The Open Health Care Economy


Priced Out of Health Insurance and Care

Brian Birdwell, MDBy Brian Birdwell, M.D.

Published in the Lawton Constitution
February 16, 2017

We enjoy quality medical facilities and excellent professional health care providers in Lawton. But these services do not help people who cannot afford to access them.

Many working people in Lawton and Southwest Oklahoma feel they have been priced out of health insurance. 

“The cost of health care in 2016 exceeded $25,000 per family.”

Health insurance coverage is expensive, both on the front end (premiums) and also on the back end (co-pays, deductibles, and co-insurance). The total cost of health care in 2016 exceeded $25,000 per family. Let that sink in, while I add that this cost per family has doubled from $12,500 in 2005, when the Milliman Index first began tracking it.*

Closed System

Prices are not open for consumers to see. The U.S. health care economy is a closed system. Actual price agreements for surgery, hospitalization, pharmacy and so forth are negotiated behind closed doors and we physicians have very little to say about what charges are permitted and what you must pay.

These are actual prices and discounts for an MRI from one of my patients with typical major medical coverage in a high-deductible plan:

Billed amount    $4,873
PPO discount    – $4,144
Actual price paid    $729

So, even with insurance, the typical “discounted” price was more than $700. And if you don’t have these “discounts,” you get a double-whammy: You’d have to pay the entire, inflated price of $4,873.

Insurance and our closed system drives up the cost for insured and uninsured alike.

By comparison, cash-paying members are referred for a comparable MRI in the open health care economy for about $350, sometimes less. These cash prices work for patients with, or without, a major medical insurance plan.

Taking Down The Barriers To An Open Health Care Economy

MainStreet Clinic is a point of entry for our members to access an open health care economy:

  • Direct primary care membership prices are viewable on our website
  • Membership is affordable: $40 to $80 per month, similar to a typical cell phone bill
  • We provide access to discounts for otherwise expensive services, such as MRIs, CAT scans and lab tests
  • We can fill prescriptions for many generic medications at low discounted prices
  • Access to MainStreet Clinic is unlimited for members; you see your doctor whenever the need arises
  • Members experience unhurried visits – time to explain, ask questions, be heard
  • Ongoing 24/7 contact via personal communications, such as cell phone, text or email – because sometimes, all that’s needed is a little information or an answer to a question

Employee Benefits That People Want and Can Afford

MainStreet Clinic membership is an ideal employer-sponsored health benefit. Clinic membership is a care-first health benefit that people can use with no insurance coverage required.

“For as little as $20 to $30 per employee per month, employers can ensure access to care for their people.”

For employers:

  • A flat monthly fee for all primary health care can be budgeted, easily
  • The membership benefit may be defined as all employer-paid or partially employee-paid
  • Employees access care quickly during office hours and after-hours, either in person or via cell phone, text or email
  • The clinic membership agreement is entered into by each employee individually; we protect the doctor-patient relationship

Vision care, too. When employers offer access to MainStreet Clinic membership, workers who subscribe may also enroll in Primary Vision Care Services.

Taking down barriers and opening the door to a new health care economy is a joint effort by all market players: health care providers, consumers and employers. Lawton’s own Keith Smith, M.D. at the Surgery Center of Oklahoma has attracted national attention for their totally transparent pricing.

Our hope is that others will follow the MainStreet Clinic lead in Lawton. The benefit to the health of Southwest Oklahoma’s people and businesses will be positive and far-reaching.

* Source: Milliman Index ( Total cost includes coverage premiums plus the costs of care for a typical family of four, covered by an average employer-sponsored PPO plan.

Posted in: Direct Primary Care

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