Maine Going Direct Primary Care


I am kidding.  Only two doctors in the whole state are doing it.   Why?  I think I know.  I was in Maine for 18 years.  There was a lot to like there (and a lot not to like).  It’s a place where medical monopolies run amuck and hospital administrators get paid ridiculous salaries.  I always wanted to start a direct primary care model practice when I was there but felt that there would not be enough patients to support it.  With 1 in 4 on Medicaid, only places like Portland or the coast would have enough population NOT getting free care already.  I wasn’t in either place.   I am excited that two doctors are trying this and I pray they become huge successes.  One was actually a resident, Jack Forbush, who had visited my practice when I first started.  A great guy. Anyway, their attempts to change the healthcare world scares the powers that be.  For example, in this article in the Bangor Daily News, Mitchell Stein is quoted a lot.  Who is he?  It states that he is an independent health policy consultant yet when you do a google search you see he was a major advocate for the Affordable Care Act.  Not so independent, huh?  Anyway,  here is a summary of his comments (my thoughts in parenthesis):

  • Those patients should know direct primary care doesn’t satisfy the requirement under the federal health reform law that all Americans have health insurance this year or pay a penalty. Those patients could wind up with mountains of debt if a serious illness or injury lands them in the hospital.  (All patients are told to get catastrophic care)
  • By saying that they’re going to take care of your needs up to a certain point, it leaves people very exposed (exposed to what? Most insurance plans have huge deductibles that leave them exposed anyway)
  • Some patients can’t afford direct care plus insurance, even a bare bones policy (and that is the doctor’s fault?)
  • The direct care approach highlights the need for payment reform in health care, he said. Doctors aren’t paid for connecting with patients through lengthy visits, phone calls and email. (and that is going to change?  Not!)
  • One-doctor shops will be increasingly hard-pressed to keep up in future years, as the health reform law focuses resources on big systems tasked with reducing costs and improving care (they will not be hard-pressed if idiots like you stop knocking direct primary care models)
  • I’m sympathetic to the idea that doctors want to be able to spend more time with their patients, but I think we need to figure out how to do that for the whole system, not on this piecemeal basis (what does that even mean?)
  • Health care dollars may also be more wisely spent employing providers at other levels, such as nurses and nurse practitioners, Stein said. A doctor with multiple years of graduate education, rather than answering questions about the flu, for example, could focus on medical problems more suited to his or her training (so now we have his agenda.  he wants to industrialize medicine like we do food and let the LELTs do most of the work and be paid less)
  • These individual physicians who want to go back to the country doctor model, I don’t think it’s either practical from a cost perspective or appropriate from a care perspective, in terms of providing the best quality care at the lowest price (he has no evidence of this.  in fact, any bullshit indicator would still be blown away by these models because these docs have less patients!)

What Stein says is exactly what the government believes.  In other words, they are scared shitless because this model would destroy the monetary gravy train for idiots like Stein.  I can only hope more family docs do the same.

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