You’ve heard “He who pays the piper, calls the tune.” In health care, we’ve come to expect insurance companies, employers, or the government to pay our doctor bills. We shouldn’t be surprised, then, when they tell us all what to do. When we are paying for something directly, don’t we insist on a significant role in the outcome? As both a doctor and a patient, I’m doing what I can to remove insurance interference from my health care precisely because they are NOT health care providers. They are risk assessors making very calculated gambles on whether I am going to cost them money. They are in the business of hanging on to money for their executives and shareholders.
If you see a doctor employed by a hospital system or large organization, that entity’s job is to get and keep as much money as possible from the bill-payer. They have to pay specialists and buy MRI machines, whether you need them or not. The most expensive place for you to have your basic care is in the primary care department of a large system that supports more serious and complex health problems.
The infamous 7-minute doctor visit is something we all helped design by expecting someone else to pay our bills. When you appear at a clinic where they take your insurance, you arrive attached to a set of billing codes and benchmarks that have nothing to do with you and everything to do with whether the doctor/clinic will get paid for seeing you. Can a doctor focus exclusively on what you need when in the back of their head, a stopwatch begins? Suddenly every word you speak has a price attached to it that goes down each minute the conversation continues. An insurance-based doctor makes the most per minute by limiting your conversation to 5-10 minutes and moving on to the next 25 to 30 people. It’s actually even more profitable not to talk to you at all. In the current system, doing something TO you pays better than hearing something from you.
When you pay your doctor directly, however, you hire an advocate for your interests alone. The doctor becomes accountable to you. You both stop participating in the “fluff and bloat” that middlemen add to your primary care, that part of your health care that should be easy and inexpensive. Here’s a radical notion: what if your doctor profits most by saving you money and time? When your doctor has time to listen and do only that which is needed and wanted to start with, you feel healthier, safer and better cared-for. This is the fuel under the Direct Primary Care (DPC) model, the “Community-Supported Agriculture” of health care and the simple, affordable little sister of “concierge” medicine. DPC ditches the insurance industry entirely and comes straight to you with an affordable membership model that rewards a doctor for taking time with you.
When you pay the primary care piper yourself, you could be lot happier with the tune.