Escaping the medical bureaucracy

The career tracks of Drs. Jeffrey Duckham and James Taylor and the reactions they've faced from advocates of socialized medicine say a lot about the future of health care in the United States.

A few years ago, the San Francisco-area physicians were grinding it out, forced to see dozens of patients each day to balance their books. Insurance companies mandated that they accept less and less money for their services, and as a result, the doctors had to devote less and less time to their patients. Staff members spent all day on the phone sorting out insurance plans and arranging reimbursements.

"Our whole office staff felt it was becoming more and more like a treadmill," Dr. Duckham told The Associated Press.

So the men decided to tear down their respective practices and start fresh under an entirely different business model. No more rushing patients in and out the door. No forcing their clientele to wait weeks for an appointment, then wait some more in the office.

No more insurance companies.

Drs. Duckham and Taylor decided to become "concierge" doctors. They collect a flat annual fee from their patients, who in return get an annual physical exam and wellness plan. They also get half-hour, same- or next-day appointments when they get sick.

Dr. Taylor charges each of his patients $1,500 per year, or $125 per month. Most of his clients are people with modest incomes who "are sick and tired of being bounced around" by insurance companies in rushed appointments, not "rich, old sick people."

More and more physicians are choosing this path, not because it makes them rich, but because it allows them to provide better, personalized health care. Rather than have for-profit insurance companies dictate their hours, patients, practices, staffing and salaries, doctors are deciding to let the open market determine what their time and services are worth.

But not everyone is happy with the growth of this alternative service.

"This is basically the way medicine works in a Third World country," Temple University health care management professor David Barton Smith told The AP. "There's no acknowledgement of any universal right to health care."

Of course, there is no universal "right" to health care. A true right doesn't impose an obligation on others. And when people such as Mr. Smith insist that health care be "free," they conveniently forget that literally trillions of tax dollars would be required to convert the country's semi-private system into a public one.

But even more revealing is the hostility from many who favor socialized medicine toward consensual transactions between physicians and patients.

Recall that under the universal health care scheme proposed in 1993 by Hillary Clinton, Drs. Duckham and Taylor would likely have been breaking the law by accepting direct payment from patients for their time.

Today, virtually every Democratic presidential candidate currently in the race has a plan to eventually impose a single-payer, universal health plan. It's no exaggeration to suggest that such a system will go to great lengths to prevent citizens from having the option of receiving medical attention outside the control of some top-down bureaucracy.