Paying cash for an ordinary office visit is fine, and there are a number of primary care physicians who are turning to the concierge care or cash practice model.
But there are a LOT of medical procedures that the average person can’t afford to pay cash for. Labwork, surgical procedures (even minor ones), and some imaging are more than people can come up with on a regular basis. Many people have medical problems that need care constantly and paying for it is just not possible. This is especially true of old people who have a constellation of problems.
I work for a physician and I have a good bit of insight into what it actually costs to run a practice and thus what a doctor needs to charge to stay afloat. We get so little from Medicare and Medicare supplement plans that the doctor is already giving charity just by seeing these patients. As some patients next year lose their insurance coverage due to Obamacare and can’t afford to pay out of pocket for treatments, this practice may have to close. It will be a great loss, if so.
“But there are a LOT of medical procedures that the average person can’t afford to pay cash for. Labwork, surgical procedures (even minor ones), and some imaging are more than people can come up with on a regular basis. Many people have medical problems that need care constantly and paying for it is just not possible. This is especially true of old people who have a constellation of problems.”
I disagree. I just went in for a battery of tests, and the bill was right around $420. As it happens, my insurance was cancelled about a year and a half ago. Not related to 0’care, related to...never mind. I suppose I could have spent $592 a month times 18 which is $10,656. Or, I could have spent $420. which was a 30% discount for cash.
You or I can go to the Oklahoma Surgical Center and pay approximately 1/5th of nominal rates for surgical procedures. They do not take insurance. They take cash money. There are 2 takeaways from this.
One is: The medicare co-pay is 20%. One fifth. If you are a medicare patient and go in for surgery, you will be charged 20% of the total as your co-pay. Now think very carefully: What the hell difference does it make whether I pay the 20% to medicare or to the OK Surgical Center? Answer: Absolutely nothing. Question what do you get for medicare? Answer NOTHING.
Now there are a lot of people who can not come up with $50K cash on the spot but arguably, those who can, are in many cases older people. That’s not the point. People go into debt ALL THE TIME for gambling, stock market losses, harebrained business ideas. Peopl take on $50K in debt all the time, and it’s irritating, it’s a pin in the butt, but they do it, and maybe they take a few years to pay it off but it is not life-ruining, it is not the end of the world.
You may work at a doc’s office and have an insight into what it takes to operate such a business with the attendant overhead. But your view of that is absolutely skewed, and I say that without reservation, by the compensation rates for insured medical care. I saw this in my Mom’s last year, when she needed all manner of medical care. Procedures that were billed at $1327 and paid out at $58. Billed at $732 and paid out at $37.62.
The fact of the matter is that nobody works for free. When you add an insurance company into the picture, they must be compensated. When you add the overhead into the doctor’s infrastructure, the person or persons who do that clerical work must be paid, and the delay in receipt of payment from the various ins companies must be taken into account.
I recommend you view this:
http://www.youtube.com/watch?v=r9q1Id41wGo
The second takeawy from the OK Surgical Ctr is: Healthcare costs are 5 to 10 times their real world costs. And the system is designed to preserve this gouging, primarily by the insurance companies. never mind the incredible assault on liberty and personal freedoms implied and mandated by 0’care, as long as this is the case and the free market is foiled, there is no solution other the egregious cost shifting we have seen.
for’a lot of’those procedures many go to good hospitals/docs outside the us and pay a ton less, even including flights and recovery.