An Conversation with James English, MD, 71 year old Primary Care Physician in Minneapolis

You see, of course, if you’re not a

dunce, 

How it went to pieces at all once –

All at once, and nothing first –

Just  bubbles do when they burst.

O.W. Holmes, MD (1809-1884), The Deacon’s Masterpiece

I  prefer to talk to physicians on the ground rather than to policy types in Washington.  I am a bottom-up rather than at top-down person.  As James Naisbitt observed in his classic Megatrends book in 1982, America is a bottom-up society and, as Alvin Toffler later observed in Powershift, fundamental societal shifts are more likely to occur from below not  above.

In speaking to physicians around the country,  I get the sense that ObamaCare has outrun its premise – that Americans want government-insured universal coverage – and its promises – that government can lower costs, expand access, and raise quality.  These physicians believe that ObamaCare is unsustainable.   It’s a bubble about to burst.

Why?  Because the public disapproves of ObamaCare by 57% by 38%,  because people are losing their health plans and their doctors, because premiums and deductibles are going out of sight,  because of the disastrous healthcare.gov rollout, and because of general lack of confidence in the competence of government to implement ObamaCare.

Enter Doctor English

Enter Doctor James English, a 71 year old board certified family physician in Apple Valley, Minnesota, a practitioner for 40 years, formerly a partner in a 12 person independent primary care group, and not an active participant in in the Minnesota Primary Care Network, a group that hopes organize 150 primary care physicians into organization that provides direct primary care to Minnesotans, this in a state where many physicians are now hospital employees. This will be carried out through another organization, called Direct Primary Care.

Doctor English is excited about the prospects for primary care.  He believes in 3 to 5 years, primary care physicians will be the fulcrum, the hinge on which the health system revolves.  He is still involved in the Minnesota Health Care Network, where he is Chairman of the Board, and still spends three days a week seeing patients in Benson, Minnesota.  

He works closely with Direct Pay Primary Care.  In that organization, for a flat fee of $68 a month, the patient can receive all the care the participating clinic provides.  Direct Primary Care has only been operational for a year and a half.  No bills are generated for the patients, and whatever the clinic does it will for that flat fee.   

The patient receives all the primary care they want from the primary care physician that the physician customarily does.  This includes immunizations,  antibiotic or other injections, joint aspirations,  abscess drainage, routine xrays, and other routine services, such as ECGs.  Patients can go to another clinic as long as that clinic is in the network

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Doctor English is “enthused” about the prospects for Direct Primary Care, even though it is still in the development stages.

As  Doctor English says,

“At first, I was reluctant.  But now I believe this thing really has legs.”

“You know the patients in depth because you evaluate them once or twice a year.  You can provide care by e-mail or phone rather than having them come in for every little thing.”

“You know your patients.  Insurers  don’t.”

“For the most part,  the insurance company is cut out of the loop, but that’s all right.”

“This is a program for patients to get all the primary care they need, and they don’t have to worry about co=pays,k or deductibles or other insurance jargon, like  “benefits.”

“And as a doctor, you  don’t have to waste your time looking up codes to justify  what you do to get paid for it.”

“The time for this thing has come.  The stars are aligned. This a game changer. This is the greatest thing ever to happen to primary care."

 "That’s my gut sense.”

“ObamaCare is like the housing bubble.  ObamaCare is unsustainable, and it is going to burst.  And it will burst in favor of primary care.”

Tweet:  In Minnesota,  doctors are organizing a Direct Primary Care Network, which, they predict, will thrive when the unsustainable ObamaCare bubble bursts.