From The Archives - I’m going back through the old blog and reposting some of the best articles.
Trigger warning: some people may read this as a political post. There is no intention of politics made while writing this. It's just a little insight into how I think and what I hope are some ideas that you can use to help guide your life. Or not.
I often joke that I'm a crazy government-hating libertarian, and Randy and I often get into political discussions about it. But the more nuanced view is that I'm against large central control no matter where it comes from - government is just the most visible form of it. Small distributed systems are more robust and corruption proof, some would say "antifragile".
Many of you are aware that Amy and I (mostly, Amy) are homeschooling our kids. The main reason is that the entire education system now is terrible. In the last two generations we transitioned essentially from one-room school houses with incredibly local control over your schooling to federally mandated teach-to-the test standards with no local control. I don't think anyone can make the case that our education system is keeping up with the world, or even simply doing a good job educating children. It's great at turning out mindless factory workers - at the precise time that factory work is going away!
Rather than fight it (you can't, the central control is just too strong), we're avoiding the system. Sure I'll keep paying my taxes - and it's really bad for me, I own a house in one of Colorado's most coveted school districts. So we pay to support a system that we won't ever use. I don't complain (much) about it, it's just my way of dealing with this system.
The same thing is happening in health care. We used to have much more local control over our providers and the services we wanted. Now it's all federally mandated standards of care that simply make you a cog in the system with essentially no options for customization to your preferences and needs.
I had a fairly serious illness about a decade ago, and I had cheap crappy grad-student health insurance. But I got the best possible care around and everything was personalized to what I needed. Other than the fact that I was sick and it really sucked, the care providers were a pleasure to deal with.
Now that we have kids we have to deal with the (trigger warning) post-Obamacare world. I have the federally mandated insurance that I need to have. I go to a provider that follows all of the standards of care. And guess what, it's terrible. Our doctor's office is over crowded to the point where they can't even make time to get back to you. The waits are bad, and the care is just check-the-box style of care. Just do what they need to report and report what they can to get reimbursed. FYI, the average caseload for a PCP that accepts Obamacare compliant insurance is 3,000 and the average face-time per visit is 8 minutes.
So we left that office (and all of the standard-of-care offices are pretty much the same - we've done some research). We're following the homeschooling pattern - though we (mostly Amy) aren't arrogant enough to think we can do this one on our own. We joined an out-of-the-system medical practice. Our new doc has a cap of 250-300 for her practice, and we spent more than 2 hours getting check-ups for all four of us (so, an average of more than 30 minutes).
Our new place doesn't even deal with the insurance companies. We pay a monthly membership and we get access to the practice. We can directly email our doc without HIPAA getting cranky, and she can give us advice over the phone. It's a wonderful experience. Our doc has a direct incentive to help us, because if we don't like what we're getting, we take our money elsewhere. It's not like having a third and fourth party in there being a buffer between our doc and us. Her costs are really low since she doesn't need to do any insurance paperwork, hire an insurance coder to maximize the number of ICD9 (or is it now ICD10) codes to charge for, or any of that overhead. The entire system cost is a fraction of the standard medical care system.
So yet again, I'm paying for a system that I hopefully will never need to use while also paying for my personal care. God forbid that we ever go to a (trigger warning) single-payer system - then there is no incentive to work with me since my money and my attention is meaningless. In fact, with the direct provider system, my doc has an incentive to keep me healthy - If I pay my monthly membership and don't use the services, she wins. In the current system, the incentive is to continuously treat but not cure anything, that way they keep the recurring insurance payments coming in. So while this personally costs me more, it is so much more in line with my philosophy that I have to do it.
If you can, I urge you to check it out - I'm sure there are closer direct providers than mine who is all the way in Denver, but I got a personal recommendation from an old friend who knows this system well, so that's why I'm making the trek out of the bubble. Or you can keep eating your hearthealthywholegrains and stay reliant on the system.