Sierra Sacramento Valley Medicine
Vol. 61 / No. 1 - Jan / Feb 2010

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Posit: Dealing Directly with Patients, not Insurers

"Physicians should refuse to be agents of the Public/Private insurance complex, by negotiating fees and payment only directly with patients."

Among 93 responses, a majority of 55 percent disagreed with the posit; three respondents were undecided. Slightly edited comments from 28 members follow:

Ever since physicians “bought in” to the third party payor concept and decided they were above participating in the “business of medicine,” abdicating this responsibility to third parties, we have merely been part of the fodder utilized by insurers to make profits for themselves and their stockholders. When will…[we] stop accepting crumbs from the table as the endpoint of a successful negotiation.... When will we…relegate the “third parties,” profit-hungry interlopers in the healthcare system, to an administrative role only. The healthcare system should not be a vehicle for “For-Profit” companies and their stockholders to dilute the “healthcare provider-patient relationship,” and skim 40-45 cents off the top of every healthcare dollar.

"I resigned as a CMA delegate after a resolution I entered concerning this very matter was efficiently shelved by the “powers that be” in the CMA at that time. Unless things have radically changed, the CMA is an organization run by large medical groups (the “Health Chains”) who…employ and control physicians.... Until physicians understand that the system cannot run without them and are willing to stage a job action to support their autonomy and patients’ rights, all changes (like the present so-called healthcare reform which, without a “public option” will only fatten insurers pockets and solidify their control of healthcare payments) are less than window dressing…. I applaud the Phoenix Mayo docs.... I myself do not participate in managed care, but do accept most PPOs. This policy will change before the end of the year, as I cancel all of my contracts and go strictly fee-for-service. It’s a damn hard row to hoe, but my relationship is with my patients, not the profit hungry, stock price-driven insurance industry." -Michael P. Goodman, MD
"…Why do most of us “take assignment” from Medicare today? Because when we did not we often could not collect, either in a timely manner or at all, from the patient, even though Medicare had reimbursed them for our services. This was back in the 70s and 80s and most of us decided it was better to get some payment (albeit discounted) from Medicare than to get none at all. The physician’s specialty and the demographics including average income of where one practices will influence one’s decision." -Ralph Koldinger, MD
"Though I agree with this concept, it is impractical due to so many who do have insurance. However, the government programs (i.e., Medi-Cal and Medicare (especially) have caused undue damage to physician reimbursement abilities." -Richard Gray, MD
"While insurance has made payments to physicians seemingly easier and painless, in the long run they have taken the patient out of the equation and led to an unreasonable demand for services and care." -Pankaj Patel, MD
"The patients can use the superbill and any notes they request to argue with the insurance companies. This will be the fastest way to educate the public on the problems with our current system and will lead to further overhaul of the system by public demand." -Janet Abshire, MD
"Fee-for-service is one of the big contributors to our health care system dysfunction in this country." - Sidney A. Scudder, MD
"[Agreeing,] I also suggest this as a future posit: A prepaid health insurance policy [should] be required for foreign travelers in the USA" -Thomas J. Curran, MD
"I believe that_our mission should be to serve our entire community and not just a select few. If this step is allowed, where does it end. " -Thomas J. Curran, MD
"Perfection of “means” and confusion of “goals” seems to define our generation of health care. The goal should always be the patient and the patient welfare only!." -Sat Giri, MD
"Health insurance is there for a reason. People cannot afford catastrophic care and even everyday care would be unaffordable for many, particularly seniors and people with chronic healthcare issues. Health insurance helps people get the care they need without worry. Physicians should be given more freedom to negotiate fees without fear of anti-trust so that the fees paid by insurance companies are fair. But not by cherry picking the wealthy out of the system." -Joanne Berkowitz, MD
"I agree. Things will only get worse in the future, and physicians need to grow some business sense." -Robert Tang, MD
"That would severely compromise the therapeutic doctor/patient relationship." -Dineen Greer, MD
"Selfishness is unbecoming to our profession." -Captane Thompson, MD
"The best “single payer” for medical care will be the patient or patient’s family. Catastrophic insurance with high deductible may be best for many. The wasteful effects of prepaid medical care were revealed in the RAND Corporation’s “Healthcare Insurance Experiment” — see “Health Care Crisis, or More Misinformation?” page 2 of Liberty Link, Volume 2, Issue 2, at www.sacramento.ca.lp.org/Newsletters.php" -Lee O. Welter, MD
"We are just insurance/gov’t agents...medicine is neither a right nor should it be free, but like groceries should be affordable as per patient needs as opposed to being dictated..." -Spencer Silverbach, MD
"I believe in universal health care. " -Hartej S. Uppal, MD
"My father, who was also a Family Physician, taught me that “it is always the patient’s money,” and I should be careful how I spend it. That is true whether it is cash from their wallet, their tax money, or from their insurance premiums. A physician should always be the agent of and acting as an advocate for their patient, regardless who happens to write the check on a given day. A doctor who thinks that accepting the insurance company’s check makes them the company’s agent might want to reconsider their choice of career." -Francisco Prieto, MD
"Better to focus the pt on their [own] plan for health." - Anthony A. Rayner, MD
"It’s much too complicated for physicians to negotiate fees directly with their patients. The same dynamic, however, would apply should patients negotiate directly with their health insurance plans. Think about how car insurance works. It’s mandatory, pre-existing accidents are irrelevant, range of plans hungry for the business. The patients are the ones that need to drive the market, not their physicians." -Phil Poor, MD
"A third party that is not insurers or docs should do this." -Gary Raff, MD
"Those MDs who want single payer medicine will need to accept single payer fees set by the payer. It would be nice for physicians to be able to negotiate fees with patients, but this type of payment is no longer realistic." -Byron H. Demorest, MD
"There would be a huge number of Americans who would then not have any health care as they could in no way afford negotiated fees. If there are 40 million Americans without insurance now, it will easily be twice that under this scenario. Additionally, it would leave patients who could not afford these fees with only one alternative, the emergency room, and that would create havoc and potentially force the closing of many emergency rooms which currently just get by. Better to work within the system to make it workable for all of us rather than closing the door to our patients." -Sydney Scudder, MD
"Wow! The first statement is laudable: The second statement is impossible. " -Wayne C. Matthews, MD
"I also believe that patients should do their own billing to Medicare. Negotiate the price with your physician, pay, and seek reimbursement on your own. It’s like getting a rebate." -Gregory Joy, MD
"I suppose it would be nice, not to have to deal with the restrictions that come with dealing with an organization that is at odds with providing care [and] that reduces its purpose to financial profit. But as with all things in life, nothing is all good or bad. In fact, insurance agencies are here for a reason. I have not seen physicians posting signs of their fees. And there is a reason for that as well. If it was a good idea, there would be people doing it." -David Gunn MS III
"I agree; if patients understood cost of care, there would be more efficiency in the delivery and care that is provided. Insurance should be for severe illness, hospitalization, and catastrophic care.… We should have a basic health care maintenance policy that covers routine visits and vaccinations. Acute self-limiting illness should be paid for out of pocket. This would eliminate a lot of [unnecessary] tests and procedures…that may be performed more selectively. And catastrophic insurance should be for significant illness that was or is unforeseeable, such as cancer or stroke or being admitted to the hospital for acute surgery. This would be similar to collision insurance...we should break up health care insurance into different types of policies similar to auto policies, rather than trying to lump everything into a one size all…everybody would be better off." -Rajan K. Merchant, MD
"That horse has been out of the barn for 50 years. Think of Medicare as the new Medi-Cal." -Tom Wilkes, MD
Posits are simplistic one sided statements intended to promote discussion among members. Therefore your comments are particularly relevant. Results do not constitute valid polling data and may not reflect the position of the Editorial Committee, or SSVMS Board of Directors.

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