Single payor

(cjs56) #1

I was wondering what the D.P.C. Community thinks about the possibility of the Single Payor System and is possibility of it becoming law in the near future?
That is, how would Single Payor affect the D.P.C. world?
I have lost faith in any type of government run health care except for those that honestly are not able to afford it and who have a very difficult road to get off Medicaid and to join a D.P.C. practice. I empathize with them.They do exist.
I am a big fan of Gillebrand and Bernie and the others as people and support some of their other issues. It’s just that I do not see their Single Payor Plan as being a better solution than D.P.C. Maybe I do not know enough about Single Payor. But, it sounds like more government without any real guarantee of improved health.

(Robin Dickinson) #2

That’s an interesting question. I personally don’t think single payer would have much of an effect on DPC except maybe to slightly shift the demographics of who our patients are. Full disclosure: I’m in favor of universal health care and think that for-profit insurance companies are evil.

(Robin Dickinson) #3

@philsq What do you think would be the effects of single payer on DPC?

(cjs56) #4

Got it. Just hoping that single payor would not hurt D.P.C. and would not be too much government interference.

But, single payor could decrease insurance market power and be better for D.P.C.

(Robin Dickinson) #5

Especially in areas where one insurance company has a throttle hold on the market.

(Dr Phil Eskew, DO, JD, MBA) #6

I doubt the government (as a payor) could effectively understand DPC. I hate the large insurance companies as well. I think there are more effective ways to make them irrelevant than going single payor. If the single payor system is an acceptable floor of care (similar to our food stamp system) then this could be helpful. If the single payor system is a false promise of cadillac care while simultaneously banning the practice of private medicine - then that would be the end of DPC and then end of my medical career (I would solely practice law).

(Robin Dickinson) #7

I can’t imagine that actually happening… our country seems to be all about making exceptions to every rule.

(czechm1) #8

If Phil’s one theory is correct and a single payer system was only used as a foundation for those who sort of slip through the cracks then there is a chance DPC would survive. However, I do not see any version of single payer that would allow DPC as we know it, to survive. Even in countries that have relaxed their single payer systems, only the wealthy can afford the private doctors. DPC survives because it is an option for all. And to be honest, we have forms of single-payer system out there and it is called Medicare and Medicaid. Many of us got into the DPC model to get away from those models that are government run. The are wasteful, restrictive, and prevent ingenuity and innovation. If anybody wants to see what a single payer program would look like, just look at those programs. I believe it was Bernie who actually wanted Medicare or Medicaid for all. I personally could not support that. DPC allows for innovation and true collaboration… most of us have been more than happy to share our experiences, good and bad, to better our practices. DPC allows providers to look at the market and cut costs in very creative ways. I can check labs so much cheaper than what is billed and payed for through Medicare and Medicaid simply because of bloated bureaucracy. DPC allows me to take the time to sit and create a plan with my patients and truly work together towards better health for the patient. It is me and my nurse who are hearing about the donut hole that so many of our Medicare patients suffer and then finding ways to get around it. We are the ones who are now able take the time and sometimes tell them to not use their insurance because that medicine is cheaper through other means. All these are issues that I suffered through for 15 years with private insurance but also the government run models that a single-payer system would be modeled after. No thank you!!! Viva la DPC!

(Robin Dickinson) #9

But is that because of the prices the private doctors charge? How would our prices be driven up?

Then doesn’t that mean there would be a definite role for DPC in single payer?

I’m just not seeing how having single payer would magically transform the country into a place where DPC can’t exist.

(cjs56) #10

I agree with you. I believe the single payor would hurt the D.P.C. market. That’s why I was asking. I was thinking that a D.P.C. physician might even have to “opt-out” of a single payor since it is government run.
A “slip through the cracks patient” would be one that makes too much money to qualify for Medcaid yet is not able to afford health insurance…correct?
One way to look at it would be…as you said…take a look at the other countries with single payor and see if there are any D.P.C. models in that country and how the D.P.C. models are doing.
I am not sure f there are any D.P.C.s in Canada or Germany or Australia?
In the end, the U.S. voters decide, and if they vote for a single payor, then I guess a D.P.C. physician would have to decide how to re-structure the D.P.C. practice.
Best to get a book on single payor, read it and try to critically decipher the salient points …as would relate to a D.P.C. practice.
In essence, it is out of our control unless lobbying can be done on D.P.C. behalf to try and weaken single payor.
It usually revolves around pricing…is D.P.C. less costly for the patient that a single payor?

(cjs56) #11

The more you read…the more you learn.

(Robin Dickinson) #12

I thought DPC was invented here. We could just as well look at countries without single payer and see if they have any DPCs. I’m guessing we won’t find many (or maybe any) outside our country.

I just really don’t want to adopt a “sky is falling” attitude. I opened my practice prior to the ACA taking effect. Everyone said, “Oh no, don’t do it, what if what if what if…” The reality is that I only need a few hundred patients to be successful. I’m not at all worried that I’ll have trouble finding a few hundred people who need me. :grin: People say not to do it in areas dominated by Kaiser…but the majority of my patients who have insurance have Kaiser. There isn’t a rule about the exact situation DPC needs to thrive. The glory of DPC is that we can role with the punches.

(cjs56) #13

You are right. With the low volume of patients needed for D.P.C., then outside threats may not be so formidable.

(czechm1) #14

DPC does not need many pts but in a single payer system, depending on how it is drafted, is exactly what it sounds like “single”. There are no other options and even if there are carve outs, it will become much harder for average Jane and Joe to even pay for a monthly membership fee when they are essentially coerced into taking the single payer plan. I have plenty of Medicaid and Medicare pts from my old traditional practice who wanted to follow me into DPC for all the reasons we do DPC but couldn’t justify the cost. Those with private insurance can more easily see the true cost of healthcare and justify the transition to DPC.
By the way, DPC exists under Obamacare for 2 main reasons. The first being the most important, it was literally written into the law as an option. The second is that there are still other options (like high deductible plans) so people can choose and we can compete with cost. A single payer system will force so many pts to pay more in taxes that we would not have an option. The tax increases that Bernie’s plan suggested will be no better than just keeping the system as it is and let cost continue to rise
So I am not a “sky is falling” guy either but just discussing why I feel single payer is not, in general, compatible with DPC.

(cjs56) #15

Sounds like you hit the nail on the head. Patient may choose the free or cheaper plan. Othes will pay higher taxes. Free care is not free. But, I still think DPC could be done. Suppose single payor turns into what they call “7 minute visits?” Then, the patients may switch back to DPC.

(Robin Dickinson) #16

That’s just it… There will always be people who believe they just can’t justify the expense and there will always be people for whom it’s worth it. I know plenty of people who say they can’t justify it who have plenty of money and people just barely squeaking by who think it’s a great deal… And it’s not always because they are stuck between a rock and a hard place when it comes to accessing care.

(cjs56) #17

It may take 10 more years before single payor would be enacted. Come to think of it, I see your point. Money may not be factor in choosing D.P.C. Part of it could be whether the Medicaid, Medicare, insured or uninsured patient…actually likes the D.P.C. model.

Good way to think of it. And, a real life example.