ACA and CSFM

Many people have asked me why I am continuing to not take insurance even though everyone is going to be required to obtain some.  I think this question stems from a basic confusion…a belief that insurance means access to care.  Current estimates are that 40% of the cost of primary care is in dealing with the insurance companies.  Which means that by eliminating the insurance companies from my practice, I can make care more affordable and accessible to families and individuals whether they are uninsured or underinsured.

Spend just a moment reading the examples on page 3 of this document from the American Cancer Society.  I’d like to break down the first example a little bit more.  I don’t feel that talking percents or annual incomes really explains the situation very well.  The first example talks about Juan, who spends 18% of his income on his medical expenses.  What they are actually saying is that Juan is earning $1750 a month and will receive a hospital bill for over $3000 about a month after he gets home from the hospital.

Let’s say he didn’t get appendicitis but instead had trouble getting his diabetes under control.  His doctor wants to see him every month, does labs every three months, tells him he needs to join a gym and “work on lifestyle,” and prescribes a couple medications including one that is brand name only.  So now he is paying $150 per visit, doing $120 worth of labs every three months, buying food that he thinks might be a better choice but is a lot more expensive than what he was eating before, pays gym membership fees, and is spending over $200 a month on his medications.  So now of his $1750 a month, he is spending over $500 a month just on his medical condition.  This leaves $1250 to pay his insurance premiums, rent, car payment and insurance, and other basic living expenses.

While I can’t help much with the hospital bill that is almost twice what he earns gross in a month, I can help with the theoretical situation in the next paragraph.  As a member in my practice, he would be paying $30 a month to see me.  The same labs when run through my account would be under $20.  I have the time to spend an hour teaching Juan how to eat a diabetes friendly diet on a budget and discussing affordable options for increasing his fitness level.  I am used to working with people who pay out of pocket for their care so either know already or make sure to research which medications are the most affordable…I also encourage him to call around to get the best price.  He can continue to have his insurance, both to be legal and to limit his hospital bill in the event of appendicitis to something he may eventually pay off.  He gets the care he needs while buying insurance as required.

This solution is not for everyone.  Some people would prefer to pay higher premiums, obtain more comprehensive medical insurance, and go to someone who takes insurance.  That is fine with me and will not hurt my feelings.  I’m sure most of us would do the same if we could.  But for everyone who is going to continue to pay for the majority of their regular medical care out of pocket, CSFM is still here and I’m still offering the same care and prices as ever.

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