Health care reform coverage: Spot on or missing key options?

“Health care reform: Possibilities & opportunities for primary care” (J Fam Pract. 2014;63:298-304) was terrific. You nailed the opportunities and challenges with implementing advanced primary care.

Joseph Scherger, MD
La Quinta, Calif

Your article focuses on so-called “value-based” care and Affordable Care Act (ACA) options and ignores other forms of free market health care, such as concierge and direct primary care, that are growing in popularity with physicians and patients. When patients shop for and pursue self-paid care, they are invested in the process, participate in their own care, and have better outcomes. The free market will bring many diverse options to the table, increase the quality of care, and decrease the price of care to stay competitive.

Physicians must step up for their individual patients and be health care leaders, not followers of government mandates and insurance company policies. Patients deserve nothing less than a free-market, competitive environment, and a variety of care and insurance options—not just a few, as dictated by the ACA.

Craig M. Wax, DO
Mullica Hill, NJ

Authors’ response:
We appreciate the comments of Drs. Scherger and Wax. We also agree that there is a move in some areas of the country toward direct primary care, as well as toward concierge medicine. However, it is our opinion that in their current form, these models are a symptom of today’s health care system and not a solution.

The vast majority of Americans cannot afford to pay directly for their care. And since health care is not a free market system, free market reforms are not likely to be the solution for most Americans. However, if concierge medicine or direct primary care could be part of a menu of options through existing insurance, government, or employer models, the potential negative impact (including the exacerbation of the current strained primary care system) could be ameliorated.

We agree that physicians should always advocate on behalf of their patients, but we also believe we should think of all patients and how policy changes may impact society as a whole.

Randy Wexler, MD, MPH
Jennifer Hefner, PhD, MPH
Mary Jo Welker, MD
Ann Scheck McAlearney, ScD, MS
Columbus, Ohio