An Old Idea Whose Time Has Come Again


    A possible solution to some of the inefficiency and waste in America’s health care system is quietly, under the radar, showing us an alternative to the insurance corporate monopoly on the delivery of health care. It’s called Direct Primary Care. The concept was included as an option for state insurance exchanges in last year’s Patient Protection and Affordable Care Act and also has been approved as a “qualified medical expense” for tax purposes.

    Here’s how it works for the more than 100,000 Americans already enrolled in such plans. Medical practices using this model charge patients a flat monthly fee, sometimes as low as $49, to see their primary care physician for all routine illnesses and preventive and chronic care management. At many clinics, doctors are available 24 hours a day, 7 days a week. There are no insurance forms, no co-pays, no hassles about care.

    Since over 90% of medical care is primary care, the 40 cents of every health care dollar that insurance companies take out for administrative costs and profit become available for actual care…more time spent with patients, more medical education able to be done, etc. These patients typically also have catastrophic health insurance to cover specialists, hospitals and emergency room visits, but those policies cost much less because they don’t need to cover primary medical care.  

    Ironically, this is nothing more than a modern version of the way medical care used to be delivered. It could be a godsend for small businesses wishing to provide medical care benefits for employees in a cost-effective way and for working people who cannot afford the cost of profit-bloated and bureaucratically drive health insurance.

    As the Direct Primary Care Coalition states, “more than three-quarters of America’s uninsured are working families. The annual income from a full-time, minimum wage job is only a few hundred dollars more than the cost of an average family insurance plan. With direct primary care, supported by a low-premium ‘wrap-around’ insurance plan that covers everything primary care facilities do not, cost to families can drop by as much as 50%.”

    By eliminating insurance burdens and the resulting office overhead, primary care physicians and nurse practitioners are able to do what they were trained for – practice medicine. They can develop strong relationships with their patients and have time to diagnose and treat underlying problems. They don’t have to see 25 to 35 patients a day, the average for insurance-based practices.

    The hodge-podge mess that is the insurance profit-driven model for health care in the United States is in crisis and needs changing. Direct Primary Care may be one way to accomplish that, especially in light of the fact that single-payer insurance fell by the wayside in last year’s health care reform.

    This model doesn’t eliminate health insurance. It simply makes it more like the model we all use for auto insurance. I don’t buy a policy to cover routine oil changes, battery replacement, etc., for my car. Instead, I buy catastrophic insurance. Why can’t we apply the same common-sense idea to basic health care?