Health Care without Health Insurance
For more than a year, I haven’t received a single dollar from any insurance company. I work for my patients. A few hundred doctors across the country are working the same way, some in blue-collar towns. Routine care should be affordable to the middle class, and as more doctors and more patients form relationships that exclude insurance companies, prices will drop. Insurance doesn’t make routine care affordable; it makes it more expensive by adding a middleman. I know that some patients can afford nothing, so two afternoons a month I volunteer at a clinic that cares for indigent patients, which I could not have done with the huge patient volume I was seeing a few years ago.
This is a doctor writing in the LA Times.
The Health Insurance Mafia
Here is a great editorial in the Wall Street Journal on how the health insurance industry acts like the Mafia:
The Los Angeles Times also featured a “doctor against health insurance” editorial on Wednesday (HT to John Goodman):
Dr. Fuchs’ actions seem to show that market forces work quite well in health care as it pertains to insurance, even on the supply side.
As for shackles imposed on doctors by insurance companies, that is entirely misplaced. Doctors are free to see any patients they choose to, even without insurance, as Dr. Fuchs has shown. Doctors voluntarily choose to join a network. (Agreed to charges/fees are set by Network Operators – often separate and distinct corporations unrelated to insurance companies.) Doctors are hardly forced to join a network. They can even opt out of a network, again as Dr. Fuchs has shown.
The federal government, through the creation of Medicare as as part of LBJ’s Great Society, and state governments, as part of Medicaid, stimulated out of control pricing by creating Usual & Customary fees-paying doctors AND hospitals directly through assignment of Medicare benefits. Rates were set at whatever the market would bear. Medicare had no rate limits or other governors – such as network contracts.
Prior to Medicare, doctors were paid by their patients directly without any middleman insurance company, as Dr. Fuchs likes to think of them. Prior to Medicare, the insurance industry offered Hospitalization Insurance. No such policy of Major Medical Insurance existed. Payments to insured patients (not to doctors or hospitals through assignment) were made in a flat dollar amount by indemnity policies with no regard as to what the hospital charged.
It’s nice to see that Dr. Fuchs regards his business model as progress. To me, it merely appears to be the same physician practice model used back in the 1950s and 1960s. Remember Marcus Welby, M.D.?
I think it also shows that government involvement is not the answer and that market forces ultimately win out – even in spite of government involvement.
Mr. Goodman: Thanks for the plug.
Mr. Dowling: Market forces do ultimately win out, but the tax incentive of employer-funded health insurance creates a large incentive to purchase care through insurance rather than directly. This inflates prices and ultimately leads to the problems I wrote about in the op-ed.
PS: Regina Hertzlinger, who I see is a contributor to this blog, is one of the people who inspire me to remember that paying attention to market forces and giving patients choices is better for everyone.
Good for you, Dr. Goodman! I agree with you about
insurance. Especially when it comes to Medicaid.
If everyone in the USA were to drop their insurance
(many of us may be forced to if we’re unemployed!)
then I’m certain more doctors would be following your
example.
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Gas28man is right about the AMA. The doorcts’ union gets to say how many new doorcts there are to compete with. Funny that. But Congress could change that easily enough. Pass a law, write a regulation. Most medical schools are public institutions, or accept public money. Congress has a lot of clout.It was (and may still be) easier for an aspiring doctor to go to school overseas, get licensed there, then return to the US. I don’t know if that round-about is still possible.Anyway, the doctor license idea was simply an example of a simple way to increase medical care quantity.My suggestion that the gov build lots of hospitals with the stimulus mmoney was somewhat tongue-in-cheek. I am a libertarian, so would prefer the gov to simply not take that money away from us in the first place. If we all had our own money to spend there would be plenty to go around for medical needs, building new facilities or whatever. But we don’t live in that world. Since the government IS taking our money, well I guess building hospitals is as good a way to spend it as any.Which brings us back to the doctor shortage. No point in building lots of new hospitals if there aren’t any doorcts to staff them.