There are two ways to get medical care: (1) pay for it yourself, or (2) get someone else to buy it for you.
There is prepayment through insurance or post-payment through cash or credit. There is direct payment or “assigned payment” through an insurer. One can request charity, or use force, the latter most often through government, the largest third party.
Though it may be dismissed as irrelevant, the method of payment is critical. It affects almost everything else in some way: the patient-physician relationship, the type and quality of service, the availability and promptness of service, the conditions for delivery of service, the documentation, the morale of medical professionals and the cost.
Almost all the complexities that have ensnarled medical offices during the past 50 years and distracted physicians from attending patients and expanding their medical knowledge are the consequence of third-party payment. Physicians are forced to “game the system” and bill higher amounts if they have any hope of getting reimbursed just a few dollars.
Without the third party there is no need for coding, claims forms, authorizations, eligibility checks, documentation of medical necessity, post-payment audits, payment delays for “re-pricing,” compliance plans, or expensive consultants.
Some patients believe that they can only buy medical care with an insurance card, not cash. That’s because we’ve been told we have to have a health care “plan.” But third-party payment is a recent phenomenon, rare and unimportant when many doctors started practice in the ’60s. Maybe it’s time we started to take a look at the “good old days.”
In response to escalating regulatory costs and threats of prosecution for “non-compliance,” thousands of doctors across the country have chosen to go back to “patient-doctor direct” cash-based practices. In doing so, they have reduced administrative and compliance costs, and passed those savings along to patients.
Dr. Todd Coulter of Mississippi has shown critics to be wrong when they proclaim cash-based practices can’t survive and serve indigent or low-income communities. His walk-in clinic has provided him with a livable income and caters to his uninsured patients. “I’m practicing medicine again,” he says.
Taking a quote from an Illinois surgeon who participated in the National Survey on Physicians Attitudes Towards Medicine, “Less government will mean better and less expensive medical care. Government is the problem. Are there any long term government-run programs that aren’t riddled with inefficiency and corruption?”
Upon reading the above perhaps a “Marcus Welby”-type of doctor is just right for you.
Three of my favorite subjects are football, baseball and lots of good food. Therefore you can imagine that these past few weeks have been a lot of fun for me.
Mega-Kudos to the NHHS football team for their splendid efforts and wins over CDM and number 8 ranked San Clemente. The CDM game with NHHS winning in the last 24 seconds is certainly one of the best games ever played at any level. My choices for players of the weeks are the entire NHHS football team and coaches.
If you love baseball be sure to see the movie “Trouble with the Curve,” out this week. This heart-felt movie is as much about life as about baseball. Baseball fans will love the references to baseball minutiae and memorabilia. Amy Adams, Clint Eastwood and Justin Timberlake give endearing performances. This movie is a home run for the soul.
As you know by now Whole Foods opened at Fashion Island on Sept. 19. This cornucopia of food and drink is worth touring even if you can’t afford the prices. Thanks to Whole Foods for this fine addition to our community.
Michael Arnold Glueck, Newport Beach, is an ornery curmudgeon who writes locally, nationally and internationally on medical-legal and related issues. He writes “Deep Thoughts From Dr. Mike” for NewportIndy.com.