Dr. Mack is Right

Editor: With all due respect, Drs. Maria Raven and Craig Smollin's response (“Boutique Medicine Will Not Save Health Care,” EMN 2004;26(3):54) to Dr. Neal Mack's editorial (“Can Boutique Medicine Save the Health Care System?” EMN 2003;25(10):5) is pure conjecture and transparent political posturing. The 20-year experiment that has wrecked the market for health care is destroying itself, along with American medical superiority in a fiscal meltdown that will have a devastating impact on our entire economy. I am uniquely qualified to assess Dr. Mack's claim that boutique medicine can save health care. After practicing four years of emergency medicine, I opened a “boutique” practice more than a year and a half ago. Dr. Mack is right: capitalism is cheaper, faster, and better. Contrary to the baseless assertions of Drs. Raven and Smollin, my patients (wealthy and poor) pay far less at my office than they would at an ED or at another doctor's office. Ninety-five percent of adult visits are less than $85, and 95 percent of child visits are under $60, including labs. My patients also get a doctor who is board certified in two specialties and immediate appointments, and they spend under 10 minutes in the waiting room and get an unrushed, comprehensive visit from a real doctor who knows them personally, a doctor who can even see patients for free and make house calls. For my part, I enjoy taking the time to treat my patients as people, not symptoms, and though I see fewer than 20 patients a day and work four days a week, I can still provide a comfortable living for my family. I don't take insurance. I don't take Medicaid. I don't take Medicare. I have excised these non-medical aspects of medicine so that I may spend my time caring for my patients instead of trying to follow arbitrary, capricious, expensive, and cruel mandates from insurance and government that drive up costs, waste time, endanger health, and steal privacy. My calling is clear. I am a doctor. I work for my patients. The health care debate in America is a farce. Most health care money isn't spent on health care at all; it's paying $16-million-a-year insurance company CEOs, it's paying tens of thousands of insurance employees whose sole purpose is to deny or delay patient's claims and whittle down doctor's reimbursements, it's paying additional staff hours to bill and code, and re-bill and re-code Medicare and insurance. The torrent of health care money passes through a giant sieve of bureaucrats and profiteers before a few meager drops trickle out to be used by patients to pay a caregiver. The real penalty is paid by the hardworking backbone of America, the families with children who have been bamboozled into paying an insurance company $800 a month for a privilege of a $30 co-pay (when the insurance company pays the doctor just $29 dollars for that visit), it's paid by the small business owner who is forced to add another 28 percent of the cost of each employee, it's paid by the mechanics, the laborers, the self-employed, who, when they visit an ED or “charity” hospital are gouged $79 for a CBC lab that costs less than $3. If Drs. Smollin and Raven believe Canada or England has something to offer our health care system, perhaps, as a show of confidence, they could go to one of these countries the next time they are sick or injured (and take Ted Kennedy with them). As long as people like these two echo the big lie — health insurance equals health care — consumer costs will rise and provider compensation will drop until the crisis is lack of doctors instead of lack of insurance. If a few doctors in each community provided fairly priced (in most cases for less than a hairdo) quality service outside of the destructive constraints of managed care, Americans will be free to spend their health care dollars where it does them the most good on their health. Juliette Madrigal-Dersch, MD Marble Falls, TX

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