From Med Rants, about retainer medicine:

I urge these authors and their ideological colleagues to look beyond the trappings. I urge them to perform a thought experiment. Why are patients increasingly willing to pay? Why are highly ethical physicians opting for this style of practice? If they are honest, they will find some truths that knee jerk opposition obscures.

Some might argue that these “highly ethical physicians” aren’t so highly ethical by practicing retainer medicine. One ethical framework would suggest if all physicians just practiced retainer medicine, there would not be nearly enough physicians to go around. In that framework, retainer medicine would be viewed as unethical.

(I also don’t really get how Dr. Centor combats the classist and racist arguments he brings up. They’re totally valid, and I can’t help but draw a parallel between retainer medicine and insurance company cherry-picking, the latter I find to be despicable in its bottom-line philosophy. By practicing retainer medicine, you are selecting out for people who can afford to pay extra, and health and SES are intrinsically linked (and also race), so you’re essentially picking out people who are already healthier. If you look at things through an equality and social justice lens, who needs a physician’s help more: the poor, smoking diabetic or the executive with an HDL of 39 who bikes 20 miles a day?) (I however absolutely agree with Dr. Centor that health care financing is a complete and total disaster in the US, but I would argue we need to fundamentally change the system–yes, with all the turmoil and terrible problems and growing pains it would cause–than work within it and continue to try piecemeal approaches we’ve been attempting since the 1970s.)

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