Direct Primary Care: A real alternative under Obamacare

I have written about this before and I get endless flack over unimportant details while people miss my main point. I don't know what I did wrong or what I need to do differently, but I am trying again.

I worked in insurance for over five years. I still do insurance related writing to earn money. I have a spiffy technical certificate in insurance stuff (making me a "Certified life and health insurance specialist," at least when I worked for Aflac). So, I think I know whereof I speak and understand this stuff better than most people.

When combined with either a high deductible health insurance or health savings account (to cover surgery, hospitalization, etc), membership in a Direct Primary Care clinic is legally compliant under the ACA such that you will not be dinged with a tax penalty for not having regular health insurance.

Unlike the rest of Obamacare, Direct Primary Care has a track record of actually a) lowering costs and b) improving health care received by patients. The rest of Obamacare is, in my opinion, a shit show and the worst of all possible worlds.

If Direct Primary Care is available where you live, you should look into it. It isn't available everywhere, but is on the rise dramatically -- because it actually works. I am not the only person to think so.



Rapunzel 1701 said…
How is this different from capitation, which has existed for years?
I don't really know the answer to that question. I don't know all the details of this model. I am just trying to let people know it exists and is an option and makes more sense than the third party payer model.
Rob Bartlett said…
the simple answer to the question about capitation is this: capitation was a method HMOs used to press the Dr into being their gatekeeper -- in that arrangement, Primary Care Doctors were working for the HMO insurance company -- they assumed an obligation to manage each patient and prevent patients from advancing to higher-cost specialist care -- and they were paid (the capitation fee) in the range of $25/month per patient (which takes the total average cost of primary care visits that a PPO would pay and divides it by 12 months) -- this is insufficient reimbursement for Doctors -- in Direct Primary Care, the Dr works only for the patient because the patient is paying the membership fee directly -- and the fees are 2x to 4x more -- in the range of $50 to $100 per month -- which sufficiently compensates the Dr to spend an average of 30 to 45 minutes with patients on a Dr visit and be accessible by text and email 24/7.
Rob Bartlett said…
wow, Michele, your post showed up 5 times in my Google News Alert today for "direct primary care." your post got picked up by Google very well. I see in discussion threads the nitpicking you referred to here. I think your description is fine. some people will nitpick anything and everything. you say clearly that DPC pairs well with high-deductible COVERAGE for big-ticket costs, when they occur. DPC covers all the health CARE most people need most years. and then there is the year when you have a $20k problem. I had one this year and it is the first time I have been to the hospital in 20 years. it happens. that's why people need COVERAGE. in the 19 years in between, all I really needed was TIME with my primary care doctor, which is what DPC offers best. what your nitpickers do not understand about the insurance industry is 2 things: 5% of people use 95% of health care spending and insuring primary care is a dumb idea (auto insurance does not cover tire rotations and oil changes). buy primary CARE directly from your family doctor, and buy COVERAGE from an insurance company. overall costs go down 20%. thank you for posting, cheers!
Hi Rob,
Thanks for your meaty comments. Yes, that's exactly why the American health insurance system is broken: It makes zero sense to cover basic care with insurance. There is no risk or gamble involved.

Insurance makes sense when it is applied to a situation where, for example, five percent of people will have X unexpected problem and we cannot predict which five percent. Then you pool money as a group so that when random bad stuff happens, those people are covered. This is a net benefit for both individuals and society.

Basic health maintenance does not fit that model. Everyone is supposed to have annual checkups and basic preventive care. Using insurance to cover that merely drives up costs by adding completely unnecessary overhead that adds zero value to the equation.

This is a large part of why American health insurance prices are skyrocketing.

The other reason is that Obamacare has hamstrung insurance companies by saying you cannot be denied coverage for a pre-existing condition. This removes the gamble from the equation. It forces insurance to cover guaranteed, unavoidable high costs. They have no choice but to pass on the costs by raising premiums.

We need another model entirely for basic, essential health care. Direct Primary Care is an excellent model that can contribute to solving this crazy situation we have in the U.S.

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