Any number of economists will tell you that medicine just has to be different from other goods and services provided on the market. They will offer elaborate theories to explain, for instance, why competitive markets won’t work for health care, and why more government is necessary, and why, in fact, today’s hospitals don’t publish their prices.
I see this mainstream “explanation” as mere apologetics, designed to justify evermore government. The truth is that medicine is “different” because legislation — at local, state, and federal levels — has made the industry different. It’s an accident of history, not something “natural” to this particular market.
But, as Obamacare further consolidates medicine under the government rubric, there appear some daring examples of non-compliance. The latest is from Dr. Michael Ciampi, of South Portland, Maine, whose family practice group has stopped accepting insurance payments of any kind, public or private.
Posting its prices on the Web, Ciampi Family Practice claims to offer substantial savings over other providers. And other benefits, too, including house calls:
Because we no longer contract with insurance companies, Medicare or Medicaid, we can be more flexible and innovative. We use technology when it helps us take better care of patients, but we refuse to use it for technology’s sake. We will not spend our visit staring at a computer screen instead of looking at you. We can also spend more time with patients than the typical provider in a “big box” medical practice.… We do not have physician assistants or nurse practitioners.
Ciampi is not the only (or biggest) provider to do this.
Could competition just erupt without a government-provided “solution”? Could “the market” provide the leadership medicine needs now?
This is Common Sense. I’m Paul Jacob.
8 replies on “Doctoring, Priced”
Eventually, when the subsidized and paralyzed by regulatory and third party service sectors become impossible, the providers react. Note Harley Street in London (a reaction to NHS) for a more mature example in health services.
Such are not a function of libertarian philosophy or politics, simply the market. The fact the movers in the market may answer in a libertarian approved manner is NOT the driving factor, economics is!
Hello All,
Great column! I have always said there will be a medical revolution if they would just post the darn prices in the waiting room! People would freak out if they saw the real cost! Doesn’t most everybody else?
What if I went to a fast food joint, ick, and no prices were shown? I recently went to a sit down dinner, before the new Star Trek movie, and got nailed for a $5 beer because their menu did not show a price. I won’t be going back there. At least it was a Sam Adams…but still, I have noticed restaurants do not show their beer and booze prices and that is wrong.
I called the dentist asking what it will cost for a cleaning several days before the appointment. It took her at least three minutes to look up the price! They wanted $130! That is wrong. I looked up a receipt for a past dentist, $99. I called back and cancelled the appointment. What is it with this medical scam?
I hurt my knee last year. I got a bill for $13,000!!! For what? I didn’t even get a kiss! They took some Xrays, a scan of the knee, a blood vessel check, and gave me an ill-fitting brace. They even kept the rolling bed in the hallway! I lay in the hallway for hours! They could have at least served me a beer for 13 Grand!? That is wrong.
For those of us who know the difference between Right and Wrong, it seems to me the entire medical field pricing is all wrong. And it is only getting worse…
This Ciampi Family Practice and others could very well kick off a revolution in medical pricing! I would love to see this happen…
When are “We the People” going to wake up and quit electing these idiots that keep getting paid for the rest of their lives? Why do we put up with it? The Founders were very clear on this subject…
And this medical mess is all wrong…Good article, Paul…Thank you.
-John in Sioux Falls
Oh, thanks for the little math problem instead of those silly mashed up letters!
While I love this idea, the problem I see in the short term is that to take advantage of this you would need a pretty good income because you would be forced to pay for health insurance while opting for healthcare on a cash only basis.
Thousands of physicians already have escaped from the nightmare of dealing with government and insurance payers – and their complicated rules and restrictions.
A psychiatrist I know has no staff. She accepts only personal checks as payment. Her computer only is for sending prescriptions to pharmacies: no other patient data is in it. This seems like a leap backwards to the 1980s, but this structure provides patients with full cost information (not just copays), keeps her overhead low, and has excellent patient privacy and medical record security. And, addressing Ms. Haring’s concern, patients with insurance coverage can file claims for care.
My gripe is with labs. My doctor wanted me to have an EEG. Since I was unemployed, he suggested I file for financial assistance. I was hit with a $900 bill for a test done by a technician in under an hour. By the time I paid the bill, it had been cut by more than two thirds.
American health care companies should be able to advertise and should be forced to compete for my business. I don’t fault doctors. They are not the villains, here. They work for a living, like everyone else.
My doctor accepts cash payment and I am supremely grateful for that.
One item omitted from this article was insurance. Government has put insurance on a higher level than cash. And employer-based insurance above private insurance.
Those of us in the private market should be able to buy our insurance and our medical care with pre-tax dollars.
Technically, an electroencephalogram is a procedure, not a lab test. (I’m a lab director and don’t like to get blamed for overcharges in other departments.) I do agree that a $900 EEG charge is outrageous.
What will happen is that we’ll end up with a 2 tier medical system: one for those on Obamacare, and one for those who pay cash. The cash health care will be good, but you have to buy Obamacare whether you want it or not.
Most articles on Obamacare have been from a patient point of view, or on exchanges. For one that looks at the incentives to doctors and hospitals regarding their businesses, and Obamacare from a physician’s point of view see http://reason.com/archives/2013/04/22/how-government-killed-the-medical-profes
read the “Welcome”,all the way to the bottom, and check out the surgical fees and compare them to what you get hammered with on a trip to the hospital:
http://www.surgerycenterok.com/index.php