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Welcome to the blog section of the website. The purpose of this portion of the website is to demonstrate the viability and successes of Direct Primary Care to potential patients. Direct primary care describes the model of health care at Free Market Physician. The term Direct Primary Care is often used interchangeably with the terms Concierge Medicine, Boutique Medicine, and Retainer-Based Medicine. For those who are not already familiar with direct primary care, it may seem a wild and untested idea. But as you will see, Direct Primary Care is becoming increasingly popular as Americans consider how to improve health care.

Why I Opened a Direct Primary Care Clinic

Towards the end of a busy Neosho Business Expo this weekend a potential patient asked me why I had opened my Direct Primary Care clinic. Usually I would answer this question with enthusiam, but my tired mind sputtered. My answer was pathetic.

I hope do better here. This is why I opened my Direct Primary Care Clinic, Free Market Physician.

1. Health care is too expensive. As a physician and as a patient I have experienced the inside and outside of the health care structure. I know how much care should cost and how much it does cost. Health care is simply too expensive. What patients pay are not a true reflection of the cost of their care. As a Direct Primary Care doctor, I have the chance to change that. I have removed the insurance middle men from the health care equation. I keep my overhead low. I strive to fulfill the clinic’s mission to make health care personally affordable to my patients.

2. Patients are getting pretty crummy care. There are plenty of reasons to complain as a patient in most clinics. We get insufficient time with our doctors. Our doctors don’t listen to us. They can be short-tempered. They don’t answer questions. We can’t get in to the clinic when we are actually sick. Our visits are always late. We can never reach our doctors (or even the nurses) by phone.

In the insurance system I was going to be that doctor. I would enter the system as an idealistic, people-loving medical school graduate and surely be beat up and worn down to an short-tempered, hen-pecked, chronically late doctor. But here it is different. I have time with my patients. We talk. I know them. I am on time for our visits. My patients can reach my cell phone. I can give truly good care.

3. American health care has to change. Things were bad before the Affordable Care Act (Obamacare) and worse after. The Act did not reform health care- it reinforced and mandated all the worst aspects of the system. I didn’t want to participate as a physician and I certainly don’t want to participate as a patient. I have opened a Direct Primary Care clinic to be part of true health care reform. I have left behind dealing with health insurance and oppressive federal mandates. I work directly for my patients. I believe this is the change that America needs and along with thousands of other physicians I am taking action now.

Whether you are a patient or a physician, please join the Direct Primary Care movement to enact true health care reform.

Rusty Scalpel

Free Market Physician is now a direct primary care clinic!

After years of researching and writing about alternative approaches to health care, I am excited to personally take a crack at it. In July I will be opening a direct primary care clinic in Neosho, Missouri. It will be called Free Market Physician. I am grateful to many colleagues and professionals that have assisted me in getting started and paved the path for insurance-free clinics. I hope to see them multiply in response to our current health care trends. Feel free to check out my website.

"Want a Doctor at Your Beck and Call?"

This story, came out in February of 2012 in the Chicago Tribune. It shows why patients would choose a concierge (or direct primary care clinic) over a traditional medical clinic. You might notice the prices quoted in this story are much higher than charges at Free Market Physician. This demonstrates the trend over time of direct primary care being increasingly popular and made more affordable and available to broader markets.

Free Market Physician Blog

In medical school I began a medical economics blog called Free Market Physician FMP Blog Screen Shot(hence the name of the clinic). I enjoyed researching and discussing ideas for improving healthcare, and hoped others would contribute their ideas. Unfortunately the demands of my residency program forced me to stop writing temporarily, but I have hopes to continue some day soon.

If you are interested in medical economics, you may enjoy reading some of the articles, especially the “Essentials” posted in the sidebar to the right.

Senate to Vote on Repeal of Health Care Reform Bill

The Senate will be voting on a bill containing an amendment that would repeal the health care reform bill as early as tonight. Four democratic senators are considered key in this vote: Senator Claire McCaskill of Missouri, Ben Nelson of Nebraska, Joe Manchin of West Virginia, and Jon Tester of Montana. Any readers in these states are encouraged to contact their senators and encourage them to vote for the repeal.

This vote comes shortly after a second federal district judge ruled the health care reform bill unconstitutional and outside of the powers of Congress due to the individual insurance mandate. Essentially the rulings reinforce Congress’ constitutional bounds. Congress cannot pass a law forcing American citizens to buy health insurance. Not only is this concept crucial in the health care reform debate, but it is essential in preventing further abuse of powers by Congress. If Congress can force Americans to spend their money on private insurance plans, what other businesses and organizations could a corrupt Congress force Americans to patronize?

Rusty Scalpel

U.S. District Judge Rules Against Health Insurance Mandate

After all the spin and misdirection of the health care reform debate, the legal process is going to renew debate on the critical, constitutional American issues. Most importantly, can the federal government force its citizens to buy health insurance? Can the federal government force Americans’ involvement in any private market? A lot of complex, convoluted arguments about the the good the legislation will achieve have been used, but they all require the lynchpin of forced involvement. None of this intricate social experiment is going to work without mandated participation.

But judges are already calling a foul. Yesterday a Virginia U.S. District Judge ruled the mandate requiring Americans to maintain health insurance unconstitutional.  As U.S. District Judge Henry Hudson stated in his 42 page opinion, “At its core, this dispute is not simply about regulating the business of insurance — or crafting a scheme of universal health insurance coverage — it’s about an individual’s right to choose to participate.”

 As stated in a Bloomberg piece on the ruling: Hudson said the “unchecked expansion” of congressional power represented by the insurance requirement “would invite unbridled exercise of federal police powers.” No Supreme Court decision has authorized Congress to “compel an individual to involuntarily enter the stream of commerce by purchasing a commodity in the private market,” he wrote.

Judge Hudson’s ruling will certainly be appealed and the insurance mandate may soon visit the Supreme Court. With the current composition of the Court, is is likely that the court will agree with Judge Hudson’s opinion. What will happen to the legislation if the mandate is removed? 

As stated above, the insurance mandate is really the lynchpin in the reform bill. Without it, the reform bill just doesn’t work. The legislation forces the insurance industry to open its doors to all comers without regard to pre-existing conditions. It sets price controls on the how much the industry can charge for its policies and also removes the industry’s ability to limit their payout on each patient. The bill will bankrupt the industry, especially if the insurance mandate is not present.

The insurance mandate was implemented to moderate this strangle hold on the insurance industry. With the insurance mandate, the government forced some 40  million Americans into the insurance industry. The majority of these new clients were young and healthy, rarely utitlized health care, and did not have need for comprehensive insurance plans. Congress sold these Americans to the insurance industry to balance the huge financial losses the reform legislation would inflict on the industry.

Without these Americans being forced to participate, the whole house of cards will tumble. Health insurance companies, already doomed to eventual bankruptcy by the legislation, will immediately begin to fall. Health care reform will be shredded with a new set of legislators left to put together the pieces.

Legislators will be forced to revisit health care reform. They will decide if America should continue down this path of socialization, with a blatant takeover of the insurance industry. Or they can recognize the inherent, God-given rights of American people and the constitutional checks on American government. If so, perhaps true reform can take place with the restoration of freedom and resulting access and affordability in the medical market.

Rusty Scalpel

Both Oranges and Health Care Can Be Substituted

(And Why This Is Important)

Imagine that a bored billionaire made it a pet project to research all of the health benefits of eating oranges. The billionaire would hire the best scientists and use cutting edge technology for his research. Imagine the findings that might be produced. The billionaire’s new Orange Journal would be brimming with excellent research showing the benefits of eating oranges.

Oranges’ antioxidants would be categorized and individually studied. Research might show that eating oranges extends lifespan. The benefits of potassium and Vitamin C would be further studied. Oranges might be shown to have antimicrobial properties. Other findings would show that eating oranges reduces the risk of heart attacks. Research might even show that people that eat oranges have lower incidence of certain cancers. 

With all the research and publicity on oranges, they would become a major craze. Experts would make statements about how many oranges should be eaten daily. People would be seen carrying oranges around the office. All America would be saving lives, one orange at a time.

And yet, despite all the craze, oranges would still be substitutable. This would become especially apparent once orange prices skyrocketed because of the massive orange consumption. In a pinch most of us would still survive with an apple or banana in our lunches. The vitamin C and potassium could be obtained from other food sources. The reduced cancer risk could equally be attained by smoking cessation. Despite all the excitement and research showing the benefits of oranges, most people could get by using substitutes for oranges.

American health care is a lot like oranges. Trillions of dollars of research has been poured into the development of health care services. Pharmaceuticals have been extensively studied and have proven benefits. Health care providers work hard to prove that every intervention is backed by solid research. America has swallowed the pitch that our health care is invaluable. Some even go so far to state that health care is a right, apparently inalienable and inseparable from the human experience. 

But is it? Is our current version of health care irreplaceable? Is there any substitute for American health care?

In the case of our oranges, we saw that despite proven benefits of eating oranges, they could be substituted. The same is the case with our current health care system. A substitute can be recognized or developed for every benefit that medical technology currently offers. These substitutes can be found in dietary and nutritional sciences, in behavioral changes, in further pharmaceutical discovery, or in religious exercise or divine intervention.

For example, what is a viable substitute for diabetes treatment? The answer is diet and exercise. What is a viable substitute for antibiotic treatment for childhood ear infections? Research now shows that no treatment is generally just as effective and is thus a viable substitute. What about a substitute for antidepressant medication? Counseling and therapy are proven viable substitutes. What about chemotherapy for cancer? In many cases there may be no currently recognized substitute, but it is certain that  substitute therapies will be discovered. 

It is an absolute fact that substitutes can be recognized or developed for every medical intervention now currently utilized in the American health care system.

American health care is a commodity. It is an extremely valuable commodity, but still one that can be substituted by other commodities. Unlike the right to freely worship God, the right to free speech, and the right to bear arms, health care can be substituted. It is subject to the laws of economics, as are all other commodities. 

If American health care is “universalized” and made absolutely accessible to the public, it will be consumed out of proportion to its existing supply and prices will skyrocket. Health care will be utilized for silly, trivial purposes and thus become unavailable for serious problems. Instead of attempting to mandate and universalize health care, doesn’t it make sense to allow for and encourage substitution? Wouldn’t it be better that Americans find viable substitutions for the existing system? 

Rusty Scalpel