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How Patients Can Protect Themselves Against Big Medicine

To regain control over your health care, you must regain as much control as possible over your health spending.

Paul Hsieh


September 26, 2013 - 11:46 am
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This is the fourth and final part in a series of articles on the rollout of Obamacare and how the law will change our health care system. Each week in September, we have published two articles — one on the changes in medicine and medical care and one on changes in the insurance industry. We hope this series of articles will help you make better decisions when it comes to your health care and how you buy insurance.


The first three articles in this series discussed the rise of government-controlled Big Medicine, how this will affect patient care, and how electronic medical records facilitate Big Medicine.

This final piece will discuss how patients can best protect themselves from Big Medicine.

For now, ObamaCare is the law of the land. This won’t change in the immediate future. In the meantime, concerned Americans can still take some steps to protect their ability to receive good medical care. This includes the following:

1) Take control over your health spending.

Under ObamaCare, the government will be responsible for the majority of U.S. health spending. Hence it will inevitably seek to control your health care. To regain control over your health care, you must regain as much control as possible over your health spending.

For many people, an excellent option is a health savings account (HSA). HSAs are tax-free savings accounts where patients can deposit their own money to be spent later for medical needs. Most patients use HSAs for routine predictable expenses (e.g., flu shots, well-baby checks), coupled with a high-deductible insurance plan to cover unlikely-but-expensive serious accidents and illnesses.

Because patients with HSAs control their own medical spending, they and their doctors have greater control over treatment choices without requiring approval from government or private insurers. Patients with HSAs enjoy comparably good outcomes as patients with traditional insurance, while spending significantly less.

2) Find a doctor who will work for you.

More and more primary care doctors are establishing “concierge” practices. Patients pay an annual fee in exchange for guaranteed 24-hour telephone access and longer personalized consultation time for complex medical problems. Appointments typically run 45-60 minutes, as opposed to the hurried 10-15 minute appointments common in many overcrowded primary care practices. Most concierge physicians will also act as your advocate if you require hospitalization for a serious illness, coordinating your care with the various specialists based on his detailed knowledge of your full medical history.

“Direct pay” practices are similar, but without the annual retainer. Many post their prices and offer excellent service at a lower cost, because they can eliminate the insurance middleman.

Because you pay the physician directly, he is not beholden to the government or other third parties. Concierge and direct pay practices can be a win-win for both patients and physicians. Physicians spend more time with their patients and can practice according to their best medical conscience, for reasonable reimbursement. Patients receive higher quality care for a fair price.

Nor are concierge practices necessarily expensive. Some services are surprisingly affordable, costing approximately $150 per month — i.e., the cost of a daily latte at Starbucks.

Paying cash can also protect your medical privacy in the era of electronic medical records. New federal regulations allow patients who pay cash to request that the details of their medical care not be sent to insurance companies. Hence, this frees your doctor to concentrate on doing what’s best for you, without worrying that his treatment decisions might skew his practice statistics.

Direct pay can also work for more advanced specialty care as well. The Surgery Center of Oklahoma posts their prices for various surgical procedures. Their internal efficiencies allow them to achieve excellent clinical results, while charging less than under the traditional insurance system. As a result, they’ve been cited by the New York Times, ABC News, and MSN as a potential model for market-based health reform.

3) Be engaged in your own health care.

Under Big Medicine, doctors will be under increasing pressure to limit the number of expensive tests they order or the numbers of referrals to specialists outside their network. Doctors will be tracked to see if they are ordering “too many” costly MRI scans or sending “too many” patients to the superb out-of-network cardiologist across town instead of the adequate cardiologist “in network.” Conscientious doctors will still try to provide good medical care to all their patients. But they will naturally have to exercise some discretion over the tests they order and referrals they make.

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All Comments   (6)
All Comments   (6)
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I'm a candidate for the DEATH committee and have an expensive health condition...macular degeneration. So far shots in my eye keep me from being blind. IT's hard to save money when the shots are $2,000 each.
A friend paid a concierge doc $175. and she never goes to the doctor. and died anyway so it was money down the drain. I tried going to one of those health emergency care places and they send me to the ER. So I wound up paying both places.
1 year ago
1 year ago Link To Comment
The government could conceivably outlaw the provision of any medical service outside of its system (Obamacare). See the dystopian movie Brazil, in which a man is on the run from the government for the crime of ... ? ...performing plumbing repairs without the proper documentation.

You are right, we need to take advantage of the free market options that we have while we still have them.
1 year ago
1 year ago Link To Comment
Go natural foods. Just eating right will cure most of America's medical maladies. We have already found the cure for cancer... It's in your kitchen.

Better to pay the farmer and the gym than pay the doctor.
1 year ago
1 year ago Link To Comment
The next step in the left wing playbook will be to try and control or eliminate concierge care and other steps that doctors might employ in order to stay independent. We will know when they are getting ready to do this when they attempt to institute a nationwide federal medical license and abolish the state by state system currently in place. If they do this then any medical practitioner will run the risk of having their license revoked if they do anything counter to the dictates of government run medicine. Forewarned.
1 year ago
1 year ago Link To Comment
I utilize a group (I have my own Dr. in the group) that charges $50 per 40 min. visit. They will also take my in insurance if need be. My visits are rarely 40 min. long. Cheaper than the insurance hassle as with it there is ALWAYS something that pops up where I have to pay (it's always one last payment for what ever that one last thing is) extra or no treatment. Several people I know use the ER only, because it's free. They can amply afford an office visit but use the ER for nearly everything. I spent many long days in the ER with my ailing mother. You would not believe how the system is used and abused. It was an eye opener.
1 year ago
1 year ago Link To Comment
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