Dr. Steven Knope transcript, Part 2: ‘Health insurance is not synonymous with health care’

In my interview on Tuesday with Dr. Steven Knope, a concierge medicine pioneer, I asked what he thought about the movement in Washington to impose health care reforms.

His answer:

If you’re talking politics, let’s get it on the table: We’re talking about socialization of the entire country, whether that’s the auto industry, the banks, massive stimulus spending and omnibus bills and TARP. These guys are not playing by the rules, they’re certainly not following the Constitution of the United States. If they decide to put some of these fee-for-noncovered-services concierge practices in their sights, they could make life difficult for certain concierge doctors. It’s just going to depend on how tough these doctors are, how willing they are to fight as to whether or not the administration can get everybody in lockstep with this socialized medicine model. I’ll tell you that it will not happen in my practice. I have several constitutional lawyers in my practice who have already agreed to take this to the Supreme Court if necessary. I will personally never return to a hamster wheel practice again. I will leave the country before I do that. Trust me: I take care of people from Canada who fly to see me. I’ve taken care of people in the English system. My patients have had disasters while traveling in New Zealand. There is nothing — nothing — good about big government managing medicine. It just doesn’t work.

Health insurance is not synonymous  with health care. There’s nothing synonymous about it. If you look at this experiment in Massachusetts, which was very interesting, everybody in the state of Massachusetts has now been mandated to carry health insurance [MM: Although members of health care need sharing ministries have been exempted]. What they’ve rapidly found now is that there aren’t enough primary care doctors to actually see the patients. Now there’s a year and a half wait to see an internist. The ERs are still overflowing now with people who have insurance but don’t have a doctor.  (President Barack) Obama and (U.S. Rep. Nancy) Pelosi and all of these folks who think that you simply insure people and now everyone gets health care are sorely mistaken. This is no more well-conceived and thought out than was the stimulus bill that nobody read. At some point, intelligent people have to stand up on both sides of the aisle and say, ‘Look, I know what you want and I know the kind of utopian values you profess to have, but if the numbers don’t work, then why don’t you explain to me why you think this program is going to work? If Medicare and Medicaid are already scheduled for bankruptcy and we’re already insuring 30 million people on that program, then how are you going to insure and take care of 300 million?’ The numbers don’t work. It’s analogous, when I listen to this politically correct speak, it’s really analogous to dealing with one of your teenage children. ‘Daddy I want it now.’ You say, ‘Look, we live in a real world with a budget. You can’t get a BMW at age 16. It’s not going to happen.’ ‘But I deserve it. My friends have one.’ ‘I understand, but that’s not the reality. The numbers don’t work.’

I’m not hearing even liberal publications like the New York Times or the Washington Post or the Huffington Post for that matter come out and say, ‘Look, these are the numbers of the Obama health care plan and this is why it will work and this is what conservatives don’t understand about it.’ I don’t hear any substantive discussion like that where people are saying, ‘This is why it will work. Let me convince you. You don’t understand.’ It’s this moralistic, utopian, ‘It’s a right, it has to be there, write the check and we’ll figure out later how we get the money into the account.’ It’s just absolutely without any rational thought at all. Not that I’m passionate about this. (Laughs.)

You look at this, you see Boehner standing there, John Boehner, standing there on the floor of Congress, and he drops this 1,100-page stimulus package that he got 11 hours earlier and said, ‘Nobody in this entire Congress has read this bill and we have just spent over a trillion dollars with interest.’ Bam! The thing hits the floor. And if that were not enough then here we are 120 days into this saying, ‘Now we need to do the same thing in health care. We just need to rush this through.’ It’s absolutely irrational.

Concierge doctor on personal responsibility and giving back

hires-steven-knopeI had a great interview with Dr. Steven Knope yesterday. Dr. Knope, author of “Concierge Medicine: A New System to Get the Best Healthcare,” is one of the pioneers of the concierge medicine movement, a model in which patients pay what amount to retainer fees monthly or annually for certain guaranteed services from doctors as well as discounts on other services. 

I’ll post the whole piece up here once it’s published, but I just finished transcribing his answer to a question about  personal responsibility and giving back to the community that I thought was particularly interesting. Here it is:

The first part of my career, the first 10 years, I took care of people with emphysema who smoked. People who were diabetics who refused to lose 10 or 15 pounds. Sedentary. Everybody wanted a pill. Everybody was on an HMO. Everybody wanted someone to fix them and they virtually wanted to do nothing for themselves, as a general statement. I remember the first time this dawned on me that this was really kind of a self defeatist approach. I had a woman that I was seeing free of charge who had lost her insurance, that I was seeing at 3 o’clock in the morning for an exacerbation of emphysema, and she continued to smoke. I came in at 3 o’clock in the morning and I was exhausted. I had seen 40 patients the day before and was going to see 40 the next and I said, “Look, we have to have a come-to-Jesus talk here. If you want me to treat you free of charge when you’ve lost insurance and you want me to get up at 3 o’clock in the morning and be at your bedside, I think it’s perfectly reasonable for me to ask you to stop smoking, and if you don’t do that, then I’m going to ask you to waste another doctor’s time. I’m not helping you by promoting this kind of behavior. You’re not helping me. And, frankly, you’re just taking advantage of my good will.” Though that may horrify some doctors, the lady quit smoking and she stayed in my practice. I think that unless people have skin in the game, unless they’re paying for their care, unless they’re investing in their health, people don’t really value things that are free to them. Now when I hear about a World War II vet or a Navy Seal or somebody who is getting crappy medical care and they are these incredibly responsible individuals who helped us both enjoy these wonderful freedoms, those are the kind of people I really want to seek out and say, “What can I do for you? I owe you. I was never in the military. It should be my honor to take care of you and help you for your service.” I don’t think that fits in with traditional physician philosophies. It probably rubs a few people the wrong way. I just think I’m probably going to get better results this way as opposed to playing the victim role and the enabler role.

One point to make here is that concierge doctors often get a bad rap as being “elitist” because some annual contracts are expensive. Here’s a guy, though, whose practice is split evenly between paying patients and indigent/poor patients, some of whom are veterans who are not receiving the respect they deserve from our society.

I’ll post his comments on Congress’ and Obama’s health care “reform” proposals a little later.