Doctors in Texas are showing us what a medical system without comprehensive insurance might look like. The NYT profiles the rise of Texan “direct primary care” practices that don’t accept insurance. Instead, patients pay flat fees out-of-pocket. In return, doctors save both time and money that they can then pass on to patients. By not having to process reimbursements through third party payers, fill out convoluted forms, or hire administrative staff, they can charge their patients less and spend more time with them. Here’s some examples of how different practices are implementing this approach:
In Austin, Drs. William and Mason Jones — a father-son team — practice “concierge medicine,” treating patients under a membership model in which patients pay annual fees for access to a variety of services, including unlimited office visits, routine vaccinations and round-the-clock medical assistance by phone.Mason Jones said his office was a “low-volume practice” that gives him the “luxury of time” to spend with patients. “This works out great for preventive medicine,” he said […]In Laredo, Dr. Villarreal has had a different experience. His business model frees up time for him to see more patients, he said, without the added costs that come from filing insurance claims. He still sees 40 to 60 patients a day, he said, 20 of whom tend to be new to his practice.“To me, there’s no other way I would practice medicine,” he said. “You feel like you’re a doctor again.”
One of the perverse results of the structure of US health care is that it takes doctors away from the kind of care they wanted to do when they entered the field. Replacing insurance with concierge medicine will not only reduce the bureaucracy, distortions, and over-spending that comprehensive insurance introduces into our system, it will also allow doctors to live their vocation more richly.But there’s a catch here, as the article points out. Concierge medicine isn’t a new trend—we’ve covered it here before. But now that Obamacare is swelling the ranks of the comprehensively insured, doctors who don’t take insurance are increasing the pressure on the system. There’s a hint in the NYT piece that other doctors think it’s irresponsible for their colleagues to stop taking insurance just as the Obamacare rollout promises to strain practices and hospitals past capacity. This bias against innovators is what happens when federal legislation cements a dysfunctional system in place. Doctors who want to experiment with new models of payment face social pressure to abandon these experiments because of policy choices made in Washington.