The Anti-Obamacare Doctor

By Marc Siegel

Sunday, January 20, 2019

Dr. Mark Kot, an urgent-care specialist and the owner of Southampton Urgent Medical Care in Southampton, N.Y., is the anti-Obamacare doctor. He does not participate in most insurance plans and is not in any Affordable Care Act network. He feels sorry for the patients with this restricted insurance, and when they come to his door with a bad cough or a painful foot and ask to be seen, he does his best to provide them great care for a limited cost. The insurance card they got through Obamacare remains in their pocket, useless.

Kot is not a “concierge” doctor. He does not charge a membership fee, and he does not charge for follow-up visits, where he determines whether the initial treatment was effective.

Kot works with four nurses and staff, performs and interprets his own x-rays, and administers intravenous medications when needed. There is little waiting time, and the visits are efficient — geared to the complexity of care provided. He generally sees over 40 patients per day and performs rapid flu tests; treats ankle sprains, bronchitis, pneumonia, and sinus infections; and during the summer and fall sees several cases of suspected Lyme disease each day. Kot purchases antibiotics from a supplier so he can give his patients samples. He charges a base inclusive fee ($220 per initial visit); office procedures and tests may have additional charges, and some patients with good out-of-network coverage get reimbursed by their insurance. But reimbursement isn’t Kot’s focus, because he provides an affordable product and is paid up front.

Whereas Kot provides instant access to care, Obamacare erects barriers to it, such as high deductibles and narrow networks. Doctors fight for reimbursements and patients encounter bureaucratic obstacles to tests and treatments. While it is true that Obamacare has reduced the number of uninsured in the U.S. from 44 million in 2013 to less than 28 million in 2017, at the same time it has done a poor job of ensuring access to quality doctors.

And just because a facility is covered by Obamacare doesn’t mean a patient has immediate access to health care. For example, Obamacare provided grants to expand Federally Qualified Health Centers that now number 1,200 and administer to 22 million people. These health centers rely heavily on the Obamacare Medicaid expansion for reimbursement, but there is a profound doctor shortage. Obamacare added several cars to the train but failed to bolster the engine.

There is no doctor shortage in Kot’s facility. The doctor has developed a model for acute health care that should be reproduced around the country. The Affordable Care Act should be altered so that a doctor like Kot, or groups of doctors in well-run facilities that have been left behind by the narrow Obamacare networks, can be reimbursed for the care they deliver to Obamacare patients.

After all, it isn’t health insurance that cures patients; it’s good doctors and access to the right treatments. Isn’t that what Obamacare supposedly had in mind?