During my latest trip to have my teeth cleaned, the dentist tried to sell me on the benefits of signing up for a membership with his practice instead of using insurance. I had not heard of this, but apparently, it can be cheaper for many people than paying their premiums. On top of that, the dentists prefer it because they can “cut out the middle man,” since dealing with billing departments is often a major part of overhead.
After paying the membership fee, I would get two cleanings, x-rays, and exams per year. Major dental services, if necessary, would be offered at a steep discount. Of course, the John Locke Foundation has a great benefits package, so I’m not in need of this right at the moment.
But it reminded me of a time not too long ago when, as a freelance writer, I didn’t have medical insurance. After looking at a couple options, I found a primary care doctor down the street in Raleigh that had a similar setup. For $50 a month, I could be a “member” of the practice.
At any time, I could simply drive over to the primary care office, and I would be seen, usually without any wait. Almost any basic medical service you can think of was covered without additional charge. For more serious issues, the primary care doctor would refer you to a specialist, so they recommended their members have catastrophic insurance for those potential needs.
This trend, known as “direct primary care,” is currently experiencing a boom, as are the dental-practice membership plans. According to Business Wire, between 2017 and 2021, direct primary care experienced 241% growth in memberships and 159% growth in clinicians setting up practices. This suggests not only do doctors love not having to hire people to haggle with CMS or insurance companies over every service they perform, but patients also love not having to worry about co-pays and confusing bill statements.
If insurance companies were required to create catastrophic medical insurance plans specifically designed to fill in the gaps beyond typical primary-care services, this model could really simplify medical care for both doctors and patients.
And it’s not just a pipe dream. Many conservatives have long pointed to the simplicity of Singapore’s health system as a viable alternative to both the expensive, overly complicated system in the U.S. and to the socialized systems found in many other developed nations.
Singapore is able to achieve some of the best healthcare outcomes in the world (like on infant mortality and life longevity) while only spending about 4% of GDP. In the United States, for comparison, we spend around 17% of our GDP on health care. Having 13% of our GDP back every year would unleash our economy in ways it’s hard to imagine. Socialized models also pay less than we do, typically spending about 10% of GDP, albeit for much less free, less innovative, and less efficient systems.
Singapore somehow pays MUCH less than all other developed nations, while achieving better results, all by focusing on Economics 101. They cut out the middle man, with medical care generally paid for with cash directly to the providers. Market purists may object to the fact that citizens are forced to set aside this money from their paychecks and that everyone is required to have catastrophic insurance. But even if this mandatory market-based system isn’t perfect, it shows that there are major savings and efficiencies possible in a simpler, more-direct system.
Is there a way to encourage more direct consumption of medical care in the United States and in North Carolina? Can we cut out middle men who complicate our system and make it more expensive? Both doctors and patients seem ready to find a way, and they may be in the process of building that alternative system with a bottom-up movement using models like dental-practice memberships and direct primary care.