Start a novel insurance company...?

[EtherBunny]

As an attending physician in private practice, I've become increasingly frustrated with the ridiculous third party payer system in the United States. It's bloated, illogical, horrendously inefficient, and provides ZERO value to patients or physicians. Insurance companies are getting rich off the back of doctors and patients, all of whom absolutely despise insurance companies. Deductibles are going through the roof. Premiums for patients keep going up. Denials for care keep rising. Reimbursement for clinical services continues to decline. It's madness...

And yet no doctors or patients are doing anything about it! It's obvious that the government cannot possibly fix the problem. There is so much political gridlock and corruption of government officials from special interest money, that we will never see a common sense solution to the madness. Insurance companies are making a fortune on their current system of deny, deny, deny, and shift costs to patients. Obviously they aren't going to change the status quo. Which leaves doctors and patients with the option of either bending over and grabbing our ankles OR fighting back.

One thing that occurred to me today: why don't physicians collectively form a new insurance company--hell an entire health care system--that gets rid of all the craziness! Catastrophic insurance for all patients. Everything else is out of pocket up to a reasonable maximum for the year. Health savings accounts for all patients (tax free). Transparent pricing on a sliding scale based on patient income. Is it really that hard to create something like this? Has anyone else thought about this? If so, any interest in collaborating? I can't imagine we would have ANY difficulty recruiting physicians and patients into this sort of system.

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[SSdoc33]

hop to it, etherbunny.

if we do form this so-called insurance company, how do we make all health savings accounts tax free? how do we get hospitals to "accept" the insurance? how do we care for those who dont buy any insurance? how do we justify a "sliding scale" by which a particular service or procedure costs a rich guy X, but a poor guy Y?

answer to your question is, yes, it IS that hard to create something like this -- although it is a good idea.


gvt-based single-payer for basic crappy care. everything else should be out of pocket.

 

[EtherBunny]

hop to it, etherbunny.

if we do form this so-called insurance company, how do we make all health savings accounts tax free? how do we get hospitals to "accept" the insurance? how do we care for those who dont buy any insurance? how do we justify a "sliding scale" by which a particular service or procedure costs a rich guy X, but a poor guy Y?

answer to your question is, yes, it IS that hard to create something like this -- although it is a good idea.


gvt-based single-payer for basic crappy care. everything else should be out of pocket.

Aren't there already tax incentives for health savings accounts? Correct me if I'm wrong, but I think the tax benefits are already in the current tax code. My last position allowed a certain amount annually pre-tax. We don't have to get hospitals to accept insurance because we would effectively create a new integrated system with an associated hospital that only takes patients with the new insurance. No layers of bureaucrats in the hospital because there would be no need for a huge billing department, tons of supervisors, vice presidents, etc. Far more efficient and focused on what matters--i.e., the doctor patient relationship. No more interference from bureaucrats in medical decision making. No more bean counters outside your practice. No more absurd documentation requirements for patient encounters. Just good old fashioned medicine, the way it used to be.

As for the sliding scale, it's simple. You get income information on patients on intake. Prices for services are advertised with a little clause "can't afford our care? Don't hesitate to speak with our practice manager to find a solution that works for you." Piece of cake. Easy way to discount prices for economically challenged patients or offer pro bono care.

I acknowledge that this is a bit idealistic but for the love of God, something needs to change in this system. It's becoming an absolute nightmare to practice medicine now!

 

[Ducttape]

i think Bernie just conceded yesterday. too late to get on the universal healthcare for everyone train.

 

[epidural man]

As an attending physician in private practice, I've become increasingly frustrated with the ridiculous third party payer system in the United States. It's bloated, illogical, horrendously inefficient, and provides ZERO value to patients or physicians. Insurance companies are getting rich off the back of doctors and patients, all of whom absolutely despise insurance companies. Deductibles are going through the roof. Premiums for patients keep going up. Denials for care keep rising. Reimbursement for clinical services continues to decline. It's madness...

And yet no doctors or patients are doing anything about it! It's obvious that the government cannot possibly fix the problem. There is so much political gridlock and corruption of government officials from special interest money, that we will never see a common sense solution to the madness. Insurance companies are making a fortune on their current system of deny, deny, deny, and shift costs to patients. Obviously they aren't going to change the status quo. Which leaves doctors and patients with the option of either bending over and grabbing our ankles OR fighting back.

One thing that occurred to me today: why don't physicians collectively form a new insurance company--hell an entire health care system--that gets rid of all the craziness! Catastrophic insurance for all patients. Everything else is out of pocket up to a reasonable maximum for the year. Health savings accounts for all patients (tax free). Transparent pricing on a sliding scale based on patient income. Is it really that hard to create something like this? Has anyone else thought about this? If so, any interest in collaborating? I can't imagine we would have ANY difficulty recruiting physicians and patients into this sort of system.

I absolutely love this idea. One thing that it solves, is physicians would only do the things that really are likely to benefit the patient - because the cost of doing it basically comes from their pocket. But also, they will have incentive to actually do their job because they get paid to do that also.

So doctors do things because they get paid, and they want to believe it actually helps. Insurance companies don't want to do anything that wastes money and doesn't succeed because they want money. If you are on both sides of that table -holy smokes - it makes decisions more difficult and probably improves outcomes - but puts the decision on the person who has to deal with the consequences.

I wish we could make it happen.

 

[EtherBunny]

I absolutely love this idea. One thing that it solves, is physicians would only do the things that really are likely to benefit the patient - because the cost of doing it basically comes from their pocket. But also, they will have incentive to actually do their job because they get paid to do that also.

So doctors do things because they get paid, and they want to believe it actually helps. Insurance companies don't want to do anything that wastes money and doesn't succeed because they want money. If you are on both sides of that table -holy smokes - it makes decisions more difficult and probably improves outcomes - but puts the decision on the person who has to deal with the consequences.

I wish we could make it happen.

My point is that we CAN do it. Everybody is fed up with the system. As physicians we have tremendous power to effect change because we have loyal patients who trust us and our judgment.

It won't be through government or through some miraculous change in existing insurance companies. We, as physicians, should build a new system, involving a totally different insurance concept, to save medicine as a field. Something based on common sense, not unadulterated greed and stupidity.

Patients are loyal to us. If we get enough physicians on board, the patients will follow. You can start small and build from there. I'm willing to try. Is anyone else on this forum up to the challenge? There are so many talented physicians on this forum. Surely there are some entrepreneurial souls out there who want to change the system.

It's sad that so many doctors and patients bitch about the system but no one is stepping up to plate to take a chance at a fundamentally different (and better) path for doctors and patients alike. Instead it's just inertia, apathy, and learned helplessness. Where is the Steve jobs of modern medicine?

 

[clubdeac]

I love the idea and will jump on board. Unfortunately I am clueless about anything outside of medicine

 

[Ducttape]

unfortunately, this has to be through government in some way or form. as i am reminded constantly on this forum and in my dealings with medicine now, it is all about the $$$.

 

[SSdoc33]

cant fight city hall.

to the OP, if you truly want to fight the good fight, so to speak, then go cash-only. otherwise, you may not see a major positive change for decades

 

[VA Hopeful Dr]

cant fight city hall.

to the OP, if you truly want to fight the good fight, so to speak, then go cash-only. otherwise, you may not see a major positive change for decades

This is about the only way to do it, as getting doctors to organize is extremely difficult.

Trouble is, much of pain management is very expensive. Its easy for us primary care folks to go cash-only, but even a discounted ESI is going to be quite pricey...

 

[DOctorJay]

Look to that Oklahoma surgical center as a model.


Sent from my iPhone using SDN mobile

 

[Yo GabbaPentin]

While you transition to cash only, buy some red paint and paint a gigantic target on your back. Big brother will be shooting to kill.

 

[hyperalgesia]

My point is that we CAN do it. Everybody is fed up with the system. As physicians we have tremendous power to effect change because we have loyal patients who trust us and our judgment.

It won't be through government or through some miraculous change in existing insurance companies. We, as physicians, should build a new system, involving a totally different insurance concept, to save medicine as a field. Something based on common sense, not unadulterated greed and stupidity.

Patients are loyal to us. If we get enough physicians on board, the patients will follow. You can start small and build from there. I'm willing to try. Is anyone else on this forum up to the challenge? There are so many talented physicians on this forum. Surely there are some entrepreneurial souls out there who want to change the system.

It's sad that so many doctors and patients bitch about the system but no one is stepping up to plate to take a chance at a fundamentally different (and better) path for doctors and patients alike. Instead it's just inertia, apathy, and learned helplessness. Where is the Steve jobs of modern medicine?

It's such a politically charged, anti-free market industry. I think the most lucrative model right now would be to find an underserved region, buy a small hospital with no union or existing contracts, and set up an HMO with the best docs in the region as founding partners. Some of those partners should also be city council members and the mayor to grease the wheels of sleaze.

Governocare is running on fumes but still gets the job done. I think eventually cash only will definitely be the way to go but that might be 10-20 years or more from now. I will have long since retired and playing Pokémon Go all day.

 

[deleted480308]

While you transition to cash only, buy some red paint and paint a gigantic target on your back. Big brother will be shooting to kill.

Had a talk a while bak with a pain doc that refused any cash patients due to concern of DEA considering them a pill mill. Self employed guy with no insurance but a legimate health problem? Gtfoh

 

[Yo GabbaPentin]

It's such a politically charged, anti-free market industry. I think the most lucrative model right now would be to find an underserved region, buy a small hospital with no union or existing contracts, and set up an HMO with the best docs in the region as founding partners. Some of those partners should also be city council members and the mayor to grease the wheels of sleaze.

Governocare is running on fumes but still gets the job done. I think eventually cash only will definitely be the way to go but that might be 10-20 years or more from now. I will have long since retired and playing Pokémon Go all day.

I've added "playing Pokémon go" to my list of offenses worthy of immediate dismissal from my practice.

 

[lobelsteve]

I've added "playing Pokémon go" to my list of offenses worthy of immediate dismissal from my practice.

I've done the opposite and placed lures for Blastoise, Eeveelutions, and Magmar in my procedure suite.

 

[Ducttape]

Blastiose is a water pokemon. where is it in your office? the waterfall? the toilet?

there are 8 Eeveelutions. do you have room for all? i guess if you are doing water, Vaporeon is most likely. or, if you have Magmar, then Flareon might be most apropro...


if you want to really get ppl around, then the Legendaries are the way to go - you'd get a lot of business with MewTwo or Moltres.

 

[hyperalgesia]

As an attending physician in private practice, I've become increasingly frustrated with the ridiculous third party payer system in the United States. It's bloated, illogical, horrendously inefficient, and provides ZERO value to patients or physicians. Insurance companies are getting rich off the back of doctors and patients, all of whom absolutely despise insurance companies. Deductibles are going through the roof. Premiums for patients keep going up. Denials for care keep rising. Reimbursement for clinical services continues to decline. It's madness...

And yet no doctors or patients are doing anything about it! It's obvious that the government cannot possibly fix the problem. There is so much political gridlock and corruption of government officials from special interest money, that we will never see a common sense solution to the madness. Insurance companies are making a fortune on their current system of deny, deny, deny, and shift costs to patients. Obviously they aren't going to change the status quo. Which leaves doctors and patients with the option of either bending over and grabbing our ankles OR fighting back.

One thing that occurred to me today: why don't physicians collectively form a new insurance company--hell an entire health care system--that gets rid of all the craziness! Catastrophic insurance for all patients. Everything else is out of pocket up to a reasonable maximum for the year. Health savings accounts for all patients (tax free). Transparent pricing on a sliding scale based on patient income. Is it really that hard to create something like this? Has anyone else thought about this? If so, any interest in collaborating? I can't imagine we would have ANY difficulty recruiting physicians and patients into this sort of system.

Even if you didn't sell insurance, if you set up an IPA and got buy in from almost all the docs in a town, you would have tremendous leverage over the existing insurance plans. Imagine what happens to a local insurance company when it has no docs? Bye bye.