In 1980, Bob Dylan won the first ever Grammy for Best Male Rock Vocal Performance. Fortunately, the ‘vocal’ part of the category has very low standards regarding clear articulation. From his ‘slow Train Coming’ album, Dylan told us that we’re going to have to serve somebody. You pick – the devil or the Lord.
John Lennon didn’t like those options and retorted in song he wrote in response that you gotta serve yourself.
Theological debates by philosophers with guitars.
We (yes, there was a crowd inside my head for this conversation) got to thinking about Dylan’s song related to the seismic shifts going on in primary care. While we’ve been talking about Amazon and One Medical, and before that Optum and DaVita Medical Group, and then all the PCPs who now work for hospitals, we could easily also throw in names like WalMart and CVS, or Oak Street and VillageMD and Iora and countless others.
Unless you live in one of those places where you can count more cows than people, odds are increasingly high that your primary care physician works for some very large company. Marcus Welby is now in the ancient history wing of the medical museum. In and of itself, this is not a morality issue, at least in my mind, for ‘big’ or even ‘for profit’ are not evil per se.
But as old Bob would say, those employed physicians are serving somebody and the question might be who.
Critics of the health system acquisition binge note if that if hospitals financially justify employing money-losing primary care providers because they order lucrative hospital-based services which cost more than the same services offered on a stand-alone basis then that can’t be good for society as a whole.
As the proposed Amazon-One Medical deal moves into the regulatory scrutiny phase, some people are asking just how separate protected medical data will be from all that stuff that Amazon knows about me that I don’t even know about myself.
And of course, anything that happens at Optum always causes skeptics to wonder what Orwellian strings UnitedHealthcare might be pulling behind the scenes, regardless of how wide the promised wall of separation between the two.
Surely the agenda of the big retailers is more than just driving pharmacy refills and selling toothpaste, though that is a start.
Most of the equity-backed plays are either focused on healthcare ‘consumers’ instead of ‘patients,’ or they are all about taking risk through Medicare Advantage or commercial capitation arrangements.
All to say there are more motives at play in the world of primary care than just the three options Bob and John gave us – God, Satan, or ourselves. Or maybe everything is just a twist on one of those three masters.
Patients now must be aware there might be someone else in the exam room besides just their primary care provider. Specialty physicians who have some level of a symbiotic relationship with PCPs should be mindful as well.
We all gotta serve somebody.