Just Be Tough by Pat Conrad MD

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One of the more entertaining reality TV families out there is the Brown family, the stars of Alaskan Bush People. Forgoing modern luxuries such as dentistry, this hardy band eschews modern softness for the soul enriching wilderness that makes for entertaining TV. Could they be the models for the near future of Alaskan health care? We hear a lot about how the Affordable Care Act has had more than a few growing pains since it was forcibly induced, so how is it going in a state with plenty of access issues?

Let’s ask Gunnar Ebbesson, a Fairbanks small business owner whose “premium for his family of five came to more than $40,000 a year…[for] a bare bones plan with a $10,000 deductible that he buys through the marketplace set up by the Affordable Care Act.” Well sure, seems a little pricey, but Ebbesson – who supports the ACA – should get a subsidy, right? Not with an income of $142K per year he won’t. ““I’m not able to put money in retirement, savings for my kid for college, my ten year old. Believe me I could find lots of stuff to do for my future with $40,000,” he says.” Sounds to me like he just doesn’t want to be a team player, when so many others are in need.

As in the Lower 48, Premera Alaska – one of two Alaska carriers on the exchange – claims to be losing millions despite premium hikes. What IS it about demand increases coupled with stagnant supply that causes price spikes and shortages?

Undeterred by basic economics, Anchorage dental hygienist Victoria Cronquist “doesn’t care what the solution is, as long as it helps her find more affordable insurance.” Okay, $1,600 a month for a family of four seems like a lot – until it goes to $2,600/month next year.

She does get an exchange stipend, but it’s not going up, and so may have to cancel her insurance. “To be quite frank, to have a $2,600 monthly premium payment and all this is stressful to me. Extremely. And that increases my odds of getting ill! That’s the other way I look at it,” she says.”

What these unpatriotic Alaskan whiners discount is that they’ll be pushed “into a category that allows them to avoid paying the penalty for going uninsured. The law includes an “unaffordability” exemption if the lowest cost insurance amounts to more than eight percent of income.” See, no problem! Obama & His Merry Persons were going to see you covered, and if you aren’t, they graciously created a loophole to keep you out of trouble with the IRS. So you’re not as covered as you hoped – it’s not like any new doctors, nurses, or hospital beds were created, so you really didn’t lose much, apart from the thousands of dollars spent to provide equally tenuous coverage to your less fortunate neighbors. And since the odds are pretty good you won’t get appendicitis or break a leg – well, not today, anyway – you can follow the Browns and skip all that high falootin’ medical care. And if you can’t afford insurance which might not pay anyway, there is no real incentive to live near any semblance of a modern health infrastructure, so maybe creating your own Browntown out in the bush and just toughing it out is the best way to go. Maybe that was the Obama plan all along.

Douglas Farrago MD

Douglas Farrago MD is a full-time practicing family doc in Forest, Va. He started Forest Direct Primary Care where he takes no insurance and bills patients a monthly fee. He is board certified in the specialty of Family Practice. He is the inventor of a product called the Knee Saver which is currently in the Baseball Hall of Fame. The Knee Saver and its knock-offs are worn by many major league baseball catchers. He is also the inventor of the CryoHelmet used by athletes for head injuries as well as migraine sufferers. Dr. Farrago is the author of four books, two of which are the top two most popular DPC books. From 2001 – 2011, Dr. Farrago was the editor and creator of the Placebo Journal which ran for 10 full years. Described as the Mad Magazine for doctors, he and the Placebo Journal were featured in the Washington Post, US News and World Report, the AP, and the NY Times. Dr. Farrago is also the editor of the blog Authentic Medicine which was born out of concern about where the direction of healthcare is heading and the belief that the wrong people are in charge. This blog has been going daily for more than 15 years Article about Dr. Farrago in Doximity Email Dr. Farrago – [email protected] 

  1 comment for “Just Be Tough by Pat Conrad MD

  1. Steve O'
    November 9, 2015 at 8:44 am

    You know, this is the very thing that made the 2012 election seem like Alice-in-Wonderland. One of the two candidates was the most experienced American politician in implementing universal health coverage – the other was feeling his way through the woods.
    Mitt Romney deserved to lose – he never ran on his failure, which he should have. When he was governor, Massachusetts really tried to do universal healthcare, and he did his best to make it happen, even though it wasn’t his political call. It tanked.
    It was easy to mandate that people had little cards, true. But having little cards doesn’t mean access to care. People started getting their primary care outside of Massachusetts – but that was quickly squashed, as “gaming the system.” There ain’t no back door, gents.
    And the usual fluff started floating around – chiropractors offered to become primary care providers, all that etc., but Massachusetts contracted into a big Soviet-era joke — “Meat is cheap in the butcher shop, except they don’t have any.” Mandating universal cheap stuff leads to shortages. That’s an oldie.
    If Mitt stood up and told the God’s honest truth, he would have warned us about what we’re now experiencing – and what is to come as well. Except in Massachusetts, you could drive fifty miles to get out of the game, and see a doc in a neighboring state. How far do YOU live from Canada or Mexico? Won’t it seem kinda pitiful when Americans go to Mexico because of its superior healthcare? [PS: For people making $80,000/year, Mexico has some damn fine healthcare. Their best compares with some of our best – it’s their worst that is awful.]

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