Covered at Reason 24/7: Doctors Turn to Cash Business To Escape Red Tape


Reason 24/7

Despite much talk about a very real — and growing — problem with access to primary-care physicians as older doctors leave the profession and the ranks of new providers thin out, there's still hope for Americans who don't want to wait in line for medical care. There's hope, that is, for people willing to pay cash on the barrelhead for services rendered. That's because the numbers of doctors refusing third-party payment and insisting on dealing directly with their patients as customers is steadily growing. The change not only frees doctors and patients from bureaucracy, it reduces much of the pressure driving increases in healthcare costs.

From Forbes:

Obamacare's most intrusive changes to the healthcare marketplace — including the individual mandate whereby Americans must secure health insurance or pay a fine and its massive expansion of Medicaid — are less than a year from taking effect.

Many doctors have decided that they're not interested in seeing how those changes play out in their own practices. Nearly two-thirds of doctors say that they or their colleagues will retire earlier than planned over the next few years, according to a survey conducted by consulting firm Deloitte.

Others are considering a departure from the current system of third-party payment. Instead, they're exploring direct payment, with patients paying for care on their own.

Patients should welcome this development. Not only does the move toward direct payment have the potential to reduce health costs — it could also yield higher-quality care.

Even before Obamacare, direct-pay practices were growing in popularity. According to the Center for Studying Health System Change, direct-payment practices increased from 9.2 percent of the market in 2001 to 12.4 percent by 2008.

Nearly 7 percent of doctors say they are planning to change to some form of direct-pay care in the next three years, according to a survey of 13,000 doctors done for the Physicians Foundation. The consulting firm Accenture projects that one in three doctors in independent practice will adopt "subscription-based care models."

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  1. These rogue doctors will be culled from the herd, and all cash transactions for medical care will be outlawed.

    1. You really shouldn’t be giving them ideas.

    2. You really shouldn’t be giving them ideas.

  2. Wow, that is a surprise


  3. But if doctors require monetary compensation for their services, some people might not be able to afford top-of-the-line care. The world would be so much more fair if healthcare were free and everyone had the same level of care.

    1. You mean everyone EXCEPT Congress critters who need high levels of care in order to take care of us more efficiently. Right?

      1. Right. Of course. Some animals are more equal than others, after all.

        1. The progressives have framed the argument in such a way that “healthcare” is a common good, and make the queer implication that doctors are only entitled to such compensation as the collective (read: Progressives) determines is appropriate.

          1. This ‘framing’ of the argument you bring up seems to go without question even by Red Team. Red Team believes in the entitlement and common good idea, just not the scope. This is what leaves them vulnerable, red team and blue team principles are the same. It’s not: do we have price controls, it’s are there any loopholes in the price controls for some of the private sector to survive.

          2. The “queer” implication, huh? I knew that gay marriage would come to no good.

          3. The progressives have framed the argument in such a way that “healthcare” is a common good

            Single-payer legal care, with bureaucrats determining how much each legal procedure is worth.

            Because there’s no lawyer in the country who does anything worth more than minimum wage.

            (I know I keep beating on this drum, but the lawyer-legislators need to have it drummed in their heads what a horrible idea central planning is.)

  4. [SLD]

    And that is why HSA-encouragement would have been a better government policy than the ACA. The debit card from my HSA account looks like any other card.

    And, of course, it made HSAs worse immediately, by eliminating using it for OTC medication. And next year, the high deductibles make them non-standard.

    1. HSA: is that the one where you can invest money in a mutual fund but take it out without penalty for medical expenses? Or is that an MSA?

      1. No, it’s a kind of stupidly regulated account that your employer creates and deducts money from your paycheck to put into on an annual basis, which you use to pay cash for medical costs. Only you lose any money in the account at the end of the year if you havn’t spent it.

        HSAs are a good idea, but the way they are regulated today completely defeats the purpose. If you’re forced to spend the entire amount or lose it, you have much less incentive to conserve.

        I suspect that the D’s poison-pilled the whole idea when it was created to insure that no free-market solution would ever work.

        1. NO.

          You described an FSA.

          An HSA is what Raven described, it carries over from year to year.

          Both are MSAs.

          1. My company instituted a High-Deductible plan with an HSA several years ago. It has been quite popular with the younger engineers at work (very low cost premiums and the money carries over while you’re young and don’t get sick very often). They left a Low-Deductible (high-premium) plan in place which is populated mostly by older people (e.g., kinnath and mrs. kinnath).

            But Obamacare has fucked everything up. The High-Deductible plan is not so high anymore and the premiums shot way up. The HSA has more restrictions. And best of all the low-deductible plan is going away, so creaky old dudes like me are being thrust into the high-deductible plan with the HSA. Which negates the very value of the HSA which is to start when you’re young to have the savings to pay when you’re old.

            I can’t say often enough or strong enough just how much I have the mutherfuckers that passed this bill. I hope they all die long painful deaths.

            1. Feature not a bug.

              Been dieing to say that in an applicable format.

            2. Well good news for you when you get just a little older.. you can’t be charged more than 3x what younger workers pay for the insurance part of the plan.

          2. That’s what I thought. I was about to say that I have a high deductible plan with an HSA account, and my HSA rolls over each year.

    2. Problem is most HSAs today are “use it or lose it”. If you don’t spend all of the money in the account, it doesn’t roll over into the next year, so you’re essentially throwing money away.
      That’s how the HSA at might company works. It makes no sense.

      1. Those are FSAs. HSAs carry over from year to year.

        Mine carries over, its provided by my “employer”, which is me.

  5. Well, if this isn’t snuffed out by the government, then it might be the future.

    Insurance is going to be wayyyyy too expensive for the average person to afford, and will likely only be purchased after a cancer diagnosis or something very expensive (thanks guaranteed issue!).

  6. Who runs Barter Town?

    1. Karl Hess?

    2. The methane from the pigs’ shit?

      1. It’s not shit, it’s energy.

    3. Tyrion and Hodor?

  7. My Dr. is forming a CO-OP with her patients. We will be dropping our low deductible insurance and will pay her much less per month for primary care with our 5 person family. She is dropping all insurance altogether. She will also not share our personal medical information with the polit bureau.
    Free Markets!! FTW!!!

    1. I must mention we will get a high deductible for emergencies.

      1. The problem is most hi-D plans wont be high enough anymore because of new ACA rules that start next year.

  8. I’ve already encountered this. I got one referral to a place my doctor said were “the best”, but they don’t take insurance. You can TRY to file your own insurance claim with your insurance company, but … good luck with that. My insurance company wouldn’t pay out the claim because they said it’s supposed to be filed by the provider, and the disagnosis code was “incomplete”. It’s near impossible to get an insurance company to pay for anything that doesn’t come straight from the doctor’s office.

  9. Actually, it’s not the cost of routine visits to the doctor that are the cause of sticker shock, it’s what happens when something becomes non-routine and you need tests, treatments, hospitalization. That’s where the complete lack of price competition has had the most inflationary effect.
    I’d happily pay my doctor for routine stuff, but the web of complexity surrounding health insurance in this country makes that change not only unlikely, but probably not worthwhile for the individual who has decent insurance at the moment.

    1. No, the problem is most people don’t even pay for their own insurance, so they are incentivized to use insurance for everything. Why pay $100 out of pocket for an office visit when you can get your employer’s insurance to cover it for a $25 co-pay? The cost of the insurance isn’t coming out of your paycheck, so why not?

      (Well actually it IS, ultimately, but that is obscured from you.)

      1. The first thing that should have been done is to separate insurance from employment.

        Then give that a decade to see how things shake out.

        Only then should any step 2 have been considered.

        1. The drive to do something is a little more fickle than you seem to think. The something being done must be reflexive and bold.

      2. Actually a hunk of it is–my university doesn’t pay 100% of the premiums. But it’s negotiated by my union (don’t even get me started on that…) and I have no say in any of it.

  10. I’m sure the Progressives will snuff out these wreckers in due time.

  11. OT: MSN Pulls a Tony.


    1. The real gold, as always, is in the comments:

      “B BMar 21, 2013 10:40AM i can fix the budget in 24 hours , stop giving our money to other country’s ,our gov. is cutting the throats of Americans just to give money to country’s that stab the USA in the back ,this means you Pakistan. i read they get 30 BILLION a year to fight terrorist but instead they HIDE them. come on gov.stop “helping” others and help our own”

      The capitalization and lower case suggest this is one of derpfee’s relatives. AMERRRRRRRICA! FUCK YEAH!

      1. Interestingly, this was part of the plot of the latest Metal Gear video game.

        A little war (against Pakistan) is good for the economy.

    2. where’s barfman?

  12. my classmate’s half-sister makes $82 an hour on the computer. She has been without a job for six months but last month her paycheck was $13534 just working on the computer for a few hours. Go to this web site and read more and go to home tab for more detail— http://www.JUMP30.COM

  13. Sometimes man you jsut have to roll with the punches!


    1. Thanks, Jo Dee Messina!

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