California Senate Passes Bill Banning Drug Company Gifts to Doctors

California doctors receive $1.4 billion in gifts each year

Source: NaturalSociety.com
Mike Barret
May 25, 2017

On May 18, the California Senate passed a bill that would ban pharmaceutical companies from giving gifts to doctors. The Senate voted 23-13 in favor of sending the bill to the Assembly. [1]

For the bill, SB 790, California lawmakers used a similar 2009 Vermont law enacted in 2009 as a template.

If the bill is signed into law, doctors would no longer be able to receive perks, such as airline tickets and lavish meals, from drug companies. According to Sen. Mike McGuire, the bill would lower healthcare costs, in part because doctors who receive gifts are more likely to prescribe costly drugs. [2]

Drug companies unload more than $1.4 billion a year on California doctors in the hopes they will promote and prescribe their products, said McGuire, a Democrat who represents a district west of Sacramento.

McGuire said that in 2014, doctors in his state received more gifts and payments from pharmaceutical companies than in doctors any other state. [3]

“While we have witnessed the cost of drugs rise over the past decade, industry profits have also grown significantly. We should be all standing for seniors and taxpayers to drive down the cost of prescription drugs.” [1]

According to a recent study by researchers at UC San Francisco, doctors who receive gifts from drug companies are 2 to 3 times more likely to prescribe name-brand drugs over cheaper, generic drugs. [2]

An even more recent study found that doctors at teaching hospitals are more likely to prescribe generic drugs when pharma reps are kept at bay.

Source: Pro Publica

Others have a different take on SB 790. State Sen. Ted Gaines argued that drug company gifts “provide the funding for research, for cures.”

He added:

“Why would we do anything to diminish the ability of pharma companies to be successful in providing these new products?” [3]

Senate minority leader Patricia Bates said the bill would discourage physicians from participating in clinical trials or restrict California’s access to experimental drugs.

However, the bill would still permit doctors to receive salaries for participating in clinical trials, and would allow for the payment of meals up to $250 per year for individual doctors.

The bill is headed to the state Assembly, the California lower Legislature, for consideration.

Read More At: NaturalSociety.com

Sources:

[1] Associated Press

[2] Daily Health Post

[3] RT

Pro Publica

Hazmat Birth

Hazmat Birth
Source: GreenMedInfo.com
Dr. Stuart Fischbein
May 2, 2017

When it comes to pregnancy, the bowing to the false god of safety has become the standard.

On the header of my blog are a few of my favorite historical quotes. I think my favorite has become Albert Camus’, “The Welfare of humanity is always the alibi of tyrants!” Fear is the easiest way to manipulate. And claiming safety is a perfect way to shut down any discussion. It’s good for you. It’s safer for the children. You don’t want to put your baby in danger, do you? We live in a world where ACOG admits that 2/3’s of its guidelines are not based on good scientific evidence. Yet they put them out anyway. In my world, on a daily basis, I am told directly or from print media about manipulation of women through skewed or even overtly false information. When it comes to pregnancy the bowing to the false god of safety has become the standard. Your baby is too big. Your baby is too small. Your pelvis is inadequate. The head is smaller than the shoulders which might get stuck. The fluid is decreasing. The cord is around the neck. You are 3 days overdue and your placenta is getting weak. VBAC is too dangerous. Your breech baby’s head might get stuck. Hospitals are safer. Induction is easy. Cesarean sections are routine.

Then there is the mockery of choosing an alternative to the fear based standard birthing world. Home delivery is for pizza! Having your baby at home is like driving your child without a seatbelt (This is the latest flippant simile from a doctor in Australia. Which, by the way, was how my generation grew up and I don’t recall massive death on the highway). Or as Jim Gaffigan, the comedian, quips, “when I told my friends we were having a home birth they said, Yeah, we were going to do that but we wanted our baby to live!”. Choosing a home birth is selfish! Why would you pick a lesser trained midwife? How would you feel when something goes wrong!

Ah, the something goes wrong theory of birth. Perfectly understandable in today’s fear based, litigious world. Risk management is something we all do every day. As individuals we just don’t have departments staffed with lawyers to do our personal risk management. Even if you could afford one can you imagine your life with every decision being scrutinized for safety and risk? Susie, you are not allowed to have that chocolate chip cookie because we have calculated that the risk/benefit ratio is adverse to your long term health and the viability of your family unit. Laughable? Far-fetched? Maybe, but this is the climate of the standard medicalized world we now live in. You cannot eat in labor because there is a 1/100,000 chance you might aspirate in an emergency. You must have an IV just in case. Please sign these consent forms about surgery and death after your next contraction. Sorry, hospital policy says you have to wear those belts continuously.

This past week I came upon a top secret correspondence from a local hospital that read something like this: “The OBGYN Department and the Infection Control Division would like to remind you that eye protection (e.g. glasses, goggles) and a face mask are required for all providers participating in a delivery.  We thank you for your cooperation with this important safety issue.”  The last sentence is the sinister one. Putting that tagline on anything gives it the appearance of concern and reasonableness. This may seem like a small thing but its insidious message is a continuation of the threat to all of us who value individual autonomy and see vaginal birth as something beautiful. This hospital, likely complying with some edict from some committee or oversight organization and almost certainly without a single adverse event in their institution, has turned the birth of a baby into a hazmat situation. My call to the author of this correspondence for clarification went unanswered. For those who have actually attended an un-medicated birth, a home birth or a water birth, can you imagine what the mother must think if she were to look down at a goggled and masked face catching her baby? I understand for an unscreened mother wearing protection would be a reasonable choice. But most women are screened and, unless there has been a series of incidents, universally requiring this garb is not about safety. It is about protecting the institution from liability. Plausible deniability should a worker catch something who was not wearing the hazmat protection hospital policy required. The risk managers are just doing their job. However, I believe minimizing risk must be weighed against common sense and personal choice in a free society. Sadly, common sense is losing and will continue to do so until the masses lose enough services or are inconvenienced enough that finally tort reform becomes a hot political topic.

Why have they come forth with this new rule now would be a logical question. Has there been some epidemic of exposures? I mean, vaginal birth without mask and goggles has been going on for millennia. No, it’s simply a symptom of the micromanaged and over-regulated reality we are now living in. I also just read an editorial about getting rid of the doctor’s white coat. Why now? Has there been an epidemic of disease spread by the hospital lab coat? Changing dirty coats makes good sense but banning them? Will the next suggestion be changing clothes between hospital wards, between rooms? And why won’t your own clothes be carriers of bad humours and thus need to be banned. And I can tell you that wearing scrubs from home and all day and night from the ward, to the call room to the cafeteria does not sound exactly hygienic. Wearing disposable gown and gloves makes sense in an infectious disease setting but in the maternity ward, really? So the why now question is really that someone somewhere just thought it up in response to usually an isolated incident. There are legions of administrative personnel whose job it is to try to diminish risk. The foolishness is they believe they actually can in every case no matter what the consequences down the road. Their job is to protect their job and their institution and their tyranny is always justified by safety.

There are two realities in the birthing world as I see it. One is fear based, often absurd, seeing pregnancy as illness, believing that interventions make benefit greater than risk and using safety as a canard for control. The other is trusting of nature, understanding of the imperfections of life and looking at pregnancy as wellness and a normal function of the female body. I have lived in both worlds and have a unique perspective. The first is uncomfortable and often riddled with self-deceit cloaked in cognitive dissonance. The latter is my choice and I try to be a vanguard for it. This past week I had the good fortune to attend a beautiful home VBAC in the hostile birth world of Santa Barbara and an inspirational water birth in Beverly Hills. I wore a t-shirt and sweat pants and was goggle-less and mask-less and I am delighted to report I am well and happy.  All good things, Dr. Stu.

Read More At: GreenMedInfo.com

#BigPharma #FDA – Famous Medical-Journal Editor Torpedoes Medical Journal

FakeNews
Source: NoMoreFakeNews.com | JonRappoport.wordpress.com
By: Jon Rappoport
May 1, 2017

“There is a system designed to affect every human on the planet, from cradle to grave. For each person, I’m talking about 30 or 40 diagnoses of physical and mental conditions, many of which are false; and treatment with toxic chemicals that progressively debilitate, confuse, weaken, and destroy health and life. What would you call this system? Who would you blame?” (The Underground, Jon Rappoport)

Her name is Dr. Marcia Angell.

During her 20 years of work, she looked at, perused, and analyzed more medical studies than all mainstream science bloggers in the world put together.

You want to listen to an actual pro? Listen to her:

Marcia Angell, former editor of The New England Journal of Medicine, in the NY Review of Books, January 15, 2009, “Drug Companies & Doctors: A Story of Corruption”:

“It is simply no longer possible to believe much of the clinical research that is published, or to rely on the judgment of trusted physicians or authoritative medical guidelines. I take no pleasure in this conclusion, which I reached slowly and reluctantly over my two decades as an editor of The New England Journal of Medicine.”

Before you count Dr. Angell as a hero, consider this: why didn’t she blow the whistle loud and clear while she was editing The New England Journal? Why didn’t she burn her own Journal down to the ground? After all, she was publishing studies of clinical trials of new drugs, and those fake studies were praising the drugs as safe and effective.

And therefore, The New England Journal was aiding and abetting a crime—unleashing dangerous and ineffective drugs on the public.

Her Journal was responsible for that.

Yes, the dreaded R word. Responsibility. In many circles these days, it’s not a popular term.

Take drug companies, for example. As I wrote in a recent piece, when lawsuits are launched against these companies for making drugs that kill and maim, the standard defense is: “Don’t blame us. The FDA approved our medicine as safe and effective. We’re off the hook. We’ve discharged our responsibility.”

Really? Who created the drug in the first place? Who did the clinical trials? Who sells the drug?

There’s an either-or situation here. It needs to be exposed. It goes this way: Either the pharmaceutical company or the FDA is responsible for people dying. You can’t accuse both. Pick one.

That’s a fool’s game. Both entities are responsible; the company that created the drug and the FDA who approved it and certified it as safe and effective. (And the medical journals that published the crooked studies of clinical trials are also responsible.)

The FDA seal of approval doesn’t automatically exonerate the company. “Well, the government said our company’s drug was fine.” So what? Since when does the government have the last word? Would you say the US military-industrial complex is solely the responsibility of the government, and the defense contractors play no role in launching endless wars? That would be naïve to the extreme.

As my readers know, because I’ve cited the key review dozens of times, pharmaceutical drugs kill 106,000 Americans every year. That’s a conservative mainstream estimate. (See Dr. Barbara Starfield, Journal of the American Medical Association, July 26, 2000, “Is US Health Really the Best in the World?”)

All those drugs are approved as safe and effective by the FDA. They’re also created, developed, tested, and sold by drug companies. Anyone with a shred of understanding of RESPONSIBILITY would correctly point to the FDA AND the drug companies. (And medical journals.)

Therefore, a company arguing in court that they’re off the hook for killing people with their drugs, because the FDA approved them, is evading responsibility and trying to shift it to the government. And an honest judge and a reasonably intelligent jury would recognize that in a minute.

From the drug company’s point of view, there is a game going on. The company is doing whatever it can to please and satisfy the FDA, and if it can, then it can walk away without shouldering blame.

Obscuring one’s own responsibility is one of the major industries in any nation you care to examine. The numbers of people involved, the amount of money, the time, energy—this is a field of endeavor that expands every year.

A simple law would go a long way toward righting the ship: “A government certification of a product does not exempt the creator, developer, and seller of the product from facing legal action in criminal and civil court.”

From the street thug, to the highest corporate boardroom, to professional academic fabricators, the theme is the same: “It wasn’t me.”

Oh yes it was. And is.

Let’s break down the word-origin of “responsible.” “Respond” comes from the Latin. “Re”=“again.” “Spondere”=“to pledge.” This construction eventually morphed into: pledging again for one’s actions, standing behind one’s actions, re-affirming one’s actions. And finally, “responsible” also means “legally accountable.”

—As opposed to attributing the cause of one’s action to someone else.

“I defend my actions by claiming: ‘it wasn’t me’, someone else was in charge, someone else decided my actions were correct.”

No. Not even close.

Of course, the US Dept. of Justice isn’t interested in any of these matters. If they were, they would be arresting drug company executives and researchers, FDA executives and drug-reviewers, and medical-journal editors who permit the publication of obviously fake studies of new drugs.

Understand: When you have medical drugs killing 106,000 Americans a year, this necessarily implies that published studies of clinical trials of those drugs—studies that praise those drugs as safe and effective—are a rank fraud.

Medical journals, the FDA, drug companies (and doctors)—a club. And each member of the club is responsible. Accountable. Culpable.

The next time a doctor, or some “science blogger” who loves mainstream published studies, sounds off about “real science,” show them this piece. And if they say that Dr. Marcia Angell is just one medical-journal editor, point them to the following:

Richard Horton (another pro’s pro), editor-in-chief, The Lancet, in The Lancet, 11 April, 2015, Vol 385, “Offline: What is medicine’s 5 sigma?”:

“The case against science is straightforward: much of the scientific literature, perhaps half, may simply be untrue. Afflicted by studies with small sample sizes, tiny effects, invalid exploratory analyses, and flagrant conflicts of interest, together with an obsession for pursuing fashionable trends of dubious importance, science has taken a turn towards darkness…

“The apparent endemicity of bad research behaviour is alarming. In their quest for telling a compelling story, scientists too often sculpt data to fit their preferred theory of the world. Or they retrofit hypotheses to fit their data. Journal editors deserve their fair share of criticism too. We aid and abet the worst behaviours. Our acquiescence to the impact factor fuels an unhealthy competition to win a place in a select few journals. Our love of ‘significance’ pollutes the literature with many a statistical fairy-tale…Journals are not the only miscreants. Universities are in a perpetual struggle for money and talent…”

Two famous editors (Angell and Horton) of two of the most prestigious medical journals in the world torpedo their own corrupt practices.

And if that isn’t enough to put a dent in some potato-head, conventional, medical devotee, then just keep going with this, by the same Richard Horton, editor of the Lancet (from the same piece I just quoted:

Horton makes reference to a recent symposium he attended at the Wellcome Trust in London. The subject of the meeting was the reliability of published biomedical research. His following quote carries additional force because he and other attendees were told to obey Chatham House rules—meaning no one would reveal who made any given comment during the conference.

Horton: “‘A lot of what is published is incorrect.’ I’m not allowed to say who made this remark [at the conference] because we were asked to observe Chatham House rules. We were also asked not to take photographs of slides. Those who worked for government agencies pleaded that their comments especially remain unquoted, since the forthcoming UK election meant they were living in ‘purdah’—a chilling state where severe restrictions on freedom of speech are placed on anyone on the government’s payroll. Why the paranoid concern for secrecy and non-attribution? Because this symposium—on the reproducibility and reliability of biomedical research, held at the Wellcome Trust in London last week—touched on one of the most sensitive issues in science today: the idea that something has gone fundamentally wrong with one of our greatest human creations [biomedical science]”.

Conventional science bloggers, take notice. You’re working in a field where studies supporting the general consensus are tainted and stained.

Starting sentences with “the FDA approves” or “the CDC confirms” or “a study published in The New England Journal established” isn’t a ticket to the truth. Far from it.

You’re wading in a stench-ridden swamp, and you don’t know it; or you do know it and you don’t care, because you want to be part of the club; or someone is paying you to make absurd assertions. One way or another, you’re doomed if you follow the party line.

This is a much different landscape than you think it is. It’s a wholesale fabrication of what looks, sounds, smells, tastes, and feels like truth. But it isn’t. It’s a lying cartoon.

And it has vicious consequences for the health of the millions of people.

Read More At: JonRappoport.wordpress.com
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Jon Rappoport

The author of three explosive collections, THE MATRIX REVEALED, EXIT FROM THE MATRIX, and POWER OUTSIDE THE MATRIX, Jon was a candidate for a US Congressional seat in the 29th District of California. He maintains a consulting practice for private clients, the purpose of which is the expansion of personal creative power. Nominated for a Pulitzer Prize, he has worked as an investigative reporter for 30 years, writing articles on politics, medicine, and health for CBS Healthwatch, LA Weekly, Spin Magazine, Stern, and other newspapers and magazines in the US and Europe. Jon has delivered lectures and seminars on global politics, health, logic, and creative power to audiences around the world. You can sign up for his free NoMoreFakeNews emails here or his free OutsideTheRealityMachine emails here.

Dr. Suzanne Humphries Discusses Why Most Doctors Miss Vaccine Reactions

Source: iHealthTube.com
April 5, 2017

Do vaccine reactions get reported enough? How do you know if it’s a reaction to a vaccine or something else? Dr. Suzanne Humphries discusses the difficulty in noticing reactions, but also what she’s noticed in her career.

Think Your Doctor Reports Reactions to Drugs and Vaccines? Watch This

Source: iHealthTube.com
March 23, 2017

Many of us assume that our doctors will report any reactions we may have to certain prescriptions or vaccines in the hopes of ensuring safety down the road. But Dr. Suzanne Humphries shares the reality of what it happening when most doctors see problems with patients on certain drugs or after getting vaccinated. You’ll think twice about the safety of these things.

Preventable Medical Errors Are The Third Leading Cause Of Death In The United States

bigpharmamoney

TheBreakaway | BreakawayConciousness
Zy Marquiez
March 22, 2017

“Probably as much as 75% of the medicine of sickness is unnecessary and its cost can be avoided.”
–  Dr. Ghislaine Lanctot, Author Of The Medical Mafia

It was reported by the British Medical Journal [BMJ] – although it had already been reported for quite some time by various researchers who outlined Dr. Barbara Starfield’s study for more than a decade – that preventable medical errors were the third leading cause of death in the United States.

Its quite unfortunate downright disturbing that such a system kills 250,000 [conservative estimate] a year, like clockwork, and still fosters so much trust even though prescription drugs are in fact 16,400% deadlier than terrorists.

There are many things that Big Pharma doesn’t want you to know.  And given that the Big Pharma literally pays the Mainstream Media’s bill, we can’t expect decent coverage of such deleterious issues.  Furthermore, coverage of Big Pharma’s dirty laundry would crack the reality egg and wake people up.  The establishment will always make sure that doesn’t happen.

Think about it, if terrorists were killing 250,000 Americans EVERY YEAR, people would be out for blood, asking for war, justice, everything. 

But the medical establishment killing 250,000 people EVERY YEAR?  That’s standard procedure.

That’s really no big deal.  It happens. Nothing to see here, move a long now.  That’s standard procedure.

And if you happen to still believe that the mainstream media reports the truth, where are they now covering this?  This was published in arguably the most prestigious medical journal in the world. Where is the coverage?

Nothing but crickets.

There should be some serious discussions taking place considering that people are dropping like flies at hospitals.

What’s more, disturbingly, Newsweek reported:

“The researchers for the study from Johns Hopkins say their findings suggest the CDC’s method for collecting data on causes of death is flawed, leading to inaccurate estimates on just how dangerous a visit to your local hospital has become.

Death certificates currently don’t have a separate coding classification for medical errors, which means estimates are not accurate.

The medical coding system used by the CDC was originally developed for physicians and hospitals to determine what to bill health insurance companies for individualized patient care. The authors recommend an overhaul of how cause of death data is collected.”[Bold Emphasis Added]

That’s overwhelmingly significant, considering that this could mean there are even more big-medica-caused deaths that are not being counted.

Furthermore, with prescription drugs being doled out at the tune of 4 Billion per annum, it’s no wonder that medications are also injuring 1.5 Million people a year.

Not only are there 400,000 injuries that can be prevented each year at hospitals, but there are also 800,000 injuries that occur in long-term care facilities. 

When does this stop?

By becoming aware that there is a problem, first.  Secondly, this begins to change when the individual decides to not become a statistic.

There are alternatives, which is why alternative medical care, which usually has no side effects, keeps growing at an unprecedented rate.

Don’t allow what happened to my family, losing two family members and nigh becoming a third loss myself, happen to yours.

Awareness is the key.  And awareness of this issue might just saved your life, or that of your loved one.
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This article is free and open source. You have permission to republish this article under a Creative Commons license with attribution to Zy Marquiez and TheBreakaway.wordpress.com.
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About The Author:

Zy Marquiez is an avid book reviewer, researcher, an open-minded skeptic, yogi, humanitarian, and freelance writer who studies regularly subjects like Consciousness, Education, Creativity, The Individual, Ancient History & Ancient Civilizations, Forbidden Archaeology, Big Pharma, Alternative Health, Space, Geoengineering, Social Engineering, Propaganda, and much more.

His own personal blog is BreakawayConsciousnessBlog.wordpress.com where his personal work is shared, while TheBreakaway.wordpress.com serves as a media portal which mirrors vital information usually ignored by mainstream press, but still highly crucial to our individual understanding of various facets of the world.

A new kind of doctor’s office charges a monthly fee and doesn’t take insurance – and it could be the future of medicine

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Source: BusinessInsider.com
March 19, 2017

Dr. Bryan Hill spent his career working as a pediatrician, teaching at a university, and working at a hospital. But in March 2016, he decided he no longer wanted a boss.

He took some time off, then one day he got a call asking if he’d be up for doing a house call for a woman whose son was sick. He agreed, and by the end of that visit, he realized he wanted to treat patients without dealing with any of the insurance requirements.

Then he learned about a totally different way to run a doctor’s office. It’s called direct primary care, and it works like this: Instead of accepting insurance for routine visits and drugs, these practices charge a monthly membership fee that covers most of what the average patient needs, including visits and drugs at much lower prices.

That sounded good to him. In September, Hill opened his direct-primary-care pediatrics practice, Gold Standard Pediatrics, in South Carolina.

Hill is part of a small but fast-growing movement of pediatricians, family-medicine physicians, and internists who are opting for this different model. It’s happening at a time when high-deductible health plans are on the rise – a survey in September found that 51% of workers had a plan that required them to pay up to $1,000 out of pocket for healthcare until insurance picks up most of the rest.

That means consumers have a clearer picture of how much they’re spending on healthcare and are having to pay more. At the same time, primary-care doctors in the traditional system are feeling the pressure under the typical fee-for-service model in which doctors are incentivized to see more patients for less time to maximize profits.

Direct primary care has the potential to simplify basic doctor visits, allowing a doctor to focus solely on the patient. But there are also concerns about the effect that separating insurance from primary care could have on the rest of the healthcare system – that and doctors often have to accept lower pay in exchange for less stress.

How direct primary care works

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Courtesy Lauren Clark

Dustin and Lauren Clark, who operate Black Bag Family Healthcare.

For Brent Long and his family, paying for healthcare is now like paying a cellphone bill. Since they joined Black Bag Family Healthcare in Johnson City, Tennessee, about two years ago, the family has paid about $150 a month to belong to the practice.

Long joined around the time he was shifting his insurance to a high-deductible health plan. There were two reasons he decided to switch and start paying for all six members of his family to get direct primary care: the cost-effectiveness of not having to deal with copays or urgent-care visits, and the fact that it could easily fit his family’s busy lifestyle that doesn’t jibe with spending hours in waiting rooms.

Included in that monthly fee are basic checkups, same-day or next-day appointments, and – a big boon to patients – the ability to obtain medications and lab tests at or near wholesale prices.

Direct primary care also comes with near-constant access to a doctor – talking via FaceTime while the family is on vacation, or taking an emergency trip to the office to get stitches after a bad fall on a Saturday night. Because direct primary care doesn’t take insurance, there are no copays and no costs beyond the monthly fee.

BI Graphics_Healthcare Chart

Skye Gould/Business Insider

When Blythe Fortin went in for a recent visit at sparkMD, a direct-primary-care practice in Boise, Idaho, Dr. Julie Gunther spent an hour chatting with her before getting to the results of her blood test, which showed elevated blood-sugar levels.

“She listened when I said I can manage with diet,” rather than starting her on medication, Fortin said.

Fortin, who pays $60 a month for sparkMD, had used a different kind of subscription healthcare called concierge medicine. It has some similarities to direct primary care but often costs thousands per month and still incorporates health insurance. She says she prefers direct primary care because the quality of care she has received is better than concierge medicine, and she likes that it’s available to a wider base of patients.

At the 17 direct-primary-care practices Business Insider spoke with, the percentage of members who still had insurance varied. At some practices, all but a handful had some form of insurance, while at others a little more than half didn’t have insurance.

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Courtesy of Dr. Julie Gunther

Dr. Julie Gunther of sparkMD with one of her newest patients.

To describe how coverage functions under direct primary care, doctors use the example of car insurance: You don’t use your car insurance for small transactions like oil changes, but it’s there for you if you get in a car accident. Likewise, health-insurance plans – especially those with high deductibles – can be there if you require healthcare beyond primary care.

For those who have insurance, the choice to pay for both makes financial sense, even if they can’t use it at their doctor’s office.

Fran Ciarlo has coverage through Medicare but decided to pay for sparkMD as well. One of the ways she’s seen an advantage is in prescriptions – like many direct-primary-care practices, sparkMD can provide prescriptions at wholesale prices, adding a 10% fee. On a recent visit, Ciarlo estimated she had saved at least $100 on prescriptions for standard steroids and antibiotics that in total cost her $6.

And for those with high health-insurance costs, it’s occasionally a choice between paying a monthly premium or the monthly membership fee for a direct-primary-care practice. For Rebekah Bennett, paying for direct primary care at sparkMD made more sense for her and her children than opting for insurance through the Affordable Care Act marketplace, since for roughly the same cost, if not less, her family could see their doctor without any copays.

The history of the direct-primary-care movement

Philip Eskew, who has tracked the movement through his website, Direct Primary Care Frontier, said direct primary care began at the end of the 1990s and early 2000s. Around that time, three doctors had the idea to go insurance-free, charging monthly fees instead and freeing up time to enjoy practicing medicine. This way, patients who might not have insurance could have a clear idea of how much going to the doctor would cost.

One of the three founded Qliance, a direct-primary-care system based in Washington state that got its start in 2007. The company was backed by Amazon CEO Jeff Bezos and Dell founder Michael Dell before the company leadership bought it to run it privately, without investor pressure. Qliance now has about 25,000 members visiting a handful of clinics around Puget Sound.

Cofounder Dr. Erika Bliss sees this movement growing in the future from its grass roots, rather than becoming big and national.

“It keeps the resolve and the drive toward independent primary care,” she said, which she described as a critical element. She says she envisions independent practices with maybe 10 to 20 providers at three to five locations being about as big as they’d get.

Getting off the ground

Dr. Matthew Abinante opened his practice in Huntington Beach, California, in September. Since then, he has had two people call his office to find out more about his practice. When he explained the system, he said, the callers thought it had to be a scam.

It’s one of the biggest hurdles doctors face when starting direct primary care – the “too good to be true” factor, the learning curve that comes with the understanding that “No, you won’t be using insurance here.” Even so, Abinante has signed up about 150 patients.

Going into direct primary care often means ditching the reliability of a salary. Because the practice relies on membership fees, the more patients who sign on, the more money that can be made. Practices cap their number of patients at anywhere from 300 to 1,000.

And it’s not exactly cheap to get started. Dr. Vance Lassey, who runs Holton Direct Care in Holton, Kansas, took out a loan to start his practice and spent time renovating a 750-square-foot space he rented from a friend at an industrial park. He picked up a lot of old equipment from a nearby nonprofit hospital and surplus stores. For his in-house pharmacy, Lassey took mismatched cabinets and refinished them so they matched.

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Courtesy Dr. Vance Lassey

Dr. Vance Lassey in front of the pharmacy cabinets he built from a mismatched set.

Keeping his costs low helped Lassey break even within four months of opening his practice. Still, he’s not earning as much as he used to when he worked at a hospital and had only five to 10 minutes with a patient – a lot less time than he gets to spend with his patients now.

“I am making a profit, I have more free time, and I can practice properly,” he said. “It’s worth it to me.”

Others, like Dr. M. Chad Williamson in Fort Payne, Alabama, went upscale – he offers his patients a 24-hour gym as part of his practice’s $60 monthly membership fee. Williamson, who opened his practice in August, a few months after finishing his residency, currently has 215 members. He wants to bring that up to between 600 and 1,000 people, ideally.

And it’s not just building the office space – direct-primary-care doctors are also responsible for building referral relationships with other doctors in the area.

What’s holding direct primary care back

While doctors and patients using direct primary care might praise the model – it was hard to get anybody to suggest a group, geographic or otherwise, that they thought wouldn’t benefit from direct primary care – not everyone is sold just yet.

Carolyn Long Engelhard, a public-health expert and professor at the University of Virginia School of Medicine, broke down the main concerns with direct primary care:

  • It might give the false impression that it’s a kind of insurance, so people might not opt to also get a real insurance plan. But if a patient were to have a health issue outside the scope of primary care, they wouldn’t be protected financially. All the providers Business Insider spoke with said they recommended patients have some form of insurance, and there were many instances where most patients in a practice had insurance or took part in a healthcare sharing plan, a program that functions like insurance in which an amount is sent monthly to people who have medical expenses in the plan.
  • Because doctors at direct-primary-care practices take on fewer patients than doctors at traditional primary-care practices, it might add to the caseloads of primary-care doctors. There is a shortage of these doctors in the US, partly because many choose to go into specialty medicine. Some doctors, on the other hand, say that they would have considered leaving medicine outright if they hadn’t had the option to do direct primary care. “There are doctor shortages already, so I say, ‘Compared to what?'” Dr. Chad Savage, who runs YourChoice Direct Care in Brighton, Michigan, told Business Insider.
  • Direct-primary-care physicians could become isolated from other doctors, and because the only person the direct-primary-care doctor has to answer to is the patient, there are fewer insurance regulations in place, potentially putting patients at risk. This is one of the reasons that getting hard data on how direct primary care compares with traditional practices is difficult. But between direct-primary-care networks and the referral relationships doctors build in their communities, there might not be so much isolation from the rest of the system. Dr. Deborah Moore of AmarilloMD in Amarillo, Texas, said she has more time now to do research than she did when she worked at a clinic. “I can do what I really need to be doing,” she said.

Engelhard worries about the direct-primary-care model becoming the norm. Generally, she said, “I do think it has a place in our healthcare system.” Instead, though, she’d like to see more adoption of the “patient-centered medical home,” a model in which primary care is more of a team effort.

Medical organizations have had mixed reactions to the movement as well. The American Academy of Family Physicians supports it, while the American College of Physicians, which represents internal-medicine doctors, has chosen not to take a stance on direct primary care.

There are also logistical hurdles that present challenges. For example, Eskew said that in the eyes of the Internal Revenue Service, having a health savings account is illegal if you’re a member of a direct-primary-care practice. The IRS views the monthly fees as insurance payments, making the person ineligible for an HSA, he said. Patients also can’t use the funds from an HSA, flexible savings account, or Medicare savings account to pay their monthly membership bills.

But politicians have shown support for the business model. Libertarians see direct primary care as a free-market solution to healthcare, and legislation at the state level has gained support from Democrats and Republicans alike. And direct primary care is on the radar of Department of Health and Human Services Secretary Tom Price, who while he was a member of Congress introduced a plan that would allow HSA funds to pay for direct primary care.

“Whoever is in power tries to take credit,” Eskew said. The ACA contains a paragraph about direct primary care that allows for the business model. It’s unclear what would happen to direct primary care under the American Health Care Act, the proposed bill to replace the ACA.

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Courtesy of Dr. J. Bryan Hill

Hill with a patient.

Where does direct primary care go from here?

As one of the first pediatricians to go into direct primary care, Hill has had the additional challenge of figuring out how the service works with children. Unlike many direct-primary-care physicians, he offers one-time visits to nonmembers. He said he also spends a lot of time listening to what parents want and sets his prices accordingly, offering discounts to families with three or more kids.

Doctors who are part of the movement tend to be the first in their area to have a direct-primary-care practice, and patients the first of their friends to use direct primary care. But all said they had positive experiences with the model.

“This is a niche, but a niche that makes sense,” Long said.

If direct primary care continues to gain traction, it could lead to new kinds of insurance plans – ones that don’t necessarily factor in primary care. Already, patients with high-deductible healthcare plans are using this. But direct-primary-care doctors also said they’d prefer to recommend catastrophic health insurance plans, which have deductibles as much as $10,000 or $30,000 and aren’t allowed under the ACA.

Even with the growth in the last few years, Bliss said the market is still slow, and a lot of unknowns would come with the AHCA should it become law. And it will be hard to get fully insured employers to use it in the same way self-insured employers and unions have picked it up.

Either way, those in direct primary care are optimistic about the movement’s future.

“In 10 years, we’re going to be an overnight success,” Eskew said jokingly.

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