Obamacare does a great many things to the healthcare system. Some of which we know, most of which we probably know nothing about. Many of the rules haven’t even been written and those impacts may not be understood for years. One of the things we do know is that Obamacare expands insurance (through public and private systems) to 30 million new people. Those people are going to want to go see a doctor.
But by 2020 it is estimated that the US will be short about 45,000 primary care physicians (PCPs). The reason being that folks in med school know they don’t make any money and choose to specialize. PCPs are pressed for income due to the overhead of dealing with insurers, and price pressure from Medicare, etc. So what we have then with Obamacare is a dramatic increase in demand for PCP services, and no addressing of the supply of providers.
This has led many physicians to seek fewer patients that use Medicare and Medicaid. And a new trend has started where doctors don’t accept any insurance at all. It’s called Concierge Medicine.
What is Concierge Medicine? Think of it like a subscription model. At the high end individuals and families can pay thousands of dollars a year for this service. The doctors give them more attention, and in some cases do things like make house calls or be available 24 hours a day. At the lower end you still have better access to your doctor and they have an incentive to keep you out of their office while still providing outstanding service. This costs something more like $50-$100 a month.
The downside to this system is that concierge physicians dramatically reduce their patient load, which means more patients for an already crowding system. But there are upsides too. Doctors have an incentive to keep you out of their office. So they do things like diagnosing swollen tonsils through some cell phone pictures and sending a perscription straight to the pharmacist. The patient never needs to step foot in the office but still gets great care. Everyone saves money. Methods such as this will be needed if we hope to reduce costs or get more patients in front of a strained PCP workforce.
It’s not hard to picture a future where concierge medicine plays a greater role in our healthcare. Right now many people pay too much per month for health coverage that gives them cheap copays. With a huge discount, one could forgo those benefits while still getting the coverage that will take care of your big ticket items. Part of the savings can go towards having a concierge-type doctor that gives you better access to your PCP. The trade association for concierge medicine claims their patients are measurably healthier and therefore less of a burden on the system.
It remains to be seen how sustainable this system is. As of right now it’s most useful for the wealthy. Some experts say it’s the beginning of a two tiered system where the rich have better healthcare providers. This is probably already the case. But one thing Obamacare should be watching for is an overall quality of care. If the base level of care starts to deteriorate, then the new policies are putting too much strain on the system.
Image: Robert S. Donovan