Thank you to Martha Bebinger from WBUR for interviewing me and publishing this great piece today on Gold Direct Care and how Direct Primary Care in general can work to improve the healthcare system as a whole. Also thank you to Mr. Bird who agreed to be interviewed that day while he was here. To reinforce why I feel the arguments against Direct Primary Care presented in the article today are weak at best:

1. DPC worsens the primary care shortage:

I ask these questions in response. What is the current system doing to fix it? Bogging down primary care doctors with more paperwork and more patients to see a day? “Value-base payments” that are based on how complex a physician “codes” their patient and visits rather than how complex the patient actually is as a human being?

By making primary care attractive to medical students from a professional and financial standpoint- including the ones I teach from Tufts Medical School- we can further supply this system with high quality, passionate students that want to do primary care for the right reason which is caring for patients. Most medical students graduate with around 150,000-250,000 dollars worth of debt. It is very challenging to offer them primary care as it currently is and currently pays. So lets fix that with Direct Primary Care.

2. DPC is “insurance”:

Without getting into legalities, the Affordable Care Act states in Section 1301 (a) (3) that Direct Primary Care combined with a catastrophic or high deductible insurance plan qualifies a patient as meeting the ACA standards of full “insurance”.  However, having DPC alone would result in the patient paying the Obamacare fine. Therefore, it seems clear that DPC alone is not “insurance” or an “insurance-type product”.  If you are interested in reading about this further please read this article by Dave Chase from Forbes. Mr. Chase is a great proponent of Direct Primary Care and very knowledgable on the topic.

Forbes Article on DPC Regulation by Dave Chase

So the main question we get asked a lot by former and prospective patients regarding  DPC is “why should I pay you when I already pay insurance”?  This is a very good question and I think I have a very good response- what value does insurance give you? Insurance value should be that you pay as little as possible upfront (the premium) in the hope that you never have to use it. That way,  you get to keep more of your hard-earned dollars in your pocket rather than in the hands of an insurer. You then have the money in your bank account if– god forbid- something catastrophic happens. Yes, you may have to pay a deductible but this is again a “what if. ” Insurance is supposed to protect you when the big unexpected stuff happens not the everyday stuff. Think of it this way: do you pay your contractors, plumbers, landscapers, etc with your home insurance?? Do you pay for gas, oil changes, mechanical issues, tire rotations, etc with car insurance?? The easy answer is no! So my question is why are we paying for affordable, routine primary care with 3rd party insurance? Instead, why not:

1. pay a Direct Primary care doctor an affordable monthly fee to cover all of your primary care needs (no copays, no deductibles, no hidden fees).  Even better we have negotiated cash pricing on routine labs, imaging studies, and most common medications (our cholesterol panel cost $4.00)

2. Carry a lower premium high deductible plan with an HSA account (tax free savings in your bank!) and be protected against the big stuff if and when it happens- i.e. hospital, surgery, cancer, heart attack, accidents, etc

3. Have your own personal primary care physician available to 24/7 through any form of technology- text, cell, Skype, even twitter! We work for you- not insurers or the government. And I include visits to the hospital and do home visits for 30-50 dollars. 

So there is the value now lets look at the perspective. Our maximum monthly rate is $125 for age 65 and over. Here are some examples of “value/perspective” to ponder:

1. This year the average household cable TV bill in the USA is $123 per month

2. Average cell phone bill $73.00 per month

3. Dinner at Uno’s for four averages $60 without tip

4. Going to a movie averages out to a minimum of $60 including tickets and food for a family of four

5. A filet at Abe and Louis is $48

and here are the final two- which people have daily- that amazes me….

6. A regular size latte at Starbucks is 3-4 dollars. 

7. A medium hot coffee with bagel and cream cheese combo at Dunkin Donuts is $3.69

I will leave the math to you the readers. Hopefully, my analogies and the value that we provide for people are clear. What is more important than your health?

If you wish to read further about what a typical family of four pays out of pocket in the USA for their “employer-based” insurance premiums, copays, deductibles, coinsurance, etc please read the following link below. Or I can save you the time and tell you: $23,215.00. I think we provide high value, transparent, affordable care to our patients. So I leave you with a final question: Does your insurance provide this?

Milliman Medical Index 2014