ObamaCare : Where You Stand Depends on Where You Sit

Rufus Miles, Jr. (1910-1996), assistant secretary under presidents Dwight Eisenhower, John Kennedy, and Lyndon Johnson, and under 6 HEW secretaries articulated Miles Law which reads, “Where you stand depends on where you sit.
Nowhere is this law more relevant than with ObamaCare.

If you sit in the editorial offices of the conservative Washington Examiner, you will write articles with title like “ObamaCare Death Spiral a Gift to Republicans” November 19, or “The Health Law Is Crumbling Before Our Eyes,” November 20. You will cite the threatened withdrawal of UnitedHealth from health exchange markets; rising costs of premiums and out-of-pocket costs, the failure of the young and health to sign up for health exchanges, the cascading failure of ObamaCare co-ops, and for many, the impossible burden of researching, shopping, and switching health plans.

If you sit in the offices CMS or Health and Human Services or the New York Times, you will notice a different pattern, namely, that the Supreme Court has against endorsed ObamaCare ( Hooryay for ObamaCare, NYT, June 25, 2015) and that the number of uninsured are dropping in the East and Midwest but not in the conservative South and Southwest, and that given time, ObamaCare will grow in popularity and reach, given time and recognition that the health law is a good thing (“For Tens of Millions, ObamaCare Is Working, NYT, February 15).

If you sit in a physicians’ office, you may feel overworked, undercompensated, over-regulated, and overly-second guessed. You may even act by doing one of four things; retiring early, going to work for a hospital, becoming a locum tenens physician, or abandoning the traditional mode of private practice to go into direct patient contracting.

Many physicians are seeking to escape from the regulations and restrictions of ObamaCare by switching to Direct Patient Contracting (DPC). The American College of Physicians, the nation’ largest organization for internists has reservations about Direct Patient Contracting (“Warily, ACP Eyes New Practice Model,” Healthleadersmedia.com. The ACP fears patients with low incomes or minorities will be abandoned with alternative access to care or will be charged more than they can afford. The ACP says DPC has three components: 1) downsizing your current practice to send more personal time with patients; 2) charging a retainer or concierge fee; 3) not participating in patients’ insurance.

Practitioners who have switched to DPC say the ACP has it wrong and is oversimplifying. DPC, the practitioners say, has many variations- physicians who combine traditional practice with direct contracting with patients, direct cash transactions without retainers for patients who wish to retain their insurance, negotiated and lowered fees for patients with lower incomes, and bundled fees which include the visit, routine lab work, certain tests like EKGs, and minor surgical procedures such as skin lesion excisions. Furthermore , they maintain DPC is often less expensive than ObamaCare or insurance backed plans with their array of co-pays, premiums, and deductibles. For whatever reason, DPC is growing, and physicians and patients alike say DPC fills a need for what patients want - personal, more accessible care, available 24/7, with costs for services known upfront, without 3rd party intervention, with patient and doctor autonomy.