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Ben Hagopian is a direct primary care physician in South Portland.
Open enrollment season is here again. And like clockwork, it arrives with another double-digit premium hike and another round of shrinking benefits.
Next year, if you carry conventional health insurance and get sick, you will face up to $12,000 in out-of-pocket costs — $24,000 for a family — on top of your monthly premiums.
I’ve worked in health care for 20 years, and every year the system grows more absurd, more painful, and less affordable.
A growing number of Americans want major reform — Medicare for All chief among them. But that’s probably not politically realistic or fiscally feasible, at least not soon. Fortunately, necessity has bred alternatives, and they’re already delivering better access, better quality, and real cost control.
For hospital-based care, more employers and individuals are contracting directly with independent physicians and hospitals for cash-pay care, at discounts of 80% to 90% off insurance list prices for services like elective surgery and specialty procedures. For the right candidates — and it’s worth doing your homework on any company or plan — health sharing has also become a cost-effective way to cover emergency or high-cost needs at a fraction of traditional insurance premiums.
For everyday care, most people get most of their care in a clinic, and here the case is already made: direct primary care (DPC) can beat insurance-based primary care on cost, quality, and access. DPC physicians charge a flat monthly fee — often around $100 — for essentially unlimited visits and direct digital access. Compare that to a conventional practice, where physicians juggle thousands of patients and squeeze them into rushed 10- to-15-minute visits that can frustrate both doctors and patients.
Drug costs are another major driver of the crisis, and innovation is showing up here too — from GoodRx, a free app that finds discounted prices, to Cost Plus Drugs, which ships low-cost generics (and now some specialty medications) straight to your door.
For those not ready to leave insurance behind. Startups like Firefly Health are building leaner, smarter health plan products meant to disrupt the market and actually bend the cost curve. And next year, Community Health Options is rolling out a plan built around free DPC and low-cost mental health care at its core.
The future of health care isn’t the all-purpose plastic card we’ve all grown up carrying. The status quo is more frustrating — and less sustainable — by the year. Businesses, towns, school districts, unions, and families are watching their budgets buckle under health costs, and more of them are realizing that real health care isn’t a card in your wallet. It’s timely, high-quality, affordable access to care.
The insurance and pharmaceutical industries are powerful, and policymakers aren’t coming to save us anytime soon. So ask yourself: when will you have had enough? When does the pain of doing nothing finally outweigh the cost of change?