Barack Obama

The Obamacare Revolt: Physicians Fight Back Against the Bureaucratization of Health Care

Will it make a difference?


Dr. Ryan Neuhofel, 31, offers a rare glimpse at what it would be like to go to the doctor without massive government interference in health care. Dr. Neuhofel, based in the college town of Lawrence, Kansas, charges for his services according to an online price list that's as straightforward as a restaurant menu. A drained abscess runs $30, a pap smear, $40, a 30-minute house call, $100. Strep cultures, glucose tolerance tests, and pregnancy tests are on the house. Neuhofel doesn't accept insurance. He even barters on occasion with cash-strapped locals. One patient pays with fresh eggs and another with homemade cheese and goat's milk. 

Dr. Ryan Neuhofel (Photo Credit: Tara Higgins/Fosse Photography)
Credit: Tara Higgins/Fosse Photography

"Direct primary care," which is the industry term for Neuhofel's business model, does away with the bureaucratic hassle of insurance, which translates into much lower prices. "What people don't realize is that most doctors employ an army of people for coding, billing, and gathering payment," says Neuhofel. "That means you have to charge $200 to remove an ingrown toenail." Neuhofel charges $50.

He consults with his patients over email and Skype in exchange for a monthly membership fee of $20-30. "I realized people would come in for visits with the simplest questions and I'd wonder, why can't they just email me?" says Neuhofel. Traditional doctors have no way to get paid when they consult with patients over the phone or by email because insurance companies only pay for office visits.

Why did he choose this course? Neuhofel's answer: "I didn't want to waste my career being frustrated."

This model is growing in popularity. Leading practitioners of direct primary care include Seattle, Washington-based Qliance, which has raised venture capital funding from Jeff Bezos, Michael Dell, and comedian (and Reason Foundation Trustee) Drew Carey; MedLion, which is about to expand its business to five states; and AMG Medical Group, which operates several offices in New York City. Popular health care blogger Dr. Rob Lamberts has written at length about his decision to dump his traditional practice in favor of this model.

"Since I started my practice, I seem to hear about another doctor or clinic doing direct primary care every other week." says Neuhofel.

Direct primary care is part of a larger trend of physician-entrepreneurs all across the country fighting to bring transparent prices and market forces back to health care. This is happening just as the federal government is poised to interfere with the health care market in many new and profoundly destructive ways.

Obamacare, which takes full effect in 2014, will drive up costs and erode quality—and Americans will increasingly seek out alternatives. That could bring hordes of new business to practitioners like Neuhofel, potentially offering a countervailing force to Obamacare. (One example, the Surgery Center of Oklahoma's Dr. Keith Smith, profiled for Reason TV in September, is doing big business offering cash pricing for outpatient surgery at prices about 80 percent less than at traditional hospitals.)

Health "insurance" is more than just insurance; it's also "a payment plan for routine expenses," as University of Chicago business school economist John Cochrane puts it in a superb recent paper. The late free-market economist Milton Friedman pointed out that we insure our houses against fire and our cars against major damage, but we don't also insure ourselves against cutting the lawn and buying gas. That's the main reason innovation almost never makes health care cheaper. Most patients never see the bill for an ingrown toenail removal or a glucose tolerance test, so doctors have little incentive to seek ways to offer their services for less. For simple consultations, why bother with Skype when insurance will pay full price for an office visit.

Insurance plans that cover everything, a situation that came about largely because of a quirk in our tax code, have also led to the "bureaucratization of medical care," Friedman wrote in a 2001 essay, in which "the caregiver has become, in effect, an employee of the insurance company or…the government."

Dr. Lisa Davidson had 8 years of frustration while running a successful traditional practice in Denver, Colorado. She had 6,000 patients when she decided to stop taking insurance and adopt the same business model as Neuhofel. Her patient list has dropped to about 2,000. She used to spend about 15 minutes with each patient and now it's more like 45 minutes. "We're on track to make more money and take better care of our patients," says Davidson. "It's a win-win all around."

Dr. Lisa Davidson (pictured to the far right) and her staff

Before adopting direct primary care, Davidson was unhappy working at the practice she had built because the insurance system imposed a way of doing business that resembled an assembly line. "It's true that in 2014, many more people will have insurance, so there will be a profound need for primary care doctors," says Davidson. "You might say I've done a disservice by dramatically cutting the size of my practice. However, if we make it desirable again to be a primary care physician more people will want to do it."

Under Obamacare, more and more doctors are becoming employees of large hospitals, where there will be more control over how they practice medicine. Hoover Institution Senior Fellow Dr. Scott Atlas fears this will cause a brain drain in medicine. "Really smart people want autonomy, and when you take that away it's naive to think you're going to get really bright people becoming doctors," says Atlas. "The best doctors could excel at any profession, so why go into medicine if they won't have the opportunity to be their best?"

When she was operating a traditional practice, Davidson witnessed firsthand how our "payment plans for routine expenses" drive up prices and block innovation. She recalls that one insurance company paid $118 for a routine PSA test. Now that her patients pay the bill directly the cost is $18. Insurance used to pay $128 for a bag of IV fluid. Now Davidson doesn't bother passing on the cost of IV bags because they run $1.50 each.

Dr. Eric Bricker is the medical director at Compass, a Dallas-based company that helps individuals with high-deductible insurance plans. In a previous job, Bricker was a finance consultant for hospitals, giving him firsthand knowledge of how health insurance drives up prices. "When insurance companies and hospitals negotiate," says Bricker, "it's an exercise in horse trading." For example, an insurance company might let a hospital get away with charging $2,000 for an MRI, says Bricker. In exchange, the hospital agrees to charge the bargain price of $2,000 to deliver a baby. "You do that mixing and matching," says Bricker, "and at the end of the day it works out about even."

According to Bricker, this horse-trading method provides an opportunity for hospitals to earn windfall profits: If the hospital gets $2,000 for MRIs, it will start encouraging patients to get more MRIs.

Given how prices are set, it's no mystery why in health care high costs often correlate with low quality. Bricker cites one facility in Dallas, where a 3-tesla MRI (the more teslas, the higher the resolution) can be had for $860, while a nearby facility offers a 1.5-tesla MRI for $2,500. The latter facility stays in business only because many of its customers don't know the difference. They pay the same $20 co-pay wherever they go for an MRI.

So Bricker co-founded Compass, which works with about 1,200 firms to guide their employees to those doctors and testing facilities that offer both high quality and low prices. These employees have an incentive to seek out value because they're responsible for paying a large portion of their own routine medical costs before their insurance coverage kicks in.

High-threshold plans are exploding in popularity, which is a promising trend. According to a 2012 report by the Kaiser Family Foundation, about 31 percent of firms now offer health plans in which patients pay most routine costs out of pocket, like a Health Savings Account (HSA) or Health Reimbursement Arrangement (HRA), and 19 percent of covered workers have one of these plans. High-deductible plans go a long way towards unbundling our "payment plans for routine expenses" from the catastrophic coverage that should be the sole function of health insurance.

Growing Popularity of Consumer-Driven Health Care Plans (Source: Employer Health Benefits 2012 Annual Survey, Kaiser Family Foundation)

"These plans offer hope," says Scott Atlas, "because they drive patients to care about what things cost. High deductible policies also eliminate much of the administrative cost of insurance because there's no need to file claims for routine charges."

Obamacare imposes new mandates on high-deductible plans, but it doesn't outlaw them. "The most devastating thing Obamacare could have done is to say it's illegal to have a deductible of more than $200," says Bricker. "So within the existing confines we can still have a successful business and help people."

Americans with high-deductible policies still have the misfortune of shopping for services in a health care market dominated by traditional health insurance. Since insurance companies and the government still pay the vast majority of medical bills, it's nearly impossible to find doctors who offer competitive and transparent prices.

A Houston-based start up called Snap Health is trying to remedy that by signing up doctors to list their prices on its website. Currently, there are 290 tests and about 100 doctors to choose from. You can buy an EKG (about $35), have a kidney stone analyzed ($250), or get a heart check up (about $400). Patients choose the procedure they want, pay online with a credit card, and then show up for their appointments. Snap Health's CEO and Co-founder Dr. David Wong says the biggest obstacle to building up a menu of offerings is that doctors accustomed to getting paid by insurance companies have no idea how to price their services for direct-paying clients.

Snap Health co-founders Dr. Christopher Langan and Dr. David Wong (Photo Credit: Brad Ottosen)
Credit: Brad Ottosen

Wong says he launched his business partly on the belief that Obamacare will drive up health care costs, causing more and more companies and individuals to drop out and start paying their own health care bills. Neuhofel agrees that Obamacare could be good for business. "I expect some real unintended consequences after Obamacare is implemented. There could be more uninsured people."

Lisa Davidson plans to enter the state-based exchanges that Obamacare will put in place. She cites a provision in the Affordable Care Act that explicitly allows direct primary care practitioners to marry their services with a catastrophic plan and enter the exchanges, although the details of what will be permitted under the law haven't been hammered out yet.

Eric Bricker also sees opportunity to work within the Affordable Care Act. "Compass is trying to make lemonade out of lemons," he says. "I think you can incrementally make improvements within Obamacare, and the situation will change over time."

The efforts of these doctors and others will undoubtedly help constrain exploding health care costs and improve care. But it's hard to fathom how within the legal constraints of Obamacare we'll see the sort of innovations that could solve the very problems that, ironically, were used to justify Obamacare's passage. As economist John Cochrane puts it, without government meddling, health insurance would be "individual, portable, life?long, guaranteed?renewable, transferrable, [and] competitive." And going to the doctor would be as simple and straightforward as eating out. What needs to be done to get there is painfully obvious.

NEXT: Neanderthals' Large Eye Helped Cause Extinction

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  1. Ooh, hipster doctors!

    1. what Rachel implied I am stunned that some people can get paid $7316 in 1 month on the internet. have you read this web site…

    2. Dang, Ted. My first reaction to the pic was “Hipster doc? No thanks.”

    3. but a hipster housecall!

    4. They prescribe only artisanal medications.

  2. My wife would find it reprehensible that she would even have to pay a mere $30 – $40 for any of those. Free everything!

    1. This attitude is ingrained in the American public. Everytime somebody recounts in horror how they actually had to contribute a little money to their own healthcare, I cringe. And I mean a $50 bill or something along those lines.

      My wife has patients who ask for Advil prescriptions so they don’t have to pay $2 at Wal-Mart.

      1. It never ceases to amaze me that people who can come with hundreds of dollars to fix their car never have any money to pay for healthcare.

    2. It took a knee replacement and a round of cancer treatments to convince my former wife of the awesomeness of high-deductable insurance. $2500 over the monthly payments for a year covers everything.

      I don’t see the problem and why O’care gets rid of that arrangement.

      1. Because it works and doesn’t give Big Government more power.

      2. You dont?

        *does a double take*

        What do you think Obamacare is about?

    3. OMG! The poor can’t afford $30 to $40 for routine healthcare! We must coerce them into buying $300 to $400 per month insurance plans via the individual mandate!

    4. You’re not married to Sandra Fluck, are ya?

  3. 30 bucks for an abscess drain. I’ll do it for free if I can film it.

    1. *hurls* Gross, dude.

      1. It’s not that bad sheesh. Just gotta run your knife over a flame beforehand and then cool it under water. I’m the closest thing to primary care most of my friends ever get.

    2. Jeez! Just had this done last month. Had a sebaceous cyst on my back that my immune system attacked. It was in a spot right between my shoulder blades that I could barely reach with my hand and it was sore as hell. I couldn’t even lean back in a chair. Went to my regular clinic. Medicare paid for 80% and I had to pay the remaining 20%. Cost me $62.50 $30.00 bucks seems like a real good deal to me?

  4. I have a $1000 deductible policy. I would use this above model for all routine care.

    1. Holy crap Shreeky…..another day flirting with sanity.

  5. But .. but … but how will patients get quality care without the gentle yet form hand of government guiding them through the healthcare process???


    1. Ya that hand is about as a gentle as a claymore…. Both kinds.

      1. Metaphorically and literally. Ever go to a military dentist? I’ve never had my gums set on fire and doused in acid, but I imagine the feeling is similar to the warfare that those sadists inflicted on my mouth.

        1. Yeah, I went to the dentist in the Navy when I was in. My experiences weren’t that bad but I do remember some of the guys in boot camp getting a bunch of teeth pulled and being laid up for a couple of days. To be fair to the Navy dentists, some of those guys had never been to a dentist in their lives.

          1. True that. Get a kid from out in the sticks and he may need some repair work done. Pulling teeth seems to be the preferred method, and I can only assume it’s because it’s cheaper to pull teeth than to take care of a guy after his mouth gets infected due to rotten teeth.

            That being said, even a tooth cleaning can turn into a torture session under some of these guys’ hands.

          2. My navy boot camp dentist yanked my four wisdom teeth two at a time, two visits. Each time he gave me a bottle of codeine (?) pills for the pain, but I never needed them, and gave them to the recruit CPO to leave me alone.

  6. But insurance companies are tightwads. They would never overpay!

    This is just another crackpot libertarian myth.

    1. Yeah especially the hipster docs. The only docs that would do this libertarian thingy here would be homeless docs.

  7. $50 an hour for a nurse house call. I wonder how much of that the RN gets. And I wonder if they’re hiring. And I wonder if there is some way I could do the job without moving to Kansas.

  8. Don’t worry liberal trolls, this, ahem, practice, will be outlawed soon enough.

  9. This is one of the most fascinating artiles that y’all have run in a while. Thanks!

  10. They’ll try to make this illegal if it starts to drain the pool of doctors available to ObamaCare. These doctors will be excoriated as profiteers.

    1. They won’t need that excuse, they will crush it as soon as it reaches their radar screens.

  11. This is part of trend I’ve been crowing about for a couple years – the fracturing of American medicine into two-tier system of Dr. Clown for the Donkey mob staffed by has-beens, and a ‘real’ health care system run by cash money staffed by people good enough to actually get paid.

    I think there are some huge investment opportunities in that emerging re-alignment of the industry, maybe even some of the outfits mentioned in this article.

    1. Remember, half the doctors now in practice graduated in the bottom half of their classes. Where do you think they will seek employment?

  12. bureaucratization is OVER

  13. The most relevant comments here… to the effect of… the feds will swoop down and crush these rogue anarchist doctors. Who the hell do they think they are anyway!?

    The feds had better get their asses in gear. They have to stomp out states legalizing illegal drugs, gunz, 3D printers, and now rogue doctors.

    What’s next? Looks like we’re going to create a whole lot of new gubmint jerbz, unemployment problem, solved!

    1. Oh, and I forgot about alternate currencies.

    2. They’ll probably hire 400 special prosecutors to go in with a fine toothed proctologist comb and desperately trump up some “fraudulent over charges” then shut down the facility while the “investigation is ongoing” , then we’ll have Obama the turd and his dungfeces crew get up on TV and proclaim they’ve stopped medical waste fraud and abuse, and the minute they’re off the pop liars stage they’ll get handed 100k from a medicaid fraud mobster for their next election scheme.

  14. I was thinking this as well, the part about the government not tolerating these ideas for too long. The cat’s out of the bag. It’s over. The government is in health care now. That means any innovation that comes from the people/doctors will be either stopped or restrained by the state. All roads pass through Washington.

    Just hope you don’t end up with a psycho-rigid, mediocre public health care system like we have in Canada.

    1. Just hope you don’t end up with a psycho-rigid, mediocre public health care system like we have in Canada.

      I have real faith that our government is 100% capable of making it worse than anywhere else on earth, and that they most certainly will.

    2. Come on, Rufus, all the liberals I know say that Canadians love the “free” health care they get. Are you sure you are from Canada? /s

      1. I have grown up in the Canadian system. It is great if you have 6 months to wait for anything. Everything is a waiting list. Technology is sparse and, as you could have guessed, the government bureaucracy wastes money whenever they can.

        I still cannot wrap my head around the idea that a Doctor in Canada can’t just treat somebody for money. They MUST go through the government.

        1. It says so on my passport.

          Canadians have made public health a cornerstone of what “defines” us. It’s ridiculous. If we invented the concept, I could sorta get that, but not only we didn’t invent it, we have arguably one of the crappiest in the OECD.

          Similin’ Joe is on the right track. Access to it is ridiculous and hope you don’t have a serious sickness or you’ll find yourself looking for options in the States. Once in the system, our doctors and nurses are as good as any and care is solid. It’s just that our facilities are old and we lack state of the art equipment.

          Nothing to love or be proud of really.

          I pay for private care. The system is too expensive and under too much stress to not allow for private options.

          Wait in the emergency room for 12 hours for a blood test or see a doctor for an ailment? Fuck that. $100 and I’m in and out at the private clinic.

          Problem is I still pay taxes into a public system where if I had the choice I wouldn’t pay into but this is the system we have and we have to live with it.

          1. And ultimately this is what Obamacare envisions for all of us. It was never about healthcare or lowering costs. If it was tort reform and lowering of compensation lawyers receive for class action suits would have been part of the deal. But instead Obama promised the Trial Lawyers Association, big contributors to his campaigns, that he would never push for tort reform. So the same vaccines that I paid $30 for when my own kids were young twenty years ago, cost four times that amount. And for that we can thank the celebrity worship of Oprah, Jenny McCarthy and countless other types of promote bad science as a means of getting the limelight. This bill was meant to transfer wealth. It’s just one of many this administration has pursued. Oh sure, they say publicly that they will tax the rich, but the cost of every layer of liability insurance, every lawsuit, is rolled into higher costs to the consumer. And what is more, this administration just doesn’t care about that.

          2. So what you’re really saying is it kills off the poor and needy and broke and broken, while those with means move to the private market instead of wasting an entire day of their life sitting in a germ infested emergency spewhole, waiting…
            a WHOLE DAY OF YOUR LIFE, for the simplest of things, the assholes drawing a vial of blood.

            Man, what a wreck we are headed toward.

  15. I would LOVE such a system. When my son had to have knee surgery, my husband was unemployed. I needed to know how much day surgery would cost. I was quoted a price by the doctor’s office, only to find out that the surgery suite, in the same building, wanted another $1500 up front. Here’s another puzzle-I haven’t had a mammogram in five years due to the cost. My doctor started making appointments for me and when the various clinics would call they would cite one price $379 out of pocket due to our $5000 deductible, but when pushed would say the same exam would be $179 out of pocket if I didn’t file with my insurance. I can’t afford most of the basic exams I’m supposed to have because just the office visit is $135. And that doesn’t include labs whose costs the doctor doesn’t even know. Please, PLEASE put one of these direct pay facilities in the Denton County area of Texas. Of course, I would still have to pay a penalty for not having insurance, but at some level, I think that would save me money.

    1. My ACL knee surgery costs anywhere between $10 000 and $15 000 from what I can ascertain. Covered by health care. Pros and cons. Pros and cons.

      1. That’s the kind of surgery you have catastrophic coverage for.

        You have a $3-5k deductible with 0-20% in coinsurance, and that becomes a manageable amount.

  16. Do physicians have a plan – or even care – to see that every American has good health care? The Individualism belief is that everyone should be responsible for having the money to pay for their own health care, including hundreds of thousands of dollars for cancer.
    The free market is an incentive for the rich to thrive and every one else to be impoverished.

    1. What a crock of shit your last line is lotsoluck. Stop fucking reading all that leftist garbage and better yet, turn the volume down when Obama yaks away and rants and rails against the rich and business.

      1. Good advice Rufus. Everytime that lyin sonofabitch comes on T.V. with a soundbite, I hit the mute button. Don’t think I’ve listened to a word he has said in ages!

    2. You must have missed the part about catastrophic coverage, and the whole discussion about how insurance is designed to hedge against large, infrequent unforeseen events…like cancer.

    3. “Do physicians have a plan – or even care – to see that every American has good health care?”

      Should they? Are they obligated to?

      Go fuck yourself commie.

      1. WTF is up with that freak ?

        I’d like to know what his err – “profession” is and see if he has made certain every american is taken care of in that industry.

        I got a thousand bucks that says dumb commie pinko boys brain never gave it a thought, and won’t even after reading this. ( he will be too busy screaming some leftist screed he was trained to emotionally react with, not to mention his 3 personal misfortunate diseases one of which is dyslexia according to the local public school, not to mention ADD which means he couldn’t pay attention to more than part of one sentence.)

    4. Fuck off, slaver.

  17. “the caregiver has become, in effect, an employee of the insurance company or…the government.”

    Doctors are duly deputized government rationers of health care, controlling your access to tests, services, and drugs through prescription laws.

    1. And when Obamacare kicks in, they will view you, the patient, as a freeloading piece of dog ****, who gets all their freebie medicine from the taxing Leviathan ordering them what to do, and they will be angry, and modify their bedside manner accordingly.

      Welcome to the dumb **** world of liberals.

      Let’s not forget the patients, many of whom were brought up with good values, and want, desire and demand that they pay their way and work for it. They will be twisted and stomped upon in the new system as well. The obamatards will make certain with obamacare that their self esteem is lowered accordingly.
      Yeah, it’s evil.

  18. “As economist John Cochrane puts it, without government meddling, health insurance would be “individual, portable, life?long, guaranteed?renewable, transferrable, [and] competitive.” And going to the doctor would be as simple and straightforward as eating out.”

    Laughably naive and clueless. So what we’re saying is that had Obamacare not passed insurance would be getting simpler and healthcare would be getting cheaper? Yes, that explains exactly why we were seeing a trend of cheaper, simpler insurance and healthcare before the law was passed (HAHAHAHAHAHAHAHAHAHHAHHAHAHAHAHAH)

    1. Clearly, vfr800cr250, your reading comprehension skills are significantly subpar.

      1. maybe he understands that in canada, thanks to government meddling, health insurance is individual, portable, life?long, guaranteed?renewable, transferrable. it’s not competitive for price, since the mds get a set rate, but it’s competitive in that the individual can go to any doctor he believes provides superior service without the insurance company telling him that they don’t contract with that doctor.

  19. “So what we’re saying is that had Obamacare not passed insurance would be getting simpler and healthcare would be getting cheaper?”

    No, what he is saying is that goverment meddling, via Medicare, Medicaid, the invention of the HMO by Ted Kennedy, and the special tax treatment of insurance premiums paid by employers has severely distorted the health market. The PPACA does nothing to address this underlying issue and instead exacerbates it.

    In order to have cheaper medical care, and simpler insurance we would have to roll back much more than the PPACA. Getting rid of the tax exemption for employer-paid health insurance premiums would be a great start.

    1. “Health Maintenance Organization (HMO) is a term first conceived of by Dr. Paul M. Ellwood, Jr. The concept for the HMO Act began with discussions Ellwood and his Interstudy group members had with Nixon administration advisors who were looking for a way to curb medical inflation. Ellwood’s work led to the eventual HMO Act of 1973.”…..ct_of_1973

      You’re right about the employer deduction for buying the employee insurance, though. I’m pretty sure Ted Kennedy wasn’t behind that either.

      As for Medicare distorting the healthcare market, only in the sense that as the biggest player in the insurance game and thereby carrying the most customers, it is able to drive the tightest bargains with providers and provides the main counterweight to the tendency of practitioners and manufacturers to raise prices skyhigh in the belief that the average consumer feels his/her life is worth that much and will pay it.

  20. Note that this is a rejection of insurance, not just Obamacare. I think it’s great, but most people will need to carry insurance for catastrophic hospital stays, and if doctors don’t accept insurance than the money you pay them does not go towards your deductible. The best combination would be standard pricing WITH accepting insurance claims.

    1. The best combination would be standard pricing WITH accepting insurance claims.

      You seem to have missed the point entirely. If they accept insurance, that necessitates “employ[ing] an army of people for coding, billing, and gathering payment” which drives the costs and prices up. They can only offer better prices iff they don’t accept insurance.

      1. or if they only take one insurance company.

        of course, the no-insurance policy just puts the labor and risk onto the patient. do you know which procedures are required to be preauthorized by your insurer? which drugs your insurer covers and which not? (they change every week, literally). all the other rules and hoops that the doctor is fed up with jumping through, so that you can follow them yourself and ensure you get repaid by your insurer? are you prepared to get on the phone when a claim is denied and argue about the medical reasons for the treatment with the nurse on the other end?

        all courtesy of the free market competition between insurers, in which they are all working very hard to find new ways to cut costs.

  21. Also, the best surgical models now are specializations that do only a few kinds of surgery, but lots of them. Sort of an Olive Garden model where you offer a few dishes, but b/c you do thousands of them you can make them successfully every time, cutting down on error. This kind of medicine is a team effort and can’t be delivered by this decentralized model of independent practitioners. There should be many experiments in delivering medical care.

    1. Firstly, your analogy fails on the face of it because you equate Olive Garden’s food with a good outcome. Secondly, it’s called direct primary care. You go to a primary care doctor for routine and preventative care, and he or she refers you to a specialist if you require some specialized treatment. That doesn’t change regardless of the way you pay your primary care doctor. The specialist would have a difficult time adapting to an insurance-free model however, because they would be treating the unexpected conditions for which the client would have catastrophic insurance.

      1. the specialist would also have trouble adapting to an insurance free model, because unlike the primary care docs, the specialists are used to getting $1000 an hour for their services, and outside of insurance companies not a lot of folks can pay that.

  22. “Traditional doctors have no way to get paid when they consult with patients over the phone or by email because insurance companies only pay for office visits.”

    Whether that’s true or not, my doctor (UW Medicine) is easily available for simple consult questions. I simply log in to “mychart” and I can access all my medical records and test results and send her questions. I usually get a reply within a couple of hours. I don’t get billed for it either. It’s a GREAT system.

    They use EPIC for medical records. EPIC and Cerner are the two big ones. I’ve used both and they are fantastic. Can’t say enough about them.

  23. like Clara answered I am shocked that any body able to profit $7089 in 1 month on the computer. did you look at this web site

  24. Smilin’ Joe Fission| 3.13.13 @ 2:27PM |#
    “I have grown up in the Canadian system. It is great if you have 6 months to wait for anything. Everything is a waiting list. Technology is sparse and, as you could have guessed, the government bureaucracy wastes money whenever they can.
    I still cannot wrap my head around the idea that a Doctor in Canada can’t just treat somebody for money. They MUST go through the government.”

    I have an acquaintance who is a licensed MD in the US and Canada. He is a ‘professional’ Canadian in that he swears the Canadian medical care system is far superior to the US equivalent, but it seems his mother (in Canada) needed treatment and all it took was for him to pull strings to get her that treatment in time for it to be worth it.
    And he seems to find it difficult to return to Canada given his practice in the US.
    Yes, I do mention the concept of stated vs. reviled preferences. He is not happy to hear those comments.

  25. So the bottom line is that we have 950,000 doctors and 5,700 hospitals in the U.S. – all intent on overcharging for services by a factor of something like 4 to 10 times fair and reasonable pricing. Funny how we all jump up to protect these thieves to protect them from our overbearing government thugs.

    A little back of the envelope math says we don’t have a government spending problem if we dismantle the Medicare, Medicaid and Obamacare structures and go back to the direct pay systems that existed before Lyndon Johnson’s Great Society.

    Since I really do not believe this can happen, let me hope that more doctors, hospitals and clinics wake up to the disservice they do for us. Unfortunately, these few direct pay providers will disappear in January 2014 when everybody has to sign up for healthcare – or else . . .

  26. Very inspiring and liberating. Plan to sell my current practice to a big group and do something similar.

  27. The arrangement between providers and insurers also feeds the claims of politicians that health care is too expensive. My hospital sent me a statement (by accident, I assume) that showed the cost of my surgery (~8K$) and the payment (~2K$). Would that mean a 400% markup had I walked in to pay cash? Similarly, a friend settling his mother’s estate was told that a ‘donation’ to the hospital would clear out his mother’s tab (I don’t know why she was not covered under insurance or medicare); I recall that the bill was upwards of 100K and the donation recommended was about 10K. Since insurance companies (or some governmental body) pay the vast majority of the claims, I can only assume that “mark it up to mark it down” is standard practice. What a great way to frighten the plebes and simultaneously give the politicians an excuse for a power grab!

  28. Government will try to ‘fix’ the alterantives. Although they may already be ringing the death bells.

    Since Obamacare mandates insurance and specific types of policies, it will limit choice for people who can afford little more than the insurance itself. This will then limit the opportunity for providers in the direct care alternative. Otherwise, there would be even more consumers willing to participate in high deductible plans and pay for routine care. I understand the Medical Savings Plans are under attack by Socialist/Liberals/Democrats, elimination of the Medical Savings Plans is part of the effort to limit alternatives, leaving people in the crony capitalist and government system. I don’t like our tax law and carve outs for anything – flatter is better and I’d prefer a one size fits all tax, but in our current system anything that promotes a freer market, as does the Medical Savings Plans, I feel obliged to advocate.

    “Health “insurance” is more than just insurance; it’s also “a payment plan for routine expenses,” as University of Chicago business school economist John Cochrane puts it in a superb recent paper.” – Great Line; I’ve been saying this not as well for years.

  29. what Joan explained I didnt know that any body can profit $6664 in one month on the computer. did you read this website

  30. uptil I saw the draft of $9973, I did not believe …that…my father in law could trully receiving money part time at their computer.. there aunts neighbour has done this 4 only about eleven months and at present paid for the mortgage on there place and got a gorgeous Chrysler. we looked here,

  31. It’s not the ACA that is to blame for the bureaucracy, but the private insurance industry. The answer is a single-payer system that is MUCH more efficient and less costly.

  32. ACA is a step in the right direction. Many are now insured and are able to see a doctor, hence not end up neglecting themselves and end up with bills for interventions that could have been prevented. See specific comments below:

    “Obamacare…will drive up costs and erode quality” There are several measure to increase quality by identifying and implementing EVIDENCE BASED PRACTICES to better outcomes, increase quality and reduce costs. Here is one of many examples of such programs:…..bleDetails

    “A drained abscess runs $30, a pap smear, $40, a 30-minute house call, $100…” What do these individuals plan to do if they need to be hospitalized or visit an ER??

    ”…’I expect some real unintended consequences…There could be more uninsured people’…” The bill mandates that ALL, including the healthy have insurance to prevent the uninsured getting services which they cannot afford that the insured bare the burden of.

    “Under Obamacare…doctors are becoming employees of large hospitals…there will be more control over how they practice medicine…” Again, the argument here is to standardise practice with evidence based practices. The relationships with doctors and hospitals NEED to improve to prevent rehospitalizations and fatalities that occur due to lack of necessary follow up after discharge.

    1. “Under Obamacare…doctors are becoming employees of large hospitals..”

      Indeed. Doctors have been being forced into groups, clinics, and hospital practices for decades now. I guess they must have seen that Obamacare coming, huh?

      Meanwhile, in Canada where there is single payer government medicine, most doctors are still self-employed. and don’t maintain a large staff for billing and collection, they just write a short form telling what they did for each patient, stuff them into an envelope and mail once a month, and a check returns. No arguments, no preauthorization requirements.

      those big staffs US doctors have had for decades now are busy looking up the agreements with all the different insurers, checking what each insurer allows or disallows the patients to have, calling up the insurers to preauthorize everything so they can get paid, making sure the patient’s insurance is still valid, that he/she still has the same member ID, keeping track of how current each insurer is with paying recent bills, etc etc etc. free market efficiency in action.

  33. No one’s talking about situations that cost REAL money. Sure it’s ridiculous for insurance to pay $300 for a typical doctors office visit, I hope most would agree. Maybe there’s room for both systems. This is peanuts. I work in a level 1 trauma center ICU and even if I took out the segments of the bill that pay for the insurance bureaucracy I have had patients whose bills would exceed well over 100k(real bill:over 500k), I’ve know of bills much much larger, and bills very routinely run past 50k to 75k. That’s without rehab that comes after the hospital. Do I hear rumbling about death panels? How many of you feel as if this is a cost you’d be able and willing to absorb? Insurance, whether it be private or single payer, has its place…period. That said, if I had a choice to opt for a major medical policy and pay a HCP the peanuts I’d do it…unfortunately I don’t.
    ‘Hipster’ docs work for healthy people to fix bumps and bruises and even to manage some chronic conditions but what about someone who’s on tri-weekly dialysis for example. That equipment and the filters and blood circuits aren’t cheap and could you imagine having to pay out say $1200 a month or so…no, lets cut that in half $600 a month thats $50 a visit(a real bargain) for the rest of your life? Not to mention the fact that this takes 2-3 hours and is done during normal business hours so working a normal job with good pay is not very likely. I’ve gotten off topic again but to walk a mile in someone else’s shoes.

  34. I noticed that the article, exclaiming the virtues of “direct primary care”, sticks to procedures such as strep throat cultures and MRIs. There’s a good reason for that: these are procedures that most people could conceivably pay for “out of pocket”. Direct care is totally useless for most if you need a craniotomy or lung resection.

    But with a banner like “free minds and free markets”, I suppose your readership is of the “let ’em die” mentality that was on display in last year’s Repub debates on health care. Fortunately, thinking like that is found only at the right fringe.

    PS: there has never been anything resembling a “free market” since they tried it in 18th century England – and it was quickly abandoned.

    1. Direct care is totally useless for most if you need a craniotomy or lung resection.

      That’s what catastrophic coverage is for, you moron. You know, the purpose of actual “insurance.”

  35. how exactly is it exactly that the government prevents transparent pricing? and how is it exactly that the doctor in the article manages to provide transparent pricing, despite this hypothetical government law forbidding it?
    and where exactly does the government forbid doctors competing by lowering prices? and again, how exactly does this doctor manage to violate this hypothetical law without penalty?
    especially when medicare, which is government controlled, provides the lowest prices (and is the one segment of US healthcare which really is “best in the world”?)

  36. I agree Drs are now left with giving substandard care and spending less time with patients than before.

  37. Hey, I found an interesting gofundme. Looks like someone was directly affected by obamacare (or lack there of…) They had to go OUTSIDE of the country to get care. Also looks like they are going to get lawyers involved. wth.

  38. I just realized this was written in 2002. I wonder what the gun crime rate is now. Any government that tells you that you have no right to self defense is not looking after your best interest. Self defense is the most basic right anyone has. No government or police can protect you. I can’t believe you all allow this to continue. I keep a gun at home for self defense and have a license to carry it concealed any where I go. And I do. If I am attacked then at least I have a chance to stay alive. By the time the police arrive they can either arrange for my body to be picked up or take a statement from me. I choose the later. Britons let a right be taken from them and now it will be much harder to get it back. But you should try.
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