Interview
with Sean Purnell, Author of The Self-Pay Patient
A
thing is worth whatever the buyer will pay for it.
Maxim
Q:
Tell me, Sean. What is your official title? What do you want to be
known for?
A:
I suppose it would be author of The Self-Pay Patient: Affordable Health Care
Choices in the Age of ObamaCare and blogger at TheSelfPayPatient.com.
Q:
What is your background? How did you come to write this book and create
this blog?
A:
A couple of things. I used to work for the Congressman from Iowa, Greg Ganske, who was interested in the Patients Bill of Rights. I didn’t
completely agree with the Congressman, but I learned a lot about how insurance
companies can interfere with care. Then I went to the Heartland Institute
where I wrote about free market health care, where I kept writing and
researching and studying what makes the system tick and what the options are in
paying for health care. Last year I decided I would write a book about
it.
Q:
What is the Heartland Institute?
A:
The Heartland Institute is a non-profit think tank with a free-market
orientation. It deals with health policy issues. It is located in
Chicago.
Q:
Let’s get back to your book. When did you publish it, and where can our
readers get it?
A:
The book is available on Amazon as well as
the Apple bookstore and Barnesandnoble.com.
I published it in December of 2013, and the paperback version came out in
January 2014. I’ve sold about 1000 copies so far, and I hope to
ramp that up in the next couple of months.
Q:
What is the thesis of the book?
A:
The basic idea is that people who are looking for affordable health care can simply pay directly for medical treatments to
eliminate the middleman and not to enter the insurance system, just as you
would any other market transaction, such as paying a mechanic. If you do
that, you cut out a lot of the bureaucratic costs, and you have better
access to care.
Q:
In your recent talk before the American Association of Physicians and Surgeons
in Minneapolis, where I was the keynoter, you listed the number of people
who are interested in self-pay. Could you cite that list for me again?
A:
Yes, these are the number of people who are or who are going to be self-pay.
Roughly speaking, you are looking at
.
· 40 million Americans
who are uninsured.
· 30-40 million
Americans who are in high deductible health plans, who are going to have
to pay directly for many routine treatments or evaluations.
· Then there are
millions of people, whose numbers are not known, with comprehensive insurance
who will not be satisfied with narrow networks and limited choices of doctors
and hospitals.
Somewhere
between 60 million to 100 million Americans will be self-pay.
Q:
This is paradoxical to me. ObamaCare health exchange plans, with
their high premiums and high deductibles, have opened up the self-pay floodgates.
The direct pay/concierge/cash-only or cash-friendly physicians whom I have
interviewed, all tell me ObamaCare has stimulated their business and is
their number one salesman. Am I reading this development correctly?
After all, that was not the way it was supposed to be.
A:
Self-pay is a very common consequence of ObamaCare. ObamaCare, with
all of its faults, has caused people to rethink how they react and feel
about health care and how they choose to pay for it. Many people are deciding to
go with high deductible plans or no health insurance at all. When ObamaCare drives up the price of insurance at the same
time deductibles are going up, people re-examine the premise that you need good insurance to get good care.
It is not surprising to me ObamaCare is causing a lot of doctors and
patients to gravitate towards the direct-pay model.
Q:
I have read that more than half of the uninsured do not plan to buy a
health exchange plan. Could that be?
A:
It doesn’t surprise me at all. When I looked at the premiums and
deductibles, it made sense people would be reluctant to pay for insurance
they were never going to use. People were being asked to pay $300 a month for
premiums when they only went to see the doctor once or twice a year. Those numbers
don’t make sense to a lot of people.
People
simply don’t see value in those kinds of policies, especially when they are associated with co-pays, waits, short
visits, and bureaucratic hassles. ObamaCare is asking them to buy
policies they didn’t see value at at $100 a month, and now they are asking them
to buy policies at two or times that $100 a month. It’s no surprise they
rejected it at the lower price, they reject it at the higher price.
Q:
In your talk before the AAPS, you made the distinction between “cash-only” and
cash-friendly” practices. What’s the difference?
A:
Cash-only really and truly is cash-only. Cash-only doctors do not
participate in any insurance, including Medicare and Medicaid. They are 3rd
party free. Cash-friendly practices are often overlooked.
These are practices that keep a couple of their health plans
active, but they have organized their practices in such a way they
actually have real prices. When people call and ask how much something
costs– a physical, a blood test, the suturing of a cut – they can
promptly and directly answer without asking what kind of insurance
patients have.
Q:
So upfront transparency is a big attraction to consumers?
A:
Yes, very much so. People want to know how much things are going to
cost, and most doctors and hospitals and surgery centers at this point
are unable to tell them. Now some practices are more forthcoming and
transparent and are offering bundled pricing for a variety of services.
Q:
That question “How much does it cost?” is particularly difficult for hospitals
to answer, is it not?
A:
Yes, almost every hospitals has dozens, even hundreds of associated line
items with any procedure or episode of care. So if you need an
appendectomy, hospitals are unable to give you a single price, and their
separate line items are often inflated to cover the administrative costs.
Bureaucratic medicine is pricey.
Q:
But bureaucratic obstacles can be overcome. I was speaking to Doctor
Keith Smith, who runs the Oklahoma Surgical Center. He has an arrangement
with a local hospital for inpatient surgical procedures, and the hospital can
give him a bundled price for any procedure within a half hour after Smith calls
asking, “What will it cost? What will the bundled price be?”
A:
Yes, but in most metropolitan markets, in which you do not have a
transparent independent surgical center, you cannot get that information for
political and financial reasons.
Q:
I notice you are a member of the Free Market Medical Association, which
promotes direct pay and self-pay. Why did you join?
A:
For me given my background in free market economics, I see free market
health care as the future where buyers and consumers negotiate directly and
work off a transparent health bill sheet. You buy on the basis of
value, and there’s very little of the interference the government or
insurer-directed system has. It’s simply a more normal market as any other good or service. The Free
Market Medical Association is good natural fit for my belief system. It will
have to co-exist with the larger and more dominant payment system, but it
does and will continue to exist. The Free Market Association
facilitates networking, promotion, and market of those of us who
believe in the cost effectiveness and quality provided by market competition.
Q;
In your talk before the AAPS, you made a very salient point. Consumers
interested in self-pay or direct pay have difficulties finding physicians
offering these services. One quick way of breaking through this
information barrier, you said, was to notify your local media outlets of
the availability of your services. The media will find your
story to be irresistible because their readers and viewers want to know
obamaCare alternatives, as indicated by a poll just today which contains
the statistic that 55% of Americans who oppose ObamaCare versus 41% who favor
ObamaCare. Your message, I gathered, was: go to your local media,
they are dying to tell the self-pay story?
A:
Yes, the media is fascinated by story. To some extent, the media regards
the story as strange and exotic. But strange and exotic is newsworthy. Writing a story outside the
box connected to a controversial national
story is a no-brainer. The story of getting health care inside ObamaCare
has been written thousands of times. But getting care outside ObamaCare
offers a different and refreshing angle. People have been conditioned to
think if you need health care you have to have insurance, and that is simply no
longer true. Self-pay and direct pay challenges pre-set
assumptions. A lot of things, like direct-self pay, telemedicine
and clinics in drug and big box stores, are now occurring outside the
government and insurance systems.
Here
are links where you can obtain the Self-Pay book:
Here
are the links to my book, if you could include them in your blog post that
would be great!
Paperback
on Amazon: http://www.amazon.com/The-Self-Pay-Patient-Affordable-Healthcare/dp/0991209400/ref=tmm_pap_title_0
Nook:
http://www.barnesandnoble.com/w/the-self-pay-patient-sean-parnell/1117760260?ean=2940148925019
And
here is a link where you can view the video of Sean Parnell’s
presentation before the American Association of Physicians and Surgeons:
Sean
Parnell
Resources
for The Self-Pay Patient
![The Road to Hell is Paved wtih Good Intentions: The Story of ObamaCare: The First Book of a Tetrology [Kindle Edition]](http://i57.tinypic.com/14cgxgx.jpg)
![Direct Pay Independent Practice Medicine and Surgery [Kindle Edition]](https://blogger.googleusercontent.com/img/b/R29vZ2xl/AVvXsEgKJWM6SltCn4DnwWhN4vOVwSOfpffemkWEbuZ-sA3qYPS5DucGczP4X5yB9eJGpnCm41EkvBiXUgPa4B6kCMl8qW_VL_BLVMCB-EFyNzY_Yj_oMbVo58r9cbLt824oQOEnEx-ZRkiy_q19/s1600/direct-pay-independent-practice-medicine-and-surgery.jpg)
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