The debate about boutique medical services

"Boutique" or "concierge" medical practices are ethical violations and represent America's notorious greed for luxuries and special treatment, as well as this country's outrageous lack of compassion for the less fortunate.

American health care is moving farther and farther away from the direction that it needs to move in — a system that meets the basic medical needs of all citizens, rich or poor.

Paying doctors thousands a year so that they can cater to your every medical whim is the latest in luxuries offered only to the richest of Americans. Some practices, such as MD2 in Seattle, charge patients a whopping $20,000 a year for additional medical costs such as house calls, monogrammed robes, guaranteed same-day or next-day appointments, 24-hour access to their physicians via cell phones or pagers and marble hallways filled with antique artwork. With these sizeable new fees, the doctors only have to see one or two patients a day.

States such as Florida and Massachusetts have already begun to investigate these practices, which may or may not be violating insurance laws or laws pertaining to charging Medicare patients additional fees.

I sympathize with the hassles doctors must deal with involving HMOs and their reluctance to pay for tests that patients need. I've had my own share of frustration with various HMO plans, but "boutiques" represent a growing abandonment of patients not wealthy enough to pay enormous fees. By only accepting a handful of patients able to afford their services, physicians earn more by working less, and doctors with economic interests at heart instead of their duties to their communities will naturally turn to concierge practices.

There are fewer and fewer doctors who can treat the middle and lower classes, who need medical care just as desperately as the wealthy. If more graduating medical doctors decide to work for concierge companies instead of more traditional practices, problems are likely to occur. I've already witnessed many doctors begin to refuse HMO-insured patients in favor of private health insurance, and now good doctors will be even harder to find for a person who is reliant upon an HMO.

Doctors are neglecting their obligation to help those in need, in favor of blatant greed. They forget that many of them owe their success to the public, attending public schools and universities funded by taxpayers.

These doctors argue that minimizing their clientele allows them to spend more time with patients and truly help them, accompanying them to specialists and such, but their patients are patients who can afford the very best specialists while less wealthy patients have no healthcare at all.

I happen to know a patient with schizo-affective disorder, which is a severe psychotic illness. He is without health insurance completely now, and therefore, without medication or counseling. Even when he was on his mother's HMO, he was unable to find a psychiatrist who would take him due to his numerous stays in mental hospitals. There are far too many people in this country who are either underinsured or without insurance whatsoever, and in the richest country in the world this is an outrage.

What we need is not further privatization of healthcare, but a more extensive social program that grants healthcare to every citizen of this country, regardless of income. It is a travesty that we are the only developed nation without a universal healthcare program and that people die every day because they cannot afford treatment.

Medical care is a basic human need, and anyone involved in the boutique practices should feel ashamed of their greed and their ignorance of the suffering of the poor. Natalya Efros is from Plano, Tex. She can be reached at eefros@princeton.edu.