Investing & Startups| August 29, 2018
Hungry for Healthcare Solutions? Meet Direct Primary Care and HR6199
A whopping 44 percent of Americans who were sick or injured last year chose (yes, chose!) not to see a doctor. Why? Research says they were intimidated by the confusion and expense of the healthcare system. For those millions and others like them, the recent passage of HR 6199 in the U.S House of Representatives signals that new, more appealing solutions may be just around the corner.
Now awaiting action in the Senate, HR 6199 passed the House in July by a vote of 277-142, with 9 abstentions. The legislation modernizes the list of medical goods and services eligible for purchase with Health Savings Accounts (“HSA”), leveraging the rapid proliferation of these popular savings plans throughout the country to spur grassroots innovation in healthcare delivery.
HSA-holders are hungry for solutions. In recent years, they watched their insurance premiums spike while their coverage shrank behind higher deductibles. However, the Affordable Care Act disfavored HSAs and curtailed their use even as out-of-pocket expenses skyrocketed. With HR 6199, Congress is set to expand Americans’ freedom to spend their own health savings in ways that best suit their individual needs, rather than limiting 350 million of us to the same “one-size-fits-all” menu of healthcare options.
So how does an obscure tax code change enable better access to quality, affordable care for Americans?
Start by considering the problems that bedevil our current system.
Pricing is murky and expensive. Networks perplex patients and restrict choices, while effectively locking out the uninsured. Even those patients with health insurance must wait weeks (or even months) for an appointment when they desperately need care, forcing them to choose between “drive-thru” clinics or expensive, crowded emergency rooms. Who is winning here?
It gets worse once at the physician’s office. If those patients finally get in to see a doctor (often after wasting hours in the waiting room), visits are often too rushed for doctors to fully answer patients’ burning questions. Overwhelmed doctors, fearing penalties from onerous administrative mandates, are forced to focus on their computer screens more than their patients. Often, they can do little more than react to patients’ problems by throwing pills at symptoms before hustling out the door to the next appointment.
Today’s average patient visit has dwindled to 12 minutes, meaning doctors rarely have time to fully explore each patient’s issues to resolve underlying health problems. Not only are these encounters unfulfilling, but research indicates that seeing a physician who is rushed, distracted and only half-listening is more likely to lead to serious health problems. In fact, beyond an inconvenience, the British Medical Journal recently reported that building a foundational, personal relationship with one physician can actually save lives.
Why does 21st century American healthcare look like this?
In this dynamic economy where we can obtain nearly anything within 24 hours from a device in the palm of our hand, why is it so difficult to obtain good healthcare when needed?
Why can’t we know the price of visits or procedures in advance?
Where are the doctors with time to look you in the eye, listen, and go beyond insurance billing codes in search of a cure?
HR 6199 increases the chances that you’ll get the chance to enjoy this type of “old-fashioned” care once again. Among other benefits, the legislation authorizes the use of HSA’s to pay for membership in Direct Care practices. In these radically-simple and fast-growing practices, patients and doctors cut out insurance companies with their co-pays, restricted networks and other barriers. For a flat monthly fee averaging $60 to $120, patients easily secure unobstructed access to their own personal physician: similar to “concierge medicine,” but much more affordable for the average American.
The benefits of innovations like Direct Care ripple through the entire system. Patients get to choose the care that best suits them, and purchase it directly from their own physician for a clear, affordable price. Doctors are free to explore new therapies and holistic medicine, since they are no longer forced to limit their playbook to the insurance industry’s billing codes. They have time to get to know each patient, refocusing their talent and energy on prevention and quality of life issues, which is proven to reduce expensive claims and hospitalizations down the road.
Instead of annual price hikes, health insurance finally gets cheaper since it’s no longer funding routine medical care. Specialized insurance products are already emerging to complement direct primary care, guarding against large-scale events like hospitalizations while discounting that portion of the premium allocated to primary care – which can translate to a 20 to 30 percent overall premium reduction.
Entrenched interests have stymied innovation in healthcare delivery for decades, even as other industries modernized
The entrance of renowned disruptors like Amazon reveals an industry ripe for innovation. Critics bemoan HR 6199 and consumer empowerment in healthcare because it grants people the right to exit the established, broken system by voting with their dollars – but disruption has marked the ascent of human progress over the centuries and today. Tens of thousands of Americans – old, young, rich, poor, insured and uninsured – are already voting with their dollars by flocking to direct care practices. HR 6199 could further accelerate the availability of alternatives like this that ultimately deliver better value to consumers by eliminating the barriers that make medical care so difficult to access and degrade its quality.
When citizens in a free society direct their savings to the type of goods or services that best suit their needs, efficiencies like Direct Care emerge. Murky hidden charges are supplanted by clear, up-front prices. Long wait times and rushed appointments are eclipsed by same-day, punctual visits that last as long as necessary. Health insurance costs adjust to reflect the financial risk of the individual customer, rather than a stealth subsidization of government exchanges. The astronomic cost of healthcare begins to recede as market pressure compels the industry to modernize and provide better service for clearly marked prices.
The ultimate goal? High-quality American healthcare that is both accessible and affordable. Achieving this goal should unite all sides of the political spectrum, and does not necessarily require the political pain of massive, systemic reforms.
Hopefully the Senate seizes the opportunity offered by HR 6199. By modernizing HSAs, Congress can help accelerate the types of innovations that are expanding choice and already making this dream a reality for patients across the country today.