Black Market Medicine - Staying Off the Grid (2)

Posted on February 26, 2008
Filed Under New business models for healthcare |

In a previous post, DrRich made a (more or less) tongue-in-cheek suggestion that our healthcare system is now presenting American physicians with a brand a new business opportunity - Black Market Medicine. Doctors operating in this new, blacker healthcare sphere would offer their patients “off the grid” healthcare services, that is, clandestine medical care. Their customers would be comprised mainly of otherwise law-abiding individuals who want and need medical care and who are even willing to pay for it (which, admittedly, will limit the potential clientele to a very tiny proportion of the American public), but who are afraid to leave a paper (or database) trail of their medical problems. In other words, they want their medical conditions to be professionally addressed, but wish to avoid documenting that dreaded “pre-existing medical condition,” which will be used to deny them future healthcare.

The occasion for revisiting this seemingly absurd idea arises from an article appearing in the most recent Sunday New York Times, which describes the case of Victoria Grove, an individual who did not want her doctors to know that she had a genetic condition - alpha-1 antitrypsin deficiency - which predisposes her to emphysema. Ms. Grove made the discovery herself using a home test kit. Having several family members with this genetic disorder, Ms. Grove understood that her condition meant she would need immediate medical care for her occasional bouts of pneumonia - but at the same time, she did not want her genetic condition to appear on her medical records. Thus, whenever she got sick she sought medical care right away, but never divulged her alpha-1 antitrypsin deficiency to her doctor.

At last, there came the day when a nurse decided Ms. Grove merely had a cold and did not need a chext x-ray. Ms. Grove tried to tough it out, but her condition worsened. She called the clinic to beg for antibiotics, and was told she needed to be seen in person before a prescription could be written. But she was too sick to drive. Finally, under severe duress, she caved in. From the Times: “‘I have alpha-1,’ she remembers sobbing into the phone. ‘I need this antibiotic!’”

Ms. Grove got her antibiotic, but from that moment she was outed.

American physicians: The desire of American patients to receive medical care while remaining off the grid is now undeniable; even the New York Times acknowledges it. The demand is there. Which of you will rise up to will meet it?

When DrRich says Black Market Medicine, that’s exactly what he means. These doctors will be functioning illegally, in the proud tradition of their spiritual ancestors, namely, the old pre-Roe back-alley abortionists who also dispensed their special variety of medical services on the sly, clandestinely, taking pains to leave no traceable record of their activities or their patients’ medical histories.

These new Black Marketeers will not be offering medical services that are themselves inherently illegal (like abortion was in the 1950s), but instead will be offering the same legitimate, routine medical care that you can get from any “on the grid” doctor. The only difference is that no formal record will be created - none whatsoever - of the care thus dispensed. Once the patient leaves the office, the encounter never happened.

Black market economies of any variety, of course, are inherently bad. Any product or service provided illegally is not subject to normal rules, regulations, or safeguards. (If there are enforcers of the “norm,” they tend to be even less savory than those in the employ of the feds.) The purchaser of those products or services is pretty much at the mercy of the seller, and has little recourse if the product or service proves faulty.

This is why black markets only arise when the legitimate pathway to the desired product or service has become so exclusive, oppressive, expensive, or toxic that anything would be better.

Which, again, fully explains why the time for Black Market Medicine is nigh.

Comments

6 Responses to “Black Market Medicine - Staying Off the Grid (2)”

  1. Jared on February 26th, 2008 12:51 pm

    Eh? I do not see the correlation of a person paying out-of-pocket for a medical service and its nature being clandestine.

    My car is insured. If I bend the fender and pay for it out-of-pocket, that is between me and my repair shop. Likewise, if my house and household good are insured, I do not need to notify my insurance company if I pay out-of-pocket for new carpeting and dining sets.

    It simply does not follow that a physician who is already required to maintain documentation becomes clandestine when the patient simply pays up front, removing the need to involve the insurance company.

  2. DrRich on February 26th, 2008 1:32 pm

    Jared,

    It’s probably me, but you’ve missed most of my point.

    Under my proposed Black Market system, there are NO RECORDS. That’s the clandestine part. That’s the primary reason for the Black Market. It’s so that no records are kept. At all.

    You say that physicians are required to maintain documentation. This is true. This is why the Black Market system will be illegal. Doctors are required to maintain records, but they will not do so. Illegal.

    Now, since there are no records, and since the doctors are therefore practicing illegally, the only option is to pay the Black Market doctor yourself, out-of-pocket.

    Again, I am NOT proposing a Black Market system so that doctors can be paid out-of-pocket. (Unless you’re on Medicare it’s generally not yet illegal to pay doctors yourself, though if Wonkonians have their way it someday will be.) Instead, I am proposing a Black Market system so that medical care can be clandestine.

    So, bottom line: Just as you say, it is not yet necessary for out-of-pocket for medical care to be clandestine - but I never said that it was. It is, on the other hand, necessary for clandestine medical care to be out-of-pocket. Because if you report the medical care in order to be reimbursed, then it won’t be clandestine any more.

    I am sorry if I did not make this distinction clear.

    DrRich

  3. Dr. Val on February 28th, 2008 10:35 am

    Hmmm, well there’s an important distinction to be made here between “concierge medicine” and “black market medicine.” I agree that not keeping a medical record is illegal. But keeping a record that cannot be accessed easily by insurers (or subpoenaed in court) is not illegal (and sadly, may be beneficial in our punitive system). I’m actually a fan of the “concierge docs” who are making their services available to the masses at reasonable fees by cutting down on the overhead required to code/bill/track fees with the “Gekkonians.” Although this is clearly not the solution to our major healthcare system woes, it’s not a bad interim approach for a subset of the population, IMO. http://www.revolutionhealth.com/blogs/valjonesmd/concierge-medicine-fo-8713

  4. DrRich on February 28th, 2008 11:22 am

    Val,

    I agree with you on concierge medicine; it is a viable option for doctors who want to actually practice medicine, and a very good choice for patients who actually want their doctors to be their advocates.

    I see a clear distinction between concierge medicine (which we both believe to be a good idea), and the illegal practice of black market medicine (which neither of us feels to be a good idea, but nevertheless for which our current dysfunctional healthcare system seems to have created a niche).

    Rich

  5. Dr. Val on February 28th, 2008 2:31 pm

    Then we’re on the same page, as usual. :)

  6. paul on October 15th, 2009 10:39 am

    Why don’t people fly to Toronto and then to Havana for health care? Or, maybe they’re already doing this and the government doesn’t report it just like they don’t report on the free college in Cuba.

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