Concierge medicine for the rich

Re “Dollars to doughnuts diagnosis,” April 16

Dr. Albert Fuchs’ rejection of insurers is also a rejection of the vast majority of patients. How nice it is that his Beverly Hills patients pay cash for his services so he can assuage his conscience with two afternoons a month of community service.

Yes, it is awful that insurers have too large a role in setting prices. However, lay the blame where it belongs -- on the federal government for not setting up a system in which insurers are just insurers. The federal government needs to set up a system that separates price-setting from insurance and guarantees coverage for everyone regardless of employer. One way is to follow the plan of former Sen. Tom Daschle, which outlines a system of oversight based on the Federal Reserve Bank.

Christopher Hane

Irvine

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I appreciated this article until I thought of a snag: hospitalization. While Fuchs presents a Rockwellian picture of a doctor who has enough time to hold his patient’s hand at the hospital, he doesn’t talk about how payment would work.

Hospitals charge for tests. Surgeries and procedures tend to be expensive. I don’t know if hospitals would lower their prices for Fuchs’ patients just because he has found a healthy balance. And if one of Fuchs’ patients tried to use insurance for a hospital stay, it’s a sure bet his insurance company would reject the charges because the referral would have come from someone out of network. Although I certainly appreciate the doctor’s efforts to find a more holistic practice of medicine, someone is going to have to work on the hospital payments before things can really change.

Michael Riordan

Washington

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In an era of six-figure hospital bills, we all need health insurance. Most people under 65 have insurance that was chosen by their employer. Appropriately, the employers select plans that cover physician payments as well as other services. Fuchs’ patients pay through their insurance for primary care they don’t use and then pay out of pocket for Fuchs’ services. Most people just can’t afford to pay twice.

Despite the growth of concierge care and other niche styles, most doctors would not structure their practices to serve just those with the ability to pay. They accept insurance rates they may not like in order to serve the needs of the vast majority who cannot afford to have it otherwise.

Fuchs’ vision of healthcare without insurance may appear as tempting as the sprinkled doughnuts he admires; from a public health perspective, it’s pure junk food.

Daniel J. Stone MD

Associate Medical Director

Cedars-Sinai Medical

Group, Beverly Hills