Monday, February 01, 2010

More on Cash-Only Medicine: Like Being Born Again

TRAVERSE CITY, MI -- Oct. 1, 2006, marks the fifth anniversary of the date on which Michael Harris, MD, opted out of Medicaid and Medicare and rid himself of all commercial insurers. He put his urology practice on a strict cash-for-services basis in 2001 and he has not looked back (see his website here for Northern Institute of Urology).

"This is how you practice medicine," Dr. Harris told Urology Times in a recent interview. "All the bureaucracy that is inflicted on a typical medical practice today contributes absolutely nothing to the care of the patient. All it does is hamper performance."

See related story "
Opting Out is Like Being Born Again, MDs Say."

See related CD post.


At 2/01/2010 10:50 AM, Anonymous DrTorch said...

Interesting stuff. The article is 3.5 years old. I like to see follow up info from some of these providers.

At 2/01/2010 11:36 AM, Anonymous morganovich said...

i think that one of the great fallacies of this medical debate is this weird assumption that people who don;t have health insurance don;t get healthcare until they get really sick and go to an ER and foist their costs on the society.

that's just crazy. in my 20's, i just paid cash to go the the doctor. i was healthy and spending $2k a year on insurance seemed dumb. maybe if i'd needed a triple bypass surgery, i'd feel different, but seriously, how many 25 year olds do things like that happen to? insuring all of them against such unlikely outcomes is a losing proposition.

efficient price for insurance = size of loss X likelihood of loss.

further, the cash system has a massive advantage over 3rd party payer - price control. you'll shop and get a good deal if you spend your own money.

you would never, never buy a car by going to the dealer closest to you, asking them what they think you should drive, and then taking one home without ever asking what it costs. alas, that's how we mostly consume medicine. it's utterly insane. most providers CAN'T, not won't, but actually can't tell you the price. they don't know either. when you doctor sends out tests, he has no idea what they cost. try asking him/her.

the new trend in the bay area is for all the best doctors to not take insurance. it's just not worth it for them. it's too hard and too expensive. the result of this is i can get in to see my doctors virtually instantly. i get good care from the best guy. i choose them myself and decide what is and isn't worth it. i found a great anthem plan that costs $2100 a year, has no deductible and no out of network restrictions. i have a 40% copay from dollar one and a $7500 annual out of pocket max.

so far, seems to work great. sure, i would have to spend $3500 in cash before this plan is break-even, but the "disaster insurance' is worth something as well as is the chiropractic i was using anyway.

i have maximum choice, and incentive to price shop and only consume what i need which keeps costs/prices low. the only annoyance is submitting bills, but this is not terribly difficult and will keep getting easier as insurers and doctors alike seek to make it easy to attract and retain customers.

markets are extremely good at providing goods and services if you just let them function. i find it endlessly ironic that the industries we deem "too important to be left to markets" wind up being the most problematic industries BECAUSE we have disrupted their markets...

At 2/01/2010 1:10 PM, Anonymous Anonymous said...

This, coupled with HSA's is the way to go.

At 2/01/2010 3:57 PM, Blogger Shawn said...

morganovich posts a great comment, and is very similar to my experience w/ "catastrophic insurance" that I've got from blue cross/blue shield as a 31 year old.

I've had to have a couple visits to doctors, and they've offered to perform a rather routine procedure in their office for a reduced price, because I was not going to be paying via insurance.

At 2/01/2010 4:43 PM, Anonymous Anonymous said...

Let me suggest one other change, you agree to arbitrate any mal-pratice claims with the physician in exchange for getting his services, and agree that only economic damages will be covered. I don't see why physicians can't make this agreement at least with private pay patients and reduce the amount of defensive medicine.
Now if you had universal health insurance, you could provide that essentially the only thing you could sue for on Mal-Practice is economic damages, i.e. excess medical charges such as long term care, and lost wages. No squishy loss of companionship or pain and suffering, that life, and as Jimmy Carter observed life is not fair.

At 2/02/2010 2:30 PM, Blogger sethstorm said...

Mr. Harris's arrogant smirk can be removed quite easily.

further, the cash system has a massive advantage over 3rd party payer - price control. you'll shop and get a good deal if you spend your own money.

Except that cutting corners in medicine is similar to playing Russian Roulette.

This, coupled with HSA's is the way to go.

Until one event exhausts it. Then you're more or less screwed. For those on conventional plans, you're not.

At 2/02/2010 2:32 PM, Blogger sethstorm said...

markets are extremely good at providing goods and services if you just let them function.

Just because there's nobody to attack? The only thing that it results in is outsize influence and shoddy products.

At 2/22/2010 4:27 PM, Blogger ChrisA said...


An HSA medical plan is a high deductible health insurance plan combined with a tax deductible savings account. The insurance is still there regardless of the balance in the savings account.


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