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....