LESSONS FROM THE PANDEMIC

A Better Way to Provide Primary Health Care

What Started Me Thinking

When I started my business, Obamacare had just started.  I still had time on COBRA with my last employer, so I didn’t worry all that much.  Earlier quotes had made health insurance seem affordable.  But then, I had to start looking.  Even the bronze plans were outrageous and in California, I couldn’t pick an Obamacare plan as none of my doctors accepted it.  Even so, I was just at the edge of making too much money to get help.

After a few years, my policy (remember—the bottom level) went to $1600/month with a $6800 deductible.  Catastrophic insurance at platinum coverage prices!  I went to a Christian ministry plan—affordable, but only really catastrophic insurance.  And despite some great policy plans from such experts as Sally Pipes at Pacific Research Institute, all movement on the health care front was failing to deliver affordable insurance, let alone affordable health care.

A Fresh Approach

At FreedomFest a few years ago (http://www.freedomfest.com), I learned about something called Direct Primary Care (DPC).  A number of doctors realized that a middleman (the insurance company) added cost and complexity to their practice. Taking a leaf from concierge medicine, they created affordable, self-pay plans which worked somewhat like HMOs.  You pay a monthly, very reasonable fee and you get all the primary care you needed.  They went one step further and began making arrangements with testing labs to give substantial discounts to patients.

How could they do that?  Well, it turns out a large part of a doctor’s time and money goes to handling insurance claims.  The right codes have to be discovered and entered, a lot of paperwork is required and a doctor has to justify every decision and fight claim rejections. This means at least one full-time staff member just to manage claims and doctors’ and nurse’s time wasted on all the minutiae to handle the agency and Medicare.  Instead of relying on training and experience, they had to justify every decision made on behalf of patients.  Not only did this mean fewer patients could be seen, each of them only got a fraction of the time they may have needed.  Thus, the cost per patient went skyrocketing.  Billing and other insurance issues also burden the testing organizations.  When a doctor sends only a single monthly bill for testing to a provider, everyone saves time and money.

The Time is Now

Most of us have had a learning experience from the 1 ½ years of unwarranted lockdown due to the CCP virus.  Lots of us can work from home and actually work better.  I prefer doing Jazzercise in my office.  But perhaps the biggest lesson was what happens when the government controls everything.

Patients began postponing or cancelling medical/dental/vision services in fear of exposure.  It took months for the government and insurance companies to decide to flex to telemedicine, where it could be implemented and then, the offices had to figure out how to make that work.  Health care professionals are not IT gurus, nor are most of their patients; the challenge was huge.  And whatever they did had to have approval.

Enter the DPC practices.  While they couldn’t operate in their offices, they immediately moved to a tele-health/parking lot/house call model.  These practices had no need to seek out approval.  They could flex in the moment and keep access open, which meant far better outcomes for their patients.[1]

Bending the Cost Curve

The referenced Reason article quotes doctors saying that “the more people you insert between the doctor and the patient, the more expensive it gets, the more cumbersome it gets, the more impersonal it gets.”  Turns out, patients will drive a long way to get a better product, not just because it’s cheaper.  And I’m guessing, a lot fewer mistakes are made when doctors can choose how much time to spend with a patient.

The subscription model works really well for lab work as well as primary care.  They have the same paperwork nightmare and reporting challenge, but billing each doctor once a month for all their patients is simple.  The doctor collects the vastly lower lab fees from patients at the time he recommends the test and pays the monthly bill. 

The analogy I like to cite is that of auto coverage. Imagine the price tag if your insurance paid for tires, oil changes, and other basic services.  Add to that perhaps paint jobs (the care equivalent to some of the add-ons we find in CA plans).  You’d probably be paying around $10,000/year for car insurance.  The highways might be emptier as few could afford it, but why pay for this? 

Some people have said, “Why should I pay for health insurance?  I’m young and healthy.”  That question arises because the costs are so high.  But I doubt anyone who pays for home owner’s insurance is particularly upset that their house didn’t burn down and they paid for insurance all that time. When insurance is affordable, it gives you the peace of mind that you won’t be bankrupted by an unforeseen emergency.

What Will it Take?

As you can imagine, the health insurance companies will fight this and try to keep it out, state by state.  The government will as well, as it cuts into their power and control over us.  We’d have to get rid of any block on catastrophic insurance, plans that traditionally cost very little, but provide a backstop when something awful happens.  With the DPC model and a catastrophic policy, nearly everyone can afford these plans.  And for the very few who cannot, that’s an appropriate pickup for the government.  The cost will be a huge discount over Medicaid/MediCal. 

As a Medicare recipient, I can tell you—I would get a DPC if one were available, happily paying the monthly cost myself.  Having the open access to a doctor who isn’t watching the clock and feeling rushed and the ability to know the cost of testing ahead of time (and that it is now affordable) is a model that’s highly attractive to me.

If you see this as a model you’d like for yourself and your family, write your congressmen and let them know.  This, rather than government-run health care, is the real solution.

[1] “Osterhoudt, John, What Free Market Health Care Would Actually Look Like,” Reason Magazine, July 2021