Creative “Why Not” Approaches to Treating and Paying for the Insured

Creative “Why Not” Approaches to Treating and Paying for the Insured

You see things, and you say,”Why” But I dream things that never were, and I say “Why not?”

George Bernard Shaw (1856-1950), Back to Methuselah (1921)

November 13, 2011- “Everyone knows” that the number of uninsured recently passed 50 million.

“Everyone knows” that paying for these uninsured through government subsidies of up to $88,000 for a family of four will break the federal bank and the banks of the states.

“Everybody knows”the United States and Western Europe can no longer afford generous social welfare programs with an aging population, huge federal debts, and high unemployment.

“Everyone knows,” including the “99 percent” participating in the Occupy Wall Street movement, that these things are a social abomination – a travesty of social justice.

“Everybody knows” that less than 10%, some say 2% of medical students, are entering primary care and that primary care physicians will not accept 50% of Medicaid patients.

“Everybody knows” that administration and billing accounts for $360 billion of the $2.6 trillion spent on health care ( Ezekial J. Emanuel, “Billions Wasted on Billing,” New York Times, November 14, 2011).

“Everybody knows” that about 50% of overhead in a doctor’s office goes for justifying claims.

Why Not Adaptations to These Realities?

So why not do something – in many cases something that has already been done and works – about it?

• Why not post “cash only” charges in the front office for the price of care? Robert Berry, MD, A family physician in Greenville, Tennessee, a rual area with many uninsured patients, has a “cash only” practice and lists his prices in his front office. The uninsured, who can’t afford to pay health premiums, flock to his office for care they can now afford, and for which they no longer have to pay monthly premiums.

• Why not do what the Simplecare network in Reston, Washington has done? It is a “direct cash” practice that charges for short , medium, and long )visits without the hassle of third party visits. Simplecare has crated a simple billing system – 3 codes rather than the 7500 codes found in the CPT code book. Simplecare has national network of some 1500 practices. Many, sometimes most, of Simplecare’s patients are uninsured.


• Why not encourage employers to offer health savings for flexible saving accounts with high deductibles, as 30% of employers are now doing. Employees like these plans, partly because premiums are roughly one-half those of traditional PPOs and PPOs, partly because one-third of those joining were previously uninsured, and partly because they can set aside unspent and untaxed money in retirement accounts. Employers like it because they save up to 40% for health benefits for employees

• Why not allow doctors to deduct the cost of charitable care for the uninsured? Let doctors write off charitable care. This would be elegant solution to the uninsured problem problem: Allow doctors to write off charitable work as a tax deduction. On the downside, this solution would cost the government a slight reduction in tax revenues. On the upside, it would significantly reduce the tax burden for primary care physicians and encourage them to treat the uninsured.


• Why not let doctors charge for phone calls, as attorneys do? Some doctors spend as much as 1/3 of their time on the phone, so they delegate the task of talking to patients to nurses or receptionists. Charging for phone calls would spare patients the expense of office visits. Charging for call is done in some European countries, like Denmark, and is accepted by patients and doctors alike. Charging for phone calls had become a lively subject at medical conferences across the country. After all, Donald Berwick, administrator for CMS, has declared “The health care encournter as a face-to-face visit is dinosaur.”

• Why not more walk-in clinics, retail clinics, ambulatory clinics, home care visits ? Why not more membership care models, where patients pay a fixed amount for care, whether they are seen or not? Why not indeed? There is more than one way to make care affordable for the uninsured without resorting to massive federal subsidies or resorting to the last resort – emergency room care?

• An why not, critics of the present system will counter, let government preside over the system- paying for everyone, setting the rules, and offering the same level of care for all? Two reasons why not: one big government cannot possibly and fairly manage a complex adaptive system; two, America is a nation with a culture that cherishes freedom and individualism.

Tweet: Creative approaches to making care affordable and convenient for the uninsured are evolving without requiring massive federal intervention.