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What Republicans and Democrats can do to fix our health care

Anyone watching the most recent round of Democratic presidential primary debates should recognize that in both the first and second sets of debates, all the candidates worked from the assumption that Americans face a binary choice: government-run health care or private health insurance.  Republican responses to the debates made the same assumption.

Big Brother or Big Insurance — love one, hate the other.  That’s the anemic range of health care messaging to expect from Democrats and establishment Republicans alike.  The problem?  Both sides are wrong — myopically, expensively wrong.

Democrats insist that you must love government-run health care and hate private insurance companies.  Republicans insist that you must love health care from insurance companies and hate government-run options.

But government-run and private insurer–run health care are both bad options, especially when Democrats and establishment Republicans present them as the only ones.  That’s why I choose option three: patient-run health care.  So do my patients, and so do countless other patients across the country — not that you’ll hear about them in the debates.  Such patients — many of them low-income — buy health care directly from their doctors for pennies on the dollar compared to what Democrats and establishment Republicans would have patients (or taxpayers) pay for insurance.

Instead of patient-run health care, expect to hear more about its opposite: government (single-payer) health insurance.  On its face, it sure sounds good: free health care!  Who wouldn’t like that?

Read the full article by Chad Savage, M.D. at American Thinker.

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Ep. 85 Trump’s 6/24 Executive Order: A Turning Point for Direct Primary Care?

President Trump’s June 24, 2019 Executive Order on health care transparency contains a key provision regarding direct primary care.  We have the pleasure of having back on the show Dr. Lee Gross.  Dr. Gross and colleagues in the DPC movements were instrumental in getting the White House to clarify a prior ambiguity regarding how direct primary care membership fees ought to be considered from a tax standpoint.  Dr. Gross will be telling us about this effort and about the implications of that change for the growth of the direct care movement.

Dr. Gross is a family physician in North Port, FL.  He is a pioneer and a leader in the DPC movement.  He is a health care consultant to physician practices, medical organizations, insurance groups, hospitals and private businesses. He founded and serves as President of the Docs 4 Patient Care Foundation and he is chairman of a new lobbying organization called DPC Action.

Listen to The Accad & Koka podcast.

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Why the Trump Executive Order Making Healthcare More Transparent Is A Big Deal

On June 24, President Trump signed an executive order, intended to return health care decision-making back to patients. It requires hospitals to publicly disclose how much patients will actually pay for services that they receive. It also gives patients the ability to use funds in tax preferred accounts such as HSAs (health savings accounts) to shop for health care. Both puts power in the hands of patients by providing information and opportunities previously unavailable to them.

Health care is the only industry where consumers have no idea how much they will pay for services until after they have received them. Powerful special interests, like insurance companies, hospitals and pharmaceutical companies, prefer to keep things as complicated as possible, shielding patients from the true price for medical services. At the executive order signing ceremony, a young woman shared the story about the stage 3 cancer that she successfully battled, but that caused her family tremendous financial hardship. Much of this problem was caused by the inability to shop for medical services. She had difficulty understanding why two bone scans done three weeks apart at two different facilities in the same city should differ in price by 30 percent.

Read the full article on Townhall.

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Refuting the Tortured Arguments Against Health Care Price Transparency

President Donald Trump signed a historic executive order on June 24 that will require hospitals and insurers to disclose medical care prices. Once enacted, patients will for the first time in decades have an unfettered view of the ugly underbelly of the health care beast.

Those who oppose health care price transparency rely on several arguments. One is that the process of revealing prices will prove very costly and that providers will pass this supposed expense on to patients.

This argument is ridiculous. The expense, if any, of posting health care prices will be infinitesimal to providers and vastly surpassed by the benefits to be created by empowering patients with additional pricing information. Prices are readily available on nearly everything sold throughout our economy. From a 25-cent gum ball to a $40,000 SUV, prices are almost always out front, posted, and prominent in U.S. markets. Only in medical care are prices obscured until long after the service is provided, leaving the patient with almost no negotiating power to get a fair price on these “gotcha” bills.

Read the full article at Townhall.com

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Physicians Applaud Executive Order Exposing True Health Care Costs & Opening Doors for Direct Primary Care Patients

FOR IMMEDIATE RELEASE
June 24, 2019

CONTACT
Dan Rene of LEVICK
202-973-1325 or drene@levick.com

PHYSICIANS APPLAUD EXECUTIVE ORDER EXPOSING TRUE HEALTH CARE COSTS & OPENING DOORS FOR DIRECT PRIMARY CARE PATIENTS

Transparency to Close Gap Between ‘Costs’ and ‘Price’ of Health Care and Allow for Patient Choice

[Washington, DC] [June 24, 2019] – At an event today at The White House, physicians from the Docs4PatientCare Foundation (D4PCF), the only health care organization composed of practicing physicians with hands-on, practical knowledge of the American health care system joined President Trump as he signed an Executive Order demanding transparency in what has become an opaque cost/pricing system.

At the event, physicians applauded the recognition of Direct Primary Care options allowing patients to use Health Savings Accounts for their care. These innovative relationships established between a physician and patient without the distraction of an insurance company or other third-party interference are increasing in the health care marketplace.

“In this age of information, we can compare prices on everything, except our health care, which places patients at a disadvantage,” stated Dr. Lee Gross, President of the Docs4PatientCare Foundation. “The prices patients pay for health care must be driven by the costs of that care, not a patient’s ability to pay nor a result of secret negotiations where the only motive is profit – at the expense of the patient.”

The Executive Order will compel disclosures of details on what it costs for insurers, doctors, hospitals etc., to provide health services. There is often a major delta between the costs of these services and the prices paid by patients, insurance companies, and the government.

“Until we know what the true costs are, having a fair pricing system is impossible,” Dr. Gross continued. “By developing rules that force everyone to show their cards simultaneously, we will finally achieve truth in the health care marketplace.”

The current system keeps patients and their doctors in the dark about pricing considerations – especially for the vast majority of predictive health care decisions.

The Docs4PatientCare Foundation team attended as guests of the White House and were recognized for their expertise and leadership in these transformational endeavors.

“While this Executive Order and subsequent rule changes may expose some warts in the previous contracting process, the patient will come out ahead. An informed consumer will be healthier and make better decisions. And doctors who pledge to first do no harm can take that a step farther and to do no financial harm to their patients too,” Dr. Gross continued.

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Please visit: http://d4pcfoundation.org/

For more information or to schedule an interview with the Docs4PatientCare Foundation leadership, please contact Dan Rene of LEVICK at 202-973-1325 or drene@levick.com

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Fixing High Healthcare Costs Should Help Patients And Not Insurance Companies

The latest attempt to tame the healthcare beast is a surprisingly bipartisan effort coming out of the Senate. The Lower Healthcare Costs Act of 2019, introduced by Senators Lamar Alexander (R-TN) and Patty Murray (D-WA) would attempt to solve a problem that has attracted considerable attention recently- surprise medical billing.

Surprise medical billing occurs when a patient who has insurance, receives a bill from a doctor after expecting the services they received to be covered and paid for by insurance. This troubling situation mostly occurs in an emergency situation and fortunately does not occur very often. However, when it does, it is aggravating to patients and costly.

The proposed Senate bill attempts to fix this problem by dictating that doctors not on insurance panels are paid a rate that is tied to the Medicare fee schedule in their community. This is a bad idea which will have far-reaching ramifications, ultimately harming patients in the long run.

Read the full op-ed on Townhall.com

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DPC Physician meets with Senators and Congressman on HR6199

Dr. James Pinckney II, ABFM of Diamond Physicians met with eight senators and two congressmen last week in an effort to reintroduce the Direct Primary Care Bill HR6199.

To further demonstrate the effectiveness of direct primary care, Michael Schneider, CEO of A-1 Locksmith DFW, accompanied the team. Together, they presented how a small blue-collar business was able to save 25% on their health benefits as a company while improving the care and health of their employees.

As this process progresses, it’s becoming increasingly likely that direct primary care membership will become a qualified medical expense under 213-D via executive order. This would allow for the bill to bypass congressional approval.

Upon passage, the bill would allow consumers to use HSA cards to pay for direct primary care membership.

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An easy, free way to lower health-care costs for millions of Americans

In October, the Trump administration proposed a new rule that would expand the ways employers can use health reimbursement arrangements (HRAs) to provide their employees with high-quality, low-cost health coverage. The United States Department of the Treasury estimates that once the new rules go into effect, 800,000 employers will take advantage of HRAs, which could affect coverage for more than 10 million employees.

HRAs are employer-funded accounts used to augment group health plans. Contributions made to HRA accounts are not taxed. Under Obama-era rules, HRAs can be used by employees to pay for qualifying health expenses, as determined by federal regulations and employers, in conjunction with a group health insurance plan.

HRAs can, for example, be used by people to cover out-of-pocket costs for a medical procedure. Funds that remain in an HRA account at the end of each year can be rolled over to the following year, encouraging health care savings.

Although HRAs currently offer some employees and their family members important benefits, they have been limited dramatically by federal agencies — a problem the Trump administration is now working to solve.

The administration could improve its proposed rule by clarifying that patients who pay for direct primary care (DPC) agreements would be eligible for reimbursement through their employer’s HRA. By classifying DPCs as a qualifying health-care expense, employees could use their HRAs to pay DPC costs, making it easier than ever for them to have access to more affordable primary care services.

DPCs are fixed-fee agreements made directly between primary care doctors and patients. Direct primary care agreements offer patients access to a defined set of health care services, including chronic disease treatment, check-ups and various health tests, at a flat, fixed monthly rate. At Epiphany Health, the direct primary care practice I founded in North Port, Fla., we charge only $65 per month for an adult membership and $25 for one child. A four-person family pays just $155 per month to receive primary care services, as well as have access to other typically more expensive care, like MRIs or blood tests, at a steeply discounted rate.

As the Docs 4 Patient Care Foundation, an organization I serve as president, noted in our substantive, eight-page comment invited by the administration, allowing the millions of people expected to access HRAs in the coming years to use these funds to pay for DPC agreements would be one of the most important improvements the Trump administration could make to the proposed rule. This would not only save money for millions of people, it would also reduce health care costs across the board and encourage those with HRAs to access routine care, save money and build up the funds in their HRA accounts.

Read the full article at The Hill.

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D4PCF Asks Trump Administration for Tax Protection of Direct Primary Care Members and Their Employers

An 8-page legal letter asks multiple federal departments to recognize DPC membership dues as tax-free medical expenses

WASHINGTON, January 4, 2019 — Last week the Internal Revenue Service (IRS) received an official request from the Docs 4 Patient Care Foundation (D4PCF) to recognize dues paid to direct primary care (DPC) practices as tax-free medical expenses reimbursable by employers.

Multiple federal departments ought to clarify “that the monthly fees associated with DPCs are qualified medical expenses which can be offset by HRA funds,” states the eight-page letter, which has 31 footnotes citing federal regulations and court cases.

DPC membership is not a form of insurance, so dues are a legitimate medical expense, D4PCF argues. Consequently, patients should be allowed to submit their monthly membership costs—which range from $40 to $150 per person—to their employers for tax-free reimbursement, if their employers offer health reimbursement accounts (HRAs).

The Trump administration appears amenable to the viewpoint that tax protection for DPC patients is long overdue, according to a statement made by D4PCF Board President Dr. Lee Gross upon filing the letter:

“The direct primary care community has spent many years frustrated by the lack of progress in fixing the HSA issue that has hamstrung the DPC movement for so long. D4PCF recognized an opportunity to advance this initiative through our multiple meetings with the executive branch, while also working through our legislative priorities.

“D4PCF engaged the Washington, D.C. law firm of Foley Hoag to draft a legal basis for allowing HRAs to be used for DPC memberships. This legal argument was submitted as a formal comment to the Departments of Health and Human Services, Treasury and Labor during the public comment period for the proposed rule for overhauling the use of HRAs across the country.

“We look forward to continuing to work with the Trump administration and Congress to expand access to this affordable care model for all Americans.”

D4PCF filed its letter as a comment on the proposed rule “Health Reimbursement Arrangements and Other Account-Based Group Health Plans” (REG-136724-17).

In November of 2018, Gross testified to the U.S. Senate Health, Education, Labor and Pensions Committee that removing barriers to DPC membership would immediately achieve multibillion-dollar savings for patients and taxpayers.

Docs 4 Patient Care Foundation is the only 501(c)(3) public policy think tank governed exclusively by doctors standing up for the health and freedom of patients and physicians. The D4PCF mission is to preserve the sanctity of the physician-patient relationship, promote quality care, support affordable access to care for all Americans, and protect the patient’s personal health care decisions.

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Direct primary care can rein in America’s out-of-control healthcare costs

By: Dr. Lee Gross

While Democrats and Republicans debate the merits and drawbacks of reforming America’s broken health insurance system, few policymakers are paying attention to perhaps the biggest reason health insurance is so expensive: The actual cost of healthcare, which insurers have to pay, is out of control.

There are many reasons the cost of providing healthcare has been steadily rising in most sectors of the healthcare industry. One of the most important is that the traditional health insurance model wastes piles of cash. It pays health insurers to act as middlemen between patients and their doctors. Patients continue to use their health insurance to pay for virtually every healthcare service, including those that they could easily pay for on their own, like primary care visits, flu shots, and routine exams.

Insurers’ involvement in nearly every primary care visit is causing healthcare expenses to skyrocket. Patients are being forced to pay extra so insurance companies can facilitate transactions they really don’t need to be involved in. Not only does this cause the cost of primary care services to rise, it also forces doctors to squander time filling out paperwork instead of treating patients. Some doctors choose to hire more staff to handle much of the administrative work, also contributing to the rising cost of providing primary care.

As I recently noted in testimony before the U.S. Senate Committee on Health, Education, Labor, and Pensions, “We don’t expect our homeowner’s insurance to pay for blown light bulbs or routine maintenance. Imagine how complex and expensive it would be to purchase gasoline if we used our auto insurance to pay for fuel. This is what we expect from our health insurance, yet we are surprised that it is expensive, inefficient, and impersonal.”

Fortunately, there is a better way to provide primary care, one that offers high-quality healthcare services for much less money and without inflicting mountains of complicated insurance paperwork and government regulations on doctors.

Direct primary care is a membership-based primary care model that provides patients with a set number of healthcare services in exchange for a flat monthly fee. At Epiphany Health, the direct primary care practice I founded in North Port, Fla., we charge just $65 per month for an adult membership and $25 for one child. (A membership for each additional child is just $10.) A family of four pays only $155 per month.

In exchange for that fee, we offer all of our members the primary care services they need most often, including physical exams, EKG testing, strep and urine testing, blood-thinner monitoring, minor surgical procedures, joint injections, and much more. Patients don’t pay a single penny more for these services beyond the cost of their membership fee.

Read the full op-ed at the Washington Examiner.

 

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