Tuesday, June 3, 2014

Interview with Sean Purnell, Author of The Self-Pay Patient

A thing is worth whatever the buyer will pay for it.


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!

 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

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