If you include inevitable incidental expenses.

It’s a lovely idea, and not surprising with the general 30 year decline of middle class income levels, and increase of income levels for the super-rich that this would come about. But let’s not pretend anyone below the top 5% income level could afford this.

Perhaps if doctors considered an “economy rate” concierge service (forget the house calls and 24 hour service, just give me a good intelligent physician who is willing to treat me like a human, actually thoroughly research my situation, recommend preventative measures and spend more than 5 minutes in an appointment) and I might consider.

The other thing this leaves out of the equation is other health care professionals. I had a recent back problem, and some of the most compassionate, indepth, and ultimately helpful interaction came from a physical therapist who was deeply trained in some specific current research and methods for muscle training to help eliminate the problem – not just as a quick fix, but on a long term basis. What she gave me actually has helped, But when I tried to discuss what I had learned from her with my primary care physician, she had no idea what I was talking about.

In my opinion a good physician is not enough.

CNN has an article on “Qliance” medical group in Seattle, Washington. It seems to me, we should let doctors choose how their monthly or yearly flat fees are invested to provide reliable income and invest in new medical technologies.

The top down approach of insurance models usually insures the money stays at the top. Instead a truer free market approach would be, to let people choose their doctor then in-turn let doctors chose their investment e.i.insurance company. For low income and complex cases the government could provide extra incentives or medical vouchers to offset cost.

Why should doctors be at the mercy of bean counters? Doctors are the producers the providers. Insurance or investors should be catering to them. Why should I have to have a degree in medicine and business to understand my insurance or medical billing statement. How can a doctor treat you if they don’t even know you.

Ten minutes isn’t enough time and doctors are continuously coming and going in our PPO. We spend 7,500 dollars out of pocket and our employer matches with another 7,000 for basic service. Imagine how a doctors group could invest this at 500 patients per year. Imagine the insurance administration cost this would save.

I have lost trust in the medical field do to the increasing greed and influence of insurance companies and their profit margins over actual medical care. My only interest in a new business model is to bring back integrity and worth to the field of medicine.

I think the elitist criticism is a real, serious concern. I would love to see some of the management companies taking the initiative to do their part to mitigate this issue. For instance, my doctor has limited his practice to 600 patients. I’d be willing to consider switching companies if there was one that limited the practice to 500 concierge patients and 100 patients who were unable to afford the service.

Additionally, I believe that whatever the ultimate outcome, the emphasis being put on healthcare and the growing issues involved will have a positive impact on the current circumstances.

Concierge medicine is driven by patient dissatisfaction over our present fast-food medical model of HMOs, PPOs and a failing Medicare system. Patients love the time they have with their concierge doctors. Doctors love having the time to do what they were trained to do. Unless primary care medicine becomes more attractive to young doctors, by implementing models such as concierge medicine, no one will opt for a career in internal medicine, family practice or pediatrics and the shortage of primary care doctors will only worsen.

Steven D. Knope, M.D.