12.23.2016

OT: Concierge Doctor Service. How does that work for a freelancer?

I live, day to day, under the watchful eyes of Studio Dog...

Whenever freelancers get together, especially freelancers over 40 years of age, the conversation, at some point, gets around to health insurance and healthcare costs. Here is my solution.

Like most self employed professionals in the U.S.A. I've spent the last 30 odd years paying the full cost for my own health insurance, and the insurance for my family. Like many I tried to balance the scales between having enough coverage to prevent bankruptcy should I get hit by a car, have a heart attack or stroke, or a cancer diagnosis; and having a high enough set of deductibles to keep the overall costs low enough to make coverage (marginally) affordable. In the last few years the costs crept up from around $12,000 per year to somewhere north of $16,000 per year. 

Mixed in to the whole equation was the need to make sure, with each insurance change, that I could see my favorite doctor. I had to check carefully to make sure his practice was on whatever plan I was considering. I've had the same doctor for nearly 25 years and he was instrumental in helping me get over a big health scare and a nearly crippling bout of anxiety. I trust him and want to have access to him regardless of what carrier I might choose. 

So, this year my doctor announced that he was walking away from the traditional insurance-reimbursed paradigm and re-thinking his practice to relaunch as a Concierge Medicine provider. He would no longer accept insurance but would, instead, charge a yearly fee which gives his patients full access to all of his services and knowledge with no additional charges. His yearly fee would cover routine office visits of all kinds as well as a thorough yearly exam with a complete battery of tests. In exchange for our trust in him he would trust us (the patients/clients of his private practice) with his cellphone number, access by text, e-mail and office phone. I could e-mail him a question about anything that comes to mind, from some nagging symptom to a question about the side effects of my parents' prescriptions. 

Everything is life seems to be a gamble but this is one I happily accepted. I am generally very healthy, lead a relaxed and happy lifestyle, eat very well and get more good sleep that the average adults I know. I'm pretty sure that my doctor will come out ahead, financially, but I am equally sure that I will come out ahead as far as my general peace of mind is concerned. In addition to his services I will, of course, continue to carry an ACA approved, major medical policy with a high deductible, and now my kid is covered through his college...

So, why am I talking about this today? Well, I've had a nagging stuffiness in my left ear. After swim practice today it felt a bit worse. In the days of old I might have held off seeing my doctor until the symptoms were obvious but not now. I called the doctor's office on my way home from swim practice, around 10:00 am. I explained what was going on and, after a brief pause, the office manager asked if it would be convenient for me to come by in an hour. Yes; very convenient. 

I showed up and was seen by a nurse immediately. She took my vitals and we briefly discussed my general health. I am happy to report that I weigh exactly 160 pounds, my temperature was 97.6 and my blood pressure was 110/65. My resting pulse rate was 55.  The nurse looked at my age and took my blood pressure once more, just to verify. I was hoping to get a Pokemon sticker or something for my good numbers but I guess that's just for younger kids...

My doctor came in and we chatted about swimming, about my kiddo getting home from college last night, and my general view of life. He examined both ears. I did not have swimmer's ear  or any other kind of ear infection. Seems my allergies have been affecting my eustachian tubes. He suggested several remedies and wrote a prescription for the one of last resort. We wished each other a "Merry Christmas" and he reminded me that he was available for anything I might need. I should just call, text or e-mail. 

I walked up to the reception desk, preconditioned by a lifetime of paying co-pays, etc. The reception person smiled and said, "Thanks for coming by! Happy Holidays!" There was no paper work, no request for a credit card, no demand to see my insurance card. Nada. Just a smile. 

By cutting back on a traditional insurance policy to one that is more barebones (but still covers major illness, accidents and emergencies) and adding in the cost of the concierge service I am paying about what I did the year before. It's nice though  to have a dedicated doctor and the ability to get nearly "same hour" appointments. 

The most important thing though, as a freelancer, is to take control of your lifestyle and engineer it to be as healthy as possible. 

Here are the things that seem to work for me: 1. Maintain your proper weight. If your pants start to feel tight don't buy bigger pants, re-examine your diet and exercise strategies. 2. Exercise at least an hour a day. More (much more) if you can. Doesn't have to be brutal, like full contact power lifting combined with ultra-marathoning but you should be on the edge of being out of breath for at least a large part of your (minimum) hour. I try to swim five or six days a week and I try to walk a lot every day. When my schedule permits we all walk with Studio Dog in the early dawn (about 2.5 miles with hills) which serves as a warm-up and then I head straight for the pool. 3. Get a lot of sleep. I get to bed with the idea of getting 7 to 8 hours of sleep a night and, I supplement that with an afternoon nap on the couch under the watchful eyes of Studio Dog, when I feel a nap is suggested or required. 4. Eat good food. Don't eat too much. Push away from the table before dessert rears its ugly head. 5. I have a glass or two of red wine with my evening meal. I think it is good for your blood pressure and I know it's good for my general attitude. Finally, 6. Try to make leisure time, hobbies, art and socializing your top priorities and keep your "job" as a lower priority. Work makes most people crazy. I try to avoid doing too much of it. 

In the end we are able to deduct a certain amount of our healthcare costs, insurance, and medical consulting from our federal taxes. Insurance takes a chunk out of my gross income but having coverage, and a good doctor on call, add back a sense of security that lowers my overall stress. If we had universal cradle-to-grave healthcare that I did not have to pay for directly I would most likely still maintain my new relationship with my primary doctor. I like both the continuity of care and the ready access. 

For an older freelancer good health (and by extension, good healthcare services) is a very important asset. Unlike an employee we do not have paid sick days. If we have recurring health issues we lose income. If we have health limitations those limitations limit our ability to provide services that require more physical rigor. 

As a nation we pride ourselves on being self-reliant but the reality is that 50% of healthcare cost (maybe more!) is self inflicted; caused by lifestyle choices. Exercise may seem boring to some but the alternative is accelerated physical decline and muscle loss. Eating healthy may seem like a fussy or expensive undertaking but the value of controlling weight and blood sugar pays enormous rewards. 
If we all made the right decisions, and followed good advice from experts we might, as a nation, be able to lower our costs of healthcare a lot. 

I can't make anyone accept my routine but I follow it because it's proven to be cost effective for me so far. 

Health is an investment for freelancers; especially those that have professions requiring mobility and strength. My final thought is that my cost for concierge care at my doctor's office is less than the price of a replacement, full frame camera. Looking at it that way makes it seem like a bargain.

Final thought. Pets are good for your physical and mental health. It's hard to over estimate the value of unconditional love.... 

12 comments:

Frank Grygier said...

I hope this type of medical practice catches on. Merry Christmas.

seany said...

Kirk with your lifestyle I think your Doctor should be giving you a large discount on your annual fee,my money is on you being the first guy to reach the much talked about 150yrs lifespan we hear so much about nowadays, you are my hero.
Michael.

Daniel Walker said...

Great post, thanks.......Merry Christmas

milldave said...

Amen,amen and,again,amen!
Best advice ever before the Christmas celebrations!
Merry Christmas and a Happy New Year to you and your family; may you and they go from strength to strength in the coming year(s)!
David
PS: does your doctor accept Canadian patients??

Patrick Dodds said...

Nice post - happy Christmas to you and yours.

Helen said...

Thanks for being so inspirational. Please keep it up.
Season's greetings from a hot Melbourne.
Helen

Stephen Emmons said...

Eat less, but better. Move more. Doing both helps not only the body but the spirit.
I see all too many university students who are carrying 50+ pounds. Just depressing to think of the seeds of bad health they are sowing.

Merry Christmas and Happy New Year to the Tuck family. And to the most important member of that family -- Studio Dog!
Stephen

Sherwood said...

Those $ amounts for health care are mind numbing. I remember growing up as a boy in rural Ontario and being fearful If my dad got sick for an extended period, we could lose our house. Then universal health care came into being, at a very reasonable price.

Perfect Universal health care is like the perfect camera... it doesn't exist, but our health care appears to check off most of the right boxes.

Have a healthy and happy Christmas Kirk

Paul said...

Sage advice Kirk, you've prompted me to stop typing and go and do some exercise.

Another seasons greetings to you, your family and all your readers from a warmish Melbourne (we are only expecting 91F today)

Craig Yuill said...

The cost of health insurance in the US is insane. I understand that much of the cost is due to the extensive bureaucracy maintained by the private insurers, as well as the need to produce profit. In Canada we have publicly-funded health care. In my province we have to pay monthly premiums, but they don't add up to anywhere near $12000-16000 US per year. As mentioned by an earlier poster, our health-care system isn't perfect, but it is there when we need it. And I and other members of my family have needed it on occasion.

The current government in my province is perhaps too focused on cost control. In the spirit of managing costs, the local health authority has closed down medical practices operating in community health centres in my area and merging the services to a central location. We used to have practices spread out throughout my city with programs that emphasized preventative medicine and healthy lifestyles to the community. We now have a single centrally-located service that handles only patients with "complex issues". This move might lead to immediate cost saving, but will undoubtedly lead in the long run to more people having more problems (that will cost more to treat) because preventative medicine/healthy lifestyles (eat right, exercise, etc.) aren't being emphasized now. I hope your experience with concierge medical service is a good one.

I definitely agree that having a pet is a good thing. My family has a beautiful cat. I admit to being serene and calm when she is on my lap or laying on top of my while I stroke the fur on her back. For me it's good mental therapy.

Kirk Tuck said...

Sadly, I think we are working toward a "euthanasia" policy for the poor and working poor, going forward. Sad to think that the "world's wealthiest nation" should provide such spotty healthcare to so many people and at prices that are multiples above what people in most civilized countries pay. We seem to be at the mercy of profit.

Bassman said...

About 10 years ago, we were considering changing our primary care physician, as he had gotten progressively hard to reach or schedule appointments with. Then one day, we received a letter from him announcing that he was firing all of his patients, and opening a concierge practice along the lines you described. We signed up immediately, and have been thrilled ever since. His take is that he's making less money and enjoying being a doctor again, rather than a clerk for the insurance companies. He still files insurance claims for us for any procedures or supplies which are covered, but we never do any paperwork or pay anything other than the periodic retainer. He does actually respond very quickly to either phone calls or emails, and appointments are next day at worst. My wife has consulted with him throughout her mom's decline just as a double check on the progress, which he was happy to do. Rather than facing a constant barrage of lab tests and treatments, we now are councilled towards a minimally invasive treatment plan.

All health care should be like this.