Instead of Asking “Who Pays”, We Should Ask, “Who do We Pay?”

When  I first started the Free Market Health Care Blog, I fully intended to write detailed posts about health care reform on a daily basis, but then I started connecting with industry leaders on social media and discovered, what we really need is one place where all of this information can be conglomerated, where the average person can search and find the answers they are looking for.  Today I came across this excellent write-up, which basically explains that when it comes to healthcare cost reduction, we are all asking the wrong question!  Instead of asking “Who pays”, we should really be asking, “Who do we pay?”.  Thoughtfully written, you’ll learn why healthcare is so expensive.  If you want to become a part of the solution, you owe it to yourself to read this:

We All Want Healthcare to Cost Much Less-But We are Asking the Wrong Question


Cost of Treating Type 2 Diabetes via Direct Primary Care

I asked my friend, Dr. James Brook, who also happens to be a Direct Primary Care Physician, to give me some feedback on the cost of treating a person with Type 2 Diabetes, so I could share that with my readers.  He kindly obliged with the following, frank, yet witty response:

“I commonly hear that health care is beyond financial reach for patients with chronic disorders, like diabetes, without either insurance or a government program.  People say that free market medicine may work for a healthy person that gets a sinus infection once in a while, but not for those needing chronic care.  In reality, I see plenty of those people.

Take a typical patient with type 2 diabetes, high blood pressure, and high cholesterol.  Those disorders put people at risk for heart attacks, kidney failure, etc.  Controlling these illnesses at the level of family practice helps to reduce the rate of those catastrophic outcomes.  Type 2 diabetics are actually not very expensive for a direct-pay family practice doctor to treat.  I was claiming that the typical diabetic pays me $250 – 300 per year.  I was wrong.  I apologize.  The number is actually lower.

Last year, I averaged $227 per year for these patients.  The labs are not expensive.  A comprehensive metabolic panel, complete blood count, and thyroid stimulating hormone level together are $17.  A HgbA1C is $10, a lipid panel is $8, and a urine dipstick for protein at my office is $0.  I charge for these tests at my cost, rounded to the nearest dollar.  I charge by the time that I spend, plus lab costs.  I make my money on the time I spend.

I supply meds to some patients also.  A fairly aggressive regimen for a diabetic with high blood pressure and cholesterol problems could consist of metformin 850 mg thrice daily, glipizide 10 mg twice daily, lisinopril 40 mg daily, hydrochlorothiazide 25 mg daily, and simvastatin 40 mg daily.  If I supply all those, 6 months at a time, I would charge the patient $280 per year.  Just so you realize I am making a living at this, all those meds cost me $98.  The total of office visit fees, labs, and meds is then $507 per year, for a typical diabetic with high blood pressure and high cholesterol.

The best treatment, of course, is for a patient to exercise, watch the diet, and get in shape.  Then they can get off their meds and have better probabilities.  I am occasionally able to influence them to do that, but not often enough.  I harp on it at just about every visit, to the point of being a pest at times.  Just to put my money where my mouth is, and have a bit of fun, I put a sign on my wall offering a $15 discount to any patient that beats me in a pushup contest.  But until they get in shape, they can afford my medical care for their chronic conditions, without having money confiscated from somebody else’s paychecks to do it.

My method for arriving at the numbers:  I looked at my financial records, and found all the patients I treated for diabetes in the first 3 months of 2016.  I then removed any for whom I did not provide care for the whole year, such as a patient who moved.  I then added up the total they paid me for the year for their diabetes visits.  These visits sometimes included care for additional issues, such as plantars fasciitis. ”

If you are interested in finding a Direct Primary Care Physician in your area, simply follow the Affordable Health Care links to the right of this webpage.

Watch 2/8/17 House Health Innovation Subcomittee Discuss Direct Primary Care

I encourage my followers to watch the video linked below.  The cost savings people can realize by using Direct Primary Care are staggering as illustrated by Dr. Lee Gross in his powerpoint presentation.  If you want to have a clear understanding of how Direct Primary Care works and how health care can be reformed utilizing this model, watch it!  You will be shocked by the savings.

House Health Innovation Subcommittee  discussion about Direct Primary Care in Florida