This is an expansion of my reply to a doctor’s office about why I won’t become a “member.”

While I appreciate that the concierge model is an attractive business model for doctors, it is also an extremely effective way to isolate a medical practice to the wealthy, privileged, (and probably white.)

Personally, I carry a great deal of privilege as an educated white woman, my intersections also include living in a fat body, having metastatic disease, and being a lesbian. Your annual fee and monthly expenses are over 25% of my income last year and as much as I would continue to need to pay for health insurance.

There is a lot to unpack around medicine and insurance, money and healthcare. Far too much of how we are cared for is dictated by insurance companies who are focused on making a profit. The timing and payment for doctor visits seems capricious and non-sensical. I know it is broken. Yet for me and millions of other Americans this is the system we need to work with. I will literally die without medical care and will work politically for change.

I think doctors should make a good living. I want a doctor who can take time with me to listen and understand. I do generally receive that within the current system, and I acknowledge my privilege of being able to advocate for myself.

I’m not convinced that the concierge model with an huge annual fee plus very high priced visits is the fix and I find it biased and reeking of privilege. The people who will pay that much are either extremely wealthy or absolutely desperate. That’s not an attractive business model.

It also reinforces the “I won’t play in the sandbox if I can’t have it my way” thinking that isn’t helping the system improve.

Intent does not release us from responsibility for our impact. The impact of concierge medicine is a further erosion of our health care system and the reinforcement to tiers of privilege.

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