There is a current movement called Direct Primary Care, where you sign up to a binding agreement to pay a continuing monthly subscription fee that covers your office visits, and your labs and prescriptions are also discounted. So it’s possible. And it sounds absolutely fantastic upfront.
But the problem there is that places that do not accept insurance and/or Medicaid and Medicare are also not governed by HIPAA and other state and federal healthcare laws, something most people don’t even know until they find out the hard way. I have a relative who thought DPC was the best thing since sliced bread until she found out that all the strange tests she kept being told she needed were not actually for her, and she was actually being submitted to various clinical trials without her knowledge and against her directly expressed wishes, for symptoms and diseases she’s never even had.
So now she’s paying for a monthly DPC subscription she can’t use because she’s afraid of them and refuses to go back. They won’t even give her her medical records (not surprising, because that practice is all a clinical trial fraud scam so they’d be a work of fiction anyway). And she doesn’t have a lot of money to start with; she can go to an urgent care place if she needs something immediate, I suppose.
But if you break a DPC agreement, you have to pay full value for every office visit you ever had, every non-billable service under the agreement, and it gets added up against the monthly subscription fees you’ve been paying. These agreements are written so as to be difficult to break (pick one and look for the following “Termination” language):
If this agreement is terminated or held to be invalid or unenforceable for any reason, you agree to pay practice an amount equal to the fair market value of the services actually rendered to you during the period of time for which the fees were paid commensurate with prevailing rates in the practice area . . .
So yeah, DPC is great in theory, as long as in practice it’s not just a front end for some other medical scam, because they lack oversight and are exempt from all the consumer protections built into insurance-oriented laws like HIPAA. There is no recourse with these non-insurance places, because insurance laws are also pretty much the only consumer protection laws with teeth that exist in the doctor-patient relationship, and very few states have any legislative experience with, much less written law, in regard to Direct Primary Care. We’re trying to find an attorney that knows enough about it to be able to assist, but even that’s a challenge.
I don’t know if fraud was the primary intention of Direct Primary Care, but because of the way it is structured it absolutely attracts the bottom feeders of medical practice who want to pull in otherwise underserved (uninsured, poor, undocumented) patients for some kind of economic exploitation.
Yeah, and it’s still ongoing. She can leave and get hit with an as-yet-unknown fee/bill, or she can stay and not have her own needs addressed but be pressured into carrying on underwriting her own clinical trial eligibility tests.
She’s terrified of setting foot in there now because when she started to argue she’d never had [whatever] and didn’t need these tests they got really aggressive. Not physical, just verbally hard hitting, like abruptly changing the subject and then coming back around to it two minutes later to insist she needs this, and doing that over and over again, ignoring or twisting anything she tried to say in reply, and this was at the end of a day long fast for blood tests. There’s more, just petty shit like you’d expect from a high-pressure con, but that’s the kind of thing.
Fortunately the tests she was objecting to were not common, and she has an in-law who is retired from medicine, so when she asked him what was going on and named the tests they wanted he was able to cotton on pretty quickly and at least tell her it had nothing to do with her or her own needs.
But the only red flag up front was that they have ZERO local reviews. None. They have pay-to-play awards like “best in town” in a local newspaper, and NOTHING else anywhere. That was odd. Now we know why.
I don’t see how this ends well. She’ll either pay some fat bill or end up in court, none of which has anything to do with the healthcare she signed up for. I wrote all this so that maybe someone thinking about DPC will think twice before they sign up.
Probably a justice system where you can’t be sued for 150 bajilion for every time someone slips on wet floor. And where health insurance does not expect you to give them 95% discount because every other hospital does. Among other things.
Ok it isn’t bloody free either. What do you mean there is not a lot of them? Have you been to any clinic the past 30 years? Look at all the gear they got. What about medications? They aren’t going to be able to buy in bulk. It feels like every single doc I have met in my life tried at least once to go into private practice and struggled.
But hey if these are easy to defeat problems I am all for someone doing it. Open up a clinic and run it at cost and donations. Take no insurance and somehow find a way.
Marginal costs capture the costs for helping one more patient, so most of the issues presented are handled. Fix costs cover the cost of equipment that can be reused without additional costs. Fixed costs can be paid for with “one time” money like grants and donations.
Malpractice insurance accounts for about 2.4% of overall healthcare costs in the US. Meanwhile, healthcare costs are going up at around 4% a year. So, let’s assume malpractice never really happens (ha) and we can entirely eliminate that cost by outlawing malpractice suits completely. Great, we just solved half a year of healthcare inflation.
I am tired of this. Is anyone actually working on solutions or are we just going to complain?
What would it take to setup a low cost health care clinic and hospital that is covering it’s marginal costs?
There is a current movement called Direct Primary Care, where you sign up to a binding agreement to pay a continuing monthly subscription fee that covers your office visits, and your labs and prescriptions are also discounted. So it’s possible. And it sounds absolutely fantastic upfront.
But the problem there is that places that do not accept insurance and/or Medicaid and Medicare are also not governed by HIPAA and other state and federal healthcare laws, something most people don’t even know until they find out the hard way. I have a relative who thought DPC was the best thing since sliced bread until she found out that all the strange tests she kept being told she needed were not actually for her, and she was actually being submitted to various clinical trials without her knowledge and against her directly expressed wishes, for symptoms and diseases she’s never even had.
So now she’s paying for a monthly DPC subscription she can’t use because she’s afraid of them and refuses to go back. They won’t even give her her medical records (not surprising, because that practice is all a clinical trial fraud scam so they’d be a work of fiction anyway). And she doesn’t have a lot of money to start with; she can go to an urgent care place if she needs something immediate, I suppose.
But if you break a DPC agreement, you have to pay full value for every office visit you ever had, every non-billable service under the agreement, and it gets added up against the monthly subscription fees you’ve been paying. These agreements are written so as to be difficult to break (pick one and look for the following “Termination” language):
So yeah, DPC is great in theory, as long as in practice it’s not just a front end for some other medical scam, because they lack oversight and are exempt from all the consumer protections built into insurance-oriented laws like HIPAA. There is no recourse with these non-insurance places, because insurance laws are also pretty much the only consumer protection laws with teeth that exist in the doctor-patient relationship, and very few states have any legislative experience with, much less written law, in regard to Direct Primary Care. We’re trying to find an attorney that knows enough about it to be able to assist, but even that’s a challenge.
I don’t know if fraud was the primary intention of Direct Primary Care, but because of the way it is structured it absolutely attracts the bottom feeders of medical practice who want to pull in otherwise underserved (uninsured, poor, undocumented) patients for some kind of economic exploitation.
That story is pretty horrific.
Yeah, and it’s still ongoing. She can leave and get hit with an as-yet-unknown fee/bill, or she can stay and not have her own needs addressed but be pressured into carrying on underwriting her own clinical trial eligibility tests.
She’s terrified of setting foot in there now because when she started to argue she’d never had [whatever] and didn’t need these tests they got really aggressive. Not physical, just verbally hard hitting, like abruptly changing the subject and then coming back around to it two minutes later to insist she needs this, and doing that over and over again, ignoring or twisting anything she tried to say in reply, and this was at the end of a day long fast for blood tests. There’s more, just petty shit like you’d expect from a high-pressure con, but that’s the kind of thing.
Fortunately the tests she was objecting to were not common, and she has an in-law who is retired from medicine, so when she asked him what was going on and named the tests they wanted he was able to cotton on pretty quickly and at least tell her it had nothing to do with her or her own needs.
But the only red flag up front was that they have ZERO local reviews. None. They have pay-to-play awards like “best in town” in a local newspaper, and NOTHING else anywhere. That was odd. Now we know why.
I don’t see how this ends well. She’ll either pay some fat bill or end up in court, none of which has anything to do with the healthcare she signed up for. I wrote all this so that maybe someone thinking about DPC will think twice before they sign up.
Thank you for sharing this story. Things can only change is the abuses are shared with many people.
I am sorry she is going through this.
Thank you. I don’t mind saying it’s scary as hell.
That really sounds like some dystopian science fiction novel. But I guess that’s true for a lot of things going on in the US right now.
Funny you should say that. When she first told me what was going on, my mind immediately went back to that Robin Cook novel Coma from the 70s, lol.
Probably a justice system where you can’t be sued for 150 bajilion for every time someone slips on wet floor. And where health insurance does not expect you to give them 95% discount because every other hospital does. Among other things.
I don’t know. How would you get around malpractice insurance and deal with the competition that has economy of scale?
Malpractice insurance is not infinitely expensive.
As for economies of scale, there are not a lot of them. One doctor and one patient.
Ok it isn’t bloody free either. What do you mean there is not a lot of them? Have you been to any clinic the past 30 years? Look at all the gear they got. What about medications? They aren’t going to be able to buy in bulk. It feels like every single doc I have met in my life tried at least once to go into private practice and struggled.
But hey if these are easy to defeat problems I am all for someone doing it. Open up a clinic and run it at cost and donations. Take no insurance and somehow find a way.
Do you know what “marginal cost” means?
Edit: that was more aggressive than is helpful.
Marginal costs capture the costs for helping one more patient, so most of the issues presented are handled. Fix costs cover the cost of equipment that can be reused without additional costs. Fixed costs can be paid for with “one time” money like grants and donations.
Malpractice insurance accounts for about 2.4% of overall healthcare costs in the US. Meanwhile, healthcare costs are going up at around 4% a year. So, let’s assume malpractice never really happens (ha) and we can entirely eliminate that cost by outlawing malpractice suits completely. Great, we just solved half a year of healthcare inflation.
do what everyone else is doing
vote biden he promises to fix it