Wednesday, November 20, 2019

Why primary care costs a trillion dollars more than it should - By Dr. Robert Berry

As a Direct Primary Care physician in Greeneville, Tennessee, who has not accepted health insurance for over 18 years, I have been in a unique position to see how insurance for nonemergency outpatient medical care not only increases our country’s debt but also how it stifles our overall economy leading to reduced tax revenues from which to resolve this debt.
Americans carry insurance for unexpected catastrophes such as car accidents, burned houses, and inpatient hospital care. We don’t purchase it for routine car or home maintenance, so why do we have it for everyday medical care? The reason is, unlike other insurance, it is a pre-tax expense enjoyed primarily by large and medium-sized corporations that exert a large amount of political influence.
Most people don’t know that this tax exemption for employer-provided health insurance adds about $350 billion to our national debt each year while discriminating against the self-employed and employees of small businesses, many of whom can’t afford health insurance yet were cruelly forced to pay ObamaCare penalties. The increasing number of families choosing membership in Christian health care sharing ministries don’t benefit from this tax exemption. As a matter of justice both to future generations who will be responsible for this debt and to the many uninsured, Congress should eliminate this tax favor. While they are at it, Congress should remove the tangle of insurance regulations so companies will have to compete by offering consumers the opportunity to buy policies that make sense.
When Americans pay directly for outpatient medical care at facilities that make their pricing transparent, they pay much less than they would at facilities that don’t.
Doing so -- I estimate -- would return to the economy as much as $1 trillion a year, mainly because insurance for routine health care makes it easier to conceal and inflate prices while charging for services that patients wouldn’t necessarily allow to be done if they knew ahead of time that they would have to pay for them with their own money.
I have observed that patients and health care providers today don’t seem to know what -- or even if -- insurance will pay for elective outpatient care. My Direct Primary Care patients who pay me directly are not confused by such uncertainty. They make me cost-justify diagnostic strategies and therapeutic interventions before they are undertaken. As a result, lab tests purchased at my clinic to evaluate fatigue cost about $500 less than what insured patients have told me they have had to pay other providers after receiving bills from them in the mail for amounts not covered by their insurance.
My uninsured and high-deductible insured patients regularly drive to private, for-profit facilities in nearby towns and cities to save around $100 on X-rays, several hundred dollars on ultrasounds and cardiac stress tests, over a thousand dollars on CT and MRI scans, and several thousand dollars on colonoscopies. One patient traveled 900 miles to save more than $10,000 on outpatient surgery at the Surgery Center of Oklahoma, which posts all-inclusive prices on its website and offers patients a way to pay for such procedures on credit.
These examples show that when Americans pay directly for outpatient medical care at facilities that make their pricing transparent, they pay much less than they would at facilities that don’t.
Since Direct Primary Care practices such as mine don’t bill insurance, we require three fewer employees per physician than those that do. That means that, with roughly 350,000 primary care physicians in this country, health insurance drains approximately 1 million dependable, hard-working persons from our labor force when there is less than 4 percent unemployment. Many jobs that are unfilled as a result are arguably of greater service to our fellow citizens than the settling of small medical claims that require a ridiculous and onerous level of documentation in electronic medical records .
So, from my perspective, simply eliminating the tax exemption for employer-provided health insurance would bolster the economy by reducing health care costs and supplying much-needed labor to our nation’s employers while leveling the tax playing field for all Americans. Most importantly, it would help to reduce our national debt and preserve our legacy of freedom for generations to come.
Samaritan Ministries International member Dr. Robert Berry practices medicine in Greeneville, Tennessee. He ran an insurance-free fee-for-service practice for 18 years before transitioning it in January 2019 to a Direct Primary Care named DirectMD Greeneville. To read an interview with Dr. Berry, visit