Like all US medical students, I recited a Hippocratic oath at my medical school graduation. At the time, I considered only bodily or emotional harm that could be done to a patient. Today I know that doing harm can also include financial harm. In fact, I would argue that I have seen far more financial harm than any other harm done to a patient over my 17 years of practice.
I myself grew up under the poverty line. When the parents on my high school basketball team generously made available to us warm up t-shirts for the low price of $5, I am sure that most of them could not fathom that $5 was simply not something I could come up with. When you have zero dollars, even $5 is insurmountable. With this backdrop, I entered the world of medicine absolutely dismayed at the costs. How in the world could anyone afford a $3,000 MRI? How can anyone pay off a 100,000 hospital bill? The cost of a simple pair of sterile gloves was $20. It seemed that anything “medical” came at an inflated cost even if an identical counterpart was available in a non-medical version. Cost was always on my mind, but I did not realize all of the reasons that went into inflated medical costs.
In his excellent, informative podcast The Paradocs, Dr. Eric Larson explores the reasons for these inflated costs and brainstroms ways to start fixing the problem. If you have any interest at all in understanding why the US healthcare system is full of utterly bewildering pricing and practices, this podcast is the best way I know to inform yourself. In episode 071 Dr. Larson explores the four main reasons that healthcare is so expensive (pharmacy benefit managers, insurance charges, hospital charges and health professional fees). Like many Americans, Dr. Larson initially assumed the reasons had to do with advanced technology. But compare healthcare to other industries, and you will see that technology has brought down costs in other industries. Think about your smart phone. Advancing technology should bring down costs. It should make technology more accessible to more people. We also know that while we spend more of our GDP on heatlhcare in the US compared to Europe or Canada, we actually have poorer outcomes.
Check out this post for Dr. Larson’s explanation of why US healthcare is so expensive, and if you have time, give the episode a listen.
Enter direct primary care. The beauty of direct primary care is that it cuts out some of these unnecessary, burdonsome and massively expensive layers. By negotiating fair prices for CT scans, MRIs and lab tests, I can save healthcare dollars. By cutting out the pharmacy benefit managers, I can offer medications to patients at a fraction of the cost. I am also free to choose medications based solely on cost and efficacy, rather than the whims of a pharmacy benefit manager formulary. Better for patients, better for doctors - hooray!