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Hubbel Advocates Concierge Care as Alternative to Insurance

Republican candidate for Governor Lora Hubbel sends out an e-mail that reiterates her standard charge that her primary opponent, Governor Dennis Daugaard, has facilitated the implementation of the Affordable Care Act in South Dakota. Hubbel says that if you'll make her Governor, she will implement a health care reform plan that will kill the ACA in months:

We can make ObamaCare dry up and blow away. Doctors and patients will love the plan I've found. But the uber-rich politicians and big healthcare business in South Dakota won't because they will lose money.

Imagine going to a Doctor and being able to pay for the visit and treatment without breaking the bank. Imagine no insurance claims and codes...doctors can treat you without looking at a computer.

Imagine no government paper work for the doctor and none of your personal information going in government data banks like it does now. Instead computers would be used by the patient to look up the prices of all doctors and treatment available... no limits on which doctor you can see.

This is the brainchild of Dr Merlin Brown, Cardiologist in Minnesota. He has developed a health delivery system that is truly patient/doctor controlled and big government and big hospitals/Big managed care hate it. However doctors, patients and private Insurance companies love it. If we get it going it can be up and running in 6's already developed [Lora Hubbel, campaign e-mail, 2014.05.11].

Instead of telling me what her plan is, Hubbel then veers off into bashing Daugaard, Mike Rounds, and "blog-dogs" who call her crazy because they "can not refute my research...." I'm thus left with a campaign pitch that sounds more like an Amway recruitment pitch than a serious policy proposal.

But that's what the Googles are for. Melvin Brown, cardiologist, health delivery system... ah ha! Concierge care. Dr. Brown and his colleagues at Southdale Internal Medicine in Edina don't accept private insurance. Southdale posts its prices online. Patients can pay fees for specific services, or they can buy into a "Total Care" plan: $118 per month for the first family member and $68 per month for each additional family member covers all in-clinic services. $1,416 for an individual is well below the $3,300 limit for tax-deductible individual Health Savings Accounts. A worker could get full service for herself and up to seven family members under the $6,550 limit for a multi-user HSA.

Dr. Brown is doing what we discussed here in a follow-up to my conversation with Independent gubernatorial candidate Mike Myers: price transparency and direct-to-consumer pricing.

Of course, concierge care doesn't de-implement the Affordable Care Act. Concierge care simplifies business for primary care providers. Concierge care could save patients money, but they'll have to do some figuring:

  1. If I pay up front for concierge care, will my insurance company reimburse me?
  2. If not, can I cover the cost of the concierge care plan with the savings from choosing a higher-deductible insurance plan?
  3. Do I qualify for an hardship exemption from the ACA insurance mandate so I can just buy a catastrophic health insurance plan to cover the really big procedures that concierge care doesn't provide?
  4. Is it cheaper for me to pay for concierge care to get my check-ups and other primary care, go without insurance, pay the ACA penalty, and hope to heck cancer or a dump truck doesn't get me? (You should really try not to get to #4.)

As far as I can tell, there is nothing stopping South Dakota clinics from adopting concierge care. One of Annette Bosworth's employees developed a concierge care plan for Bosworth's clinic last fall. Successful implementation of the plan at Meaningful Medicine was stopped not by state law or the "entrenched powers" but by the distraction of a fake Senate campaign, Bosworth's general inability to organize, and Bosworth's failure to pay her employee to implement the plan.

Lora Hubbel leaves me wondering just what role there is for a Governor to implement concierge care beyond bully-pulpitism. Hubbel would have the chance to present that role in her debate with Governor Daugaard and for us to hear the Governor weigh on alternatives to private insurance... but oh, that's right, the Governor declined SDPB's invitation to a May 22 debate, and SDPB declined to seek an alternative date. (Boo on DD and SDPB!)

Luckily, Lora Hubbel will have an opportunity to elaborate on concierge care and other policy issues right here on the Madville Times. Hubbel has agreed to appear in a live online interview on this blog on Wednesday, May 14, at 9 p.m. Central, 8 p.m. Mountain. Stay tuned for more details, and send your questions about health care and other issues!


  1. owen reitzel 2014.05.11

    I'll make sure I'm listening.

    One question. Won't the patient have 2 deductibles? The monthly fee to the clinic and then the insurance comapny if you have to go to the doctor?
    Plus I don't understand how this would get rid of the ACA or how it helps people with preexisting conditions.

  2. Tim 2014.05.11

    Better idea, vote for Lowe and forget all of this republican diversion.

  3. caheidelberger Post author | 2014.05.11

    Tim, I'm all for that course of action. But if Republicans happen to come up with a good idea, I'm open to listening and implementing.

    Owen, like you, I don't see how promoting concierge care does anything to repeal the ACA. In practical pocketbook terms, determining whether concierge-care fees would count toward your deductible would depend on your insurance company. As for pre-existing conditions, I don't see any indication that Southdale turns patients away who come in with illnesses. Since they aren't qualified insurance plans, I suppose they could say, "You've got cancer/asthma/whatever, so we're not going to treat you." But concierge care is just for primary care, basic clinic stuff, not big hospitalization. So maybe taking on folks with pre-existing conditions doesn't add as much cost to a concierge-care clinic as it would for an insurer in general who has to pick up full hospitalization.

    Such will be good questions for Hubbel!

  4. Tim 2014.05.11

    Yes Cory, I am willing to listen as well, but in typical republican fashion, Hubbel gives no substance to her plan. I would be willing to bet, what we get would be a lot different than what she's preaching now, always is.

  5. owen reitzel 2014.05.11

    But Cory Hubell says " Imagine no insurance claims and codes." The doctor would have to file a claim to the insurance to have the doctors visit go toward the deductible.
    Maybe I'm confused.

  6. Stan Gibilisco 2014.05.11

    ... And I thought that all the spinmeisters were liberals.

  7. Les 2014.05.11

    Who is Cory Hubbel? Another spinmeister, Owen?

  8. owen reitzel 2014.05.11

    guess I needed a comma Les. sorry Cory

  9. caheidelberger Post author | 2014.05.11

    Ah, there's a problem, Owen. Southdale tells its patients it will not deal with insurers. It's up to policyholders to submit their own claims. That doesn't get rid of insurance; that just shifts the complications to the consumer. And that seems to be a big part of the advocacy I hear for direct-payment care: make consumers immediately aware of the costs (both monetary and administrative, like submitting your own claims), and consumers will demand better prices or (warning!) use less health services.

  10. caheidelberger Post author | 2014.05.11

    And that's where I come in, Tim. Whether we're talking health care, EB-5, or other issues, some of our arch-conservative friends have trouble staying on message. I'm happy to look for the good ideas, elevate them out of the Tea-muck, and pass them on for broader consideration.

  11. caheidelberger Post author | 2014.05.11

    (Commas: the difference between simple conversation and weird marriage. Punctuate, Owen, or I may have to punctuate Owen!)

  12. Roger Cornelius 2014.05.11

    My question for Hubbel and all candidates that want to repeal Obamacare, is what will you tell those 8,000,00 plus enrolled in ACA that just happen to like their coverage?

  13. Kevin Weiland 2014.05.11

    Most (if not all) of these clinics cater to the "healthy wealthy." My question for candidate Hubbel.......the fact that 90% of our health care dollars spent in this country are in the last few months of life, who is responsible for the cost?

  14. caheidelberger Post author | 2014.05.11

    That's a good point, Dr. Weiland. Concierge care doesn't look like a complete solution for the elderly and the sick. Does it offer even a partial solution for folks of healthy folks of modest incomes?

  15. Les 2014.05.11

    """"...the fact that 90% of our health care dollars spent in this country are in the last few months of life, who is responsible for the cost?"""" Or, who is responsible for ordering those high cost treatments for the walking dead.?

  16. owen reitzel 2014.05.11

    Roger that is a great question as I am one of those 8 million.
    I've asked that before of those people that want to repeal the ACA and you hear nothing but crickets

  17. Les 2014.05.11

    What has the ACA done for you Owen?

  18. Nick Nemec 2014.05.11

    Les, are you suggesting we should implement Mrs. Palin's much talked about "death panels"?

  19. Nick Nemec 2014.05.11

    In my family the ACA has allowed us to keep college graduate daughters on our insurance until they found jobs that provided insurance. It has allowed us to change insurers despite my wife being a cancer survivor and previously being caught in the death spiral of the group policy we had at the time of her diagnosis. It has freed us from fears that we would reach the lifetime limit for the health policy we had at the time of her diagnosis.

  20. Les 2014.05.11

    I've watched dying friends and relatives insurance getting hit with 25k orders when they were 10 days remaining in terminal at best, Nick. Is that a death panel?
    Or as Dr W states, the last few months of cutting, burning and poisoning rather comfort care, the death panel?

  21. Nick Nemec 2014.05.11

    I agree that too much is spent in the last few days of life on heroic but futile measures but rest assured any attempts to rein in those expenses will be met with screams of "government death panel" by Sister Sarah and the know nothing chorus from Fox News. Unless of course the President who proposes changes happens to be a Republican.

  22. Roger Cornelius 2014.05.11


    Isn't "we respect all life" a Republican mantra?
    What is the age or health threshold for the "walking dead" according to you?

  23. JeniW 2014.05.11

    There is a way of getting an estimate of medical costs. Plastic Surgeons use it all the time because plastic surgery that is not re-constructive surgery, or is only for enhancement is not covered by most insurance.

    People have to ask what the estimates are. How much for an office visit? How much for a certain type of treatment or surgery, follow-up and etc.

    That cannot always be done, especially in the case of emergency treatment/surgery, or for extensive treatment for conditions such as cancer, but for most elective medical appointments, treatments, etc it can be done.

    Need to remember that that the provider that puts you under is a separate billing.

    I needed dental treatment for which my insurance did not cover. I obtained an estimate of the doctor bill, the facility fee, and from the doctor who put me to sleep. I also had an estimate for the cost of a partial. I paid the estimated amount in advanced, and did not have to pay any more than that.

    There is nothing that says that we cannot "shop" around for medical care/treatment unless the insurance company requires doing business with certain providers, for example Avera's insurance providing coverage for using Avera staff.

  24. Kevin Weiland 2014.05.11

    Les, having been in that battle with so many patients, believe me when I say this, not one of my colleagues are doing this with a financial motive. What happens at the end of life is more about, unfortunately, about the spouse or son or daughter who makes the decision to continue aggressive therapy, despite the advice of a professional opinion. The culture behind our end of life is at best, decided at the end of life, and with a patient who can not make medical decisions for themselves.

  25. JeniW 2014.05.11

    Thank you Kevin. I think many people want to continue the treatments because they want to have the peace of knowing that they had done everything that could be done. If a certain test is not done, a treatment not implemented, a medicine not tried the loved ones may wonder "did I do all that could have been done, what if the medicine had been tried...," "did my saying "no more" meant that my mom had to suffer more....," "was my dad really ready to die?"

    Although my cat was not a human, I asked about his vet about the prognosis with and without more testa, or treatment before I said to let him go. It was heartbreaking decision, but I do not have feeling of guilt if there had even been a glimmer of hope of making him feel better.

    Perhaps what needs to be done, if not done already, is reassuring the loved ones that they have done the best that they could, allow the loved ones to talk to someone who can help them with their grieving before they can say "no more."

  26. Kevin Weiland 2014.05.11

    JeniW, you are spot on, and, I will be the first one to admit, that I have been fooled by how tough the human spirit to live, no blame for the end of life. The blame should go to those who do not have the courage to discuss the wishes of the patient at the end of life.

  27. owen reitzel 2014.05.11

    "What has the ACA done for you Owen?"

    Les I have health insurance now because of the ACA. It's a long story and I'll tell you why I had to use the ACA if you want me to. Trust me, without the ACA I'd have no insurance and I wouldn't be able to afford my medicine.

  28. Les 2014.05.11

    It's given you health insurance, means nothing if you haven't used it. My opinion.
    You've gotten health care you didn't get without it, before it, Owen?

  29. Kevin Weiland 2014.05.11

    Well Les, let me tell you another story. A person in our community contracted Legionares disease. Had she seen a doctor in a timely fashion because she had health insurance (like the 8 million) she would be alive today and the place of business where she contracted the illness would still be in business, making a living and providing jobs. she had no insurance and die as a result.

  30. lorahubbel 2014.05.11

    For those who had a question of who will submit insurance...the clinics still can print out a HCFA form for anyone and the patient or clinic can mail it to their insurance company.... don't worry....this plan has been in the works for over 3 years and the developer has invested over $800,000 on it. It will start with the self insured, until it make enough money to be a fully bonded insurance company. I hope to have Dr Merlin Brown here soon in SD to give a presentation to our doctors and their staff.

  31. lorahubbel 2014.05.11

    If you are on ObamaCare, you are giving heath care dollars to bureaucrats and big business. This money should stay in the healthcare arena and not go to the parasites making boocoo bucks on your premiums or government subsidies.

  32. Jerry 2014.05.11

    You make no sense lorahubbel. It is clear that your definition of Obamacare and the reality of it are a night and day difference. I would love to have you define your meaning of the ACA or Obamacare in written form. Can you enlighten me on that and I will thank you very much, merci beaucoup.

  33. Roger Cornelius 2014.05.11


    That doesn't sound like a very satisfactory answer to the 8,000,000 enrolled in Obamacare

  34. Les 2014.05.11

    I will wait for your success stories to come from the ACA as they pass through your world. We all know change was needed and I'm not proud of my party for not looking to improve a plan which was coming regardless of quality.
    As a healthy self employed citizen, I've seen my costs double in the last five years. There are I believe 30+ Mil like myself in this country who are being pushed into the group you call the 8 Mil, so hindsight prophecy to interpret the future function of the ACA gives us little comfort.
    And btw, Rounds ad(for the 14th time on Sunday Morning) on the ACA theft of money from Medicare sucks for many reasons, yet we are trouncing on Lora Hubbel.
    Play straight ball with us. Insurance, Big Pharma, medical fraud, litigation....along with the host other problems possibly only you docs are aware of that need attention.

  35. Deb Geelsdottir 2014.05.12

    I'm pretty sure ACA is not taking any money from Medicaid, Les.

    We could easily solve this by going with the most cost effective plan of all:

    (That was happy shouting, not angry.)

  36. caheidelberger Post author | 2014.05.12

    Les, I think Nick gives us a pretty concrete, multi-faceted ACA success story.

    Lora, I'm still not seeing how concierge care kills the ACA. Are you saying you'll organize all the primary-care clinics into their own insurance company? Won't that turn them right back into the same bureaucracy they are trying to avoid?

  37. Doctor not Bricklayer 2014.05.12

    The conversation between Dr. Weiland and JeniW regarding ordering tests and procedures at the families' request towards the end of life ealier in this thread is a very pertinent and important one, and illustrates the kinds of conversations we should be having about health care.

    Unfortunately, the conversation seems to be currently driven by Tea Party types who's only goal is to politicize these complex issues into bullet points to support their cause.

    I am afraid that Ms. Hubbel's completely unworkable proposal serves only as a springboard for her to start spouting off anti-Obama rants, and should not be given any more press or attention. It is a sad state when anything remotely considered an opposition to the ACA is given as much or more press than positive examples of how the law is currently helping people.

  38. Jerry 2014.05.12

    No matter what you do, you must have a bureaucracy to administer healthcare. What happens is that we humans are a little more complex than a simple cold and a simple diagnosis for that cold. Look at how many forms of arthritis there are for example and how each one of those effects us. Self insured plans will only work if there is enough in that group to float it when catastrophic claims come in. The ones that happen with premature babies and cancer along with long term acute illnesses. Smaller, under 100 person groups have difficulties with those and the third party administrators do as well. My grandson was a half million several years ago, but worth every penny. His group was a large self insured group that had a few more major hits in it when he was born and the premiums most definitely were sent upwards.

    A concierge plan would not address major illness and would be in line with what is called a "mini-med" plan, basically a limited medical plan. About as good as workmen's comp with off the job cancer.

    All of the dancing we are doing is not to the same beat as that beat would be Medicare for all. With such a large pool, you can then see how costs are controlled for both providers and policy holders.

  39. Les 2014.05.12

    I have no doubt, freeing Nick from fears and forcing his insurance company to provide ins for daughters until they can provide for himself is comforting. However, Nick had coverage before the ACA and taking the fears away from 8 Mil to force them on the 34 Mil is just transferring from one to another.
    Doctor not Bricklayer is a condescending SOB who we can all bet on being without fear throughout the ACA's life, limited or not. Bricklayer, huh. Could you even carry his mud?

  40. CK 2014.05.12

    I agree with Dr.Weiland and JeniW...America has a major problem when it comes to end-of-life, and life-saving measures.

    Now please do not consider me heartless, but given my rural upbringing, there comes a point when one must realize that quality is more important than quantity. I wish more people would consider this. Example: A fellow veteran, wounded severely in Vietnam, contracted a vicious staph infection in the Ft. Carson hospital. It is "under control" at this time, but the only way to possibly clear the infection from his body would be to amputate his legs from the hip joints down.

    He and his wife made the decision years ago that it would be better for him to live his life as best he could, as wholly as he could, rather than opt for the surgery and be bed-ridden, and a "burden" (his words, not mine) on her and their children.

    I wish more people would have this difficult conversation with their loved ones. It is one thing to fight, it is another thing to be beaten against the rocks until there is very little semblance of humanity left.

  41. larry kurtz 2014.05.12

    Hubbel on Bill Janklow's idea of public radio this hour

  42. Jerry 2014.05.12

    Et tu Goldman Sachs? It seems like business kind of gets it that this ACA Obamacare works with the exception of tea party republicans. I know I know, this is a banking financial outfit that makes money off stuff like this for your 401K's and stuff like that, so they should not be listened to.

    Oh yeah, they do not understand capitalism or the market in general. I can't wait to see what Ms. Hubbel, Nelson, Rounds or the rest of the gang has to say. I can't remember for sure, oh yeah, now I do, it was Don Quixote and the fight against the windmills. Good luck with that all of you tea party kind of folk. The ACA works just fine and will continue to get stronger until Medicare for all comes on line.

  43. larry kurtz 2014.05.12

    Hubbel was positively lucid as she pounded DD today on the radio. She doesn't want uranium mining in the Hills, she thinks the governor has too much power and believes Pierre is a toilet.

    Please join me and send her some money.

  44. Deb Geelsdottir 2014.05.12

    I was a chaplain at Ft. Meade for 6 years and saw several end of life issues. Sometimes they were resolved with the utmost humanity and kindness. But not always.

    There was a very sad case in long term care. The aged patient had been semi-sentient for more than a year with a negative prognosis. His wife came to spend time with him every day. As he deteriorated to a comatose state, medical and spiritual staff suggested she allow him to die. There were treatments to prolong his life, but no recovery was deemed possible. She insisted on further treatment because she didn't know what she would do without him. Before you judge her too harshly, consider this:
    She had devoted herself to his 24/7 care for several years at home before relinquishing him to Ft. Meade, so her life had centered on his for 6+ years. At age 72, she was frightened of being set adrift. I still think she should have let him go, but her story enabled me to feel more compassion for her.

    On the other hand, my mother died at 84 of cancer. She went to the doc where they discovered she was riddled with cancer. He gave her less than a month, and said treatment would only prolong her life by a few months, and make her very sick. Mom said, "Nope. I'm ready." The only medication she took was for pain, which was minimal. 2 weeks later, she died peacefully. It was her last gift to her loved ones.

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