Millions of Americans have learned a hard truth under Obamacare: just because you have health insurance doesn't mean you can get affordable care. Yet Congress' proposed fixes all seem to revolve around getting people insured. In fact, some experts say one reason health care costs are bloated is because the government and private insurance are willing to pay with our money. Today, in our cover story, we look at three alternative models, as millions of Americans are quietly going outside the box.
Dr. Larkin: I had a very traditional private practice for 10 years where I did take insurance.
Lisa Larkin calls herself a “health care disrupter”. One of the first doctors in Cincinnati to quit taking health insurance under a new model called Direct Primary Care.
Sharyl: What does “direct care” involve?
Dr. Larkin: So this is a model where the patients and the physician have the relationship without the barriers of insurance kind of being in the middle.
Because Dr. Larkin doesn’t have to run down a checklist of insurance-mandated tasks, she can spend far more time with fewer patients. Like astrophysicist Tom Sitko.
Sitko: I have greater access, certainly I can come in pretty much when I need to or want to. If I have a real problem I can call her cell phone. She does make house calls. And so those are the kinds of things you just don't see in any you know, places that are supported by health insurance coverage.
Sharyl: For example, how much could a patient pay, and how would they pay, and what would they get?
Dr. Larkin: I opted to do three tiers of monthly membership. So it's either $40, $60, or $80 a month and then $40 an office visit.
Older patients pay the higher monthly fee. And there’s a huge factor that may benefit the entire health care system: lower costs.
Sharyl: You've had lab work done here.
Sharyl: And have you noticed there's a difference in cost?
Kato: Yes, absolutely. Last week I had electrocardiogram cost me 25 bucks.
That’s a fraction of what insurance companies may get charged for an EKG: up to almost $3,000 in some cases— with patients covering co-pays and deductibles.
Dr. Larkin: The amount of markup in pricing for laboratory services, imaging services diagnostic testing is just mind-boggling. I can set the price for what things actually cost.
Sharyl: Can you give some examples of some procedures and how inexpensively you can do them versus what they might cost elsewhere?
Dr. Larkin: Blood work for your annual labs may get billed to insurance for 300 to 400 dollars. I can do those exact same labs through the exact labs thru the exact lab for $40 in the office. I can do a breathing treatment for an asthmatic for $3 in the office. And insurance that can be $100.
Attorney Jennifer Lewis is another of Dr. Larkin’s patients.
Lewis: I would describe this model as a hands-on model where you have access to your physician, where the physician has time to sit down and talk with you about your concerns.
Sharyl: Have you saved money because of this?
Lewis: Instead of paying the exorbitant amount for the deductible, I'm paying the care provider directly.
Even though they don’t use it with Dr. Larkin, both Sitko and Lewis have insurance through work. Those policies kick in for other doctors or hospital care.
Sharyl: You're a little over a year into this. Is it sustainable? Is it working?
Dr. Larkin: It's absolutely working for me and my practice. I would tell you I am delivering primary care to patients for a vastly reduced cost and I'm doing a better job doing it with higher quality.
Jeanette Slaw of Pennsylvania searched out new options when her insurance premiums and deductibles skyrocketed under Obamacare.
Slaw: I had to up my deductible to 10,000 dollars. I said this is crazy. I said what am I doing? I thought I need to look into health care sharing.
Under health care sharing, people with common religious beliefs pay each other’s costs. Slaw is now in her third year with a Christian health care sharing group called Samaritan.
Slaw: Instead of sending a premium into an insurance company every month, I get a notice from Samaritan that tells me where I should send my share and basically, I'm sending my share to another member of Samaritan who has an actual need. So rather than feeling like I'm, you know, again paying a bill to an insurance company, I feel like I'm sending a gift to someone who has a need. And it's really kind of a nice feeling.
Exempted from Obamacare rules, the number of patients in “health care sharing” more than doubled under Obamacare from 200,000 to 530,000.
Slaw: This is the big comparison. Instead of having that 10,000 dollar deductible, if I have a need that I need to submit to Samaritan, or talk to Samaritan about, I’m responsible for the first three hundred dollars. I can handle 300 dollars.
She says she hasn’t had a medical “need” in 3 years but her sister has.
Slaw: She’s had three needs Matter of fact, I just talked with her last night and she told me for her third “need,” she's already started getting checks in the mail, but her first two needs were met. She told me every penny was met. Instead of a deductible, your responsibility is going to be considerably less. Ten thousand dollars versus three hundred dollars. I would take a look at it. What have you got to lose?
The last model we’ll look at is the so-called “concierge” practice offered by Dr. Beth Duvall in Dayton, Ohio.
Sharyl: What made you decide to go outside the traditional insurance model?
Dr. Duvall: I was really getting frustrated in the busy office model that I was in. And I just thought I couldn't do that for a number of years I have left to work.
It’s similar to Dr. Larkin’s Direct Primary Care practice except patients pay a flat annual fee and there’s no extra charge for office visits and tests.
Sharyl: For the patient when they come and see you, what’s the difference?
Dr. Duvall: Our office we're able to do some in-house testing which we don't have an extra fee attached to so we can do in-house stress testing, and vascular studies, EKG, hearing screening.
Sharyl: Can you go over the basic price points for this practice?
Dr. Duvall: Patients over 50, you pay $2000 a year. From 30 to 49 is $1500 a year. And adults up to 30, pay $1000 a year.
Like Dr. Larkin’s practice, there’s a big difference in doctor-patient face time. Nationally, that averages six minutes per visit. Not here.
Dr. Duvall: Average patient is a half hour visit.
Sharyl: So you had you had over a thousand patients at the last practice?
Dr. Duvall: to be considered full I had over 2,100 patients
Dr. Duvall: Now it's we're capped at 400. So it's a much smaller population which I think is much more personalized care. Whatever pops up, we have this fabulous doctor that takes care of us and is here for us anytime day or night.
Patient Donald Vandeley and his wife even got an unexpected home visit from Dr. Duvall one Friday.
Vandeley: We called and asked if we could get in, and my wife was having some issues. And we were told that she wasn't available. And then later in the afternoon about 4:30, 5:30 somewhere now we got a call from the doctor herself saying ‘I heard you tried to get in— I don't want to see Ann be worried all weekend I'm going to be in your neighborhood can I drop by?’ She did. It was great.
Like other patients who use concierge or direct primary care, they have insurance to cover other doctors and services.
Sharyl: So people can be clear: This doesn't mean you don't need health insurance. You still have insurance that covers other stuff?
Vandeley: Yes, because you know many years ago I had I got cancer and I was able to work through that thank goodness, and we always worried that's going to come back again some point. And so you know it's critical that we have health insurance. We would never stop.
Ideally, say the doctors, there will eventually be large networks of doctors and hospitals, allowing patients to operate almost entirely off the insurance grid. Dr. Duvall told us her practice saves over six figures by not having to hire employees to push the insurance paperwork.