Sunday, April 13, 2014

Is Direct Care for Cash Your Choice of Care?

This land is your land. This land is my land

From California to the New York island; 

From the red wood forest to the Gulf Stream waters 

This land was made for you and Me

Woods and Lyrics by Woody Guthrie

The emerging debate over whether government-guaranteed care versus direct independent care reminds me of the lyrics of “This Land is Your Land.”  I suppose it’s because direct independent practice is sprouting in every corner of this land as an alternative to the Affordable Care Act. 

People have been sending me newspaper articles from across the land about this new kind of personal practice, which goes by various names, but shares one feature – cash for care.   This used to be called “fee-for-service,” of FFS, if you prefer capitalistic acronyms.  But FFS is now a No-No for those on the left, who believe it to be an incentive for greed.

Just  yesterday,  a believer in DIP (Direct Independent Practice) sent me two articles – one for the New York Times citing the experiences of Texas primary care doctors in charging cash for care, and the other from Maine, telling how an uninsured woman in that state relished insurance-free, cash-provided care.

From these and other sources,  I am gaining  the impression interest is surging nationwide on how to circumvent care paid for  by government and other 3rd parties and to get care directly from the doctor. What startles me about this movement is that many seeking this kind of care are the uninsured, who, you would think, would seek help from government, and the insured, who you might think, would lean on insurance companies as the source of funds for their care.    

Ironically, however,  the cost of getting care, according to these stories, as told by doctors and patients, is less when obtained directly by cash rather than indirectly from 3rd party payers.  Maybe, after all is said and done,  as noted by economist Milton Friedman is his classic 1975 book,  There Is No Such Thing As a Free Lunch.  

If you want to read the two pieces on what’s going on in Texas and Maine,  go to the Internet and type in “New York Times,  ‘Doctors Shun Insurance, Offering Care for Cash,’ April 10”) and “Bon Maine Health, “Maine Doctors Ditch Insurance, Offer Monthly Subscriptions for Primary Care, “ April 13).

I will leave it up to you to judge the merits of the argument for DIP being presented.    The doctors being written about are saying  transparent  subscription fees for a bundle of primary care services – annual physicals, office visits for chronic conditions, illnesses, and injuries; diagnostic testings, ECGs,  pregnancy tests, draining of abscesses, joint injections, vaccines, routine x-rays, discounted generic drugs,  lab tests, and referrals to specialists for cash discounts – are cheaper, more convenient, and more quickly accessible than insurance-covered care.   You be the judge.

If you are still doubtful, I invite you to read any or all of the 6 interviews on my blog I have conducted with  doctors offering care for cash.     To do so, go to the Internet and type in the names of those who were  interviewed in the Medinnovation search box.   Their names and their practice locations are:   Jane Orient, MD (Tucson, Arizona), Keith Smith, MD (Oklahoma City, Oklahoma) , James English. MD (Minneapolis, Minnesota),  Josh Umbehr, MD (Wichita, Kansas),  Lee Gross, MD (Northport, Florida), and Donald Gehrig, MD (St. Paul, Minnesota).

Tweet:   Doctors in Independent Pay Practices claim their arrays of services are less expensive than those offered by private insurers and government.

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