The debate about boutique medical services

Imagine a world in which a Princeton education is illegal. The government, having paternalistically decided that all students should attend more affordable state-subsidized colleges, arrests and prosecutes those who attempt to pay top dollar for what they perceive as a better quality education. No student, regardless of effort, talent, or increased willingness to pay, is allowed to receive a better education than any of his or her peers. Such blatant 'elitism' is viewed as immoral.

Such a bizarre scenario might not be too far in the future if the medical establishment succeeds in banning so-called "boutique medicine," a type of medical practice in which doctors provide extra services such as same-day appointments, increased personal attention, and even housecalls. However, these luxury services can cost up to $20,000 per family per year on top of regular fees for office visits, prescription drugs, and hospital stays.

Doctors engaged in these practices say their frenetic, overbooked schedules prevent them from providing quality care for their patients. They say they would rather deal with fewer patients in a day and devote more time to each.

However, critics allege that these doctors have "sold out" to the rich and recklessly abandoned those who cannot pay the extra fees. Though it is only fair that patients should be notified well before their doctor begins charging an extra fee, it is ridiculous to refer to the practice as "abandonment." It is, or should be, the doctor's prerogative to decide how many patients to see in a day. A doctor's skills are valuable and a true free enterprise system guarantees the freedom to sell or withhold them at will. No one would cry foul if a doctor decided to retire and give patients adequate advance notice, so why complain when she continues to see a small fraction of her original patients, with each paying an extra fee?

Concerns about a "shortage" of doctors as a result of this practice are unfounded and contradictory. For one thing, simple supply and demand tells us that the more doctors charge extra fees, the smaller their fees will become. Most products that are now available to the masses were originally novelty items only the rich could afford. By initially paying higher prices, the rich voluntarily "subsidize" the development of new products for the masses. If the rich were prevented from purchasing these new products, they would never get developed to the point where they would become affordable for everyone. Would the world be the same today if the government had banned the telephone when it was invented in the 1870's just because only the rich could afford it?

Furthermore, it is blatantly contradictory for the medical establishment to feign concern at the possibility of a shortage of doctors when it has already taken measures to create and maintain that shortage. As Lawrence D. Wilson notes in his essay "The Case Against Medical Licensing," professional associations, licensing boards, and limits on medical school enrollment and construction unnecessarily restrict the number of doctors that can legally treat patients, thereby keeping doctors' salaries artificially inflated and limiting access to care.

On a more philosophical level, restricting doctors' ability to collect higher fees for better service contradicts the doctrines of free enterprise and individual rights that Americans supposedly hold so dear. A ban on boutique medicine is hardly consistent with the Constitution and the Founding Fathers' vision of liberty, self-responsibility and limited government. There is no law saying you cannot pay a higher price in order to get a higher quality product at a supermarket. It should be the same at a doctor's office.

In a Dec. 18 letter to the Boston Globe regarding this issue, Dr. John D. Goodson, MD, an associate professor of medicine at Harvard Medical School, wrote that "The implication that well-heeled patients have the right to something more is abhorrent." In other words, you don't have the right to better service from your doctor, even if you pay for it.

By this standard, it is also "abhorrent" for Dr. Goodson to demand a higher salary than the average worker in America. Why should a "well-heeled" doctor have the right to something more?

It is also "abhorrent" that I chose to come to Princeton instead of going to a more affordable school where I might not have gotten the same quality education and access to the same opportunities.

And finally, it is "abhorrent" that you are reading this newspaper rather than the tabloids. Eric Harkleroad is a physics major from Overland Park, Kan. He can be reached at eharkler@princeton.edu.