From Big Medicine to DPC: Dr. Michelle’s $10K Startup Story

Why does healthcare cost so much in America? More importantly, what exactly can we do to fix it?

It is the single most common question I receive as a healthcare attorney and large group benefits consultant. On one hand, answer is frustratingly simple. The entire system is designed to extract maximum profit from your business. Every major player in the game makes more money when your healthcare claims go up. That includes the major insurance companies, massive hospital systems, Pharmacy Benefit Managers, and even your traditional broker. It is a rigged game. It is fueled by deeply misaligned incentives and the Iron Law of Bureaucracy. When the entities managing your plan get paid a percentage of the total spend, they have absolutely zero motivation to actually lower your costs.In this video, I break down the American healthcare machine. We pull back the curtain on the government agencies and Wall Street giants that dominate the current landscape. We examine how they intentionally keep you in the dark to maintain their profit margins. However, we certainly do not stop at simply admiring the problem. I provide concrete and actionable solutions that employers can implement right now to take control of their plans. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit gottwals.substack.com [https://gottwals.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

When to Use High Deductible Plans & 2 Surprisingly Dark Downsides

I've always been a proponent of high-deductible health plans for individuals, families, and smaller employers who cannot safely self-insure or partially self-insure. However, once an employer self-funds, there are a couple of surprising ways in which installing a high-deductible plan can have a very negative impact on your employees and their families.The referenced podcast from Stacey Richter [https://www.linkedin.com/in/stacey-richter-14b3234/] referenced: Episode 486 of Relentless Health Value [https://relentlesshealthvalue.com/blog/transcript-for-ep486-with-stan-schwartz-md]. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit gottwals.substack.com [https://gottwals.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

Overworked, Overtreated & Over It. A Doctor Speaks

Handcuffed by the standard of care. Twelve minutes or less with each of her 2,500 patients. Pushed to prescribe drugs she knows aren’t the answer. This is the reality of primary care today. Dr. J, as we’ll call her, is a two-decade veteran of primary care, a good friend, and an amazing doctor. In this episode of Gott’s Gulch, she tells us what so many of her peers whisper about between exam rooms or keep bottled up until burnout incinerates them. She describes the difficult choices primary care docs face today: spending twelve minutes or less with each patient, frantically typing every CPT Code they can into electronic medical record systems, feeling pressured to prescribe medications that may not be the best option, and facing the harsh reality that homogenized protocols often lead to deadly overtreatment. She discusses what it’s like to be restricted by the so-called “standard of care,” overworked, sleep-deprived, and constantly forced to make difficult decisions between her conscience and the system. This is a raw, honest account from a physician who still loves medicine and her patients. But nonetheless, a doctor who’s had enough of pretending everything is fine. If you want to understand why primary care is collapsing, and why good doctors are leaving, you’ll want to hear this one. In This Podcast Medical errors are the 3 [https://www.bmj.com/content/353/bmj.i2139]rd [https://www.bmj.com/content/353/bmj.i2139] leading cause of death [https://www.bmj.com/content/353/bmj.i2139] in the U.S. In the United States, three in 10 people report having difficulty accessing primary care. A shortfall of more than 13,000 U.S. primary care clinicians today is expected to worsen in years ahead [https://keck.usc.edu/news/primary-care-doctors-are-in-short-supply-usc-family-medicine-is-doing-something-about-it], with the Association of American Medical Colleges predicting it could grow to as much as 40,400 by 2036. A 2008 study [https://pmc.ncbi.nlm.nih.gov/articles/PMC2765780] estimated that imaging services accounted for 14% of healthcare spending in 2005. Think Fast [https://open.spotify.com/episode/6bm6SZNWEEsHytI6D92shs?si=Q89KsMUYRSS-QEHiZI0PBQ]. The 252nd Evolutionary Lens: DarkHorse Podcast Episode 252, released November 20, 2024. In that one, Bret and Heather describe completing a seven-day dry fast and discuss the biology and traditions around dry fasting. Timestamps 02:20 - Most patients don’t get to keep one doc anymore 05:32 – Dr. J still has a few primary care patients 06:45 – Primary Care docs in the system work more than 100 hours a week 08:30 – Primary Care docs are responsible for 2,500 patients/year 15:00 – The worst part of her job when a patient has an HMO 19:44 – Capitation vs. Fee for Service 24:00 – How I met Dr. J 26:50 – How much does the Standard of Care suppress creative medicine? 28:00 – Overtreatment kills 34:00 – Medical errors are the 3rd leading cause of death in America 36:52 – Did you ever feel pressure to overprescribe? 46:45 – How is/will AI impact primary care? 56:15 – Average doctor pay 01:07:00 – The Obamacare “free” annual physical 01:18:15 – How referrals work in modern medicine 01:21:30 – Compelled imaging 01:26:30 – Cost of malpractice insurance by specialty 01:27:45 – Vax schedules, how about those ingredients? 01:36:45 – The Iron Law of Bureaucracy 01:42:05 - Fasting and Dry Fasting This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit gottwals.substack.com [https://gottwals.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

AI & Russian/Ukraine with Jack Armstrong

I’ve been making visits on the Armstrong and Getty Radio Show for sixteen years now. That is a crazy thought. It is always a treat to join the crew, and for me, an even bigger treat that I didn’t have to talk about what an utter nightmare American Healthcare is during this visit! This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit gottwals.substack.com [https://gottwals.substack.com?utm_medium=podcast&utm_campaign=CTA_1]

From Big Medicine to DPC: Dr. Michelle’s $10K Startup Story

Dr. Michelle-Linh Nguyen became a Direct Primary Care (DPC) doctor and launched her independent practice in a few short months, and nearly a year in, she’s spent less than $10,000 on the whole project. Yeah, it’s that doable. A DPC doctor is a primary care physician who contracts directly with patients or their employers for healthcare services, instead of billing insurance. Patients pay a flat monthly or annual membership fee, typically between $75 and $150 per month, that covers most routine and preventive care, including office visits, basic labs, and virtual consultations. Because there’s no insurance middleman, DPC doctors usually keep much smaller patient panels (often 300 to 600 patients compared to 2,500 to 4,000 in the legacy system). This allows them to spend more time with each patient, offer same-day or next-day appointments, and communicate directly by phone, email, or text. In this podcast, hear why doctor Michelle left a large healthcare system in the San Francisco Bay area to a DIY practice in the gold-laden foothills of Gott’s Gulch. * Dr. Michelle’s website: https://michelle-md.com/ [https://michelle-md.com/about/] * Michelle’s Substack: mtln.substack.com 5:00 DPC vs Concierge Medicine 12:20 Home visits and length of visit 31:00 Doctor burnout. 34:08 Pairing DPCs with self-funded plans 47:50 Ordering referrals 55:45 Malpractice insurance 56:20 How employees flood to DPC when available 58:08 Working with independent grocers 1:07:45 How to build your own health plan 1:15:30 How DPCs treat you when you’re hospitalized 1:25:00 DPCs can now be purchased with HSAs Build-Your-Own Health Plan article: https://gottwals.substack.com/p/build-your-own-health-plan [https://gottwals.substack.com/p/build-your-own-health-plan] Music by Marc “MIRV” Haggard. This is a public episode. If you would like to discuss this with other subscribers or get access to bonus episodes, visit gottwals.substack.com [https://gottwals.substack.com?utm_medium=podcast&utm_campaign=CTA_1]