What Will Happen

My Take on Reforming Health Care - Part 2

As an independent, solo physician, I am in business for myself. I make decisions about payment policies -- including insurance participation -- based on a number of variables. I have to pay my overhead and make a profit while keeping my patients (customers) satisfied, without running afoul of the law; just like any other business. At this particular time and place, my customers (patients) expect that I will participate with their medical insurance plan. Some, in fact, have chosen to utilize my services for that specific reason.

But my relationships with insurers -- including the government -- are deteriorating. The promise of volume in exchange for fee discounts isn't working to my benefit the way it used to. As dealing with insurers becomes less rewarding monetarily and the hassle-factor continues to increase, the time will come when it will no longer be worth my while to contract with them. At that point, I will stop doing so. As it happens, I believe that many other physicians in situations similar to mine will come to the same conclusions as I, and will also choose to terminate those contracts. The eventual result will probably be that no outpatient primary care physicians will participate with insurance.

At that point, the insurance companies will almost certainly adjust their business model to take the new reality of non-participating physicians into account. With any luck, they will move towards something that looks like actual insurance (think home and auto; coverage only for catastrophic care) and will therefore be considerably less expensive. Who knows; they may even have to make do with less revenue. That's what capitalism is all about, isn't it?

Note what doesn't have to happen: no legislative changes; no change in insurance regulation; no vote; nothing but individuals making their own decisions for their own benefit, granted without taking the overall effect on society into account, but who cares? The essence of capitalistic decisions is accepting that what is good for me might not be good for someone else, and not allowing it to become my problem. After all, if I decided to continue participating with Medicare because "the elderly would be in big trouble if everybody did it" but I then cannot stay in business because of continuing pay cuts year after year, I wouldn't be much good to anybody, least of all myself.

Right now the idea of a cash only practice -- be it fee-for-service or prepaid; so-called retainer medicine -- is just beginning to take hold. I think it is a good idea, and I do believe I will move to it sooner or later. I also believe that many other physicians will come to the same conclusion and take the same action. I see the insurance companies' gradual demise, bleeding from a thousand tiny wounds as each of us divests ourselves of our servitude to them.

Certainly if we could manage to unite and do it in an organized manner, it would happen sooner. Then again, we doctors can never agree on anything, can we? Trying to organize doctors is like herding cats, right? Such a group of rugged individualists would never be able to come together for something like this. But that's ok. It will still happen as one by one, we each come to the same inevitable conclusion.