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There is definitely an ethical line, but it really is a case by case basis. Sometimes it takes big money to solve big problems.

Money should not be able to buy anything and everything without restriction. Having visited countries in which the black markets for organs have been rife with hospital corruption, violence, and law enforcement looking the other way in exchange for bribes from the wealthy looking to get ahead, it is my opinion that people who are rich should not have the ability to jump the line in the matters of life and death. The value of one’s bank account does not determine the value of one’s life. Who is to say that a millionaire has a right to live over a working class man?

That said, concierge or boutique medicine is not necessarily an unethical practice if there are certain limits and a systematic way of regulation is implemented. While concierge doctors bring to mind billionaires who are able to have doctors cater to their every whim for an exorbitant retainer fee a month, there can be a less extreme method of operating that benefits different levels of income. For example, doctors can work without a retainer fee, charging on a per-incident basis, much like what would happen at an urgent care facility. It could work similar to how you hire a repairman; you get service in exchange for a flat or hourly fee. Many times, a patient can go see a doctor without knowing how much it will all cost until the bill arrives. Will it be $200? Or will it be $1000? I’ve seen patients who expected a $500-range bill get hit with a $3,000 bill. This precludes many from seeing doctors in the first place, in spite of the fact that they need to. They don’t want to be hit by a surprise bill they just cannot pay. With a regulated concierge service, a patient might be more open to paying an agreed-upon fee for a personal consult in his or her own home.

One common problem I see is that patients can tend to work for the doctors, not necessarily vice-versa. You call a doctor’s office, see if you can fit his schedule, go, wait, get consultation, and then you follow-up on your own. Though there are some great doctors who keep communication, call you to follow-up, and even give you their numbers, that doesn’t always happen, especially when a patient is uninsured or has a medical history that has been lost in the system. In a concierge service, a doctor can allow more consistent access: e-mail, phone, same-day care, and ample time for the patient to discuss the problem (rather than you getting 5 minutes of face time in a doctor’s office). Many times, a patient doesn’t really get a chance to talk to their doctors; it’s more like a rotating door scenario—get in, get out.

Though concierge medicine might be seen as unethical because it emphasizes the haves and have-nots, I think it is important to note supply and demand. Much like phones and other gadgets, once the product is deemed desirable, even indispensable (and I think healthcare is), by a large portion of the population, costs can potentially go down, with competition, innovations, and cost-saving techniques created to make a booming market that can benefit everyone. Of course, this will be new problems, new complications not mentioned here, but every industry has them.

Money shouldn’t be able to buy anything without an ethical line—a wealthy man shouldn’t jump the waiting list to get an organ just because he can pay for it; important medicines shouldn’t be priced only for the rich; and a life-saving surgery shouldn’t be granted to a man with a big bank account but denied for someone who has worked hard all his life without being able to have a large surplus of money. The value of a life isn’t measured in dollars; if that were so, then what about the victims of natural disasters in third-world countries? Do they not deserve care and our help because they are destitute? But in terms of medicine, I think concierge medicine can reinforce and improve doctor-patient relationships and even make the whole system more democratic. The dynamic of the doctor coming to the patient is one that can make the doctor be the patient’s advocate again, and that’s the most important bottom line.

There should be a very blatant ethical line, however the reality is that money can buy anything and if not it can move that line back and forth and make it very faint.

THere are somethings money can’t buy.

But, for everything else, there is mastercard.

most anything can/should be able to be bought if someone is willing to sell it but then there are/should be exceptions—-an example of the latter is the swine flu vaccine, which was set up, at least in part, on a most needed category basis—-rick

I don’t think $$$ should buy anything. My doctor is now going to be a VIP doctor & charge his wealthy patients $1000 annually. I think this stinks!