Beware of Advocacy Groups Bearing Specialists by Pat Conrad MD
A-freakin’-Ha! After burying the headline “Direct Primary Care Promises to Ease Paperwork” on page 31 (Family Practice News put other obvious choices about opioids and heart failure on the front page), I wondered whether organized Family Practice was willing to stop the auto-colonoscopy. Nope.
In the first paragraph, author Shefali Luthra tells us DPC “has been considered health care for billionaires”. Really?? She does not cite the source for such an idiotic phrase, nor does a writer on economics explain how a rising industry could be sustained off of such a (obviously) small population. We supporters of independent medicine unencumbered by Big Government and Big Insurance should be thrilled by recognition of DPC, right? Not so fast.
The author cites a lobbyist for the Direct Primary Care Coalition, and cites the AAFP estimate that 2% of its membership offer DPC. She cites the AAFP president, Dr. W. Filer: “I hear a lot more interest.”
Then comes the role call of do-gooders, and the corruption radar snaps on:
- Dr. Robert Berenson of the Urban Institute: “Can people afford this?” “Berenson pointed out that partnering with insurance or public programs is key to making DPC affordable for lower-income people.”
- The American College of Physicians, advising doctors to recognize how DPC could affect “poorer” patients.
- Dr. Ann Hwang of the Center for Consumer Engagement in Health Innovation: “This is so new that I think the jury is still really out on whether this will be successful.”
- A Seattle company named Qliance is testing how to blend DPC with Medicaid, promising enrollees the unlimited visits and virtual access of the direct model. Qliance has a contract with Centene, the company running Washington state Medicaid, and promises that enrollees who need specialist care will be referred to one that accepts Medicaid. Qliance is trumpeting “personalized” care for government patients as “a breath of fresh air,” but then shunting them off to Medicaid-accepting providers. So your access is “unlimited” – until it isn’t. Oh yeah, I almost forgot – Medicaid negotiates the monthly payment rate. Do any of us really believe that they will forgo the ability to review records, check for accurate coding, quality, core measures, and all of the other garbage that has most of us wanting to find other work? Similar initiatives are underway for Medicare Advantage, which we can bet will come with similar strings.
- A similar initiative is starting up in New Jersey: “The monthly fee is undetermined.” “That’s appealing,” said Mark Blum of America’s Agenda, another of the ubiquitous advocacy groups. “There are a lot of eyes on New Jersey right now.”
Now Ms. Luthra really gives it away: “Despite its potential, the direct primary care model faces the challenges of integration into existing payment systems…” The ever-loving point of DPC is to completely divorce existing payment systems, trash them, deep-six, set them afire, throw them in the river, and otherwise have no involvement with them, not integrate!!
The author belies a larger systemic prejudice against DPC in the guise of a balanced article. The AAFP will continue to indirectly oppose DPC, as will the AMA, ACP, CMS, Big Insurance, and every bleeding heart, worthless consumer advocacy and do-gooder group able to cash a charitable contribution check. I have learned over two careers and a few decades that big government corrupts everything it touches, and that goes double for medicine; blending Medicaid with DPC is simply, obviously a way to undo DPC while keeping the name. Offering access to specialists that sign on to these hybrid programs is also another way to diffuse, dissipate, and undo the actual value of DPC. The more that DPC grows, the more we will hear the cries of class warfare – “it’s unaffordable!” – and see a growing threat of government force to shut it all down.
-DPC is in the same position that the “black market” is in, in tyrannical countries with regulated markets. Centralized market regulation always leads to a mess – it works only to the degree that the Main Authority is more with-it than the population. Now, that’s never happened in history.
-When the “official market” provides the citizens nothing, the “black market” supplies goods at a price that consumers will pay for it. The “official market” can never seem to get the price right – the suppliers can’t afford to stay in business, the consumers can’t afford the product, or both.
-Tyrannical economies have to overlook the black market somewhat – otherwise, their wretched citizens will not have chocolate, flowers, shoes, durable clothing – only the crap which the State-owned factories produce. But the State must remain shrill and scolding about the black market – otherwise, the State might be seen as endorsing their competition.
-Note that most black markets have gone out of business in the last fifty years – not because the State has ground them under the State’s heel, but the markets have caused the collapse of the State that opposed them. That’s a Nightmare on Elm Street for massive Government bureaucracies – stay awake, or you will die.
-DPC is black-market medicine, simply because it does not recognize the official Medical Market. It leaves medicine to be a private agreement between a doctor and a patient. That’s treason to most bureaucrats!
-Therefore, black markets must be crushed when possible, co-opted otherwise. Yes, OK, you can do
Black MarketDirect Primary Care, but you must pay a Medicare Tax of, say, 50% on your earnings from your satin-cloaked billionaire patients! That’s only fair – look at how hard CMS works for you, and you’re leeching off their hard work!-The myth of the Black Market is that the greedy businessman is only doing business with the fat-cat consumer, depriving honest businesses and decent consumers of opportunity. That is universal rubbish in every predatory economy, so they all discover this excuse. If you looked, the people who bought from the Black Market in the old Communist countries weren’t the elites, but the average Joe. It was the only way to get your honey chocolates and flowers for Valentine’s Day. The 1%, the top-top fat-cats, why they never needed the black market – they always got the finest of everything, usually imported. The Vanguard of the People in the old USSR always had a helluva fine liquor cabinet, you bet.
-You know that the fat cats in Washington get the top-shelf medical care, and always will, no matter what happens down there in Flyover Country to the little people. DPC is a revolution carried on by the average patient. That sort of insurrection must be crushed, you’ll see.
-Sorry to be so pessimistic, but DPC tweaks the noses of some very great Power Players in the US, ones that are constructing the Medicine of the Future, and they don’t like to be interrupted by those who should quietly catch crumbs from the table. We expect parades and rewards from the Little People, they say – not IDEAS!
-Let’s see how the Power Players react to DPC. They’re right on-target so far, they just have to turn up the screws. Tax it, outlaw it, criminalize it, just like every other black market is treated. But usually, when David meets Goliath, the story goes the same.
I really want to believe that AAFP is just being naïve about this, but it seems it’s contributing more and more to the demise of the independent private Family Practitioner.
The public faces – Filer, the Board, etc. – seem clueless to a degree that borders on village idiot status. I’m pretty sure the true nexus of evil is the permanent executive staff, from Henley on down.
Writing as a “consumer” in Illinois.
I love my physician, he is a brilliant man, but I hate Advocate where he is now employed. If I want to switch to DPC, how do I locate a PCP who works in this model?
How do I discontinue paying for other insurance? Or must I keep what we used to call “major medical” coverage (hospitalization, surgical)?
Is there a list somewhere with FAQs?