The Commonwealth Fund People Now Hate DPC
This Authentic Medicine blog is biased for Direct Primary Care (DPC) and the free market. I am very open about that. This, and the fact that I have been doing this daily for sixteen years, makes me more critical of other articles, studies, opinions, programs, initiatives, etc. that get traction in the media. So when I saw this crappy article by the Commonwealth Fund I knew it couldn’t be good. They are a socialized medicine proponent who cherry picks their data points. This article was no different except they have no data points and now they are attacking DPC! Nothing gets my ire up more than that. Read the whole article if you can but here are some highlights with my thoughts in parenthesis:
Direct Primary Care Arrangements Raise Questions for State Insurance Regulators
- These consumers might be caught unaware by the limited scope of services available to them; when they get sick, medical services such as hospitalization, prescription drugs, or rehabilitation may not be covered. (Hence why we never say we are insurance because, ummm, we are not. And every DPC doc tells their patients this.)
- While some practices accepting direct primary care contracts serve vulnerable populations including the chronically ill and undocumented immigrants, others might have an economic incentive to enroll healthier members who are least likely to use services. (The word “might” is a pretty big matzo ball hanging out here. My aunt might have testicles and therefore might be my uncle or she might not. The truth is that DPC docs take all comers because our monthly fee is affordable).
- Without state regulatory oversight, there might be a greater risk of DPCA insolvency when demand for promised services unexpectedly exceeds the practice’s ability to provide them. (Did I mention my aunt’s testicles? There is no evidence found ever that demand has exceeded a DPC doc’s services. NONE. Why? Because we only have 600 patients. There has been instances of more patients wanting to join then we can handle and then you know what happens? We hire another doctor to take them on. It’s called the free-market. Look it up.)
- With the rise in popularity of DCPAs, states might have to consider, or reconsider, their regulatory stance toward these arrangements. (And there it is. Without any evidence these three authors claim we need more government oversight because that hasn’t destroyed our system enough).
Let me just say a few more things. DPC = Direct Primary Care. DPCA is the Direct Primary Care Alliance, which is the only official organization that can speak on behalf of Direct Primary Care. Maybe these authors could have spent a few minutes calling the DPCA to get their facts straight? Nah, why let facts get in the way of a good story.
P.S. Yes, that tweet image from 2105 above is real.
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Their arguments are pretty silly. I have never heard of patients complaining that they cannot obtain the care they paid for from a DPC physician. I would imagine that any doc that took on too many patients would quickly have not very many patients because people would stop renewing their contract if they had an excessive wait for an appointment or didn’t have the access to their doctor that was promised. Also, it is the very people they claim you will exclude (for example, poor people who can’t afford insurance) to whom you promote an affordable option for obtaining primary care.
While I don’t think DPC is right for me right now as either a patient or a physician, I don’t think there is anything wrong or immoral with the practice. This organization does think so because they feel that DPC gets in the way of their goal which apparently is to have everyone in a system where the government controls peoples access to healthcare and everything else is illegal. The very fact that they obviously find DPC a threat is interesting. I don’t like to use hyperbole but I think their position is evil. If I thought that I could get 600 patients to pay me $6-700/year cash I would do it in a heartbeat. I already provide what many would consider concierge level of care to my patients so it would be a reduced workload and most importantly reduction in needing to comply with charting requirements which I absolutely hate.
America is deep into becoming the Eternal High School. If something displeases us, we snitch to the teacher, and the perpetrator of our displeasure is busted!
We do this with retail purchases; also with our workplace; we do this with our physicians now, those who are employed by faceless rubberheads who catch the flak from patient tantrums.
DPC is a threat to the system in the same way that the black market was in the Soviet Union. People complained about the cost, but they got what they wanted.
The authorities used to shake down the black market now and again, but just for loot. A little kick-back here and there made a Soviet policeman’s drab job a little brighter.
Anthony Olcott wrote a rousing and hilarious account of a simple gumshoe detective policing a murder at a hotel, called Murder at the Red October.
DPC is under massive threat, because the institutions like the Commonwealth Fund and “health insurance” and the HHS and all of the mediocre machinery which grinds out an inferior product like the Soviet factories did, all of them are terrified of direct primary care.
Direct Primary Care is quintessentially AMERICAN. It requires rational self-interest and adult behavior on the part of the patient.
But there are plenty of horrible people out there. DPC providers are vulnerable to the woeful denizens of America’s Snitch-n-Bitch culture, who will swear to the media that “Doctor Jones offered me a narcotic prescription!” and you’re dead where you stand. By the time the story’s cleared up, the spotlight is off.
Beware the revenge of systems like this. We don’t have a Siberia for DPC doctors. Yet.
Oddly enough, everyone of these things can be said of medical insurance, but actually have some evidence to support it.