Benjamin Brewer, MD, writes in a Wall Street Journal op-ed piece dated February 12, 2008, that he has always considered his practice to be a one-stop shop for nearly anything medical. He says that he can provide the initial evaluation for almost any problem and treatment for most things, and that his wife considers his practice to be his second home, considering all the time he spends there.
The Illinois Medicaid program considers Dr. Brewer’s office to be a “medical home” for recipients of public aid – about 1,700 of them. The idea is to provide an accessible, lower-cost entry into the healthcare system than a hospital emergency room. By becoming a “medical home” Dr. Brewer has agreed to take an “active, integrated approach to coordinating a patient’s medical care.”
No, he says, this is not a return of the managed care we saw in the 80s and 90s, but it is answering a need that he finds people from all walks of life are having – someone to coordinate their medical care. Dr. Brewer refers to a survey a he took of Wall Street Journal readers where 25% of the respondents said that they had lost track of “who is in charge” of their medical care. Worst of all these people reported a 100% increase in being hospitalized or using the emergency department in the last year compared to those with a single doctor coordinating their care.
This all got Dr. Brewer thinking that his practice covers 80% to 90% of what the average person would ever need a doctor for, and that he could have covered his salary for 2007 and the costs of all his staff and overhead for less than $20 per patient per month, including maternity and hospital care.
Most Americans, Dr. Brewer reasons, could afford a package that combined $20-per-month primary care, $4 generic pharmacy prescriptions and some catastrophic coverage. If the combination were tax-deductible for the individual, then he thinks it would be a slam dunk.
But then there is a catch: The Illinois Department of Insurance would send him to the slammer for running an unlicensed insurance company. That’s right. By taking on a little risk, he is considered to be in the insurance business. (Never mind the fact that that is what the Illinois Medicaid people have him doing.)
As Dr. Brewer concludes, Netflix can rent you 4 movies a month for $23.99, but he’s not allowed to rent you a medical home for less than you’d spend to watch a movie each week.
Again, I conclude that neither big government nor big business has the power to solve America’s health care cost and access issues, but they certainly do have the ability to block the path for innovators like Dr. Brewer to get the job done.