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High Deductibles – A Silver Lining for Family Medicine

November 23, 2015

Many say high deductibles make their health law insurance all but useless — so reads the headline of a recent piece in the New York Times. The article points out that while supporters of the new insurance exchanges talk about low premiums, the deductibles are so high that it , “… makes it impossible to actually go to the doctor,” according to one person interviewed.

According to data from Kaiser, health plan deductibles are growing seven times as fast as wages since 2010. It is not unusual for family policy deductibles to be $4,000 – $6,000. In fact, Obamacare plans can go up to a $6,600 annual deductible for a single person plan and $13,200 for a family. I see no better trends in employer-sponsored insurance in my region. The large employers here aren’t dealing with the cost issue except for dumping the costs onto the backs of their employees.

Because nobody in this country is really dealing with cost issues directly, this means that health insurance is going back to just being catastrophic care. Families will only use it when major events occur such as heart attacks, car wrecks, pregnancies, cancer, etc. This means that in most years, most people will pay for family physician care out of their pockets, because they won’t come close to their deductibles.

And that’s the silver lining for family medicine! It means that very little revenue to the physician will come from insurance companies, which means we don’t need them. Imagine practicing with no accounts receivable because you won’t have to bill insurance companies. Patients pay you right after you provide your services. Imagine throwing away the onerous CMS documentation rules. Imagine chucking the AMA CPT codes out the window, and ICD-10! Imagine not having to enroll to be a “provider” for an insurance company!

The direct primary care movement is doing this, but I encourage you to think of even more payment models and mechanisms to provide other payment options besides a flat monthly fee. The shackles of the restrictive AMA CPT codes and CMS rules are being loosed.

What will you do with your new-found freedom?

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