Health Care

"What Happens When Doctors Only Take Cash"? Everybody, Especially Patients, Wins

The Oklahoma City Surgery Center is a model for how medical care can be better, faster, cheaper.


Anyone who has ever tried to shop around for prices on medical care knows how dysfunctional the market is. It's not because huge amounts of money isn't changing hands; it's that nobody really knows what anything costs at any given moment in time.

When I first moved to Los Angeles from Buffalo, my then-wife was pregnant with our first child and we were on a grad-student plan that didn't travel far beyond Western New York. Reason's benefits might not kick in until after our son was born, so I called around to area hospitals to try and find out what things cost. Four hospitals refused to give me any information, saying that they could not (and would not) price out anything. Part of that's understandable—what if something went seriously wrong?—but the people I spoke to refused to even say what basic charges were for things like delivery room time, anesthetics, and the like. Of course they have rate sheets for all that but share them with potential customers? Go fuck yourself, buddy.

For good reason: These costs are completely contingent on a wide variety of factors, especially what insurance plan you have or whether you have insurance at all. More recently, I've had the same problem trying to price out basic blood tests (a lipid panel) in southwestern Ohio, as simple and mechanical a procedure as exists. Without clear pricing, we'll never get far in radically improving the cost and quality of care for non-emergency services. In areas that are not traditionally covered by insurance—think Lasik surgery, cosmetic dentistry, and plastic surgery—a very different model obtains and you see exactly the sort of market-driven efficiencies that we see in virtually every other part of our commercial lives. The surgeon Jeffrey Singer has written about how various insurance contracts bar him from even discussing discounted cash payments with patients who announce they have insurance.

Time has a great story about bringing basic market forces to medicine. Titled "What Happens When Doctors Only Take Cash," the article uses the Oklahoma City Surgery Center as a model for a different way of doing business. Co-founded by the outspoken libertarian Keith Smith and Steven Lantier, two anesthesiologists, the center takes no insurance whatsoever. Instead, they take cash only and advertise and guarantee their prices and services. The result is pretty goddamned amazing:

The all-inclusive price for every operation is listed on the website. A rotator-cuff repair for the shoulder costs $8,260. A surgical procedure for carpal tunnel syndrome is $2,750. Setting and casting a basic broken leg: $1,925….

The Surgery Center would charge $19,000 for [patient Art Villa's] whole-knee replacement, a discount of nearly 50% on what Villa expected to be charged at his local hospital. And that price would include everything from airfare to the organization's only facility, in Oklahoma City, to medications and physical therapy. If unforeseen complications arose during or after the procedure, the Surgery Center would cover those costs. Villa wouldn't see another bill.

The savings for Villa's surgery were so awesome that his company footed the bill. Others are following suit:

Villa, for example, says his decision to go to the Surgery Center saved his company money, since his $19,000 bill is less than it would have been charged, even with a negotiated discount, by a traditional hospital. The Oklahoma state public employees' insurance fund, which covers 183,000 people, recently did similar math. In 2015 it announced a new rule: If patients go to a traditional hospital, they pay their deductible and co-payment. If they go to a cash-based provider that meets the fund's criteria, including the Surgery Center of Oklahoma, they pay nothing at all.

At the heart of this are the price signals that help us guide decisions in all parts of our lives. If you don't know what things cost at a given point in time, there's really no way to make an informed decision. Smith laid out for Time how he and Lantier came up with what to charge:

They asked their fellow doctors how much compensation was expected per procedure, factored in necessary expenses like surgical equipment and medical implants, then tacked on a 10% to 15% profit margin. Since their surgery center does not employ the army of administrators that is often required to haggle with insurers and follow up on Medicare reimbursements, their overhead is smaller. The whole operation is 41 people. "Finding an average price doesn't require complicated math," Smith says. "It's arithmetic." Since posting the price list eight years ago, they've adjusted it twice, both times to lower rates.

Read the whole thing here.

With about half of all medical dollars being spent by the government and much of the rest covered by completely inscrutable insurance-company payment systems, good luck figuring out what anything costs at any given point in time. Ironically, Smith notes that Obamacare's forced march toward high-deductible plans (still a rarity among insured people) is actually fueling more cost-consciousness among patients (who should be called customers! enough with the mystifying of medical care as something more than other types of services!). After all, if your deductible is $6,000 or $15,000 or something you're unlikely to reach in a given year, you have more incentive to track your costs.

Indeed. I started this post with anecdotes about the difficulty of finding medical prices and I'll end with another. A few years back I had switched to a high-deductible plan and was prescribed something—a statin or antidepressant, I can't remember which, but it was a drug for which many brand names and many generics exist. My doctor prescribed a name brand and I asked him how much it would cost per month. He replied, I have no idea. I pressed him a bit and he had his staff call my insurer and find out. It turned out it would be something on the order of $80 a month while a generic drug would do basically the same thing for about $8.00 a month. He prescribed the latter and said we could always switch if it wasn't getting the job done.

Start multiplying those sorts of interactions throughout the medical-care system and big things start to happen. You supercharge it with outfits like the Oklahoma City Surgery Center. What happens when doctors only take cash? The lucrative field of medicine gets demystified, prices go down, services go up, and everybody except insurance companies come out ahead. Paying cash on the barrel head isn't the full limit of how to increase the quality of medical care while driving prices down, but it's an essential part of any serious reform that doesn't simply involve rationing the quantity of care. Different conditions apply (obviously) for emergency situations, but those sorts of costs are exactly what real insurance—as opposed to the pre-payment plans we effectively call "insurance"—are designed to cover.

Back in 2012, Reason TV's Jim Epstein visited the Oklahoma City Surgery Center and talked with Keith Smith and patients. Watch this video to see the future of medicine—if we're lucky, that is.

NEXT: North Carolina Hospital Wants State to Block Competition From Two New Surgical Centers

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  1. Had a very interesting conversation over dinner last night (wrapping up our annual planning meeting for insurance coverage and underwriting) with one of our insurance brokers, who is a pretty straight-up San Francisco liberal woman.

    What was remarkable to me was that it sure seemed like this is the first time she’s ever discussed politics with a libertarian. Anyhoo, when I pointed out that subsidies always increase the cost of something, usually by more than the amount of the subsidy, it seemed like the first time she had heard that. And, when we talked about insurance, I told her it acted a lot like a subsidy, and that it was no coincidence that medical inflation has exploded as third party payment for medical services has exploded.

    This is a very smart, well-informed woman, but again, it seemed like the first time she had heard this idea. Which is pretty basic to people in our political bubble, but apparently simply a non-thought to many others.

    1. I’ve read your post and I have formulated one important question that most libertarians are wondering: Was she hot?

      1. I’m betting average. Insurance broker and San Fran liberal probably balance each other out.

        1. Hey, I dated an insurance broker from San Francisco!

          She had her angles.

          1. Were they obtuse angles?

              1. Right ongle, man!

              2. To a certain degree, I’m sure.

              3. “She was acutie”

                Are you saying her angle was less than 90 degrees?

            1. And probably got off on a tan gent.

          2. They aren’t supposed to have angles. They are supposed to have curves.

            1. The angle of the hip bone……..

              1. I’m not a serial killer, btw…

          3. Hey, I dated an insurance broker from San Francisco!

            And the only one getting broker was you!

            *cymbal crash*

        2. She had all the right curves in all the wrong places.

      2. Was she hot?

        For @ 60 years old, she was in the top quintile.

        1. Yikes, the ‘non thoughts’ lasted around 60 years?

          1. San Francisco liberal. That’s a hermetically sealed bubble. She’d have had to actively run down information contrary to what was assumed and reinforced in her daily life.

            Its quite common, regardless of age.

      3. “Was she hot?”

        Not if she looked like Nancy Pelosi.

    2. Entirely expected…and disheartening.

      1. the question if she is hot or the fact this never crossed her mind?

    3. Nobody cares how much something costs if they’re not directly paying for it.

      In a similar vein, I see people at work buying lunch at the cafeteria all the time with their credit cards. Every now and then, the prices for everything go up but nobody says anything about it. It’s at the point now where it’s $7.00 for a flimsy sandwich and a bag of chips. But nobody seems to care because they don’t see the numbers.

      1. because the price increase isn’t worth the hassle because they have the money or feel as if they have the money.

        1. The rest of us just stick to plundering conference rooms after the big meetings let out. Like real office workers.

          1. [Checks watch, heads to conference room.]

          2. +15 pounds of bagel-weight

      2. UberEats is making a killing on this. My brother manages a Mexican chain restaurant in Tampa. People spend $8 to get fucking chips and salsa delivered. I think its a ripoff at the $3 for a la carte they charge in store, but holy fuck.

        The restaurants love it because they basically split the markup.

      3. Raise the price to $12 or $14 and see if they notice.

      4. When I travel on business, the company pays for my meals as a travel expense.

        I’m sure they would notice if I spent a ridiculous amount, but I do use it as an opportunity to treat myself.

      5. It’s easy to use the same argument for the withholding tax. Most people don’t really appreciate how much they pay in state and federal taxes.

        It would be an interesting experiment to do away with the withholding tax and have everyone send U. Sam and their state a check say every quarter.

        It’s a free country – I can dream.

        1. If Trump wanted to dick the feds, that’s what he would do.

    4. Was she hot?

      Something something no libertarian women. But seriously, was she hot?

      1. Hey!!! There *are* a few Libertarian women around, doncha know? If you’re ever in south central KY, drop me a line (no, I probably don’t qualify as hot these days and no spring chicken, but what the hey). 🙂

    5. “… it seemed like the first time she had heard this idea.”

      Well yea. Most people believe that before Obamacare, we had an absolute Rothbardian market in healthcare that resulted in people literally being thrown out into the street to die, then Chocolate Jesus swooped in, karate kicked some obstructionist Republicans, hospital managers, and insurance company executives out of the way, and heroically mailed out insurance/welfare cards to everyone (and having the card in your wallet is the same thing as getting world-class medical care, right?)

      Republicans share the blame for this: they’ve been pulling interventionist and cronyist shit for decades while talking up a storm about how wonderful the free market is, so most people think that Republican polices are free market. They’re not.

      1. “Chocolate Jesus.”..awesome.

  2. my then-wife

    Rejected by The Jacket after she produced a successor?

    1. At least it wasn’t a Thenn-wife.

      1. NO SPOILERS!

    2. Women sense the Jacket’s power and they seek the life essence. It does not avoid women, but it does deny them its essence.

  3. It’s not the doctors who want to take cash. The game is never fixed enough and cash creates a loophole.

    See: Modi’s India.

  4. Speaking of free healthcare: Lefties angry with Trump find out Canada imposes strict immigration laws.

    As one hysterical liberal lamented on Facebook, “What are the actual implications of these Executive Douche Orders? Should I just pack my bags and move to Canada?” After researching the Canadian immigration system, the individual posted that he had determined that “ironically,” as an artist who could not afford to buy property and only rented a loft in Brooklyn, Canada had no desire in taking him in.

    1. Like rain on your wedding day ironic.

    2. So “ironic” actually means “completely predictable”? Does Alanis Morrisette know?!?

      1. Ironically, no.

    3. My brother started dating some deadbeat from Chile. We learned first hand how rough Canada plays where immigration is concerned. Turns out Canada is not all that interested in crazy parasites who want to teach Yoga or build furniture.

      American progressives are so clueless and ignorant they don’t realize A) we had a pretty prejudicial immigration system (which I reckon John Titor or Pan can expand on if correct) and it remains pretty tight and B) single payer and universal care is not quality driven or patient-centric and extremely expensive to run and operate (something lie 75% of costs go into labour).

        1. No. And she was nuts.

          She’s no longer around.

          1. You mean, no longer around . . . anywhere?

            Wow. Canada does play rough.

            1. We have beavers, moose and grizzly bears. We don’t have to play rough, nature does it for us.

              1. How crazy are the beavers?

                1. I hear Chilean beavers are the worst.

        2. Generally latin american women who snag gringo husbands are pretty hot, but keep this in mind: Traditionally when a latin american girl turns 15 they have a ‘princess party’. It is their version of our debutante ball and it makes ours look like a greeting card and a cupcake with one candle on it.

          Rufus, tell your brother to RUN.

          1. Oh, she’s gone trying her game on someone else.

            We sniffed her out pretty quickly.

          2. Traditionally when a latin american girl turns 15 they have a ‘princess party’.

            A quincea?era. They’ve gotten so crazy out here that the churches out here had to remind people that it’s not a wedding, the girls shouldn’t wear white like a wedding, and they shouldn’t spend so much money on them.

            1. How can they blow a lot of money on it? I mean, these are poor indigent human beings that…that…sorry I can’t keep a straight face saying that. These guys are making a killing on under-the-table untaxed income, mostly in construction. Is it hard work? You betcha, most of the time. Does it pay well? You better believe it, since it saves the hiring company a ton of money on benefits and withholding even if they’re paying out the same hourly rate. They can actually afford to pay the laborer more than a normal employee, although you might expect the amount they pay for certain materials to be far higher than reality to hide the cost.

              1. These guys are making a killing on under-the-table untaxed income,

                Libertarian heroes.

                1. I’m not knocking it, honestly.

                  I just don’t know how anyone who lives in a town or city with a lot of illegal immigrants doesn’t notice that there seem to be a whole lot of them driving Escalades around town when they’re not in the beaten down F-150 they drive for work.

                  Any time the government paints them as wastrels I’m just like ‘yeah, that’s because you have no idea how much money they make Uncle Sam. According to you they make zero, according to reality they make $75,000 a year.’ And good on them for that.

                  To be sure, I advocate for everyone to be able to make that kind of money with the same amount of regulation. The only difference is I’d like it to all be above board and legal.

              2. And you can bet that of all the under-the-table workers in this country (immigrant or not) there are some unscrupulous members in their ranks who collect every welfare benefit they can because they earn jack shit on paper.

              3. One way they can blow a lot of money on it is that they’ll share a house with their entire extended family (see a house in your ‘hood with six or eight cars parked in front, at least one of them a low-ride small Toyota truck, well there you are), and each “head of household” in that extended family will get on welfare, using fraudulent/stolen SSNs. They qualify for aid because they either don’t have any over-the-table income or employers, or their over-the-table income is minimum wage.

                If the entire house is collectively getting $1500 a month in welfare checks, and you’ve already got income from construction gigs and the neighborhood Mickey D’s, that’s a nice quincea?era.

      1. This explains the shortage of Yoga furniture in Canada.

      2. Indeed, unless you can try to diddle something with “family reunification” category, Canadian system is downright racist by US standards – you get graded on things like age, skill, speaking languages etc.
        “Buy your way in” program has been shut down, too. Except in Quebec. So, if you get some cash*, you can move to Quebec, then go to some sensible part of Canada. But that’s racist to poor people.
        Finally, you can try to do something with marrying in, but Canada is pretty ruthless here as well. You bring in a foreign spouse, you are on the hook if they use welfare – even if they divorce you first.

        *no, you can’t just borrow, show it and then return it – govt. puts it into investment fund and pays out five years later.

        1. I notice this trend in my business. People pay Quebec’s fee and do exactly what you say. Turns out immigrants don’t like being told where to send their kids to school and in what language as well as the idea of paying taxes to two levels of government (Federal and Provincial). They ‘hang out’ in Quebec until they figure out how things work in Canada and quickly split for Ontario – and where possible the USA.

          Quebec is not worth the hassle in their eyes.

          Who knew?

          1. Well, works out for Quebec government. They get to play with people’s money for five years, and people self-select for those who want to stay in Quebec as it is. Since most likely they will speak French, fine by both PQ and Liberals.

        2. Wait a second. What about coming in through Nunavut?

          1. People have tried. There were no survivors.

            1. Why not? It’s a tropical paradise, according to the government literature.

              1. -1 HMS Terror

        3. Portugal is doing that now. If you can get up the down payment for a $500k real estate investment and hold it for 5 years, you can be a citizen. I think Costa Rica’s was $100k in a 10 year bond to become a citizen, but they also had way too many American “citizens” and changed the plan.

        4. Indeed, unless you can try to diddle something with “family reunification” category, Canadian system is downright racist by US standards – you get graded on things like age, skill, speaking languages etc.

          And, IMO, the funniest part is, it’s not like here or in Europe where there’s rampant crossover and a melting pot or cultural issues.

          The population is like 93% varying definitions of ‘white’, 5% Asian, and

          1. derp less than 2% ‘other ethnicities’.

            It’s like they could give the Nazis and the Klan lessons on ethnic purity.

          2. I think you are a little behind on Canadian demographics. According to Wikipedia:

            76.7% European
            14.2% Asian
            4.3% Aboriginal
            2.9% Black
            1.2% Latin American

            Only slightly whiter than the US.

            1. But don’t you know that Asians don’t count? After all, they tend to do even better than whites. Yellow = White. The only people of color are brown or (sometimes) red. At least by US reckoning.

    4. an artist who could not afford to buy property and only rented a loft in Brooklyn

      Beyond parody.

      1. I’m surprised proggies have begun to demand we owe them property.

          1. /flashes poster of Dale Gribble.

    5. Compare our immigration clusterfuck with almost anyone else’s, especially Mexico’s, and suddenly we don’t look so bad.

      1. That is true to a certain extent. This has always been a country of immigrants. It is what made this country great.

    6. Executive Douche Orders?

      I’ve noticed a remarkable increase in people who detest executive orders and hate paying taxes.

    7. That sentence is telling me that Canada is an artist who could not afford to buy property and only rented a loft in Brooklyn. And I thought it was a sovereign state! And I wonder what else you would do with a loft in Brooklyn.

  5. …then tacked on a 10% to 15% profit margin.

    Boo. Boo. Booooooooooooooooo.

  6. I don’t know….seems racist.

  7. “a statin or antidepressant,”

    /stops drinking 175ml of bitter.

    Wait. Was this before or after you purchased The Jacket?

    1. Silly Canuck. The Jacket can neither be bought nor sold. It exists. When and where it pleases.

  8. “What happens when doctors only take cash? The lucrative field of medicine gets demystified, prices go down, services go up, and everybody except insurance companies come out ahead.”

    Yeh, well good luck explaining this basic axiom of economics to progressives.

    1. I’ve been assured that healthcare is some kind of outlaw economic good that breaks all the laws of economics.

  9. Add in a medical savings account ?

  10. enough with the mystifying of medical care as something more than other types of services!

    That’s the money shot, right there. Progs, including some friends of mine (with whom I can discuss these things civilly and they respect other opinions), will never let go of medical care being an absolute right. $19,000 for knee replacement? A McDonald’s worker can’t afford that, therefore, this is a non-starter.

    1. I remember one of our resident trolls arguing you can’t have people make choices about medical treatment because it’s a highly skilled field and the average person doesn’t have the knowledge base to make informed decisions. This argument, of course, could be used to prevent most people buying or selling cars.

      1. This is the heart of a prog’s mindset. How very gallant of them, eh?

        Why, if only I could see their humanism behind that thick wall of retarded smugness.

        1. In some ways he was right: I don’t know medicine. But, if doctors had to compete more then I could decide if I wanted to go to a doctor who explained everything to me OR I was happy with a “here’s a prescription.”

          1. Honestly it’s not that hard to explain most medical concepts. If you find a healthcare person who tries to get super technical and can’t explain something plainly, odds are they don’t understand what they’re discussing either. There’s a lot of bullshit in the medical profession (like in most other professions).

          2. I recently switched doctors because I switched jobs, and the new insurance didn’t cover my old doctor. Come to find out the new doc has a policy (which is actually pretty common now, thanks to insurance meddling) that you can’t discuss more than one issue at a time during your appointment. You have an annual physical, but if you want to bring up any issues, you make a separate appointment for each issue. Got knee pain? Doc won’t discuss it with you during your physical; you make a separate appointment. For everything. Maximum pain in the ass, and you get to make a new appointment to talk about that, too.

            I’m betting when you go to a cash-on-the-barrel doctor, you don’t have to deal with that bullshit.

      2. you can’t have people make choices about medical treatment because it’s a highly skilled field and the average person doesn’t have the knowledge base to make informed decisions.

        Unless, of course, you are a thirteen year old child who wants an abortion.

      3. Which, as I see it, is a big part of the problem. A lot of doctors are arrogant fucks who think they should just be obeyed and can’t be bothered to explain to their patients what they are doing. 90% of the time (a number I just made up) when someone goes to the doctor, the doctor either does nothing at all, or prescribes something that any pharmacist, or reasonably smart person with an internet connection could have figured out is the appropriate treatment.

        1. We had a great experience with our first kid being born. Wife was in trouble, docs (plural) were attentive, informative, always explaining exactly what they were doing to me and wife and they answered all, and I mean ALL, of my questions (I I didn’t stop asking them until I fell asleep). And their answers jived with wikipedia and webMD as I checked on my phone when they were answering…yeah I am THAT guy.

    2. Ask them who they’re willing to enslave to provide that “right”. Point out that it is impossible for any right ti require behavior of any other(s) except insofar as there is a right to enslave the other(s).
      They will vehemently disagree.
      Ask them to explain, in detail, how medical care can or would be provided with enslaving medical care providers.
      Or someone else, the fruits of whose labor will be taken to fund that care.

      It all comes down to “do you approve of slavery or not?” “No, but…” is not an answer.

  11. “…Everybody, Especially Patients, Wins”

    Well, proggies lose.

  12. Had to scream at the tv yesterday – protestors in Philly included a big contingent from one of the local teaching hospitals. “Everyone is entitled to health care” said one woman in a lab coat. Yeah, how about if Trump institutes wage controls on medical personnel or we draft health workers and make them do pro bono work for 25 hours every week? Then we see that everyone else is expected to pay for the healthcare, not the caring professionals who treat the patients.

    1. Everyone IS entitled to health care. As much of it as they’re willing to pay for.

      1. They don’t even think about it in those terms. They don’t think that a doctor could be forced to work for free, or that someone’s money will be taken against their will to pay that doctor. Because for progs, taxes are axiomatic. You can’t disprove axioms.

      2. Everyone IS entitled to health care. As much of it as they’re willing to pay for they can afford or self-administer.

        Fixed it because, for all I care, Hitler, Bush, and Trump can go resuscitate themselves.

      3. Having money doesn’t entitle you to other people’s labor or stuff.

    2. Everyone is entitled to health care…

      Except what you feel ‘entitled’ to hinges on someone’s labor.

    3. Most of the people I went to medical school with had never held down a real job in their lives. If anything, they had worked a year or two for some nonprofit trying to build up their application. I had a previous life before going into medicine, so I just generally shook my head when they started going on about social justice and whatnot. There was, however, a delightful moment when the president of our medical college asked our assembled class how many of them thought that the rich should pay for healthcare. Almost every hand (mine excepted) went up. He then told the dumbfounded crowd that “the rich” was going to be them.

      1. ^Love it^

        Reminds me of the electromagnetics prof who, when asked about his curve, replied that there wasn’t one. He said “Five years from now you people are going to be designing the elevators I’m riding in. These are my standards.”

    4. Sure. We’ll pay the government docs just like we pay public defenders.

  13. “Everyone is entitled to health care” said one woman in a lab coat.

    So, you don’t mind if we don’t charge for it, and don’t have money to pay your salary?

    1. Boom. Ask someone in healthcare if they’d work for free…

  14. One thing to think about when equating medical care with other commodities:

    “Can I stay alive or do I die from appendicitis?” is a qualitatively different from “Can I have a Porsche or do I buy a used Ford?”.

    1. qualitatively different question

    2. What about “Can I live without a Porsche?”

      1. Yes we can!

    3. But not qualitatively different from “Do I have the right to forcibly steal someone else’s money to pay for it?”

      1. I said nothing about the answers, I just point that there are important differences between health care and automobiles. The fact that libertarianism responds to that issue by saying “No free shit” and letting it go at that is one of the reasons that Libertarian politics will be perpetually stuck in the land of “Not fair that Gary Johnson can’t get in the Teevee debates”.

        1. Yeah people love to think they are “entitled” to something at someone’s else’s expense.

          No surprise there.

    4. Regarding your example, most people don’t understand that US healthcare is the Porsche, and European healthcare is the Ford.

      It’s oh-so irritating seeing these people yammer on about “free” healthcare in Europe, not realizing that the cost is actually a large percentage of everything you earn for life, and on top of that the medical technology it pays for is 20 years behind the US.

      Healthcare is cheaper and better in the US, the bill just isn’t disguised from you.

    5. Can I stay alive or die from cold weather? Can I stay alive or should I starve to death? Same question. Same answer.

  15. Medicine is too important to worry about things like cost and quality.

    1. As Dave Barry used to say, “I am not making this up.” True story follows!

      My family doctor of a few years ago used to take Medicare ? Medicaid or both (I cannot recall). He moved a short ways down the road for cheaper rent and/or better digs. He had to totally re-apply. He either forgot the staple on a multi-page application, or added a forbidden staple. (I can’t recall which was the case). For this YUUUUGE issue, he was required to re-apply! That’s when he stopped participating!

      How any supposedly rational person (beside Government Almighty parasites) would favor more Government Almighty involvement in health care, baffles me to no end!

      1. See ? = How Are the Amish Lowering Health-Care Costs? ? and ?. ? Amish get MUCH lower prices on medical care by agreeing NOT to sue (forgo the option to sue for medical malpractice). I have read that this is an “on your word” thing, though, and that such agreements generally can’t be enforced. All it takes is for one Amish person to sue, and the whole thing falls through?
        WHY in Blue Blazes can we NOT get iron-clad, lawyer-proof agreements to NOT sue, and get price breaks in return?
        Probable answer: Too many lawmakers are lawyers, and parasitical lawyers will NOT allow us to “opt out” and be free of parasitical lawyers!!! They are like the Mafia? They are part of our “deals” whether we like it, or not!!!!! Grrrr!!!!

      2. Most independently owned practices, as well as most hospital systems, are going to have a maximum number of patients they will see who use Medicaid/Medicare. Why? Because they are a loss. Those costs get passed along to you, the person who has insurance.

        If you want to really shake your head, realize that all E.R. are a loss for the hospital, and a huge one at that. Who do you think those mandated costs get passed along to? Again, you, the individual with an insurance plan.

        It’s pretty irritating to me that the government has done nothing, nothing, to reduce costs. They have only massively inflated costs, along with a helping hand from Doctor Associations. Yet they blame insurance? Yeah, sure, whatever.

        1. Interesting comments, BYODB…

          BYODB… “Bring Your Own Dead Baby”? “Beyond Your Odiferous Dim-witted Bulb”? “Building Young Oysters Daily, Benevolently”? … Inquiring minds want to know!!!

          1. I thought it would be obvious: Bring Your Own Damn Beer. That’s the nice thing about an acronym though, it leaves some creative room for interpretation. Let your inner artist flow.

      3. Good God, man! Never staple anything sent to Medicare! And while we’re at it, never use any other color of ink but black, unless it’s on the special form that requires blue ink. People’s lives are at stake here!

  16. Anecdote: in 2014 my older son had appendicitis. Thanks to a clueless hospital employee who coded this as elective surgery, the insurance company initially turned us down, so I got to see an itemized list of most of the charges, including $18,000 for the surgical suite and $6,000 for the anesthesiologist. (The surgery took 20 minutes.). The total was $48,000.

    Remember a few things: 1. Appendicitis is quite often fatal if the sufferer doesn’t get surgery within a short time, and is really terribly painful. 2. There is a short window of time for treatment, and the symptoms don’t have a long lead time. That is, it shows up and escalates to “needs the ER” within a couple of hours. 3. There is only one effective treatment at this time and that is surgery.

    Questions: How is someone supposed to compare prices on something like this in a way that makes the standard economic theory work? I wasn’t going to call around town for the best price with my son doubled over in agony. What happens to people who can’t come up with the kind of money for surgery?

    Please, I’m serious about this. If you really want this as public policy you should be able to answer the questions. If you have good answers I really want to hear them. Our system for providing health care has some terrible problems and any solution should be on the table, including this one.

    1. It’s called catastrophic insurance, and it’s what insurance is really supposed to be – a hedge against unlikely scenarios.

      1. Essentially, health insurance should be more like car insurance. Your car insurance company will get your back if you’re in an accident, but they won’t pay for routine things like oil changes.

      2. Would catastrophic insurance allow any more time for comparison shopping than Karen24’s policy allowed? No.

        1. You miss the point. The point is that some kind of insurance is probably still necessary to cover emergency situations, which are, fortunately, relatively rare.

        2. there wouldn’t be such a need to shop around because due to the competitive nature of a free healthcare market, prices at all the hospitals wold already be lower.

          1. And she’d likely go to the closest hospital anyway – assuming it’s a good one – for obvious reasons. Moreover, what would *probably* happen is, like any business, you’d know before hand which hospitals charged the most and least. Think along the lines of Price Club, Wal-Mart, Target etc.

      3. One and done Citizen X.

        Insurance has become cancerous, as there is one central truth that can not be made false; you can not insure against a sure thing. This modern idea that insurance should be the middle man in every transaction is madness.

        At the point where you’re insuring things like Birth Control it’s no longer insurance, it’s simply an installment plan designed to spread the costs of everyday items that the individual should be responsible for between everyone. I’m sure socialists like that idea, but such a system will invariably fly apart and hurt everyone involved in it.

    2. Not true. Many cases of appendicitis can be treated with antibiotics and do not need surgery. In fact there has been an increasing movement for nonsurgical treatment in recent years. Most cases in any event do not need to go to the OR immediately.

      I’m not arguing with your central proposition, that it’s difficult to discuss and compare prices under duress caused by pain, time constraints, and other factors, but your characterization of appendicitis isn’t factual.

      1. The question is, could Karen24’s son’s appendicitis have been treated in time as suggested? The people on the spot at the time made the decision it couldn’t. Absent their information, Contrarian P is full of shit.

        1. The statements I disputed were clearly about appendicitis in general, not the her specific case. Do try to keep up.

    3. There was this thing we used to call “Major Medical”. It was insurance. It covered this.

    4. All reasonable answers, thanks.

      (And if I ever get appendicitis I’m going to ask about non-invasive treatments because I have something like a clinical phobia of being put completely out.)

      1. For a long time the non-surgical approach was out of vogue, but it has made quite the comeback recently for quite a few reasons. Not all cases of appendicitis can be treated non-operatively, but quite a few can. About 10% of them eventually go on to have an appendectomy, sometimes years later, but 9/10 do not. I’ll take those odds if it means avoiding an operation, particularly since having an abdominal surgery has a significant chance of having complications such as bowel obstruction later in life.

        1. Keep in mind that non-op management is a good option for some groups of patients and less so for others. It’s always tough to talk about topics like this on a message board because there are many variables that a surgeon will (and should) consider when deciding whether or not to operate, including the patient’s overall health and operative history, the complication of the presentation of the surgical problem, how unstable the patient is, the experience and capabilities of the surgeon and hospital, and so forth.

  17. OT: So I have I decided to take a break from sharing cat videos on Derpbook and wade into some political discussions. One of my friend is a BernieBro, volunteered for campaign if I remember correctly, he has been posting a constant stream “literally Hitler” histrionics about everything Trump does. This story’s author was aghast that members of the Trump administration were keeping their RNC email and tried to posit that this was somehow analogous to Clinton’s email server. I pointed out that as long as they don’t use them for official White House business and disclose them, there was no legal issue.I added that many of Trump’s policies are actually bad, illiberal ideas (e.g. trade war with China), why don’t we go after those instead of this specious nonsense? I also threw in a bit snark along the lines of, “Hey its not like he has a secret kill list or is starting wars without congress.” It was at this point that one of my fairly close High School friends, who, by the way, managed to get Master’s in Economics at The University of Chicago and somehow came out a Keynesian, jumped in and started spewing the “he’s crazy and he could nuke people, he’s a Russian plant” argle-bargle. It was pretty bizarre to see someone that I thought was pretty thoughtful descend to Alex Jones levels of paranoia. But the point is I am seeing a lot of this, otherwise well-read, generally intelligent people reaching grandma’s forwarded email, “Obummer is a secret muslim!!1!!!!111” levels of delusion.

    1. Happened to me man.

      Happened to me.

      Why, it’s almost like someone is at a main switch board and making people go straight to crazy.

      1. I mean I kind of expected it from the BernieBro, but he was silent. Wierd, maybe Professor X is just fucking with us. It seems like some folks got complete personality changes.

    2. But the point is I am seeing a lot of this, otherwise well-read, generally intelligent people reaching grandma’s forwarded email, “Obummer is a secret muslim!!1!!!!111” levels of delusion.

      My wife noticed the same thing about the vagina march. Seemingly normal people going off the deep end because …. well …. they really couldn’t explain why in rational terms. She found it really disappointing to watch these people quickly piss away the respect that they had built up in her mind.

      1. A friend of mine posted that B.S. about Viagra and Rogaine being tax free while tampons are not, and linked this to Trump (Because of that Judd, or whomever, speech that’s been making the rounds). When I pointed out that Rogaine is in fact taxed in Texas, but not in all states, therefore it is clearly an issue at the state level rather than federal (not to mention that it’s been this way for the last 8 f’ing years) they lost their damn minds.

        I think I’ve come to the conclusion that no one thinks anymore, and it doesn’t matter how ‘smart’ or ‘educated’ they are. Critical thought and reflection are things that people simply don’t have time for between episodes of this or that or the latest reality show and the outrage people project has nothing to do with policy, but is entirely a social signal that you either agree with this propaganda, or you agree with that propaganda. No one is interested in actual truth anymore.

        In other words, this is essentially the last gasp of society before some event pushes it over the cliff and into massive and painful structural change. I could be wrong, but with the way things are going I see no other likely outcome. History tells me that the natural progression will be authoritarianism, and boy howdy does that seem to fit our current trajectory.

    3. Since the election I’ve found myself awake at 2 a.m completely convinced Trump was going to cancel the 2018 and 2020 elections or start a nuclear war for grins. I realize that thinking those things is not rational, but knowing that doesn’t help me sleep at night. Part of it is simply knowing a bunch of people who went from normal to Alex Jones fans for the last eight years, and having the equal but opposite reaction to that. To the extent that there’s any basis in reality, it’s that the only things we sorta know about Trump are that he likes to Tweet in the wee small hours and that he holds grudges and acts on those grudges. Lots of pols have nursed resentment and acted on it — see Nixon and Johnson — so that really shouldn’t keep me awake. I finally decided that it was Trump’s Twitter habit that scared me. Foreign policy involves lots of complex unwritten rules, none of which can be explained or followed in 140 characters. His habit of expressing every single thought in Tweets and then never following through creates the impression of chaos, and chaos is terrifying in a head of state. So, sympathies to your friends. I feel their pain and hope all of us can work through this.

      1. Since the election I’ve found myself awake at 2 a.m completely convinced Trump was going to cancel the 2018 and 2020 elections or start a nuclear war for grins.

        If it makes you feel any better, I’ve been doing that since about 2005 when I stopped drinking the GOP koolaid. Or started drinking the libertarian koolaid, depending on your point of view. It kind of helps that I’ve been wrong for over a decade and I actually feel much more comfortable about the State/Defense/President team today than the era of Hagel/Kerry/Obama.

        1. It is surprisingly conforming to talk to people who suffered for the last eight years.

    4. All the inmates at the prison LOVE Hillary and HATE Trump. There was a noticeable uptick in the frequency and severity of mental health “crisis” reports the day after the election. They get into stupid political discussions out there in the waiting room. A few gems of military-grade derp:

      “Trump’s wife is a spy.. She’s Russian!”

      “I don’t understand why Trump is allowed to be president with no political experience at all.”

      “I heard Trump is going to privatize all the prisons in America!”

      “I’m scared of Trump cutting welfare benefits… What are we supposed to do??”

      “I hope Donald Trump sends this dumb motherfucker back to where he came from!” (in reference to our Pakistani doctor who was making her wait a long time. She got handcuffed and taken to segregation for that; I couldn’t help but find it funny)

  18. RE: “What Happens When Doctors Only Take Cash”? Everybody, Especially Patients, Wins
    The Oklahoma City Surgery Center is a model for how medical care can be better, faster, cheaper.

    This must be stopped immediately,.
    The best way to control the unwashed masses is through healthcare.
    Allowing the little people of this country to pay for cash for goods and services only weakens The State, its ruling elitist vermin and their quest for a socialist slave state.
    If this trend continues, then other industries will want cash also, like grocery stores, retail outlets, and fast food restaurants.
    How will our obvious betters keep track of us and what we’re doing if we use cash instead of insurance forms, credit cards or debit cards?
    Have these medical professionals ever thought of that?

  19. If our medical office didn’t have to employ a small army that must spend every working second trying to keep up with Medicare’s hundreds of thousands of pages of regulations, fill out paperwork and chase down prior authorizations, appease claim reps, wait on hold for insurance companies for hours while being told how important our call is, hound insurance companies until they actually pay their contractually obligated amounts, and document compliance with the ACA, OSHA, HIPAA, OIG, and a thousand other acronyms, we could easily drop our prices by half.

  20. What if a person can’t afford the cost? The real solution is not a program that punishes the middle-class and the poor, but rather a federally funded, comprehensive Medicare for every man, woman, and child in America.

    Then, you don’t have to shop around and wonder whether that doctor whose price is the lowest is also best for your medical condition.

    And since federal taxes (i.e. FICA) don’t pay for Medicare or for any other federal spending, the cost would be $0.

    1. This is a nice dream, but one major component that it would need to succeed would be for Medicare to stop behaving like Medicare (i.e. the bureaucratic hydra that exists solely to pile regulation upon regulation upon regulation upon medical providers so that they now spend far more time doing compliance-required paperwork & EMR box-clicking than treating patients, not to mention all the staff they must employ just to keep up with said regulations), & that will NEVER happen.

    2. RodgerMitchell|1.27.17 @ 5:11PM|#
      “…a federally funded, comprehensive Medicare for every man, woman, and child in America.”

      Do you deal with, oh, the DMV? Is that what you want for medical care?

    3. “punishes ”

      Uh, making quality care available at lower prices is punishing people?

      Making Medicare available to everyone will work about as well as making VA care available to everyone.

      1. I clicked his link. Mr. Mitchell apparently believes that the government can pull infinite money out of our collective ass forever, with no negative consequences. With infinite money, we can buy infinite health care.

  21. Seems like “Reason” would point out that healthcare in nations with universal health care enables citizens to live longer healthier lives, and takes a huge burden off of business.

    1. There are many, many more factors to a nation’s life expectancy than just the type of healthcare system. How do you know the healthcare system is wholly responsible for this? The higher life expectancy predates the socialized healthcare systems in many of these countries. Also, for every country with a high life expectancy and “universal” healthcare, there is another country like Cuba with “universal” healthcare and terrible results.

      “Takes a huge burden off business?” The taxes required to fund these systems do not exactly constitute the lifting of a burden. If you want to take a burden off business, why not change the law so that employers are no longer required to provide health insurance? Coupling health insurance with employment has brought all kinds of problems with it, mainly cost distortion and a disincentive to leaving a crappy job for fear of losing health insurance.

    2. billdouglas|1.27.17 @ 5:23PM|#
      “…and takes a huge burden off of business.”

      That’s GREAT! I’ll bet you got a million of ’em.

    3. Could have as much or more to do with the fact that we, as a nation, live considerably less than healthy lives as plus the fact that we pay for a lot of palliative and rapid care that govt run medicine countries don’t.

      Here if you wake up with a sore throat, you call the doctor, get in that day, get a scrip and head home. There you don’t even bother calling because you know that by the time you can get in you’ll be better anyway.

      Here, a 90 year old can get bypass surgery. Not in govt run countries. I’ve even had that justified to me as, well that’s democratic. If you’re no longer capable of contributing then you shouldn’t expect the care.

  22. Another interesting approach to medical payment is Direct Primary Care (DPC). Googling for this phrase will show several URLS.

    One quick testimonial is at http://www.physicianspractice……-years-out

    In short,
    – A patient or family arranges to pay a minimal monthly fee to a DPC physician. This is usually $50-75/month and some offer discounts for whole family inclusion.
    – This patient has access to the physician at all time, usually including email and text.
    – The doctor comes out ahead because there is no more insurance form processing, contesting payment, etc. and the patient comes out ahead because the monthly fees are way below typical insurance rates and the doctor has more time to spend with his/her patients. DPC phsicians usually do not charge a co-pay. They also pass through the cost for lab work meaning that patient pays at lab cost which is usually pennies on the dollar lowering costs significantly.
    – The client patient should have a very high deductible catastropic insurance, but it is not used at all for day-to-day medical, only the most serious emergencies.
    – It’s easy to link up an MSA to a DPC plan.

    On the surface this sounds good. Time will tell.

  23. I work in a large emergency department in the south. I agree that price transparency is great. But realistically, how are community hospitals, which are mandated by the federal government to treat all comers regardless of their insurance or ability to pay, going to survive?
    Surgery centers like this are great, but all their clients pay and they do not deal with emergencies. In our department about 35 percent of our patients have no insurance, and most of rest have either Medicare or Medicaid.
    People talk about comparing prices and such, and having catastrophic insurance, but in reality when a car turns over, someone gets shot, or some meth head goes in to labor with no prenatal care, these people get plopped in to our lap.
    Yet, those doctors who stopped taking call, are simply doing elective procedures down at a private surgery center. And don’t tell me about doctors doing charity care either. It is a lot of crap. Many of our specialists don’t take call and we find ourselves sending people across the state after begging some specialist elsewhere to take care of our emergencies because the oral surgeons, eye doctors, ENT doctors (and our city has plenty of each) won’t take call anymore, because they only operate in their private survey center.
    So how do we stay solvent , when all the paying ones go to their little surgery centers?
    And if hospitals stop taking Medicare and Medicaid with its mandate to treat all patients, where do these patients then go?

    1. This country used to be covered with charity hospitals and clinics. The government intrusions into health care wiped them out.

  24. the deductibles on OhBummerTax were so high the figure was many times what I have EVER spent in a year, most often higher than I’ve ever spent in a DECADE. So WHY do they think I’d bu their stupid insurance? Get real, guys….

    THIS system is what it should have been all along. All the middlers, flappers, Idoannoers, simpl add cost.. like any gummit boondoggle, dozens of useless confusers making things more complicated, arcane, dwelling in the shadows…. so NOBODY really knows anything except what’s on that piece of paper in front of them. And barely that.

    Take your car to a shop that refuses to tell you what its gonna cost, no idea the contingencies and what THEY might cost, what do we do? We go find another mechanic. Or fix it ourselves.

  25. What everyone here meant to say was:


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  29. I would encourage Reason to do an article on the good and bad of Direct Primary Care (DPC). It seems to me this method of payment has a lot of promise.

    How about an investigative story?

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