7.14.2018

Totally off topic: Healthcare. Not a discussion about the Affordable Care Act !!!


I know many of my readers worked for the government or big corporations before retiring or may still work within those entities. I don't want this to devolve into a political discussion about the ACA. I just want to start a discussion about how freelancers access healthcare and what my strategy is for my healthcare. It's part of being a photographer and it's even more important as one hits middle age (and older).

I've always carried health insurance, rarely had to use it. I researched physicians in Austin about 30 years ago, asked my dentist and friends of mine who were doctors in various specialties, and went out and actively interviewed general practitioners. Most people just throw a dart at the dart board of whoever is offered in their employer paid health plan but I wanted an actual partner in my healthcare and I wanted someone who would go beyond the seven minute evaluation and the quick exit after writing a prescription. I wanted the kind of doctor my grandfather was; a caring and dedicated professional who would follow you through life, understand your history and think before diagnosing.

I found a great general practitioner and over the years I'd go in for a yearly physical, get ear infections treated and get my immunizations done. He never blindly prescribed, we talked through modalities of treatment and he offered options and let me know his preferences.

About two years ago my doctor decided he'd had enough of jumping through hoops and reducing fees for the big insurance companies and he decided to re-start his practice as a "concierge medicine" practice. Clients pay a yearly fee (mine is $1,600) and in return they get a thorough yearly physical exam with lab tests and all the office visits one might need over the course of the year.

I was also happy to get a direct cellphone number (not a medical exchange number) so I could get in touch right away if I needed to. Since insurance is not involved (although I still carry an ACA approved policy with a high deductible) there's no paper work when I go to see my doctor. There are no bills, no copays, no road blocks.

I had a rash on my forearm that popped up a day or two ago and after swim practice yesterday I called my doctor's office to request an appointment. It was 9:15 in the morning. The scheduler at my doctor's office let me know they had appointments available that day. Did I want to see my doctor at 10:15 a.m. ? They could make that happen.

I arrived on time and was ushered straight into an exam room where my doctor's nurse took my temperature, blood pressure and asked me a few pertinent questions. She was out of the room for 30 seconds when there was a knock on the door and my doctor entered. He examined the rash and prescribed something. He burned off an actinic keratosis on the other arm with liquid nitrogen. Then he asked me how life was treating me. We talked about my dad's recent cardiac event and my anxiety over the impending house sale. In all he sat and chatted with me as a friend and advisor for nearly 45 minutes. I left with the assurance that the rash was not some deadly cancer (me: ever the hypochondriac), feeling better about my recent changes in lifestyle (father's administrator and supervisor of his care) and happy to see that my long term "white coat syndrome" has largely resolved and that I can actually have a normal blood pressure of 115/65 while talking about my health.

Jointly my wife and I pay nearly $20,000 a year for health insurance although both of us are very healthy and rarely need more than glancing course correction. That represents nearly 15% of our income. Some of my associates suggest that I not pay for the concierge medicine and only pay for health insurance but I can say that once you've experienced appointments on demand, real continuity of care and the unhurried attention of a professional you trust it would be very difficult to give it up.

I remembered back, as I was writing this, to December 24th which was the day my mother was rushed to the emergency room. Being able to get my personal physician on the phone on Christmas Eve to talk me through the enormity of issues confronting my mother, and, by extension, me as her medical P.O.A. was something I just can't put a price on.

At 62 years old I am cognizant of the inevitable decline all of us will eventually experience. No one gets out of this alive. But there are good ways to get care and frustrating ways to get care. For me the investment in a dedicated professional seems to be a bargain.

If you are a freelancer under 65 years of age what is your strategy? Have you looked into Concierge Medicine providers? What has your experience been?

In a way my physician has become more of a freelancer, like me. He's just working on a fixed retainer. I get the whole idea. I like it. I'm waiting to see what changes in whole insurance world. I'd love to be able to buy a catastrophic policy and have that in reserve instead of having to duplicate some expenditures to get my care the way I want it.

You could buy a lot of cameras for $20,000 a year.......