Health Care

What Free Market Health Care Would Actually Look Like

Dr. Lee Gross' direct primary care practice takes the complexity and unaffordability out of health care.

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If you have health insurance but no primary care physician, the process for getting a physical can be a bit complicated. Whether or not you get your health insurance through an employer, you'll probably have to find a practice in your area that is in your network. Then you'll have to find out if it's accepting new patients. You may have to wait months until the office will let you come in for a physical. You'll have to figure out if you're responsible for a co-pay. Even after the visit, you may need to cover the additional cost of any blood work or other tests, and you probably can't figure out how much you'll be billed for that ahead of time. At some point, you'll also have to decide whether it's worth the trouble to set up a tax-advantaged account to cover the unpredictable costs of this visit or any future ones.

Or you could just find a direct primary care doctor who's accepting new patients and pay a flat monthly fee that covers all your in-office services and tests. If you need an out-of-office test or a prescription, the practice may also give you access to steep discounts compared to what it would cost with insurance.

There are currently more than 1,400 direct primary care practices operating in 49 states. Among them are doctors Lee Gross and William Crouch at Epiphany Health Direct Primary Care in North Port, Florida. They charge just $75 a month for an adult, $30 per month for one child, and $15 a month for each additional child. After that, nothing more is owed for services provided in the office—no health insurance necessary. In January, Reason's John Osterhoudt visited Epiphany and spoke with Gross about what free market health care should, and can, look like.

Reason: What is primary care at a fundamental level?

Gross: Primary care in its most fundamental level is the most basic aspect of health care delivery in the world. It is where most people interact with the health care delivery system. It's where you do your preventative maintenance, where you go for respiratory infections, where you manage your high blood pressure, your diabetes. About 85 percent of all health care delivery in the country can be managed at a primary care level, so that is really the bulk of health care delivery in our country.

What is it that you and Dr. Crouch do at Epiphany, and how is it different from the traditional fee-for-service, insurance-based model?

When I was in the fee-for-service system, I felt like I was playing a game of Whac-A-Mole with Medicare. We had to find ways of doing as much stuff to as many people as possible to generate as much revenue just to pay for the computer systems that I needed to bill Medicare so that I could get paid. So I'd have to get more people and I'd have to hire more staff, and then I'd have to see more patients to pay more staff, and it was a snowball. Every time I found a way to generate revenue and prop up this monstrosity that we were required to build, Medicare would knock the knees out from under us and take away that revenue source. Eventually we just said, "No more."

The name of our practice is Epiphany Health, and that's a very strange name for a health care company. But we did have an epiphany, and the epiphany was "Why are we inserting so many people at the primary care level between the doctor and the patient? Why are we insuring primary care?" The more people that you insert between the doctor and patient, the more expensive it gets, the more cumbersome it gets, the more impersonal it gets. We had our epiphany about 11 years ago: Let's kick the middlemen out of this relationship. Let's have a direct relationship between the doctor and the patient, and at that point we created one of the first direct primary care practices in the country.

Now, at the time we were doing this, there were many other practices simultaneously working on this model. It has since come to be known nationally as "direct primary care," but essentially it's a membership-based primary care program. Instead of a fee for service, instead of a charge for every time the doctor touches the patient, you have a flat subscription fee, much like Netflix. Once you pay that membership fee to your primary care physician, all the services that are provided in the doctor's office are done so at no additional charge. If I see you 10 times in a month to manage a complex condition, it doesn't cost you any more, and I don't bill your insurance for every one of those interactions.

When we opened our practice in 2011, the first thing we saw was uninsured patients coming to our practice from all over Florida. We're in Southwest Florida, this is not the Mayo Clinic or the Cleveland Clinic, but patients were driving hours to access care because they could afford it. They couldn't afford an insurance policy, but they certainly could afford health care in the manner that we were providing it.

What can you do in the office? Can you give me a range of what is included in that $75-a-month fee?

Once a patient is a member of our practice, anything that we can do within the four walls of our office is included at no additional charge. That would include things like electrocardiograms (EKGs); 24-hour heart monitors or Holter monitors; minor procedures like taking off a small skin cancer. I can do biopsies and joint injections, we can remove moles and sew up lacerations. I can splint uncomplicated fractures. Most tests that we do within our office, like a strep test, urine test, or pregnancy test, those are all things that we do at no additional charge.

There is so much that can be done on a primary care level. Let's let the insurance take care of the unpredictable things. Insurance is good for the big stuff. It's not good for the little stuff. It's too complicated. What we do in direct primary care is we make the predictable things affordable for everybody. We take the stuff that you're going to need on an everyday basis and we put affordable price tags on it, and we say you don't need your insurance for this. In fact, the insurance makes it more expensive. If you can expect that in the course of your lifetime you're going to need something like this, let's just make it cheap for everyone.

We make it cheaper than a cellphone. If you can afford a cellphone, you can afford the most basic aspect of health care delivery in the United States.

And when patients need services outside your office, like a lab test?

We have negotiated wholesale prices on everything.

For example, if I do a biopsy, I don't charge you for the biopsy, but my pathologist is going to charge you $35 to tell you whether that's cancer. So I collect $35 from you and give it to the pathologist. If I send your urine specimen out for a culture, I charge $35 for that.

What we very quickly realized is that with uninsured patients, we had to find a way to get them other services outside our office that people needed on a routine primary care basis. They needed access to affordable labs, affordable imaging services, affordable physical therapy. We reached out to our local friends in the health care community, we reached out to local labs, and we said, "If I were to send a patient to you that agreed to pay you in full at the time of service for an X-ray, what could you sell me an X-ray for?" And they sold us those X-rays for pennies on the dollar.

I said, "If I were to collect the money upfront from the patient, and instead of you sending one bill to each of 500 patients, if you sent me one bill for all 500 patients, and you didn't have to worry about coding, you didn't have to worry about collecting, you didn't have to worry about filing insurance claims for every single lab that you order, what could you sell those labs for?" The most expensive thing they do is not the lab. It's the cost of the human labor associated with processing those claims and getting paid. If we eliminate their No. 1 line item expense in their service delivery, we can bring those prices way down. And that's exactly what we saw. We would see 95 percent discounts on the laboratory services.

For example, the very first patient that I enrolled in our direct primary care practice, they went to see their rheumatologist, and the rheumatologist gave them a lab order. The lab quoted them $1,800 for the blood work. The patient got on the phone and said, "Wait a second, I can't afford this. I thought I was supposed to get some sort of discount by being a member of your direct primary care practice?" We said, "Well that order has to come through us, and you have to pay us for it, because we buy labs wholesale." That patient was able to get the same exact labs at the same exact facility for $85. So with the savings on a single lab test, that patient paid for [months and months] of membership in our program.

Ideally, what should insurance pay for? 

If I were to be able to design the perfect marriage between direct primary care and the coverage that's needed for the what-ifs, the major catastrophes, I would have some high-ceiling, bare-bones policy, much like your homeowners insurance. You need your homeowners insurance if your house burns down. You don't need it to mow the lawn. Let's make the routine stuff affordable, and let's have some safety net for "What if I get cancer? What if I have a heart attack and need a bypass surgery?" That's what the insurance is ideally good for. Unfortunately, Obamacare basically made those plans -illegal.

From my understanding, most direct primary care offices have a very small administrative staff, if any at all.

The nice thing about a direct primary care practice is that your staff is not hired to interact with insurance companies. We don't have an entire billing department. We don't have a coding department. Our staff is hired for patient care. When I have a nurse, my nurse is not spending her entire day on the phone fighting for authorizations. She's not fighting for payments. She's not fighting denials. She is providing direct patient care. She's able to pick up the phone and call my patient that I saw two or three days ago and say, "Hi, this is Brittany from Epiphany Health from Dr. Gross' office. I just wanted to see how you were feeling." Where does that happen ever in the American health care system? But it happens here in our direct primary care practice.

Some direct primary care practices have no staff at all, and when you call up, guess who answers the phone? The doctor. People say, "Wait a second, I wasn't expecting to talk to the doctor. Hold on. I wasn't ready for it."

What role does telemedicine play in your business, and how does that compare to other primary care offices?

Telemedicine was critical for us, particularly during this pandemic. One of the things that we very quickly realized is that doctor's offices make their money on seeing patients in person. So if you're a fee-for-service practice, you have no choice but to bring people into your office in order to generate revenue. When this pandemic hit, patients weren't coming into the office. They were terrified to come into the office.

More than half of the primary care practices in the country almost went bankrupt. They started laying off employees. They started closing offices. You're in the middle of one of the worst health care crises in over a century and doctors are laying off health care workers and shuttering primary care doctors' offices. That's not what the direct primary care practices did, because we had the flexibility to audible and change our practice model. We flipped a switch, and instantly from an in-person practice we were an online practice. We were a parking lot practice. We were a house call practice. We did whatever we had to do in order to get the patient the proper care at the proper time.

We didn't need to wait for Blue Cross to convene a committee to pay for telemedicine services. We didn't need the county facilities to come and certify that the parking lot was a safe place to provide these fee-for-service visits. I didn't need to wait two or three months for Medicare to create a new billing code in order for me to provide technology visits for a patient, and I didn't need to determine whether or not a phone call was the same thing as a video visit, and whether FaceTime was appropriate. I just did it. We did what we had to do in order to provide the care, and that's the flexibility that's built within this model.

For what Medicare pays for a single technology visit, I provide two to three months of unlimited technology visits, unlimited office visits, unlimited home visits, unlimited email visits. So now our model is pandemic-tested. It's proven that it's a superior model because we have the built-in flexibilities to do what we need at the time we need it.

Tell me about direct primary care as a movement, for lack of a better word. Has it been growing recently?

Direct primary care is absolutely a growing movement. If you look back about 10 years ago, when we started our practice, there were probably a dozen practices like us that were all starting our own little silos. Nobody knew anybody else existed, but we all knew that the system was broken and that we weren't going to look to Washington to fix it. The cavalry was not coming from Washington to save our practices and our patients. We had to do it ourselves, and we did it. We all fixed it in our own separate ways. We started adopting best practices from these other people, started communicating how we were doing things, and before you know it a community started to form out of these practices, and started sharing ideas, and almost started preaching the gospel of what's possible.

Fast forward 10 years: There's well over 1,500 practices around the country, all individually owned and operated. We're probably seeing another practice pop up almost every single day. There are some regulatory barriers that get in the way of expanding this model. One of the major issues that we saw at the state level is if you charge a flat monthly fee for unlimited primary care services, some people might consider that an insurance product. So what we had to do was protect the practices from an insurance commissioner that might say: "You're an insurance product. We need to regulate you as an insurance product. If a patient signs up, you need to have cash reserves, and you need to use COBRA, and you need to be treated as if you were an insurance company, and you need to be licensed to sell the insurance product."

What we've effectively done the last decade is passed legislation in 29 states that says direct primary care is not a health plan. Direct primary care is not insurance. We'd like to see that legislation in all 50 states. One of the barriers that we see on the federal level is the IRS tax treatment of how this works. So the question from the IRS is: If somebody pays a membership for the promise of services, is that actually money spent on health care services, and is that tax deductible? Can you use pretax dollars to pay for those services? Can you use a health savings account?

That's been the bulk of what many of the leaders in direct primary care across the country have been working on for many, many years now. We've made some progress on that front. We did get an executive order signed in 2017 that declares that direct primary care is a tax [deductible] expense. We continue to work with the Treasury Department and the IRS on implementing that executive order. We hope to work with the Biden administration to finalize that rule. The good news is that the IRS is very supportive of the concept of direct primary care and of memberships being qualified as pretax expenses.

I saw someone claim on Twitter recently that the American health care system is run by "the ghost of Ayn Rand." Someone might say, "Look at these private insurance companies in this capitalist system making health care so expensive." Why is that not true, and how does the direct primary care model align better with free market principles? 

The myth is that profit by its mere definition does not belong in the American health care system, and it's evil, and it creates perverse incentives. While there certainly are perverse incentives in all these systems, the key to making that profit work is, again, the elimination of that third party in the middle of that profit which just drives up cost but adds no value.

Direct primary care is about as close to a free market in health care as you've ever seen in our country. People say, "We tried the free market. It didn't work. That's why we need the government to take over with a single-payer health care system." We have never had a true marketplace in health care. We have competition, but we have competition in a price-fixed system, with very opaque prices. While I was trained in Cleveland, we had the Cleveland Clinic and University Hospitals Cleveland Medical Center, two massive institutions right across the street from one another that competed aggressively to do lots of very expensive things to lots of people. But they had no incentive to compete on price. They might compete on quality, they might compete on service, but they never competed on price.

The first time I went to Washington and made a presentation on direct primary care, I gave it to a group of physicians, and after I gave my presentation on our practice and what we were doing, a doctor raised his hand and said, "You are charging $80 a month. What happens if some doctor sets up right next door to you and charges $40 a month?" I said, "That's an excellent question, because if the first question out of the audience is 'What are we going to do when we bring down the price of health care?' we're onto something. Because that question has never been asked in the American health care system ever."

I said, "That doctor and I are going to have to compete on price and quality, and I'm going to have to justify why my price is twice as much. Maybe I provide better service. Maybe I'm just better trained, have better credentials, or have more experience. But something tangible is going to have to justify that, or I'm going to have to lower my prices to compete, or I'm going to lose patients to the person down the street." Value is determined by the user of the services, which is the patient. It's not the value as determined by how many codes I can send to the third party to justify why I'm doing the things that I'm doing and that I can get certain lab results out of you or certain blood pressure readings out of you to prove that I'm a good doctor. I'm going to prove I'm a good doctor to you by how you value my services.

So if we're looking for the ideal health care system, we want to see three pillars. We want to see lower cost, better quality, and more choices. You cannot have all three of those in a government-run system. You can only have those in a free market capitalist system.

This interview has been condensed and edited for style and clarity. For a video version, visit reason.com.

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250 responses to “What Free Market Health Care Would Actually Look Like

  1. Or you could just find a direct primary care doctor who’s accepting new patients and pay a flat monthly fee that covers all your in-office services and tests.

    Nurse practitioners are even cheaper than doctors and they can do 90% or more of what doctors can do given that you probably have high blood pressure from being fat and lazy rather than from a rare liver disease from Siberian fish scabies. Real free market health care would allow you to go to somebody other than a doctor for routine health care. And there’s a thousand schools that offer nursing degrees – the supply of doctors is kept artificially restricted by the number of schools allowed to offer medical degrees. It’s a scam and a fraud that doctors are in short supply.

    1. Gas station attendants are even cheaper than nurse practitioners. And in some places can offer bait worms too.

      Serial killers offer serious discounts on surgery. Even more if you’re not some soyboy wuss who wants anesthetics cuz you’re overly sensitive to ‘pain’.

      1. Cowardly piece of lefty shit attempts false equivalence, gets called on it one more time:

        “Gas station attendants are even cheaper than nurse practitioners. And in some places can offer bait worms too.”

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      2. So, nurse practitioners (who my primary care doc employs in his practice, mind you, and have been quite good in caring for me and other patients) are no better than gas station attendants? Intriguing theory.

      3. Goddamn that was stupid.

      4. Just got back from the grocery store. This post inspired me to ask the kid stocking shelves how much he’d charge me to check my cholesterol. He couldn’t really give me an answer.

        1. Twenty years ago, I met a stock clerk who checked prostates in his spare time. Just saying.

          1. That was JFree.

    2. Nurse practitioners are even cheaper than doctors and they can do 90% or more of what doctors can do…

      There are also physician assistants (P.A.’s). But all of the nurse practitioners or P.A.’s that I’ve seen were employed by a practice led by at least one doctor. Seeing that level of professional for something they are trained and have experience for is fine, but doctors also need to be available if there is something more complex to diagnose.

      1. Or, they could say up front that there is no overseeing doctor so buyer beware and let people make a choice that way.

        1. That’s would be fine if NPs couldn’t get doctoral degrees or misrepresent themselves as “doctor,” the way chiropractors, optometrists, and physical therapists do. That also doesn’t count PAs who walk around hospitals and offices pretending to be doctors and not correcting misunderstandings.

          The public is largely too ignorant to know the difference between PA Timmy and NP Dr. Thompson or PT DPT Dr. Timmy or MD Dr Thompson or DO Dr. Thompson or optometrist OD Dr. Timmy or DC Dr. Quack.

          To anyone who isn’t a healthcare worker or chronically ill, all “doctors” are the same. There needs to be some regulation in place to clear up confusion and prevent providers from claiming something they’re not.

          1. Ah, yes:
            ‘The population is too stupid to take care of itself, therefore the top men (like you, perhaps?) has to take control.
            Fuck off, slaver.

            1. All the “authorities” of the medical Deep State murdered hundreds of thousands of Americans with what they did and didn’t do about Covid.
              The most positive thing you can say about that from a competence perspective is that it was more likely malice than incompetence.

    3. They are skating on thin ice with those cheap lab tests and x rays.
      Our health care system has its own scanners and labs and we offered x rays and labs done cheaper (we still billed insurance) in the same building as the doctors office.
      We were fined 60 million dollars for not allowing the patient to go anywhere they wanted for these tests.
      How dare we want to capture these reduced charges for ourselves!

      1. The medical mafia don’t like competition, and can always have their regulators snuff it out.

    4. “Real free market health care would allow you to …”

      Buy medicine and medical care from whom I damn well please. Naturally, Reason doesn’t advocate an end the government enabled rent seeking of the medical mafia.

      Anyone know of a libertarian organization that does?

  2. Terrific article. Reason needs more like these.

    1. I don’t know. I thought it should have focused more on critical race theory and the need for health care to eradicate systemic racism and promote equity.

      #LibertariansForCRT

      1. Haha! Jeff’s dumb. And fat.

        1. That’s enough impotent incel rage out of you. Muted.

          1. Oh, oh! Mute me too, lefty shit!

          2. Chipper associates laughter with rage. Is he a sociopath like DOL?

            1. Not sure, but he’s an obnoxious combo of smug and stooooopid.

    2. It is nice to see the free market making inroads and solving problems in one of the areas of our economy that is the worst for not being a free market.

      1. Main concern, though, is with licensing…government is quite capable (and willing) to make it even LESS of a free market than it currently is.

        1. Yeah. The more they can just stay out of the way of developments like the one in this article the better.

    3. The interview was. The intro was not. It was dumb. “Want to go to the Dr? First, you have to figure out your transportation. Buying a car can be expensive”.

      Newsflash – there are no more additional charges on physicals. Obamacare mandates their 100% coverage. At least understand what you are blathering about.

      1. I believe the notion here is that you can join a practice (for $75/month in this case), rather than buy insurance.

      2. And how about the tests that the physical inevitably leads to? The ones that this doctor cut from $1800 to $85? Obamacare makes those more likely so the hospital can make enough to fill out the forms.

        There is no free lunch. If you think it’s free you are naive.

        1. And if you believe that story I have another one.

          1. I’m sure you do; equally as unbelievable.

  3. I’ve yet to see a cogent argument about how inelastic healthcare actually is and how that correlates to any kind of low cost in free market healthcare.

    If you’re having a heart attack, you can’t and won’t yelp for an ambulance and the best bang for the buck hospital. You are entirely at the mercy of the market for that, something which doesn’t exist in most markets and if it does- you don’t care anyway because all your money means jack if you’re dead.

    1. 99.999% of healthcare spending isn’t spent on ambulance trips and emergency room visits (for actual emergencies). Almost all of it is drugs, specialists, therapies, and outpatient services. If you’d be willing to trade 100% socialized emergency services for 100% market driven everything else I’d make that trade in a heartbeat and I think most other people would do. The only people who wouldn’t would be the insurance companies.

      1. You are off by four orders of magnitude. Emergency medicine is anywhere from 2% to 10% of total health care spending.

        1. Except for the fact that many young people use the ER as a primary care service.
          As a lefty shit, you are expected to be, and are, very skillful at picking cherries.

        2. Oh so it’s not 1%, it’s 2-10%.

          Of the point he was making, you’ve at best muddled with the edges.

          1. Oh so it’s not 1%, it’s 2-10%.

            n00bdragon’s hyperbole was 0.001%, so providing a citation at 2-10% was an important correction.

            1. So 90-98% of health care isn’t emergency healthcare.

              Still sounds like, if we socialize the emergency cases, that translates to… only about 2-10%.

              Gee, it seems like emergency medicine really isn’t the reason for socialized medicine.

        3. Okay, so 90% of healthcare spending is NOT emergencies. That’s terrific and means a lot of that spending is elastic and available for price competition.

      2. They make quite logic leap, don’t they?

        “We need government to have 100% control of the healthcare system until you show me how a heart attack victim can shop.”

        First, why don’t you show that’s the case before we take that seriously.

      3. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/downloads/highlights.pdf

        Hospital care is 33%
        Physician and Clinical Services 20%
        Retail Prescription Drugs 10%
        Other Health, Residential, and Personal Care Services 5%
        Nursing Care Facilities and Continuing Care Retirement Communities 5%
        Dental Services 4%
        Home Health Care 3%
        Other Professional Services 3%
        Other Non-durable Medical Products 2%
        Durable Medical Equipment 2%

        Rest? Unclear from the article.

    2. Is there a point in all that? A message, a topic, something which can be answered for a discussion?

    3. “I’ve yet to see a cogent argument about how inelastic healthcare actually is and how that correlates to any kind of low cost in free market healthcare…”

      You expect us to believe you’d recognize one if you saw it?Fuck off and die, steaming pile of lefty shit

      1. Sevo, stop being the tRumptardian clown.
        “we don’t want anything socialized, except the stuff we want socialized”

        1. con-fuse9
          Stop being a TDS-addled lying asshole.

    4. You know what is even less elastic than healthcare? Eating.

      People need food EVERY DAY, or at the very least, every few days. And yet we all somehow get our food access through a mostly free market system.

      The hysterical health crises you mention are the exceptions, and comprise a very, very small part of what we spend for health care. And, as Dr. Gross recommends, are easily covered by the type of insurance focused on catastrophic events, and not routine spending.

    5. That’s because you, like all leftists, are fucking mentally stunted idiots who can’t think for yourself or imagine anything that the government doesn’t tell you.

      1. The real question is if essential services need to be socialized to some extent and if healthcare is one of them.
        Outside my house I have a single telephone pole that is shared by 2 power companies and 2 lets call them data companies. Thanks to socialism, the government gives these companies right of ways, but controls their pricing (to some extent) and forces them to play nice to MY benefit.
        The alternative is 4 telephone poles, with each company negotiating with each property owner along the way for rights to cross the property etc. Assuming of course there is only 4. Same with water, sewage etc.
        When it comes to food, I have multiple stores that I can go to and verify prices. No need to socialize except food safety.
        When it comes to health care, I can find the cheapest doctor. Not sure how wise that would be. But when it comes to emergency care, I pretty much have zero choice. Emergency care becomes essential. Not to mention transportation to emergency care – plenty of stories about private “air ambulances” charging $60K for a helicopter ride.

        1. “…But when it comes to emergency care, I pretty much have zero choice…”

          Why do apologists for socialism make it so easy?
          Hint: Every hospital has to accept emergencies, regardless of pay, so, that’s already covered.

        2. and forces them to play nice to MY benefit.
          Is this sarcasm?

    6. Shitlunches just got thoroughly destroyed.

    7. I was involved in a car accident where the other party (a motorcycle) was killed (his fault, he was street racing, I was stopped at a light). I had no say in where my car was towed after the investigation, or how much it cost. I guess the government should take over car insurance.

      1. We can call it Obamadrive.

    8. You do understand that ambulances are private contractors with the hospitals right?

      1. Umm…not near me. They’re township/county-level volunteers.

      2. This depends on your location

    9. That’s the same situation for when your car breaks down on the road – there’s no time to shop around in an emergency, but thankfully nobody is clamoring for nationalizing the towing industry (for now).

    10. Almost like you didn’t read the interview or absorb any of the lessons. Dudes are literally charging 75 a month for unlimited in-office care that you’d have to pay over twice as much through regular insurance. And they say explicitly they wouldn’t pay for the emergency stuff; that’s what your insurance is for. And if you can’t find catastrophic health insurance on the market to supplement your ultra cheap primary care subscription you can thank Obamacare for mandating that all insurance policies cover routine care. Understand?

  4. Of course if you carve out the services of one doctor and you have no actual complicated or chronic illnesses than youncan pay the low price of $75 for the mfer to check your blood pressure. That’s not even a good deal for me because I have zero health problems but people who actually use doctors have all kinds of healrh problems and if they don’t have help paying for the medications they take every month and all the specialized lab work then they could not afford it and they would die under the front porch. I’ve seen how that Trump low cost crap insurance woeks. It’s cheap because it never pays a dime and you end up paying everything out of pocket and you pay for worthless insurance.

    1. No shit jack. There are others which are pay as you go and have similarly low prices, and both leave the emergencies to actual insurance. Is your imagination too feeble to figure that out?

      1. “…Is your imagination too feeble to figure that out?”

        Add “intellect”.

        1. His intense case of TDS makes me think that he really is Jacob.

          1. He also stated that sullum was a good writer, so it’s eighter Jake or his mother

    2. That Trump crap? There is TDS, and then there is you. It is impossible to be any further gone.
      Trump didn’t set up the “Bronze” plans.

    3. If you need a healthcare of it and have no money, you go bankrupt, which, to a person who doesn’t have any money, doesn’t change much.

      1. Well, it does. Because while the emergency room will keep you alive, if it isn’t deemed essential, other services may be curtailed – including surgery, recovery, medicine etc.
        Then there are some jobs you cannot get with a bankruptcy on your record…
        And if you do run into money – maybe from a lawsuit over what injured you, that can be clawed back to cover your debt plus lawyer fees.
        So bankruptcy isn’t a get out of jail free card.

        1. Is it the purpose of socialized medicine to provide unnecessary healthcare?

    4. I have chronic health problems. I’m really afraid that 30 cents a month I pay for warfarin is gonna bankrupt me.

  5. Why the fuck do all you see on TV are commercials for car insurance companies? Don’t get me wrong some of them are fucking hilarious and worth their cost for the entertainment value alone. Progressive should be writing material for Saturday night live. Liberty Mutual is terrible. And “we’re your best friend” ones make me want to puke. And not a single commercial educates or convinces me of anything. It’s like some elaborate scheme to subsidize media companies.

    1. “Why the fuck do all you see on TV are commercials for car insurance companies?”
      This tells you
      1. Where the lefty shit LoS spends all his time.
      2. His intellectual level.

    2. Shitlunches made a very stupid post, so I decided to make two, to out-stupid her.

      — Sir Strudel

    3. Why the fuck do all you see on TV are commercials for car insurance companies?

      Because car insurance has been commoditized and the best way for them to make money is by getting new customers.

  6. It’s crazy how Obamacare started, or at least hastened, a free-market revolution. Pretty sure that’s not what its supporters intended.

    1. Obamacare was supposed to be a pure voucher system. By filing your taxes you got a voucher for health insurance that could be spent at any health insurance you wanted.
      But between how much insurance really costs, the number of insurance companies that were willing to sign up, and the opposition to anything that smacks of government (or Obama) – whether it made sense or not, it was probably a failure.

      1. Was there some point intelligent people would find interesting, or did you just poke at the keyboard?

  7. “Unfortunately, Obamacare basically made those plans -illegal.”

    A simple,accurate summary of Obama care that Suderweigel, for all of his endless blathering, could never quite come out and say.

    Libertarian my ass.

    1. ^^^THIS

  8. A group of drop-in clinics in a town in which I used to live banded together and did this exact same thing. I have several friends which are members, and they seem pleased with the service — or at least, I haven’t heard any complaints. It makes total sense to me to pay out-of-pocket, either in cash, or through a membership, for routine visits, and have insurance for “major medical,” with a deductible tailored to your specific economic circumstances.

    1. When I was self-employed before ObamaCare, I had a catastrophic health insurance plan. I paid the first $2400 over a year on my own, they paid everything over $3200, and we split in between so there was no sudden cliff. I’d have been glad to keep it when I went back to being an employee several years later, if the company had allowed me to just keep their insurance payments as salary, but I’ve never heard of any such arrangements. Then ObamaCare came along and made that insurance plan illegal.

      I have a lot of faith in humans, their self-interest, and people finding ways to make their life better by providing goods and services which other people want. Unfortunately, government is controlled by all the scammers who ingenuity is restricted to fleecing people by convincing them how stupid and incapable they are, and how they must rely on government to solve all their problems.

      1. “I have a lot of faith in humans, their self-interest, and people finding ways to make their life better by providing goods and services which other people want.”

        I don’t know, that sounds way too “libertarian” for me. /sarc

        1. Are you sarc?

          Also is sarc me? I get accused of being him all the time. I don’t think I’m sarc, but who knows in today’s crazy world.

          1. NO, KAR. I am not “Sarc” — I just use that to ensure that everyone knows the statement preceding it is meant as “sarcasm.”

            As far as you being Sarc, I don’t think so, but I could be wrong….

          2. asshole flag

        2. Well, lets look back at history…..
          German, Wiemar Republic medical crisis – with hyper inflation.
          It didn’t help that many of the doctors were Jewish either (fueled antisemitism).

          I’d prefer more certainty than a society dependent on “go-fund-me”

          1. Wanna try that in English?

      2. When I was self-employed before ObamaCare, I had a catastrophic health insurance plan. I paid the first $2400 over a year on my own, they paid everything over $3200, and we split in between so there was no sudden cliff.

        That sounds fine, as long as the insurance company really does pay everything over that higher limit. The issue is when they start restricting what kinds of doctors you can see, what kinds of treatments you can get, and so on, in order for them to cover it at all. Or, they could just refuse to cover certain things your doctor thinks you need entirely. No one has the time to research all of those details for every such plan offered in advance to find out what they will and won’t cover.

        That is why there are regulations about what insurance companies have to cover. The ACA created federal regulations for that, but states had been doing that long before Obamacare. It was just that states varied a lot in what they would require.

        The choice of government bureaucrats deciding what procedures, treatments, medications, and devices will be covered by insurance as they look to keep Medicare and Medicaid budgets from exploding vs. pencil-pushers at private companies looking to maximize profits is a lesser of two evils choice. Neither of those sets of bureaucrats have the best interests of individual patients as their primary goal.

        One thing that is good about this article and the idea of direct medicine is how it challenges this whole fee-for-service model. It is a worthy project to experiment with this, if nothing else.

        1. “ The issue is when they start restricting what kinds of doctors you can see, what kinds of treatments you can get, and so on…”

          You mean like they do now under Obamacare?

        2. Ahhh a classic, completely disproven, and long winded for profit companies are evil, because… Reasons rant. Congrats

      3. $75 a month may seem like a reasonable amount, when you compare it to a cell phone plan. But that adds up to $900 a year. For someone young and healthy, that still sounds like insurance, in that they would be unlikely to use $900 worth of service in a typical year. So, Epiphany’s business model is still based around spreading the cost of medical care between many patients, just like insurance.

        Ultimately, this is the challenge of paying for medical care that any society faces. How distribute that cost is the fundamental question. The U.S. takes such a piecemeal approach that it is inherently inefficient at distributing costs.

        Employer-based group plans cover most people, with their built-in risk pools. The down side to that method is tying people’s ability to manage their health to their job. This limits mobility in the job market.

        The individual insurance market lacks built-in risk pools. This means that the people that most need insurance are the most expensive to cover. That was the idea behind the individual mandate. If everyone has to have insurance, then the individual market will include enough healthy people paying for insurance to balance people needing more care. But that was politically unpopular and of debatable legality.

        Then there is the moral question of what to do about people that can’t afford insurance on their own. Enter Medicare, Medicaid, and other taxpayer funded plans for children. Eligibility for Medicare is based on age, and Medicaid is based on income. But then there are people in the middle that are not poor enough or old enough for those plans, but still have trouble affording private insurance if they don’t get it through their jobs. (Or their job covers them, but they can’t afford to add family members.)

        This is our problem. So many different circumstances, and no system that can deal with them all. This makes government intervention in the market for health care inevitable. I don’t think you’d ever get a majority of people in this country willing to go full libertarian and just let the free market handle everything and private charities deal with those that can’t afford free market care. I’d be surprised if you’d get even a quarter of people that would say that government shouldn’t spend anything to help poor people pay for basic medical care. The question is never about free market medicine versus socialized medicine. The question is how much socialized medicine and what methods of socializing it.

        1. Get up of of your damn knees.

        2. “The question is never about free market medicine versus socialized medicine. The question is how much socialized medicine and what methods of socializing it.”

          These, and the other question you raise, are legitimate. The problem is that government entities tend to generate “one size fits” all programs — and even when they might think they have multiple programs which fit different sizes, they inevitably come up short.

          Check out Australia’s program, combing both private and public programs and agencies. It’s complicated, but effective, ranked 3rd or 4th in the world, and is a universal program. And, it runs about 30% less expensive than our current system — that is, if you can call the mess we have a “system” at all.

      4. BTW, what did this cost you?
        What background information did the insurance company have on you?
        What restrictions were their on specialist, out of state or out of country medicine?
        Restrictions on which hospitials you could go to?
        Were (it can change now right?) you a woman in child bearing years?

        I suspect at the time, the average person’s medical costs were about $8000/yr. Family of 4, would cost $32,000. On average. Your insurance seemed to have covered all but about $12,000 of that. So, if they didn’t include pre-existing conditions, you would have payed $20K/year? Call it $2000/mon?

        1. I suspect you’ll drag WAGs and strawmen around in the hopes someone buys your BS.

  9. Problems from the market

    1. Bullshit from lefty assholes.

    2. I thought you died, Hihn?

      1. ohlookMarketthugs is a DeOppressoLoser sock

  10. Poor people too unhealthy to work.

    Talk about a shithole welfare state.

    1. Bullshit from Nazi asshole.

      1. This from a humiliated liar who can’t refute what it denies.

        You’re a waste of skin.

        1. Gee, you’re right! I didn’t bother to “refute” your insinuations and speculations.
          More bullshit from Nazi asshole.

          1. I am right.

            1. Yes, your speculations, fanciful readings and insinuations are very convincing to Nazi scum like you.
              Still more bullshit from Nazi asshole.

              1. You troll, piss and moan endlessly but “can’t be bothered” to refute my statements.

                Those feeble mental gymnastics are yours alone.

                1. No, I point out that refuting the incoherent rants of Nazi scum is neither possible nor required.
                  Anyone reading the bullshit you claim to be ‘proof’ can easily understand that your claims of fact are, in fact, nothing other than wild speculation.
                  Fuck off and die, Nazi scum.

                  1. Speculation isn’t defined by being unable to refute evidence fuckwit.

                    1. Ignore Sevo, he’s not smart enough to participate in conversation. He’s just here to make the other violent people feel better .

                    2. Hey Hihn, I heard you died. Glad you’re still kicking, but I wish you’d post as often as you used to. You’re one of my favorite commentators.

                    3. “Speculation isn’t defined by being unable to refute evidence fuckwit.”

                      “Speculation”, especially when offered by Nazi shits like you, has nothing to do with ‘proof’, and you, as a scumbag Nazi, are far too stupid to understand.
                      Fuck off and die.

                  2. In fact, so called “flimsy evidence” should be easy to refute by anyone with an IQ above fuckwit.

                    Like I just did by demonstrating that you were wrong to conclude that you can’t refute speculation.

                    1. Leave Sevo to argue with the lefties in his head. He’s an embarrassment.

                    2. “In fact, so called “flimsy evidence” should be easy to refute by anyone with an IQ above fuckwit.”

                      You’re right again!
                      Now come up with something which approaches “flimsy evidence”. You don’t have anything that robust.

                    3. “Leave Sevo to argue with the lefties in his head. He’s an embarrassment.”

                      No great surprise to find what must be an embarrassment to your parents defending a Nazi anti-semite.
                      Do you hope that this year they’ll let you out of the 6th grade?

                2. What’s funny is the general majority here thinks exactly what Sevo says but many like myself are just a hair more courteous and don’t actually make the comment.

                  So yah; The belittlement IQ in your two heads (Rob and Thugs) is the embarrassment taking place.

                  1. Dipshit.

                    I talk about healthcare and you call me a Nazi.

                    You are a humiliated liar who can’t refute what you deny.

                    1. “Poor people too unhealthy to work”
                      …But certainly healthy enough to [WE] mob-up together in masses and run around with their Gov-Guns and STEAL whatever they want.

                    2. “I talk about healthcare and you call me a Nazi.”

                      Good reasons for that:
                      You’re a pile of stinking Nazi scum.
                      Your comments regarding healthcare show you’re a fucking ignoramus besides.

    2. Hey stormfag – you still haven’t provided evidence on your zog bullshit noahide laws post.

      Where in the CFR can it be found? Who sponsored the bill? Which congressmen ratified it?

      1. Public Law 102-14, H.J. Res 104
        EDUCATION DAY U.S.A
        Public Law 102-14, H.J. Res 104
        102nd Congress of the United States of America

        March 5, 1991

        Whereas Congress recognizes the historical tradition of ethical values and principles which are the basis of civilized society and upon which our great Nation was founded;

        Whereas these ethical values and principles have been the bedrock of society from the dawn of civilization, when they were known as the Seven Noahide Laws;

        Refute that fuckwit.

        Unlike you I soundly refute what I deny.

        1. Joint Resolution
          Mar. 20, 1991
          [H.J. Res. 104]
          To designate March 26, 1991, as “Education Day, U.S.A.”.

          You stupid fuck. Nothing in the resolution proclaims the noahide laws as the law of the land. It’s a fucking proclamation of a holiday.

          1. NO!
            That Nazi pile of shit Misek is caught lying AGAIN?!
            (still).
            Fuck off Misek.

            1. Is it lying, or just believing stupid shit?

          2. “You stupid fuck. Nothing in the resolution proclaims the noahide laws as the law of the land. It’s a fucking proclamation of a holiday.”

            BTW, this is in no way surprising.
            The strongest “evidence” posted by Misek, to ‘refute’ the holocaust is a Nazi comm intercepted by (probably) Bletchly Park wherein the Nazis claimed to be trying to limit the spread of Typhus (I think); therefore there was no Holocaust.
            It’s been obvious for many years that Holocaust-denial requires both self-deception and stupidity, but I’d yet to run into an example like Misek to make clear how great both can be.
            And now we have the lefty adolescent lefty asshole ‘market-thugs’ to add to the idiocy!

            1. You always leave out that the enigma intercepts clearly stated actual numbers of deaths in Aushwitz that contradict the holocaust narrative.

              Your feeble mental gymnastics demand that the Germans LIED to themselves in their top secret communication about prison camp deaths while clearly describing their actual military plans.

              My other evidence is equally irrefutable. At least none of you fuckwits can claim you ever refuted it.

              1. “You always leave out that the enigma intercepts clearly stated actual numbers of deaths in Aushwitz that contradict the holocaust narrative.”

                You are stupid enough to accept the lies the Nazis told about the number of Jew they were murdering, and therefore claim the Holocaust did not exist. And then claim your idiocy as ‘irrefutable truth!!!!!!’
                What a fucking ignoramus! Wanna tell us how many Ukrainians Stalin claimed to have murders, shit-for brains?

                1. Why would zee Nazis “lie” to themselves in their most secure coded communications?

                  They knew how many deaths occurred at the prison camps, didn’t they?

                  So why would they communicate the truth about their planned military actions?

                  You’re not capable of recognizing the fault in your reasoning are you?

                  1. “Why would zee Nazis “lie” to themselves in their most secure coded communications?”

                    Here, folks, is irrefutable evidence of the idiocy of Nazi scum; asshole posted that, I only quoted it.
                    Hint, you pathetic piece of shit: Most Nazis who knew what was going on were not only not proud of it, they knew that if the world knew about it, and they were caught, the best they could hope for was the gallows. Anyone with knowledge of WWII beyond what Parade Magazine offers ought to know that.
                    Now Duranty profited quite well in repeating Stalin’s similar lies; you OTOH get only the bogus justification for your slimy anti-semitism.
                    Go crawl back into the septic tank you came out of; you stink up the place, asshole

                    1. Mine is evidence. Just like a secure email from Biden admitting to rigging the election would be.

                      Yours is less than speculation. It’s feeble mental gymnastics.

                    2. “Mine is evidence…”

                      You bet it is: Evidence of how stupid you have to be to believe your bullshit.

            2. I though OANN commenters were a waste of air… Thanks for taking up the challenge.

        2. Here is the text of Public Law No. 102-14 in full from the American Library of Congress website:

          While it does not make the Noahide laws the law of the land it clearly describes them in law as “upon which our great Nation was founded;”

          They are not.

          “Whereas Congress recognizes the historical tradition of ethical values and principles which are the basis of civilized society and upon which our great Nation was founded; Whereas these ethical values and principles have been the bedrock of society from the dawn of civilization, when they were known as the Seven Noahide Laws; Whereas without these ethical values and principles the edifice of civilization stands in serious peril of returning to chaos; Whereas society is profoundly concerned with the recent weakening of these principles that has resulted in crises that beleaguer and threaten the fabric of civilized society; Whereas the justified preoccupation with these crises must not let the citizens of this Nation lose sight of their responsibility to transmit these historical ethical values from our distinguished past to the generations of the future; Whereas the Lubavitch movement has fostered and promoted these ethical values and principles throughout the world; Whereas Rabbi Menachem Mendel Schneerson, leader of the Lubavitch movement, is universally respected and revered and his eighty-ninth birthday falls on March 26, 1991; Whereas in tribute to this great spiritual leader, `the rebbe’, this, his ninetieth year will be seen as one of `education and giving’, the year in which we turn to education and charity to return the world to the moral and ethical values contained in the Seven Noahide Laws; and Whereas this will be reflected in an international scroll of honor signed by the President of the United States and other heads of state: Now, therefore, be it
          Resolved by the Senate and House of Representatives of the United States of America in Congress assembled, That March 26, 1991, the start of the ninetieth year of Rabbi Menachem Schneerson, leader of the worldwide Lubavitch movement, is designated as `Education Day, U.S.A.’. The President is requested to issue a proclamation calling upon the people of the United States to observe such day with appropriate ceremonies and activities.
          Speaker of the House of Representatives.
          Vice President of the United States and
          President of the Senate.“

          – Public Law 102-14, Library of Congress Website (Please Google “Public Law 102-14, Library of Congress”)

          1. That being said, there is more than enough evidence of freemasonry symbolism around the US and in plain sight on the one dollar bill to make anyone pause to consider that a satanic secret religion has been at work in the highest offices of the US since it’s founding.

            They just never spelled it out so clearly in law as in this resolution in 1991.

            1. Anyone else looking forward to the new show where Kar, misek, and stupid Rev are roommates?

            2. Nazi scumbag here to explain how his “evidence” is but one more pile of speculative shit.

  11. For lack of a better term, let’s look at the mega-macro level. No matter who pays, what gets spent on health care cannot exceed cumulative production.

    If most people produce about a million dollars worth of goods and services over their lifetimes, then they can’t all get a million dollars worth of healthcare. And, assuming those people expect other things, they can’t all expect even a fraction of a million dollars in healthcare.

    1. What if we give everyone a million dollars a year in stimulus checks though?

      1. No such thing as ‘fiat’ human resources; only fiat ponzi-scheme’s by politicians and governments use to STEAL human resources.

      2. Then I’ll be real glad to own gold and silver. Even if going to sell a coin every time I have to go to the store will get annoying quickly. As will needing a wheelbarrow to pay for a bag of groceries.

        Of course, then I do at least have the wheelbarrow to carry the groceries in…

    2. Sacrifice yourself, since you’re willing to kill others. Wow, you’re the next Sevo. Just say leftie so you can hurt others.

      1. Lol wut?

      2. “Sacrifice yourself, since you’re willing to kill others. Wow, you’re the next Sevo. Just say leftie so you can hurt others.”

        Did the cat run across the keyboard, or are you that stupid?

  12. “When I was in the fee-for-service system, I felt like I was playing a game of Whac-A-Mole with Medicare. We had to find ways of doing as much stuff to as many people as possible to generate as much revenue just to pay for the computer systems that I needed to bill Medicare so that I could get paid.”

    Don’t worry doc, when we have national health care, you will work for the national service, and get paid a “fair” salary, something incrementally more than baristas. And you will not have to spend any time chasing reimbursements.

    1. I’ve heard glorious people’s republic of Cuba has world class healthcare. They pay their doctors double what the average person makes — 50 bucks a week instead of 25.

      1. But they have a fairer taxation system than we do. 100% after the first 25 bucks.

    2. “And you will not have to spend any time chasing reimbursements.”

      Nope, you’ll spend most of your time protecting your rice bowl.

      Patient care becoming DMV level customer ‘service.’

    3. Ask any provider who pays better and quicker – Blue Cross or Medicare….

  13. In the future, doctors will come to your house when you are sick to check on you and to prescribe medicine.

    Maybe there’ll be an app called DoorDoc or something.

    1. After all, why would you want to be around a bunch of sick people, especially when you are sick?

    2. *starts writing an app*

      You don’t mind

      1. Fuck this stupid comment software.

        “You don’t mind if I use that ‘DoorDoc’ name, do you? :-D”

  14. “Some direct primary care practices have no staff at all, and when you call up, guess who answers the phone? The doctor.”

    I had the privilege of doing pre-paid primary care for a couple of years, and it was so much better. And the doctor, who was a personal friend of mine, was much happier just practicing his medical skills and not dealing with insurance.

    It was the doctor’s wife answering the phone, so close enough.

  15. It’s not just primary care. Check out what the Surgery Center of Oklahoma has been doing;

    https://www.econtalk.org/keith-smith-on-free-market-health-care/

    1. I also expect that, as the prices of surgery and other treatments rise in the U.S., medical tourism will expand. Imagine catastrophic health insurance that will pay to send you to Singapore for that knee replacement surgery.

      1. If catastrophic insurance is covering knee replacement surgery, then the system you’re thinking about is massively fucked up. If health insurance is sending you to Singapore for treatment, then you don’t actually understand the medical conditions that create the big spending issues.

        1. OK, maybe I shouldn’t have used the word, catastrophic. Imagine a level of insurance that covers big things like knee replacement surgery but not routine primary care. I’m not sure what word to use an adjective for that.

          1. “OK, maybe I shouldn’t have used the word, catastrophic.”

            Dee fucked up, AGAIN.

        2. “If health insurance is sending you to Singapore for treatment, then you don’t actually understand the medical conditions that create the big spending issues.”

          I wasn’t even trying to address the problem of the medical issues that cause the most public spending. I was just talking about how these mid-level medical treatments and surgeries could benefit from insurance that utilizes medical tourism. Not even tying to claim medical tourism would solve all health care spending problems.

        3. Let’s see the arm-waving, you cowardly piece of lefty shit! Tell us about the turbo incabulator!

  16. A lot of the costs are in medical insurance, and Congress has seen fit to ignore tort reform for decades. Why because most people in Congress are lawyers.

    1. This.

      The entire medical insurance program was expanded over the past fifty years to bloated proportions precisely because governments got involved.

      It went from paying your doctor directly for simple care similar to what the article describes, while catastrophic coverage was affordable for everyone for a few dollars a month. Then it morphed into our current system, which no one can afford without a good paying job…. or welfare.

      It’s nice to see doctors pushing back. But it’s kind of disgusting that they’re charging $75 a month. Really.

      I hope some major non-insurance company finds a way to just hire the doctors directly and just charge $15 a month and you walk in like McDonald’s and get what you need etc etc.

  17. I wish people actually understood the first thing about the medical system and the distribution of spending. It is very transparent that you people do not.

    FACT:
    1% of people incur roughly 20% of total medical spending. That’s well over $100,000 per person per year.
    5% of people incur roughly 50% of total medical spending. That’s over $50,000 per person per year.

    Most of those people above are at least temporarily disabled because of their health. Meaning – an employer-based system (or any insurance coverage based on cherry-picking the healthy pool) will fail to pick up spending and will dump it on, likely, govt. Most people who die each year come from one of those above groups. Meaning – an individual market simply can’t work because dead people can’t pay their bills.

    Further, giving those people the ability to control their usage does NOT result in lower spending. These people are way into free lunch territory and that can not change. Corollary being – individuals cannot change the total spending curve (or the cost of insurance). You people can beat them up and pretend this is a moral failing or somesuch bs – but it just means you like beating up defenseless people. Which is of course not apparently a moral failing unlike those people you beat up getting sick.

    On the other side – 50% of people spend less than $300 per person per year. Which accounts for less than 3% of total medical spending. THAT is the range of medical spending people can really perceive and control. Those are the people who obviously have to subsidize others in any insurance (or other financing) system. But go above say $600/year and people will, correctly, start hemming and thinking they are paying too much to subsidize others. Why can’t they control their spending like we do? So they will start dropping out – with – drumroll – 94% or so of costs still out there.

    1. OK, so what’s the solution?

      1. Mandatory eutinashia for progressives?

    2. “…FACT:
      1% of people incur roughly 20% of total medical spending. That’s well over $100,000 per person per year.
      5% of people incur roughly 50% of total medical spending. That’s over $50,000 per person per year…”

      And most of those people are different every year, and others (like Tiger Woods) pay for what they use, which means your simple-minded “analysis” is NWS.
      Go back to waving your PANIC flag, cowardly piece of lefty shit.

    3. “Which accounts for less than 3% of total medical spending.”

      So, what’s wrong with discussing ways to improve spending in that sector? It’s solving a smaller problem, but it’s still a lot of money being wasted.

      More importantly, I personally know general practitioners, and they think insurance and billing makes their job suck. Why not make being a general practitioner more appealing?

      1. No problem at all with that. What most countries do is center health care delivery around the GP. Which tends to look like one of the many forms of HMO with GP as gatekeeper to specialists and specialists/hospitalists as gatekeeper to tertiary care.

        But Americans really have a problem with someone else making the important access decisions around healthcare even if someone else is paying for the whole thing. And before you can even figure that entitlement mindset problem (three or four or more generations in the making), we’d have to get at least double or triple the number of GP’s in place. It may only take a few days to get an appointment for a specialist but it can take months to get an appointment with a new GP assuming they are even taking patients.

        1. “…But Americans really have a problem with someone else making the important access decisions around healthcare even if someone else is paying for the whole thing…”

          No, you pathetic piece of lefty shit, the TAXPAYERS are paying for it. Them; the people you accuse of ‘having a problem’ with being told what to do.
          Fuck off and die; give your dog a place to shit, and quit making a public ass of yourself.

    4. FACT: And that’s where most of the Top 1% comes from.

      WHO moved into the #1 wealthiest person in the USA within a year of Obamacare???? That’s right the owner of a medical insurance company… So spare me your sob stories about how making everyone pay to lift the RICHEST sector of the US market up even higher is a moral obligation.

  18. Sign me up.

  19. Medicare for imaging exams is half a year away from becoming worse. Starting in January, MDs are going to have to log into a system which will suggest less-expensive imaging before eventually handing off a code of approval for the exam. It will start out as a limited number of scans, but will undoubtedly be extended to include more, and labs are next on the list for the system.

    This means every single doctor’s office are going to figure out this new system. So far, there are a handful of free versions of the approval system, but it will complicate Medicare orders and they will take more of the MD’s or assistant’s time.

    1. Another gimmick to force doctors to hire administrator staff just to handle this crap. All the regulations are to increase complexity and create more costs, so more unskilled morons can get desk jobs that really contribute nothing to the world.

  20. Does anyone here imagine free market healthcare coming into being with the Democrats in charge of the government?

    1. No.

      1. Asshole flag

    2. You approve of killing people who cAnt pay. Shut it.

      1. lol… And which planet do you live on?

        Judge ruled ‘death row’ because bob-the-bum couldn’t pay for his stitches??? URFOS… We are oceans lengths away from that kind of system.

        No; on this planet it’s gimme more drugs that I refuse to work for, refuse to sell my million dollar mansion for and refuse to NOT buy that new TV for…

      2. “You approve of killing people who cAnt pay. Shut it.”

        Lying piece of lefty shit asshole; no flag.

        1. It’s against the law to refuse ER service to patients on the basis of their inability to pay.

          White Knight is an ignoramus in addition to being an idiot.

          1. I’m not sure that’s WK; there are more than enough ignorant lefty shits to go around and most are probably not capable of registering a sock.

            1. They’ve both got that special kind of stupid.

          2. BTW:
            “It’s against the law to refuse ER service to patients on the basis of their inability to pay.”
            This was probably the best ‘safety net’ we could have ever found, but Obo couldn’t claim to own it. We all paid for it in higher insurance rates, but no one stuck a gun to your head.
            The decisions, including triage, were taken locally: the junkie who OD’d the third time this week was put behind the kid who got shot in a drive-by since we only have 8 MDs working. The junkie died, as the junkie, his/her family ans society is better off.
            Society does not owe unlimited resources to those who continually make self-destructive choices.

            1. Being able to charge even a $5 copay would have made it a lot better. I’ve seen too much abuse of the system to think that there shouldn’t be some mechanism to discourage some portion of the visits.

              1. So exclude only those who cant part with $5. Do you suppose those are all the healthiest people?

                1. Best comment today, “Society does not owe unlimited resources to those who continually make self-destructive choices.”

                  …And a good reply to this comment.

                  Ya know Tony; The only ‘unhealthy’ enough person I can think of unable to earn $5 would be someone who is in a lifelong coma and questions of pulling the plug become part of that discussion.

                  Of course; Everyone knows your examples are F.O.S. and cry-baby cries about sympathetic-knee-jerk emotional STEALING. Rotten scum like this (criminals) seems to be the new ‘living’ for far too many.

                  If you lefties spent as much time PRODUCING something/anything as you did crying and fussing to STEAL something the world would have a lot more human resources and be a lot better off.

                  I mean for crap sake; How healthy does one have to be to program? Yet, tomorrows news will be how there isn’t enough specialists in the programming industry as reflected by it’s higher pay rate…

                  No; This manipulative emotional crockery needs to STOP.

                  1. The assumption being that people are poor because they make bad choices.

                    What about the choice to be born to poor parents? There are 18 long years where people are subjected to the whims of their parents.

                    So maybe reassess your thoughts with that in mind.

                    1. Your speaking to one; maybe reassess your thoughts with that in mind. And guess what? Just because we were “poor” didn’t mean we inherited the indoctrination that it was OKAY to run around STEALING from ‘those’ people.

                2. “So exclude only those who cant part with $5.”

                  No, you pathetic piece of lefty shit, hoping to fool people with your strawman.
                  Prioritize the care of those who have made some effort to take care of themselves, regardless of their ability to pay.
                  Fuck you with a rusty running chain saw; you deserve it.

      3. Asshole flag

    3. Or a Free market Education
      Or a Free market Energy
      Or a Free market Housing
      Or a Free market Food
      Or a Free market ANYTHING????

      Nope; Nazi’s don’t support ‘free market’ anything.
      But one has to take notice of how ‘survival’ items are always the hardest pressed for Nazi Control.

      Na-zi: The acronym for National Socialism that the Democrats wants to sell you on via “democracy” taking over the Constitutional Union of Republican States.

      1. So, the first step on the road to free market anything is to remove the progressives from power.

        Is there anyone here who imagines that doesn’t involve replacing the Democrats with Republicans–as an interim step on the road to free market anything?

        1. The Republicans were in charge and did nothing. I cannot imagine either major party making free market reforms.

          1. I don’t think I’d call the deregulation committee of the Trump Administration “nothing” but your point stands truthful 90% of the time.

          2. “The Republicans were in charge and did nothing.”

            TDS-addled asshole lies. Again.

            1. Yeah, White Knight is an idiot.

              The question isn’t whether the Republicans did everything they could have. The question is whether it’s even possible to improve to a more market oriented solution while the progressives are in power, and the answer is “no”.

              1. BTW, Ken, the “Battlegrounds” book is probably worse than you expected

                1. Oh God.

                  That’s the Democratic party’s foreign policy going forward, too.

              2. You don’t know that. Did white knight show you his idiot ID? If not then his idiocy is more of an idea

              3. “Is there anyone here who imagines that doesn’t involve replacing the Democrats with Republicans”

                How is that a helpful first step, when we have already seen that the Republicans were in power they did nothing, and weren’t even capable of forming a policy agenda other than “suck up to Trump’s daily whims”.

                1. “How is that a helpful first step, when we have already seen that the Republicans were in power they did nothing, and weren’t even capable of forming a policy agenda other than “suck up to Trump’s daily whims””

                  1. Too stupid to know better
                  or
                  2. Dishonest, and hoping others don’t notice
                  or
                  3. Both.

                2. How is that a helpful first step, when we have already seen that the Republicans were in power they did nothing

                  LOL… “Doing Nothing” is a HECK of a LOT better than the ‘doing’ going on right now.

  21. Interesting article, but it would be even more interesting to compare this proposal to single payer like they have in Canada and some European countries. They all get better outcomes than we do and spend vastly less. What do they know that we don’t? (Before you tell us how awful the Canadian system is, ask some actual Canadians. I know a lot of them of whom zero would trade their single payer Medicare for the US system.)

    1. What do they know that [we] don’t?

      I don’t know – maybe you should MOVE YOUR COMMIE-*SS there and find out….

      As far as [I] am concerned I’ll find whatever way suites me BEST without your [WE] talking for me and pointing Gov-Guns at me.

      1. The problem is that what you feel suits you best includes driving on public roads, using public utilities, getting free education for your children, and a number of other things that I paid for.

        1. Fuck off, lefty asshole ignoramus. Your lies are irrelevant.

        2. Dumb*ss — None of that is ‘Federal’.
          – I don’t use your public utilities
          – I don’t use your public roads (probably never)
          – I don’t use commie-education
          Yet you STILL show up with your Gov-Guns to rob me blind.

          …And that is why communism is B.S. — It contains no motivation for “better” and gobs of motivation for “worse”.

    2. “…They all get better outcomes than we do and spend vastly less…”

      Left shits repeat this lie on a regular basis; consider yourself busted, lefty shit

    3. Canadians pay more and get less. The richest Canadians pay cash to avoid their government’s healthcare system.

      1. So the most valuable people to society are *FORCED* to pay more to get ‘nothing’ and then have to ‘pay cash’ for ‘something’? 🙂

        Now; what kind of moron would sign-up for that!!! Oh; I know… The people who add no VALUE to society but only look out for themselves.

      2. Even those not so wealthy end up in the US:
        “Mother Gives Birth to Very Rare Identical Quadruplets”
        […]
        “Amazingly, the quads were conceived naturally, odds of 1 in 13 million. However, even more shocking is that the mom, who’s Canadian, had to give birth in Montana because not one neonatal unit in any Canadian hospital had the room to handle identical quadruplets. However, Benefis Hospital in Great Falls, Montana, population 50,000, did…”
        Yep, you’d better hope that Mexico adopts a better medical care procedure if the US adopts the failed Cdn effort.

    4. “They all get better outcomes than we do and spend vastly less”

      You used the word “all” but you don’t seem to know what the word means.

      Do wealthy Canadians ever come to the United States for treatment?

      And your citation fell off.

    5. Here’s the deal with Canada: A cat with four legs who needs a CAT scan can get itimmediately, because veterinary service is private and competitive. A cat with two legs who needs a CAT scan has to wait for months because all the heath care for human beings is single-payer and government-provided.

      To Canada: Why you no treat human beings as good as you treat other kinds of ani-mal?

  22. https://fee.org/articles/lodge-doctors-and-the-poor/

    Pretty good rundown of how medical services were delivered and paid for before government and the AMA conspired to fuck it up.

    -jcr

    1. This is the weirdest porn site…

  23. As long as doctors control how many more people can become doctors they will have a monopoly on the supply side.

    1. See below.

    2. That physicians control the education and training of physicians is the essence of being a profession. That they also control the provision of, and payment for most all of healthcare is the problem.

  24. This is not quite what free market healthcare would look like, because this is still under the labor union monopoly of the American medical Association. Without the union’s monopoly wages and regulatory captured regulations, this free market healthcare would cost a fraction what it does here.

    1. True, but at least it gets rid of the only monopoly enforced by guns.

        1. Though this is an even weirder porn site than the one above about feet.

    2. That is nonsense. There is no Union. Perhaps AMA still produces a credible journal and sells insurance. Around 10% of doctors are members. You have no idea what you are talking about.

      1. The AMA exerts outsized control over the supply of MDs through the LCME accreditation process.

        1. That so few members of the profession actually participate in the AMA makes this control even more oligarchic and obscene.

          1. Because they don’t offer much. Most docs belong to organizations corresponding to specialty because they offer credits and publications they can actually use.

            I do not think that the supply of doctors has anything much to do with costs and accreditation is not the limiting factor. Actually foreign grads are a deal because they already come with the education and training.

            I think people overestimate the influence of the AMA. They were a bigger deal in the past but not so much now.

      2. Echospinner
        June.20.2021 at 5:00 pm
        “That is nonsense. There is no Union.”

        So we should use “cartel”?
        You’ve been obvious from day one, an apologetic for any ‘accepted’ medical issue presented here.
        Do you really think no one here sees the AMA’s control over ‘acceptance’ as anything other than a protection racket?

    3. Actually it’s an organized interest group engaging in free speech.

      Any other ones of those you want to see government disband by force?

      1. “Actually it’s an organized interest group engaging in free speech.”

        Actually shitstain here has invented a whole new definition of ‘free speech” from the ones he opposes.
        Fuck if and die

  25. The whole civilized world, minus the US, has figured out how to deliver universal, affordable healthcare programs that make their citizens happy and healthy.

    What sets the US apart is poorer outcomes for higher expenses without universality, and a lack of a universal scheme subsidized by government (getting close though!).

    Obviously the solution is to look at that spectrum and go in the objectively worse direction, because reasons. Because you read Ayn Rand in 9th grade and forgot to read more books after that.

    1. Obviously the solution *IS*….
      USA traitors, dictators, thieves be “banned” from using Gov-Guns..

      EXACTLY as the U.S. Constitution (The Peoples Supreme Law) over government spells out…

      You want to spout your B.S. and believe it… GO MAKE IT WORK WITHOUT *FORCE* of threatening people with Gov-Guns… Go start a DNC “universal, affordable healthcare program”…

      NO ONE IS STOPPING THE LEFT FROM DOING SO….

      Just STOP pointing Gov-Guns at the people *forcing* them to hand over their wallet… Crooks I tell you… Rotten Crooks.

      And if you don’t like it — MOVE out of the USA!

      1. …And the worse part is — The more subsidizing of criminals this nation does the more criminals it will get.

        I have faithful Democrats in my family and one sure factor of every one of them being a faithful Democrat seems to be getting their income by pointing Gov-Guns at people.

        Someone should do a study on how many Democrats live off government programs. We know commie-education is loaded with them..

  26. “The whole civilized world, minus the US, has figured out how to deliver universal, affordable healthcare programs that make their citizens happy and healthy.”

    The whole brain-dead lefty shit world has claimed that free shit is free, and should therefore be invited to duck off and die.

  27. The practice is in a little town about ten miles from where I live in SW Florida. I vaguely remember hearing about it years ago, but didn’t think much about it (and wondered if the doctors were still billing insurance companies). Glad to learn more about it and glad the practice is still open.

  28. $900 per year just for a primary care doc doesn’t seem like such a great deal to me.

    You still need insurance to cover the big stuff anyway and insurance companies already negotiate rates with providers.

    1. Yes, and assuming, as is more and more obvious, you are either an MD or someone closely involved in medical care, it’s fine by you.
      It is also fine by me; I have access to resources denied to many by O-care; I can pay for it.
      Did you pull that $900/year out of your ass?

  29. it seems low for me. care doc should be more than it should be! !

  30. Honest question: If a doctor charges $100/month, his practice makes $1200/year per patient. If that doctor has 500 patients, the practice makes $600,000 per year. Once you pay a nurse or two, front office staff, rent for the office, malpractice insurance, etc., that money is pretty much gone.

    Is 500 patients a small number for a standard single-doctor primary care practice? 500 seems like a lot for a single doctor to me, but I know absolutely nothing about the medical business.

  31. First of all, medical care should be at the highest level. Health is the most valuable thing we have. Many decide on plastic surgery and, alas, get to unqualified doctors, and then suffer from the consequences. It is always important to treat it responsibly, and find the best for yourself, besides now you can do it so easily here https://www.enblocsurgeons.com/

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