Direct primary care is an interesting model and the article is exactly right that administrative costs (that is, trying to get someone else to pay the bill) are the fastest growing portion of our medical spending.

Still, it's important to point out the limitations of the model. The obvious one is that it only works for primary care. Fresh eggs and goats milk aren't going to pay for chemotherapy, dialysis or heart-lung transplant surgery. Neither will they pay for the overhead costs of keeping a major trauma center or neonatal ICU up and running.

Another limitation is one of scale. Direct primary care works best with indiidual practitioners or small practices with close ties to the community. It also requires the physician to be a businessperson as well as a care-giver and to accept more financial risk in operating a practice. For many doctors, particularly those graduating with hundreds of thousands of dollars in student loans, there is a strong pressure to join a large established practice to have a predictable salary.

In short, it's an interesting model and one that can be very promising in certain circumstances but it's unikely to think that it would scale to address all, or even a significant subset, of medical care in the US today.

Neither will they pay for the overhead costs of keeping a major trauma center or neonatal ICU up and running.

Most people don't seem to understand that this is a large part of what your insurance premiums are putting into place for when you need it.

Health insurance builds the system (flawed though that system may be).

Direct primary care is like paying that fireman guy who put up a notice at the local church to put out the fire at your house. He'll probably be well-trained and may even have some appropriate tools.

However, if you want him to respond with a full complement of trained firefighters in a hook and ladder truck at a moment's notice, you're gonna need to set up a fire department in advance of the fire.

It never ceases to amaze me that people who can come with hundreds of dollars to fix their car never have any money to pay for healthcare.

They also always have i-Phones. And active social lives where they often consume lots of alcohol.
Just sayin...

"They also always have i-Phones. And active social lives where they often consume lots of alcohol. "

Quite right. To quote one recless spender/ recent college graduate. " There will always be bills that have to get paid, which will always find a way. But this $ is here now and I'm going to spend it"

Much of this behavior was learned from their parents in that, the parents wouldn't give them $ for beer/parties in school. but would shell out for the necessities. The necessities quickly became the last thing to get paid because they had an out with those bills.

Why would I pay for healthcare when I can get it for free and buy
these instead??

Yeah, well, one of the Five Guys guys is mightily p.o.'ed about Obabacare:

http://money.msn.com/now/post.aspx?post=5cc2b240-49cf-471a-8f1f-3c22387174d8

From the article: "Mike Ruffer, a former Marriott (MAR +0.60%) executive who owns eight Five Guys restaurants in the Raleigh-Durham area, told attendees of a seminar dedicated to the new health care law and hosted by the Heritage Foundation that all the profits from one of his eight outlets would have to be dedicated to health care and that “any added costs are going to have to be passed on."

"Five Guys headquarters, perhaps with the president's 2009 visit to a Five Guys in its Washington, D.C., birthplace in mind, immediately put a few peanut bags' worth of distance between itself and Ruffer.

""Mike Ruffer is a franchisee of Five Guys and independent business owner," Molly Catalano, director of communications and public relations, wrote in an email to The Huffington Post. "He does not represent Five Guys on this or any other subject matter.""

I guess they'd rather stay mum and court their growth potential. Maybe they think it'll all go away after a while...

The NY State legislature has decreed that I can't even buy an insurance policy for catastrophic illness. This might be the future, but it won't be the future, here.

$128 for an IV bag? That's *salt water*! Even D5W is salt water with a bit of sugar.

I guess they'd rather stay mum and court their growth potential. Maybe they think it'll all go away after a while...

No.

It will keep potential competitors from growing too large. Any time a big business is in favor of legislation, it is usually because it imposes a barrier to competition, or otherwise provides them a competitive advantage.

Having to compete on merits: hard.

Having a governmental body do the dirty work for you: priceless.

@Factual: "Another limitation is one of scale ... It also requires the physician to be a businessperson as well as a care-giver and to accept more financial risk in operating a practice."

That's a good point (and so were your others). But even a partnership, which might need a little administrative overhead to do it, could still manage to operate on a direct primary care model. In any case, by stripping away the layers of bureaucracy, the direct primary care concept suggests something important -- that costs for medical care can be mostly knowable and predictable.

Now, catastrophic and chronic care? That may be a whole different issue, but something tells me that could be simplified a lot.

For simple consultations, why bother with Skype when insurance will
pay full price for an office visit.

That must have been written by someone who has never visited his
doctor's waiting room. The price for visiting the doctor is not
purely monetary, and I suspect many people would welcome a
shortcut where appropriate.

Well, for starters, it's crazy that if I want to pay cash for medical services, I have to pay more than the contractual rate paid by an insurance company. If health premiums increase enough, it might be more advantageous to bank the money and pay cash. This variable pricing is just nuts.

And while we're on this topic, with Obamacare, all of us taxpayers will be subsidizing those with bad habits (too many donuts, excessive alcohol, not wearing seatbelts, helmets, etc.). I think there will be a lot of backlash from people who take care of themselves and do not want to subsidize those who don't. This could get ugly.

I pay cash for some medical stuff, and I get a discount. Most MDs are glad to do so.

I think there will be a lot of backlash from people who take care of
themselves and do not want to subsidize those who don't.

... and how is this supposed to be a change from the status quo?
Currently, anyone who gets group medical insurance via their
employer is doing exactly the same thing.

I think that averaging the risks is far better than having the
insurance company or the government be our nanny and mandate
helmets, long underwear in the winter, and the size of the soft
drinks we're allowed to consume.

The one that always amazes me is that I can walk into Wal-Mart and buy a vial of insulin for about $25 cash. I walk into CVS or Rite-Aid and pay about $50 a vial.

I mean the exact same barcode.

WTF?

"Dr. Ryan Neuhofel, 31, offers a rare glimpse at what it would be like to go to the doctor without massive government interference in health care."

Well, DUH.

The hospital double-billed me for anesthesia for a colonoscopy. The bill arrived with the statement that it had been audited and was correct (no). I pointed out another discrepancy: a local anesthetic was not used. I was told it would be removed.

Magically, when the charge for a service not rendered was removed, two "adjustments" appeared for exactly the same amount - a hilariously obvious way to avoid changing the bottom line!

The cost for medical services can and does far outpace the costs for car repairs and cell phones. Having a baby cost $23,000. We have a great insurance plan, so it cost us $3,000 out of pocket. It's difficult to put that on par with a data plan and fixing a headlight. And having a car and a cell phone is frequently an economic issue. Lots of people wouldn't be able to make it work without their cars. People need their cell phones (more and more frequently their only phones) for work, too.

Plus, personally acquiring the services of all the nurses, doctors, midwives, orderlies and anesthesiologists I worked with would have been a nightmare.

"The cost for medical services can and does far outpace the costs for car repairs and cell phones."

You really need to ask yourself, "Why?"

It's not a given, it's not a "done deal". In other industries, advances have also been made.

I suggest that you do NOT want a government agency telling you what cell-phone features you may have, or when you may have your car maintained or repaired. There's something very strange going on with people who think what we have is even good, much less the best that can be done.

The cost for medical services can and does far outpace the costs for car repairs and cell phones.

Mostly due to lawsuits and regulation.

If your mechanic, after spending 8 years on an education costing half a million dollars, risked a potentially career-ending lawsuit every time he failed to correctly diagnose an engine problem on your car, you'd be paying a lot more than $25 for an oil change.

If that same mechanic risked jail time if he failed to account for every quart of transmission fluid in his inventory or was accused of "over prescribing" oil changes for your car....