If they didn’t know it before, Americans are now gradually discovering that ObamaCare is not about health care; it’s about regulating the cost of health care and those who provide it. While many health care providers will soon be taking down their shingles only to become employees of large hospital-based practices, or accountable care organizations (ACO’s), some are fighting back against the massive government interference in the doctor-patient relationship.
According to Jim Epstein at Reason, doctors like Ryan Neuhofel of Lawrence, Kansas, are getting back to basics and practicing medicine the old-fashioned way, based on a fee-for-service model. No health insurance is involved, or even accepted, in “direct primary care.” Patients choose the services they need from an online price list, pretty much the same way they choose their toppings on a pizza.
Neuhofel’s practice, NeuCare Family Medicine, is an example of a new brand of health care entrepreneurism. From his medical service “menu,” you can choose a regular office visit for $20, or a Skype-type “virtual” visit for $10. A pap smear will cost you $40, and a house call $100. If you prefer a membership plan over “a la carte” fees, patients aged 29 and under are charged $10 per month, while those 30 and over pay $20 per month.
At NeuCare, a “family plan” for families with up to four children, costs $50 per month and includes email and phone communication, many free lab and diagnostic tests, leases for medical equipment, an online personal health record, coordination of care with other health care providers, and remote pharmacist counseling.
In addition, Neuhofel will also barter with patients for goods or services when they are short on cash. Currently, he is getting paid in fresh eggs and handcrafted cheese and goat’s milk from a couple of patients.
“What people don’t realize is that most doctors employ an army of people for coding, billing, and gathering payment,” says Neuhofel. “That means you have to charge $200 to remove an ingrown toenail.” Neuhofel’s charge for the same service is $50.
Regarding his “virtual” office visits using Skype, Neuhofel says, “I realized people would come in for visits with the simplest questions and I’d wonder, why can’t they just email me?”
Neuhofel says he chose this practice model because “I didn’t want to waste my career being frustrated.”
“Since I started my practice, I seem to hear about another doctor or clinic doing direct primary care every other week,” says Neuhofel.
While direct primary care gets doctors out of the practice of the type of “assembly-line” medicine representative of bureaucratic systems like ObamaCare, the model also allows them to keep costs down and patients to have more control over their medical expenses. Neither of these outcomes is really possible even with the pre-ObamaCare health insurance system in the U.S. in which patients rarely even see, or are concerned about, the actual costs of their medical services. Direct primary care is the only model of the three that accomplishes the goal of keeping costs down so that more people can gain access to high quality care. In addition, the personal relationship between health care provider and patient is preserved.
The aspect of the current health care system that comes closest to direct primary care is the Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA) through which consumers pay for their own routine health expenses while they hold catastrophic health insurance plans for major hospitalizations, surgeries, etc.
Atlas ultimately fears that the bureaucratization of medicine under ObamaCare will lead to lower quality care.
“Really smart people want autonomy, and when you take that away it’s naïve to think you’re going to get really bright people becoming doctors,” Atlas says. “The best doctors could excel at any profession, so why go into medicine if they won’t have the opportunity to be their best?”
If there is any question whether supporters of ObamaCare hope to wipe out private practitioners or those who practice direct primary care, just listen to the words of Gov. Deval Patrick (D) of Massachusetts, home of “RomneyCare” which served as a template for ObamaCare. Upon signing legislation, last year, for the second phase of his state’s health law, which left health care costs 27% higher than the U.S. average, Patrick said:
We are ushering in the end of the fee-for-service care system in Massachusetts in favor of better care, at lower cost.
Patrick credited former Gov. Mitt Romney for taking the state on the path to universal health insurance coverage.