How Patients Can Protect Themselves Against Big Medicine

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.