Since PPOs make their revenues off access fees with absolutely no responsibility to screen claims for accuracy and since their market value is directly tied to the number of physicians and facilities they have inside their networks, employers and their administrative payers’ demands for transparency have gone unmet over the last decade. This has led to the significant movement to eliminate PPO arrangements altogether as they not only provide no real value to the healthcare equation but in many cases promote a negative value. This is the efficient market theory at work, all elements within a market that do not add value to the overall market will eventually be eliminated.
“Just as health insurance is not health care, so too health insurance reform is not health care reform. Yet, because the ACA got so much press, and many previously uninsured individuals did secure insurance (giving us all the warm and fuzzies), the result was a nationwide misconception that affordable insurance equates with affordable health care. For many, ObamaCare is therefore viewed as a success because millions of uninsured Americans are now insured.
One of the best pieces I’ve read that exposes the real cost drivers in healthcare. Many of us have been shouting from the rooftops that the “villains” we implicate are just symptoms of a more fundamental poison in that is embedded in our third-party billing system and the cartel-like system it has created. Thanks to Dave Chase for putting the pieces together so clearly. Given the realities exposed here, we can no longer implicate something that has been virtually wholly absent from the healthcare economy which could have prevented this generational theft: A free market.
The Sovereign Patient
Mike Dendy: I hear the talking heads on business TV (like CNBC) talk about stagnation of incomes for the middle class. Wrong. The additional money is there every year, it’s just going into a pool to pay for healthcare instead of into the pockets of the employees in the form of salary increases.
Americans overpay for healthcare by at least 30% and likely 50% in aggregate. For all intents and purposes, every employer in America gives every covered member on their healthcare plan a blank check every year and says….consume all the healthcare you want, anywhere you want, anytime you want, and never be concerned with or ask the price because it’s all paid for. Deductibles and co-pays are irrelevant, especially to hospitals, because pricing is so high it becomes somewhat immaterial.
Trillions Have Been Redistributed from the American Workforce to the Healthcare Industry Creating An Economic Depression for the Middle Class The Washington Post and Vox have done excellent reporting that shows U.S. spends so much more than other countries for one simple reason — price. The good news is that some […]
1.“Insurance is not necessary for all healthcare.”
2.“Not all healthcare is expensive.”
3.”Employers can use Direct Primary Care to lower healthcare costs.”
Healthcare is the only field where insurance is not only used for rare events, but also common and frequent events. However, “insurance is not necessary for all healthcare”.
To reduce frequency of claims, a large segment of medical care has to be affordable to render insurance unnecessary. Thankfully, “not all healthcare is expensive.”This is where Direct Primary Care makes its grand entrance.
Direct Primary Care takes this majority of healthcare, and caps the cost into an affordable, manageable, flat monthly fee, typically less than $90 per month. As a result, insurance use (and cost) is minimized to rare occurrences.“Employers can use Direct Primary Care to lower healthcare costs.”
I just returned from the Mississippi Academy of Family Practice’s one day Direct Primary Care (DPC) event in Jackson, MS. Pretty impressive I must say. Truly a new breed of physician is emerging that if welcomed, properly supported, and given the opportunity can drive meaningful and valuable healthcare reform and transformation in communities throughout the United States.
Riding in to rescue the victims of Obamacare and other government healthcare schemes are guess who? The legislators? The regulators? Don’t make me laugh. It is the growing group of healthcare free marketeers. The celebration following the receipt of an Obamacare insurance card or qualifying for Medicaid is short-lived once patients realize that “coverage doesn’t mean care,” as my friend Dr. Jane Orient has famously said.
Leading the way on the primary care front are Atlas MD (http://atlas.md/wichita/), Epiphany Health (http://www.epiphanyhealth.net/) and Medlion (http://www.medlion.com/). I apologize if I have left anyone out and this is likely as more are entering this space even as I write this. These are all primary care subscription programs where a patient or family pays a small amount each month to cover their primary care needs. When I say small, I mean less than what it costs to administer Medicaid primary care needs, or as my friend, Dr. Lee Gross (founder of Epiphany) has said, “…less than a cell phone bill each month.”
Take a look at the above websites for a glimpse at what the subscription fee includes. Keep in mind also that self-funded businesses are increasingly intrigued with this concept of primary care delivery for what it doesn’t provide: entrance and exposure to the overpriced world of hospital employed physicians and specialists and care at their bosses’ establishments.
What is the reaction of the healthcare industry to the efficient, fairly priced and high quality solution to the delivery of primary care? Bribed bureaucrats and legislators as a favor to their corporate pals want to regulate them out of business, treating them as “insurance.” Several states (kudos to them) have passed laws specifically designating Direct Primary Care (DPC) practices as immune to such destructive regulatory attempts. The absence of such crony-limiting laws invites the very orgy of bribery and corruption you would suspect. While it is sad it is not surprising that we have for some time been in a place where any oasis of liberty requires a statute protecting it from the predatory state.
The growth of the DPC practices and industry is key to the continued delivery of health care in this country, particularly as the effects of federal intervention wreck havoc on patients’ ability to afford basic care. More basic healthcare needs are declared ineligible for payment every week while at the same time insurance deductibles and premiums skyrocket. DPC practices are not only the life raft, they are the key to bringing healthcare costs under control, particularly for those requiring care for conditions such as diabetes and vascular disease (to list just two examples) that require chronic and continuous disease management.
As the federal government and their crony accomplices attempt to make off with an even greater percentage of GDP for healthcare, I believe it is important to understand, recognize and support the tenacious underdogs (like the DPC practices) standing in stark defiance. Here is the Journal Record article by Oklahoma Council of Public Affairs President Michael Carnuccio appealing to the power brokers in the state house to ensure that these DPC practices remain unmolested.
G. Keith Smith, M.D.