Pinned Tweet
Thirty-six times.
Same brain MRI. Same CPT code.
$406 at Henry County Memorial in New Castle, Indiana.
$14,681 at Sky Ridge in Lone Tree, Colorado.
Five years of price transparency. The gap did not shrink. It just got public.
A posted price without a shopper is still a sticker.
Direct care posts the fee before you walk in. The number on the door is the number you pay.
medicalpricecheck.com/resear…
About 65–70% of private enrollees are already in self-insured plans that state coverage mandates don't touch.
The freedom to build a leaner plan around direct care already exists. Most employers just haven't used it.
$12,000.
That's the most a single person on an ACA plan can be asked to pay out of pocket in 2027 before the plan covers the rest of their in-network care. Family: $24,000. Up 13% from this year's $10,600.
Premiums are slated to rise about 15%, after last year's 26%.
So for most people, most years, that plan is a catastrophe policy. Fine. Buy it like one.
Then put everyday care somewhere you can actually afford to use it: a flat monthly fee, a doctor who answers your text, labs and meds at prices you see before you say yes.
Open enrollment starts Nov. 1. What's your deductible next year, and when did it last stop you from seeing a doctor?
Source: Julie Appleby, KFF Health News (Oct 23), h/t @KFFHealthNews
kffhealthnews.org/insurance/…
46% of employers now use a PBM outside the big three. Up from 37% last year.
People in pharmacy benefits contracting say the wait for change is over.
Employers don't have to wait on Congress either. Direct care and transparent pharmacy pricing are open for business today.
h/t @A_Ciaccia: xitter.cf/A_Ciaccia/status/21118…
Survey of 408 employers by @ntlalliancehlth, via Axios.
Everyone I talk to in the pharmacy benefits contracting space says the same thing: The wait for change is over
@TreedinDC @ntlalliancehlth axios.com/2026/08/12/more-em…
pssst....what if i told you that your doctor might be choosing to be uninsured?
washingtonpost.com/health/20…
If they don't think its worth it...then you know there's a problem...
Direct care isn't popping the health insurance bubble.
The bubble is popping because insurance stopped working for people.
Every renewal, the healthy leave and the costs stay. The employers, doctors, and families already in direct care are the ones who won't be standing under it.
Dr. Michael Fine on Rhode Island's premium increases: whatsupnewp.com/2026/10/dr-m…
Most family doctors went into medicine because they love it.
Our job is to clear the clutter so they get to keep loving it.
Quote: Steve Jobs, Stanford Commencement, 2005. Full text: news.stanford.edu/stories/20…
11%.
That's next year's jump in employer premiums. Biggest single-year increase in over two decades.
She's right that employer insurance locks people in jobs and eats the raise.
She's wrong that collapsing Medicare and Medicaid into one federal plan is the only way out.
Make care too cheap to insure. Then the bubble doesn't matter as much.
Direct primary care in Canada wouldn't mean leaving public coverage.
Hospitals, specialists and the ER stay public. The question is whether there's room for a primary care model built on time: a doctor who knows you, answers your text, and isn't buried in forms.
That only works with rules clear enough that patients and doctors both know where the lines are, province by province.
Choice with clear rules. Not a replacement.
Background: the Canada Health Act bars extra-billing and user charges for insured services, and provincial rules vary, so this is a pathway conversation, not a how-to.
laws-lois.justice.gc.ca/eng/…
Manitoba's push for more family doctors: canada.ca/en/health-canada/n…
$0 at the visit.
That's the Medicare Advantage pitch. Costco and SCAN are rolling co-branded MA plans into 17 California counties and two in Nevada for 2027 — Costco's first time selling MA.
Most doctors I know aren't fans. Patients pay up front for the option of little out of pocket at the time of care. Then the plan adds steps that deny care and slow payment to physicians.
I'd much rather see Costco put its own DNA on direct primary care.
Simple membership. Extremely high value. Unlimited visits. Free telemedicine. No copays. Office procedures included. Meds and labs at wholesale.
That already sounds like Costco. An MA wrapper does not.
Would you rather buy another insurance plan at Costco, or a doctor membership that works like the warehouse?
2 tries this year to show drug cash prices before the script is sent.
Feb: Surescripts and GoodRx pulled their Script Corner pilot weeks after launch.
Oct: Epic announced Prescription Marketplace. Due summer 2027.
Direct care patients didn't wait. They shop cash prices now.
h/t @healthapiguy for the timeline: xitter.cf/healthapiguy/status/21…
In February, @Surescripts and @GoodRx pulled Script Corner, their patient price transparency pilot, weeks after launch. Yesterday, @HeyEpic announced its own take: Prescription Marketplace, which will put pharmacy cash prices next to insurance copays before the prescription is sent.
A Kansas Health Foundation listening tour listed "primary care for a flat monthly fee, so the price is known in advance" as already working.
Six conversations named direct primary care, memberships, or clinic-owned plans. One clinician asked for DPC networks with labs and imaging at cost. A hospital leader asked for help contracting directly with self-insured employers.
The model is already on the whiteboard.
So many great questions about fxing healthcare in this reply, i thought i'd make a thread out of the answer
Where / how would persons with disabilities access care? Or persons with catastrophic injuries? Or persons with chronic illness? Or persons with SCI needs?
How would costs be reduced if business owners still had to pay commercial health insurance investment bank fees?
What would that model look like for unemployed persons; pregnant persons who have a partner working; gig workers and performing artists who work on a project to project basis; DBAs, sole proprietors, consultants and contractors who are often in between lucrative employment?
Would there be gaps or barriers to care for those persons? And of persons are employed and salaried, what happens when they get sick and are unable to work?
Can you publish the model somewhere or point us to read the comprehensive legislative framework for Direct Pay? Eager to learn more about those questions.
13/ The legislative framework: DPC is a private contract between patient and doctor, so there’s no single federal program.
The rules come from state DPC laws (30+ states clarify it isn’t insurance) and the 2025 One Big Beautiful Bill Act, which made DPC HSA-compatible.
14/ To read more:
How a DPC practice runs: atlas.md/dpc-curriculumIRS guidance on DPC + HSAs: irs.gov/pub/irs-drop/n-26-05…. 1162: congress.gov/bill/119th-cong…
Happy to keep going on any of these.