Is a Cash-Only or Direct-Pay Medical Practice for You?

High cost of government plans

The reason I got a high deductible health insurance plan is because I didn't see the logic of paying $3000 dollars of premiums for an additional $2500 of coverage (100% coverage).

But since getting a high deductible plan I've been more sensative to cost and I recently balked at my kids doctor for charging $250.00 for a rushed 15 minute exam (reason: underpaid bills from Medicaid). I now got a doctor that doesn't accept Medicaid and I'm paying $138 for a visit, that didn't seem rushed and very little waiting time.

Last Posting (Not a good idea)

To Vivian, who was worried about the cost of this system if you are using the doctor 4 times a month: Yes, if you go to the Doctor 50 times a year, then this will mean more out of pocket expense for you. However, this is because OTHER PEOPLE ARE PAYING YOUR BILLS in the current model. If you tried to buy insurance outside your employer and had a record of going to the doctor four times a month, you would simply be denied coverage at any cost (and if someone was willing to do it your premium would be thousands of dollars a month... much more than $66 bucks a pop).

This is exactly why the system is so messed up in the first place! "I want to be able to consume anything I want, whenever I want, at any cost, so long as someone else is picking up the bill". You are the reason that my insurance premium is so expensive. Right now, when you go to the doctor, he is charging a LOT MORE the $66 a visit (look at your insurance statement next time you go to the doc), it's just that he bills your insurance, who then raises the premium on your employer, who then docks your salary (or, as in the case of a growing number of businesses, simply drops coverage or is driven to bankruptcy if that is contractually impossible). I'm not sure what you're looking for, but when you take up the time of someone who costs hundreds of thousands of dollars and decades to train, he is going to demand reimbursement, and it has to come from somewhere... it's just that in the current situation his bills can be even larger and he has incentives to run unnecessary procedures because his customer is the insurance company.

This system isn't the only solution, but you are exactly why the insurance system isn't working and why a single-payer system is likely to fail as well.

For people with chronic or acute ailments that they cannot afford, we should have something in place to make sure that they are able to get reasonable treatment, but if most people were paying directly for what they consumed, they would be a little wiser about what they bought and doctors would actually have an incentive to lower their costs to court customers.

Why do we have to cover everything for everyone?

There are some assumptions that the current healthcare reform initiatives are taking on behalf of taxpayers. We need to cover everyone...and we need to have relatively comprehensive coverage. We dumb it down to like making everyone have car insurance..."or else." 1) Insurance started out for catastrophic events. Managed Care brought coverage to comprehensive levels with some assumptions that capitation would be best for patients. The "but" is we'd have to include lots of services to make it affordable. Why can't we return to a scale of catastrophic core for all and build from there based on who's kicking in the $.2) We need to cover all but there are lots who don't need/want insurance and we want to make them play/pay so we can afford it everywhere else. Not everyone has life insurance but they do have social security... let's make everyone buy insurance so we can cut the social programs? 3) Let's make providers & consumers accountable..let's give warranties/guarantees for services provided and let's require a provider give a copy of a patient's cholesterol(for example)results if they ordered it and it cost money that someone else paid for. Let's not require a patient to pay for another office visit to discuss the results of the cholesterol screen.

cash only health care

This is the same old model. Why don't they do something about the quality of care and how much one pays. Paying by the minute does nothing to ensure quality care.

Tne next step

In order to make health care more reasonable, more quality outcomes and more timely we need to take Simple Care to the next step (level).

American needs nationwide insurance plans that offer multi-tiered catastrophic coverage. Currently insurance plans very state by state depending upon state regulations. Catastrophic plans currently available have limited amount of deductible options. (For example, there is no nationwide insurance available that offers a deductible of 1, 3, 5,... to $25,000). This addition would be to take care of everyone who can afford coverage.

Medicare and Medicaid should be a single payer system for the legitimately disadvantaged and poor.

Medicare has given a promise to those over 65 who could afford to pay for their own insurance, if unnecessary cost were slashed. Most Americans Do Not Know the Following: Since the government is unable to pay for the promises they have given, Medicare has cut reimbursement to providers of health care to levels near or below health care providers break even point. Consequently, cash pay patient and insurance companies are covering their own responsibility in addition to what Medicare does not pay of Medicare's fair share. In health care, this is called cost shifting.

With this mentality, a single payer system will fail to meet the needs of all, keep our taxes down and give us timely health care. Our press and public representatives too often only tell us the negative aspects of our health care system (without going to the root cause) and the benefits of some other countries health care system (without telling the negative aspects citizens of those countries know).

Some will say, we can't afford to pay more for our total out of pocket care (cash for visits to physicians, dentists, insurance premiums...). I hear you yet please realize that the above will actually cost less over all. Your employers will not have to spend as much of your wages on insurance, tax subsidized care costs will be decreased and uninsured costs will be decreased. The unnecessary paperwork to third party payers (employers contracted insurance companies, Medicare, Medicaid, Worker's Compensation, Labor and Industries...)to justify the care that you have been given is robbing you of your hard earned money.

Re: Another Partial Answer

Sorry to post a third time in the same comments section, as a smoker for over 50 years I can assure you we are subjected to a great deal more than a "barrage of nice articles just saying that you should "change your behavior". Over the past several years several states have passed laws denying smokers the ability to use their Visa and MasterCard debit or credit cards to make online purchases for tobacco. In 2002 I worked part time for an opinion research company to make a little extra money. There was a smoking survey that was very difficult to do because in the Southeast section of the United States, the American Cancer Society had run a campaign that involved calling smokers, pretending to do an opinion survey, having identified a smoker they would start yelling at them, telling them how stupid and ignorant they were. Those people were terrified.

Then there are the taxes. When the taxes were increased in April at the Federal level to $2.00 a pack, the tax on loose tobacco was increased $23.67 a pound. The cost for a .75oz of loose tobacco at the corner convience store increased by approximately $3.50 a pouch.

Currently Senate Bill S.1147 is pending in the Senate Judiciary Committee. Stops internet cigarette sales; PACT ACT Prevent All Cigarette Trafficking Act. Basically, if this bill passes, Congress and the White House will have taken it upon themselves to prevent the sale of any legal product they disapprove of under the guise of regulating commerce and preventing the loss of taxes in those states with the highest tobacco taxes.

To paraphrase an old Jewish poem. First they came for the Smokers and no one came to help. When they came for me, no one was left.

Now consider the just passed Cap and Trade Bill and the building campaign against "un" healthy food. Looks a lot like the anti-smoking marketing in the '80s and '90s

As a smoker I'm assuming I will need an option like this in the near future

Another Partial Answer

Ultimately this and other approaches are an attempt to provide medical care for the least cost to the highest number of people possible. The article does not discuss to any great degree the other higher cost components of heath care such as the imaging, blood work, and prescriptions other than to say that you still need insurance. It only is dealing with the cost of the physian's time which in my experience is most often the least expensive part of any of the various medical procedures. In one assumes that 55 to 65% of all medical care cost are associated with fundamentially individual choices, i.e. smoking, obesity and sedendary life style. Without forcing consquence discussions on those who have made these lifestyle choices, i.e. not paying with government by forcing them to pay for their own care with their own money, the medical cost debate will not be worth the paper that is written or discussed about it. There would be a lot of tragic stories but if the US population as a whole understands without question that these types of activites leads to consequences, the behaviors might change. It would be more effective than the barrage of nice articles just saying that you should "change your behavior".

Market driven vs Public (Government)Mandated Economic Systems

Isn't a "private" market driven system offering as many options as there are ideas, to as many people who are willing to buy "vs" systems controlled by one or two major players like the government and insurance companies making one size fits all decisions for everybody the real issue here. I prefer the first, it's called free enterprise. I like this option being available along with the clinics Walgreens and Walmart are trying in some areas.

The plus is the doctor and the patient is in in control of treatment, not a bean counter or a company that is reluctant to pay any benefits ever. Have you ever tried to work with a HMO or a major insurance company. Ever needed government help for one of your kids?

Could cash driven options like this help with cost controls in a competitive market. See comment by BLH

Yes I edited and expanded my first post. Sorry. It's a dsylisic thing.

To this doctor's credit (below)

we should COMPLIMENT his/her practice on one very important bit of integrity not emulated by insurance-accepting doctors.

That is that THE PRICE IS THE PRICE!

Most of us in other plans know that our doctors routinely charge an "initial" billing of much more than they have already agreed (in their network contracts) to accept. Then the insurance company knocks it down to "usual, reasonable & customary" and sends you an EOB showing that something lesser was paid and the doctor "writes off" the rest. There is now and has ALWAYS been something morally questionable about this whole pricing game.

Still, I'm in greater favor of a single-payer model, primarily because even though some primary care physicians and their patients may be happy with "cash only" for small office-visit bills, the whole concept will break apart and not work when you get to specialists, surgeons, anesthesiologists, hospitals, radiologists, and so forth.

Market driven vs Public (Government)Mandate Eonomic Systems

Isn't "private" market driven system offering as many options as there are ideas, to as many people who are willing to buy vs systems controlled by one or two major players like the government and insurance companies to make one size fits all decisions for everybody the real issue. I prefer the first, it's called free enterprise. I like this option being available along with the clinics Walgreens and Walmart are trying in some areas.

The plus is the doctor is in in control of treatment, not a bean counter or a company that is reluctant to pay any benefits or ever. Would cash help driven options help with cost controls maybe. See comment 1