Are Genericare and Concierge the Next "Two Americas"?

The American Medical Association's mission statement begins with: "To promote the art and science of medicine and the betterment of public health."

There's an important concept in there: the physician's group believes that medicine is both a science and an art. Hold that thought for a moment.

One of the goals of the ARRA of 2009 is the promotion and adoption of electronic health records, and within that goal is the mandate that EHR technology report quality data out to the Secretary. Without question, one of the objectives of reporting healthcare quality data is for aggregation and study.

The study of aggregated healthcare outcomes data will produce better quality healthcare, or so the logic goes, by improving protocols. For those of you who don't know, a protocol in the medical sense is a standard procedure for a specific diagnosis. With better protocols, we will have better outcomes, and therefore better quality healthcare. Cost can be lowered by then putting the most routine protocols in the hands of lower-cost healthcare providers. Think "Minute Clinics" and home pregnancy tests, as examples.

Clay Christensen writes about this disruptive innovation in "The Innovator's Prescription", and suggests that the movement of treatment from highly-skilled (and highly paid) professionals to lower-skilled professionals (and perhaps even the patient herself) is the way that the healthcare industry will follow the path of many other industries, such as the computing industry did. Most of us can remember when computing was done in huge labs by a select few people. Now everyone has more computing power in their laptop than existed in an entire building forty years ago. People without any computer science education can make sophisticated models in Excel, for example.

So, if we start to put the pieces of the puzzle together, is this the picture that emerges? Given the pricing power of Medicare, and the government's aggregation of healthcare quality and outcome data in the near future, is there much doubt that protocols will be established to address many common ailments? That's the point, you say? Let's make this into a science and then we will all benefit from the most cost-effective, and demonstrably the most frequently-successful treatment.

However, many people, apparently the AMA included, believe that the practice of medicine is as much an art as a science, and so I believe that what we have the beginnings of is the crystallization of a two-tiered system: those who will consume "genericare", or predominantly protocol-based medicine, and those who will opt for the science and art of "concierge" medicine - an out-of-pocket based service where doctors treat you like a person and not an algorithmic input, and charge you a hefty fee for the honor.

Inadvertently, we may be accelerating something that I think we'd all like to avoid: a two-tiered system of healthcare, where those who have the financials means will still enjoy both the science and art of medicine, while the rest will have to hope that their specific ailment falls within standard deviation.