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These Doctors Got Fed Up With Insurance. Now They Treat Their Patients Like Valued Customers.

The “direct primary care” movement is attracting physicians sick of red tape. And it’s transforming the doctor-patient relationship.

One of the most profound changes brought about by the Affordable Care Act is that it drove thousands of independent doctors to throw in the towel and join large hospital networks. This is particularly true of primary care doctors. As the rules involving medical records, billing codes, and prior authorizations have gotten more complex, physicians find they can't survive without joining large health care networks. And they're becoming increasingly demoralized.

Today there's a small but growing movement of doctors who are opting out of the traditional health care system by no longer accepting insurance. This new approach is is called "direct primary care," but it's essentially a throwback to an era before insurance companies were responsible for covering routine services like ear infections or strep cultures.

When companies like Aetna, Blue Cross, and Oxford started signing the checks for even minor health care expense, it had a destructive impact on the doctor-patient relationship. The direct primary care movement is an attempt to reverse the damage.

Dr. Ryan Neuhofel, who's been running his own direct primary care practice in Lawrence, Kansas since 2011, has a page on his website that lists the cost of each procedure, which the patient, not the insurance company, actually pays.

Need an x-ray? That's $25 to 40, along with a monthly subscription fee that runs from $35 for minors to $130 for a family of four.

Most direct primary care practices charge a monthly subscription fee. It allows them to offer other services, like answering patient phone calls, text messages, or even having appointments over Skype—services that our insurance-dominated system doesn't allow for.

"Because I'm membership supported if someone calls me and says, 'hey, I have a rash,' they can send a picture," Neuhofel says.

Removing the interference of third parties changes the dynamic between patients and their doctors.

"We're able to be creative in meeting their needs," Neuhofel says. "[We are] able to give them transparency in pricing, and redesign the entire health care experience around what patients really need."

Direct primary care physicians are able to charge less than traditional practices because the lack of coding and billing means they don't need to hire support staff.

The direct primary care movement is a way of opting out of an industry that's dominated by a cartel of hospital and insurance companies, thus insulating doctors and patients from policies crafted on Capitol Hill.

But there are some changes to the tax code that could speed adoption. The IRS doesn't allow patients to use their tax-deductible Health Savings Accounts to pay direct primary care doctors. In fact, just having a direct primary care subscription disqualifies individuals from contributing to an HSA at all. Dr. Neu and others have been meeting with lawmakers and proposing legislation that would change this.

"We're not living off the reservation just because we're cowboys," Neuhofel says. "We're doing it so we can provide great care, but at the same time we need to figure out how we integrate with the larger health care system."

Shot and produced by Mark McDaniel. Music by Candlegravity, Podington Bear, and Nine Inch Nails. All music is licensed under a Creative Commons Attribution Non-Commercial Share Alike license.

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  • esteve7||

    "One of the most profound changes brought about by the Affordable Care Act is that it drove thousands of independent doctors to throw in the towel and join large hospital networks."

    That was intended all along. It's a feature, not a bug.

  • BrianPierce||

    This is a wonderful story that would be great for promoting DPC and weaning people away from the idea that they need insurers or the government to pay for primary care except for the opening attack on the ACA.

    Not only is it inaccurate (primary care practices like my old practice were being crushed by insurers and Medicare/Medicaid long before the ACA arrived) but this ACA attack turns off progressives and others who would otherwise find a lot to like in DPC.

  • Stormy Dragon||

    One of the most profound changes brought about by the Affordable Care Act is that it drove thousands of independent doctors to throw in the towel and join large hospital networks.

    Ad hoc ergo propter hoc

  • Old Mexican's Speedos||

    It's "post hoc, ergo propter hoc"

  • Paloma||

    But I gotta remember that "Ad hoc ergo propter hoc". Pretty cool.

  • NotAnotherSkippy||

    That made me chuckle.

  • Diane Reynolds (Paul.)||

    Both healthcare initiatives, both Clinton Care and Obamacare caused massive disruptions in the healthcare industry which both led to large-scale consolidation among health care organizations.

    To wit, the record-keeping requirements became more complex during both, and with Obamacare's 'meaningful use' pile of money, every healthcare organization wanted an EMR, stat.

    Epic, the 'best in breed' EMR literally won't sell its product to small hospitals. So, small hospitals started consolidating and banding together/merging with larger hospitals (mine was one) just so they could 'qualify' to purchase Epic.

  • Diane Reynolds (Paul.)||

    Further, the small clinics who used to have their own systems and software also wanted to benefit from 'meaningful use' and often, the only cost-effective way to do it was drop their independent status and join large hospital organizations.

    This effect was real and measurable.

  • BestUsedCarSales||

    So, I can't tell you how your usage is, but from my time at Epic it's a real shit show.

  • Diane Reynolds (Paul.)||

    You should see Meditech.

  • HillTown Trader||

    Nationalizing a handful of large healthcare companies is easier then nationalizing thousands of sole proporietors or small businesses.

  • Enemy of the State||

    ^^^This guy gets it....

  • Occam's Stubble||

    Nationalizing a handful of large ________ companies is easier then nationalizing thousands of sole proprietors or small businesses.

    Applies to any industry. That's why when all the swamp creatures were overly concerned about "too big to fail," they passed legislation that took us from ten large banking conglomerates to five.

  • Kaatje||

    I worked with Epic as a PA-C. A nightmare of epic proportions. Before working while they implemented Epic, I was at a consolidation of clinics.

    They implemented EMR because they got paid thousands per patients, mandatory by the federal CMS. Every EMR sucked balls, it was a matter of which one sucks the least.

    Btw, the owner of Epic made out like a bandit. The government did not go with the best program, or the most user friendly, or patient friendly. Deals behind closed doors, as always.

  • Old Mexican's Speedos||

    These Doctors Got Fed Up With Insurance. Now Their Patients Are Treated Like Actual Customers: New at Reason


    Barbarians! Health care is a right, which means patients should not be treated like customers! Tjey should be treated like cattle, just like those places where care is free!

  • DirkT||

    Tell us, which country, where healthcare is free, were you treated like a cow?

  • Magnitogorsk||

    Countries where healthcare is "free"? Impossible. Single payer would immediately bankrupt any government that tried it. The dozens of countries that have been doing it successfully for decades are a myth

  • Enemy of the State||

    Vermont considered it and said no. So did CO. Both because the cost was massive. But CA may forge ahead yet as CA believes Econ 101 to be a vast right wing conspiracy.

    Move to CA and vote your reality into being!

  • Tionico||

    Yup. Veterinary care is not bogged down by stupid FedGov manacles. Therefore the cows, and their owners, get far more efficient and pleasant care, at a fraction of the cost cppared to human care. Which is rather oxymoronic, as veterniarians need to have far more schooling to work on the wide range of critters they receive as patients. All humans are essentially the same, physiologically. Fish, birds, elephants, cats, gerbils are all quite different, this the vet must have broader training.

  • BYODB||

    I have nothing but respect for providers that choose this route, and frankly if you're not going to be a system provider this is basically your only real option.


    But there are some changes to the tax code that could speed adoption. The IRS doesn't allow patients to use their tax-deductible Health Savings Accounts to pay direct primary care doctors. In fact, just having a direct primary care subscription disqualifies individuals from contributing to an HSA at all. Dr. Neu and others have been meeting with lawmakers and proposing legislation that would change this.


    This is frankly a great idea, and I think the HSA rules were put in place basically to screw over Doctor's that didn't want to participate in the cartels. You would be amazed at some of the shenanigans that get pushed through literally to fuck over independent practitioners, and it can not be stated often enough at how large systems systematically look for regulations to keep these types of practices out of the game entirely.


    The large health systems are hand-in-hand with the Government precisely to keep this type of reform from happening, and don't ever forget that. The largest health systems are for overarching regulation because the more regulations there are the more business they get since smaller systems can't survive the regulatory burden. Honestly, neither can the large systems but they get the sweet deals and subsidy to keep going.

  • HillTown Trader||

    Half of Americans don't pay any income taxes, so the tax savings from HSAs is ZERO.

    The lower the tax bracket, the less HSAs matter

  • DrZ||

    "Half of Americans don't pay any income taxes, so the tax savings from HSAs is ZERO. The lower the tax bracket, the less HSAs matter"

    I would rather see the feds butt out of medical insurance and place flat amounts of what was medicare into the HSA accounts of those not paying taxes than to micro manage medicine for the nation. Leave it to individuals to decide how the money is spent.

    Allow anyone to contribute to HSA accounts. Get the politics out of medicine.

  • Tionico||

    having neither health insurance nor a health savings account, it makes no difference to me practically. However, the FACT that these direct care folks are beginning to wake up and build alternatives taking realistic steps to return a truly free market to bearing on that industry. Two friends of mine who know each other and work in two radically different types of clinic are both talking about advancing to private practice and not welcoming insurance, and adopting a direct pay at time of service plan. Both spend obscene amounts of time writing out reports, etc They are planning to move to patient payment at time of service.

  • Hugh Akston||

    Good on these docs for trying to wrest control of their profession back from the insurers and the government. DPC + cheap catastrophic coverage should be more than enough for most people.

  • Paloma||

    ^^^ 100% with Hugh

  • NotAnotherSkippy||

    Throw in high risk pools and AHP and expanded mandatory (yes mandatory because ppl won't save on their own and they won't be allowed to die from the consequences) HSAs and you've solved just about everything.

  • BYODB||

    Mandatory HSA's, what like Social Security? Because that worked out well.

    *rolls his eyes*

  • DrZ||

    As much as I hate the word mandatory, it may be the only way out of the morass. Without HSAs there will never be such a thing as true, really true catastrophic insurance.

    We need to ween people from the idea that all medicine, all the time should be free and if you pay a few bucks for medical services you have been ripped off. This is one of the primary driving cost factors in US medicine today.

    HSAs are a route out of this problem. HSAs pays the first dollar and most dollars for that matter, but if something unforeseen happens very high deductible catastrophic kicks in.

  • HillTown Trader||

    Do you also want mandatory car breakdown accounts, or mandatory food accounts, Or mandatory roof or furnace replacement Accounts.

    Healthcare is just one more costs --- why should it be subject to all these interferance?

  • EscherEnigma||

    Hrm... well, we don't have "mandatory car breakdown accounts", but we do have food stamps, section 8 housing, TANF, Social Security, programs to reduce the cost of electric and gas bills for needy customers, and so-on.

    Face it, if someone needs something to live? Then there's a not-insignificant portion of the population that has demonstrated that humans are really bad at planning for things they should plan for.

  • Bubba Jones||

    "cheap catastrophic coverage"

  • JFree||

    The reality is that the catastrophic coverage will only be cheap if PC's are given a gatekeeper role - and PAID for that function. That is the biggest failure of our current system - PC's are paid in 15-minute time increments (vs the large$ fee-for-service reimbursements of specialists) which means the billing overhead burden is monstrous for them. And American patients have the most extreme entitlement mentality in the world re seeing specialists. As long as that is the case, no insurance company can really reduce 'emergency-only' prices since that entitlement mentality creates adverse selection.

  • Bubba Jones||

    catastrophic. not emergency.

    That means $10k deductible.

  • RenaD||

    It really is just that simple!

  • Occam's Stubble||

    I wish I could get cheap catastrophic coverage in my state but nope, it's a Cadillac plan or nothing around here.

  • Quo Usque Tandem||

    The "government and insurance cartel" will do anything to keep this from succeeding. They will claim that their system is more accountable, produces measurable "quality" and has the capacity to provide something like "seamless patient care delivery in a patient centered medical home" bullshit. It is to serve themselves alone, and provides greater control. It works for the government because they can intrusively manage it and justify their existence. This system cares about efficiency [see as many patients as you possibly can in a given hour/day/week/ month] and avoidance of liability [spend only as much time as necessary to avoid mistakes]. I work in health care and am employed by a amalgamation of hospital and insurance interests, but a system that is literally and not figuratively patient focused cannot be bad.

  • Bubba Jones||

    I work at a pharma that prides itself on being patient focused.

    It's not hard to figure out which of my coworkers actually know what that means.

  • Longtobefree||

    Next thing we know, some fool will put forth the notion that insurance is to cover UNEXPECTED financial losses!!

    One of the major obfuscations in this whole mess is conflating health insurance with health care itself. Two different things.

    All the mandated "free" stuff (aka routine medical care) is why no one can afford health care or health insurance.

  • JFree||

    That is complete CRAP. Routine medical care is almost never actually paid for by insurance. It is paid for via co-pays and annual deductibles. The reason health insurance costs are so high is because Americans insist that they and only they have the right to determine which specialists they will see and what those specialists will do - in the huge dollar items - and with insurance paying for it, Americans have absolutely no incentive to 'ration' their expensive medical treatment/utilization.

    It is the EXPENSIVE stuff that drives insurance prices higher here. Not the cheap routine stuff.

  • JFree||

    Just to give you an example:

    A decade ago, I ripped up my knee while skiing. A perfect example of UNEXPECTED medical expenses. I didn't have insurance at the time. If I had had insurance, I would have simply gotten ACL reconstruction surgery - paid my annual $1000 deductible and not given a shit that the remaining $20,000+ was passed on to others in the form of higher insurance costs.

    Since I didn't have insurance - and didn't have $20,000 either - I didn't have the surgery. It did mean a long rehab - and it took years before I was able to ramp my skiing back up. So I paid the price. The difference is YOU didn't pay 95% of the price that you would have had I had insurance.

  • frankania||

    You should have come to Mexico. I have been doing it since the 80's. Got a double cataract operation for $1400 including everything--even 2 hospital stays. Here you can see a real doctor for $2 in almost every town!

  • Diane Reynolds (Paul.)||

    To a Democrat, 'direct primary care' is a hate crime.

  • BestUsedCarSales||


    Abscess Drainage = FREE
    Ear wax removal = FREE
    Wart Treatment = MKT PRICE
    Abscess Drainage = FREE
    Ear wax removal = FREE
    Wart Treatment = MKT PRICE
    Mole removal/Skin biopsy* = $20
    Wound repair (stitches, glue) = $20
    Ingrown toenail removal = $20
    Joint Injection (steroid) = $20
    Splint = $20
    Cast = $20-40

    Man, seems like the Wart Treatment market needs to be better regulated to fight against this uncertainty.

  • JFree||

    Not being confused in public as the Wicked Witch from the Wizard of Oz - Priceless

  • Tionico||

    wart treatment USED to be about six bucks for twenty years' worth of wart removal. A small one ounce jar of acetylsalicylic acid will remove at least that many warts with a few skimpy applications.

    Trouble is, FDA decided the stupid public should no longer have access to that product. Its been gone for a long time now. So have ny warts, and I still have half the jar f the maguc bullet.

    By question is WHY do economical things that WORK get pulled off the market by the government hooh hahs that spend too much time in bed with big pharma? Another example....... used to get misereable hayfever each season. Lived in Canada, doc told me to run on down to Shopers Drug Mart and get a box of a product he named..... 30 caps cost me $3.05CDN. BEST antihistamine ever. Moved back to the states, could not find it. Regulated. Next visit to Canada I bought half a dozen boxes. Finally ran out, had to pay a doc for a full office visit ($135)JUST to have him scribble out a paper so I could go get more.... $12 for ten caps. (used to be $4 for 30 caps, identical drug and dose). SO... what I used to be able to do by and for myself for 4 bux a season now cost me $135 plus $24.

    Hi we're from the gummit, and WE're here to help. Begone, scoundrels!!

  • Curt2004||

    It's actually salicylic acid (Compound W), not acetylsalicylic acid which is just apirin.

  • Mike Laursen||

    I've been part of my family physician's care program for a couple of years now. I pay an up-front annual fee for all routine care. It's a nice setup.

    Unfortunately, he doesn't have enough enrollees to go exclusively this route. He still has to take insurance-based patients.

  • HillTown Trader||

    Finding these great programs or finding doctors who welcome and offer discounts for cash programs is very hard.

    The industry standard is still to keep patients or potential patients in the the dark about pricing and programs.

    We need to take the chains off of the healthcare providers by allowing them to post prices and share information.

  • Brandybuck||

    I would take that route if I could get coverage. But I'm just not rich enough to have to pay for insurance out of one pocket and then pay for independent non-insurance care out of the other. It's like send your kid to private school while still paying taxes to public schools.

    Sigh.

  • Fairbanks||

    Right up there with sending your kids to private school while paying taxes to public schools is having no kids and paying taxes to public schools.

  • Occam's Stubble||

    You'd rather kids from poor families not go to school and end up as illiterate criminals who support themselves by robbing you?

    We all get benefits from having an educated populace so we should be happy to tax ourselves to get it. That said, the government has no business running the schools, just paying for a basic education.

  • HillTown Trader||

    Consider that you might "be rich enough" if you stopped paying for other people's healthcare.

    Add up all the health insurance premiums you paid for in the past ten years, mark it up by the S&P earnings, minus your actual healthcare costs, and you might find that you would be richer NOT buying insurance.

  • Tionico||

    its worked for me for more than four decades. One year's premium for OhBummerTax is about four times what I've actually paid out of pocket for ALL my medical and health needs for that four plus decades. And that does not include any co-pays or deductibles I'd have to pay for OBT.

  • Ron||

    this system will work until the hospital are not allowed to allow private care doctors to see their patients while in the hospital. it will be the rule when the next democrat is president in 2020

  • EscherEnigma||

    I wonder what happens when one of his insurance-free patients gets cancer.

  • DirkT||

    That's why this sort of scheme has never worked anywhere in the world except an isolated clinic here and there in the USA ...

  • Diane Reynolds (Paul.)||

    They're thrown into the traditional system. I think the article was clear that this is just for routine care.

  • DirkT||

    Libertarians often tout this sort of system as a panacea ...

  • Diane Reynolds (Paul.)||

    We do?

  • Paloma||

    The advantage is that with inexpensive routine care, cancer would far more likely be spotted in the earlier stages, when it's both easier and cheaper to treat.

  • RenaD||

    Libertarians often tout this sort of system as a panacea ...

    No, they don't. As mentioned above, this is just for routine care. People can then buy catastrophic insurance plans to cover the big stuff. I had one before the ACA. It cost me $90 a month; all my routine care I paid for out of pocket, no problem.

  • MichaelL||

    This is what the costs should be. But, with the doctors charging $125/visit, seeing them a couple of times a year would not meet our present deductibles. My wife and I pay $4800/yr for $500 of care. I am not able to meet my deductible! So, in the same way, we are getting the same "catastrophic care" for a lot more/month. But, she gets visits for a copay. Catastrophic care should be much cheaper. A good portion of us will never use the catastrophic care. The older I get, the less likely I will be willing to get treatment for cancer, without results expected to have a high cure rate. Pancreatic cancer is probably a waste, at the present cure rate. And, we all will die! How we face death is as important as the way we face living.

  • Magnitogorsk||

    What if someone has an expensive chronic condition, why would any insurer sell them coverage? Or allow them to renew their coverage at any reasonable price if they develop a chronic condition mid-coverage period? This is the ultimate problem with healthcare - this is an element that does not exist in the market for any other good/service that I can think of.

  • Bubba Jones||

    For most "expensive chronic conditions" there is a treatment that is 80% as effective for 20% of the cost.

  • Occam's Stubble||

    Therein lies the problem. The purpose of insurance is to indemnify the policy holder against financial ruin. Government has turned health insurance into a prepayment plan. You likely pay a bigger chunk of your premium to cover annual physicals than you do to cover cancer.

  • EscherEnigma||

    From the article:

    The direct primary care movement is a way of opting out of an industry that's dominated by a cartel of hospital and insurance companies, thus [...]


    So I'm not sure it's unfair to say that's not the picture the article is trying to paint, even if it is the reality.

  • HillTown Trader||

    The insurance industry has sold the American public on the myth that everyone who drops insurance will immediately contract cancer. Its the "chicken little" sales tool.

    In reality, only 5% of people consume more healthcare costs then pay premiums every ear.

  • MichaelL||

    My mom had a cancer policy. Out of the $8500 my dad was owed, he received a $1500 check from a big "Mutual" company. They are a big scam! He paid on it for, at least, thirty-five years!

  • Paloma||

    That's what the catastrophic insurance is for.

  • jonnysage||

    Your catastrophic insurance pays for it. Like how disaster insurance pays when your house is demolished, but it doesnt pay to paint the front door.

  • EscherEnigma||

    So this bit in the article was a lie?

    The direct primary care movement is a way of opting out of an industry [...]


    A bunch of commentators are acting like this would be supplemental, but the article was pretty clear that it was an alternative.

  • Bubba Jones||

    It's an alternative to the low deductible health insurance plan.

    It might be cheaper to combine this with a high deductible employer plan than to purchase a low deductible plan.

  • Heraclitus||

    Sounds great, if you are relatively healthy. Not incl - specialists. And what happens when you get a disease or start the dying process?

    This libertarian dream fails to account for the other dream - that we make a social contract to take care of each other's health. Insurance and single-payer are designed to do just that. If we are fine allowing sick people to lose their jobs, go bankrupt or just plain die then this is a great model. But if you believe it is important to take care of each other then just paying subscriptions for primary care is not enough. To get to the next level you need a bureaucracy. But some bureaucracies are better than others. The ACA is no good. What we had before the ACA was no good either.

    How about if doctors were just employees and not small business owners? Something like the NIH model in England There will always be pressure to meet with more patients per day. That's capitalism. Name one industry where workers are not being pressured to squeeze more productivity out of the day? It's funny to see doctors complaining about that on a Libertarian website but there you go. If this model went widespread they would be forced to see more patients per day (unless they run boutique joints for the rich and famous). Under this model you would have discount doctors who offer crap service. They would advertise that they read your rash online but the low-budg ones would not get back to you in a timely manner or steer you into the brand that buys them lunch.

  • Diane Reynolds (Paul.)||

    Something like the NIH model in England There will always be pressure to meet with more patients per day.

    One thing you can say about the NHS model in England is they're definitely not pressured to meet with more patients per day.

  • JFree||

    The concierge type model for PC's is based on a slightly 'exclusive' or upscale clientele. Most of them are based on a 600 patient-base per doctor. But the reality worldwide is that that is only really 'exclusive'/'upscale' in the US - because the US only has 1 PC for every 3000 people (which is why patients feel like a rushed hamster when they go to their PC - because they ARE a rushed hamster here). So if every PC were to go to that system here, roughly 80% of the population would no longer have a primary care doctor available.

    In every other country, there are TONS more PC's per person:
    Australia and France have about 600 patients/PC. Most of the rest of the rich countries average about 1000 patients/PC. So there are enough PC's for healthy people to develop a relationship with a doctor who can KEEP them healthy and who the patient will trust when they do get sick - so those other countries don't incur all the damn expenses of sick patients wandering around blindly incurring MASSIVE medical bills from specialists who are rewarded handsomely and incented perversely in our fee-for-service system.

    The entire 'concierge' move is a symptom of PC shortages here - which is a direct consequence of a fucked up medical system here. And no - that does not mean a single-payer NHS is 'the solution'. There's a ton of different solutions - and 'single-payer' is one of the worst possible.

  • Bubba Jones||

    There is a much bigger gap between Specialist and GP pay in the US than in the UK. GP pay is about the same between countries, but specialists get a fat premium in the US.

    It makes no economic sense to be a GP when a 3 year fellowship gets you into a highly paid speciality. Even general hospitalists make twice as much as a GP.

  • JFree||

    That's all true. Problem is that means that our medical training system is what's at fault - and that dates back to the Flexner Report of 1910 (which was written at the behest of a guild (AMA) and a typical upper/middle class-oriented charity (Carnegie Foundation). That is when we began to diminish the role of the 'family doctor' (who was admittedly often poorly trained) and increase the role of the scientific specialist. Our reimbursement systems merely reinforced those changes a half-century later.

  • JFree||

    Oh - and 'GP's paid roughly the same across countries' while true means that those other places are recognizing the value of GPs. Since those GP's earn that same pay with a smaller patient base. So they can spend more time with each patient - and earn their trust and serve as a better 'gatekeeper'. Not surprisingly, it also means GP's can attract Type B personalities (people who also want a life outside work) and those personalities are generally better dealing with people.

  • jonnysage||

    When did we make that social contract? No one ever asked me or my state to pay for others states citizens healthcare. Or are you saying thats the liberal dream?

  • Tionico||

    reality check.. today's healthcare professionials spend more time dealing with records and paperwork and forms and insurance documents than they actuallly spend face to face with patients. I've had friends who are MD's........ one has had his patient load reduced to less than half what it was ten years ago, NOT by any particular decision but by the mandated time spent pushing paperwork to keep Uncle Stupid happy. Another had to hire a new fulltime worker JUST for paperwork (solo doc in private practice) and THEN had to move to a bigger office to have workspace for her!!! Over three years his office visit charge went from $35 to $135. He worked longer hours, had to cut out several classes of service that were high risk or labour intensive, and takes home far less in net salary than before this insane system we have today.

  • Bubba Jones||

    Specialists in the US make 50% more than specialists in the UK, Canada or France. That might have something to do with our healthcare spend.

    http://economix.blogs.nytimes......ries-make/

  • Occam's Stubble||

    You mean the NHS model that is murdering 130,000 elder patients per year? The one that won't lift a finger to save a premie if it's born too soon? The one that forces patients to sit in ambulances in the parking lot so the hospital administrator can meet his mandated service times?

    Yeah, that's some real tender, loving care they've got going there.

    Anybody who thinks that a government bureaucracy has the ability to care about you is a blind fool.

  • lap83||

    "Valued customers"

    Ugh. I can't even. What about the jerky patients with no money? Who will stand up for them?!?

  • Diane Reynolds (Paul.)||

    Obamacare.

  • HillTown Trader||

    I dumped my health insurance in 2006 -- and, yes, dear Virginia -- I was not struck with cancer the next day. The world did not come to an end.

    By investing my "premiums" month after month, I can cover just any any rare healthcare cost.

    85% of folks might as well be flushing their premiums down the toilet every year -- it all goes to pay for other people's care. 10% break even; 5% suck up all the costs. They just don't suck it out of my pocket.

  • RenaD||

    Last week I was informed my monthly premium for 2018 is doubling—$336 to $668. That's a little over $8,000 a year. If I drop my insurance and pay the tax penalty instead, that's about $1700. I estimate that I have about another $1500 a year's worth of routine visits, assuming I can find cash-only docs in my city (I'm currently calling around). That leaves me with $4,800 a year to invest exclusively for future health care costs. A MUCH better deal than tossing it all in the toilet.

  • Petie Cue||

    My husband and I have been living in Mexico for four months.

    In that time, between the two of us, we've had four primary care visits, a cardiologist visit, a rheumatologist visit, a nephrologist visit, five sets of comprehensive blood work, an MRI scan, a stress test, two EKGs, a mammogram, and a colonoscopy under sedation at a world-class hospital. We have all our doctors' personal cell phone numbers and e-mail addresses, and every lab and radiologist e-mailed us our reports the day after the tests were done.

    For all these services, we have spent less than we would have spent in the USA for two months of premiums on a Bronze Obamacare policy which would have 60% coverage after we met a combined $12,000 deductible.

    Why is high-quality medical care cheaper outside the USA? No surprise to Reason readers to learn that it's less regulated.

  • Uncle Jay||

    RE: These Doctors Got Fed Up With Insurance. Now They Treat Their Patients Like Valued Customers.
    The "direct primary care" movement is attracting physicians sick of red tape. And it's transforming the doctor-patient relationship.

    This must stop immediately.
    Red tape is the instrument to keep the masses in line.
    Besides, who in their right mind would want private healthcare with all the trappings of lower costs, doctor choice and better service than good ol' fashioned government healthcare with long lines, apathetic medical staff and inferior services?

  • JeremyR||

    There was a 1950s Sci-Fi author who wrote a parody of health insurance, only about car insurance that covered everything. The net result was basically identical to the health industry we have the in the US.

    I'll be damned if I can remember the name, but it was republished by Baen books.

  • DrZ||

    Another model is "cash-only surgical centers" which are proving that surgical procedures can be done much cheaper when cash is use and the insurance/government paperwork goes away.

    These centers provide, online, costs of each procedure.

    Example: https://surgerycenterok.com/

  • vek||

    My father went to a guy who specialized in cash patients in Vegas for a hernia surgery after he didn't like the way the docs in Seattle wanted to handle it. We paid half as much as it would have been here, and had a guy who had done THOUSANDS of hernia surgeries and was a total boss with the procedure. Often times you can save money by paying out of pocket for minor surgeries EVEN IF YOU HAVE INSURANCE, because these practitioners are so much more efficient. It's pretty ridiculous when you really let that sink in.

  • Paint Thinner||

    I clicked on wrist surgery and was quoted $4,300

    I had (broken) wrist surgery done on my insurance. Cost me $800 in a waaaaaaaaayy costlier state.

    How is that much cheaper? Granted, it was a rare incident, and all the years of paying for insurance could have been planned for ONE surgery and that would have been cheaper. But that is an argument against insurance, separate issue.

    Yours was supposedly the example of surgery costing less when paid directly.

  • vek||

    YOU might have only paid $800, but I bet your insurance company paid way more than $3,500 more for it. Bottom line is when you get rid of middle men, and just have people cut checks for services rendered, it costs less than having a third party involved and making a profit off of your payments for years and years.

    Also, you probably didn't shop around for any kind of a specialist type thing, you probably just compared two generic options. In my dads case IIRC he was quoted something like $16K for the surgery in Seattle, and ended up paying something like $7-8K at the specialist in Las Vegas. I'm not saying it would be that big a difference in every case, but cutting out middle men is always good.

  • vek||

    I don't understand how people don't intuitively get the whole medical issue.

    You pay for minor stuff out of pocket. If this is paid out of a tax advantaged HSA all the better, I think the HSA concept greatly improves the scenario versus how it was saaay 75 years ago. Then you get catastrophic care for when you're breaking down in old age or have something random happen.

    This saves everybody tons of money because less paperwork and fewer middle men. How does this not occur to every single person in the universe? It's not hard. If some people want to cover the poor, then just pay for their shit via Medicare or whatever nonsense. Ruining the free market portion of the market for people that CAN be responsible and pay is 95% of the problem with healthcare in the USA.

  • Lester224||

    Pay for the poor with a government program? Like the Medicaid expansion that is so maligned?

  • Paint Thinner||

    Yes, insurance. Pfft!

  • vek||

    Well, I'm saying as a REAL WORLD possibility that we should 100% deregulate the medical/insurance market. Let the market do its thing. This will obviously still leave some of the poorest and whatever without any care. So IF private charity doesn't take care of the problem (which is probably largely would, like it did in the past) THEN you have one single program that pays ONLY for completely broke losers.

    The way we have it now we ruined the market for EVERYBODY, which in fact makes it worse for EVERYBODY, in an attempt to make it affordable for people who can't afford it either way. If we let the market work and just doled out care for the truly destitute it would be far better than the mess we have now.

    It's kind of like how we dish out food stamps. The government didn't try to regulate the supermarket industry into manipulating markets where rich people pay more for care at the checkout so that poor people could walk in and take stuff for free... They just let Safeway do their thing, and kick them down a card to snag stuff from the free market. It's not libertarian, but it's the best way to handle it IF we want to do anything at all for the poor. I think it would work itself out with a real free market, but this method would shut the proggies up and allow the market to work better for everybody else too.

  • Occam's Stubble||

    My state spends $7,400 per year per Medicaid recipient. They could provide everyone in that program a catastrophic health care plan and $2,000 per year in a Flexible Spending Account. That would run about $3,500 per year. How many more poor people could be covered that way? Dump the single-payer Medicaid and cover more people.

  • Cloudbuster||

    The movement is great, but really disorganized. It's hard to find out if any physicians in my area are engaging in this type of practice.

  • Lester224||

    If I had to pay out-of-pocket for all the appointments for my dependents with health issues I couldn't afford it. We go over the limit even with an expensive plan. We're one of those families on the right side of the bell curve when it comes to costs. I better not lose my job. What we really need to do is make health care less expensive. Let nurse practitioners do more. Make room for more internships instead of controlling the supply of doctors (AMA BS). Incentivize results instead of the number of tests. Let us buy pharma from around the world so that the drug companies have to level the pricing instead of having the U.S. pay 5X what everyone else does. etc.

  • rageon||

    What a great idea! Doctors get rich and poor people die.

  • Paint Thinner||

    This has been the case for the longest time. Many physicians, for example, stopped accepting HMOs, and some started charging for filling out insurance forms and were always willing to deal with patients for direct fees.

    No one is stopping anyone from doing this.

    This is not where the healthcare costs kill you. Hospitalization or treatment of a serious malady.

    Insurance companies subsidize those costs by charging more for these visits and non-procedural visits/exams.

    But now that "Obamacare is finished, dead, not to be mentioned" things will be all better.

  • Longtobefree||

    Of course, when single payer is implemented by the democrats following the 2018 sweep of house and senate races, it will come to light that they are shocked, shocked to find out that there isn't enough money in the printing presses to pay for it.
    So the only solution will be to draft those arrogant independent doctors, and order them to staff 'public' clinics. Then it will be obvious that they can draft lots of other folks and make them technicians, billing clerks and the like.
    Behold! Now healthcare is again affordable because we can force people to work for wages we set, and force them to do the jobs we assign.
    What could possibly go wrong?

  • Vernon Depner||

    "...just having a direct primary care subscription disqualifies individuals from contributing to an HSA at all."

    Did anyone else find in the attached document where it says that? I couldn't find it.

  • nicmart||

    How many of these cowboy docs are willing to forsake the cartel that government licensing affords them, and the prescription drug laws that net them billions while abolishing the right to primary property right of self-ownership?

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  • buybuydandavis||

    But there are some changes to the tax code that could speed adoption. The IRS doesn't allow patients to use their tax-deductible Health Savings Accounts to pay direct primary care doctors. In fact, just having a direct primary care subscription disqualifies individuals from contributing to an HSA at all. Dr. Neu and others have been meeting with lawmakers and proposing legislation that would change this.

    This would be a big improvement. Level the playing field.

    But the real change needed is freedom. We need to be free to buy medicine and medical services from anyone we please. Then the medical mafia can't extract government enabled rent from us, and would actually have to deliver services we want if they wanted our money.

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