Thread by @alexhillman

My weirdest hobby is testing out healthcare systems and providers, especially those who claim they could help freelancers and entrepreneurs.

In the US, we’re borderline brainwashed to think about healthcare in one way. Here are some of the lessons I’ve learned:

https://twitter.com/alexhillman/status/1485702167864479753

Apart from the entire idea of for-profit healthcare being abhorrent, it’s the insurance intermediaries to blame.

They make things worse for EVERYONE. People who are insured, people who are uninsured, even the medical professionals who provide care.

The ah ha moment for me was, after years of trying to answer “how do we get legal group rates for a pool of people who don’t have the same employer,” that the right answer was to look outside of the insurance-based system.

Of course a functioning single-payer system would address these problems as well, and I believe our country needs one, but IN THE MEAN TIME….

I did what I do, and started exploring the margins.

1 - Direct Primary Care. Not as fringe today as it was, say, 10 years ago, but very few people know about it!

Basically a monthly subscription payment to your primary care doctor’s office. Usually more technology-enabled, and may be a mix or hybrid Telehealth + in person care.

What’s amazing about Direct Primary care is that it economically reorients the relationship around “billing for when patient is sick” to “access to care to help patient stay well.”

Plus, you get MORE time with the doctor for a lot less $$. How?

With insurance-based primary care, doctors have to churn through patients to make a practice economically feasible in large part due to the administrative overhead of insurance.

1500-2000+ patients per doctor is NORMAL. That’s why you’re lucky to get 5 mins of their time.

But with DPC, the subscription economics allow a practice to sustain on an average of ~600 patients per doctor, or less.

That means more time with your doctor. More of a relationship, too. They can actually help you take care of yourself, not just fix your broken body.

We’re talking less than $100/month for more access to a doctor, with less hassle and no worries about paying out of pocket every time you talk to a doctor.

As a result, I’m now in the habit of asking for help/advice with things I’d never make time to go see a doctor about.

And with the addition of telehealth as an option, being able to dash off what’s basically a text message for something that’s medically important but not urgent feels SO ALIEN with the traditional healthcare system, but I use all the time and love.

Is this stuff interesting/useful to learn? Should I continue this thread and include other surprising lessons and lesser known resources from the edges healthcare? I have so many other lessons learned!

OKAY, surprising lessons from the edges of healthcare.

Next up:

Did you know that you can negotiate prices on a LOT of common health services, or even pay less overall by asking for a cash rate + payment plan?

Insurance companies sure do, and pocket the difference!

I encountered this first with a dentist, because as an entrepreneur I did not have dental coverage.

I needed a BUNCH of dental work after neglecting my teeth (again, no dental coverage). Time to pay the piper.

When I told the office I was uninsured, they said “we offer a cash discount for people without insurance and a payment plan if that helps.”

*what*

In that moment I understood their upside. Less paperwork, receiving some money faster than insurance remittance, customer for life.

Now, this approach tends to be easiest and even normal/standard practice in smaller family-owned practices compared to bigger institutions.

But it exists and I never even thought to ask. And what’s the cost of asking, if it saves you $$ and helps you avoid credit card interest?

A few years later I learned about the role of a healthcare advocate.

They’re called a few different things, and most commonly a service that folks who are either older or otherwise have limited capacity to look after their own medical needs.

But…stay with me…

When you’re sick or injured, or even just stressed about a medical procedure, the LAST thing on your mind is negotiating prices. I don’t even particularly like doing it when I’m healthy.

What if there was a person who could do it for you?

Imagine your primary care doc says you need some procedure.

Your advocate gets the info about what you need, your availability/schedule preferences, and in some cases even your budget.

They call around to reputable providers, say “I have a patient who needs XYZ” and maybe even “they have X amount budgeted to pay cash on day of service” or “they have X amount budgeted for day of service and need a payment plan for the rest.”

Outside of emergency needs, especially if you’re flexible with your schedule and can fill an opening where someone was staffed but they weren’t doing their service, you can save a TON of money.

Americans are so used to dealing with the healthcare industry as a byzantine labyrinth of confusion, and expecting things to go wrong/get more expensive at every turn so we just accept whatever we’re shown.

THIS IS INSURANCE’S FAULT.

To be clear, I’m not saying that you shouldn’t have insurance!

If you can afford it (and I desperately wish more people could), it can keep you alive and out of bankruptcy especially when you encounter a serious or unexpected health problem.

However…

The big takeaway from me is that even if you DO have insurance, it’s probably the worst way to interface with the rest of the American healthcare industry the vast majority of the time, *especially* for daily care needs.

You shouldn’t have to know how to navigate the catacombs of the healthcare industry to get the care you need, and a healthcare advocate is something that I believe everyone should have access to regardless of your age or health.

I’ll continue this thread with more weird and unexpected lessons from the edges of the healthcare industry later!