Should we have single-payer healthcare?

[Tortelloni]

About half of my patients are uninsured, part of the working but can't afford ACA health insurance since I'm cheaper than both insurance and regular insurance-based practices.

Cash can be very feasible on a large scale. Granted we will always need some form of insurance for length hospital stays or open heart surgery, but most things can be done cheaply. For example: I had a patient who needed his uvula taken out. His ENT agreed to do it for $500 but warned that the OR fee would be around 15 grand since he only operates at the local hospital. I set him up with a private ENT group who agree to do the surgery for $350 and the OR fee at their free standing surgical center was only $900.

But yeah, cash will obviously never work for anything other than niche primary care...

Thanks for correcting me in one regard, I'll research it more.

I would still maintain it cannot work on large scale. I'm not sure what area of country you are in, but the uninsured in my area do not have$50 for a simple visit, nevermind $350 for surgery. They definitely would not have capacity to drive from state to state in their non existent cars shopping for discount.

My phd research in economics revolved around studying poverty. Part of my project was to"be poor" where I lived like the average person in a super poor rural community followed by super poor urban community for eight weeks each. I (somewhat educated, pretty good with money) did not have money left over despite living like the average person, healthcare outside of the"average policy" was not possible. There is lots of research on this in economics journals, you don't have to take my word and makes for fascinating reads. It helps that those are usually not politically biased.

So yes it probably works in some zip codes, and perhaps if the average person wasn't as poor, it would even work on larger scale. As it stands, cash only is not possible on macro level. On micro level - it likely limits access.

That post was longer than i wanted but hopefully it makes my reasoning clear.

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[Tortelloni]

the AAPS has a number of cash only surgeons...

Yeah, you should look up the median income of their population and compare it to median of county/state/national. Cash only practices, esp sureons are inaccessible to about 150 mill people (i am probably underestimating)

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[deleted480308]

Thanks for correcting me in one regard, I'll research it more.

I would still maintain it cannot work on large scale. I'm not sure what area of country you are in, but the uninsured in my area do not have$50 for a simple visit, nevermind $350 for surgery. They definitely would not have capacity to drive from state to state in their non existent cars shopping for discount.

My phd research in economics revolved around studying poverty. Part of my project was to"be poor" where I lived like the average person in a super poor rural community followed by super poor urban community for eight weeks each. I (somewhat educated, pretty good with money) did not have money left over despite living like the average person, healthcare outside of the"average policy" was not possible. There is lots of research on this in economics journals, you don't have to take my word and makes for fascinating reads. It helps that those are usually not politically biased.

So yes it probably works in some zip codes, and perhaps if the average person wasn't as poor, it would even work on larger scale. As it stands, cash only is not possible on macro level. On micro level - it likely limits access.

That post was longer than i wanted but hopefully it makes my reasoning clear.

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you're saying his way doesn't work when it is quite literally cheaper than the alternative.....

 

[Tortelloni]

you're saying his way doesn't work when it is quite literally cheaper than the alternative.....

No i didn't say that. Please reread, i think i quantified my statements

EDIT: Sounds like you are just arguing for the sake of arguing. That's cool if you need to let off steam, I understand.

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[VA Hopeful Dr]

Thanks for correcting me in one regard, I'll research it more.

I would still maintain it cannot work on large scale. I'm not sure what area of country you are in, but the uninsured in my area do not have$50 for a simple visit, nevermind $350 for surgery. They definitely would not have capacity to drive from state to state in their non existent cars shopping for discount.

My phd research in economics revolved around studying poverty. Part of my project was to"be poor" where I lived like the average person in a super poor rural community followed by super poor urban community for eight weeks each. I (somewhat educated, pretty good with money) did not have money left over despite living like the average person, healthcare outside of the"average policy" was not possible. There is lots of research on this in economics journals, you don't have to take my word and makes for fascinating reads. It helps that those are usually not politically biased.

So yes it probably works in some zip codes, and perhaps if the average person wasn't as poor, it would even work on larger scale. As it stands, cash only is not possible on macro level. On micro level - it likely limits access.

That post was longer than i wanted but hopefully it makes my reasoning clear.

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You're working under several incorrect assumptions.

First, my cash basis is not per visit. My patients pay $50/month for unlimited access - visits, cell phone, e-mail, you name it. I also have dirt cheap labs/drugs (we're talking 90% cheaper than LabCorp and CVS). Most of my uninsured patients are blue collar workers, not poverty level certainly but definitely can't afford ACA insurance AND copays/deductibles.

Second, cash only improves access. I just called my PCP for a sick visit. 2 days before they can see me. I've had 2 patients text me so far today, both got same-day appointments. 2 others e-mailed pictures of rashes that I have already called in drugs for. But sure, access sucks with cash only.

Third, ask the 9% (and growing) number of cash-only family doctors how this won't work on a larger scale. We've gone from around 200 docs in 2007 to over 1500 as of 2013. I'd bet we're over 5000 now.

Fourth, I'll be the first to admit that without some kind of assistance we can never go back to 100% cash only for every single person. You'll always need some kind of safety net. Now that being said, Medicaid is doing a pilot with a practice like mine in Washington State (basically paying for Medicaid patients to use a clinic like mine). First year results seem to show decreased overall spending and resource utilization but its too early to be 100% sure about that.

 

[VA Hopeful Dr]

Yeah, you should look up the median income of their population and compare it to median of county/state/national. Cash only practices, esp sureons are inaccessible to about 150 mill people (i am probably underestimating)

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You are overestimating

 

[Tortelloni]

You're working under several incorrect assumptions.

First, my cash basis is not per visit. My patients pay $50/month for unlimited access - visits, cell phone, e-mail, you name it. I also have dirt cheap labs/drugs (we're talking 90% cheaper than LabCorp and CVS). Most of my uninsured patients are blue collar workers, not poverty level certainly but definitely can't afford ACA insurance AND copays/deductibles.

Second, cash only improves access. I just called my PCP for a sick visit. 2 days before they can see me. I've had 2 patients text me so far today, both got same-day appointments. 2 others e-mailed pictures of rashes that I have already called in drugs for. But sure, access sucks with cash only.

Third, ask the 9% (and growing) number of cash-only family doctors how this won't work on a larger scale. We've gone from around 200 docs in 2007 to over 1500 as of 2013. I'd bet we're over 5000 now.

Fourth, I'll be the first to admit that without some kind of assistance we can never go back to 100% cash only for every single person. You'll always need some kind of safety net. Now that being said, Medicaid is doing a pilot with a practice like mine in Washington State (basically paying for Medicaid patients to use a clinic like mine). First year results seem to show decreased overall spending and resource utilization but its too early to be 100% sure about that.

Thanks for your explanation.

The highlighted was always my main point. I am glad we agree there.

As far as access - we are defining it differently. As you said your patients definately have increased access to you via visits, phone, email. I was referring to access for entire patient community. Meaning, a patient with a job+ insurance does not have access to your services without being willing to pay an extra $50/month . Concierge medicine/direct care however you want to call it caters to those that can afford it. For the physicians, it's a great model. For patients, it's also great, so long as they can afford it. The growing number of family docs going into direct primary care makes sense, on a micro level (read as personal decision) it works well to balance good income without relying on third party to dictate how to practice. But it also creates additional healthcare disparities on a larger scale. That view does not mean direct primary care should go away, but it has its cons for sure.

You are overestimating

The median HOUSEHOLD income in US is <$55K. The average family cannot drop $350 for surgery + $900 for OR fee as you used in your example. Again, in some zip codes absolutely and it makes sense for them. In others not so much.

 

[deleted480308]

Thanks for your explanation.

The highlighted was always my main point. I am glad we agree there.

As far as access - we are defining it differently. As you said your patients definately have increased access to you via visits, phone, email. I was referring to access for entire patient community. Meaning, a patient with a job+ insurance does not have access to your services without being willing to pay an extra $50/month . Concierge medicine/direct care however you want to call it caters to those that can afford it. For the physicians, it's a great model. For patients, it's also great, so long as they can afford it. The growing number of family docs going into direct primary care makes sense, on a micro level (read as personal decision) it works well to balance good income without relying on third party to dictate how to practice. But it also creates additional healthcare disparities on a larger scale. That view does not mean direct primary care should go away, but it has its cons for sure.




The median HOUSEHOLD income in US is <$55K. The average family cannot drop $350 for surgery + $900 for OR fee as you used in your example. Again, in some zip codes absolutely and it makes sense for them. In others not so much.

as someone who operated for some time with children at that income.....yes you can pay those prices

 

[Tortelloni]

as someone who operated for some time with children at that income.....yes you can pay those prices

Great for you. At what sacrifice? Retirement? Home? I was conveying a greater point than the one liner you chose to take out of context.

 

[deleted480308]

Great for you. At what sacrifice? Retirement? Home? I was conveying a greater point than the one liner you chose to take out of context.

you've repeatedly claimed that the avg family can't afford those prices.....I'm telling you that I've been that family, and they absolutely can afford those prices. It's not that complicated. Far more people can afford what they prioritize than you are giving credit for

 

[Tortelloni]

Your anecdotal testament does not speak for the average family.

I've been in that average family too and it did not work out for us. I have 2 disabled kids. My anecdotal story also does not speak for average family either. But, data does. That's what I reference. You can speak in hyperboles/anecdotes all you like, but do your research first.

 

[deleted480308]

Your anecdotal testament does not speak for the average family.

I've been in that average family too and it did not work out for us. I have 2 disabled kids. My anecdotal story also does not speak for average family either. But, data does. That's what I reference. You can speak in hyperboles/anecdotes all you like, but do your research first.

two disabled children isn't the avg american family...you know that.

 

[Tortelloni]

two disabled children isn't the avg american family...you know that.

Average family income wise. I'll quote my statement again. "My anecdotal story also does not speak for average family either"

 

[deleted480308]

Average family income wise. I'll quote my statement again. "My anecdotal story also does not speak for average family either"

mine does....math is math. I had avg income. We had two kids with avg level of health issues. Avg to high cost of living for the city. a family with $55k/income can absolutely pay DPC pricing and occasionally swing a minor surgery.

 

[Tortelloni]

mine does....math is math. I had avg income. We had two kids with avg level of health issues. Avg to high cost of living for the city. a family with $55k/income can absolutely pay DPC pricing and occasionally swing a minor surgery.

Data does not support that working for average family, but glad it worked out for you and your family.

 

[deleted480308]

Data does not support that working for average family, but glad it worked out for you and your family.

link to your data?

 

[Mad Jack]

Thanks for your explanation.

The highlighted was always my main point. I am glad we agree there.

As far as access - we are defining it differently. As you said your patients definately have increased access to you via visits, phone, email. I was referring to access for entire patient community. Meaning, a patient with a job+ insurance does not have access to your services without being willing to pay an extra $50/month . Concierge medicine/direct care however you want to call it caters to those that can afford it. For the physicians, it's a great model. For patients, it's also great, so long as they can afford it. The growing number of family docs going into direct primary care makes sense, on a micro level (read as personal decision) it works well to balance good income without relying on third party to dictate how to practice. But it also creates additional healthcare disparities on a larger scale. That view does not mean direct primary care should go away, but it has its cons for sure.




The median HOUSEHOLD income in US is <$55K. The average family cannot drop $350 for surgery + $900 for OR fee as you used in your example. Again, in some zip codes absolutely and it makes sense for them. In others not so much.

People don't need surgery all the time. Hell, if people invested all the money that they and their employers currently spend on health insurance, Medicare, and Medicaid, most people would come out WAY ahead if they paid out of pocket on a per-instance basis. Unfortunately, we don't live in a culture that values investment and personal responsibility, but rather an infantile culture that believes bad things shouldn't happen and when they do you need some big company or the government to handle it for you.

 

[Mad Jack]

Data does not support that working for average family, but glad it worked out for you and your family.

DPC costs less than the average family's cable subscription. To say they "can't" afford it is incorrect- they can, but they would rather spend money on other things.

 

[Tortelloni]

link to your data?

You can start here - https://www.cbo.gov/topics/health-care and here http://www.bea.gov/iTable/iTable.cfm?reqid=9&step=1&acrdn=2#reqid=9&step=1&isuri=1
The US dept of commerce is raw data tables you can figure out how to navigate through that. Also, check here http://www.bls.gov/data/

People don't need surgery all the time. Hell, if people invested all the money that they and their employers currently spend on health insurance, Medicare, and Medicaid, most people would come out WAY ahead if they paid out of pocket on a per-instance basis. Unfortunately, we don't live in a culture that values investment and personal responsibility, but rather an infantile culture that believes bad things shouldn't happen and when they do you need some big company or the government to handle it for you.

DPC costs less than the average family's cable subscription. To say they "can't" afford it is incorrect- they can, but they would rather spend money on other things.

The basis for insurance is that if something catastrophic happens there is a means to sustain that without having to sell your house. Can a family survive paying $50/month for colds/antibiotics sure. Can it survive when a family member needs surgery or chemo or anything like that? Probably not, that's not something the average family can save for without sacrificing education, home, something. @sb247 shared experience where it worked. Great. I have 2 kids that require >50K/yr in care. It would not work for me. The point being that its not a one size fits all. Despite my personal responsibility I would not be way ahead on per-instance basis. Again my anecdote is weak, but so is your hyperbole.

Can DPC work for some? Absolutely. So long as patient is prepared to cover emergencies/chemo/surgery etc or have insurance on the side. Not for median family, not in all zip codes.

Is DPC good for primary care docs? Hell yeah. Does it limit overall community access to the patients? Yes.

 

[deleted480308]

You can start here - https://www.cbo.gov/topics/health-care and here http://www.bea.gov/iTable/iTable.cfm?reqid=9&step=1&acrdn=2#reqid=9&step=1&isuri=1
The US dept of commerce is raw data tables you can figure out how to navigate through that. Also, check here http://www.bls.gov/data/





The basis for insurance is that if something catastrophic happens there is a means to sustain that without having to sell your house. Can a family survive paying $50/month for colds/antibiotics sure. Can it survive when a family member needs surgery or chemo or anything like that? Probably not, that's not something the average family can save for without sacrificing education, home, something. @sb247 shared experience where it worked. Great. I have 2 kids that require >50K/yr in care. It would not work for me. The point being that its not a one size fits all. Despite my personal responsibility I would not be way ahead on per-instance basis. Again my anecdote is weak, but so is your hyperbole.

Can DPC work for some? Absolutely. So long as patient is prepared to cover emergencies/chemo/surgery etc or have insurance on the side. Not for median family, not in all zip codes.

Is DPC good for primary care docs? Hell yeah. Does it limit overall community access to the patients? Yes.

I'm not looking for a data dump as it's not my job to find the data you claim in a haystack.....link the actual paper or chart that somehow shows the avg income home can't afford this...

Seperately, DPC models don't claim that people shouldn't also carry catastrophic insurance for unforseen large ticket items.

 

[Tortelloni]

I'm not looking for a data dump as it's not my job to find the data you claim in a haystack.....link the actual paper or chart that somehow shows the avg income home can't afford this...

Seperately, DPC models don't claim that people shouldn't also carry catastrophic insurance for unforseen large ticket items.

http://lmgtfy.com/?q=health+economics+pubmed

I don't have time to do your research. I didn't give you a haystack, the info is there. People like to talk economics without knowing wtf they are referencing.

I don't disagree with bolded above.

 

[deleted480308]

http://lmgtfy.com/?q=health+economics+pubmed

I don't have time to do your research. I didn't give you a haystack, the info is there. People like to talk economics without knowing wtf they are referencing.

I don't disagree with bolded above.

Elevate your discourse...you made a claim that the data said "x".....specifically provide the data or just admit that you don't have it. It's not my job to sift through the entirety of pubmed or cbo.gov to substantiate your claim. That's not how this works...

back up your claim or back off of your claim...

 

[Tortelloni]

Elevate your discourse...you made a claim that the data said "x".....specifically provide the data or just admit that you don't have it. It's not my job to sift through the entirety of pubmed or cbo.gov to substantiate your claim. That's not how this works...

back up your claim or back off of your claim...

Ha! I asked the same of you earlier in this thread. You dodged it. Gotta love hypocrisy.

I gave you my data and my reading. Go through it. It took me a PhD to work through it. I am not in a position to teach a health economics course via sdn. I referenced a textbook earlier in this thread. No one article should ever convince you of truth.

 

[Mad Jack]

You can start here - https://www.cbo.gov/topics/health-care and here http://www.bea.gov/iTable/iTable.cfm?reqid=9&step=1&acrdn=2#reqid=9&step=1&isuri=1
The US dept of commerce is raw data tables you can figure out how to navigate through that. Also, check here http://www.bls.gov/data/





The basis for insurance is that if something catastrophic happens there is a means to sustain that without having to sell your house. Can a family survive paying $50/month for colds/antibiotics sure. Can it survive when a family member needs surgery or chemo or anything like that? Probably not, that's not something the average family can save for without sacrificing education, home, something. @sb247 shared experience where it worked. Great. I have 2 kids that require >50K/yr in care. It would not work for me. The point being that its not a one size fits all. Despite my personal responsibility I would not be way ahead on per-instance basis. Again my anecdote is weak, but so is your hyperbole.

Can DPC work for some? Absolutely. So long as patient is prepared to cover emergencies/chemo/surgery etc or have insurance on the side. Not for median family, not in all zip codes.

Is DPC good for primary care docs? Hell yeah. Does it limit overall community access to the patients? Yes.

The average employer-sponsered health plan for a family of four costs $17,500/year, while your contribution to Medicare is $800. If all of that money were invested, instead of spent on insurance, you'd be looking at 286k in 10 years of working at 55k/year, assuming an 8% return on investment. Hell, if you can work 20 years with no major health issues, you'd have 904k. That's an insane amount of money people throw away for "insurance." There's a reason insurance companies stay in business, and it's that they make money off of the process.

The other major issue is that current insurance doesn't function as insurance. It covers every little thing. It's like if your car insurance covered tires, oil changes, gasoline, wiper fluid, and repairs- it would be insanely expensive, and the cost of everything associated with it would skyrocket since you weren't paying for any of it. We should have actual health insurance- plans that kick in after a catastrophic amount of spending (5k or so) that cover everything above that amount. Wraparound plans coupled with DPC do this- your DPC provider covers all services with a catastrophic plan available should you end up needing expensive care. Such plans provide comprehensive services largely without involving traditional insurance (unless you end up under catastrophic care) and cost substantially less than traditional insurance while providing higher levels of service to patients and better quality of life for providers. The way we're doing things isn't the only way for them to be done, it's just the stubborn way we're used to, and it's stupid.

https://directprimarycarejournal.co...ealth-insurance-plan-for-direct-primary-care/

 

[deleted480308]

Ha! I asked the same of you earlier in this thread. You dodged it. Gotta love hypocrisy.

I gave you my data and my reading. Go through it. It took me a PhD to work through it. I am not in a position to teach a health economics course via sdn. I referenced a textbook earlier in this thread. No one article should ever convince you of truth.

ok...so we'll go with you don't have the data. thanks

 

[Tortelloni]

ok...so we'll go with you don't have the data. thanks

I gave you the data dude. And a solid text. Go with whatever you like.

 

[deleted480308]

I gave you the data dude. And a solid text. Go with whatever you like.

still nothing specific to back up your claim...I'll wait

 

[Tortelloni]

still nothing specific to back up your claim...I'll wait

You can have the last word on this. Go pat yourself on the back.

 

[deleted480308]

You can have the last word on this. Go pat yourself on the back.

you forgot the link to the data for your claim...

 

[Mad Jack]

I gave you the data dude. And a solid text. Go with whatever you like.

It's pretty widely agreed by economists that a large part of why health care is so expensive is that there is no pricing transparency and that consumers are disconnected from the actual payment of services, which leaves them with no incentive to look for less expensive care (and leaves hospitals with no incentive to compete in regard to prices). Like, I've got the same coverage whether I go to the small local community hospital or the big major medical center- why wouldn't I go to the latter, despite the fact that they charge five times what the community hospital does and their outcomes are negligibly different for all but the most critical of cases? A big part of the problem with healthcare economics as an academic field of study is that it is largely a field that was shaped by certain ideologies rather than by general economic principles- it's a very "come up with the means to fit the desired ends" sort of thing, which is why so much about how healthcare economics is taught differs from general macroeconomics (despite the fact that the very same principles are at work).

 

[Mad Jack]

I gave you the data dude. And a solid text. Go with whatever you like.

Do you honestly believe that you have utilized in excess of the $17,500/year in health care costs? There's a simple question for you. Because if you haven't, you're losing out by having insurance (if your insurance plan costs the same as the average American's).

 

[Tortelloni]

It's pretty widely agreed by economists that a large part of why health care is so expensive is that there is no pricing transparency and that consumers are disconnected from the actual payment of services, which leaves them with no incentive to look for less expensive care (and leaves hospitals with no incentive to compete in regard to prices). Like, I've got the same coverage whether I go to the small local community hospital or the big major medical center- why wouldn't I go to the latter, despite the fact that they charge five times what the community hospital does and their outcomes are negligibly different for all but the most critical of cases? A big part of the problem with healthcare economics as an academic field of study is that it is largely a field that was shaped by certain ideologies rather than by general economic principles- it's a very "come up with the means to fit the desired ends" sort of thing, which is why so much about how healthcare economics is taught differs from general macroeconomics (despite the fact that the very same principles are at work).

That's a great and valid point, I will answer when i get on my computer tonight.

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[Tortelloni]

Do you honestly believe that you have utilized in excess of the $17,500/year in health care costs? There's a simple question for you. Because if you haven't, you're losing out by having insurance (if your insurance plan costs the same as the average American's).

Yes. Every year for past 7. First year in excess of 100k.

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[Mad Jack]

Yes. Every year for past 7. First year in excess of 100k.

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Wow, you are most definitely the exception. That's crazy. But again, the sort of thing catastrophic coverage would cover.

 

[Tortelloni]

Wow, you are most definitely the exception. That's crazy. But again, the sort of thing catastrophic coverage would cover.

For sure, exception. Far removed from average.

Catastrophic insurance wouldn't cover my kids' chronic care and home care.

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[ProfMD]

Its not entirely true that coverage is the same at the community hospital as it is at the academic center - nor is it necessarily true that the insurance company pays more. Insurance companies negotiate discounted prices with providers. If the provider does not play ball - they are mad "out of network" thereby limiting patient access - academic centers included.

I agree with the overall sentiment, however, regarding lack of transparency in prices.

While it does seem that cash only plans can work for routine care, catastrophic plans are needed. There should also be some sort of provision for long-term care, etc.

I feel quite strongly that the ACA should have allowed for catastrophic plans.

 

[VA Hopeful Dr]

Thanks for your explanation.

The highlighted was always my main point. I am glad we agree there.

As far as access - we are defining it differently. As you said your patients definately have increased access to you via visits, phone, email. I was referring to access for entire patient community. Meaning, a patient with a job+ insurance does not have access to your services without being willing to pay an extra $50/month . Concierge medicine/direct care however you want to call it caters to those that can afford it. For the physicians, it's a great model. For patients, it's also great, so long as they can afford it. The growing number of family docs going into direct primary care makes sense, on a micro level (read as personal decision) it works well to balance good income without relying on third party to dictate how to practice. But it also creates additional healthcare disparities on a larger scale. That view does not mean direct primary care should go away, but it has its cons for sure.

You are somehow still missing the point. Most of us DPC people are actually increasing access. I get at least one new patient a week who says some variation of "I've been needing to see a doctor about this for a long time but couldn't afford to". The cheapest new patient doctor around, outside of me, will be minimum $120 for the visit for cash paying patients (more for those with high deductible insurance plans). That's 2 months of care with me and some to spare. Plus I have negotiated special cash discounts of X-rays ($30), labs (CBC $4, lipid panel $7, PSA $11), and drugs (I'm usually around 60-80% cheaper than even the wal-mart $4 list). My very first patient was a state employee, best insurance SC has to offer. I save him $40 per month on drugs alone. Add the $80/year I save by doing his PSA here compared to his previous hospital-employed physician and his membership is paid for.

As for people with insurance still having to pay for our services, how do you think insurance works? I have insurance but when I go see my doctor I still have to pay him - either a co-pay or a deductible. The only people that never pay for physician services are kids with Medicaid. Everyone else has to pay something. In fact many of my patients have expensive, high deductible ACA plans who, despite having insurance, still can't afford to go to a doctor. If every visit costs $120 (like it does when I go to my doctor), they're often better off coming to me. Plus, unlike regular doctors, since I get paid no matter what, I don't make my patients come to the office for everything. Telemedicine is awesome and a big time saver and it keeps people from having to take off work all the time.

 

[Tortelloni]

You are somehow still missing the point. Most of us DPC people are actually increasing access. I get at least one new patient a week who says some variation of "I've been needing to see a doctor about this for a long time but couldn't afford to". The cheapest new patient doctor around, outside of me, will be minimum $120 for the visit for cash paying patients (more for those with high deductible insurance plans). That's 2 months of care with me and some to spare. Plus I have negotiated special cash discounts of X-rays ($30), labs (CBC $4, lipid panel $7, PSA $11), and drugs (I'm usually around 60-80% cheaper than even the wal-mart $4 list). My very first patient was a state employee, best insurance SC has to offer. I save him $40 per month on drugs alone. Add the $80/year I save by doing his PSA here compared to his previous hospital-employed physician and his membership is paid for.

As for people with insurance still having to pay for our services, how do you think insurance works? I have insurance but when I go see my doctor I still have to pay him - either a co-pay or a deductible. The only people that never pay for physician services are kids with Medicaid. Everyone else has to pay something. In fact many of my patients have expensive, high deductible ACA plans who, despite having insurance, still can't afford to go to a doctor. If every visit costs $120 (like it does when I go to my doctor), they're often better off coming to me. Plus, unlike regular doctors, since I get paid no matter what, I don't make my patients come to the office for everything. Telemedicine is awesome and a big time saver and it keeps people from having to take off work all the time.

I did not miss your point, we are talking about different things in regards to access. It sounds like you have a solid, successful model, glad it is working out for you.

 

[VA Hopeful Dr]

I did not miss your point, we are talking about different things in regards to access. It sounds like you have a solid, successful model, glad it is working out for you.

Then explain yours better cause from where I'm sitting, my clinic has better access (meaning availability) than anyone else and better access (affordability) for almost everyone as well. The small percentage who literally can't afford my office have Medicaid.

 

[bommer1389]

I'm pretty ignorant to the economic/political landscape of healthcare, but I'm definitely intrigued by the thought of improving it.

This morning I googled "why our healthcare system is broken" and found this article.
http://www.thedailybeast.com/articl...o-broken-it-s-time-for-doctors-to-strike.html

Its 2 years old, and it's just some random healthcare journalism, but my first thought after reading it is "direct payment is the future!" (more or less my actual reaction)

So, naturally I came to SDN to find out if anybody has heard of this model? And it led me here! Not two days ago, people were having educated conversations about it! This is why SDN can be great.

Anyways, just wanted to say that there are future docs out here (n=1) that are intrigued. This model sounds like it could be huge in the primary care field, and I hope somebody (govt, NIH, a random researcher, etc.) continue to monitor the success of these models.

 

[acountant835]

With insurers wishing to leave health insurance business it’s a perfect time to move healthcare to single payer, merge Medicare and Medicaid.

*Pay for it the same as Medicare with matching employer/taxpayer contributions. It will be expensive but not as expensive for families as buying healthcare now. (My family of 5 pays 9- 12 thousand a year -no dental/vision- for care we never use because the deductibles are so high, on top of 7,000 a year in Medicare contributions). It would be cheaper for employers because they will be paying into a huge risk pool that lowers costs instead of paying for Medicaid contributions and employee health insurance plans which keep going up.

*Set up a non-profit entity run by major insurance companies from the private sector to administer and oversee it. The entity would be governed by a board of directors with members from the A.M.A. Nurses Union, Pharmaceutical Industry, AARP, Insurance Industry, Hospitals, Medical Schools, Government, and independent members selected by the board itself.

 

[VA Hopeful Dr]

With insurers wishing to leave health insurance business it’s a perfect time to move healthcare to single payer, merge Medicare and Medicaid.

*Pay for it the same as Medicare with matching employer/taxpayer contributions. It will be expensive but not as expensive for families as buying healthcare now. (My family of 5 pays 9- 12 thousand a year -no dental/vision- for care we never use because the deductibles are so high, on top of 7,000 a year in Medicare contributions). It would be cheaper for employers because they will be paying into a huge risk pool that lowers costs instead of paying for Medicaid contributions and employee health insurance plans which keep going up.

*Set up a non-profit entity run by major insurance companies from the private sector to administer and oversee it. The entity would be governed by a board of directors with members from the A.M.A. Nurses Union, Pharmaceutical Industry, AARP, Insurance Industry, Hospitals, Medical Schools, Government, and independent members selected by the board itself.

Terribly idea

 

[NeuResurgens]

I still hate the thought of single payer. Our govt. is so horribly mismanaged that I don't want them getting anywhere near being the sole payer or provider of healthcare services.

Trying to mimic the systems run in Germany and Switzerland is our best bet. Leave the insurance industry privatized, but let the government play the role of mediator and referee to make sure unethical things aren't done in the name of capitalism.