Two Hopeful Signs – Econlib

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There are currently more than 1,400 direct primary care practices operating in 49 states. Among them are doctors Lee Gross and William Crouch at Epiphany Health Direct Primary Care in North Port, Florida. They charge just $75 a month for an adult, $30 per month for one child, and $15 a month for each additional child. After that, nothing more is owed for services provided in the office—no health insurance necessary. In January, Reason‘s John Osterhoudt visited Epiphany and spoke with Gross about what free market health care should, and can, look like.

This is from John Osterhoudt, “What Free Market Health Care Would Actually Look Like,” Reason, July 2021.

This particularly interests me because my primary care doctor announced last month that he’s retiring in September. When I started with him 6 years ago, I asked him if he would guarantee to stay in business for at least 5 years. He kept his word. I didn’t realize it until he became my doctor, but he’s the first really good primary care doctor I’ve ever had. His practice has 3 people: him, his nurse (who’s also his wife), and his office assistant. It’s fee for service and he’s not in my health insurer’s network, but the extra charge for me is only about $30 per visit. And he listens and takes time.

So I’m looking around for another doctor and this article in Reason caught me eye.

Another excerpt that answers something I was wondering about:

What can you do in the office? Can you give me a range of what is included in that $75-a-month fee?

Once a patient is a member of our practice, anything that we can do within the four walls of our office is included at no additional charge. That would include things like electrocardiograms (EKGs); 24-hour heart monitors or Holter monitors; minor procedures like taking off a small skin cancer. I can do biopsies and joint injections, we can remove moles and sew up lacerations. I can splint uncomplicated fractures. Most tests that we do within our office, like a strep test, urine test, or pregnancy test, those are all things that we do at no additional charge.

And something else I was wondering about when I see the charges for blood work before the insurer knocks them down:

For example, the very first patient that I enrolled in our direct primary care practice, they went to see their rheumatologist, and the rheumatologist gave them a lab order. The lab quoted them $1,800 for the blood work. The patient got on the phone and said, “Wait a second, I can’t afford this. I thought I was supposed to get some sort of discount by being a member of your direct primary care practice?” We said, “Well that order has to come through us, and you have to pay us for it, because we buy labs wholesale.” That patient was able to get the same exact labs at the same exact facility for $85. So with the savings on a single lab test, that patient paid for [months and months] of membership in our program.

And, completely unrelated, another hopeful sign:

35 years ago, it was illegal in 16 states (including Texas) for a civilian to carry a concealed weapon. Only Vermont did not require a pistol permit.

Working through the slow process of going state to state to change the law, the revolution happened.

First came the switch from no permit to may permit. That placed the decision on issuing permits in the hands of elected sheriffs, which explains why California and New York have not budged. Democrat sheriffs pocket a lot of money from patrons who want to carry.

Then came shall permit. This put the onus on law enforcement to show why a person should not carry a concealed weapon.

Finally, came freedom. 19 states no longer require the state’s permission to carry a concealed weapon.

Texas and many other states went from red (a ban on concealed carry) to yellow (may issue) to blue (shall issue) to green (no permission necessary).

It is the Vermontization of America. The Green Mountain Boys always put the right to firearms off limits to regulation. Interesting state. For 14 years, it was a republic — longer than Texas and other states that were republics for a time.

This is from Don Surber, “The gun revolution,” June 18, 2021.

About 15 years ago, some students at Hillsdale College invited me to give a talk there. I did. I think my talk had more than a touch of “ain’t it awful?” as I listed the various relatively new restrictions on freedom in America: the USA Patriot Act, the requirement of government permission before you get on a commercial aircraft, and a few other things.

In Q&A, a student asked me if I could think of any area in which freedom had increased in the last decade or so. Always wanting to be the glass half-full person, I thought hard and told him that I couldn’t. But my friend Harry Watson was in the audience and he piped up with a major one: the increasing freedom in many states to carry a gun.

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