Our PhilosophyVision for the Future of American Medicine
Cloud Medical is a full-spectrum direct primary care (DPC) practice devoted to our patients’ health and wellbeing.
We offer healthcare which is “independent of time and space” and saves our patients significantly on healthcare costs.
We are also an “idea-lab” dedicated to leading the way towards meaningful US healthcare reform.
Re-envisioning and re-building a more sane and ethical healthcare system requires both a view from 30,000ft, as well as an insider’s angle which can accurately diagnose, honestly address, and eventually help ‘heal’ the various inter-related systemic dysfunctions.
Our “Big Why?”
At Cloud Medical we strive to be the most user-friendly and convenient primary care program on the planet. You hire us to take care of the majority of your health care needs and we are here for you when you need us.
But our philosophy runs deep. We are mission-driven and founded on a deep conviction grounded in love for our patients and for our community.
Our primary loyalty is always to you, our patient-members, but we also recognize that it is our responsibility as physicians to lead the way toward meaningful healthcare reform.
So in the spirit of gratitude for the miracles of modern medicine, we celebrate and harness the wonderful aspects of our healthcare system, while simultaneously meeting its dysfunctions and enormous challenges head-on. There are 10 big ones.
These “10 Heartbreaks” which inform our “10 Core Principles” are described here.
The first heartbreak is “Cost”: many Americans are spending twice as much on healthcare than they should be (or could be) spending.
According to Forbes magazine, our children (the millennial generation) will spend two thirds of their total lifetime earnings on healthcare bills if we continue along our current trajectory.
This is both unacceptable and unsustainable, and our politicians have failed to find real solutions for this crisis.
Our first loyalty and devotion is to our patients, and we have helped many of them cut their total healthcare spending in half. But we are also committed to prototyping innovative models of healthcare delivery which address the “10 Heartbreaks” and which can be rapidly scaled in other regions.
We believe that the most effective scenario for solving the US healthcare crisis on a systemic and economic level begins with every American having a devoted personal physician on speed-dial who is available for unlimited visits with zero copays—for less than the cost of a cup of coffee per day.
You can download this free ebook which broadly describes our philosophy of “Salutogenic Eudaimonics” to see if our point of view resonates with you. And for a deeper dive, feel free to read this essay.
The most efficient way to accomplish this is to unbundle primary care from insurance and convert to a widespread national Direct Primary Care (DPC) model, while still maintaining insurance policies or using a Healthshare for catastrophic “major medical” coverage.
Read more about why we do not accept insurance plans at Cloud Medical
Read Dr. Tusek’s article, “Why insurance companies should love DPC”
The 10 Heartbreaks
Cloud Medical Core Principles
1. The US healthcare system is the #1 cause of bankruptcy
We must lead toward drastic reduction of our national healthcare costs. Direct Primary Care (DPC) is the most promising innovation capable of meaningfully bending down the cost curve. Combined with a healthshare, most individuals, families, and businesses can save approximately 50% on their total monthly healthcare spend. This model is available nationwide today.
2. The US healthcare system is the 3rd leading cause of death
We must reorient from a purely pathogenic sick-care model based on synthetic pharmaceuticals and surgery as our only tools toward a model that incorporates salutogenic principles. The purely pathogenic model is FAR too dangerous. Functional integrative medicine and naturopathy are better at seeking “source causes” rather than bandaid approaches. A growing number of PCPs are being trainined in functional medicine by the IFM, A4M and similar organizations. This is an excellent start.
3. We enable, and are complicit in, rampant conflicts of Interest & perverse incentives
We must stop conflating “prescribing” with “selling”. They are very different! DPC physicians receive adequate payment from their patients ($80 per member, per month provides a more than reasonable salary) so that no additional selling and marking-up of tests, supplements, drugs, or therapies for profit is necessary whatsoever. All such products and services, including diagnostics and medications, are provided to you at costs that don’t include insurance company markups (i.e, all are provided at net-zero profit). This keeps the karma clean.
4. We often withhold power from our patients
Our major goal should be, plainly stated, “patient empowerment”. We must retire the pretentious and outdated paternalistic approach of “doctors know best”. By getting to know our patients as human beings with their own values and aspirations, and embracing humility for how little we actually do know, we can help orient our care to support them on their own terms.
5. We often devalue and discount the innate healing capacity of our patients
Physicians who tell their patients that “they will never walk again” effectively curse their patients, similar to voodoo. They are imposing their own limited views which are not based on fact. This happens far too often and their are myriad examples (E.g. Lance Armstrong was initially told he would “never bike again” upon his testicular cancer diagnosis).
6. We often poorly rank risk/ benefit and cost/benefit ratios and ignore various biases inherent in publications
There are certain interventions that have very high benefit at very low risk. But many of our drugs have marginally beneficial effects with significant potential for adverse ones. We must always advocate for our patients and help them select the safest and most cost-effective treatment options. If you believe that “we already practice that way” as a healthcare system, please re-read #1 & #2 above.
7. We tolerate a lack of systemic transparency
The healthcare system operates behind a massive “wizard of Oz screen”. This is a key problem that enables bad behavior and fraud. We should never prescribe a test or a therapy without knowing its cost—to the penny—and share this information openly.
8. Our patient privacy laws protect the wrong parties
HIPAA may protect patients from snooping neighbors and passers-by, yet (while appropriate) this offers no protection against insurance companies and governmental agencies. Doctors should help their patients shield sensitive data from such large entities. If sensitive data is to be shared, it should be consensual, anonymized, and financially compensated.
9. We are far too beholden to special interests
Most medical consensus panels are composed of “experts” who are paid large sums by pharmaceutical and other for-profit companies and many are employed by hospitals whose incentives may not line up with our patients’ best interests. The independent direct primary care physician is the rare healthcare guide who is not beholden to or biased by special interests.
10. Our system is vampiric and the “healers” have lost faith in our own profession
PASSION FOR MEDICINE
When the “healers” themselves are disillusioned, jaded, and have unexpressed heartbreaks about systemic dysfunctions (such as the ones noted above), the transmission to our patients is neither salutogenic nor eudaimonic. We must be intellectually honest and define the true causes of why our profession is so broken. The politicians won’t fix them because a.) they don’t know how, and b.) they are too entangled with special interest groups. Who is left to lead the way toward a sane and ethical system if not us?