Paying on the Way Out

For better or worse, articles and blog posts about healthcare issues are now blinking on my radar. This hit the other day:

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 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 cash.

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. ...

He started a group called SimpleCare to spread the gospel of cash-only medicine. The organization steers patients to doctors who offer cash discounts, and gives technical and moral support to doctors who want to start cutting their ties to insurance. Membership has grown to 22,000 patient members and 1,500 doctors. Some reject all insurance and take only cash, while others continue to accept insurance while offering discounts of 15 percent to 50 percent for cash-paying patients.

Independent of SimpleCare, doctors in California, Colorado, Minnesota, Texas, Mississippi and other states have also quit the insurance game. Some tired of the paperwork and administrative expenses. Some wanted to spend more time with patients without managed care bean-counters peering over their shoulders. The patients who pay cash range from poor to wealthy, with most in the blue-collar middle.

To build on my still-blurry view of a solution, a pay-at-the-door component might do much to revivify the medical profession for both doctors and patients. Some basic coverage for calamities and expensive procedures would be mandatory — perhaps with some sort of minimum coverage, such as one free checkup per year — and everything else would be paid on a cash basis.

That might open up an area of competitive differentiation for insurers, which could offer additional free visits and the like to attract subscribers. It would certainly open up the options that doctors would have in designing their practices. If they can receive more income per visit, and therefore spend more time with patients, who knows but some might offer house calls for slightly higher fees.

This might be the PR basis for building consensus behind healthcare reform laws. The possibilities of a liberated system beyond the stifling shelter of insurance are manifold and tremendously appealing, with powerful and comforting imagery to draw from our cultural past.