I know it has been a while since I have written anything, but it has been a bit since I have seen something that has really driven me to write about. Yesterday I happened to see an article that was in the Boston Business Journal regarding health insurance options for our state employees that are on GIC plans- police, fire, DPW, teachers, etc. The following is a link to a free version by Martha Bebinger at WBUR Major Mass. Insurers Dropped From State Employee Health System. The three major players that are now out are Tufts, Harvard Pilgrim, and Fallon. What I find interesting about this change is that the GIC is quoted in the article are saying that “moving members to a more limited, less expensive number of insurance plans will save the state $20.8 million in the next fiscal year with little disruption.” I am very curious to see what these premiums will look like to our valued state employees. As a self-employed business owner I had to do my renewal by January 1st and by choosing Tufts Direct I was not only able to have great hospitals like Lahey and Tufts Medical Center in the network, but also saved $400 a month in premium compared to a similarly structured plan (i.e. same deductibles etc) with Neighborhood Health Plan that is owned by Partners. So again, I am curious to see where the costs savings will be? I highly doubt it will be to the employees.

See the issue here is that no one is actually addressing the cost of health”care” and only focusing on the cost of insuring it. The public has been led to believe that everything in “healthcare” is so expensive that we need a prepaid “insurance card”- one with a very large finance charge while we are at it-  so we don’t go broke. The irony is that it is the actual cost of insuring everything under the sun that is making people go broke. So employers- including the state government- have only two options to keep their spend under control: 1. transfer more cost to employees by raising out of pockets such as deductibles/copays/coinsurance and 2. limiting the network of hospitals/doctors employees can use with restrictive HMO-type plans. (As already mentioned, given that one of the options left here is NHP is quite strange given that Partners hospitals/practices are much more expensive but let us wait and see what the premiums are.) As a result of union leaders not wanting to see their employees carry huge out of pocket responsibilities such as deductibles and the like, what other options does the state have? When you expect a third party to cover 90-95% of your care this is what will happen. You lose money and the freedom to choose.

So my question to all GIC beneficiaries is do you really think your employer and the insurance carriers they are choosing are going to help address this cost equation for YOU? Are they providing the actual care you receive? No they are not , but they are determining where you can and can not get it from. So speak up! I lost a lot of you as valued patients when I stopped taking your “payment/insurance card” and instead wanted to be paid directly by you for all your primary care at a reasonable monthly fee that averages out to $75 a month. Sadly what you did not see is how on your side I was and continue to be.  Your choices of payment cards are now fewer and fewer and my educated guess is that it will cost you more to carry the card(s) offered to you and fewer places where you can actually use them. So why not grab your local DPC doctor as an ally so that we can fight this fight together and get more options for you-  like say a higher deductible plan that works like real insurance by covering major expensive medical care not the affordable part like primary care (lower premium) and combine it with a Direct Primary Care option. The only way we fix this system and the cost to you and the taxpayers of Massachusetts is to disrupt it from the ground up instead of letting policymakers do it for you from the top down. If you need more proof or evidence that it works look at what my colleague Dr. Rushika Fernandopulle has done at Iora Health in Boston for GIC members on Unicare: Iora Health and GIC Combine to Offer DPC to Unicare Enrollees. Why doesn’t NHP, Tufts, and HPHC offer the same? Hmmm. Also look at what Union County in North Carolina has saved offering DPC to their county employees! And this is with only 40% enrolled in the high decutible/DPC plan! Direct Care Helping North Carolina Public Sector Save Big On Health Care Claims. If you’re really bored but truly want to see how this worked in North Carolina watch this video. It includes my fellow DPC colleague and friend Dr Amy Walsh. It may be an hour but it is well worth it in my opinion.

I am willing to speak with any town administrator, union leader, state official you would like. Just ask them to schedule a meeting. You, that provide our communities with so much service, deserve much much more when it comes to your coverage and your care. Remember, they are usually not the same. Thanks for listening.