Health Care Reform Irony: Thousands Could Be Denied Low-Cost Coverage

If offered the choice, how many of you would sign up for access to a primary care physician 24/7 for a flat monthly fee of $49-$79 per month? Imagine -- no more lengthy waits for a doctor to see you and no more dealing with insurance companies for routine, preventive care. That sounds pretty good, doesn't it?

Ironically, the health care legislation being debated by the U.S. Senate does not allow this option. Direct primary care medical homes, which form the foundation for a high functioning, lower cost, higher service health care economy, will no longer be an option for the 50,000 Americans (a number that is growing by double digits annually) who prefer this health care delivery model.

As one of the first doctors in the country to set up a direct primary care practice, I wouldn't practice medicine any other way. I simply prefer to work directly for my patients, not insurance companies, and use my time to treat my patients, not fill out paperwork.

At my practice in Seattle, individuals and employers pay a flat monthly fee for unlimited access to services that include everything from urgent care to preventive treatment, from chronic disease management for things like diabetes or hypertension to wellness education and hospital care coordination. There are no co-pays, no disagreements over covered treatments and no insurance forms to be filled out because there is no insurance billing necessary with these practices. Most importantly, there are no barriers for those with pre-existing conditions.

In my community, many local businesses and unions have turned to practices like mine as a way to offer their employees health care at substantial savings over traditional insurance-only health care. For example, one Washington state non-profit employing 75 people expects to save more than $1 million over the next five years by moving employees from traditional insurance plans to a local direct primary care medical home and supplementing that care with a lower-premium insurance for emergency and catastrophic care. Washington state's largest employee union just announced that it will be participating in a pilot program that will provide their members access to this proven health care delivery model.

Like so many other innovative business models, direct primary care medical homes are growing in numbers across the country and are currently thriving in at least 20 other states. If utilized nationally, direct medical homes could save tens of billions of dollars - money that is currently wasted on administering health care insurance - and could reduce needless hospitalizations and procedures while providing world class primary care to all 46 million uninsured Americans for roughly $35 billion a year.

As a physician I am supportive of efforts to reform our broken health care system -- especially to provide care to those who for whatever reason lack health insurance. However, that doesn't mean that we should deny access to innovative health delivery models such as direct primary care medical homes.

Thankfully Senator Maria Cantwell (D-WA), with strong support from Senator Patty Murray (D-WA), has pledged to introduce an amendment that will preserve states' rights and ensure direct primary care medical home plans - in conjunction with a lower-premium insurance policy - will be able to compete in the proposed health insurance exchange where Americans will shop for health care beginning in 2012.

Direct primary care medical homes have proven that we don't need health insurance for our most basic health care needs. As a nation we are at the tipping point where the skyrocketing cost of health care will bankrupt families, businesses and eventually as the U.S. Treasury. As the Senate begins debate on its version of health care reform, let's hope they consider the cost-savings to the country of direct primary care medical homes and the security tens of thousands of Americans have already found in this innovative concept.