Some Doctors Turn to Cash-only Policies (Traditional Medicine; No Insurance)

Baltimore Sun ^ | 4/4/04 | Rebecca Cook, AP

[mountaineer]

RENTON, Wash. -- When Chuck O'Brien visits his doctor, they talk about his aches and pains, his heart problems and his diet, but never about his health insurance. That's because his doctor only accepts cash.

Dr. Vern Cherewatenko is one of a small but growing number of physicians across the country who are dumping complicated insurance contracts in favor of simple cash payments.

When O'Brien leaves the exam room, he writes a check for $50 and he's done -- no forms, no ID numbers, no copayments.

"This is traditional medicine. This is what America was like 30 years ago," said O'Brien, 55 and self-employed, who believes he has saved thousands of dollars by dropping his expensive insurance policy and paying cash. "It's a whole world of difference."

Is this the health care wave of the future? Probably not, experts say. Most people are content with monthly premiums and $10 copays; nine out of 10 doctors contract with managed-care companies.

But cash-only medicine is becoming an increasingly attractive option for doctors frustrated by red tape and for the 43 million Americans who lack health insurance.

"It's a terrible indictment of the collapsing health care system," said Arthur Caplan, chairman of the medical ethics department at the University of Pennsylvania Medical School. "Insurance and managed care were supposed to streamline -- instead what they've done is add so much paperwork and bureaucracy they're driving some doctors out."

[mountaineer]

I remember it being like that when I was a child in the 1960s. Today, for a simple check-up, I have to give the doctor a co-pay, then she bills the insurance, then we all wait while the insurance company pays her what they deem a reasonable fee for her services, then I get another bill for the balance the insurance company refuses to pay. The whole process takes months.

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[mountaineer]

Cash crusaders acknowledge the need for some type of insurance. Without it, expensive surgery or hospitalization would force most people into bankruptcy. But they think health insurance should work more like car insurance: you pay for the routine maintenance and little dings yourself, and insurance pays for more expensive repairs. O'Brien, a freelance marketing specialist, switched from a comprehensive health plan with $300 monthly premiums to a catastrophic plan that costs $75 a month, with a $2,000 deductible. He pays out-of-pocket for routine checkups, and his insurance will kick in if he ever needs expensive care.

I've heard some say health insurance should be like auto insurance - no coverage for the regular, everyday stuff, e.g., new tires, windshield wipers (or, in medical terms, an annual checkup or mammogram), that you could just pay for with cash. Insurance could be purchased just for the big, unexpected events like collisions or emergency room care.

[syriacus]

"This is traditional medicine. This is what America was like 30 years ago

I've wondered, on and off, if there wasn't something good about the old system.

[traumer]

Save your $$ for your doc.

Stop shopping, consuming - halt the economy to a screeching stop....

[The Great RJ]

Imagine what the cost of the insurance clerks, delayed cash flow and less than cost reimbursement rates add to your medical bill. Cash only services probably saves money for health care consumers in the long run.

[mountaineer]

My mother has kept the cancelled check from the hospital bill for my birth - paid in full at a little over $300. Compare and contrast to modern times!

[angkor]

Check out Health Savings Accounts:

http://www.usatoday.com/money/perfi/taxes/2003-12-04-mym_x.htm

Health savings can be tax shelter
By Thomas A. Fogarty, USA TODAY
A potentially lucrative tax shelter becomes available to the masses next month, courtesy of the Medicare act Congress just passed.

In IRA-like fashion, investors soon can build tax-sheltered nest eggs to cover out-of-pocket medical costs. Called a Health Savings Account, the new investment vehicle permits a taxpayer, starting in 2004, to shelter up to $4,500 annually.

But there's a catch. The new accounts are linked to high-deductible health insurance plans. The accounts are designed in part to help consumers pay for health expenses until insurance benefits kick in.

Just how popular the new accounts will become remains unclear. But their cost-saving features and likely promotion by big employers could make them huge. (Related chart: Health costs and the income tax)

[SauronOfMordor]

I've wondered, on and off, if there wasn't something good about the old system.

In the old system, medical expenses were fully deductable, and there was no 1040 "short form". There thus was no tax advantage to having employer-provided health care versus the employer paying you the cash and you buying your own health care, with maybe a (self-purchased) hospitalization policy

[TomB]

Save your $$ for your doc.

Stop shopping, consuming - halt the economy to a screeching stop....

Huh?

Are trying to make a point here?

[ffusco]

A doctor visit costs just $67.00 nationwide average.
so pay cash...

But

A 9 day hospital stay will cost about $12,000.00

[ffusco]

How many people have 50 thousand dollras for a liver transplant?

[EllaMinnow]

When I had my daughter in 1990, we had medical insurance, but no maternity benefits.
At that time, my husband owned a cycling shop, and we "paid" the obstetrician with bicycles and helmets for himself and his 4 year old twins.

[goodnesswins]

RE: Health Savings Accounts.....

I consider this tidbit a GOOD MOVE...."But there's a catch. The new accounts are linked to high-deductible health insurance plans. The accounts are designed in part to help consumers pay for health expenses until insurance benefits kick in."

[traumer]

"A 9 day hospital stay will cost about $12,000.00 "

Sounds like a case for an emergency insurance (high deductible). And pay ca$h for 'regular' visits.

[goodnesswins]

There would be more money available for liver transplants if we all paid for REGULAR HEALTH CARE ourselves, directly, and took more responsibility for our health.

GET THE GOVERNMENT OUT OF HEALTH CARE!

[mountaineer]

How many people have 50 thousand dollras for a liver transplant?

That relates to the excerpt I posted at #3. Catastrophic insurance could cover the big things like surgery, transplants, cancer treatment, etc., but the patient might pay cash for the everyday stuff like the office visits for checkups and sore throats, or even for regular annual tests like mammograms or uncomplicated labwork. In those cases, his monthly insurance premium would be a fraction of what he - and his employer, typically - are paying.

[SauronOfMordor]

But there's a catch. The new accounts are linked to high-deductible health insurance plans. The accounts are designed in part to help consumers pay for health expenses until insurance benefits kick in.

Sounds like a great idea. Carry around a "health credit card". For routine doc visits, you hand the card over, and the doc charges against your account. For hospitalization, the card charges against your insurance carrier

[hometoroost]

Milton Friedman believes that is the way it should work and I agree. Deductible levels of up to $10,000 are practical and affordable with the new Healthcare Spending Accounts (HSAs). You put money aside on a tax-free basis in a savings account. Money you pull out to pay covered medical expenses is not taxable. Earnings are also tax-free and more investment options are becoming available.

If you are young and healthy you can keep putting money in every year and unlike flexible spending accounts, you don't lose the money you don't use. This prevents the year-end spending binges to use the money you have put aside and must spend it or lose it.

Younger, healthier people have a reason to be involved in insurance again. Why pay $5,600 a year for insurance when you know you won't spend $1,000 for care and don't feel that you are going to get a catastrophic illness or injury. Also, people become consumers again and they have skin in the game when it comes to visiting doctors. Doctors get paid faster and paperwork will be reduced. There will be increased pressure on providers to lower costs, improve quality and in general operate more efficiently and more effectively.

The left and big insurance companies like Blue Cross and Blue Shield hate these kinds of programs (MSAs, HSAs, and HRAs) because they put control of the system back in the hands of doctors and patients and they threaten the system as it stands today - which is precisely why I like them and I think Consumer Driven Health Plans are the wave of the future. Provided the Dems don't strangle the baby in the crib.

[ffusco]

A mantra is a nice, have any ideas?