Dollars to Doughnuts

From the L.A. Times: Dollars to doughnuts diagnosis

Do the many THCB proponents of government-run, bureaucrat-controlled, global-budget, everybody in- nobody out,  health care advocates want to drive doctors like the author of this article out of medicine?

For more than a year, I haven’t received a single dollar from any insurance company. I work for my patients. A few hundred doctors across the country are working the same way, some in blue-collar towns. Routine
care should be affordable to the middle class, and as more doctors and more patients form relationships that exclude insurance companies, prices will drop. Insurance doesn’t make routine care affordable; it
makes it more expensive by adding a middleman. I know that some patients can afford nothing, so two afternoons a month I volunteer at a clinic that cares for indigent patients, which I could not have done
with the huge patient volume I was seeing a few years ago…

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4 replies »

  1. twa, you hit the nail on the head.
    Eric, to answer your question, very few models of universal health care forbid physicians from refusing to take insurance. What they do is streamline insurance and make all but the wealthy better off by being part of the system. A small fraction of physicians who really, really can’t abide insurance can continue to make a living treating the very wealthy. You mention “several hundred.” That sounds about right. The other 800,000 can practice in an increasingly interconnected system focused on the cold details of process improvement rather than warm romantic visions and memories of the days when intuition and personal insight rather than science and system were king.
    Thomas, for someone who works in insurance you sure don’t understand its function. If everyone could afford major illnesses, health insurance wouldn’t have been invented in the first place. Once there was no insurance. It caused major hardship and outright financial catastrophe for enough people that the light bulb went off in a few minds and insurance was created. And Eric Novack has been unhappy ever since.
    If homeowner’s insurance were illegal, would home prices suddenly drop so low that everyone whose house gets damaged or destroyed could afford a new one? No. If causualty or accident insurance is illegal, will people stop having debillitating accidents that make them unable to work? No.
    I agree that prices will come down, but not enough to make healthcare affordable for everyone. The top 10% who make up 50% of the costs will still mostly be going broke. Eric’s tale of the doc who devotes more time to charity is a nice anecdote, not a solution to a social problem.

  2. You know, I sell health insurance for a living- but there is one way, the US could get everyone adequate health care at an affordable price.
    Make health insurance illegal.
    Watch how fast prices would come down, when people had to pay out of pocket for everything. Doctors would have to compete for your business (most would offer free checkups just to hope to get your health care dollars). Presecription meds would come WAY down as pharmaceutical companies realized that CURING a patient would be far more profitable than simply maintaining an exisiting illness or condition. Hospital ER’s would no long be full of people with non lethal emergencies.
    I’m telling you it would work. Whether or not the health care industry would allow it, is another matter.

  3. I’m not a big fan of single pay one tier healthcare, but if this guy gets “driven out of medicine” its because he is trying to practice like its 1949. Why do we expect every other facet of life and business to work in the 21st century, and yet somehow we have to care about keeping these siloed, cottage industry physician models in place.

  4. Eric, the major cost of healthcare is not your local MD. Do you think hospitals are going to by-pass insurance to lower their costs? “If you pay cash Mr. Smith that by-pass will only be $75,000”. But those who argue that insurance adds little in additional costs are disproven when doctors get paid directly in cash. A local MD here working outside insurance charges $45 for an office visit. Yet he still gets patients that can’t afford that when they’re trying to manage cronic disease. Under single-pay (one tier, access for all) doctors (and hospitals) would all get paid. They would be able to negotiate re-imbursements and only have to deal with one “insurer” and one set of rules. And the system would enjoy cost controls. And you know, cost controls would spur inovation in care instead of what we have now – inovation in finding new revenue streams.