Happened to me with my Santa Monica doctor. Had been with her for years, too.

"If all it means is that doctors who serve the wealthy are figuring out ways to avoid the hassles of insurance,..."

Marsha Gold is an idiot. Adding bureaucrats and insurance people does not increase care. It reduces it, for everybody, by making an hour of treatment MORE expensive. This is camouflaged by the tendency to look right in front of you, at someone whose care is paid for by someone else. It's not "insurance", it's socialized medicine, and yes there's a difference.

To be a doctor is eight years of college plus about four years of internship. That is essentially paying for school from age 18 to 32 and then an insurance company is going to say your time is only worth $35 an hour.

Why would anyone do it?

From the quote: "... and nearly 7 percent plan to switch to cash-only or concierge practices, in which patients pay an annual fee or retainer in addition to other fees."

The concierge practice is actually kind of intriguing. It makes me think of the maintenance plan dealers offer when you buy a new car. Might this turn out to be the Next Big Thing?

What Radwaste said. With insurance, you are not only paying the doctor, but also a lot of clerical time for someone to file the insurance paperwork, plus the entire insurance bureaucracy. If you can just pay cash, it's easier for everyone.

The government needs to get out of the way and let insurance companies offer policies that people want. Many years ago I had a policy with a huge deductible. For anything ordinary, I just paid my own bills. The policy was only in case something catastrophic happened, and it was dirt cheap. The saving on the insurance policy more than made up for my out-of-pocket medical expenses.

I cannot buy a policy like that anymore; they simply do not exist. With Obamacare, the choices will become even more limited, and the number of non-medical parasites living off of your health-care dollars will increase.

A last note: someone is going to whine "but I have a pre-existing condition and can't afford insurance". To which I must say: "that's right, you can't." But the reason is the same - over-regulation.

If the government would get out of the way, insurance companies would offer policies for people with pre-existing condition. They would be either expensive, or would exclude certain treatments, but they would at least exist. It is a simple fact that sick people are going to have more medical expenses than healthy people, and it is therefore only right that their insurance cost more.

Trying to deny this ("it isn't faaaiiir") doesn't help. We do not live in Lake Wobegon, life isn't fair. Attempting to legislate "fairness" has simply resulted in insurance companies taking products off the market, i.e, reducing the possibilities we all have to get appropriate insurance.

A_random_guy is right. In New York, the legislature has mandated that insurance policies cover a whole list of things, thus making them expensive.

Since legislators have all the answers, why don't they just pass a bill making all of us rich, happy and healthy and cut out the middleman?

This article annoys me. Areas of medicine that aren't traditionally covered by insurance---LASIK, orthodontia, cosmetic dentistry and cosmetic surgery---have become better, safer, and more affordable every year because *gasp* that's how this stuff works. Pediatricians in NYC won't charge $150 out of pocket for sick visit if they have to compete with other family docs and pediatricians who charge $80 for comparable care unless parents Yay capitalism.

Besides, insurance shouldn't have EVER been your ticket to a doctor's appointment. Insurance works better when it's actually insurance, set aside for big problems that are unlikely (like when your kid gets hospitalized for meningitis, not when she goes to the doc with strep throat) rather than prepaid medical care. People tend to make decent decisions when they actually have all the information.

Whoa, I did something weird in my first paragraph. That should say "Pediatricians won't charge $150 for a sick visit if they have to compete with docs charging $80 unless parents are idiots or there's another reason to charge a premium, like a convenient location. Yay capitalism."

We have a small business that works with insurance companies. The fuckers simply don't pay. Period. They will come up with any reason to just not pay the provider.

It's one thing to submit a claim and then wait a month to get paid. It's very different when you submit and the wait a month to tell you it's denied. They claim to not have the paper work. You call the nice idiot on the phone (if you're really luck they speak English) and they assure you that the problem is fixed. They deny the claim AGAIN, you point out the claim they paid for the same client and the same service. Their response is garnish all future payments to cover the one claim they did pay. Which they still refuse to pay. Call again to be told it's fixed guess what denied again for the same reason. Finally after 5 rounds of back and forth the client calls the insurance company in a mad rage because we refuse to provide services. Now they finally start to trickle payments. Well while we work for free to build the company out employees won't and we refuse to ask this of them. So now we had to sink thousands into the company out of pocket. We are then rewarded with a corporate tax filing fee of 500. Since we had near zero profit after the filling our bill was $25, yes one Lincoln and one Jefferson. The cost of filing was 20X the actual taxes owed. This is why most small businesses die. Don't get me fucking stared on the relatives attitudes.

The reason that PCP are running is that after 8 years of schooling and debt you are not done. You need to dump tens or hundreds of thousands to cover the gap between first patient and first payment. Staff, insurance, in our state staff medical coverage, rent, supplies, off site IT as the records must be electrical and have off site back up, hazmat permit and disposal. In some cases like us you have relatives sticking their fucking hand out since "You're a business owner so you have loads of money."

The reduction of access has little to do with insurance and more to do with unimaginable case loads since no one in their right mind would be a PCP or worse family physician. Where mom brings in the whole herd at once to duck her co-pay. In some ways I have to say why not? That welfare mooching slag on Mass health has no co-pays. There are people that need it and then there are people that make sure they need it.

On the plus side looks like we may have hit solvency without going into debt. There were a lot of sacrifices. The worst is having to live separate for 3 years and counting. Most recent doctors can't have a paper route to cover then medical office.

Vlad is right about fighting with the insurance companies: the doctor's office needs to hire a person who does nothing but carry on that fight, and the cost of that labor is factored into the cost of medicine.

I bartered for my last medical treatment, an AB prescription for a mysteriously inflamed wrist (spider bite? i don't know) and i still owe an unspecified future favor for that. I have no plan if i need medical treatment, but i will ride that bus when it hits me.

Quote: "... and nearly 7 percent plan to switch to cash-only or concierge practices, in which patients pay an annual fee or retainer in addition to other fees."

I already do. I pay my pcp $65 monthly to see him 4 times a year, tests are extra.
Best deal I ever made. He doesn't bill insurance, just provides care. My deductible for insurance is 2K, so I rarely dip into that, either.
I wish to hell the gubbymint would get its nose out of medicine

Sounds like we're headed back to the days of Doc Baker on "Little House on the Prarie," when indigent patients paid with live chickens.

geez, people... doncha know how this will all work? There will be a requirement to expand govt. services to actually provide the doctor too, and ALSO, it will become illegal to pay cash for health services.

und Viola! Single Payer Govt. Health Care. Don't they call it National Health Service in the UK?

QED.

When you proceed from the idea that healthcare MUST somehow be provided, then your means of making sure it happens can and will take on a life of their own...
and whole legions of technocrats find employment.

I have a cash payment deal with most of my Drs. and it works great. I'm not at all looking forward to federal government employees having access to my medical information.

I pay with cash to my psychiatrist. Can I tell you all something? Best fucking doctor I have ever had, and best service I have ever experienced.

I just shoot her assistant an email and they fill my prescriptions right away. Everything gets done amazingly well.

Now for my regular insurance paid doc? It's pretty good service, the doc is great but but it takes me 3 weeks to get an appointment.

Also it has made me be stuck in jobs where I earn less than I could.

One problem is that healthcare is rapidly progressing in complexity beyond the understanding of the average American.

We sue doctors not because they actually screwed up, but because they were supposed to be able to cure Grandma.

When it was just Doc Baker on the prairie setting broken bones, sewing up cuts, bleeding with leeches, birthin' babies, and chopping off limbs people had a basic level of understanding of what he was doing. In more rural areas, they did these things for themselves.

Except for the book learnin' part, most people viewed the local doctor as a sort of high-level tradesman. Most doctors, especially rural ones, didn't attend medical school; they apprenticed.

Doctors were as stymied as everyone else by cancer, polio, measles, and the other calamities to which the human body is subject.

In the 1918 flu pandemic, many rural doctors still bled their patients with leeches - making the influenza worse by hampering the immune system's ability to fight it.

However, when medicine started becoming science-based (around 1918), people began to lose their understanding of what the doctor was doing.

Today, doctors spend eight years in college, four years in residency, and even more years in specialty training. Medical students study biology, chemistry, psychiatry, anatomy, physiology, etc. Doc Baker wouldn't even be qualified as a nurse today.

So, when Grandma was given some medication that is effective 75% of the time and it didn't work on her, that's the doctor's fault, right?

To truly understand what's going on when the doctor starts talking about chances of recovery (statistics), drug interaction (chemistry and pharmacology), disease progression (physiology), and surgical options people would need to put down the "Twilight" and "Harry Potter" and pick up some nonfiction, forego taking ethnic studies or "Intro to Leisure" and take a science class or two in college, or stop watching "Here Comes Honey Boo Boo" and turn on the Discovery Channel once in a while.

The government is like a black box to most people. They don't have to (or want to) worry about the inner workings of it. They just accept what comes out of the other side. So, give healthcare over to the government and you won't have to try to understand what the doctor is telling you when you're forced to make a choice about Grandma's care.

ObamaCare is very attractive to some people because not only do they not have to understand the science of it, they don't have to worry their little heads about who's going to pay for it.

No more planning ahead and choosing between competing insurance plans.

No more dealing with the complexities of deciding between surgery or drugs as treatment options.

Just turn Grandma over to the nice government man in the white coat.

And, because their entire economic education consisted of reading the Occupy manifesto, it's all free! Right?

Amy, dont know you local reg and laws, but one, even two chickens are not enough to generate an offensive smell.

Neighborhood cats would be a problem though. You could get a extra large dog cage top and move it about your yard randomly. Claim they are 'organic pest control'

Females make very little noise for the most part, and offer your neighbor some of the eggs in exchange for the food they throw into the garbage and I'm sure they wont have any complaints

or stop watching "Here Comes Honey Boo Boo" and turn on the Discovery Channel once in a while.

I dont know, wasnt it the discovery channel that did a 'documentary' on how the government has captured and weaponised mermaids?

luj, you mean you've never heard of "Ariel warfare?"

I've heard about the conceirge practice but the trouble comes when you also need lab, radiologist, hospital, ER...you would need insurance or something like it.

Hey, Doc Baker knew some stuff to justify his exorbitant fee of one live chicken per visit!

He knew that Mary Ingalls was going to go blind because she had scarlet fever as a young girl.

Several years ago I read an article in the NY Times about a doctor who quit his hospital position and opened an office that didn't take insurance. I'm pulling numbers out of my ass, because I can't find the article, but I think his pay was only about 20% less than his prior position, and he worked FAR fewer hours. Their overhead was reduced, his staff was happier, and if I remember, the prices (labs too) were really affordable. They got complaints from those on gov't insurance, which the article briefly touched on, but I remember thinking it was an interesting idea, and hoped it was feasible enough to expand. Glad to see it is.

At work, we have a computer system called "Puridiom". Whatever its merits, it was placed into service and then promptly failed. It required a 25-page set of instructions on how to order a pair of safety shoes. No, not to actually get them -- that's just to arrange for the $75 stipend to be applied electronically when you pick them up yourself at a shoe store, or off the trailer when it stops by.

Imagine if you had to do this instead of use Amazon to buy things on-line.

When there's no market pressure, nothing will be improved.

Because if you're not the one paying, you have NO say in the outcome.

Paying cash is great in theory, but what do you do, cash in your CDs on the way to the hospital? I found out the hard way that without the promise of some kind of payment such as full insurance (I had a $5,000 deductible per illness - and enough funds with the monthly premium that I saved to cover that deductible) that I wouldn't get a full work up in the emergency room.

Hospitals are wary about those without insurance and take advantage of those that do have insurance.

When I asked my doctor how long I needed to stay in the hospital, he said that he would have to check with my insurance. I told him that I didn't care about the money. I wanted his professional opinion. I would pay if the hospital didn't. On the other hand, I don't care if insurance will pay, if I don't need to be in the hospital then I need to go home. My doctor said that it is not allowed. He kept reiterating that he needed to check with the insurance company. Nauseating!

*****The government needs to get out of the way and let insurance companies offer policies that people want. Many years ago I had a policy with a huge deductible. For anything ordinary, I just paid my own bills. The policy was only in case something catastrophic happened, and it was dirt cheap. The saving on the insurance policy more than made up for my out-of-pocket medical expenses.

I cannot buy a policy like that anymore; they simply do not exist. With Obamacare, the choices will become even more limited, and the number of non-medical parasites living off of your health-care dollars will increase.*****

Maybe I am misunderstanding you, but I have a high deductible plan with my employer that costs me $20/month. My deductible is $5000 out of pocket before insurance kicks in. As in, the first $5000 is all on me. These type of plans are great for the very healthy, or very sick. (I'm the accountant at my gov't workplace, so trust me, I have DONE MY HOMEWORK).

I also have an HSA tied to this account, where I put part of my check in there each month, pre-tax, for medical expenses. Even if I quit this plan for a PPO, I keep that money.

I'd love to untie health insurance from wages - quite frankly I think as an employer we'd pay less. Currently we pay 90% of the premium, to the tune of $21,000/month for 37 employees. I'd rather give that out in wages. And we have been touted as extremely generous (and we are, but our overall wages are lower, so it's all relevant).

The hard truth is, most employees do not realize how much the employer pays out for insurance, which IS a benefit to the employee, and a "bonus" to his/her wages.

I'd kind of like to see health insurance like car insurance. You decide your level of coverage, and you pay accordingly. That said, if that happens employers have to give their employees the wage increase that they would normally pay for insurance.

*****The government needs to get out of the way and let insurance companies offer policies that people want. Many years ago I had a policy with a huge deductible. For anything ordinary, I just paid my own bills. The policy was only in case something catastrophic happened, and it was dirt cheap. The saving on the insurance policy more than made up for my out-of-pocket medical expenses.

I cannot buy a policy like that anymore; they simply do not exist. With Obamacare, the choices will become even more limited, and the number of non-medical parasites living off of your health-care dollars will increase.*****

Maybe I am misunderstanding you, but I have a high deductible plan with my employer that costs me $20/month. My deductible is $5000 out of pocket before insurance kicks in. As in, the first $5000 is all on me. These type of plans are great for the very healthy, or very sick. (I'm the accountant at my gov't workplace, so trust me, I have DONE MY HOMEWORK).

I also have an HSA tied to this account, where I put part of my check in there each month, pre-tax, for medical expenses. Even if I quit this plan for a PPO, I keep that money.

I'd love to untie health insurance from wages - quite frankly I think as an employer we'd pay less. Currently we pay 90% of the premium, to the tune of $21,000/month for 37 employees. I'd rather give that out in wages. And we have been touted as extremely generous (and we are, but our overall wages are lower, so it's all relevant).

The hard truth is, most employees do not realize how much the employer pays out for insurance, which IS a benefit to the employee, and a "bonus" to his/her wages.

I'd kind of like to see health insurance like car insurance. You decide your level of coverage, and you pay accordingly. That said, if that happens employers have to give their employees the wage increase that they would normally pay for insurance.

Conan the Grammarian: "...they don't have to worry their little heads about who's going to pay for it... And, because their entire economic education consisted of reading the Occupy manifesto, it's all free! Right?"

A lot of people believe that medical care will be free under obamacare. In reality, the amount that people pay out of pocket will increase. Having consumers pay more out of pocket is part of the strategy for keeping health care costs down.

Under the present system about 11% of health care services in America is paid for out of pocket by consumers. The rest is covered by some form of insurance or government. Obamacare would increase that to something like 30%, similar to the amount paid for out of pocket in Canada.

Under obamacare consumers can choose from four levels of coverage, depending on how much they want to pay:

Bronze level, with actuarial value of 60%.

Silver level, with actuarial value of 70%.

Gold level, with actuarial value of 80%.

Platinum level, with actuarial value of 90%.

Actuarial value is the percentage of expenses of all the members of a plan that will be covered by the insurance company, for example 70% under the Silver plan. The rest will be paid for out of pocket by plan members through various forms of deductibles, co-pays and coinsurance. The higher the actuarial value the higher the premium. Only the Platinum level (90%) is required to include dental and vision coverage.

Here is a web page of the Kaiser Family Foundation to estimate what your premium and government subsidy will be for the "Silver" plan (actuarial value of 70%) beginning in 2014:

http://healthreform.kff.org/SubsidyCalculator.aspx

Jen, the story is about primary care docs and specialists---not hospitals and definitely not ERs---moving away from insurance. Everyone should have insurance for the big stuff, the hospital stuff and the follow-up for after the hospital. This sort of "big stuff" or "hospitalization and accident" insurance would be a lot cheaper if it wasn't also obligated to include basic maintenance.

I don't know what you mean, though, about not getting "the full work up" in the ER. You're not supposed to get the full work up in the ER; if you need a full work up, you're admitted. If you mean that ER docs don't do as well for their uninsured as for their insured I must say I've had to go to the ER while without insurance before and the docs never even knew whether my daughter was insured or not. The paperwork people just sent someone in to ask if I would like to set up a payment plan or talk to their social worker about Medicaid well after the doctors and nurses were good and done. The experience with insurance is exactly the same---treatment, then questions about how you will pay.

Jenny, my experience may have nothing to do with my deductible, but when I had a high deductible I was not admitted to the hospital for tests when a had brief incapacitating "episodes." After I got a more comprehensive insurance plan, I was admitted to the hospital and a full work up was done. They finally did an MRI and MRA. Sure enough, I had two blocked arteries and they could see atrophied arteries and loss of brain tissue - most likely from previous strokes.

I was not at risk for strokes. It was more likely to be what I was originally diagnosed with - migraines, panic attacks, or an inner ear problem. I didn't have anything obvious like a broken bone. On the other hand, when someone suddenly can't stand, or see properly, or half of their body goes numb, shouldn't we take a little look at the brain?