Thursday, December 27, 2007

Off the grid or black market medicine

I have written before about the expected effects of rationing health care and listed the usual outcomes-shortages,poor quality etc. The rise of a black market is another well known outcome but I did not think that we had reached the point in the the U.S. where there was actually a black market. I had to rethink that position after reading this entry by DrRich in which he talks about the off the grid medical activities.

If you accept the classical economic definition of a black market (An illegal market, in which something is bought and sold outside of official government-sanctioned channels)
then it seems that what DrRich is discussing is not really black market because it is not illegal to do most of what he describes. But this is really pedantic quibbling over definitions ( I think black market activities is a sub set of off the grid) and the issue is that we have still another consequences of the de facto medical rationing about which DrRick speaks so eloquently. Here patients choose to spend their money for various reasons to buy medical care outside of the insurance hegemonic universe even though they have health insurance.

I should not have been the least bit surprised by tales of off the grid medicine.My son while "insured" with a large nameless HMO in California fractured his radius at the elbow, was pinned and then began his battle with the HMO. He couldn't get PT ( ok he did get a handout sheet ) and later the wires began to almost push through the skin when he flexed his arm. The docs at the HMO said they did not take out hardware in "older patients"- he was 24. They were adamant and refused to accept calls from me or my wife,also a physician.We were told that Dr. X, head of orthopedics, did not talk to physicians on the phone .I had him come back home to Texas and he had the hardware removed by an orthopedic friend who did not charge him and the hospital discounted the facility fees a bit as I was on staff at the time ( that type of professional courtesy is, of course,history now).

The retainer medicine movement could be considered an off the grid activity at least off the insurance grid but at least so far is not illegal in the U.S. However, as the movement grows- as it seems to be doing- I predict we will be hearing more arguments to limit it or restrict it entirely by legislation if necessary. The anti retainer practice propaganda mill is already at work . See DB for examples.The insurance industry will bray about it as will those who believe that social justice principles trump individual freedom and choice.

1 comment:

DrRich said...


Thanks for commenting on my post regarding Black Market healthcare.

Actually, I agree entirely that retainier medicine is not Black Market (at least, as you insightfully point out, not yet). In n a retainer practice the physician still interfaces fully with the healthcare system. That is, the retainier practitioner still refers patients to specialists, orders tests from legitimate labs, and above all, keeps records. It would be difficult to really and truly “stay off the grid” by going to a concierge practitioner, as the patients’ medical records would still be carefully maintained, and would certainly be discoverable.

Again, not to push too far a point that was meant to be at least somewhat tongue-in-cheek, when I say “Black Market” I really mean it. I mean back-alley, clandestine medical pratitioners who dispense medical services on the sly, keeping traceable records no more assiduously than did the old 1960s abortionists. And like the old illegal abortionists, this would be very bad medical practice, often harmful, most certainly illegal - and would fit the definition of Black Market.

That the current system is dysfunctional enough that such a thing might soon become thinkable - and for the same reason illegal abortion was once thinkable, that is, because at least some patients were sufficiently desperate to demand the service - is my point.