Déjà Vu: Not Just Another Good Van Halen Song

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My colleague Kenneth Qiu posted “A Well-Balanced Diet” here on DPC News on Thursday.  It was the first in a 2 part essay, and I very much look forward to reading part 2. However, I feel compelled to respond to part 1 even before we get a chance to read part 2. I’m being a film critic of a movie I only watched half of, but I’m super busy; it was now or never.

I thought of the Van Halen song Take Me Back (Déjà Vu) from their underrated 1995 album Balance as I was writing this. So much so that I took a break from the “No Mariah Carey, Wham!, Or Paul McCartney Christmas Playlist” and played the album while I was writing this. I have no doubt that the driving hard rock pace of tracks like Big Fat Money (remember this song for later) will flavor the tenor of my words. I blame Eddie, Sammy, and crew.

My take will be as equal a helping of Déjà vu to our regular readers as the article I’m responding to was. We just keep doing this. Somebody says “Let’s talk about getting back to working with 3rd parties” and another of us asks “Umm..why?”. So lets go.

In context of his post, Dr. Qiu will say I’m addicted to meat and too old and jaded and close-minded to consider returning to toast, even if I have healthy meat to go with it.  And for the record- it’s possible he’s right.  Toast doesn’t kill everybody. Maybe there’s a responsible way to eat it.

But if I have diabetes and hyponatremia from eating nothing but toast, and reverse the disease process by switching to meat…why would I EVER go back to eating the poison that was killing me?

Middlemen caused our problem. 

I will reluctantly go along with an employer paying an employee’s DPC directly (if for some reason, they insist—I mean, why can’t they just give the employee money and let the employee pay it?…but I digress). I reluctantly agree, here, because the money is the same and there is no 3rd or 4th party taking a cut.  (It seems arbitrary- why not pay their rent/mortgage/utilities/groceries too? But it can be a fringe benefit, might help with taxes etc. so this is my exception).

But every other version of working with 3rd parties will be working with some corporate entity (DINO, matchmaker, or even government entity). This is an entity that will both interfere with care (want data, PA,s etc.) and want a cut, driving up costs. That $ comes from SOMEWHERE and it’s unnecessary. It enriches the corporate administrations at the cost of care quality and doing financial harm to patients. EVERY TIME. We know that’s what will happen, and you’d have to be purposefully sticking your head in the sand to say it wouldn’t.

This leads me to the conclusion that those who push for us to get involved with the government or other 3rd party payers, do so for one of three reasons: 

1) They never suffered too bad on the inside.  They lack the memory of the pain that pushed us all out. Yesterday I ran into a rant by a former FM doc on Reddit, who made a horrible comment about the execution of the UnitedHealth CEO:

“I burned out of primary care and left my PCP role permanently partly because I spent countless hours on the phone and inbox appealing denied orders and MD and BS. My last weeks as a PCP I lost it and started cursing loudly in my office as I was on hold with aetna for the nth time, to the point another doctor next to me just told me to hang up and that they’ll inherit the patient. Took me less than 1 year to have passion for primary care to despising it. F*** any bootlickers defending insurance execs. I think of all my patients who had delayed care due to denials. Meanwhile this CEO made more in 1 year than iI will in several lifetimes. May he rot in hell.”

UGH! His celebration (sort of) of murder is abhorrent, but this doctor’s pain is palpable. This is the pain I’m talking about, the pain that pushed us out. I think some doctors either forgot or never experienced it—it’s one of 3 rational reasons to push us back toward 3rd party payers.

2) They want to make lots of money.  This one is self-evident.  If a doctor is pushing toward corporate DPC where they become that corporate administrator charging employers a fortune for DPC and keep a percentage, and farm out the work, of course they’re going to be in favor of something like this.  The idea is: “Yes, this will drive up the cost of care and might decrease the quality and access to some degree, but it won’t be as bad as the old system, will be kind of DPC-ish at least, and all that extra $ will go to me, and I like money.”  I understand this, and as a good capitalist, I won’t criticize their entrepreneurial spirit. But pushing 3rd parties in DPC often boils down to a person “selling something” and they are not being honest about their motivation or admitting their bias. [Big Fat Money plays in the background, just reminding me that there is no such thing as coincidence.]

3) They have some version of Stockholm syndrome, and return to their abusers against prevailing logic and reason.  I would lump those who overly trust the government in with this group. 

History repeats itself, and dealing with 3rd parties is a clear path to repeating it, despite the oft-repeated idea (that’s voiced in Dr. Qiu’s post too) that “Well…we’ll just do it right this time”.  This reminds me of all the people that defend communism and when confronted with the 100 million deaths it’s caused, say “It just hasn’t been done right yet.” 

This “let’s just do it right next time” idea comes from a defeatist attitude that I am too idealistic to get on board with, and Dr. Qiu, while well-meaning, has demonstrated this with a word used twice in this article: “REALITY”. The mantra is always some version of “The reality is that the majority of patients get insurance and medical bills paid for by an employer or the government, it’s been that way since WWII.” They are simply declaring: “That’s just the way it is.”  YES! That’s the way it is, but the way it is sucks! The assumption that the status quo is the only way forward is wrong. History will always prove that. “That’s just the way it is” is always a bad reason to do anything irrational. CHANGE THE WAY IT IS.

I’m looking forward to chapter 2 of this post, and I’ll stop this déjà vu with quotes addressing the paradigm shift needed to change the way it is; quotes we use often in DPC:

“You never change things by fighting the existing reality.

To change something, build a new model that makes the existing model obsolete.”

― R. Buckminster Fuller

“The electric light did not come from the continuous improvement of candles.”  -Oren Harari

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About Vance Lassey, MD

Dr. Lassey earned his medical degree from the University of Kansas School of Medicine and completed his residency at the Smoky Hill Family Medicine Program, where he served as the chief resident. He went on to practice rural inpatient, outpatient, emergency room, and obstetric care, in Holton, Kansas. He found the calling he loved to have been hijacked by middlemen. Stuck in a broken system, mired in bureaucracy, clicking boxes, coding, not seeing his family, and hearing patients complain bitterly about medical costs he had no ability to control, Direct Primary Care (DPC) became the solution for him, his family, and his patients. He is passionate about restoring the physician-patient relationship, bringing transparency and sanity to medical costs, and advises physicians around the country on how to get out of the FFS system. He serves as an Assistant Clinical Professor at the University of Kansas School of Medicine, is the recipient of numerous clinical and teaching awards, and is a founding member and the past President of the Direct Primary Care Alliance.