reprinted from August 1, 2003
Note: you'll find that the websites for SimpleCare and AAPP are incomplete. I spoke with Dr. Cherewatenko this week - the sites are being redesigned, and several new promotions will shortly be announced.
Meanwhile, this related news about Medicare: The White House released budget figures yesterday indicating that the new Medicare prescription drug benefit will cost more than $1.2 trillion in the coming decade, a much higher price tag than President Bush suggested when he narrowly won passage of the law in late 2003.
Are we really surprised?

  Yesterday, I described some of the problems with our health care systems, and the fact that one major reason costs have risen so much is the enormous amount of paperwork required by Medicare and ever-larger managed care systems that have been spawned because of government programs and regulations.

The larger the system the more it depends on paper communication, and doctors and clinics have had to add large clerical staffs for that reason. Those same large systems that doctors are now almost forced into working with pay reduced amounts for medical procedures. That leaves medical practitioners trapped between increased costs and reduced payments, with HALF of physician/clinic income going for clerical, not medical costs.  It also unfortunately results in less time spent with patients, and medical decisions that are made by insurers rules rather than the medical providers' advice.

In 1998, Dr. Vern Cherewatenko and colleague Dr. David MacDonald, whose clinics had gone bankrupt as a result of this institutional mess, started over again with a cash-basis program called SimpleCare. They also founded the American Association of Patient and Providers, a nonprofit organization promoting the benefits of paying cash for routine medical care, and providing some other novel health care ideas. You may have seen Dr. Cherewatenko on the cover of U.S. News and World Report in April.

"For patients", said Cherewatenko, "the basic idea is this: "Insure for the big stuff, pay cash for the small stuff - just like you do with your car."

Cherewatenko said half of his patients now belong to SimpleCare, pay cash, and therefore pay less for care. Instead of being charged $79 for a 10-minute office visit, for instance, SimpleCare patients pay $35. That means Cherewatenko makes a profit of $5 instead of losing $7, which he said happens when he bills an HMO for a $79 office visit. The HMO pays only $43. But administrative expenses of $20 and overhead of $30 result in a net loss of $7.

This IS the way health care used to be provided... back when it worked well. It's also the sensible way to use insurance; to insure only those risks you just can't cover out of current income. Doctors treating patients, no paperwork, no claims, no rejections, no billing... just health care. How's that for radical and sensible?

20% of Americans are now uninsured, and that number is growing. Those people are prime candidates for SimpleCare, which now has about 16,000 members (counting me), including about 1,100 doctors. They're signing up doctors and clinics all over the nation, and also signing up pharmacies, who have some of the same problems.

I've been uninsured for close to 15 years now, and have probably spent no more than $300 on health care during that time. You're thinking it's luck or good genes, and you're probably right, but it could also be because I'm a heavy smoker and coffee drinker. ;)
It just might also be because I know that if I do go to the doctor it's going to cost me money. That's a lot more "real" than having hundreds invisibly taken out of your paycheck each month... and it does tend to make one not go unless it's important.

I really hope that all of you readers who have group health care provided with your jobs realize that it isn't really free. It costs you and/or your employer a lot, and if it wasn't bundled in with your job, your income could be considerably higher than it is. Group health plans have become extremely costly and inefficient. A lot of what you pay for health care is supporting massive staffs of clerical workers.

I don't know whether the founders of SimpleCare are libertarian, but they certainly have come up with an idea that exemplifies a free-market solution to problems caused by government force.

The SimpleCare idea is still growing. You can suggest that your own doctor join and offer discounted rates for cash patients. It's a better idea... an idea that may just be able to resurrect our once-great health care systems.
It's so good that you may find yourself wishing that you were uninsured so you could take advantage of it.

Postscript: No Force No Fraud passed the 10,000 reader milestone yesterday, on it's 64th day. I don't attribute that to great writing, but to libertarian ideas that simply make sense to a growing number of people.
That pleases me... and it gives me hope.

P.P.S. No Force No Fraud passed the 185,000 reader mark yesterday, Feb. 9, 2005