Free Market Healthcare? Reality or Fiction. I have been contemplating our state of Healthcare for many years. I have come to several conclusions. Some of what I have to say may surprise you and other things you were never aware of.
“So by definition, Free Market is simply supplies and demand, with little or no government control.” In a free market system, buyers and sellers negotiate self-regulated prices for goods and services in an open market.
Recently read two articles that addressed the free market and Healthcare. One was about Saving the dying free market in Healthcare. The other claims there is never a free market in Healthcare.
One article is written by a physician, the other an active Republican. At the same time, I valued and listened to their voice. They are both missing basic facts and certainly not addressing the big picture.
The first author, a physician, writes, “We Can Save The Dying Free Market In Healthcare.” Much of what he states is true. He is focused as a Primary Care Physician. The personalized relationship with your Primary Care Provider and them truly knowing the patient is pivotal. They are spending time learning about the patient, taking time to teach and educate.
A patient is no longer a number and an appointment. Lost in the system or tossed from specialist to specialist. Not that Specialists are not needed or referred. It is a matter of the Primary Care or DPC relationship with the patient, and I like to relate it to treating the whole patient, not just the diagnosis or disease.
An Improved Model – Using Direct Primary Care Physician
A DPC that has the time and energy to KNOW their patient and listen. Then mold the care of the patient to the patient not just according to the Standard of Care. As I see it, we have lost sight of caring for the patient since the EMR (Electronic Medical Records) and the questions that the government now requires. I feel that the patient-provider experience is deflected by the needed government-mandated question for providers to get paid.
When your provider sees you, they ask all of these random questions that leave you wondering why you are in the office. When in reality, those questions are mandated and not necessarily crucial to the reason for your visit. Not that you shouldn’t be able to discuss anything with your provider. But, the questions often leave you wondering, why are they asking me these questions? Again, the questions are mandated and part of the requirements for providers to get paid by insurance.
Now we all work, and we work hard. But let me say this. All of the “hoops” providers must go through to get paid has grown excessively. I know that it can be frustrating. But for them to get paid, all of the boxes and questions must be completed. And to add insult to injury, if you bring an additional issue or complaint. I have seen where it was responded to by, “make another appointment. “
Sometimes this is not a problem. However, the example I present could have had a severe consequence. And many times, this could be the case. Just like, how many times do you make an appointment to see your provider for something. I am sure we have all had those times sitting in the office waiting to be seen, wondering why you made the appointment in the first place?
But, sitting in the office on a scheduled visit, bring something up you forgot to mention and be told to come back. That is where a DCP is a far better option than most office settings that practice medicine inconveniently. The focus is centered on getting patients through the door. I understand; they are there to make money. But not at the expense of the patient. For that reason, I was never a fan of Managed Care.
The problem I have with Managed Care, it is not patient-centered. It is payor-centered. They spin it to appear patient-centered, but in reality, it is far from. As a nurse that has been around for as long as I have, providers are no longer practicing medicine. They are puppets checking boxes and filling in blanks, leaving little time for the patient before them. Not to mention the time they and their staff are jumping through hoops to get procedures and tests ordered to care for their patients.
The time they must spend defending the need for tests has become a deplorable state for both providers and patients. For example, a provider is sure of a diagnosis and needs a CT scan to confirm. However, the insurance company has the algorithm that ultrasound is required first.
Insurance companies are more willing to pay for the ultrasound and the CT scan instead of saving them money on not having the ultrasound. What I am trying to say, and as far as I am concerned, providers are dictated how to practice medicine, and I am here to say that is flawed. How insurance companies, including Medicare, decide what they pay for and what they don’t.
Insurance Companies and Free-Market Healthcare
Can you tell I am not a fan of Insurance companies? I am very much a supporter of the model of DPC. Based on the Dr and his writing about saving “Free Market Healthcare,” I am totally on board. Get away from the constraints of Health Insurance and into the care of a Direct Primary Care Provider that takes care of you, the patient. It is your right to get the care you deserve, and it is also your right not to use your insurance.
However, this option is challenging for folks to embrace once they understand the big picture and save money instead of overspending on their basic Healthcare needs.
My mission is to get patients to embrace the DPC model and learn to maximize their spending when you need more than what your DPC can offer—saving unnecessary expenses on the unexpected. Particularly those that have High deductible plans. Most of the time, present your high deductible insurance to the provider, and you spend way more than you need to and have you not. You could have saved money.
Consider What You Spend On Healthcare
Something to consider when making decisions on how to spend your hard-earned money. If you are healthy and are carrying a high deductible plan, let’s say $7000-10,000. You have nothing going on health-wise, but maybe you need a Diagnostic Colonoscopy.
If you go to a hospital setting and even accessible standing facilities and present with insurance, you could spend the total allowable amount, depending on your insurance contract with the provider. Depending on where you live, your insurance could pay anywhere from $1000 to $5000 in some parts of the country, depending on the corporation and their charges. You would be spending way more than you should.
Part of the problem is people being afraid not to use their insurance, and most often, there is the issue of not having the expense of the high deductible and the ability to pay. That, too, puts people in the position of using their insurance to buy them more time of the out-of-pocket expense. That is an issue for a different time.
The DPC model is a “Free-Market in Healthcare model.” I embrace the Free-market “self-pay model.” We need to put insurance back where it belongs. Healthcare could move back to a more fee for service, instead of the current over-regulated and overreaching nightmare that it has become.
So we have looked at the Dr take on Free-Market Healthcare. Now let’s look at the “Never A Free-Market In Healthcare model.” The article was written over four years ago, but the sentiment is unchanged.
A Politicians View?
He claims that the medical industry is “entirely there to serve people rendered incapable of representing their own interests.” He uses the analogy of being unconscious under a bus and in the care of the Ambulance. Which in that circumstance is true. You would have little to no say in where they take you and what it will cost.
While that is very true, there is much more involved in our choice and where we do business when it comes to our Healthcare. He goes on to claim that insurance companies don’t bleed, get pregnant or get cancer.
He again talks about being at the mercy of his insurance when critically ill.
He then states that an insurance-driven system with private insurers and private health providers cannot survive in an unregulated, “Free Market.”
He faults the Republicans for not seeing past their Free Market philosophies. My opinion is that it is a very superficial take on a much larger picture. There are more layers than just doing business as a Free-Market.
This article alludes that that less government does not necessarily give us more freedoms. He then goes on to blame the GOP and the Republicans for not looking at sensible solutions.
Healthcare Is A Bipartisan Nightmare!
I’m afraid I have to disagree. This bipartisan nightmare is full of too much government and lacks viable alternatives that do not fit in the Insurance and government culture.
Furthermore, I am seeing many viable alternatives that do work, and they are Free-Market Centered. But what would make Healthcare easier to navigate is some changes to how we do insurance and the oversite and inability to have more flexible options.
Now I do agree when you are injured or emergently critically ill. The Free-Market approach may not be a viable option. However, if you fall and injure your knee, you can find alternatives to surgical interventions that are more cost-effective. For example, you injure your ACL. A ligament in your knee that requires surgery.
Think About Costs
Would you instead receive a bill for $17000-45000 or more, plus the cost of the surgeon, assistant surgeon, anesthesia? Or would you pay $6,360.00 total?
There are many factors to the first bill, depending on insurance and allowable charges and your out-of-pocket expenses, deductibles.
Suppose you had an insurance plan with a deductible of $10000. Using the first scenario, you would be responsible for the bill up to $10000 and whatever else your insurance and the hospital deemed. And the facility could ultimately balance the bill if they so chose.
In the second scenario, you would be saving almost $4000.00. Have you ever looked at your Healthcare expense in this way? Or are you like most people, business, as usual, I have insurance.