committed to delivering primary care as it was intended--through trust, openness, and investing in the doctor-patient relationship.
I am not writing about Covid-19 to make it a political issue (it’s not), to discuss what we should have and could have done better (hindsight is 20-20), nor am I writing about it to discuss all the fatalities and lives that have been adversely affected by it. It has been devastating for many people of all walks of life in so many ways- death, isolation, loss of income/jobs, loss of savings, etc etc. All these facts are known. The reason I am writing on Covid-19 is to try to see the hope in the devastation that it has caused. We as a society have a chance to better for ourselves and our children. We have seen the best and the worst of our society during the past few months. My hope is that we can be better to each other and for each other- learn how to meet in the middle on all issues, treat each other with respect, and have dialogue that may never end in an agreement, but that ends in mutually respectful disagreement with all parties learning something from one another. One of my favorite quotes is from Ayn Rand, who is admittedly a polarizing writer and thinker herself, but nails it with this one. “When I disagree with a rational man, I let reality be our final arbiter; if I am right, he will learn; if I am wrong, I will; one of us will win, but both will profit.”
With that being said, one thing I hope we can all agree on is that this pandemic has exposed the best of our healthcare system- the doctors, nurses, therapists, CNA’s, janitors, cafeteria workers, maintenance workers, etc that have kept hospitals/ERs operating like well-oiled machines so that people could be treated to the best of their ability, even while putting themselves and their families at risk by working every day with a lack of adequate PPE and support. Many have actually died themselves which I am pretty sure is not part of the Hippocratic Oath, yet they went to work because medicine is a calling not a job. Another aspect I hope we can all agree on is that the pandemic also exposed every aspect of our healthcare system that sucks. We are fragmented, the clinical staff of all ilks are underpaid and undervalued, we are overly expensive, and we are always reactive to everything rather than proactive. Ultimately, we don’t have a healthcare system, but rather sadly a “sick care” system. Being proactive, working to prevent chronic disease, and staying healthy are sadly not profitable nor “sexy”. Filling hospital beds, MRI machines, specialists offices, prescribing expensive drugs, and DOING more TO people rather than less are. Yet there is hope. We have an opportunity to rebuild a healthcare system that our children and grandchildren and generations following them deserve. We need this, but the question is do we want it badly enough? Do we really really want it? If you think we do then keep reading and ask yourself this- if given 5-10 million dollars to build a brand-spanking new ocean side mansion would you put it on top of a leaky, cracking, termite-ridden foundation?
My guess is that your response is a big fat NO. So now ask yourself why in gods name are we doing that in healthcare? Why have we devalued primary care to 7 cents of the dollar and a minute fraction of the spend from public payers like Medicaid and Medicare, from private insurers like BCBS etc, right down to the public itself that believes real primary care can be done well at a drive through clinic? In a ten minute visit? Costs nothing more than a 20-30 dollar copay? Can be done well by any Tom, Dick, Jane, or Harry with a white coat and initials after their name?! And these beliefs are mostly not the fault of you, the general public, as you have been brainwashed and trained over decades by the rulemakers- pharma, insurance lobby and bureaucrats- to believe them. If you do not believe this fact here is a reference: https://www.benefitspro.com/2019/07/26/u-s-spending-less-than-other-countries-on-primary-care/?slreturn=20200428161727 No wonder why our system is not affordable, easily accessible, and navigable?! Yet we- patients and doctors- can fix it. Let me restate that…it is UP TO US TO FIX IT!!!. From the bottom up, we can rebuild a system that works for us. We can be the rule makers. This is our chance for once and for all to stop relying on the wrong rule makers to fix it. As a dear friend and benefits advisor says “you can never win a game where the opposing coach and the referee are the same person. This is how we do it….
This article below was published in STAT news today and discussed how “Covid-19 has devastated independent primary care practices.” Well guess what? It isn’t Covid-19 that devastated it. It is the screwed up, inefficient, overly expensive way that we- or in most cases the way third parties like government, insurers, and self insured companies pay for it- and those dollars all come indirectly from working peoples pockets at hugely jacked up rates! It is what triggered me to write this post and urge people to help us rise like a phoenix from the ashes of this unfortunate nightmare that Covid -19 did nothing except shine a light on. https://www.statnews.com/2020/05/28/covid-19-battering-independent-physician-practices/?fbclid=IwAR17jbNkb02eHKZ0NKHh1Ue_3UiETM9PBsgfB87vSnE853nloCODjmKgk-k
So it is time we s&*t or get off the pot. For five years myself and many other primary care doctors across the country have felt like we are moving a whole beach by ourselves. We need help. We need the public to grab a pail and start moving some sand along with us, because it’s the wet, dirty heavy sand of the Northeast, and not the light, fluffy white sand of the Caribbean. NEWS FLASH! No one else is going to do it for you and if we continue to try to do it on our own we will burn out and fade away (which is already happening at alarming rates). Sorry but thats the reality. A contractor friend of mine says that a foundation of an average home is about 15-20% of the spend. Imagine if we did that for primary care in the US? Imagine insurance premiums that do not cost a mortgage? Imagine transparent, affordable care delivered to you the way you want with a doctor of your choice? All for less than 3-4 dollars a day? One can only dream. We all want change, but we often resist the path to change. Why? Because its freaking hard! So here is my call to action: grab your pail(s), walk with your feet, speak with your words and your wallets (and if you truly can not afford an average of 70 dollars a month for unlimited primary care, discount labs, imaging, meds telehealth visits- yeah hey policymakers/insurers us DPC docs have been doing them all included for 5-10 years so welcome to the 21st century- call your elected officials and demand a health savings account funded with money based on need to use toward primary care with Medicare and medicaid to cover all that happens outside of it). Stop using insurance like a credit card for stuff that doesn’t cost as much as a sandwich. It makes no sense. Join a DPC practice, or at a minimum, use an independent primary care practice that is not owned by an unchained Goliath- aka major hospital system. If you do not like the beast and hate what it has done to you and your income, be a David. Help us starve it until it dies. Find something positive out of the Covid-19 pandemic and act on it. Do it for those we have lost and for our children and grandchildren who did nothing to inherit the ashes of the Goliath that now rest upon the beach we all want. Or please….DO NOT complain. Take the PATH less traveled: https://dpcalliance.org/dpc-path. You may enjoy the hike. If not, I’m sure the cartel of “rule makers” will be there waiting to pull you right back in. “Where’s the tylenol?”