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Boutique doctors in the New York Times

The New York Times had an interesting story on Sunday about what it calls "a new breed of 'boutique'" doctors who make money by charging patients an annual fee instead of charging per appointment. The article raises an important point -- such a model, should it proliferate unabated, will harm the U.S. health care model. The uninsured, not to mention people who rely on Medicare or standard HMOs, will be left out.

But what the article doesn't fully acknowledge is that the standard health care model is screwed up to begin with! Calling a doctor who doesn't keep you waiting for hours, provides same-day care, and offers 24-hour emergency phone access "boutique" just goes to show how low are expectations are for medical care in the U.S.

Ok, granted, patients have to pay $1600-$2000/year for concierge doctors, but they get better care and don't have to pay per appointment. For those of us who can't afford $350/month for health insurance, that $1,600 actually looks like a decent alternative. (Click here for the NYT's handy chart of the advantages of concierge care.)

In the 19th century, before the rise of the medical industry, this "annual fee" model for doctors -- and the personalized care that went with it -- was the standard. Of course, mainstream medicine in the 19th century was in many ways a disaster, but it's worth revisiting why this model faded (short answer: economics) and what about it might be worth resurrecting.