Direct Care Is The Most Political, Least Political Healthcare

Originally posted on

This post deserves a caveat — healthcare shouldn’t be a political issue. When someone comes into my office because they have chest pain, I don’t ask them “What’s your political leaning?” before administering care. And now after reading about the recent delay of ICD-10 in Congress, I realized that my choice in practicing Direct Care was the most political and least political thing I could have done.

According to Politico, in neck-breaking fashion, GOP leadership took to the House floor in March and voice-voted a one-year patch to the Sustainable Growth Rate (SGR is the pricey formula that determines how much the government pays doctors who treat Medicare patients).

It was a team effort, though. Republican leaders worked with their Democratic counterparts to orchestrate the ploy. As members were returning to the floor as the House came into session, they realized that the bill had already passed.

Nearly all of them were surprised. That’s because no one had the chance to vote no. And no one had a chance to vote yes.

The maneuver came after a long delay amid opposition that threatened to kill the bill and had GOP leaders trying to chart a course to pass it. It was a slick move, to say the least, for a Republican leadership team that for years was obsessed with operating the House under “regular order.” Even before the delay, GOP leadership was considering a voice vote. They asked Democrats about the tactic. Democrats were initially skeptical but later agreed.

But this time, Republican leaders were constrained: They would have had to find upwards of 270 yes votes to pass the bill under the fast-track mechanism they set up. They could have waited until next week to lower that threshold to 218 votes but decided to move ahead that Thursday.

And now let’s make this long line of crises even more dramatic: Fee-for-service physicians were faced with a 24 percent pay cut under Medicare on April 1 if Congress didn’t act. And they didn’t. But the President did, signing a new bill that would delay the cuts by another year.

And that right there is what’s so disheartening about the prospects of entering medicine today. That a practice might be made or broken by something happening in a room in Washington. That lack of control was one of the main drivers for me starting a practice that operated outside of the insurance system.

On one hand, that might make me a very political doctor. But on the other hand, I really am an a-politcal doctor. I’m here to do two things: provide high quality care and make high quality care more affordable.

Yes, it’s my personal belief that by pushing healthcare closer to a “free market” model, overall costs will fall. Although, technically this isn’t just opinion. My patients are a testament to the potential savings offered by the Direct Care model.

In the end, though, I just want the opportunity to practice good medicine, and make a good living for doing exactly that. For me, the less Washington has to do with that, the better. I don’t want to waste time riding someone else’s roller coaster. I just want to practice medicine to the best of my ability.