The Enemy of Better by Pat Conrad MD

Should HSA money be allowed to pay for Direct Primary Care services? Yes, according to pending legislation H.R. 6015, a bi-partisan proposal as explained by Wendy Wolfson in Medical Economics. This is being driven by the growing interest in, and availability of DPC practices. Making HSA money eligible for DPC fees lowers the cost of primary care, and would be a win-win for both patient and physician. The article also notes that the American College of Physicians decided not to endorse the bill, calling DPC “potentially a reasonable option as authorized by the ACA in insurance exchanges paired with a wraparound insurance policy covering everything outside of primary care – as long as consumer protections are not weakened.”

You insufferable, duplicitous bastards. Obamacare was by definition a weakening of consumer protections, giving Big Insurance government approval to run riot over consumers with unjustified, unsustainable premium increases. Why would they try to tie DPC, a growing success, to the proven failure that is Obamcare? Why would the ACP not be willing to judge DPC on its own merits? Even if you don’t have insurance for anything else, wouldn’t better access to more affordable primary care be a good idea on its own?

The ACP policy paper Wolfson references has some jewels:

  • “… ACP notes that there is little in the way of high quality, independent research on the impact of DPCP models on quality and access.” (And what “independent” research did the ACP use to justify the system they are still trying to defend?)
  • “there are concerns that DPCPs may cause access issues for patients, especially among patients who cannot afford to pay directly for care.” (And yet you idiots supported Obamacare, probably as an incremental approach to the single-payer system you endorsed in 2007.)
  • ” Physicians in all types of practice must honor their professional obligation to provide nondiscriminatory care, to serve all classes of patients who are in need of medical care and to seek specific opportunities to observe their professional obligation to care for the poor.” (And this sweetly coated sentiment is being used to justify the evil of attempting to force physicians to see everyone for everything all the time. The professional obligations the ACP claims are arbitrary in an age where government auditors, law enforcement, predatory lawyers, vengeful patients, welfare sucks, and the omnipresent media all target physicians.)
  • “Physicians who are in or are considering a practice that charges a retainer fee should consider the impact that such a fee would have on their patients and local community, and particularly on lower income and other vulnerable patients, and consider ways to reduce barriers to care for lower income patients that may result from the retainer fee.” (And you cowards helped create the higher prices faced by the low income population.)
  • And in a position paper on DPC, this free commercial: ” Physicians should consider the Patient-Centered Medical Home (PCMH) as a practice model that has been shown to: improve physician and patient satisfaction with care, outcomes, and accessibility; lower costs; and reduce health care disparities, when supported by appropriate and adequate payment by payers.” (Show to improve…when supported…? What a sad, stupid joke. The PCMH concept has been proven the Potemkin village of primary care and you court jesters want to push it as a way to counter DPC.)

Go read the rest if you like. The ACP tries to fight DPC by making perfect the enemy of better. In the best class warfare logic, the ACP wants to use the poor, remote, and underserved as a block to DPC helping some of the population to have improved – and cheaper – health care. Their logic is that if some are going to be left out in the cold, then you have to keep all your windows and doors open until the government can build a big enough barn to house us all. Their is nothing ethical or even practical about their sorry lies.

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] 

  3 comments for “The Enemy of Better by Pat Conrad MD

  1. HJR
    February 15, 2017 at 3:53 pm

    F-ing A!

    Whenever any idiot starts talking about a “medical home” you know instantly that they are an out of touch, ivory tower pseudo-intellectual who has never had to try and work as a doctor and actually run a functioning office.

    If you hear those words spoken with anything but derision and scorn you should immediately stop taking that person or group seriously.

  2. RSW
    February 15, 2017 at 11:41 am

    “The PCMH concept has been proven the Potemkin village of primary care”

    Great line – I’m going to steal it.

  3. Steve O'
    February 15, 2017 at 8:13 am

    This sounds like the thinly veiled racism of “Sure, I like (blacks/Hispanics/minorities.) But I just can’t understand the ones who refuse to fit in to society. What’s their problem?”

    All people under the thumb are meek, affable and polite. When they get the impression that they have the same rights to their own behavior as any other person, they wind up behaving like any other person – and sometimes are rude, impolite, even deceitful. Bad behavior by anyone is worth societal scolding. That’s different than only accepting the “right-behaved” citizens into citizenship.

    The same discolored thinking is offered to DPC. “Yes, they can move in next door, as long as they behave!” They better not upset the rest of the neighborhood; even if the rest of the neighborhood behaves atrociously. DPC better nod and say ‘YOWSAH!’ when it’s expected to, and be deferential to “normal medicine,” i.e. PCMH. See, some are more equal than others.

    DPC will be allowed in the big tent for a while – but it better not act uppity to its betters.

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