Sometimes a comment is so good it deserves highlighting. This comment by Dr. Roy Poses of the Health Care Renewal blog is one such comment. His first statement is a perfect summary: “Retainer medicine is an indication of a serious problem, and an indication that people actually value primary care. It should be looked on as a symptom, not a treatment.”

It strikes me that the increasing popularity of retainer practices suggests that people highly value care given by generalist physicians who have enough time and interest to take truly comprehensive care of them. They value this care so highly they are willing to pay for it out of pocket.

It also strikes me that the main reasons such care is not available to all people are that:
1) The reimbursement given to most generalists is inadequate to pay for such care. This reimbursement has been de facto dictated by Medicare, and in turn is determined by the secretive and unrepresentative RUC (see previous posts on this blog, Health Care Renewal, http://hcrenewal.blogspot.com/, and other blogs).
2) Most physicians’ office practice costs are driven up, and time is further wasted by numerous bureaucratic requirements imposed by Medicare, managed care, regulators, accrediting agencies, etc, etc.

These conditions seem to have developed because managers and bureaucrats believed that the practicing physician, particularly the generalist, is the cause of rising medical costs. Or maybe they just thought that the generalists were an easy target for cost cutting.

Meanwhile, the costs imposed by excessive bureaucracy, overpaid management, conflicts of interest and corruption in health care organizations go on and on.

The rising popularity of retainer practices should not be blamed for the current health care mess. It is an indicator how much people value comprehensive, generalist care, the sort of care that is now being stamped out by the bureaucrats and managers who run health care, often for their own personal benefit.

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