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Business Week explores the highs and lows of concierge medicine.
… There are 4,400 concierge doctors in the U.S., 30 percent more than there were last year, according to the AmericanAcademy of Private Physicians, their professional association. “This is all doctors want to talk about,” says Jeff Goldsmith, a health-care industry analyst and trend spotter. “ ‘I want to go off the grid. I’m done billing Blue Cross. I can’t deal with this anymore. It’s destroying my life and my relationship with my patients.’ ”
Some health policymakers are encouraged by this trend. They think an increase of direct-pay doctors—especially affordable ones—could lead to better health care in the U.S., which has the highest costs and some of the worst outcomes of any wealthy nation. “I think it’s great,” says Kevin Schulman, a professor of medicine and business administration at DukeUniversity. “We’re rediscovering that if we just ask people to pay for services, we could provide them with better value. Primary care is affordable.”
Others worry that the growth of concierge medicine will mean the affluent receive high-quality care while the rest of the country struggles to be seen by fewer and fewer doctors. “It is a step towards a two-tiered health-care system: a system where the rich get first-choice care and the not-so-rich get second-choice care,” says Kathleen Stoll, deputy executive director of Families USA, a health-care consumer advocacy group.
This much is certain: There will be greater demand for primary-care physicians because of President Obama’s Affordable Care Act. “Love it or hate it,” Atlas MD’s Umbehr says of Obamacare, “it’s going to make it harder for you to see your doctor.”
Primary-care physicians have long complained of being the poor men of their industry. Their median salary is $160,000 a year—roughly half of an anesthesiologist’s—but rising overhead, more paperwork, and packed waiting rooms are propelling ever-greater numbers to shed patients and charge a retainer. In 2011 the average American medical practice spent $82,975 per doctor dealing with insurers, according to the Commonwealth Fund. That same doctor has 3,281 active patients over a three-year period, says the AmericanAcademy of Family Physicians. She rarely has time to see them for more than a few minutes. The attraction of concierge medicine for her isn’t hard to fathom: She can winnow down her patient roster, spend more time with each, and do away with her insurance-related headaches.It will only become more enticing in 2014 when the Affordable Care Act’s individual mandate requires everyone to be insured. The law will enable 30 million previously uninsured people to get coverage through an expansion of Medicaid. They’ll need primary care, but it’s not yet clear who will give it to them. By 2020, the Association of American Medical Colleges estimates, there will be 45,000 fewer primary-care doctors than the U.S. needs. “For the last 13 years, very few students have been going into it,” says Patrick Dowling, chairman of the department of family medicine at the University of California-Los Angeles’s David Geffen School of Medicine. “What motivates medical school students is income, just like everyone else.” …
Andrew Malcolm writes about an Illinois congressional district that is illustrative of Chicago way. This also provides understanding of how we came to the present president’s putrid politics.
Ah, Chicago and its politics. There’s no other American city quite like it.
Fortunately.
It’s a beautiful city from the outside. And a political cesspool inside, a seeping source of conniving and corruption that spawned Barack Obama and his top aide Valerie Jarrett and is now ruled by the president’s ex-chief of staff, Rahm Emanuel.
Another amazing chapter in the WindyCity’s sordid politics began unfolding Wednesday, one whose lineage can actually be traced back to the very beginnings of Obama’s political career, which now has an extended expiry date of Jan. 20, 2017. Today, Obama lunches with the man he defeated, Mitt Romney.
See if you can follow along now. The details are revealing of the uncompromising history, incestuous inner workings and municipal mores of the place that produced Obama the politician.
Yesterday Mel Reynolds announced his candidacy for the House seat representing Illinois’ 2d Congressional District, which includes the city’s South Side and — oh, look! — Obama’s Hyde Park house. So, he’ll be eligible to vote in the February Democrat primary and the meaningless April special election.
That special election became necessary after the sudden resignation last week of the district’s easy Nov. 6 election winner, eight-term member Jesse Jackson Jr.
Jackson Jr. has been absent from his House duties most of this year during treatment for depression and bipolar disorder. His situation was complicated by revelations that federal authorities are probing allegations of his misuse of campaign funds, not a rare occurrence in Chicago politics. …
John Fund writes in the Corner about next years race for Virginia governor. We won’t have Chicago style, but will have a chance for some Clinton slime.
It looks as if the makeup of next year’s Virginia governor’s race is set. GOP Lieutenant Governor Bill Bolling dropped out yesterday, admitting he was unlikely to win a GOP convention against conservative favorite Ken Cuccinelli, the state’s hard-charging attorney general. The Democratic field also is now clear — former top Clinton fundraiser and businessman Terry McAuliffe will run again.
Expect the race to be a bitter one, with McAuliffe trying to frame it around Cuccinelli’s staunchly conservative social views and Cuccinelli trying to peg McAuliffe as a slippery operator who has had no experience in elected office.
Starting out, the race looks to be roughly even. The Quinnipiac poll out this week has McAuliffe leading Cuccinelli by 41 percent to 37 percent among registered voters. But as the liberal blog Blue Virginia points out “usually what happens in off-year elections in Virginia is that the Democratic base tends to show in relatively lower numbers than the Republican base.” Thus, while President Obama narrowly carried Virginia this month, Republican Bob McDonnell won a 17-point victory in his race for governor just three years ago. …
WSJ Editors point out the hypocrisy at Costco.
When President Obama needed a business executive to come to his campaign defense, Jim Sinegal was there. The Costco COST -0.68% co-founder, director and former CEO even made a prime-time speech at the Democratic Party convention in Charlotte. So what a surprise this week to see that Mr. Sinegal and the rest of the Costco board voted to give themselves a special dividend to avoid Mr. Obama’s looming tax increase. Is this what the President means by “tax fairness”?
Specifically, the giant retailer announced Wednesday that the company will pay a special dividend of $7 a share this month. That’s a $3 billion Christmas gift for shareholders that will let them be taxed at the current dividend rate of 15%, rather than next year’s rate of up to 43.4%—an increase to 39.6% as the Bush-era rates expire plus another 3.8% from the new ObamaCare surcharge.
More striking is that Costco also announced that it will borrow $3.5 billion to finance the special payout. Dividends are typically paid out of earnings, either current or accumulated. But so eager are the Costco executives to get out ahead of the tax man that they’re taking on debt to do so.
Shareholders were happy as they bid up shares by more than 5% in two days. But the rating agencies were less thrilled, as Fitch downgraded Costco’s credit to A+ from AA-. Standard & Poor’s had been watching the company for a potential upgrade but pulled the watch on the borrowing news. …