Seattle doctors try flat-rate no-limit primary care | Hacker News Reader

Seattle doctors try flat-rate no-limit primary care

reuters.com

69 pointsazanar26 comments

The problem is that the federal government explicitly penalizes this type of care through the tax code. Consumers pay these doctors with after-tax dollars while employers can use pre-tax dollars to buy insurance for their employees.

This is the central distortion in the US health-care system, and it is a major headwind for these innovative doctors.

You can set aside pre-tax dollars using an HSA (Health Savings Account. But this has some gotchas that require advanced planning, http://www.ustreas.gov/offices/public-affairs/hsa/.

HSA's are a step towards reform and are used by millions of people, but Congress is working to eliminate them:

http://money.cnn.com/2009/07/24/news/economy/health_care_ref...

HSAs are awesome if you are eligible. But, if you don't have a high deductible plan, you're not eligible. So this doesn't benefit people with lower deductibles from their employer who might still benefit from going to a doctor with a plan like this.

Really, it's like insurance in the sense that you're paying a monthly fee for access to the doctor. However, the relative cost is significantly lower than it is through insurance providers. Who would have thought that eliminating a middle man from a business transaction would mean better prices for a consumer and more profits from the service provider?

You only get primary care, so it's not really lower cost for the same thing.

They do cover 80-90% of the visits you'd normally pull out your insurance card for; including perhaps 1/2 of your emergency room visits, as they're available 24/7 for urgent care.

And considering that dealing with insurance paperwork causes a major overhead expense (estimated to be 1/2 of primary care dollars http://dpcare.org/dpc), dispensing with that cost can result in much cheaper care.

I've long heard it argued that the current model of billing insurance for primary care caused more problems than it solved. It's good to see entrepreneurs test this hypothesis.

Agreed! This is a perfect market for innovation to succeed.

If a quick Google is to be believed, Norm Wu is a EE+MBA.

I think healthcare is a field where some smart people coming from outside the industry can make some big improvements on the way things are done, especially when they reinvent the model.

Yes - the reason why health insurance is so pervasive as an employee benefit is that it can be written off with no taxes, whereas currently this kind of monthly-fee unlimited visit medicine can't. That's asinine from a tax perspective, but that's how the current system works.

Between people who don't get insurance through work and people who do but want better service, this has a definite niche.

The origin of health insurance as an employee benefit in the US is that during World War 2 wages were fixed, so employer provided health insurance was a government approved way to give more to the employee through benefits. Basically it's a bad hack to get around a bug.

> He rejected the idea that unrestricted access causes overuse, calling that "nonsense promoted by insurance companies .... There's nobody I've ever met who gets their pleasure by seeing doctors."

In my country where medical care is completely free (only medicines cost but they are often partially subsidized) there is problem with overusing doctors time by old, lonely people that just want to talk a bit and meet person that is concerned about them. Of course 100$/month price tag would drove most of them off.

Funny thing is that there are ideas in my country to introduce personal health insurances to get rid of ... long waits for some procedures and wasting money. That must be interesting problem if two antagonistic solutions fail similar way.

completely free = high taxes doesn't it? That's what it is in my country

Not really. It takes less than 10% of your income and it's almost completely deductible from income tax. Main trouble is that you have to wait long for some procedures (but not for general care), and that doctors and nurses as government employees periodically go on strike.

But restricted access causes underuse - people seeing a bump would hold off on paying $300 until they eventually start feeling pain and bam, they have a systemic tumor.

The solution to such a problem is pretty simple (and what they've done in Holland): Force everything to go through a single General Practitioner (of their choosing).

This makes it a lot more difficult for hypochondriacs to needlessly exhaust resources (like specialists), since the GP is aware of the patient's history of complaints.

It has lot of other nice side effects as well, as I'm sure you can imagine.

That's the way it's organized in my country as well. You have to go through GP to see any specialist (with exception of dermatologist, urologist and perhaps few others). It sure helps to save specialist time but there are public complaints about wasted GP time. Maybe the trouble in my country is just lack of money for medical care.

This model of care is called "Direct Primary Care," and IMO it's a big part of the real answer to high medical costs.

You can find more doctors like this at http://dpcare.org/practices

They've got listings for practices in quite a few states, and more info on the model.

My doc tried to roll out a flat-rate care plan a few years ago -- $4500/year inc. phone calls and visits. I couldn't go with it, and not just because of the price -- the referals system with my insurance company was entangled in a lawsuit, and I couldn't get a guarantee from the company managing the doctor that I wouldn't be charged some out-of-network rate for care.

I had to give up my doctor and find someone else.

A for-profit model using stock shares to entice doctors? It's already failed. They might be more efficient, but as long as profit is the motive and not spending money on treatment is the way to make a profit, it's only going to go downhill from here. Having shareholders demand more profit from a healthcare provider certainly doesn't sound revolutionary.

Accept that this model at least allows market forces to shape it a little. As opposed to Insurance Companies who get locked in customers due to deals with an Employee. Since the doctors alone are responsible for getting customers and have to compete against insurance companies for those customers there is a good chance that this could succeed. After all if it doesn't work they'll just go under. But if it does then you have improved healthcare for at least a portion of the population. Doesn't sound like a net lose to me.

Well, they've been around for 10 years and their patients seem to like them. I like them. So I don't think they have incentive problems.

They make a point of keeping any treatments they offer are revenue neutral. I just got a tetanus shot there today, and they sold it to me at cost. I like that, really -- it means they have no incentive or disincentive to give me medication.

This place is great. I have extremely comprehensive insurance, but it's worth the out of pocket expense to go here for primary care.

Just today, I sent an email to my doctor about a condition that was keeping me from sleeping. In under an hour, I had an appointment, and an hour after that, we met for a solid discussion over a stack of printed notes and research covering possible home remedies and treatments. A little over three hours after I'd initially sent an email, I had a diagnosis, a strategy, a solid understanding of both, and an invitation to check back in a few days and adjust things if they weren't working.

If you've spent time with regular doctors, the difference is night and day. It's well worth $50 a month for the sheer amount of time it saves me navigating paperwork, waiting for appointments, and generally being sick waiting for the doctor to get back to me.

Seattle's Swedish hospital is offering a similar service at their Ballard Campus.

http://www.swedish.org/body.cfm?id=2907&oTopID=1050

I get flat-rate, no-limit primary care at any medical institution I want at half their lowest rate, and I'm income discriminated rather than age-discriminated. (In Europe, private insurance)

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