by Robert Berry
On February 12th, Modern Physician summarized an Archives of Internal Medicine survey of Massachusetts physicians that indicated “they overwhelmingly support a single-payer healthcare system.” An article in the November 18th issue of the Annals of Internal Medicine entitled, “Support for National Health Insurance among U.S. Physicians: A National Survey” concluded that “a plurality of U.S. physicians supports government legislation to establish national health insurance.”
Many major medical journals and their societies have gone on record promoting single-payer healthcare and have conducted surveys to demonstrate support among their members. Yet they have virtually ignored the new grassroots movement in Insurance-Free Medical Clinics (IFMC’s) as well as the new trend in consumer-driven health plans taking shape outside the confines of academia. Not so with the popular press, however.
On November 6th a front page Wall Street Journal article entitled, “Pay-as-You-Go M.D.: The Doctor Is In, But Insurance Is Out,” publicized the growing movement in insurance-free medical clinics (IFMC’s), featuring ours as an example. Since then, patient controlled Health Savings Accounts (mentioned by President Bush in his State of the Union speech) have become universally available to all Americans under age 65 giving patients, not politicians or academic physicians, control over healthcare dollars.
IFMC’s will provide lower healthcare costs to Americans with HSA’s, since overhead at practices such as ours runs about one-third that of more conventional clinics, primarily because we do not process any medical claims.
Three years ago I opened a clinic for patients willing to pay for my services at the point of care. Unlike boutique practices that typically cater to the wealthy, my clientele has primarily been the uninsured. My goals were to provide affordable, quality care to those left out of our health care system and to jettison wasteful and dehumanizing bureaucracies as much as possible from my practice and from my life, even if it cost me financially.
These goals could be achieved only by eschewing contracts with third party payers, thus eliminating the substantial costs and hassles they impose on medical practices. Accounts at our clinic are settled directly and personally with patients immediately following their visits – as is done by most other small businesses in our community. As a result, my practice has only one full time equivalent (rather than the 4.5 required by the average family practice), is exempt from HIPAA compliance regulations, is free of documentation mandates and most other bureaucratic hassles, and has no accounts receivables. Best of all, I have been able to reconnect with the pure, spiritual purpose for which I entered medicine – the care of persons who appreciate my knowledge and skill.
Despite disdain from policy experts, I have found the uninsured neither destitute nor derelict. They are farmers, general contractors, local retailers, and beauticians who gladly pay our average $40 fee and partner with me in making intelligent, cost-effective decisions about their medical care. Some positively bristle at elitist paternalism. Most understand from experience the real costs of government mandates and are rightfully skeptical of political panaceas. All want a more level playing field – similar to that which the new HSA’s provide.
To our surprise, we have found that about one-third of our 4500 patients have some form of insurance. They have been willing to pay out of pocket for health care they have been unable to obtain with their health coverage. Our experience serving as a stopgap for these insured patients underscores the reality many countries with national health insurance are currently coming to grips with – that universal health coverage (for all its noble intentions) does not universally guarantee timely, quality health care. This reality explains why over one million Brits are awaiting elective surgery and why it takes over 26 weeks on average for a GP in Canada to refer a patient to an ophthalmologist. Inefficiency this inhumane suggests that when it comes to health care political mandates don’t work; for no one – not even Senators or Presidents – can coerce health professionals to care.
Not only have IFMC’s made medical care more affordable and accessible for the uninsured, they are strategically positioned to serve patients with consumer driven health plans such as HSA’s. With pre-tax, tax-deferred personal and family medical accounts supplanting low co-pay, low-deductible health plans, more Americans will soon feel the full cost of their routine health care decisions. As with other economic decisions affecting their households, they will search out the best value for their healthcare dollar (as the uninsured already do), finding it at clinics like ours. This new cost consciousness when applied to the nearly half billion patient-primary care doctor encounters every year could truly produce savings of revolutionary proportion for us all.
Perhaps these IFMC’s are what Harvard Business School professor Clay Christensen had in mind when he coined the phrase “disruptive innovation.” They are indeed a cheaper, more efficient way of providing professional services initially directed at low-end users that will likely catch on soon in the mainstream and eventually come to dominate the primary medical care market. In Canada, however, they would be illegal.
With the growing number of IFMC’s ready to accept the increasing number of patients with HSA’s, one wonders why the major medical journals have been silent.