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Primary Care With a Twist: Docs Go Uninsured

Philip Betbeze, for HealthLeaders Media, February 25, 2011

For as long as I've covered healthcare, I've heard both policymakers and big-time health system CEOs complain about the problems the uninsured cause—not in a blaming sort of way—rather, in a way that bemoans the system and the costs.

What they're really saying is that it's a problem that should be easier to solve than it is. Government insists these people be treated, at least in emergency situations, but seems less concerned that they run up huge bills that no one is willing to pay for.

Don't misunderstand me. I'm not even close to saying that the vast majority of the uninsured are going around without health insurance because they just want to stick it to the man. And to its credit, government is trying to do something about it by covering a huge percentage of them under the reform law.

But in a sense, the uninsured is a problem created by the government. Less than a hundred years ago, after all, just about everyone was uninsured. So what's my point? At least one doctor believes that health insurance, as we've created it today to pay for just about everything health-related, is not really insuring against catastrophe, which is the definition of most forms of insurance.

We've all been through that argument before, comparing health insurance to homeowner's insurance or auto insurance. And this is not that argument. But this physician is backing up his talk by going uninsured. That is, the medical group he runs doesn't take it, file for it or get paid by it. His patients pay cash, but they don't fit the wealthy profile you may assume.

Boutique medical practices aren't new, and in a sense, Garrison Bliss's practice is as much a boutique as any of them. But to take a look at what it costs his patients to come there, and the first word that comes to mind to describe it most definitely wouldn't be "boutique."

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