Family Medicine Care involves taking a population of Americans who believe the vast majority of their healthcare should be provided by one physician and separating those people into their own insurance pool. People who choose Family Medicine Care accept the following understandings of the doctor-patient relationship:

• They agree to see the same physician — or at least the primary clinic — as much as possible for most healthcare needs.
• They accept that family physicians’ inherent practice styles are different from ologists, but that volumes of research show the family medicine common sense approach to healthcare is safe, effective, and leads to more affordable healthcare.
  • Family physicians will not order as many tests as ologists, especially in the early stages of symptoms.
    • Patients reject the assumption that early detection of diseases improves the final outcome in most cases.
  • Family physicians will take responsibility for as much of the patients’ care as they are capable of. Family physicians will ask ologists to contribute to patients’ care only when the addition of ologists actually improves their patients’ health.
  • Family physicians accept that medical science actually cures very little, and the real challenge for many patients is learning to manage and live with chronic diseases.  Many times the best approach is a humble attitude about the limitations of modern medicine. The corollary to this attitude is that a series of useless tests and procedures isn’t in the best interest of the patient or the greater healthcare system.
• They agree to not seek ologist care unless they’ve checked with their family physician first.

Other than this cultural change of accepting the inherent quality and efficiency of the family physician-patient relationship, which I realize still won’t be easy, Family Medicine Care will function like every other healthcare plan in existence in America. All medically necessary care will be provided. Rare diseases and conditions will be investigated, and if found, treated. Standard definitions of “medically necessary” will be used.

People who choose Family Medicine Care will accept a slightly different set of assumptions about healthcare than the current POEM assumptions. The new assumptions are:

• Prevention doesn’t save money, but patients still expect a lot of prevention from their family physicians – Family Medicine Care patients would receive most customary preventive services recommended by national medical organizations, except PSA testing because it doesn’t work.
• Family physicians deliver the best health at the lowest cost — Family Medicine Care patients recognize the best care for most health conditions is provided by a single family physician who knows her patient well. Ologists would become involved only when the ologists add value to a patient’s health.
• Early detection prevents some diseases, but only if there is good evidence to support a preventive test or treatment — Most health conditions will be handled the same as current conventional care. Family Medicine Care patients acknowledge that family physicians have a different style of managing some health conditions than ologists, which doesn’t mean the family medicine approach is inferior. An example would be giving time for non-specific symptoms to mature into a set of symptoms more indicative of a diagnosable disease.
• More treatments don’t equal better care – Family Medicine Care patients will expect treatments to be offered if there is reasonable proof of effectiveness. Experimental treatments will not be covered.

END RESULT

For employed families that choose Family Medicine Care, their total healthcare costs, those paid by their employer and their expenses combined, will decrease by approximately 20%, or $3,207 in 2009. This will result in lower co-pays for some insured items and more take home pay. The ratio of these two payouts – co-pays versus take home pay – will depend on how the employee or employer would want to divvy up the savings. If all of these savings went to take-home pay, it would result in $267 more per month of personal income.

A similar trade-off could occur for elderly Americans who receive Social Security and Medicare benefits. The average elderly couple in America receives about $44,120 per year from the taxpayers through the federal government from these two programs: $22,960 from Social Security and $21,160 from Medicare in 2009. This money could be treated like the cafeteria plans common in the workplace. By choosing to spend less on healthcare by choosing the Family Medicine Care plan, more of the money set aside for the elderly couple could be directed to Social Security payments instead.

Therefore, for a couple on Medicare who chooses Family Medicine Care, their total healthcare costs would decrease by approximately $4,232 in 2009. This would increase their monthly Social Security check by about $352 per month—from an average in 2009 of $1,913 per month to $2,265 per month.

This extra income could be used to improve the couple’s health in other ways. They could reduce their stress by not living on as tight a budget as before. They could afford to move into a safer retirement community. They could join a local YMCA and start exercising regularly. They could buy healthier foods. There are lots of ways people improve their health that have nothing to do with the healthcare system.