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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jdThomas PurcelltwaPeter Recent comment authors
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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… Read more »

Thomas Purcell

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… Read more »


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.


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… Read more »