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Simon Gibbs on direct health care

Last Friday Simon Gibbs spoke at Brian Micklethwait’s. He explained that libertarians are very good at talking, which is important and useful, but that he wanted to see them doing more, and that inspiring such action is what his Libertarian Home project is really about.

He had many ideas of things that libertarians could do. Some were simple and obvious, such as attending demonstrations so that the media is forced to explain who this strange new breed of demonstrator is, or handing out leaflets at events such as Occupy demonstrations where some of the attendees might not be fully sold on all of the ideas of their movement and might be amenable to persuasion. But what he really wants to see is demonstrations of things that would be everyday in a libertarian society actually working.

An example of this is direct health care. In the USA, Dr Josh Umbehr runs AtlasMD. You pay $50 per month for access to a general practitioner. You get better service, email and phone advice, and out of hours appointments. And someone who sees you as a customer rather than a nuisance, and spends time with you and helps you to find the right consultant or to try different medicines instead of rushing you out in time for the next appointment. Simon found one doctor in the UK who offers such a service for £125 per month for a couple.

I would like to see more of this. Simon explains:

It would not need to be the dominant form of healthcare, but merely to be available for about the price of a gym membership to 10% of the population. We can then start to use this kind of care as a counter example to the sainted NHS. To get there, we need to stimulate demand. We need to talk about this idea with friends and talk about the various ways in which this would be more pleasant and more convenient than the GP service we get from the NHS. We would then be able to talk about the NHS as something like a safety net for very serious medical catastrophes, not something we rely on every day for every kind of medical assistance.

18 comments to Simon Gibbs on direct health care

  • Rob

    “The media is forced to explain who this strange new breed of demonstrator is”

    That’s easy. They will call them “the Far Right”; some already do so.

  • Fraser Orr

    This sort of medical service exists in the USA too (on top of the layers of fake private medicine.) They call them concierge doctors.
    Here the trend is the opposite though. It used to be that most doctors got together into little groups of a half dozen doctors, who had a little company, and shared the extraneous costs (facilities, admin staff etc.) More and more these small groups are vacuumed up into big mega corps (such as Du Page Medical Group where I live) primarily because the administrative cost is so utterly overwhelming. It is extremely burdensome for regular insurance patients, but the burden of Medicare is outrageous.

    My doctor inherited his practice from his father along with a boatload of Medicare patients. Medicare patients are basically zero profit, partly because the fees are aggressively low, and partly because Medicare pays their bills at best 180 days net, and NEVER pays the full amount.

    He felt an obligation to these patients and consequently had to give up his independence and become a salaried employee. No black Porsche for him.

    From my experience in the medical world the only parts of the American medical system that are flourishing are the parts that don’t accept Medicare patients.

    There are small pockets of medical innovation going on here that are being squished by the government and unions whenever possible. For example, I was just in Walgreens (a huge pharmacy chain here) and they are offering walk in school physicals for kids for $50, and they also offer vaccinations at $9.95 for common types.

    This is so much better than talking to your huffy pediatrician who is all “why didn’t you book this physical three month in advance, don’t you know how busy I am?”

    One truly wonders, were the powers of the free market set on the medical industry, what a storied transformation we would see.

  • @Mr Ed
    The monthly fee aspect of direct care (aka Concierge Medicine) is quite important I think, and your chap in Leicester seems to charge a fee per visit.

    A monthly fee is predictable and benign, but a per visit fee can be a bit of a shock. I have not attempted to survey per visit prices but I know prices can be as high as £150 in central london, and I think the sky is probably the limit.

    @Fraser apparently the concierge/direct care people in the US are opting out of even dealing with any insurance provider, apparently insurance claims suck up most of the admin costs, so better off without, or so I am told.

  • Jim

    In my experience its very hard to find private doctors or specialists who will take you on, even when money is no object. My Father has various complicated medical issues that the NHS are not that bothered with trying to sort out, but finding a private doctor who will take him on, and provide a better service has proved to be impossible, despite finance not being an issue. For one thing many private doctors or specialists will not see you unless you are referred to them by the NHS GP, and many NHS GPs refuse to refer to private doctors on grounds of ideology. It appears to be a sort of closed shop, medically speaking, even if you are able to pay.

  • @Jim: I think we could overcome that if we register our interest in dealing with doctors directly. One unconventional patient might seem like rocking the boat. 600 patients in one place is a customer base and a budget for setting up your new business.

    At least, that’s my guess.

  • What to do about this today, now?

    Well I want to assemble a list of names, emails and post codes. I don’t have an efficient way of doing that, but suggest that if your are interested then like the facebook page or follow the twitter or add the RSS to your reader and you won’t miss out

  • Julie near Chicago

    I want to second what Fraser says, as being one whose docs have been mostly in the DuPage Medical Group, with some in other “group practices,” which are either becoming ginormous themselves, or else in the process of folding.

    I have seen a few stories about docs here who have set themselves up as retainers (as Dr. Umbehr in Rob’s posting, and thanks for the link, Rob). I certainly hope this setup grows, but I do wonder how we will manage to get around our Management’s inevitable attempts to shut them down.

  • Julie near Chicago

    PS. I’m considering changing my signature to “Julie near Witchita.”

  • Richard Thomas

    Simon, how about something like “Uber” but for matching doctors with patients?

  • The biggest revolution in health care is the discovery and treatment of the endocannabinoid system of the body. It regulates everything. Dealing with it with natural plants is illegal.

  • Single-payer legal care, with all of the regulations that we put on doctors also put on lawyers (or for those of you on the other side of the Atlantic, solicitors and barristers). It’s not as if there’s any lawyer who does anything worth more than minimum wage, anyway.

  • Paul Marks

    This is the way that a lot of dentistry is already operated in Britain – I am dirt poor and I pay my dental practice so much for month(a contractually fixed amount we agreed on years ago).

    It is a good idea.

    It is the way that Friendly Societies (British fraternities) used to pay doctors before the government started to take over in 1911.

  • There *is* an easy way to register interest. Click on my name, scroll to the start of the comments and click on the big yellow button.

    It should be obvious from there what to do.

  • Direct health care looks quite a bit like an HMO except that (1) you contract directly with a doctor rather than via an insurance company who contracts with the doctor and (2) it covers office care but not hospital care. Direct care with some sort of catastrophic insurance package would make a lot of sense for average folks.

  • GC

    “Rob” is right. Once you offer yourself to the media, your theirs to play with. They define who you are to the general public, not you. They decide what you believe, not you. Cultural Marxism is the dominant media narrative, so libertarians will more than likely be dumped in the same bin as the BNP. Any speech or evidence to the contrary will be left on the cutting room floor.

  • […] I wrote about Simon Gibbs’ idea to find doctors willing to offer direct health care, providing better care […]