Rutherford: How Direct Primary Care can help Kentucky patients with health care maze

The American healthcare system is clearly not perfect. I’ve witnessed firsthand how the medical status quo fails patients in vulnerable moments, including my own friends and family. In fact, the fractured and chaotic end-of-life care my uncle endured is what drove me to apply to medical school.

A major driver of the dysfunction is the messy network of healthcare middlemen that leaves patients last. Policymakers recently took a big step in the right direction that will help put patients back in the driver’s seat.

Most Americans are familiar with some of these well-intentioned, but sometimes problematic entities. Health insurance companies provide financial peace of mind but contribute to ballooning costs that result from unclear, complicated pricing. Large hospital networks employ armies of doctors and specialists who save lives but crowd out independent practices that provide more patient choice.

Other members of the healthcare industrial complex are mostly unknown to Americans. Pharmacy benefit managers (PBMs) play a modest role in making prescription drugs available to patients. However, they swipe a big cut for themselves—leaving families at the pharmacy counter to cover their tab. PBMs also profit from pushing more expensive medicines into the market, as opposed to more affordable generic drugs.

And surprise, surprise: the federal government is also contributing to the mess. Rigid regulations associated with Obamacare restrict patient options. Americans should have the freedom to choose health plans that best fit their unique circumstances rather than being forced into a largely one-size-fits-all framework.

This web of middlemen drives up costs and disrupts care. Direct primary care (DPC) on the other hand avoids this messy middle.

The model operates independent of traditional insurance-funded, hospital-based care. It’s similar to a Netflix or gym membership where patients pay a monthly fee to access medical services. At my practice, for example, members pay between $55 to $100 a month.

For their membership, patients are given an à la carte menu of healthcare services with a clear line of sight on costs of supplemental care and treatment, such as discounted labs.

The result? I spend less time on billing codes and paperwork for insurance companies and more time crafting personalized wellness plans with my patients. They value the unparalleled access they have to their primary care physician, as do hundreds of thousands of Americans embracing DPC nationwide. The model works.

As policymakers respond to constituent frustrations about the quality and cost of healthcare, they ought to keep the DPC experience in mind. The DPC model is proof that sidestepping middlemen while offering a clear menu of prices delivers better outcomes for patients.

The recently passed One Big Beautiful Bill Act capitalizes on this idea. It allows Americans to use up to $150 a month from their Health Savings Accounts (HSAs) to pay for DPC membership. HSAs allow Americans to build a tax-free fund to pay for medical expenses, and the inclusion of DPC into the category of qualified expenses is a major triumph for patient choice in medicine.

Washington can’t fix healthcare by adding another layer of bureaucratic middlemen. But it can help by empowering patients to take advantage of more affordable alternatives that restore the doctor-patient relationship. I became a physician to put patients first. Congress should continue exploring opportunities to do the same.

Molly Rutherford is a direct primary care physician who owns and operates Bluegrass Family Wellness in Crestwood, Kentucky. She is also a partner of the Job Creators Network Foundation.