(Part of) The Future of Health Care

By now, I’m sure many of my readers have heard anecdotally at least of doctors who stopped taking insurance and move strictly to a cash for service business model.

This recent article about a Portland (Maine) doctor made me think of this again:

Bangor Daily News

Though many think that Obamacare is a great thing (likely the more meds you take/services you use, the better you think it is), it is causing many doctors to swear off insurance. It’s not only the mandated fee schedule, but it’s also the endless paperwork. Getting reimbursed by insurance (and Medicare) is time consuming and often forces physicians to hire 2-3 staff to handle. At $40-65,000/year + benefits, staff get expensive. Therefore you could theoretically see how by wiping out 150-200,000 of staffing costs, physicians can then charge much lower rates to cash users.

The doctor in the article, Dr Michael Ciampi, posts his rates online. And on many services, he has cut his fee by 50% or more!. And

having a relationship with a physician likes this makes using a high deductible health plan (HDHP) with a Health Savings Account  (HSA) VERY attractive. Since some of his patients need to use insurance, his patient numbers have fallen but as he states in the article, he hasn’t seen a drop in revenue:

Even with the loss of some patients, Ciampi expects his practice to perform just as well financially, if not better, than before he ditched insurance. ~Dr Ciampi

Amazing – but it shouldn’t surprise us. Insurance is a middle man – but why have the government involved? That’s a whole other bureaucracy that needs to be funded. Just go direct to the doctor and negotiate. Dr Ciampi mentions how much more time he has to make house calls, to offer discounts and pro bono services now that his practice is streamlined.

In my ideal world, I’d find a medical practice that takes a limited number of patients for a flat fee, to cover all non-major surgical stuff for a flat fee . Couple that with a high deductible health plan (the high deductible plan would cover major medical services) and Health Savings Account, and you have a real shot and gutting medical costs. Furthermore, work with a medical team that has physicians who specialize also in nutrition, fitness, and preventative therapies (massage, acupuncture), or has those dedicated professionals on staff, and you have a real focus to preventing illness. That would further cut costs.

The key here is, if patients (or clients – lets think healthy not sick thoughts!) are working TOGETHER with physicians to keep good health because it both FEELS BETTER TO BE HEALTHY AND KEEPS COSTS LOW, then we have something that can work very efficiently.

Having a health focus is especially important as we age. As someone who works with older clients, and see a number of them visit doctors 3+ times per week and pop tons of pills, I know health is not a focus on many people’s current overall plan. They plan for having money when they’re older but not health. I mean c’mon, for people who have the whole day off and have extra cash, why not hire a trainer? And a nutritionist? Sorry to be blunt but hey, maybe if you feared the nursing home as much as you all feared being poor, this wouldn’t be an issue. I have to be tough because it does frustrate me that people don’t focus on this. You could simply run 3 times per week (or walk!) and perhaps do what President Clinton did after his heart surgery, change how you eat!

I’m hoping more doctors do what Dr Ciampi has done because it not only puts a consumer focus on health care costs, it puts a focus on staying healthy for health benefits and to save even more of our money. 17% of our economy is already too big a number for “sick care” (that isn’t health care, most of that spending is on us when we get sick).