Why Choose Direct Primary Care?
There is a lot that can be said about Direct Primary Care (DPC). To keep it short and simple, we choose DPC because it is a solution. A solution to a problem that has been festering in healthcare for generations. Rampant and exorbitant costs, outrageous bills, overloaded providers, healthcare systems that take ages to get in to. The breakdown of the “doctor-patient relationship”. It’s a system that is headed towards collapse. In its current form, it’s unsustainable. Patients are unhappy, providers are unhappy, the whole system is a mess.
But why? How did we get this way? Surely, it wasn’t always like this, was it?
The truth is that over the last century a multitude of changes has occurred that has caused a constant evolution in the healthcare landscape for both good and ill. People will often state that a hundred years ago medicine didn’t cost what it does today. While that’s completely true, it’s not exactly the entire story. In the early 1900s, medicine was still kind of in its infancy. There weren’t standardized training programs, the skills of doctors varied wildly from physician to physician. Hospitals were in their infancy and sophisticated diagnostic imaging such as X-rays, CT scans, MRI’s, as well as the complex procedures that are available today just didn’t exist. The standard of care and technology in today’s medical landscape has advanced to levels that were unheard of a hundred years ago or even 20 years ago. Unfortunately with sophistication, comes the costs associated with it. In response to these changes, health insurance was developed in an attempt to make medicine more affordable. Hospitals began to contract with patients and employers to protect them from catastrophic illnesses and over time it became a normal benefit for employees across the nation. Over the years though, the original intentions of insurance have become obscured. The goal of protecting patients against catastrophic costs was so financially successful for the insurance companies that other parties became involved and further profit-driven policies were developed to maximize revenue. Over time, Insurances enrolled physicians and hospitals to form networks that only their members could see. Insurances began creating their own system for how to manage patients that makes them the most money and pays out the least. Insurance became a business and along the way one of the most precious commodities, the doctor-patient relationship was lost. Today, many of the Fortune 500 most profitable companies are medical companies. It’s not just insurance companies however, price managers, distributors, and various other entities have gradually stuck their hand in the pot bloating the system little by little. Once lobbyists and politicians got involved with regulations and mandates it was all over and we finally arrive at the mess we have created for ourselves today. At some point, the whole thing became rigged so that costs were so outrageously expensive and inconvenient that you just couldn’t get good care without health insurance.
As the insurance companies changed their billing practices to maximize profits they began developing what's known as “managed care”. They decided who and what they would pay for making the decisions of the providers and patients more and more irrelevant. After all, what good is it to have your doctor tell you that you need an MRI if your insurance won't approve it? Those providers who spent time with their patients, who got to know each person who walked through their door, who came to your home and who knew you and your family by name were either bought out or forced out. The practice of sitting down with a patient for an hour led to empty wallets and closing practices. Unable to keep up, they were replaced by those who could see more patients, faster, in the way the insurance companies demanded. The result is what has become the standard today: providers who don’t know you, whom it takes you weeks to get in to see, who you have to wait for an hour in the waiting room for, who you finally saw for 5 minutes before they rushed out the door and one who if you got a new job or new insurance you may lose and have to start over with someone else “in-network”. Honestly, this system is not why any of us got into medicine. None of us chose this profession so we could rush from room to room only to forget our patient’s names and come home after 16 hours exhausted. We didn’t get into medicine to memorize billing codes and watch the clock to know how much to charge you. We get into medicine to help and to heal, but the model of business thrust upon us to achieve that has become flawed and broken. There’s a reason burnout is rampant across medical providers (some studies estimate a nearly 30-50% burnout rate), suicide rates are way higher than the general population and it’s only getting worse. On average, each provider is having patient panel sizes that are orders of magnitude larger than any sane person could handle.
Now don’t get me wrong, health insurance serves a purpose. Innovation and evolution are a natural part of the history of healthcare and insurance is one of them. It is not inherently evil and despite all I’ve written so far I’m not against health insurance. Advances in medicine and specialist procedures ARE expensive. That MRI machine at your local hospital or brand new Da Vinci surgical robot that cost over 2 million dollars to acquire does not just pay for itself! Even I have my own insurance plan to protect me and I recommend everyone have something to protect them from catastrophic costs. Medical debt is a very real and potentially avoidable calamity that people in our country could face. The problem is how far the system has strayed from its purpose. It has migrated away from catastrophic costs into the arena of general everyday care and prices have skyrocketed because of it. Most homeowners have insurance to protect them against a fire, flood or other major damage to their home but most do not use their insurance to paint the walls and fix the toilet. The system has bloated so far today that the average person is paying more in health insurance than they do for actual health care. The average premium in the United States is $440 per month ($5,280 per year), with on average over $4500 deductible. Meaning on average, most Americans would need to pay nearly $10,000 PER YEAR before their health care costs are covered. Some may even have co-insurance beyond that. These costs drive many patients to forego insurance altogether and choosing to avoid visits to their providers, avoiding checkups and care regardless of their medical history. There is a way that we can co-exist but the current profit-driven system that dominates healthcare right now isn’t it.
So back to the original question, why choose Direct Primary Care? We choose DPC because it is a way that we can cut through the mess that healthcare has become. Simplifying care into something that makes sense and is more affordable and personable. This practice was designed from the ground up to give each and every patient the time and care they deserve, without the need for health insurance.
President, Starlight Health