Monday, January 27, 2020
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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.

One Immediate Benefit of Health Reform

As the Wise Free Medical and Dental Clinic begins yet again to serve those in need, the new health reform law will allow a few of the people who attend Wise for medical help to receive insurance they might have been denied because of some pre-existing condition.

The Affordable Care Act created a new program- the Pre-Existing Condition Insurance Plan - for people denied health insurance by private insurance companies because they have a pre-existing medical condition.  

Virginia is one of the states that has opted by default to be part of the federal insurance program, rather than set up a state plan. (I suppose if the state had, by some miracle, attempted to develop its own plan, Ken Cuccinelli would have sued his own administration.)

As of July 1, the plan is open to American citizens and legal immigrants who have been at least six months without health insurance because they were denied coverage. The plan isn't great - and it's fairly costly since it's individual coverage - but it will keep tens of thousands of people from going bankrupt because of medical bills.

The plan covers primary and specialty medical care, hospital care, and prescription drugs.

Here are more details: