HealthZette

Removing the Wedge Between You and Your Doctor

There's a smart way to bring efficiency back to health care

You have through the end of the day Tuesday to decide if you want to drive a wedge between you and your doctor.

The Affordable Care Act’s deadline to sign up for health insurance without penalty is Jan. 31. Health insurance can be privately purchased, purchased on an exchange, or obtained through an employer. No matter how you get it, though, you may find there are better options for you than insurance.

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Insurance can create a wedge between you and your physician. It also tends to drive up the cost of consumption by disengaging you — the patient.

Any time the consumer product is separated from the buyer, it makes all costs subject to the whims of the middle man, and there is no longer objective value with regard to your care.

Related: Insured Kids Still Don’t Get Care

Because the patient is not paying the doctor directly, the insurance company, rather than the patient, is now the customer. The result is that your doctor looks at your insurance policy to see what it covers instead of discussing the cost-benefit analysis around your specific treatment choices and thinking through this important question regarding your health: “What is the best choice for my patient?”

You want to be in control of your health care decisions, not have them constrained by a third-party other than you and your doctor.

When someone else is paying your doctor, cost-benefit analyses and objective prices disappear. In today’s health care marketplace, there is no price-point equilibrium because there are no market forces at play, and the insurance company now dictates the cost of health care.

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The ACA has only made matters worse. By pushing you to buy a product, the individual mandate not only gets between you and your doctor, but even between you and your insurance plan, because now your insurance plan requirements don’t allow you to choose what you want your plan to cover and what you don’t want it to cover.

This is why we should be looking for patient-centered models of health care delivery, as individuals and as a nation of health care consumers. Informed patients make better decisions. Informed patients talk to their doctors. They’re able to gain knowledge about, say, the value of one prescription over another. If one medication costs $300 and another costs $50, and the patient is actually paying the difference between the two — they’re likely to ask why one is worth six times more than the other.

The doctor may reply that the more expensive one will provide a better quality of life, and then the patient can decide whether it’s worth it. Or the doctor could say, “Well, if you don’t take the $300 one, you might die.” But at least they have a valuable, important dialogue about it.

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The middle man opens the door to price inflation, disengaged patients, and to doctors and patients being on opposite teams, because the doctor’s service proposition is no longer in the patient’s best interest. The doctor caters to the insurance company because it is paying his bills.

Thankfully, other choices are available. Direct primary care practices and their doctors have said no to insurance, Medicare, and Medicaid, and are working directly for the patient instead of for an insurance company. The doctors make more money because their overhead decreases dramatically, and the patients receive better care, so it’s a win-win for everyone. The patient is engaged and the doctor is working directly for the patient. If patients still want their insurance to pay for the services, they can submit the bill on their own.

Related: How the First Obamacare Executive Order Affects You

Another choice is a health care sharing ministry. Members of these organizations are exempt from the penalties of the individual mandate. Joining one of them does not cost you more money in the form of taxes under that penalty. Health care sharing ministries give you an option that is patient-centered and allows you to have a better choice of providers, a better choice of treatment, and a better product. You are depending on your fellow members’ assistance, rather than an insurance contract, and members are praying for you and caring for you — so the spiritual and emotional burdens are lifted as well.

Also, there are no enrollment deadlines with health care sharing ministries. You can sign up 24/7, 365 days a year.

Through both of these options — direct primary care practices and health care sharing ministries — patients are able to deal directly with their doctors at all stages, and the wedge between you and the doctor you trust is removed.

James Lansberry is the executive vice president of Samaritan Ministries International.