When a doctor "gives" health plans a discount, it's hardly voluntary

LETTER — Posted March 28, 2005

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Regarding "Why full price for cash payers but then a break for managed care?" (Letters, March 7): As a physician who cares for both cash-paying and managed care patients, I can understand the frustration felt by the writer of the letter cited above with the current medical billing system.

I believe the fault lies not with the physician, but with our legislators and the fact that medicine is a business in a capitalistic society. Because physicians cannot unionize and collaborate on managed care and other insurance contracts, we are resigned to accepting what we can for payment to keep our office doors open.

Capitalism requires that physicians be competitive with other physicians or they may not have a practice. We don't "give" a deep discount to insured patients, and we regretfully resign to accept less pay out of fear of not making a living ourselves. I agree that physicians should offer a discount to cash-paying patients, as it increases cash flow, reduces payment time and has a higher per-dollar value than the same amount of money received as payment from an insurer.

I do not believe the road back to control of medicine is through the cash-paying patient. I don't know of many patients who could afford bypass surgery, chemotherapy or a major surgery out of pocket. The road back to control of medicine is through political action, legislative change, a unified voice and good patient care. Only through those avenues will we take the control of medicine back from the insurer and make it truly available to who it is meant for -- the patient.

Dirk M. Smith MD, Arkansas City, Kan.

Note: This item originally appeared at http://www.ama-assn.org/amednews/2005/03/28/edlt0328.htm.

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