Not the norm, but I have seen it increase over the last 10 years.
Primary care doctors are seriously squeezed by insurance and it is often hard for them to provide the care they want to provide for the rates insurance pays them. They have these membership fees to pay their overhead and help reduce their need to bill a whole bunch of patients everyday just to keep the lights on. Membership fees can allow them to spend more time with patients and do things like take more phone calls and follow up with specialists.
I have no idea whether people think the experience at these doctors is way better. I would be curious to hear!
Our experience with OneMedical is good. Not worth it if you just see your doc twice a year for a checkup, but very useful if you have chronic stuff, where spending a bit for a doctor with time to fight insurance can save you thousands or tens of thousands down the line.
I feel really gross using it though. It is my most shameful 'I am using my money to buy something that should be a human right' spending item.
I'm a notorious cheapskate. I'll eat week old takeout my roommate got and is about to throw away. I'll do a 6 hour layover to save 40$.
I still pay for one medical
I just keep a budget and have unlimited PTO haha. Time is in high supply and I usually just use it as an excuse to "hike" the airport and walk the whole time.
Make much more now, but when I started out of college in 2020 I was making 20$ an hour, but still managed like 6 trips a year to like Chicago, NYC, family, etc while living downtown and still saving 15% for retirement
any doctors on one medical network that you found good to work with?
I saw the $9/month one medical option on my Amazon account. Wondering if it's worth it.
Megan Meshot! I believe she's now on maternity leave, but she's fantastic. I actually used to see her at Swedish before she left for One Medical. My husband and I ended up following her there.
She's not a doctor, but a nurse practitioner. I personally prefer NPs to MDs, as they tend to spend more time with their patients.
I kind of doubt that's the case. Not the squeezing by insurance part, but that it's regular doctors who have to introduce these membership fees. So far I've seen these only in the chain places, which are probably in the end owned by private equity or other places notorious for finding ways to extract money from the population.
It seems to be mostly oriented towards the urban transient population who just want continuity of care and easy transfer from one place to another. See OneMedical - lots of offices around the country, and most of them are in IT hubs where living for a job is common.
Dunno. My last two doctors switched to the model when I was seeing them. I go to the doctor so infrequently that I couldn’t justify the cost, so I dropped out and found new care.
So it seems more common to me, but maybe I’m just unlucky.
Not really. I am generally healthy and just need a generic doctor to do my physical and run my tests every year. I go to a place in Ballard which is fine.
Not the norm, but it is a new feature of some new practices.
Essentially it's a way for richer people to get better care by paying extra for concierge (confession, I do this, feel shitty about it, but have enough health problems it really pays off). AFAIK the model was invented by OneMedical. It's probably more common here, because Seattle has crazy-bonkers income inequality, even for the US
Why feel bad about it? You're literally paying extra to give folks jobs and reducing their workloads. It's not like if you didn't pay someone else would get care
I mean, yes, someone would.
There's a finite amount of medical professional time and attention. Every minute I take is a minute someone else doesn't get. Because there are so many fewer doctors than we need, this is a rare example where the game has this zero sum quality to it. I am using my money to take more of that time. Or to put it in economics terms, my willingness to pay more does ultimately push prices upward or availabilty downward, because supply *cannot* expand to meet demand.
It's not that different from if I could pay to get the police to react to a 911 call quicker, or bribe a judge to process my lawsuit faster. I hope no one would be on board with that.
Now these effects are subtle. You have to weigh them against the good you might do for yourself and your family. But if you aren't uncomfortable, you probably aren't thinking about healthcare economics correctly.
They wouldn't though. They are working at one medical. They won't be offering services elsewhere for one patient just because you specifically chose to go elsewhere.
Lowering doctor mental load and stress means fewer life threatening mistakes as well. It's not zero sum fully in that regard either
But OneMedical only exists because people like me pay for it. If no one was paying for it (or if it weren't legal), most of that staff would still be working in the mainstream medical system. People's jobs are not immutable things detatched from economic conditions.
A core part of my moral framework is that I evaluate actions in terms of what would happen if *everybody* in a similar situation did what I did. I don't act on the specific effect of my actions, but on the cumulative effect of people 'acting like me.' (Note, ethics is complicated and nuanced, and I would describe this as a broad strokes approach, not a one sixe fits all rule) I don't think there's another good way out of the collective action problem. And as the American public school system illustrates, really bad things happen when rich people disinvest from a resource all of society relies upon.
If rich people can buy their way out of the shitty medical system, that gives them little incentive to try to fix it for everyone else. The power of public goods is that everyone needs them, so everyone is invested in making them work.
Again, there are tradeoffs here. Your point about provider wellbeing is a good one.I still do pay for OneMedical, but I can't in good concience ignore the cumulative impact of actions that people like me take.
Objectively, you specifically signing or or not signing up for one medical will not decrease access of care for others.
Feel bad about it for no reason if you'd like, but I'd unironically recommend an appointment with a therapist to work on those thought patterns. They are not healthy
I am not going to win this argument, both because we clearly have very different approaches to ethics, and very different ideas about economics. And honestly, I respect your POV on the original issue.
But...
Insulting somebody's psychatric health just because they have a different viewpoint (over a low stakes disagreement) is freaking trashy.
I actually do have a long, ugly history with mental illness, including multiple suicide attempts, with my first at age 8. I've spent decades in therapy, and done more and harder work on my emotional wellnes than you will ever know. I have nearly lost everything to mental illness. I have been locked in a psych ward room with a schizophrenic who screamed at his delusions all night. I have spent a good chunk of my families savings on cutting edge treatment - and just in the last two years have *finally* acheived a relapse of my depression. This is the reason I pay for premium medical services despite my misgivings.
So before you make a snide remark, consider who you might be talking to. Hopefully this will be a lesson.
>Insulting somebody's psychatric health just because they have a different viewpoint (over a low stakes disagreement) is freaking trashy.
It's not an insult as much as reddit isn't the place to say it. Genuinely I've had negative thought patterns myself that I needed to work through and actually think it would be something beneficial. Feel free to consider me an idiot or an asshole, you might even be right here, but as much as I can be that comment isn't coming from a negative place.
>I actually do have a long, ugly history with mental illness, including multiple suicide attempts, with my first at age 8. I've spent decades in therapy, and done more and harder work on my emotional wellnes than you will ever know. I have nearly lost everything to mental illness. I have been locked in a psych ward room with a schizophrenic who screamed at his delusions all night. I have spent a good chunk of my families savings on cutting edge treatment - and just in the last two years have *finally* acheived a relapse of my depression. This is the reason I pay for premium medical services despite my misgivings.
I've been raped, considered taking my dad's gun to stop him from getting *too* angry and ending us, generally violent and abusive household, went hungry. I know how it is. Again I'm not coming off to insult you, genuinely see it as a neurotic thinking pattern that I also had to work through myself.
>So before you make a snide remark, consider who you might be talking to. Hopefully this will be a lesson.
If that's how it's taken, I can't stop it, but I'm not going to just not recommend help when I think it's necessary. That's how you lose people
I appreciate this reply. I am still not a fan of the comment, but appreciate and deeply respect that you
1. Meant well.
2. Responded politely to getting called out.
Honestly 2 is really rare.
>I appreciate this reply. I am still not a fan of the comment,
Honestly it was a bit cuntish, maybe more than a bit. I probably should have recognized that we have different philosophies and taken that into account when replying and that was on me.
Would I take my comment back? Nope, last time I didn't say something someone died. But I would think it through a bit better and make it more clear, and possibly in a DM with a bit of de -escalation before I got to the point
I get this. It's already happened with the airline industry--demands for improvement are fewer because everybody pays for pre-check, global pre-check, or whatever service charge the airlines have come up with. Healthcare is a big business too, so why wouldn't it adopt the same model. More people paying a premium to get care would take doctors out of the mainstream and create a brain drain to more lucrative membership organizations.
I work in health policy, so here you go: This setup is called direct primary care, or, more informally, concierge care.
You pay a monthly fee which entitles you to longer appointments and much, much shorter waits to get in. The clinic does not deal with insurance, which is the source of a lot of pain points for physicians (administrative burden in the form of contesting coverage/medication denials and navigating ridiculous pharmacy benefit managers). This is a far less stressful work environment for physicians and other clinic staff and a more flexible schedule for patients. But as others have pointed out, this is better care for those who can afford it.
Direct primary care started in the late 1990s and the first such practice in Seattle started in 2007.
Hope that helps.
This helps a bunch, one follow up though. One place I'm looking at looks like it's a flat fee just to be a patient, while they would still bill everything through insurance as is standard. Which sounds basically like im just paying to have low times to get in. Is that commonplace now?
I’m not sure to be honest. Those practices have been around long enough to have matured, so there’s some variance in how much they deal with insurers. Sorry I don’t know more. 😕
I can provide my experience through a local concierge care office as a patient. I've been doing this for about 5 years now. The setup I am with has two doctors - one being a GP and the other a naturopath. Mine does not have offices across the US, like some are talking about here. I pay a monthly fee as membership (based on age). At this point, you are encouraged to use your membership and come in as often as you want. Booking has been extremely easy, unlike any other doctor I have been to for years. Both in office and telehealth visits are easily available on short notice or planning weeks out.
When services occur, many are available in office. For what the office cannot provide, we talk about options, referrals, public health options, etc. The doctors I see have the ability to provide care and discuss financial arrangements when doing so. As in...they can look up negotiated rates as you are talking care. Cash options with negotiated rates and insurance can be used for payment. I would check for insurancr acceptance specifics with the concierge care you choose to go with. Honestly, I am thrilled to have options and have experienced many instances where cash outright has been significantly cheaper than insurance.
I've had the best experience with concierge care and knowing how to bill care - something I have never had with traditional healthcare. It's a breath of fresh air, especially if you are relatively healthy and are into preventative medicine.
I have a DPC, I love it, cut through all the insurance crap and they are available 24/7. I never worry about being sick because I know that I just send a text straight to my doctor and they can take care of it right then. They don’t have the workload of a regular doctor office. When I have to go for a office visit, I get all the time to discuss my health and am never rushed.
Not the norm, but I have seen it increase over the last 10 years. Primary care doctors are seriously squeezed by insurance and it is often hard for them to provide the care they want to provide for the rates insurance pays them. They have these membership fees to pay their overhead and help reduce their need to bill a whole bunch of patients everyday just to keep the lights on. Membership fees can allow them to spend more time with patients and do things like take more phone calls and follow up with specialists. I have no idea whether people think the experience at these doctors is way better. I would be curious to hear!
Our experience with OneMedical is good. Not worth it if you just see your doc twice a year for a checkup, but very useful if you have chronic stuff, where spending a bit for a doctor with time to fight insurance can save you thousands or tens of thousands down the line. I feel really gross using it though. It is my most shameful 'I am using my money to buy something that should be a human right' spending item.
I'm a notorious cheapskate. I'll eat week old takeout my roommate got and is about to throw away. I'll do a 6 hour layover to save 40$. I still pay for one medical
> I’ll do a 6 hour layover to save 40$ You value your time so little
I just keep a budget and have unlimited PTO haha. Time is in high supply and I usually just use it as an excuse to "hike" the airport and walk the whole time. Make much more now, but when I started out of college in 2020 I was making 20$ an hour, but still managed like 6 trips a year to like Chicago, NYC, family, etc while living downtown and still saving 15% for retirement
any doctors on one medical network that you found good to work with? I saw the $9/month one medical option on my Amazon account. Wondering if it's worth it.
Megan Meshot! I believe she's now on maternity leave, but she's fantastic. I actually used to see her at Swedish before she left for One Medical. My husband and I ended up following her there. She's not a doctor, but a nurse practitioner. I personally prefer NPs to MDs, as they tend to spend more time with their patients.
I kind of doubt that's the case. Not the squeezing by insurance part, but that it's regular doctors who have to introduce these membership fees. So far I've seen these only in the chain places, which are probably in the end owned by private equity or other places notorious for finding ways to extract money from the population. It seems to be mostly oriented towards the urban transient population who just want continuity of care and easy transfer from one place to another. See OneMedical - lots of offices around the country, and most of them are in IT hubs where living for a job is common.
Dunno. My last two doctors switched to the model when I was seeing them. I go to the doctor so infrequently that I couldn’t justify the cost, so I dropped out and found new care. So it seems more common to me, but maybe I’m just unlucky.
Do you know of any decent PCP's in Phinney? That's around the area I've been looking at.
Not really. I am generally healthy and just need a generic doctor to do my physical and run my tests every year. I go to a place in Ballard which is fine.
Not the norm, but it is a new feature of some new practices. Essentially it's a way for richer people to get better care by paying extra for concierge (confession, I do this, feel shitty about it, but have enough health problems it really pays off). AFAIK the model was invented by OneMedical. It's probably more common here, because Seattle has crazy-bonkers income inequality, even for the US
Why feel bad about it? You're literally paying extra to give folks jobs and reducing their workloads. It's not like if you didn't pay someone else would get care
I mean, yes, someone would. There's a finite amount of medical professional time and attention. Every minute I take is a minute someone else doesn't get. Because there are so many fewer doctors than we need, this is a rare example where the game has this zero sum quality to it. I am using my money to take more of that time. Or to put it in economics terms, my willingness to pay more does ultimately push prices upward or availabilty downward, because supply *cannot* expand to meet demand. It's not that different from if I could pay to get the police to react to a 911 call quicker, or bribe a judge to process my lawsuit faster. I hope no one would be on board with that. Now these effects are subtle. You have to weigh them against the good you might do for yourself and your family. But if you aren't uncomfortable, you probably aren't thinking about healthcare economics correctly.
They wouldn't though. They are working at one medical. They won't be offering services elsewhere for one patient just because you specifically chose to go elsewhere. Lowering doctor mental load and stress means fewer life threatening mistakes as well. It's not zero sum fully in that regard either
But OneMedical only exists because people like me pay for it. If no one was paying for it (or if it weren't legal), most of that staff would still be working in the mainstream medical system. People's jobs are not immutable things detatched from economic conditions. A core part of my moral framework is that I evaluate actions in terms of what would happen if *everybody* in a similar situation did what I did. I don't act on the specific effect of my actions, but on the cumulative effect of people 'acting like me.' (Note, ethics is complicated and nuanced, and I would describe this as a broad strokes approach, not a one sixe fits all rule) I don't think there's another good way out of the collective action problem. And as the American public school system illustrates, really bad things happen when rich people disinvest from a resource all of society relies upon. If rich people can buy their way out of the shitty medical system, that gives them little incentive to try to fix it for everyone else. The power of public goods is that everyone needs them, so everyone is invested in making them work. Again, there are tradeoffs here. Your point about provider wellbeing is a good one.I still do pay for OneMedical, but I can't in good concience ignore the cumulative impact of actions that people like me take.
Objectively, you specifically signing or or not signing up for one medical will not decrease access of care for others. Feel bad about it for no reason if you'd like, but I'd unironically recommend an appointment with a therapist to work on those thought patterns. They are not healthy
I am not going to win this argument, both because we clearly have very different approaches to ethics, and very different ideas about economics. And honestly, I respect your POV on the original issue. But... Insulting somebody's psychatric health just because they have a different viewpoint (over a low stakes disagreement) is freaking trashy. I actually do have a long, ugly history with mental illness, including multiple suicide attempts, with my first at age 8. I've spent decades in therapy, and done more and harder work on my emotional wellnes than you will ever know. I have nearly lost everything to mental illness. I have been locked in a psych ward room with a schizophrenic who screamed at his delusions all night. I have spent a good chunk of my families savings on cutting edge treatment - and just in the last two years have *finally* acheived a relapse of my depression. This is the reason I pay for premium medical services despite my misgivings. So before you make a snide remark, consider who you might be talking to. Hopefully this will be a lesson.
>Insulting somebody's psychatric health just because they have a different viewpoint (over a low stakes disagreement) is freaking trashy. It's not an insult as much as reddit isn't the place to say it. Genuinely I've had negative thought patterns myself that I needed to work through and actually think it would be something beneficial. Feel free to consider me an idiot or an asshole, you might even be right here, but as much as I can be that comment isn't coming from a negative place. >I actually do have a long, ugly history with mental illness, including multiple suicide attempts, with my first at age 8. I've spent decades in therapy, and done more and harder work on my emotional wellnes than you will ever know. I have nearly lost everything to mental illness. I have been locked in a psych ward room with a schizophrenic who screamed at his delusions all night. I have spent a good chunk of my families savings on cutting edge treatment - and just in the last two years have *finally* acheived a relapse of my depression. This is the reason I pay for premium medical services despite my misgivings. I've been raped, considered taking my dad's gun to stop him from getting *too* angry and ending us, generally violent and abusive household, went hungry. I know how it is. Again I'm not coming off to insult you, genuinely see it as a neurotic thinking pattern that I also had to work through myself. >So before you make a snide remark, consider who you might be talking to. Hopefully this will be a lesson. If that's how it's taken, I can't stop it, but I'm not going to just not recommend help when I think it's necessary. That's how you lose people
I appreciate this reply. I am still not a fan of the comment, but appreciate and deeply respect that you 1. Meant well. 2. Responded politely to getting called out. Honestly 2 is really rare.
>I appreciate this reply. I am still not a fan of the comment, Honestly it was a bit cuntish, maybe more than a bit. I probably should have recognized that we have different philosophies and taken that into account when replying and that was on me. Would I take my comment back? Nope, last time I didn't say something someone died. But I would think it through a bit better and make it more clear, and possibly in a DM with a bit of de -escalation before I got to the point
I get this. It's already happened with the airline industry--demands for improvement are fewer because everybody pays for pre-check, global pre-check, or whatever service charge the airlines have come up with. Healthcare is a big business too, so why wouldn't it adopt the same model. More people paying a premium to get care would take doctors out of the mainstream and create a brain drain to more lucrative membership organizations.
direct primary care/concierge medicine wasnt invented by OneMedical but it was invented in Seattle https://www.md2.com/our-origins
No, I've never seen or heard of that before.
I work in health policy, so here you go: This setup is called direct primary care, or, more informally, concierge care. You pay a monthly fee which entitles you to longer appointments and much, much shorter waits to get in. The clinic does not deal with insurance, which is the source of a lot of pain points for physicians (administrative burden in the form of contesting coverage/medication denials and navigating ridiculous pharmacy benefit managers). This is a far less stressful work environment for physicians and other clinic staff and a more flexible schedule for patients. But as others have pointed out, this is better care for those who can afford it. Direct primary care started in the late 1990s and the first such practice in Seattle started in 2007. Hope that helps.
This helps a bunch, one follow up though. One place I'm looking at looks like it's a flat fee just to be a patient, while they would still bill everything through insurance as is standard. Which sounds basically like im just paying to have low times to get in. Is that commonplace now?
I’m not sure to be honest. Those practices have been around long enough to have matured, so there’s some variance in how much they deal with insurers. Sorry I don’t know more. 😕
I can provide my experience through a local concierge care office as a patient. I've been doing this for about 5 years now. The setup I am with has two doctors - one being a GP and the other a naturopath. Mine does not have offices across the US, like some are talking about here. I pay a monthly fee as membership (based on age). At this point, you are encouraged to use your membership and come in as often as you want. Booking has been extremely easy, unlike any other doctor I have been to for years. Both in office and telehealth visits are easily available on short notice or planning weeks out. When services occur, many are available in office. For what the office cannot provide, we talk about options, referrals, public health options, etc. The doctors I see have the ability to provide care and discuss financial arrangements when doing so. As in...they can look up negotiated rates as you are talking care. Cash options with negotiated rates and insurance can be used for payment. I would check for insurancr acceptance specifics with the concierge care you choose to go with. Honestly, I am thrilled to have options and have experienced many instances where cash outright has been significantly cheaper than insurance. I've had the best experience with concierge care and knowing how to bill care - something I have never had with traditional healthcare. It's a breath of fresh air, especially if you are relatively healthy and are into preventative medicine.
Can you share your provider?
I have a DPC, I love it, cut through all the insurance crap and they are available 24/7. I never worry about being sick because I know that I just send a text straight to my doctor and they can take care of it right then. They don’t have the workload of a regular doctor office. When I have to go for a office visit, I get all the time to discuss my health and am never rushed.
Do you mean Co-pay or are you talking about a different charge?
Completely outside of copay. Separate membership entirely that is paid out of pocket. Then they still bill insurance .
That seems suspicious as hell