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

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

[hometoroost]

Depending on where you live you can get one. MSAs and HSAs can work for individuals as well.

[Cincinatus' Wife]

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

Bump!

[syriacus]

This was in the early days of HMO's and people were thrilled at the idea of being able to see a doctor whenever without cost.

True. That was the main selling point of HMO membership for families with a lot of little children like us. But actually getting to see a doctor was difficult and we had to learn the "quirks" of the system.

Quirk 1. To succeed as an HMO parent, you must exaggerate the severity of the child's condition or learn an alternate coping method. Shortly after I joined, an acquaintance told me I would have to "exaggerate" the urgency of the children's medical conditions in order to see a doctor within a day or so. I don't like to exaggerate. I would try to accurately describe what was wrong with the child, and the person on the other end of the line, who was used to exaggeration, would automatically discount my level of concern. I didn't become an exaggerator, so much as I developed an ability to ask probing questions.

Quirk 2. You must immediately decide whether your child's illness or injury will become serious enough to warrant medical assistance. This is what I found really odd. The HMO's operators would only make same day appointments for patients who had been seriously ill/injured for less than a day (or maybe two). If you were sick or injured for a longer time, you had to make a "future" appointment. So much for bearing up under illness or waiting to see what course the illness was following.

Our HMO is now allowing members to chose Primary Care Physicians from outside the center. From what I can tell, the doctors at the center now have a lot of free time. It looks like a lot of people prefer co-paying to going to the center.

[syriacus]

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!

I believe you.

When we were married, in 1970, my husband was too slow to tell the personnel office to add me to his health insurance policy. Even though our son was born 10 months after we were married, we had to pay the obstetrician and the hospital ourselves. We had very little money, but were able to pay for everything without going into debt.

[mountaineer]

My sister was in an bicycling accident in the mid-1980s, requiring surgery, and she didn't have insurance. The hospital set up a payment plan and the debt was paid in a couple of years, end of story. In 1992 I injured a shoulder slipping on an icy sidewalk. At that time, I didn't have health insurance. I called several doctors, but none would see me, even though I assured them I had the money to pay the bill in cash. To this day, I just shake my head in disbelief over the whole situation.

[ffusco]

Your animosity towards insurance companies sounds like democratic class envy.As long as Americans demand the best care, insurance is the best way to pay for it. A medigap policy which costs less than 200 per month and pays all your health expenses is about the best bargain there is.

[hometoroost]

"Your animosity towards insurance companies sounds like democratic class envy.As long as Americans demand the best care, insurance is the best way to pay for it. A medigap policy which costs less than 200 per month and pays all your health expenses is about the best bargain there is."

Actually, my animosity towards insurance companies is born of close experience with the industry. I am licensed in all 50 states and manage over $100,000,000 a year in insurance premiums (all commercial lines and health insurance).

I have a problem with the companies that have 60% plus market share and use the state legislatures to set rules that limit competition, raise prices and protect their monopoly status. Do you think the Blues contribute large sums of money to both Democrats and Republicans for any reason other than to protect their market share?

Insurance is not the best way to pay for your everyday health insurance costs. As someone pointed out earlier, it's like asking your auto insurer to pay for your oil changes, tune-ups, and gas. They don't process paperwork for free and when you spend their money they are going to want to tell you what you can buy, where you can buy it, and how often you can get it. And from your perspective when the oil change is "free" you will get one as often as you can and you don't care what the Quicklube charges. Things get out of hand pretty quickly.

Medigap policies are a pretty good deal but they don't compare to a major-medical policy that can provide millions of dollars of benefits over someone's life time (or even in a single year). It's a defined set of benefits providing relatively limited coverage and is like comparing apples and oranges.

The bottom line is this, we don't use insurance as insurance in the health care world - it works more like an entitlement. The people with copays and limited deductibles don't buy health care the same way they buy groceries. As a result, costs go up and there is much less incentive to improve quality. Name me one other industry where improvements in technology actually decrease productivity and increase cost. Second, insurance regulations are driven by people who want to make really bad public policy because they think the government should manage health care and by insurance companies who want to protect the current way of doing business to block other more cost-effective solutions from coming to market. That is not class-envy it is merely an acknowledgement that many existing large companies use regulators to block out competition and that is one of the major reasons that government needs to stay out the business world.