Direct Healthcare - Not All It's Cracked Up To Be
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A Good Day To Advocate for Better Healthcare
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Gender Affirming Care
The Supreme Court cleared the way for Idaho to broadly enforce a ban on gender-affirming medical care for minors yesterday, marking the first time the justices have intervened on the contentious issue.
The court’s order didn’t address the underlying merits of the constitutional challenge — only whether the law could take effect for now. The state’s restrictions will not immediately apply to two transgender teens who sued the state.
State legislators passed the Idaho Vulnerable Child Protection Act last May. The law bans puberty blockers, cross-sex hormones and certain surgeries for transgender adolescents and threatens providers with up to 10 years in prison for violations.
Countering COVID Disinformation With Data
There have been additional disinformation reports abut the modified RNA COVID-19 vaccine causing cardiac events in young people
CDC researchers examined death certificate data in Oregon from June 2021 — December 2022 and found “these data do not support an association between receipt of mRNA COVID-19 vaccine and sudden cardiac death among previously healthy young persons.” The report also noted that the risk for cardiac complications was “significantly higher” after covid-19 infection than after covid vaccination for those at or over 5 years old. The coronavirus vaccine continues to be recommended for those at and over 6 months of age.
Direct Contracting for Primary Care
This article is really a warning. I received a request from a physician friend in Alaska to review new legislation there that would allow direct contracting between patients and medical professionals for primary care. Sometimes these policies are called concierge or direct or subscription medicine. They are available in 48 states and with Alaska it will be 49.
It used to be that such policies were for the rich who would pay extra to have immediate access to their provider. Now the scaled down, McDonald’s version has become prevalent.
The Alaska Bill, Senate Bill 45, would allow patients to subscribe to have access to a primacy care provider via subscription. The legislation specifies who can engage in these contracts and who can cancel them. There is no description of required performance by providers such as the care that must be provided. In particular, such contracts typically do not cover serious illness, anything that requires hospitalization, emergency services etc.
So-called conservatives and many doctors favor such legislation since it allows “Choice”. The choice is to have this kind of limited care and maybe supplement it with a high deductible catastrophe policy. The Trump administration arranged for the Affordable Care Act mandate to have insurance to be struck down. They also enhanced rules to allow the spread of such policies. The problem with the policies is that unless the healthcare issue is dire, the policies are unused. If you’re an insurance company, this is gravy. Note if you need to be referred to another doctor it is likely that the direct contract will not cover that doctor - hence the need for some insurance.
Doctors often support this kind of contract since they will not have to deal with insurance companies. They typically have to hire additional staff to manage insurance claims and denials and prior authorizations.
In my state of Washington, these policies are legal. These contracts do not have to comply with ACA preventive care requirements. The provider will determine when you are requesting too much care for your plan. If you get really sick, you better have some insurance in place to help.
What’s the answer? If we had a national single payer health insurance plan then all of this would go away. We would all be able to go to the doctor when needed. We would all have preventive care. Public health would improve, rural healthcare would improve with global budgets. I’m just saying.
ACTION
Let’s remind our legislators that while direct primary care medicine may be cheaper than a health insurance policy, it certainly provides less coverage. Backing it up with a high deductible policy will increase the probability that that policy won’t be used. Health and public health suffer. The real answer is a National Single Payer System, like HR 3421, the vastly improved Medicare for All program. You’ll find your MoC and Senators’ contact info in the resources section.
Our use RESISTBOT by texting SIGN PYXJNQ to 50409 to send the email below. If you’d like to share it here is a link.
“I am your constituent and I have just learned that almost all states allow direct contracting medicine. A cash prepayment system for primary care. No coverage if you have anything serious. These direct systems don’t even have to be ACA compliant for basic an d preventive care. This is just another case of deregulation allowing people to choose options that wind up doing financial damage.
I very strongly urge you to pass a National Single Payer Health insurance program. Our 35 industrialized peer nations all have some kind of universal coverage. The Congressional Budget Office determined it will save more than $400 billion every year, starting in year ONE.”
President Eisenhower once said that the purpose of government is to do for people what they cannot accomplish for themselves. How about doing that and passing a National Single Payer Insurance program like HR 3421? Thank you.”
Resources
Healthcare Advocacy (Us)
Website
Our Newsletter resources including reproductive healthcare
Healthcare Advocacy Reading List
Find My Elected Officials
Contact the White House https://www.whitehouse.gov/contact/
Contact State and Federal Representatives
By phone: (202) 224-3121
By email: democracy.io
Important Healthcare Resources
League of Women Voters Healthcare Reform Toolkit
Organizations to Contact
National Nurses United Medicare4All
Physicians for a National Health Program
One Payer States
Healthcare Now
Reproductive Health
NARAL - Pro Choice America
Charley. chatbot abortion resource - make sure to use a secure incognito browser if you live in a state that has banned abortion
Planned Parenthood
Miscarriage and Abortion Hotline has references about where to procure abortion medications. They also assist women in the process of self managed abortion or miscarriage by phone or text and will respond in an hour. Details and hours of operation at their website.
United State of Women Reproductive health page (bottom of the page) has important resources such as medical support, access to Telehealth, prescriptions by mail, and legal support references.
Practice careful communications - The Digital Defense Fund has a number of tips to keep texts, calls, and internet use private. Here is their site.
If you need financial help with an abortion try abortionfunds.org
Claims Denials and Appeals & What to Do
Appeal a Healthcare Decision
Appeal/Negotiate a Hospital Bill
Disinformation Management
Cybersecurity Infrastructure Security Agency
Save Democracy
Chop Wood, Carry Water by Jessica Cravens
RESISTBOT
Link to the RESISTBOT site to learn more
Link to Chop Wood, Carry Water RESISTBOT write up
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Hi Alan,
If we are writing to a member of congress who does not support universal healthcare, is there something we can ask of them to help their constituents solve the problems with direct healthcare? If we are always asking for universal healthcare as a solution — and I believe that it is the best solution — but they’ve registered their opposition to it or the Republican majority House will never pass it, asking them to support universal healthcare will be a dead end for getting positive movement.
I also wonder whether there are differences in direct healthcare contracts. If so, what are the essential provisions one needs in order to make one of those plans worthwhile? You are seeing low and high end contracts of this sort, so there are some contracts that may provide better access and relief to the administrative burden of providers.