None of my doctors accept or file insurance, although I get reimbursed by my insurer without any problems. These practices have fee schedules, same day appointments, use email, and assure the patient a 30, 60 or 90 minute appointment. These are not concierge practices, thankfully.

It terrifies me to think about the ripple effect that more and more doctors converting their practices to “concierge” practices will have as more and more doctors with a true patient-focus leave the insurance system – and the poor and least healthy – behind. Concierge medicine, where you pay 25 grand to “join” a practice? That I find seriously troubling, but not surprising in our Market-crazed society. I think that kind of service would have evolved regardless of the HMO situation.

It would figure that now that media attention is on concierge care it doesn’t seek to address the underlying managed care issues that drive doctors to do this, but rather looks at the impact on the insurance companies.

WebMD actually looks at some of the serious implications of this issue in a clear way in Lawmakers Look at ‘Cash-for-Care’ Boutiques: Cash-Only Clinics Avoid Regulations, but Could Undermine the U.S. Insurance Market.

I’m quoting the end of the article because it sums things up nicely:

Some policy makers — mostly republicans — like the way that cash-only medical practices simplify care for doctors and patients. Many, including President Bush, want to expand the use of tax-exempt medical savings accounts that would allow consumers to put money away and spend it later on boutique services of their choosing.

But that policy worries critics, who see the accounts and the boutiques as steps toward a divided health care system where wealthier people can afford to pay cash for better care, leaving everyone else to the mass insurance market. Even worse, they say, the boutiques and specialized plans to pay for them tend to attract healthier people, leaving only the sicker — and more expensive — patients to HMOs and the government.

“‘Concierge care’ is kind a new country club for us rich folks,” says Rep. Fortney (Pete) Stark, a California democrat. “We don’t have to sit around with the riff-raff,” he said.

Almost everyone who spoke on Capitol Hill agreed that the U.S. health system’s financing is rife with waste and that costs are rising beyond control. And most agreed that for some patients, being able to shop around for the best prices for a CAT scan or a mammogram could lower costs.

But Robert A. Berenson, MD, an internist who is now a senior fellow at the Urban Institute think tank, warned against promoting boutique care as a cure-all for the health system. He told lawmakers that Medicare spends 79% of its money on patients with four or more chronic diseases.

Letting people shop only for the care they want would just make it harder to insure those ill people, he says. “It would not make a dent in what is driving our health care spending, which is really spending on the very sick.”

Still, others see the trend as a way to return doctor visits to the days before patients were rushed out the door after seven minutes. “[It’s] an older style of medical practice, a patient-focused approach that used to be the norm,” says Utah republican Sen. Robert F. Bennett.

It seems obvious that the solution is to take a good hard look at the managed care system, but instead I’m sure we’ll somehow end up subsidizing a system that discriminates, denies people basic health services, and deepens the caste system in our country.