“Concierge” Health Care to Save Costs?

When I first moved to San Francisco, I volunteered with Project Open Hand to deliver dinners to terminal AIDS patients. It was—and is—a wonderful organization that harnessed the energy of San Francisco’s liberal activist community and mixed it with practical planning to make sure that no dying AIDS patient in The City went to bed hungry. One day, I went to pick up my carload of dinners, and who was there? Senator Tom Harkin. I asked a manager what was going on, and was told that Harkin was thinking of legislating a national Project Open Hand. (I don’t think he ever did.)  “They’ll just ruin it,” the POH manager sighed.  “We work well because we are free to innovate.”

I thought of that old moment in my life as I read Ezekiel Emanuel’s prescription for the Feds to establish “concierge medicine” for all the tens of millions of chronically ill people in this country, as a way of saving money. From “Saving by the Bundle” in the NYT Sunday section:

If you’ve followed the debate over health care reform, then you’ve probably heard President Obama or some other reformer extol the importance of “integrating” care. This involves teams of doctors, nurses and pharmacists working with care coordinators to help manage patients. The team forges a personal, face-to-face relationship with the patient and the caregiver, and develops an individual plan for each patient.

They don’t wait for patients to call with problems or come in to emergency rooms. Instead they reach out to patients, sometimes daily, to monitor early indicators of trouble like weight gain, blood pressure or blood glucose levels. Some of the groups offer home visits and pre-package their patients’ medications. Some create clinics staffed by expert nurses who specialize in recurrent problems, like wound care for diabetics. In other words, they offer many more services than doctors and hospitals typically do, and more than are typically covered by standard fee-for-service insurance plans and Medicare. This is “high touch medicine” or “concierge medicine,” not for rich people who can afford it, but for chronically ill patients who need it.

Supposedly this will reduce the number of people who have to go to ERs because they don’t take their prescriptions or otherwise properly care of themselves after being diagnosed with a chronic condition.  Over the long haul, Emanuel opines, that will lower costs overall.

Let’s be real: If the Feds were presumably to mandate this approach, how many people would have to be hired and trained to hold the tens of millions of hands of people with chronic conditions? Hundreds of thousands at least, plus thousands of federal bureaucrats to oversee the system, which would be about as efficient as government welfare social work, in other words, an appalling mess.

Besides, if it is so efficient and lowers costs, private insurers would (and do) take it on themselves to create concierges that would be far more efficient and practical than anything the government mandated—complete with volumes of regulations telling companies how they have to do it—just like Project Open Hand’s system would have been ruined by the government trying to create a federally controlled meal delivery system.

Emanuel and other Obamacarian’s prescriptions for controlling health costs require building more bureaucracies—which we are already drowning in—increased regulations—which are already choking the vitality out of us—stultifying centralization—which destroys efficiency and innovation—pie in the sky financial assumptions—which almost never are realized—adding up to onerous financial burdens placed on the backs of the insurance industry, threatening to break its spine, ushering in the need for single payer.  But then, some suspect that is the actual plan.