I was asked about the following link “Doctors descend on Vermont to restore patient control over health care” as well as the ACA and single payer.

The Vermont model from the link sounds like lower cost concierge medicine, which I touched on a few posts back. In general, I like anything that lowers overhead and improves patient and physician contentment. Especially for primary care, membership models make lots of sense, because illness prevention is strongly incentivized. I don’t use memberships for Pre-R because I’m offering basic acute care instead, and I’d like to be available for the full socioeconomic range.

ACA and single payer are tougher nuts to crack. The ACA makes me nauseous, but so does (did) 45 million uninsured. Euler’s identity -for math nerds- is elegant and from the heavens. 1000+ pages of anything is inelegant and bound have problems. But it’s such an enormous bill that it can’t get just a thumbs up or down. I’m glad more people have insurance now. I’m glad folks can’t be denied insurance for preexisting conditions. Until price transparency and tort reform are addressed, however, I’m not interested.

For most of my medical career I’ve felt like a cog in a non-round wheel rolling in directions I don’t really want to go. Plenty of uplifting moments and I love the people I work with, but the system pre and post ACA remains downright embarrassing.

Pre-R for me represents the chopping out of all aspects of medicine that I dislike. Finally, I can keep a logical record. No coding, billing, collecting. No insurance company wrangling. And most importantly, medical care comes first with no financial bite weeks to months down the line. I realize that Pre-R can’t apply to cancer care or heart surgery (yet). But it’s my tiny little alternative universe for one sliver of medicine. Actually, I have to thank the ACA, because by upturning the apple cart it has made Pre-R possible.

Patients have huge deductibles now
and are becoming much more cost conscious/paranoid.

My deductible is $4500. If you’re in the same boat, I’m pretty sure Pre-R can beat it! As for single payer I don’t think our government or any one entity is capable of taking on the task. Plus I believe the definition of “healthcare” needs to be nailed down first. Trauma, diabetes, dialysis, vaccinations, transplants, botox and hospice can’t possibly fit under the same umbrella. But if anyone wants to try single payer, I’d first point them toward vaccinations, addiction rehab, vasectomies, tubal ligations and hospice care. Each of these can have hugely positive ripple effects for society and individuals. That’s the experiment I’d want to run. But for now, I’m sticking with Pre-R.