The Case For Direct Pay Health Care Part 1

With the inevitable collapse of obamacare looming on the horizon, people are once again making the case for “healthcare reform”. Sadly, even the so-called experts are ignoring the best reform of all–transitioning back to, as far as possible, direct pay health care.

Once Upon A Time, Health Care WAS Affordable…

Those of us who grew up before the government got involved in health care remember “affordable care”. You paid your doctor cash. And for things that were expensive, you made payment arrangements. The indigent and the working poor had a wide variety of options, from sliding scale and free clinics to special funds that hospitals managed and funded through donations from individuals and from profits.

People weren’t being refused care for inability to pay, and they weren’t dying in the streets by the thousands either. And health insurance was a benefit that came to those who were proven “good employees”. Private health insurance was also reasonably priced, in real dollars, compared to what we have now.

Why Did Health Care Become So Expensive?

There are a few reasons for this, but the main cost drivers were lawyers and the government. Lawyers due to changes in medical malpractice laws that allowed for an increase in frivolous law suits and more out of court settlements, and the government through increased legislation and regulation of the healthcare industry.

Were things perfect before then? Nope. There were cases where people didn’t get necessary care, and where people fell through the cracks. But had we addressed those issues with free market based solutions rather than government regulation we would have been far better off than we are now.

Now, we have the most expensive health care in the world, and we have more people falling through the cracks. Now, instead of your general practitioner handling 90% of your health care, regulation and fear of lawsuits forces the GP to refer many cases to specialists for treatment rather than treating their patients themselves.

In the past, your primary care physician or GP would prescribe your pain medication, and take care of the vast majority of your healthcare. If you did get referred to a specialist, it was because something was seriously wrong. Now, a GP can’t diagnose asthma–he or she refers you to an expensive pulmonologist to confirm what they already know. Rather than prescribing Tylenol 3 for your arthritis, your GP must refer you to a pain management specialist. Instead of sending you directly to a testing facility to get a colonoscopy, and then to a gastroenterologist if the results come back looking odd, you have to go to the gastroenterologist first, then to the testing phase.

This, along with the horrific amount of coding doctors’ offices have to do just to get paid by an insurance company or the government, is one of the largest drivers of health care costs. The same group of people who ironically protested for the government to keep its laws out of the doctor’s office and “off my body”, are responsible for the crippling layer of bureaucracy that currently stands between the average person and quality, timely health care.

Time To Bring Back Affordable Health Care

In the following articles, we’ll be looking at some of the alternatives to obamacare that are available for everyone, not just “the 1%”. Because as it stands now, the government has, through over regulation, legislation, and interference, taken much of the privacy out of the doctor/patient relationship. More than that, the average healthy person is paying far more for health insurance than is necessary–and health insurance does NOT equal health care.

If you want actual health care, obamacare is far from the best answer. If you want to be able to develop a long term relationship with one doctor or a team of health care providers, then using insurance as it currently is sold isn’t the best option either. The best option is the oldest option around–direct pay health care.

2 thoughts on “The Case For Direct Pay Health Care Part 1

  1. A couple of other drivers: computerized medical records. Anytime you mandate a computerized system it’s going to drive up the costs permanently. The local hospital redid the rooms to make it easier to use the computers in the room. There are the constant software updates and the need for increased security. Frankly, patient care has suffered. Doctors spend more time looking at the computer than they do you. I have an old school primary care doctor, the kind that does a reflex test on the physical, that really knows how to use the stuff. He does his examination. At the end, he records his notes into the software program. And he’ll stop adding info to talk to you and make sure he has everything. Most of the other doctors don’t bother to look at you.

    The other is all those shiny expensive medical devices. It’s not enough for my pulmonologist to xray my lungs. He wants to do a yearly cat scan. I drew the line when he also wanted a bronoscopy. He knows exactly what is wrong with my lungs. Yes, those test would give him a little more info, but would cost me several thousand dollars. Meanwhile, he’s done nothing to try and improve my lung function. Doctors and hospitals need to pay for that equipment so will use it whenever they think they can justify it.

    The small company I work for changes insurance companies every year. With the health exchanges failing, we’ve had a year when they changed insurance twice. The deductibles continue to rise. The current company has a $7k deductible. They fight me on everything. The only good part is that they do cover naturopaths and mine is making some progress on improving my lung function. The system truly is broken.

    Liked by 1 person

    • Absolutely–every layer of regulation adds more costs, and in the case of your pulmo doc (I am heading the same way, sadly), it’s also a matter of “defensive medicine”. With the current malpractice situation, according to my Doc Squad, almost 1/2 the tests ordered are *only ordered for defensive reasons*, so a patient is less likely to get anywhere filing a malpractice suit.

      You would do well with concierge care, and in many cases it’s actually acceptable under the obamacare rules. I’m going to be posting another article or 2 on it in the next day or so.

      All of the concierge networks in my area (AZ) have agreements with naturopaths and other alternative care doctors. And there is NO “fighting” involved either.


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