Legacy of Meadowlark

Less is more…. I believe health care is personal, and I am neither a supporter of big insurance companies nor government systems that are fixed in their attitude on what is good and bad for large populations. I think personal care relates to you, your play group (family, friends, co workers), and your culture (within reason). My suggestion as a practicing physician is that health insurance should be like your car insurance: you are responsible for your own health and maintenance, and physicians should be used more as health guides at this level. It goes without saying that 60% of health care is bureaucracy, and you do not need an inflated co pay to “wash your car”. There needs to be insurance, nonetheless, for any big ticket expense such as surgery and a cap on yearly expenses, and there needs to be a safety net for those who really do have a condition that is incapacitating. A simpler and leaner bureaucracy could function here. Specifically, I would support programs of direct physician care where a physician is paid well enough for overseeing no more than 800 people a year in primary care (as opposed to the current average of 3500). Within this care there are same or next day, unlimited visits; e mail and video visits; and an individualized plan for Health and Growth. Most visits would take 30-60 mins, and the physician would do a face to face annual executive physical every year at a minimum. There would be a reliance on telemedical consultations for complicated questions, directed at the best physicians and centers for specific issues world wide. Under several existing direct physician models, the client pays 1500 dollars a year or so for the physical and access to care, which (believe it or not) more than doubles the physician’s actual income and cuts his or her time by half. In practices with 3500 patients, the insurance companies/ government keep most of the money to support its bureaucracy and gives 30% to the doc. He or she, then, has to see 40 patients a day at 4-6 mins face time just to make a fair income, and there is no time for YOU or personalized care. Under the latter case, physicians are leaving practice or not going into primary care at all. In the former, physicians can reconnect with their roots of being a good doctor, and primary care can recover from its “leper colony” stigma amongst physicians. Combine this direct physician model with a catastrophic plan, or a Health Savings Account, and you have a MUCH cheaper model compared to many HMO’s or government run operations. People with diabetes, congestive heart failure, COPD and Asthma, and so forth would receive specialized direct physician care in these circumstances, and it would keep people out of the ER’s and hospitals because of great access to their doc. There are plenty of evidence based studies showing this direct physician “car insurance” model is cheaper, delivers superior care, and is infinitely more preventive, but it degrades the roles of bureaucratic power and money. I would argue that the national conversation is about power and money; not real health care. Donald McGee

Dr. Mcgee, what are your thoughts on the Healthcare Reform bill that has just passed the House? It's obviously not ideal, but do you think it's going to help at all? Can you write a blog about your thoughts on that?