Skip to content
  • About
  • Contact
  • Contribute
  • Book
  • Careers
  • Podcast
  • Recommended
  • Speaking
  • All
  • Physician
  • Practice
  • Policy
  • Finance
  • Conditions
  • .edu
  • Patient
  • Meds
  • Tech
  • Social
  • Video
    • All
    • Physician
    • Practice
    • Policy
    • Finance
    • Conditions
    • .edu
    • Patient
    • Meds
    • Tech
    • Social
    • Video
    • About
    • Contact
    • Contribute
    • Book
    • Careers
    • Podcast
    • Recommended
    • Speaking

Building individual health equity

Paula Muto, MD
Policy
October 28, 2022
Share
Tweet
Share

Buying health insurance is a lot like renting an apartment. Finding the perfect place is hard, and the price is always higher than you expect.  But if it is conveniently close to your employer and there are few other affordable options, you sign the lease and agree to all of the terms.  Only after a few monthly payments do you realize electricity, heat, water, and snow removal are not included. What was affordable now seems out of reach. And when you thought it couldn’t get worse, the landlord raises the rent to help pay for the unoccupied apartment across the hall or, even worse, to help subsidize the owner’s mansion.

That is exactly what buying health insurance has become. Paying into a system that doesn’t pay back.  Premiums are skyrocketing at the same time, and reimbursements have gone down. Patients not only have to pay co-pays but also have high deductibles that they are never met. The excuse is always the rising cost of care in a shared risk model, but if you are paying for practically all of your health care out of pocket, who else is taking on risk but you?

When it comes to real estate, people strive to become homeowners.  Paying a bank instead of a landlord means you own your home. It might cost you the same monthly, but you build equity because, in the end, you own property whose value will increase over time.  Investing in your home is an investment in your economic future and a measure of upward mobility and prosperity.

Buying health care coverage should be more like buying a home.  Patients should be able to build equity with every premium paid. If you are lucky to have good genetics and are able to avoid serious chronic illness while you are young, why can’t that be put away in the form of health savings for the future?  Why can’t people own their health care like they own their health? I’d like to think Medicare was created with that in mind, an entitlement rewarded after years of work. A small deduction out of every paycheck that would someday help cover the medical expenses you anticipate would occur in old age was well worth it. But we pay much more, $5 to 10 per hour, of our wages to a benefit we never see, and that expires immediately if not paid.  Much like paying rent, you must find a new plan or be left out in the cold when the lease is up.

For particular patients, chronic illness will require more utilization. Just like when the housing market is too expensive, it makes sense to rent, some patients always reach their deductible and derive the benefits of insurance. But for the vast majority, out-of-pocket maximums are rarely met, and even though premiums are set based on utilization, every encounter is counted, even if you paid it in full. Patients want it credited to their deductible, but it’s just another piece of data to justify a higher premium. It would be like paying to fix a dent in your car because it’s less than your deductible, then telling the insurance company about it so they can raise your rates.  It’s a lose-lose, but what is the alternative?

Turns out, thanks to federal legislation on price transparency and health savings accounts, finding affordable medical care has become a lot easier.  The direct primary care (DPC) model has proven time and time again, in nearly every instance, to improve the quality and efficiency of disease management at a lower cost.  Removing the obstacles created by insurance, especially for routine or office-based encounters, has lowered the overhead and freed the physician to spend their time focusing on the patient rather than the billable encounter.  The direct pay model is now available for specialty care, including outpatient surgery, imaging, ancillary services, and prescription drugs. Even at a hospital, paying directly is often less expensive than paying the balance of a price negotiated by insurance. Medical cost-sharing and self-funded plans have been the early adopters, but more and more employers are adding the DPO, direct pay option to their benefit packages.

Building individual health equity starts with a commitment to price transparency.  The current system favors a broader, value-based model that does not require individual fees for services. Resources are allocated based on outcomes and are dependent on complex and expensive data acquisition.  In a direct pay model, the physician is accountable only to the patient.  It requires shared decision-making and informed consent from the patient, not permission from an insurer.  Currently, two-thirds of the health care spend is allocated to collecting data and managing care; this can and should be returned to the patient to invest in the future of their own health.  Insurance was intended to cover the unexpected and provide protection from exceptional medical bills; it no longer serves its purpose. We need a new plan that gives patients ownership of their health and control of their health care dollars.

Paula Muto is a vascular surgeon.

Image credit: Shutterstock.com

Prev

Stop and smell the cadavers

October 28, 2022 Kevin 0
…
Next

When patients want their doctors to heal [PODCAST]

October 28, 2022 Kevin 0
…

Tagged as: Practice Management

Post navigation

< Previous Post
Stop and smell the cadavers
Next Post >
When patients want their doctors to heal [PODCAST]

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

More by Paula Muto, MD

  • A physician’s perspective on the crisis in Massachusetts health care

    Paula Muto, MD
  • Panic button: Escaping the broken health care escape room

    Paula Muto, MD
  • Practicing great medicine got a lot simpler. It’s health care that’s getting in the way.

    Paula Muto, MD

Related Posts

  • Digital health equity is an emerging gap in health

    Joshua W. Elder, MD, MPH and Tamara Scott
  • Why the health care industry must prioritize health equity

    George T. Mathew, MD, MBA
  • Melting the iron triangle: Prioritizing health equity in dynamic, innovative health care landscapes

    Nina Cloven, MHA
  • Are negative news cycles and social media injurious to our health?

    Rabia Jalal, MD
  • How social media can help or hurt your health care career

    Health eCareers
  • Sharing mental health issues on social media

    Tarena Lofton

More in Policy

  • Conflicts of interest are eroding trust in U.S. health agencies

    Martha Rosenberg
  • When America sneezes, the world catches a cold: Trump’s freeze on HIV/AIDS funding

    Koketso Masenya
  • A surgeon’s late-night crisis reveals the cost confusion in health care

    Christine Ward, MD
  • The school cafeteria could save American medicine

    Scarlett Saitta
  • Native communities deserve better: the truth about Pine Ridge health care

    Kaitlin E. Kelly
  • Third-party litigation funding threatens access to health care

    The Doctors Company
  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Why no medical malpractice firm responded to my scientific protocol

      Howard Smith, MD | Physician
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • Bridging the digital divide: Addressing health inequities through home-based AI solutions

      Dr. Sreeram Mullankandy | Tech
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • How to build a culture where physicians feel valued [PODCAST]

      The Podcast by KevinMD | Podcast
  • Recent Posts

    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • Reimagining diabetes care with nutrition, not prescriptions

      William Hsu, MD | Conditions
    • Why funding cuts to academic medical centers impact all of us [PODCAST]

      The Podcast by KevinMD | Podcast
    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • When rock bottom is a turning point: Why the turmoil at HHS may be a blessing in disguise

      Muhamad Aly Rifai, MD | Physician
    • How grief transformed a psychiatrist’s approach to patient care

      Devina Maya Wadhwa, MD | Physician

Subscribe to KevinMD and never miss a story!

Get free updates delivered free to your inbox.


Find jobs at
Careers by KevinMD.com

Search thousands of physician, PA, NP, and CRNA jobs now.

Learn more

Leave a Comment

Founded in 2004 by Kevin Pho, MD, KevinMD.com is the web’s leading platform where physicians, advanced practitioners, nurses, medical students, and patients share their insight and tell their stories.

Social

  • Like on Facebook
  • Follow on Twitter
  • Connect on Linkedin
  • Subscribe on Youtube
  • Instagram

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

ADVERTISEMENT

  • Most Popular

  • Past Week

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • A faster path to becoming a doctor is possible—here’s how

      Ankit Jain | Education
    • Why no medical malpractice firm responded to my scientific protocol

      Howard Smith, MD | Physician
    • A world without antidepressants: What could possibly go wrong?

      Tomi Mitchell, MD | Meds
    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • Bridging the digital divide: Addressing health inequities through home-based AI solutions

      Dr. Sreeram Mullankandy | Tech
  • Past 6 Months

    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • Internal Medicine 2025: inspiration at the annual meeting

      American College of Physicians | Physician
    • The silent crisis hurting pain patients and their doctors

      Kayvan Haddadan, MD | Physician
    • What happened to real care in health care?

      Christopher H. Foster, PhD, MPA | Policy
    • Are quotas a solution to physician shortages?

      Jacob Murphy | Education
    • How to build a culture where physicians feel valued [PODCAST]

      The Podcast by KevinMD | Podcast
  • Recent Posts

    • Make cognitive testing as routine as a blood pressure check

      Joshua Baker and James Jackson, PsyD | Conditions
    • Reimagining diabetes care with nutrition, not prescriptions

      William Hsu, MD | Conditions
    • Why funding cuts to academic medical centers impact all of us [PODCAST]

      The Podcast by KevinMD | Podcast
    • What’s driving medical students away from primary care?

      ​​Vineeth Amba, MPH, Archita Goyal, and Wayne Altman, MD | Education
    • When rock bottom is a turning point: Why the turmoil at HHS may be a blessing in disguise

      Muhamad Aly Rifai, MD | Physician
    • How grief transformed a psychiatrist’s approach to patient care

      Devina Maya Wadhwa, MD | Physician

MedPage Today Professional

An Everyday Health Property Medpage Today
  • Terms of Use | Disclaimer
  • Privacy Policy
  • DMCA Policy
All Content © KevinMD, LLC
Site by Outthink Group

Leave a Comment

Comments are moderated before they are published. Please read the comment policy.

Loading Comments...