Commissioner Tyler Should Stick to His Knitting

Published December 23, 2008

Maryland’s insurance commissioner, Ralph Tyler, far exceeded his authority in holding a hearing on so-called “concierge medicine” on December 19. His job is to regulate insurance, not the practice of medicine and certainly not the ability of patients to make private, voluntary contracts with their doctors.

Concierge medicine is the best way available to fulfill the goal of a “medical home” for many patients. That is, to have a doctor that thoroughly understands your medical history, your values, and your family situation, and who will see you when you need to be seen, answer your phone calls, and guide you through the rest of the health care system, including being with you when you check into a hospital and advocating for you with specialists.

These are the kinds of services insurance companies won’t pay for. Insurance companies expect primary care physician to have a patient load of several thousand people and spend no more than six minutes on each patient. It is assembly-line medicine and it results in second-rate care. Your doctor barely knows who you are and spends so much time filling out paperwork that there is no time left for the “care” side of health care.

More and more people are fed up with this situation and are contracting with their doctors to be part of a reduced number of patients who get the kind of service and the kind of caring doctors used to provide to all their patients. These patients are willing to pay an extra $75 to $100 a month for the comfort and safety of having a medical home.

This is not insurance, it is medical care. But some insurance regulators are so power-hungry that they think any advance payment for a future service is somehow “insurance” and should fall under their purview. So if you pay a roofer $1,200 in January to shingle your roof in July, insurance regulators such as Mr. Tyler want to get involved.

According to news reports, Mr. Tyler had received no consumer complaints about concierge medicine; he just took it upon himself to jump in where he doesn’t belong. Perhaps he thinks insurance in Maryland is so peachy right now that he has extra time on his hands.

In fact, insurance in Maryland is a mess. It is a near-monopoly, so there is little competition and no innovation. Prices are outrageously high, especially in the small group market, and customer service stinks. It’s no wonder there are so many uninsured in the state. They refuse to buy a product that delivers so little value.

And it isn’t just health insurance. I have friends in Pennsylvania who pay about half of what it costs in Maryland for auto and homeowners insurance.

Let’s get Mr. Tyler to focus on the job we are paying him to do—regulate insurance—and have him leave doctor-patient relationships alone.

Greg Scandlen ([email protected]) is director of Consumers for Health Care Choices at The Heartland Institute. He is a Maryland resident.