How do we make health care more affordable for as many people as possible? Democrats seem to believe we need a massive, byzantine health insurance law that drives up premiums, drastically expands Medicaid, and flips the Constitution’s Commerce Clause on its head. Republicans seem to believe in keeping that law in place but tinkering with it in the worst ways possible. In much of Europe they’ve decided taxpayers should pay all health expenditures.
Most people seem to believe health care is too expensive to be treated like a normal consumer market, so, one way or the other, we need the government to step in and do something big. But what if this is the completely wrong approach to securing affordable health care for the most people possible?
That’s the implication behind places like Dignitas Health, a new primary care practice in Richmond, Virginia. Dignitas uses the direct primary care model, a system that does away with insurance, co-pays, and deductibles altogether in favor of an affordable per-patient fee-based model.
“‘Dignitas’ speaks to how this model of care allows me to treat people with dignity,” says the practice’s founder, Dr. Jill Zackrisson. Before founding Dignitas, Zackrisson worked in “a busy general primary care practice” that gave her only 15 minutes with each patient, and “those 15 minutes were not all my time face-to-face; that was the time to room the patient, triage, have the nurse get vitals, then my time—and somehow at the end of that you were supposed to have made a thoughtful decision, documented, coded, billed.”
Government-Centered Care Sidelines Patient Needs
This, Zackrisson claims, creates “illogical circumstances” wherein doctors are not compensated properly if they do more for their patients. Instead, physicians are motivated to “fragment their care” and “bring them back for a second visit.” The entity paying the bills calls the shots, so when government and insurance companies are the primary health-care sponsors they get priority and patients get the leftovers.
“It always pitted me against my patients,” she says. In danger of suffering burnout, Zackrisson discovered direct primary care, leading her to found Dignitas last year.
The practice accepts no insurance. “It’s completely direct payment,” Zackrisson says, with a per-patient membership fee “just like at the gym, or with Netflix. You use it as you need it.” The advantages are myriad: “You know up-front what the cost will be, it helps with budgeting, there’s no per-visit fee, there’s no surprise initiation or cancellation fee. “
As well as being a more sensible way to budget for primary care, this system carries additional benefits: the numerous in-house procedures and medical amenities for which doctors’ offices routinely charge big bucks. Dignitas Health’s $60 per month Adult Primary Care subscription covers standard checkups and sick visits, plus “in-office labs” with no additional fee, minor surgeries and splinting for merely the cost of supplies, routine gynecological care, and services like “specialist care coordination.”
Zackrisson also offers an in-house pharmacy for on- and off-site medical dispensing, as she carries both a pharmacy license and a dispensing medical license. Her ability to track the prices of the pharmaceuticals she dispenses allows her to give patients highly affordable prescriptions. Where a normal prescription might run a patient $30 per month, she might be able to prescribe the same thing for $3.
“Rather than paying higher premiums to cover your primary care, your medicines, and your labs,” Zackrisson says, “if we can carve [those services] out, and put [them] at a reasonable price” then the broader insurance market’s original purpose—of covering serious emergencies and large hospital bills—might then fall into place, and insurance may once again become affordable. “I always encourage patients to have insurance,” Dr. Zackrisson notes, because, “you’ve got to have insurance for those big things.”
Simple Self-Tracking Provides a Wealth of Information
Uniquely, in additional to general primary care, Dignitas Health offers NaPro, or “Natural Procreative,” technology services, a system of women’s health care that studies gynecological health through observable signs of fertility.
This system uses observations determined through the Creighton model of fertility tracking. The Creighton model offers Zackrisson “an endless amount of information” about what’s going on in a woman’s body, allowing diagnoses on “a whole host of women’s health concerns,” including irregular menstrual cycles, ovarian cysts, and difficulty conceiving, all without “having to suppress her reproductive function.”
“Right now, there are not enough doctors doing [the direct primary model] of care,” Zackrisson says, although it possesses “enormous potential.” America’s current system of health care, she claims, is “overly complicated, totally draining, [with] physicians burning out.” Zackrisson discovered that direct primary care allows her to provide better care for her patients. “And I’m not the only one,” she adds. “There’s new practices like this opening up across the country.”
While liberals and conservatives bicker endlessly on Capitol Hill over mandates, surcharges, minimum coverage requirements, and other hopeless esoterica of government policy, a new model of health care is quietly springing up across the United States. Direct primary care offers in reality what our political class has thus far offered us only in theory: sane, reasonable, and affordable health care.
More and more doctors are signing up, giving them, according to Zackrisson, “a new energy and a new passion for primary care, which is a lot of what our health care system needs.” She is right. This system is better for everyone, doctors and patients alike.
Unlike our hopelessly complex insurance system, there’s no great mystery to direct primary care: you simply pay for a service and you get that service. That is how health care once worked—and how it might work again, if we want it to.