Disney Plus— For Health Care?

Over 10 million people have signed up for Disney Plus since it launched last year. It’s easy to understand why. The service gives subscribers access to hundreds of movies and television shows for just $7 a month— no cable plan required.

Imagine if we applied that model to health care. For a flat monthly fee, subscribers could get everything from flu shots to lab tests “on demand”— no expensive, cumbersome insurance plan required.This model already exists. It’s called direct primary care— and Americans young and old, rich and poor alike are increasingly turning to it as a means of securing affordable, high-quality health care.

Under direct primary care, a patient pays a doctor a subscription-style fee in exchange for access to an array of services. Just a decade ago, there were only a handful of direct primary care practices scattered across the country. Today, over 1,000 serve around half a million people in 49 states.

The model has flourished in part because many doctors no longer want to deal with insurance. Nearly 75 percent of physicians spend at least 10 hours each week on paperwork. Bureaucratic tasks are the largest contributor to physician burnout, which affects roughly half of all family medicine doctors.Burnout is serious. Physicians who experience it are more likely to make medical errors.

Direct primary care can ease doctors’ workload, reduce risk of burning out, and give them more time to spend with patients. Direct primary care visits often last up to an hour— four times longer than the usual 15-minute visit offered in traditional practices.

Putting a doctor on retainer may sound like it’s beyond the means of most Americans. But it costs less than the average cable bill. Direct primary care patients typically pay between $50 and $100 each month for a host of services. Many direct primary care providers also offer discounts on prescription drugs.

Consider Kansas City Direct Primary Care, where adults 26 and over pay $65 a month for unlimited primary and urgent care visits and 24/7 access to a physician. Members also get home visits and access to reduced-price labs, medicines, and specialist services. For $140 a month, two parents can get that same level of coverage for themselves and all children under 18.

For some people, that’s a much better deal than traditional insurance. The average lowest-cost plan for sale on Obamacare’s exchanges this year features a $331 monthly premium. Last year, family coverage on the exchanges ran $1,154 a month, on average.

Those high premiums don’t buy much in the way of medical services. Patients may struggle to find a doctor who will take their insurance. Once they do, they still have to shell out thousands of dollars to meet their deductibles— before they receive a dime from their insurers.

In other words, direct primary care could provide a worthy alternative to the expensive Obamacare status quo. Many patients could receive better care at lower cost by pairing a direct primary care arrangement with a high-deductible, catastrophic policy that they only tapped if they sustained a medical emergency.

The subscription model, has transformed how Americans watch movies, buy groceries, and more. As direct primary care shows, it can transform health care, too.

Sally C. Pipes is president, CEO, and the Thomas W. Smith fellow in healthcare policy at the Pacific Research Institute. Her latest book is False Premise, False Promise: The Disastrous Reality of Medicare for All (Encounter 2020). Follow her on Twitter @sallypipes.

Does America Really Have The Worst Health System In The Developed World?

America spends twice as much on healthcare as its peers in the developed world yet fares worse on a range of health indicators, including life expectancy and infant mortality.

That’s the finding of a new survey of 10 developed countries published by the Journal of the American Medical Association.

Surveys like these tend to point out that the United States spends a lot on healthcare but doesn’t appear to get much in return. A closer look, however, reveals that America’s seemingly poor performance is largely attributable to lifestyle and social factors — not the quality of the institutions that make up its healthcare system.

Take life expectancy. Americans live for 78.8 years, on average –less than the citizens of the other 10 developed nations examined in the JAMA study.

Several factors unrelated to our healthcare system explain Americans’ poor life expectancy. Our death rate from car crashes is more than double that of other high-income nations. The U.S. drug overdose death rate is higher as well; Americans are twice as likely as Brits and six times as likely as the French to die of overdoses.

Americans are also heavier than citizens of other nations. More than 70 percent of U.S. adults are either overweight or obese, which increases their risk of premature death.

None of these factors reflects the quality of America’s doctors or hospitals. Yet they all contribute to our low life expectancy.

Then there’s infant mortality. The JAMA analysis finds that America has the developed world’s highest infant mortality rate — 5.8 per 1,000 live births, compared to an average of 3.6 per 1,000.

But this statistic is misleading. Countries record infant deaths differently.

In the United States, it’s standard practice to count any newborn showing the slightest evidence of life as a live birth. The Netherlands and France, by contrast, don’t count babies born before 22 weeks of gestation or weighing 1.1 pounds or less as live births.

By excluding premature and underweight babies, many of whom don’t survive, these countries artificially decrease their infant mortality rates.

Yet another deceptive indicator is the share of the population with health insurance. America’s 90-percent insured rate falls short of the coverage rates in the other nations.

Insurance, however, is no guarantee of access to healthcare. In my native Canada, the median wait time for receiving treatment from a specialist after referral from a general practitioner soared to a record high of 21.2 weeks last year.

Patients in the United Kingdom’s single-payer system routinely wait for hours in hospital hallways — or even in the back of ambulances.

Most patients in the United States, by contrast, receive top-notch care essentially on-demand. It’s no coincidence that roughly 40 percent of patients seeking treatment outside their home country go to the United States, according to a 2017 survey.

The American system is also much better at treating serious illnesses like cancer. Five-year survival rates for breast, colon, and prostate cancers are higher in the United States than in other developed countries like Canada, the United Kingdom, France, and Germany.

The U.S. healthcare system isn’t perfect. But it’s irresponsible to blame it for our nation’s comparatively low life expectancy and high infant mortality without acknowledging the societal factors behind those problems.

Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her latest book, The False Promise of Single-Payer Health Care (Encounter), was released this spring. Follow her on Twitter @sallypipes.

Senate’s Part D Budget Deal Is No Victory for Seniors

Earlier this month, the Senate announced its two-year budget deal. It contains a healthcare provision that many are touting as a victory for American seniors. The reform aims to close the so-called “donut hole” coverage gap in the Medicare Part D drug benefit by shifting more of the program’s costs to drug companies.

But that provision is a gift to insurers — not to patients. The policy could end up raising costs for seniors on Part D, some of our most vulnerable patients. It must be eliminated from the deal.

First implemented in 2006, Part D allows Medicare seniors to buy subsidized prescription drug coverage from private insurers. Beneficiaries can choose from a variety of different coverage offerings suited to their particular prescription needs. But all plans follow the same structure: After hitting a deductible, patients pay a coinsurance on the price of prescription drugs. If a drug costs $100 a month, and a patient’s coinsurance is 25 percent, he or she would pay $25.

After total drug spending reaches a specific limit — $3,700 in 2017 — patients fall into a coverage gap or “donut hole” as it has become known. In this phase, seniors generally pay 40 percent of the cost of brand-name drugs. That gap ends once out-of-pocket costs reach a certain level — $4,950 in 2017 — after which catastrophic coverage takes over.

The donut hole was always supposed to be temporary. Under current law, the gap gradually phases out so that seniors will be responsible for only 25 percent of a brand-name drug’s price in the donut hole starting in 2020. Of the remaining 75 percent, drug manufacturers will cover half, while insurers will pay 25 percent.

Unless the Senate’s budget deal becomes law. It would change this formula by forcing drug companies to shoulder the full 75 percent of a drug’s cost in 2020, letting insurers off the hook entirely.

It’s hard to see this change as anything but a giveaway to the insurance industry. One thing is for sure — the new formula won’t help seniors afford their drugs. Once fully implemented, the policy will encourage insurance companies to accelerate drug spending for patients with already high costs.

Once a beneficiary’s drug spending passes the donut-hole limit, after all, insurers’ share of the costs will drop to zero. So from the point of view of Part D plan providers, the faster an individual’s drug costs rise, the better.

This unintended consequence likely will affect seniors with chronic diseases the most, as their drug costs are already high.

In other words, the Senate just struck a deal that benefits insurance companies at the expense of America’s sickest seniors.

Sally C. Pipes is President, CEO, and Thomas W. Smith Fellow in Health Care Policy at the Pacific Research Institute. Her next book “The False Promise of Single-Payer Health Care” will be published by Encounter in March 2018. Follow her on Twitter @sallypipes.