U.S. Senators Tim Scott (R-S.C.), Bill Cassidy, M.D. (R-La.), Jeanne Shaheen (D-N.H.), and Mark Kelly (D-Ariz.) introduced a bipartisan bill to support Direct Primary Care (DPC). This is nice because for the first time I remember, it is bipartisan. The bill clarifies the tax code so that a DPC agreement does not make a patient ineligible to contribute to a HSA and that pre-tax HSA funds may be used to pay DPC fees. I know there has been debate about this for years but the IRS has never clarified it completely.
Dr. Cassidy is the only one quoted about DPC and here it is:
“With direct primary care, patients have control over their families’ health care decisions. That was the intent when creating health savings accounts,” said Dr. Cassidy. “This bill empowers patients to see the doctor they trust.”
Part of me is glad this is getting attention. Part of me also thinks it is never good to get the government involved at all and DPC would be better off staying under the radar. What do you think?
(Correction – it has come to my attention that this is NOT the first time there has been a bipartisan bill. See comments below.)
Getting the government involved in DPC is like dealing with the Devil. Remember the first rule in dealing with the Devil…1) Don’t.
DPC legislation is always controversial in the DPC movement, as it should be. We cannot trust that government will do the right thing as regards Primary Care. That is the reason that the Direct Primary Care Coalition was founded by me. Jay Keese, a lobbyist in DC, was hired by Qliance to help us make sure that DPC was not extinguished by the Affordable Care Act or State legislatures. This effort led to the first legislature in the US (Washington State) passing the first DPC bill, thus shifting the portrayal of this movement from “Concierge” to “Direct Primary Care”, a term we invented to clarify our purpose and to dispose of the notion that this was a service for the wealthy only. We also were able to establish that DPC was not an insurance, and that it was in fact Primary Care payed for by the month – in the Affordable Care Act. Later we were able to assist DPC movements in over 30 States to pass legislation (remember, the States are governments too!) reestablishing that DPC is medical care paid for by the month and is emphatically NOT insurance.
The point that I am making here is not that Government will reliably solve our problems, but that we can no more trust Government to do the right thing without our input and lobbying than we can trust insurance companies to do the right thing in terms of payment and incentives in our contracts. The “I hate government and refuse to allow them to pass laws” approach is doomed to failure because governments pass laws with or without our approval. That is why I am a retired physician (and founder of this movement) and I am still engaging with government – not because I love this process but because it is necessary to do so to protect this movement. You don’t have to love government to engage with it, but you must engage with it if you want the freedom to keep practicing DPC. This means you also have to engage with the question of how DPC can save America and what that should be worth to this country and our many governments. Since over 90% of people buy their health care from governments, insurers and employers, we also have to look at how those arrangements can be altered so that more than 10% of America gets to have DPC. We also need to grow Primary Care in this country, which means engaging with our critics and detractors – not fun, but necessary.
One quick correction of Doug’s remarks. Every bill we have put in front of Congress (and every State bill that I know of) has been bipartisan. In the case of national legislation, Bill Cassidy (Louisiana Gastroenterologist) has been our major sponsor on the Republican side (both as a Representative and now a Senator) and the Democratic side has been sponsored by Maria Cantwell, Earl Blumenauer and others. Sens. Jeanne Shaheen (D-NH), Tim Scott (R-SC), and Mark Kelly (D-AZ) are already signed up for the latest Primary Care Enhancement Act. Yes, conservative Republicans and liberal Democrats!! How often do you see that?
Please consider this an invitation to help us pass the best legislation possible to protect the interests of DPC and the United States. High functioning Primary Care should be available to everyone in this country. So would you like to be a critic or a contributor? Either way, we would appreciate your support AND your input.
https://www.dpcare.org/
Garrison Bliss MD
100% spot on.
I admit my bias here: I full on hate the idea of DPC being involved in the government. The government screws everything up nd we got a good thing going, we can all agree. At the same time, I agree with Dr. Bliss that the government will make laws that ultimately affect us, with our without our input. Thus, our input holds value (assuming it’s listened to–I suspect that most decisions made in government are made by elected sociopaths long before hearings are held, swayed by money & power, not an honest desire to help people).
If we can be heard, and the voice actually represents the independent DPC doc just as much as corporate DPC-adjacent entities who have the money to buy influence, then that’s good. But does that exist?
And even if we rebels had voices in DC representing the DPC Everyman, presumably these people would have to enjoy (or at least tolerate) being there. To me, that’s the biggest problem. The kind of people I’d like to have representing me, are idealists who are disgusted by the corruption and forced compromise, and would rather be at the dentist’s office than a capital building. The halls of government are often referred to as a swamp for good reason.
I’m sure there are people who can stay clean living in the swamp, but I suspect those are hard people to find, and even then they’d be easily ignored by the corrupt, having nothing to trade for the favor. We need idealists with the time and willingness to periodically wade into the mire, who won’t compromise and yet somehow can’t be ignored.
Vance Lassey, MD
DPC Alliance President
http://www.dpcalliance.org
If only I had won the billion dollar lottery…..Or, if only I could clone myself.
Seriously, I wish I had the money to pay for someone to work in my clinic, take care of my family, take care of my parents, fund start-up clinics, etc., while I wade through the swamp. I’m fascinated/frustrated/amazed (not in a good way) by all of the shenanigans that go on in the hallowed halls of government, but other than firing off a few emails to the state reps and the US congressmen, I don’t really have the time or the energy some days to put up my dukes. My state medical association wants me to go sit in the Capitol as a “doctor of the day” and try to bend the ear of the state representatives/senators that drop by. I did a day of lobbying when the DPC Summit was in Washington DC. I feel it is so paltry a contribution, if it is a contribution at all. If it’s not DPC and tax laws, it’s scope of practice legislation being passed by idiots who don’t know (and won’t understand until it hits home) what they’re allowing and doing to the citizens of this country.
I wonder if the original patriots in this country felt the same way as they were trying to farm, conduct business, and earn a living while also working behind the scenes to rally the people to fight the British.
All I can say is, join the organizations (officially!) and support with your dollars where you can. DPC Coalition, DPC Alliance, PPP, and other non-AMA organizations are working on our behalf. Support your state and local medical associations and put your 2c in where you can. The fight will go on.