Providing affordable healthcare: realizing that bureaucratic paperwork was unnecessarily causing burgeoning healthcare costs and poorer healthcare overall, these doctors decided to do something about it.

This political season saw nearly every candidate for office including a platform plank to "provide affordable healthcare." And as usual, with a few exceptions for promoters of Health Savings Accounts, there was much rhetoric about how the aspiring politicos were going to have government step in (yet again) and magically make services more available and "freer" than their opponents could do. No one seems to step back and notice that government involvement in medicine and the "crisis in healthcare" are almost perfectly correlated.

But there are those who recognize this correlation and who are disgusted enough with the present "third-party payment system," where insurance companies and government pay most medical bills rather than patients, that they are putting their careers on the line and taking unprecedented action to man the barricades against further erosion of what was once the healthcare Mecca of the world. Not politicians, of course (though Texas Congressman Ron Paul, M.D. is a notable exception), but doctors themselves. Before presenting their cases, let's take a look at some healthcare facts and a little basic arithmetic.

The mean income of general-practice physicians is just over $140,000. That's not a large amount compared to their contribution to a healthy society--nor is it the major cost of healthcare services, which comes from hospitalization. Let us now look at how the earnings play out for a physician who sees four patients per hour, seven hours per day, five days per week, fifty weeks per year. You might want to sit down for this:

Twenty dollars per patient.

In my experience, any office call ends up being in the $90 range. So why the large difference between the doctor's fee and the cost of an office visit? When we go in with a sore throat, gastronomical distress, or for a physical, the doctor is seldom present for 15 minutes. Often he's there longer than we'd want, but still only a couple of minutes. Of course, he must do his paperwork to document charges to the insurance company, the Medicare adjusters or Medicaid inspectors, and if any time remains, for his own medical records.

Certainly there are overhead charges for the facility, supplies, and malpractice insurance. Normally, however, the biggest expense is in personnel: a nurse to take vital signs and assist in writing up notes, and several clerks and/or an office manager to file, re-file, explain, rebut, collect from, correspond with, and otherwise be an interface to the insurance carders that are constantly figuring out ways to pay the minimum (as they should, if they want to avoid making their premiums even higher) and the government, which is constantly changing the rules and procedures required for doctors to be paid. These clerical workers play a large role, for without them--given our third-party payment system--there would be no medical care. The doctors would spend all their time doing paperwork and have no time to do doctoring.

The PATMOS Clinic

PATMOS is an acronym for "Payment at the Moment of Service." Interviewing Dr. Robert S. Berry, M.D., there as the last of his Saturday-morning patients were leaving, I was struck by the simplicity of his office and office procedures. He counseled his patients before dismissing them, wrote prescriptions if needed, and took a check or cash for his services --free-market medicine at work! In this country, we have almost forgotten that before the third-party payment system this was the norm, yet what would possess someone to want to turn the clock back to such an "antiquated" system? Dr. Berry replied simply: "Uninsured patients."

Before medical school, Dr. Berry was a chemical engineer. While in the 99th percentile on his Internal Medicine boards, Berry also passed the boards in Emergency Room Medicine. In his ER position he noted a continuing problem: patients without insurance were turned down at most practices, and the Emergency Room became their only avenue to medical care--care that was, for those whose bill wasn't paid via the taxpayer, 10 times the cost of what treatment would be at a clinic like that he envisioned. He discussed his thoughts about an "EmergiClinic" with the hospital administrator, who soon helped Dr. Berry get his clinic started--by firing him. Like so many of us, being fired turned out to be the best thing that could have happened, not just for Dr. Berry but for nearly 7,000 of his patients over the past six years.

He initially thought he needed an RN and other personnel to support his operation, but he soon discovered that without reports and complex forms to fill out, he could spend more of his time with patients and pay personal attention to many details. At this time his practice consists only of himself and Deborah, his cordial office manager. A sign out front says (among other services):

Sports physicals/poison ivy                          $30
Simple infections of ears, throat, etc.              $40
Simple cuts (with suture removal)                    $95
Most labs                                  less than $25
Most X-rays                                          $70

Patients are given a "Fee Schedule" by Deborah that itemizes dozens of medical procedures, medications, and tests. A doctor who tells patients what they'll be charged on the front side? Oh come now, you must kidding!

Dr. Berry's practice is in Greeneville, Tennessee, seemingly among the worst places in the country to consider establishing such a practice. Only 10 percent of the population is uninsured, and there are four "free" or highly subsidized clinics within 15 miles for those who want to sit and wait for government healthcare. Yet while accepting no payment from insurance companies or government, the PATMOS EmergiClinic is thriving with folders for its 7,000 patients lining the walls. Dr. Berry's problem these days is finding another physician who shares his distaste for the third-party payment system enough to take a leap and join him in his clinic. "It would need to be someone who has a love for freedom--especially the freedom to practice medicine without constant second-guessing from those who have never seen a single patient," the good doctor explains.

Is Dr. Berry against insurance per se? Not at all. He believes everyone should have catastrophic insurance to protect against those rare cases that would fiscally destroy a person or family. Many of his patients have such insurance, but with deductibles so high that for all intents and purposes they have no insurance for minor ailments and would be otherwise forced to pay the fees that include the bureaucratic overhead costs.

Concierge Medicine: Only for the Elite?

Another physician, Dr. Charles Marable of Franklin, Tennessee, is also opting out of the bureaucratic system but via a different route. A few years ago his father-in-law, a physics professor, was on a one-year sabbatical in Costa Rica. While there, the professor noted that a family doctor in Costa Rica provided care similar to what his family doctor had provided to his family in America while he was still a child. In this respect it was as if the physics professor had traveled back in time to when a person would pay the doctor at the end of the appointment--Washington wasn't involved in the medical care in any way and non-catastrophic medical insurance was an unknown.

Only the physics professor was not in the America of his youth; he was in present-day Costa Rica. And in the latter setting he observed a case where the Costa Rican physician referred his patient to a surgeon and then assisted the surgeon in a subsequent operation. The patient was clearly the responsibility of the family doctor from diagnosis to recovery. The physics professor related the concept to Dr. Marable, who was intrigued by it.

Dr. Marable then found his way to the Society for Innovative Medical Practice Design (www.simpd.org), a fledgling movement in the medical community supporting personal healthcare medicine. As with the Costa Rican physician, a doctor contracts with a limited number of patients and guarantees them he will be available when they need him. Oftentimes, this is referred to as "concierge" or "retainer based" medicine. Not only is a house call no longer out of the question, it is actually made if necessary!

After much soul-searching, the intrepid Dr. Marable stepped up to the dive-off area of the medical high board, took a deep breath, and jumped. In this case the dive consisted in giving cancellation notice, effective at the first of next year, of his relationships with health insurance carriers in the "third-party payer" health industry. The concept of concentrating more on his patients has been Marable's dream, one likely shared by many of his colleagues but no doubt considered too radical by others. Already negotiating with future patient families, Dr. Marable is enthusiastic about results thus far. "I'll be opening a retainer-based business on January 1st and am hopeful that the community will be interested in a choice outside the third-party-payer system," Dr. Marable told THE NEW AMERICAN.

Berry and Marable's enthusiasm for working outside the present medical system is understandable when one considers how healthcare has changed over the years. In a recent interview with Hillsdale College President Larry Arnn, the late Nobel laureate Milton Friedman commented on the status of medical care in the United States in tones quite severe for this normally soft-spoken economist: "We have a socialist-communist system of distributing medical care. Instead of letting people hire their own physicians and pay them, no one pays his or her own medical bills. Instead, there's a third-party payment system. It is a communist system and it has a communist result."

Friedman acknowledges the technical progress of medical care, but laments: "Nobody is happy: physicians don't like it, patients don't like it. Why? Because none of them are responsible for themselves. You no longer have a situation in which a patient chooses a physician, receives a service, gets charged, and pays for it. There is no direct relation between the patient and the physician. Today, a third party pays the bills. As a result, no one who visits the doctor asks what the charge is going to be--somebody else is going to take care of that. The end result is third-party payment and, of all third-party treatment."

If--and that's a big if--quality healthcare is to salvaged, it will be due to individuals such as Drs. and Marable striking out on their own to show their colleagues pathways out of the wilderness of collectivist medicine. Milton Friedman would be proud of them.

Ed Hiserodt is the author of Under-Exposed: What If Radiation Is Really Good for You?