What the AAFP Does Best

Combine the expertise and philosophies of the federal government and organized medicine, and you wind up with something about as nutritious and appetizing as Thanksgiving dressing made from last year’s salmon mousse.  The self-deluded at the AAFP have cranked out another joke disguised as farsighted thinking in their Primary Care Patient Protection Act of 2019 (cue confetti).  AAFP Prez Gary LeRoy, MD is excited that this bill, “takes the financial fear away from Americans who seek care from their primary care physicians.”  Will it do so my reducing coercive premiums charged by Big Insurance, as guaranteed by Big Government?  Uh, no.  Will it create more primary care physicians (as opposed to those who just claim they are)?  Not exactly.  Perhaps it will create and fund more primary care residency slots, or increase money actually paid to those slogging through their days filled up with entitled, angry primary care recipients?  Well…

“If enacted, S. 2793 ‘will ensure that individuals and families are able to prioritize their health and well-being independent of the economic limitations established by their health plan…’”  Man, that’s HUGE, that’s awesome!  How, exactly?

The bill “would allow two no-cost primary care visits each year for people with high-deductible health plans.”  The AAFP uses as evidence a study claiming that many adults with high-deductible plans whose deductibles are $3,000 or more may have a hard time getting into the office because of cost.  They also note CDC figures that say more people are leaving employer-based plans for high-deductible ones.  The AAFP, noted supporters of the ACA which delivered a great portion of this rotting turkey, says:  “Regardless of the type of health insurance, the Academy added, Americans have seen the cost of their coverage rise sharply.” 

The AAFP is happy that this bill “promotes timeliness and continuity of care as a safeguard against expensive ER visits and other effects of delayed medical attention.”  They are proud that they are “providing individuals the ability to secure visits with their primary care physician independent of cost-sharing requirements.” 

People are still going to be stuck with huge premiums and deductibles.  This bill does NOTHING to change that, so Big Insurance will love it.  In fact, a new mandate will be the perfect cover for them to raise premiums just a little more, to offset the “free” visits they’ll have to dig deep to provide (whatever the language of the bill, does anyone actually believe Big Insurance will eat the cost?)  The government will love it because it created the appearance of doing something without actual achievement, which is always government’s highest aspiration.  The AAFP clowns love this because they think it will further demonstrate the utility and worth of a discipline they still foolishly believe they guide, even as they participate in its marginalizing.  Just think of the fun the AAFP will have collaborating with Big Insurance and Big Government to revise mandatory guidelines for these “free” visits.

And anyone who believes this bill will reduce ER visits is so ignorant of patient behavior that they should be confined with the rest of the AAFP, making macaroni art in a locked-down dementia ward.  

Yet while the cheerleaders of a broken system mumble, drool on themselves, and congratulate each other over their bureaucratic flatulence, Direct Primary Care is sitting not quite patiently out in the hall, waiting to come in and fix the mess.  Who cares about two primary care visits per year when you can have as many as you like, not to satisfy musty AAFP guidelines or government payment requirements, but to address the actual needs of the individual?    

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Pat Conrad MD

Pat Conrad is a full-time rural ER doc on the Florida Gulf Coast. After serving as a carrier naval flight officer, he graduated from the University of Florida College of Medicine, and the Tallahassee Family Medicine residency program. His commentary has appeared in Medical Economics and at AuthenticMedicine.com . Conrad’s work stresses individual freedom and autonomy as the crucial foundation for medical excellence, is wary of all collective solutions, and recognizes that the vast majority of poisonous snakebites are concurrent with alcohol consumption.

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5 Responses

  1. Natalie Newman, MD says:

    Well said Pat, well said.

  2. Jennifer Hollywood says:

    This is a horrible idea. It devalues primary care by suggesting that it has no value. Also, patients will save up 10 things to address at their one “free” appointment. The patients will be angry if you cannot spend an hour with them for their “free” appointment. If problems are identified at the free appointment that require follow up or ongoing care, the patients will be reluctant to return as these visits won’t all be free. Or if you identify a problem that needs testing that is NOT free, then the patient might refuse. Or if they have a severe medical issue that requires specialist referral, they are going to be reluctant to pay for that as well. All of this could increase our medico-legal risk of having problems that we are managing but that the patient is non-compliant with care and/or follow up due to costs. Plus, no matter how you dress this up, WE are the ones that will look like the bad guy when things don’t go as the patient expected. Insurance will appear to be the good guy. The system is always trying to displace the public’s angers and frustrations onto us and away from them.

    • mamadoc says:

      Heck this already happens. It’s not rare to have somebody show up for a ‘wellness’ visit with 10 complaints. And they want it coded as ‘wellness’ so they won’t have to pay for the visit. A little gentle education about insurance fraud is helpful.

  3. R Stuart says:

    “a new mandate will be the perfect cover for them to raise premiums just a little more”

    And to reduce physician payments more.

    Thanks, AAFP!

  4. PW says:

    I always love the terms “free” and “no-cost”. Someone, somewhere is paying for this stuff, directly or indirectly.

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