Medi¢ine the$e day$

Breathe deeply while you still can for free.

Soon enough, someone will find a way to make you pay a premium for clean air. And if you can't afford the good stuff, America . . . well, you can just kindly remove yourself to the back of the bus, where the "free market" makes "those people" sit.

Every day and in every way, the ranks of "those people" are swelling.

Take health care, for example. If you'd like some, it will cost you. If you'd like the good stuff, it will cost you a lot -- though you really can't afford the good stuff.

AND KNOW that to the extent the well-off opt for the "good stuff -- something we're coming to know as "concierge" care, where the doctor actually gives you the time of day . . . and his phone number -- what's left for the rest of us likely will come to resemble the scraps from the rich man's table.

According to Sunday's Omaha World-Herald, you can just call the vast majority of us Lazarus:

Imagine opening a letter like this from your doctor:

“I'd love to keep you as a patient, but to stay with me you'll have to pay an extra annual fee of $2,500.

“Please let my office know if you will be paying the fee. If not, we'll help you find another primary care doctor.”

Although it might be worded more politely, that's the gist of the letter you could receive if your doctor adopts a style of primary health care known as concierge medicine.

Its backers say the concept can attract and retain more primary care doctors by improving their lives and enabling them to practice medicine the way they want, rather than under the time-constrained demands of the typical doctor's office.

But the concept also raises philosophical and ethical issues. Concierge physicians limit the number of patients they see by charging annual fees, which wealthy people can more easily afford. Also, this kind of medicine could reduce the number of primary care doctors at a time when demand already exceeds supply.

Nationally, the practice of concierge medicine is still small — perhaps 400 primary care physicians out of about 250,000 nationally — but in some regions it is firmly established.

The largest concierge company, MDVIP, has more than 300 doctors nationwide and recently was purchased by Procter & Gamble. It's been more than 12 years since the first such practice opened in Seattle. There's even a cable TV program, “Royal Pains,” about concierge medicine.

But the approach has only recently arrived here. Nebraska's first, a two-doctor practice, opened last month near 90th Street and West Dodge Road in Omaha after a three-year trial at the University of Nebraska Medical Center.

It's affiliated with a new Omaha management company, Members.MD, whose chairman is former Burger King franchise owner and cancer survivor Mike Simmonds.

“Primary care is broken,” said Dr. Joel Bessmer, who is medical director of Members.MD and who opened the new practice with partner Dr. Robert Schwab. “It allows us to step off the treadmill and spend time with patients. This is a different world of trying to provide primary care.”

Physicians get to know patients thoroughly and become their health partners, he said. The doctor's office becomes the patients' comfortable, easily accessible medical home, instead of a hurried place full of other sick people and doctors who have no time to spare.

But Dr. John Goodson of Harvard Medical School said concierge medicine could worsen a system that to some degree already dispenses care based on whether people can afford insurance.

“Do we as physicians hang together and maintain our commitment to access?” he said. “That really ought to be a fundamental principle of medicine. We're there to help people, and we're not going to discriminate against people because of their economics.”
Goodson said primary care doctors should supervise their patients' hospital stays as part of normal care, not for an extra fee. Members.MD offers hospital supervision only with its upper level of care.

Eliminating people from a medical practice by charging a fee is “abandonment,” he said. Even if a patient's records transfer, the new doctor doesn't know all the information that the first doctor learned about the patient.

Yet the rise of concierge care, he said, shows that as a profession, primary care “is on the ropes and dying fast. It's like the polar ice cap, starting to fracture. It ought to be a wake-up call to everybody.”

He said that the start of a practice in Omaha indicates the concierge model, although marginal in most regions, isn't going away. “It makes me sad as a professional that my colleagues are doing this sort of charging.”

WE NOW LIVE in a country where one's bank account determines one's worth in life. You are what you make. Human dignity has become a commodity.

"Life, liberty and the pursuit of happiness"? Formerly available for free from one's Creator, they now are available only with purchase of the America Plus premium package.

If you don't want to die before the next operator is available to schedule your appointment with a Proletarian Partners physician's assistant, it's going to cost you. And you'd better hope your insurance plan allows diagnostic stethoscope use.

But that's not important now. What's important is that "concierge medicine" is the talk of the town -- the part of town that matters, that is:

Simmonds, who was inducted in the Omaha Business Hall of Fame last year for his success in the fast-food business, said the concept is “sort of the talk of the town, at least in my circles.”

Simmonds said he heard about Bessmer's practice from a fellow airplane traveler, called Bessmer the next morning, interviewed him over lunch at Charleston's and “hired him” as his doctor. Simmonds' former primary care doctor was good and even a friend, but Simmonds couldn't call or e-mail him whenever he wanted.

“When I don't feel good, I like to talk to somebody right now,” he said. “Joel spoiled me,” including supervising his care when he was hospitalized and providing other care over the past year and a half. He was diagnosed with cancer several years ago.

IF YOU BELIEVE it's a self-evident truth that "all men are created equal," you should be offended as hell right now. Some folk think their money makes their well-being more important than yours. They think that rationing isn't rationing if they slap a "free market" label on it and have enough cash to game the system in their favor.

There's a four-letter word for that kind of thinking: E-V-I-L.

And I think the Bolshevik Revolution happened for a reason. I hope people like Mike Simmonds have another think coming before finding out exactly what that reason was.