How It Works in the Real World.

or, An Alternative to the Bloated Insurance Industry Currently Struggling with Providing What Their Voluntary Contracts Promise*

As much as industry insiders and high-consumption medical patients might try to convince you otherwise, pay-as-you-go medicine for the currently youthful (enough) in decent health -- who would much prefer investing in preventative medicine for oneself than paying unused premiums to subsidize another individual's care -- can be done in the 21st Century.

= The Big Ship might go under, eventually, but there will be lucky ones who survive by paddling away furiously from the wreckage in the lifeboats. Never forget*, even when the survival instinct might be deadened by years of "civilized" living...

By Christena T. O'Brien
Leader-Telegram of Eau Claire, Wis.

Dr. David Usher is about to make a move more than a year in the making.

Hoping to bring affordable health care to patients, the longtime family medicine physician at Mayo Clinic Health System in Eau Claire is opening his own practice - ReforMedicine - Sept. 12 in Menomonie.

Usher will offer care for a flat, no-nonsense fee - paid directly by patients at the time of service instead of being billed to insurance providers, eliminating much of the overhead built into traditional care.

"I think this is a great place to work," Usher said of Mayo Clinic Health System. "But I'm pretty confident that what I'm about to do is going to work."

ReforMedicine will provide family practice and bariatric services at reduced rates. For example, an office visit will total $55; a cholesterol test, $32.50; and a strep screening, $29. Those prices, along with the cost of various packages of care, will be openly posted for patients' convenience.

The clinic will send out most of its laboratory work instead of buying expensive equipment and adding staff to process tests in the office. In addition, X-rays and other radiology diagnostic tests will be referred to local centers.

Usher said his new practice will be particularly well-suited to people who have health savings accounts, high-deductible health insurance plans or no insurance at all.

"There are so many of those people out there who won't seek care because they don't know how much it's going to cost them," said

If the needs are tame enough, and the will to make an honest dollar is there, small clinics providing basic medical services at pre-posted prices can be a viable option.

Usher has witnessed numerous changes in the health care system, most of which he said have done nothing to make medical care any simpler to receive, more available or more affordable. "If I can drop the cost and I can provide good care, I believe people will find value in what I'm doing."
...
Since 1999, Usher has been a family practice physician at Mayo Clinic Health System in Eau Claire. He was chairman of the family medicine department for five years and medical director for the weight management services department for eight years.

* Of course, it's not so much the insurance industry's fault. Once the government starts tinkering with the basic business model -- promising care for those whom the business model shows it does not pay to insure (ie/ those with significant pre-existing conditions; those "risk-takers" under 26 who comfortably have their consequences covered under Mommy or Daddy's professional plan) -- and mandating treatment for all, including undocumented non-citizens who would not be covered under the insurance mandate overreach (in legal circles, we call that a failure to "narrowly target" a measure to accomplish one's aim), it really ceases to be an independent business at all.

Instead, it becomes Charity Care lite, all the profit motive with none of the religious charitable underpinnings on the line. And when the basic business model is so broken that the funds simply are not there to carry on that way, the solution is not simply forcing more healthy non-consumers into the mix, to prop up an ailing industry for who knows how much longer?

The Court, I am confident, understands its role in reining in policymakers run amuck -- good intentions perhaps but no basic understanding of legal principles and limitations.

It'll be The Umpire Strikes Back -- you can't tell me John Roberts' Court doesn't understand that if they allow this "gift" for some, robbing Peter to pay Paul via policy directives, there will simply be no boundaries in the future to fall under the Commerce Clause reach.

Wickard wuz robbed! (even if the Court needn't go so far in their holding to reverse that travesty.)


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* Here's more, on that:

"When the Titanic left Queenstown several of the steerage passengers were given compartments in the bow. They were so near the engine room that they were unable to sleep, and after the first day we other passengers shared our compartments with them. At the time of the disaster, six persons, instead of the regulation four, were asleep in my compartment. The Titanic struck at about 11:45 o'clock, and all of us were thrown from our bunks. We were badly frightened, but the idea that the ship was in danger never entered our minds. We did not think it possible that such a giant boat could have been so badly damaged.

“When we asked members of the crew what the trouble amounted to, they ridiculed our fear, saying the boat was in absolutely no danger and we would proceed at once. Several minutes later, however, we were aroused and told to make for the lifeboats. There never was a more courageous set of men and women than the occupants of the steerage. The men behaved admirably. The acme of heroism was reached when several of the single women, who had been conversing in a secluded corner, came forward and insisted that they remain behind, and that husbands be permitted to accompany their wives. It was splendid.

"When our boat was lowered it contained forty-odd passengers, the only men in the boat being two Celestials, who were so badly scared that they cowered in the bottom and refused to move, and the members of the crew. While we were being lowered, the tackle became caught in some manner, and a lifeboat descending from the upper deck was about to strike us. One of the girls in our boat, who was one of the party which so gravely proposed the escape of the husbands as well as the wives, with rare presence of mind took a small clasp knife from her pocket and severed the rope. The sailors then began to pull with might and main in order to clear the boat from the danger zone.
...
"Most persons think the report that one of the men disguised himself as a woman in order to escape is a manufactured tale. It is not. That man occupied a seat in the boat I was in, and I never looked with greater disdain upon any creature that [sic] he. He was an object of scorn to every man, woman, and child in our boat. Just imagine, a strapping man, twenty-two years old, who admitted that he donned feminine attire and wrapped a towel around his head in order to fool the officers who were placing the passengers in the boats."

Miss Glynn saved nothing from the wreck, except the clothing she wore. She said that she was well treated on the Carpathia and commended Capt. Rostron, of that ship, for his bravery. Miss Glynn declared that a lifeboat was sighted two days after the wreck, but the Carpathia crew found only two dead bodies in the boat and they were not taken aboard.

It is probable that Miss Glynn will be summoned to testify before the Senate investigating committee, as she is the only steerage passenger who seems to have a clear conception of the conditions existing in the steerage on the morning of the wreck.