Direct Primary Care: A free-market approach to health care reform

Posted on May 7, 2015 by Kathy Hoekstra

The ACA added 17 million people to an already broken health system, while failing to address high costs. But patient-driven, common sense innovations are chipping away at this basic health care problem.

The latest numbers about America’s uninsured look promising – close to 26 million people are without health insurance today compared to nearly 43 million who were uninsured in 2013.

This from a new RAND Corporation study which tracked insurance transitions from the end of the second open enrollment period under the Affordable Care Act (ACA). And there is little doubt proponents of the federal health law will use these study results as bragging rights to justify the law’s existence.

In reality, the Ahealthcare reformCA simply added 17 million people to an already broken system, while failing to address health care’s real problem: out of control costs. As pointed out here previously, most of the cost problem stems from our country’s third-payer system by which government and insurance bureaucracies control how we spend our health dollars rather than us.

But there are some innovations happening right now that are chipping away at this basic health care problem by  allowing patients to act like paying customers instead of passive participants.

One such innovation picking up steam state by state is called “Direct Primary Care” (DPC).

As described by the Direct Primary Care Coalition, DPC is an alternative payment model in which people pay a flat monthly fee for all routine and preventive services such as checkups, urgent care and chronic care management. That fee, which can be as low as $49 allows doctors to deal directly with patients and bypass costly insurance or government regimes. Considering the traditional health insurance system adds about 40 percent to typical medical bills, charges to treat many common diagnoses are steeply discounted. For instance, treating an ingrown toenail costs $50 under a direct primary care doctor in Kansas. Under the traditional system, he’d have to charge $200.

Insurance still covers more expensive care such as hospitalization and specialist services, but DPC gets bureaucrats out of the way of primary care which can tend to as much as 90 percent of a person’s health care needs.

It is encouraging that this enterprising system is already etched into law in nine states, with legislation pending in five others. Americans need to get behind common sense ideas like direct primary care that lead toward a patient-driven, cost effective health system.