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Does Direct Primary Care hate insurance?

In a word, no.

Insurance is a good thing.  Insurance is used to cover the cost of an event for which we don’t want to or can’t pay out-of-pocket.  For instance, we carry car insurance in part to cover the replacement price of a car in the event of a car accident.  If my car is in a wreck and is undrivable I want to be able go buy another car.  As a car goes down in value it becomes easier to replace and the car insurance coverage (collision anyway) goes down.  At some point we may elect to drop coverage as replacing it isn’t hard because it doesn’t cost much.  Also, we don’t generally carry insurance on minor things.  For instance, when my son buys a used video game they offer an addition fee to cover accidents that might damage the disc.  This is a form of video game insurance.  If the game breaks for any reason they’ll replace it.  Even though the fee is small, we never purchase the added protection for two reasons.  First, it’s just a video game and he could live without it, but primarily because he can afford the $19 to buy a another one if desired.

Insurance is great at helping us protect against the financial loss of an unexpected costly event.  However, it was never designed to cover the cost of things that are guaranteed to happen.  You can’t buy gambling insurance because the house always wins.  We all know that.  In healthcare, primary care is virtually a given.  Everyone will eventually need to see a pediatrician, an internist, or a family doctor.  We all end up with a cough, a sprained ankle, or a question about our cholesterol.  Yet we insure against that inevitability with a monthly premium and high deductible.

Admittedly, health insurance is more tricky than car insurance because it’s hard to say ‘no’ to something concerning our health.  One of the basic needs is to have good health.  In fact we have a saying, “Well, at least you have your health.”  Modern health insurance takes all our health concerns from the minor sore throat to the appendicitis to the brain tumor and lumps them together in one big package of coverage.  Do we really need to prepare against the expense of a strep test?  We end up preparing against some tragedies while prepaying for others.  The unexpected gets some protection while the expected only gets a price inflation.

We believe people have a basic need for food and offer many different community based and government run programs to help people obtain food who have been deemed at risk for not being able to buy it themselves.  That may be the approach health care should take.  We expect those who can to buy their own food and those who are unable we try to support.  As such, food remains one of the lowest margin industries.  The price of groceries is typically only 1.3% higher than the cost to provide the groceries.  Our society has lots of grocery choices so it doesn’t tolerate high prices or poor service for very long.  With healthcare many people feel stuck. They have one choice so neither the price nor the service matter.

The Direct Primary Care movement encourages all patients to be appropriately insured against health tragedies and certainly to obtain all the coverage required by law.  However, DPC also realizes that it is cheaper to buy your healthcare directly when the chance you’ll need it is high and the cost of that healthcare is low.  DPC wants insurance to be used for what it is always intended.  I heard it said yesterday that ‘Catastrophic Insurance’ is an oxymoron because all insurance is by nature catastrophic.  Let’s move health insurance back to that realm.  Let it cover the catastrophe and leave the ordinary to the free market.  The free market affords the best chance for the most people to get the care they need.

mbm

 

 

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