Every day the American Health Care Act is discussed in the media, most of the dialogue I hear is about how many people will lose their “coverage” or have their “health care” literally ripped away from them if the AHCA is successfully passed by both houses of Congress and signed into law by President Donald Trump. That’s quite a picture!
Such discussion only hammers home one major truth to me – most people have become so accustomed to having the availability of health care defined as whether or nor we have insurance coverage with supposedly convenient copays. It seems that the conventional “wisdom,” if you could all it that, is those without health insurance coverage do not have health care. After all, health care itself is WAY to expensive to pay for it ourselves. Right?
This impression becomes further entrenched when patients inquiring about what a medical or surgical procedure might cost them generally get a non-answer like, “Well that depends on your insurance plan.” Let’s say that I am either unfortunate, or fortunate, enough not to have health insurance in the current environment of narrow networks and “non-profit health care” systems that are raking up huge surpluses (i.e. profits). What if I first tell someone at a typical hospital I am not covered by any insurance and then ask how much a procedure will cost? It’s a toss-up as to whether they will quote me the “Chargemaster” price (think grossly inflated) or whether they will say, “We have discounts for our cash-paying patients.” (Fat chance of that.) I am betting that they would quote me the grossly inflated price first. Then, when I balk in horror, and ask if I can get a discount for paying cash, they will quote me something much more doable.
I just saw (and actually retweeted) a tweet this week that was actually a short snipped of the movie, “The Matrix,” a movie I have generally said I did not like (amid gasps of horror from my husband and son). I am thinking I may have to give that movie another chance. But I digress. In this little snippet, Laurence Fishburne’s character (Morpheus) says, “You have to understand that most of these people are not ready to be unplugged, and many of them are so inured, so hopelessly dependent on the system, that they will fight to protect it.”
That is what I see happening as the efforts to repeal and replace Obamacare go forward … people protesting in the streets, pleading to keep their “health care” in town hall meetings, and Democrat representatives and senators howling about mostly “guestimates” from the Congressional Budget Office that as many as 24 million people (a very suspect statistic) could lose health “coverage.”
What if basic health care was so inexpensive for the average person that the only occasion for which the average person would need insurance coverage would be situations like a cancer or other horrible diagnosis or accident? Yes, those things can happen to anyone at anytime, and it is nice to feel that we could have some protection from the curve balls of life that we cannot control.
However, there is so much routine care that should not even require insurance to pay for it – the annual check up, a cold or flu visit, even diabetes management – the issues for which we usually see a primary care practitioner.
There is a type of medical practice that is continuing to gain popularity as primary care doctors get burned out and tired of the same old song and dance from Medicare, Medicaid, and commercial insurance. Many primary care physicians are ditching third party payers entirely and establishing Direct Primary Care practices. These practices are third-party free, which means they do not bill or accept payment from Medicare, Medicaid, or commercial insurers. Instead, they have very reasonable pricing for the services they offer, well below the standard Obamacare premiums and deductibles. Most of them offer a wide array of services for a low monthly membership.
For example, one doctor that I am interviewing for an article I am working on now has monthly service fees of $55 for adults 19-69 years of age, $35 per child 18 years of age and younger, and $75 for seniors aged 70 years and older. Additionally, families of four (2 parents and two dependent children 25 years of age or younger) can have a monthly membership for $130.
What do patients get for this pricing?
- Communications (phone, text, emails) with doctor and nurse.
- Clinic visits (regular hours) when necessary
- Yearly wellness and prevention planning
- Some routine labs and tests
- Medical equipment lease (crutches, etc.)
- Annual flu shot
- Access to discounted wholesale pricing on other services (labs, medications, procedures, etc.)
Another DPC practice has prices in the same range, more or less – $50/month for adults 20-45 years old; $10/month for each child with at least one parent as a member; $75/month for adults 45-64 years of age; and $100/month for seniors aged 65 years and older. Benefits in terms of access to care are somewhat similar, especially in terms of free office visits, after-hours communications with the doctor, wholesale medication and lab costs.
One person on a Twitter feed I frequent reported that their family premium is $1,600 per month with an annual deductible of $8,000. That family most likely has copays or coinsurance in addition to the frightfully high premium, so it is easy to see that access is much less expensive and available in a DPC practice.
So while many people fuss and whine about “losing their health care” and the Democrats go practically apoplectic over the AHCA, the real solution to health care access and costs is sitting right under our noses.
I would like everyone who reads this post to contact their senator (since that is where the bill is now) and tell them that the AHCA needs to be at least changed to allow free market access and cost solutions like Direct Primary Care. Please educate yourselves about Direct Primary Care, and other free market medical care solutions like ambulatory surgery centers with transparent pricing, because they can solve so many of our nation’s health care problems.
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