The healthcare system is a racket — direct primary care could fix it

Everyone has a healthcare horror story.

A hidden charge on the hospital bill. A last minute test or scan that ends up costing four figures. Hours spent on the phone with insurance companies to follow up on a claim and get a reimbursement. Prescriptions costing hundreds of dollars.

And it’s getting more expensive.

Since 2007, the cost of healthcare has risen 21.6 percent, while all other prices in the economy have risen by just 17.3 percent, according to the Kaiser Family Foundation.

It’s become an unfortunate reality for many, and it’s been rightly pushed into the arena of politics.

But despite the well-intended reforms of the past two decades, including the Affordable Care Act, millions are still feeling the pinch. Why?

Too often, talk of healthcare reform is focused on insurance rather than care. It’s less about how the doctor treats your family and more about who foots the bill. Almost no one can get a straight answer about the price of procedures or medicines.

Medical insurance, once a simple way to cover higher-than-normal expenses, has become a catch-all for almost all health spending. It’s no longer about surprise injuries and illnesses. Insurance is now used to cover every ache, pain, anxiety, pill, and more. It’s like using car insurance to cover every oil change, new windshield wiper, or tire.

And in order to recoup the amount they give out, insurance companies must price their options accordingly, which leads to higher prices for consumers. That’s why healthcare expenses in 2016 amounted to 17.8 percent of GDP, higher than any other industrialized country.

At least one new doctor-patient arrangement is promising a revolution in consumer choice by bypassing insurance altogether. It’s called direct primary care, and it’s catching on across the country.

Rather than relying on insurance for ordinary health expenses, these new doctor clinics rely on monthly fees from patients, usually less than $100.

If anything more is required during doctor visits, the prices for every service and test are transparent and don’t vary depending on your plan. By not accepting insurance of any type, each clinic saves on administrative costs and overhead, prioritizing patients over costly insurers.

The results are just as intended: lower costs, more preventive care, and more face time with medical professionals.

I first learned about direct primary care when searching for a new doctor that would be flexible and affordable for my situation.

Luckily enough, I found one within driving distance in Charlotte, N.C., after consulting the map maintained by DPC Frontier, an online resource for direct primary care patients.

After one quick phone call, the physical was scheduled. Because the doctor wasn’t rushed to see dozens of patients, thanks to the monthly subscription model he maintains for patients, he took his time and answered every question I had. In case I needed to have anything more done, the prices for procedures, tests, and more were clearly published on his website.

Then, the bill for the simple visit was paid before I left. There was no insurance follow-up, no co-pay, and no need to file any additional paperwork. It was as if I was paying the doctor for providing the service directly, rather than the dozens of middlemen required in the current insurance racket.

But this was just a simple doctor’s visit. What would happen if I had a serious injury or disease?

Here’s what my doctor recommended: Take out a high-deductible health insurance policy intended for disasters and emergencies, and sign-up for a monthly direct primary care plan. That way, you’re covered in extreme circumstances with the high-deductible plan, but can also have preventive care with the doctor’s visits at the direct primary care clinic.

Seeing that in action was indeed refreshing. As a patient, I was empowered to own and control my own healthcare spending. And as a doctor, he was freed from bureaucracy to focus on his patients.

Whether direct primary care will be the answer to all problems remains to be seen.

Of course, chronic ailments and complicated procedures will still be of concern. Those who cannot afford the monthly fees may not be able to participate. But there is at least some momentum to open up this type of patient-doctor relationship to everyone.

For people with health savings accounts offered by employers, a bill passed by the House over the summer would allow account holders to use their health accounts on direct primary care subscriptions. It currently awaits a vote in the Senate.

A similar bill sits in the House Ways and Means Committee, presumably waiting for Congress to return from campaigning in their home districts to move it forward.

If our politicians want to try to reform healthcare, the answer may lie in empowering patients and doctors to contract on their own.

Considering there is a nationwide movement of doctors looking to free themselves from insurers, and endorsements from organizations such as the American Academy of Family Physicians, it’s worth taking another look at direct primary care.

Yaël Ossowski is an economic journalist and deputy director of the Consumer Choice Center based in Washington, D.C.

Published on Washington Examiner

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