My motivation for starting this blog is a passionately held view that medical care in the U.S. desperately needs a change of direction. I believe health care needs to be RESTORED closer to the way it was prior to the advent of Medicare and third-party domination. The bandaid “reforms” that have been passed into law over the past 20 years are not getting the job done; they have actually perpetuated the worst characteristics of the current system. All the “reforms” including the PPACA have focused on the wrong thing: they have focused on coverage and ignored the real cost drivers. While well intended, ObamaCare (ACA) just doubled-down on the dysfunction because it failed to focus on the fundamental problem: The real cost drivers.
After working in primary care and urgent care for more 25 years, I became convinced that change could not be affected from working WITHIN the system. With every passing year, things seemed to get more complicated for doctors and patients. Some colleagues and patients would speak out and some just shrugged their shoulders, but virtually no one thought it was getting any easier to navigate the increasingly complex, confusing and frustrating system of third-party networks; including Medicare.
I came to the conclusion that I had to find a way to extract myself from this bureaucratically-centered frustrating system. Indeed, I had become a de facto employee and glorified gate-keeper/bill collector for the third-party payers, as opposed to working directly and solely for my patient’s best interest. I felt frustrated and knew I had to do something. I decided to put my money & time where my mouth is! So, in January of 2013 I started the planning stages of a third-party-free, Direct-Pay medical practice specializing in house calls and telemedicine where my fees are affordable on their own and I work directly for the patient. I am now taking care of patients on my terms with shared decision making with the only stakeholder that matters: The patient!
The changes needed to restore our healthcare system won’t happen in a vacuum. That is why this blog also emphasizes and promotes the importance of returning to a true free-market based economy (not the crony capitalism that is so prevalent in the U.S today which is used by politicians to play favorites and pick winners and losers) and achieving a sustainable national fiscal policy.
I believe we need a fundamental shift in the way we deliver and pay for routine medical care. If we continue the path we’re on, EVERYONE will lose. This is not a partisan political issue for me. It is one derived from careful experience-based observation for many years of trying to do the right thing for patients, while being beholden to payer contracts and bureaucratic priorities that were often in deference to the patient’s best interests.
Below is a list of 10 fundamental professional & economic beliefs that I embrace related to the relationship between a physician & patient and the role of insurance. I am sorry to say that most, if not all, of these principles are not operational in the third-party dominated healthcare market of today. I believe we should work towards restoring these principles to preserve a really precious thing: the sanctity, privacy and respect of the Patient-Doctor Relationship:
I am convinced…
…of the sovereignty and good judgment of the individual patient to seek care as they see fit at a transparent price and in the absence of insurance network constraints.
- …that quality medical care starts with an unencumbered Doctor-Patient relationship.
- …a doctor serves their patient’s needs better if they work directly for the patient, and not within the constraints, mandates or barriers of a provider contract with a third party.
- …that only by creating free-agents of both physicians and patients will we bring together the stakeholders for a meaningful exchange of value, thus substantially lowering medical costs in the outpatient arena.
- …that the main driver of health care costs in the outpatient arena is not malpractice costs, but rather expensive third party pre-paid policies that utilize “first dollar” benefits for virtually any physician interaction, regardless of how minor.
- …to gain control of spiraling medical costs in the U.S, health “coverage” needs to become a true “insurance” policy such that it only insures unexpected losses that we otherwise couldn’t afford on our own.
- …that health insurance works best when it is portable, personal, private and not linked to employment, nor zoned by networks. This approach would allow insurance policies to be tailored to individual needs, cut down on the number of uninsured due to job changes and other life events, thus obviating the need for expensive COBRA coverage.
- …that the true costs of medical care is much lower than that reflected by the cost of a co-pay based health coverage policies offered in the workplace today.
- …only by creating free agent of physicians and patients will the economic forces of supply and demand exert their desired effect, thus determining fair market value of routine medical services.
- …that better informed consumers make better patients and unrestricted patients make better consumers.
Robert Nelson, MD