Wrote Hacking Healthcare for O'Reilly, created ClearHealth/HealthCould open source EMR, built and operated ~90 acute care management services organizations (MSO) (the "things" that operate the non-medical aspects of many acute care systems).
Healthcare is highly dysfuctional but I want to dampen the notion a little bit that it is in some unique and new kind of collapse today. Everything you are stating is nearly verbatim what was being said in the 1980s at the dawn of HMO legislation which was somehow supposed to fix things.
There has been a lot of pushing the food around the plate since then. My view is that there are three legs to the tripod of the healthcare system, providers, patients and insurers. For fourty years those three legs have been fighting each other on many fronts and no leg is willing to give substantial ground. If I had a magic wand I would bring into existence a being of profound integrity and leadership that could negotiate meaningful compromises between those three groups but I think practically speaking, that is a pipe dream. The current status quo will continue, more or less, how it is for several decades yet.
I will agree with the other comentator that if you are sick a direct access primary care doctor or concierge doctor can really help. In many cases they can end up saving money versus deductibles and by helping you find specialists and facilities in your budget and timeframe. They vary but can be found in most markets for $1500 - $3000 per year. That's not cheap by any means but something that can pay for itself quickly.
I would also say to OP, seriously consider becoming a direct access provider. Feel free to reach out to me and I can put you in touch with some folks who you can talk to. You are not alone in your sentiment and in large part those sentiments are what led to the creation of direct primary care.
It is unique from my perspective. I have 17 years with major metro fire/ems department. We have crested into the hundreds of thousands 911 call volumes. People have literally stopped thinking and just call 911 for every minor inconvenience.
A massive number of calls are simply untreated low-grade fevers where the patient was unaware of the fever. I am OBLIGATED and MANDATED to send them to the ED if they request transport. Furthermore, I am LEGALLY bound to offer transport to the ED. I have ZERO authority to tell them to take a fever reducer and call back if that doesn't fix their medical concern.
We are taught to use differential diagnosis in paramedicine. However, we are not allowed to diagnose per medical guidelines from the medical director. Working with this dichotomy has made the entire pre-hospital care system complete bullshit. Based on what I see in the ER, the entire system is on the precipice of complete failure. This collapse is unique and new due to the absurd volume of patients and bullshit policy that has not changed.
Is direct primary care something to do instead of insurance, or in addition to insurance? I know someone who gets direct primary care and has no insurance, but I was telling him he should get insurance anyway in case of disaster -- was my advice incorrect?
Typically it is something you do in addition to insurance, though there is not a one size fits all model to it. Different providers and systems offer different levels and types of it. Atlas MD in kansas is an interesting one which is aimed at average income people and offers some pharmacy and labs at heavily discounted prices. From a cost savings standpoint things like x-rays, ultrasounds, ECG/EKG, stitches, cast removal, minor in office procedures, etc, are often done at no additional cost beyond the annual price. An ECG/EKG might be as much as $400 or more against your deductible, which instead could go toward direct primary care where it would be included.
In particular if you have say a chronic condition which remains unresolved after several interactions with the general purpose health system a direct primary care doctor has the time to put towards your case on an individual basis to potentially get to the bottom of it. My experience has been that they also do a much better job at management of chronic conditions but I would really like to see some more studies done in that area.
Healthcare is highly dysfuctional but I want to dampen the notion a little bit that it is in some unique and new kind of collapse today. Everything you are stating is nearly verbatim what was being said in the 1980s at the dawn of HMO legislation which was somehow supposed to fix things.
There has been a lot of pushing the food around the plate since then. My view is that there are three legs to the tripod of the healthcare system, providers, patients and insurers. For fourty years those three legs have been fighting each other on many fronts and no leg is willing to give substantial ground. If I had a magic wand I would bring into existence a being of profound integrity and leadership that could negotiate meaningful compromises between those three groups but I think practically speaking, that is a pipe dream. The current status quo will continue, more or less, how it is for several decades yet.
I will agree with the other comentator that if you are sick a direct access primary care doctor or concierge doctor can really help. In many cases they can end up saving money versus deductibles and by helping you find specialists and facilities in your budget and timeframe. They vary but can be found in most markets for $1500 - $3000 per year. That's not cheap by any means but something that can pay for itself quickly.
I would also say to OP, seriously consider becoming a direct access provider. Feel free to reach out to me and I can put you in touch with some folks who you can talk to. You are not alone in your sentiment and in large part those sentiments are what led to the creation of direct primary care.
du@50km.com