MICHIGAN State Senator, P. Colbeck: ‘The Return of Direct Primary Care’

The Return of Direct Primary Care

ColbeckIn March of 2014, Michigan will join 25 other states in the implementation of the Medicaid Expansion component of Obamacare. Supporters of this expansion maintain that it will expand coverage, save the state money, and address uncompensated care at hospitals which drives up insurance costs for everyone in our state. Politically, it would be expedient to take these assertions at face value and say, “Medicaid Expansion is the law of the land. Move on.”

The only problem with that is that I was not elected to be “politically expedient”. I was elected to promote the best interests of my constituents. My attempt to reflect these interests is represented by the platform on which I ran for office. This platform featured the promotion of effective healthcare solutions and that is what I will continue to do.

Regrettably, effective healthcare solution is not an apt descriptor for the expansion of Medicaid under the Healthy Michigan program. First of all, coverage does not equate to quality care. Second of all, anytime a budget increases by over $1.5B, it is difficult to make the claim that we are “saving money”. Third of all, substituting uncompensated care for undercompensated care in hospitals by expanding Medicaid eligibility is akin to saying “I know we are losing money on every transaction, but we are making it up on volume”.

What would be an effective healthcare solution? The Patient-Centered Care Act reflected in SB 459 and 460. The solution has been described as “two parts Marcus Welby and one part Steve Jobs” by David Chase of The current healthcare system features a bureaucratic government-insurance-administrator-doctor-patient healthcare relationship. The focus of the Patient-Centered Care solution is the doctor-patient relationship. It harkens back to the days when healthcare didn’t focus on insurance cards and paperwork. It focused on people.

How do we do that? Eliminate the need for the “government-insurance-administrator” roles in the delivery of healthcare wherever possible. The best place to start is with the delivery of primary care services (i.e. Pediatricians, Family Practice Physicians). These are called “primary care” services because they are the “primary” delivery methods for healthcare. If you remove the bureaucracy, doctors can provide all of the high quality primary care services that you need for less than your monthly cable or cell phone bill.and they can provide these services independent of whether you have a pre-existing condition or not.

What about hospitalization or major medical concerns? There are some expensive services that fall out of scope of primary care services. For these services, we would still need insurance, but the scope (and cost) of this insurance would be reduced. For many years, insurance was all about “risk” management. In recent years, insurance has morphed into “benefit” management. Costs have spiraled upward as more and more paperwork has been inserted between the doctor and the patient. The Patient-Centered Care Act would promote the return of insurance to the role of “risk management” resulting in access to high-deductible health plans that once again cost as much as your cable or cell phone bill.

What happens if I need to pay the deductible? The long-term solution is the establishment of a Health Savings Account where individuals can deposit tax-deferred income to save up for deductible payments should they become necessary. The short-term solution would be to purchase what is referred to as “gap” insurance. Insurance against invoking a $5,000 deductible can be obtained for as little as $35/month until you have an HSA balance sufficient to cover the deductible.

There you have it. Direct Primary Care Services + High-Deductible Health Plan + Health Savings Account = Patient-Centered Care.

Despite Government bureaucracy that continues to stunt its growth, this healthcare delivery model is growing in pockets throughout our state and our nation. Michigan has the opportunity to be at the center of a “free market revolution in healthcare” according to Avik Roy, Senior Fellow at the Manhattan Institute of Policy Research. Whether or not Michigan adopts this model, other states will be doing so.

We have a simple we want to lead or follow? If we lead, we have the opportunity not only to provide more effective healthcare for our citizens, but we also have the opportunity to promote job growth in our state by removing one the most significant hiring barriers for employers – high healthcare costs. I believe it is time to lead.


2 replies »

  1. This is a great perspective and analysis given by Senator Colbeck.

    I particularly appreciate the discussion about the “uncompensated care” misunderstanding that has turned into a talking point for advocates of more government intervention. There is a reasonable amount of statistical and observational data that suggests quite strongly that increased enrollment in Medicaid by those currently eligible, but not enrolled, would actually cause governmental, and thus societies’ costs to increase.

    This makes sense when you think about it. The uninsured (that are now eligible for medicaid) do end up in the ER for “uncompensated care” as the hospitals like to call it. However, most “not show a profit” hospitals, are reimbursed via CMS for a large percentage of non-collectible care costs. Furthermore, because these patients are not enrolled in medicaid, the state and federal government does not have as high of a payout and tax dollars are not consumed at such a high rate; Furthermore, these same patients are not very likely to go to the doctor for trivial issues due to cost, so they utilize less overall than their peer-matched medicaid recipients. One reason for this observation is that the way Medicaid is structured incentivises the wrong behavior.

    Kudos to a politician for speaking out truthfully with good evidence to back up his points.

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