Health Care

These Doctors Exemplify the Virtues of Free Market Medicine

"Direct primary care is about as close to a free market in health care as you've ever seen in our country," says Dr. Lee Gross.

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The patients of doctors William Crouch and Lee Gross know exactly what services will cost before they receive them—a radical concept only in health care. They don't have to deal with benefit packages, coverage denials, hidden costs, in network vs. out of network, or any surprises whatsoever. Instead, their patients buy the medical equivalent of a Netflix subscription.

At $75 per month for adults, "We make it cheaper than a cell phone," says Dr. Gross. "If you can afford a cell phone, you can afford the most basic aspect of health care delivery in the United States."

Doctors Crouch and Gross are pioneers in a growing national movement called direct primary care. Tired of dealing with insurance companies when it comes to routine medical services, physicians around the country have exited the traditional system and are saying they can provide better care at a lower price by charging their patients a nominal monthly fee directly.

COVID-19 has pushed many doctors' offices, which have been hard hit by the pandemic, to start doing telemedicine for the first time. And insurance companies and the government have started paying them for this service—for now. But direct primary care practices have proven far more agile and responsive to the needs of patients. They're demonstrating that making American health care flexible and affordable requires abandoning the use of third-party insurance for routine care and adopting a market-based approach.

"Direct primary care is about as close to a free market in health care as you've ever seen in our country," says Dr. Gross, who also serves on the Florida Medical Association's Council on Medical Economics and Practice Innovation. "We have never tried a true marketplace in health care. We have competition, but we have competition in a price fixed system with very opaque prices."

Prior to adopting a direct primary care model, the pair ran their office as a traditional, fee-for-service practice, accepting insurance and Medicare. During that time, they became increasingly dissatisfied. Dr. Crouch says the traditional model was not always accessible to patients. "You kept seeing that people were being denied care. And a lot of it was cost-prohibitive. They were able to afford their insurance premiums, but then they couldn't afford the needed test."

Dr. Gross says that the bureaucratic strain of complying with Medicare rules became too much of a burden. "Every time I found a way [to] generate revenue to support this monstrosity that we were required to build, Medicare would knock the knees out from under us and take away that revenue source to where eventually we just said, you know what, no more."

Direct primary care practices are demonstrating that the routine health services covered by Medicare and insurance companies cost so little that most patients could easily afford them out of pocket. So how did this third-payer payer system develop?

The government created it through the tax system. During World War 2, the IRS started allowing employers to provide health insurance as a form of pre-tax compensation, but if employees purchased their own health care they had to use after-tax dollars. This led to a system in which insurance companies and large health care providers negotiate prices behind closed doors, leaving patients out of the mix.

"We've essentially disrupted that entire paradigm," Dr. Gross told Reason. "We've said, 'Let's have price transparency, let's show people what these services actually cost,' because they do have a dollar value. You can put a price tag on these things. We've proven that."

When Crouch and Gross converted to direct primary care in 2010, they estimate that there were fewer than a dozen practices using this model. Today there are approximately 1,400 independent Direct Primary Care practices in 49 states. Virtually all of them charge a subscription fee that's between $50 and $100 monthly to consult with the doctor at any time in-person or from home.

Crouch and Gross provide routine services like preventative check-ups, EKGs, minor procedures like biopsies, joint injections, the removal of cysts and small skin cancers, and some urgent care, such as sewing up lacerations and splinting uncomplicated fractures at no extra charge. In-office tests, like those for strep and pregnancy, are included as well. If a test needs to leave the office, patients pay cash prices that Gross and Crouch have negotiated on their behalf. Dr. Gross says that cutting out the third parties between diagnostics laboratories and patients has resulted in discounted rates of around 95 percent.

Not only does this model result in lower prices, but the COVID-19 pandemic has shown that direct primary care is more flexible as well. According to a survey conducted in July, 78 percent of physicians had seen a decline in patient volume because of COVID-19. In March, the Center for Medicare and Medicaid Services issued a temporary waiver stating that Medicare would pay the same rate for certain kinds of video telemedicine visits as in-person ones. But the types of visits it would cover changed over the course of the year and are still changing.

Whether insurance companies and the government continue covering online visits after the pandemic has no bearing on Crouch and Gross. And they didn't have to wait for insurance companies and the government to OK telemedicine in the first place.

"We didn't need to wait for BlueCross to convene a committee to pay for telemedicine services," Gross says. "I didn't need to wait two months or three months for Medicare to create a new billing code in order for me to provide technology visits for a patient…Instantly from 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."

Gross adds that "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. And so now the model is, again, pandemic tested. It's proven that it's actually a superior model because we have the built-in flexibility to do what we need at the time we need it."

Thirty-two states and D.C. have passed laws requiring insurance companies to reimburse doctors at the same rate for telemedicine visits as they do for comparable in-person visits. Dr. Gross says that shouldn't be decided by lobbyists, lawmakers, or government administrators. Prices should be set through market competition.

"The myth is that profit by its mere definition does not belong in the American health care system. And it's evil and creates perverse incentives…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 costs, but adds no value."

Produced by John Osterhoudt. Production support from Regan Taylor and Ian Keyser.

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  1. Subverting the functionality of a government administered program? Well, that sounds an awful lot like insurrection to me.

    1. Too many healthcare options will confuse people and cause them to choose a doctor that will kill them. Nobody needs more than one option for healthcare.

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    2. Insurrection against the Nazi Regime pushing to take over the USA.

    3. Exactly-look for the fat pigs at health insurance companies squash these two doctors like an ant. The same way accountants have prevented any meaningful tax reform.

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  2. The whole problem, as I’ve said for years, is the third party payer. Government as the third party is bad, and private insurance as the third party is bad. I don’t understand why so many “market” types insist on keeping the employer funded medical insurance system.

    Yes, we need medical insurance. But not for routine care. Our auto insurance doesn’t cover oil changes, our home insurance doesn’t cover painting. So why does our medical insurance cover routine services like colonoscopies? It doesn’t mean colonoscopies are bad, just that it’s not insurance that should cover them.

    Reserve insurance for CATASTROPHIC problems. I’m not that old, but I recall an early job where I had catastrophic insurance for $5.95 a month (the boss paid the other $5.95). That’s affordable by anyone. Now my “essential” medical insurance is upwards of several hundred dollars a month. (I’m now with an HMO with smooths things out, but isn’t any cheaper in the long run).

    But even for the government to directly fund catastrophic insurance is bad, because it eliminates the market and prices will skyrocket because there will be no forces keeping them low.

    Instead, fully privatize health care. Poor people will still be poor, so provide means tested insurance premium vouchers. Any government money needs to go directly to the medical consumer, not the hospital behemoths. Not anarchism, but good enough to get out from under this mess. We can argue over anarchism when we’ve shrunk government down enough it will fit back into its leash.

    The problem is how to get out of the system we’re in. Dumping it all overnight might appeal to some, but it only creates the kind of chaos that will backfire causing even more government than before.

    One first step is to get out of the way of this direct primary care medicine. Legalize it everywhere. Remove the barricades. Then we fix the medicare/medicaid pricing scheme, and give insurance vouchers for the poor so they can participate too. Decouple employment from health care by letting everyone buy healthcare with pre-tax dollars. No need for health savings accounts when any old bank account (or mattress) will do.

    I work in the medical industry, in the R&D side. And it’s fucking nuts. The FDA is a joke, Medicare is a joke, the whole insurance scheme is a joke, hospitals are a joke. It’s all just a giant pile of bureaucracy. And the only thing the Democrats and Republicans can offer as a solution is more layers of bureaucracy.

    1. My belief is that the expectation of third-party payer has been baked into US health care since practitioners first drew inspiration from the German and British health systems in the late 1800’s.

      Those two countries were leaders in using accreditation and education to professionalize medicine. By doing so, that also made doctor’s visits more expensive than the average laborer could afford. But Socialism, so the designers of those health systems didn’t particularly worry about that bug.

      Rubber-stamping that system onto the US created relentless pressure for public funding.

      1. since practitioners first drew inspiration from the German and British health systems in the late 1800’s. By doing so, that also made doctor’s visits more expensive than the average laborer could afford. But Socialism, so the designers of those health systems didn’t particularly worry about that bug.

        They may have drawn inspiration from German medical training. But the rest of that is total ideological crap. The Flexner Report of 1910 was funded by Carnegie and Rockefeller when they were by then in their 70’s and becoming interested in preventing/delaying their own death. THEY were the ones who didn’t give a shit about ‘primary care’ anymore since they had had a primary care doctor for their entire life. That orange had been squeezed already. They did care about a medical care system that vetted the skills of specialists.

        They did so by restricting the pipeline of new doctors – leading to the closure of over half of medical schools in the following years and the state taking over credentialing. And by eliminating the main channel of doctors-in-the-hospital setting. So that in personally funding those hospitals, the ‘philanthropists’ could ensure that those specialists would get a ton of practice on rats and peasants. Ready for the day when a Rockefeller/Carnegie would be able to be wheeled in with ‘the best’ available for them. Which certainly isn’t socialism but it can work – with a donor class that actually covers those hospital costs.

        What changed is that the donor class decided they didn’t need to fund that stuff once it was already in place. That the rats/peasants should pay their own way for a system that was structured for Carnegie/Rockefeller.

        1. eliminating the alternative to main medical channel of doctor-in-hospital-setting.

          Basically there are many ways medical can be delivered in a particular geography. Most countries deliver most medical care through a doctor’s office or a small clinic. And hospitals themselves tend to specialize for tertiary care rather than all of them having all the diagnostic equipment and treatment for everything.

      2. The US mutual aid societies covered medical care and health insurance quite well with privately-contracted doctors until the AMA colluded with the government to make it illegal. The motives were the same as for plumbing codes, building codes, occupational licensing, minimum wage laws, and every other intrusion by the government into private life: cronies making sweetheart deals to get the government to restrict the labor supply and raise wages for those lucky few who remained in business.

        1. The US mutual aid societies covered medical care and health insurance quite well with privately-contracted doctors until the AMA colluded with the government to make it illegal.

          No they didn’t. And in fact it was the 1918 flu epidemic which proved fatal for that model. The major reason that the death total was so high – and is still actually unknown/estimated – is because when the hospitals began to get close to filling up (Oct 1918 and Jan 1919), patients were sent home to die (and infect their family). Churches realized honestly they could not deal with an actual epidemic. Donor-type ‘charity’ hospitals had no interest in mixing charity cases with themselves when it involved contagion.

          That marked the beginning of a huge ramp up in constructing municipal hospitals that continued even through the Depression. And by the beginning of the whole employer/tax stuff – it was muni hospitals that were filled to capacity with patients and charity hospitals that were near vacant.

          Indeed one might be cynical that the real reason for the employer now receiving a tax deduction for a corporate insurance plan was because the donor class found it better to get increased charitable deductions via the company they controlled instead of the construction budget of the hospital they named.

          1. Actual medical insurance didn’t exist until Kaiser set his up in isolated company towns in the 1930’s and until the Blues set theirs up in the same time frame. In both cases, that model did not apply to the majority of medical care in either an office setting (no insurance) or hospital (funded via muni taxes)

            1. If you think the mutual aid societies were not insurance schemes, you apparently don’t understand premiums as a bet vs specific pay for specific treatment.

              1. If you think life insurance is health insurance, then you’re just plain stupid. Nor is health insurance medical care. It is church denominations that built and funded most early hospitals – as is obvious from their names today. Doctor groups were second most prevalent then. Mutual benefit societies are almost completely absent.

                Bluntly – libertarians who yap about generic charity solving this that or the other don’t know shit about anything. And never personally participate in anything charitable. They are almost universally assholes on a personal level and that yapping is nothing but dishonest deflection that ‘someone else will solve this’. With ‘history’ that is pure blowhard bullshit through and through.

                Identical sort of personal abdication that leads to other people choosing to abdicate responsibility to government. Except that is at least honest where the libertarian sort is completely dishonest.

                1. Fuck off magic wand retard with your “muh governments can magically fix things”. You’re just saying you want to steal from people to give to others. It’s still theft and coercion regardless of how morally superior you feel about the outcome of an immoral action.

                  Theft is bad, and no one is entitled to anything, but keep believing in your faith, the state.

          2. Wrong and wrong. The AMA colluded with the government long before the 1918 flu epidemic.

            Do you understand timelines?

            And the 1918 flu was so bad because trench warfare, like the lockdowns today, isolated the mild cases and exported the serious cases to the transport system, hospitals, and convalescent care, thus telling Darwin to produce more of the successful lethal variant and let the more harmless variant die out.

            Do you even evolution?

      3. Rubbish. Medical accreditation is not more socialist than any other accreditation. People want to make sure that doctors know how to doctor, so they look towards PRIVATE accreditation of school as one means.

        That professional associations frequently lobby governments for special treatment is NOT socialism. It’s wrong, but it’s not socialism. Get a fucking dictionary. Also, it’s ALL professional associations, not just doctors and medical schools. Show us on this anatomically correct doll just where the doctor touched you.

        We didn’t get the third party payer program until WWI, more than fifty years after your claim.

        1. If you were responding to me, read again. I said nothing about socialism. I mentioned cronies. If your knee jerk reaction to mention of cronies is to defend socialism, I guess you proved the point you think I was trying to make.

    2. I’m not that old, but I recall an early job where I had catastrophic insurance for $5.95 a month (the boss paid the other $5.95). That’s affordable by anyone.

      Isn’t affordable anymore. My insurance has a $10K deductible and costs me a hundred bucks a week. I have no idea what my employer pays.

      1. If it is single coverage, probably a bit more than you pay. If family, 3x what you pay

        1. It’s family. Me and my daughter. It’s ridiculous that I have to pay the same as someone with eight kids.

          1. If you are paying full family look into parent plus child coverage or 1 + 1. Some insurance companies have that tier for partner/single parent insured coverage. I had that after divorce for me plus one child.

      2. Mine costs around $350 a month, with zero deductible because it’s an HMO. Instead I pay $20 for each visit to the doctor or hospital.

        But you’re not too far out of line. It’s high, higher than what I’ve seen my my pricey home state of Kalifornia, but still within the ballpark.

        It’s NOT the kind of plan any working poor could have. Enter Obamacare where you get fined if you don’t buy one. Then imprisoned if you don’t pay the fine. A plan that exists just to make Democrats feel smug about themselves.

      3. “Isn’t affordable anymore. My insurance has …..”

        But you’re mixing Apples vs. Oranges
        catastrophic insurance vs. comprehensive health insurance

  3. Any government money needs to go directly to the medical consumer

    This, always, and always. This solves 95% of subsidy problems.

    1. Commie-Money = Stolen Money.l

    2. Yup. I don’t like welfare, but I can’t help but notice that food stamps (ei. food vouchers) aren’t fucking up the grocery industry like government micromanagement of education and health care have. Also better to give aid (regardless of whether public or private) directly to the recipient rather than to a third party.

      1. You need to get up to speed on food stamps. Rent seekers like Pepsi/Frito-Lay (one of many) literally spend millions to make sure their products are included in what can be purchased with food stamps. Not to mention the govt employees who support pols who pass laws so the govt employees can make up rules about just what products can be purchased using food stamps.

        Not sure how the numbers turn out (and I hate the idea of UBI) but it might be cheaper to get rid of food stamps, unemployment insurance, WIC, and who knows how many other govt programs and all the govt employees who work in those programs and simply give money directly to peeps. It was painful for me to write this.

      2. So we need common sense grocery stor accredidation

  4. Oh FFS.

    85-90% of the DOCTORS in the US are specialists not primary care. If they were to switch, their income would drop by a lot.

    It is specialists who cannot structure anything on some weekly premium. Prepay a heart bypass for 15 years via monthly installments? It is specialists who have no incentive to prevent the unhealthiness that leads to heart bypass – and indeed have a direct incentive to encourage unhealthiness.

    This ain’t government’s fault. It is the nature of modern medical care. Understood in one sense at least since 1912 with the Flexner Report which structured medical training since then to meet the needs of the Carnegies and Rockefellers.

    I really like the idea of PCP’s being the true primary care medical supplier. And that can be a the basis of a true market solution. But only if ‘insurance’ for the catastrophic risks is a responsibility of those primary care doctors rather than their patients. Insurance is about risk management and that’s the whole point of having a primary care doctor. Who understands when secondary and tertiary care doctors are helpful to delivering medical care to the patient. And who understands medicine enough to know if the price for say a heart bypass done by WeIsBest Heart is worth it compared to one done by JackdaRipper Bait and Tackle Shop.

    1. Funny, these specialists seem to have it nailed down.

      1. Oh really? I can put together a website with price tags. And I’m good enough to ensure that my website will also be the one recommended by Dr Google.

        People like you who think this is the solution don’t actually ever go to specialists much. The young don’t need or use specialists much. And when you do, you are oblivious of costs or ‘insurance’ or trying to assess quality/outcomes/etc because it is all handled by your employer.

        1. 1. Tell it to the wound care specialist and hematologist that treated me back in November. Or my neurologist. Or my DME vendor.
          2. I’m not young.
          3. I have a deductible, and I am very much aware of what my costs are.

          Try taking some ownership of yourself. And don’t be so fucking stupid.

          1. There is nothing ‘stupid’ about pretending that much of medical care is NOT something that can likely come out-of-pocket for most people.

            The bottom 50% of Americans have far far less accumulated lifetime wealth than is spent each year on healthcare. From Federal Reserve
            Wealth of bottom 50% of households:
            1989 – $760 billion – $6080 average/peep
            1999 – $1360 billion – $9780 average/peep
            2009 – $400 billion – $2614 average/peep
            2019 – $1888 billion – $11,470 average/peep

            Healthcare spending annual – roughly $3600 billion. The DEDUCTIBLE for many ‘cheap’ insurance plans – $10,000 equals roughly the entire net worth for that supposed target market.

            1. “much of medical care is NOT something that can likely come out-of-pocket for most people”

              There aren’t credit cards? Interesting.

              Remember, one of the few things government is good at is making things more expensive.

      2. I know about them. So they built an outpatient surgery center. They do not have overnight facilities so limited to same day procedures. You go to a hotel and a nurse checks on you.

        They may have a niche but how many people are going to fly to Oklahoma and pay that out of pocket?

  5. I had a minor surgery last year. Took all of 45 minutes. Cost over $26K. Around three grand went to the doctor and the anesthesiologist. The rest went to the hospital to pay for the operating room.

    1. I’m surprised your doctors prescribed a circumcision at your age.

      1. The service was good so he left a tip.

  6. It is nothing new.

    What they are doing is concierge primary care. They are doing what insurance companies basically do but limited to primary care.

    You still need insurance.

    Thing is if you cut out Medicare you are losing a big part of your potential patient base.

    A lot of urgent care or telemedicine works this way.

    Blue Cross started out when someone at a Texas hospital approached a group of teachers and offered any service they provided in exchange for a monthly fee.

    1. Good Points.

    2. Yep. There’s a place near here that does that. They wanted about $800/year on top of what we pay for insurance. We rarely even need to see the doctor so that would be about $800/visit. Not a great deal.

  7. While I like idea of this medical practice, I wonder how practical it would be on a large scale. Can this practice really handle a patient with a serious medical condition? What about a person with hard to control diabetes or other chronic condition?

    I also wonder about the idea of removing third parties. It is true third parties add cost, but it also true that third parties are likely added to save the doctor time. These doctors have a limited practice. Would their idea for working directly with testing labs and pharmacies work when more complex tests and medicines are needed?

    My point here is this is a great idea and should be part of the mix of health care options. I don’t think it will ever be a large part.

    1. The problem with the third party payer system is that there’s little incentive to keep costs down. If car insurance covered oil changes they’d likely cost twice as much.

      The damage is already done. I don’t know how to reverse it.

      1. There is some incentive. The hospital can put the charges at whatever they want but it is not nearly what they collect. They have to negotiate with insurance companies and deal with Medicare and Medicaid. There are not at all unlimited funds.

        It is true that the introduction of insurance resulted in a boom in medicine. It resulted in much higher quality, technology, availability, and staffing. But these are things people want.

        They are also competing with other hospitals for patients and staff.

    2. They don’t eliminate your need for insurance. You are paying them on top of that and a hefty monthly fee. How often do you need to see the doctor? What most of us have insurance for is for.the big stuff. Actually I think it is kind of a ripoff.

      You are basically paying up front for basic care that offers little more than you can get in a Walgreens clinic.

    3. It could easily be the core part of the mix of health care options – but not in the US.

      In places like Australia and France even Netherlands, PCP’s are a large % of most doctors. So basically they can imagine or revision a medical system where the PCP does the medical care for 70-80% of the total delivery and then is paid somehow someway for the gatekeeping to the expensive specialist 20-30% of delivery. Enough PCP’s so the gatekeeping is based on building trust/relationship with patient – rather than the gatekeeping based on some bureaucratic/insurance claims shit.

      Can’t happen here because the PCP are in huge shortage. The PCP model here is hamster on a wheel for 20 minutes appointment. The concierge model can work for some people who can afford to break the hamster model. But many people can’t even get an appointment with a PCP. And there are no clinics. So peeps go to the ER and get diverted into that racket.

  8. In my city we have a cash only surgical center that’s so busy they’re building another one. They do most things at a tenth the cost of a hospital. It’s very popular with Canadians.

    1. They have those in Mexico and other places as well and Americans go to those.

      Also dental.

  9. This will never work because it’s so different from the current medical system that it blows my mind.

  10. I use my cell phone every day.

    These guys are charging $900 a year for something you may never, or rarely need. Clever.

    1. It’s still less than what the other guy selling you something you may never, or rarely, need sells it for.

      So…what? You don’t go to the Doctor at least once a year? Sounds like you don’t need to pay either of the two people selling you something you won’t use.

      And yet…something tells me you do pay for one of them assuming you have a job. Unless, of course, you’re telling me you’re a scofflaw since that would be illegal.

  11. This is actually pretty brilliant in a lot of ways since it cuts a lot of costs for MD which they can then pass on to their customers.

    Hospital administrative bloat is a well known cost of big system healthcare, but the malpractice insulation and red tape makes it hard for a lot of MD’s to justify a private practice they actually control.

    Just getting medicare and medicaid out of their practice no doubt saves them a lot.

    And just as a reminder, the only reason employer based health insurance is a thing is because the government experimented with wage controls. Don’t be stupid and think that’s a good idea to try again.

  12. Drs should start publishing pricing sheets for their most common procedures and compare them against insurance prices (including assumptions for insurance deductibles and premiums). It’s as complicated as comparing phone plans, but at it might spur the creation of a real health-care market.

  13. My Dad was a medical doctor and the primary reason I chose to go in a different direction professionally.

    He ran a private practice and had one RN to assist him. He also had a clerk/receptionist who did more paperwork than receptioning. My Mom also worked over 40 hours a week in the office as an accountant and bill collector. My Dad often claimed he spent more time on paperwork than ‘saving lives and stamping out disease’. When he retired he sold his uncollected bills to a collection agency and over $US5,000,000 turned in to less than $US400,000. One of his biggest gripes was that Medicare reimbursed less for lab tests he sent out than the labs charged him for the results. Not to mention some govt rule that he had to take a certain percent of Medicare/Medicaid patients.

    Moving on to the macro level the first thing to do is address the supply and demand issue. The first rule of economics is demand will always exceed supply in this area. At one level I get the idea that needing things like an undergrad degree in biology/chem/what ever excludes lots of folks from med school. Med school itself is no walk in the park and some peeps simply don’t have the horsepower to be a medical doctor. The bottom line is there are simply not enough doctors to deal with the number of patients. Don’t get me started on RNs who are leaving the profession at an alarming rate.

    The reality is that health care is (always has been and always will be) rationed (same for all goods and services). Rationing is done either by price or time. Those who can afford the price go to the head of the line and those who can’t spend time waiting in line; even if the waiting can be fatal.

    1. Written right into Obamacare is a provision for an insurance company to have premiums that add up to 25% to the cost of every medical procedure.

    2. Wrong. Supply always equals demand if the price is negotiable in a free market. There’s no free market if the supply of docs is controlled by the AMA.

  14. Written right into Obamacare is a provision for an insurance company to have premiums that add up to 25% to the cost of every medical procedure.

  15. Wrong. Supply always equals demand if the price is negotiable in a free market. There’s no free market if the supply of docs is controlled by the AMA.

    1. Only about 10% of docs even belong to the AMA. The journal is decent.

  16. This is how it worked when I was a kid in the 50s. At some point my parents got “major medical” insurance to cover hospitalization. Worked then and my parents were at the bottom of the economicpile

      1. Smooth ace_m82…it is hard to choose. I hadn’t read that one in while – Thanks. So many ways to say, healthcare is not magic fairy dust, too big to fail, but this time its different, etc…

  17. Thanks for this great information, I really appreciate So much

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