When I was teaching med students from the new medical school in Scranton a couple of years ago I used to tell them not to base their future practice decisions on the present situation in medical care. When I graduated in 1964 very few could have predicted the dismal state that medical practice would be in decades later. I have no doubt that these students will be in a much different environment 10 or 20 years down the road, and I predict it will be for the better.
There's much discussion these days on what should replace Obamacare. However interesting things are happening outside of the government arena which may be a harbinger of things to come.
Although primary care doctors are being chased out of the marketplace by low reimbursements, oppressive government regulations and the burdensome requirements of insurance companies there is a growing movement of what is being referred to as Direct Primary Care. These practices, which are springing up all over the country, are being developed by young doctors who still desire the great personal satisfaction of primary care practice that comes with maintaining longstanding relationships with patients and their families. The concept involves elimination of all insurance and government contracts, thereby dramatically reducing overhead and time wasted on complying with regulations, and then providing all primary care for a modest monthly fee in a much more patient friendly manner. Generally the stable income flow occasioned by direct patient payments permits the physician to place a limit on number of patients which in turn allows for unrestricted time with patients and rapid, often same day, appointments. Usually a large number of services are included such as injections, EKG's, some lab tests, etc. Often arrangements are made with specialists for reduced fees. The plan allows for innovation in modern means of communication, such as cell phone contacts, text messaging and even Skyping as needed with the doctor. Getting into such an arrangement is a scary decision for a young doctor with a family to support but there are pioneers out there with the courage to try it. For those interested here's a web site that discusses it more. http://www.dpcare.org/
This concept is of special interest to those with high deductible insurance, especially combined with a Health Savings Account who are seeking value. HSA's, often funded by employers, are the fastest growing health insurance plan in the country, with 18.2 million people using them in 2016, an increase of 25% from the previous year. This is occurring despite some headwind from the Obama administration. The Dems generally look askance at the idea because HSA's are more of a market based rather than a big government solution to medical care financing. Up to this point monthly payments for Direct Primary Care practices had been ineligible for HSA use because they were being considered insurance premiums, but a new bill is pending in congress changing this and there's little doubt that it will now pass. I was interested to speak with a Washington based friend of mine who is a lifelong Democrat and represents an exercise equipment firm. He is lobbying to make his company's products an HSA eligible expense for those undertaking an exercise program. Unlike health insurance the HSA concept is that funds can be used for any health related expense. I agreed with him that HSA's should include as broad a range of eligible items as possible.
These innovations are the thing of the future in medical care because they are so in line with good economics, controlling cost at the same time as increasing individual choice. They are some of the ways out of the absurd inflationary, rigid, bureaucratic system that we are in but have become so adjusted to over the years that we accept it as normal. But they are just the beginning. With the proper changes things could be so much better, but that discussion is a matter for another time.
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