Why write this blog?

Does direct primary care have real value in reducing , when compared to traditional fee-for-service primary care, the overall costs of care?  There is good enough reason to suspect that DPC could reduce overall costs to warrant probing analysis of currently available data and carefully designed experimentation in the healthcare marketplace. I am wide open to serious investigation of direct primary care, no matter which way it points; by the same token, I am bothered by advocacy that is not supported by reasonably solid evidence — very much so, when the stakes are as high as the health of my fellow citizens.

If direct primary care actually does not actually reduce the overall cost of providing care, but merely gives that appearance, advocacy for direct primary care could do real mischief.  For example, a presumption of a very high level of DPC efficacy has appeared in the political marketplace as part of a plan to reduce Medicaid spending.  Similarly, a presumption of DPC efficacy might be invoked to support a §1332 waiver for a limited benefit plan that could contribute to market segmentation by risk with undesirable effects. See, for example, the piece by David Anderson here.


Why now?

In the late Spring of 2019, the Georgia Public Policy Foundation released a proposal by the Anderson Economic Group and Wilson Partners (AEG/WP), one component of which was that all large insurers in Georgia be required to offer at least one comprehensive, ACA-compliant health plan plan that substituted direct primary care for traditional fee-for service care.  That suggestion opens the door to a potentially valuable marketplace experiment that could be accomplished with no more than modest risk, especially if restricted to, say, a set of pilot counties of varying population density.

At the same time, the AEG/WP report all but insisted that large savings from direct primary care was a given. And, because Georgia is indeed pursuing  a §1332 waiver that would allow limited benefit plans build around DPC, the danger of market segmentation by risk mentioned above seems very present.  Quite apart from their influence, if any, on developments affecting the wider health coverage market, the extravagant promises of DPC cost-effectiveness from AEG/WP report are likely to reappear in arguments to reduce or limit Medicaid spending.

Over a dozen of the most recent posts on this blog address the AEG/WP report. After the most careful analysis of which I am capable, I think its billion dollar claims are not justified. The things I like best about “the marketplace of ideas” is that I can opine with confidence that any mischief I may inadvertently work has a good chance of being corrected by others. The blog has both comment and contact options. Please fire away.


Who writes this blog? 

Gary Ratner. BS, JD, PhD.  I was a full-time law professor a long time ago. I taught “law and medicine” and tons other stuff.  I was an adjunct professor at a very large medical school. Then, a lawyer whose practice tilted toward health care finance law; I represented — at one time or another — providers, consumers, and the federal government.

And there was another career track involving a math-heavy area of biomedical research; some statistics and a bit of bioinformatics were involved. At least in large part because of my time as scientist, I am better with numbers than most retired lawyers. When compared to other retired lawyers, scientific training has — I hope — rendered me generally more interested in learning the truth than in winning an argument. 

I note again that the blog comes with both comment and contact capabilities. Go for it.


Let me anticipate two perfectly fair questions.

Q: Why the snark?

A: Lasting effect of being a lawyer.

Q: If DPCreferee is neutral, why do all the posts seem to argue against claims that DPC is works wonders?

A: I think that’s an artifact of insurgency. I do my best to respond to dubious claims from where ever they may come. Pro-DPC advocates are advancing a novel position and necessarily make a lot of claims; in doing so, some claims will allege wonders that seem to be too good to be true. On the other hand, most of the healthcare advocacy community more or less ignores direct primary care. I’ve not found many opponents of direct primary care. Show me an opponent making dubious claims that oppose direct primary care and I’ll analyze those, too, with enthusiasm (and snark). Show me a claim that seems too good to be true, but is actually true, and I’ll affirm it. Use the contact form.

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