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Comment by infecto | Hacker News Reader

I am a big fan of direct primary care doctors now, these are doctors that don't accept insurance. As a family of 3 we pay $200 a month to have unlimited access (person, phone, text, email) to our doctor. We pair this with a high deductible plan from work and it works out really well. It might not be the answer for everyone but it makes sense at the primary care level. As I have gotten slightly older I have appreciated having continuity of care (not One Medical) and also not have strict timelimits to discuss my health. When I see the specialist I am fine with it, give me my allotted time, I probably only have a very specific need to discuss.

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What country is this? There’s no plan in America that’s anywhere near that good, where the catch?

No catch. This is in the US, you can easily look it up. Its becoming a model that more primary care docs are adopting because there is immense overhead if you work with insurance companies. It ranges from the low end to the "concierge" doctor level where I have seen some charging in the thousands per month.

We still pay for consumables out of pocket including Rx medications. We still have a high deductible plan on top of this to cover emergencies/major illness. But I prefer this model as we get higher quality of care for roughly the same price as a non-high deductible plan.

I'm struggling to see how this works well for a family. You're basically uninsured. If you have sudden large expenses, like very expensive medication, it's not clear how you can make that work without hemorrhaging money. The high deductible isn't going to help you if it doesn't cover prescriptions.

Sorry I did not fully explain it. I am probably skipping some assortment of plans but the way I see it, you have PPO, HMO and HDHP. PPO is like a la carte to me, you generally have a wide network of doctors to pick from at your choosing, more flexibility with seeing specialists etc. HMO requires you to follow a funnel, with a single Primary Care doctor. HDHP is most similar to a PPO but you have a high deductible alongside it, while the deductible is higher than the PPO, the noticable difference is usually that you are paying for the majority of costs until hitting that deductible. So when seeing a primary care doc I would be paying for close to the full cost of that visit. The trade off is the monthly premium is significantly lower AND I get access to a health savings plan.

So when looking at it from a total annual loss perspective, the HDHP in the worst case would cost a few thousand more $3-5k than the equivalent PPO. There is nuance between plans but it can work well even if the individual as chronic conditions. Financially it makes sense and also I have strong beliefs that primary care is better served outside of insurance schemes.

High deductible might cover prescriptions but have a deductible amount. If you're in a position with enough savings, hsa or the like, you can hold enough per year to cover those deductibles. It will also shape the level of service you get. I'm paying for a PPO plan with a decently big deductible and max out of pocket so I can keep seeing one of the Mayo specialists I've been seeing for a few years now.

It's not the easiest option if I were making half as much with young children though.

I've been sticking to a PPO insurance for similar reasons. First, it's the only way to handle some of my medical needs. Second, it seems to be the only way to get decent care overall. I've thought about adding the same type of general care doctor back into the mix, as I don't like the current setup.

I have to see my regular doctor and 3 different specialists every quarter year... so, my needs go beyond what out of pocket is reasonable, given insurance negotiated rates. That said, the whole system is a bit of a mess, and insurance and pharma are large parts of the problem to begin with.

I don't want socialized medicine, but wouldn't mind replacing medicare/aid, govt employee and veteran coverage with a non-profit govt backed insurance corporation that allows anyone to buy into that coverage as an option. At least something resembling a baseline to compete with.

What is ‘socialized medicine’ in your understanding? How does what you are proposing differ from ‘socialized medicine’?

My suggestion is much less fascist/communist oriented. By socialized medicine, I mean fully socialized as in "the only option"... where medical establishments and corporations themselves are effectively govt run, not just regulated.

A state option for "insurance" that covers govt employees, but operates without a profit motive, while having the same negotiating standpoint of any general insurance provider is far different than what one would see in a fully socialized environment.

Edit: It's also from the PoV of continuing to offer coverage at all to those already covered by Federal spending, while avoiding increased costs. Basically better utilizing spend to expand competition, as opposed to limiting it.

Many countries have single payer healthcare systems and that has nothing to do with fascism or communism.

Healthcare is rife with asymmetric information by its nature. Doctors and nurses understand the medical services they offer much better than most patients. And privatizing insurance makes this worse. Now not only is the service itself opaque to patients but even the fees that they will need to pay for it.

But I also appreciate your point of view and it is good that PPO works decently well for you.

The catch is it doesn't cover anything outside of primary care.

If you're healthy and have a catastrophic plan as a backup if you get cancer, it can work. If you've got chronic issues, expensive medications, etc. it doesn't.

as a direct care doc, it can help with things 'outside' of primary care. Online doctor to doctor specialists consults, meds, labs, imaging, pathology, dme. Skin cancers can be biopsied and managed for no additional cost (procedure free, cost of pathology $70, meds) by family docs. Or we've helped get wholesale chemotherapy medications to make care affordable in coordination with specialists.

There are only a few places in America that you can do this - most doctors don't work on this plan.

While I agree that the % of DPC docs compared to insurance PC docs is small. It has been growing quickly over the past decade and it is not "only in a few places", that you are wrong about.

https://mapper.dpcfrontier.com/

as a direct care doc, there's #DirectCare clinics in every state and 20-30 new clinics opening monthly.

Google "direct primary care", chances are you have one nearby

indeed, the movement continues to grow

Small world. I had actually thought about using your practice. Great job being both a spokesperson and providing the necessary software for DPC practices.

awesome :)

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