Evolution of Medicine Podcast · Functional Forum

The Primary Care Renaissance

November 11, 2025·47 min·3 clips

DPC can now be paid with HSA dollars up to $150 a month.

1. Evolution of Medicine Podcast focuses this episode on the ownership of American medicine and the rise of direct primary care. 2. James Maskell hosts the show and uses his experience at Heal Thy Practice, Fullscript, and Evolution of Medicine to argue for physician-led care. 3. The episode asks whether HR1 and the January 1st, 2026 changes can shift power back to patients and physicians. 4. Maskell says primary care clinics have been turned into a funnel for drugs and expensive specialist referrals, especially hospital surgery. 5. He names insurance, pharma, and hospital systems as the forces that make independent practice harder. 6. He says practitioners now need about 2.4 billing staff for every clinical person, which he treats as a sign of system bloat. 7. He compares this with countries like Singapore, the UK, and Guernsey, where primary care is organized differently. 8. He says Guernsey’s model had primary care owned by physicians and tertiary care owned by the government. 9. He uses that example to describe a “pride of ownership” that appears when physicians own their practices. 10. He then turns to HR1 and says direct primary care up to $150 a month can be paid through HSA dollars. 11. He says employers with high-deductible health plans can offer DPC memberships with no copays or cost sharing. 12. He says the bill also gives direct primary care better integration with insurance and a federal recognition as a valid payment model. 13. He points to Parsley Health as a clinic that operated a $150-a-month membership model profitably. 14. He names Dr. David Tusek of Cloud Medical as a mentor who built one of the first DPC clinics in Colorado. 15. He argues that lifestyle medicine, functional medicine, integrated medicine, and longevity medicine can all work through DPC. 16. He says 10,000 to 100,000 clinicians adopting this model in three years could make the change hard to reverse. 17. The tone is advocacy-driven and instructional, with Maskell speaking directly to practitioners about practice design and payment models. 18. The format mixes solo commentary, policy explanation, and brief promotional mentions for Fullscript, TruNeura, and Freedom Practice Coaching. 19. Practitioners considering direct primary care or functional medicine practice models should get value from this episode. 20. Listeners wanting a neutral overview of medicine policy without practice-building advice may skip it.

As heard by us

A direct call for clinicians to treat primary care ownership as the lever that matters.

The episode makes a direct case that ownership in American medicine is changing and asks clinicians to lead rather than wait. James Maskell links that shift to pride of ownership for both patient and physician, and to the kind of primary care clinics he wants to see built next.

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Why you'd press play

When you want a direct prompt to rethink who should own primary care.

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