Serving the servers: Health care co-op for restaurant workers

One New York City doctor, taking a page from Gandhi's teachings, says he is being the change that he wants to see in the world. In this case, it's the world of health care.

Last year, general practitioner David J. Ores, MD -- whose patients call him Dr. Dave -- spearheaded an effort to create a nonprofit cooperative to provide health care to restaurant workers, an often uninsured or underinsured group of employees.

He said it was a natural for Manhattan's Lower East Side, where he has been treating patients, including many restaurant workers, for more than a decade. It also seemed a natural direction for his practice, which he defines as a "traditional one," reminiscent of the older, simpler days in medicine before HMOs and large group practices.

"People come to you and say 'I'm sick.' I ask how I can help them. I don't ask them about insurance up front," said the 51-year-old whose MySpace page shows an "MD" tattoo on his back and artwork on his arms.

Dr. Ores is a solo physician. He answers the office phone and does the paperwork himself.

He doesn't take insurance. Instead, he sets up payment plans with patients or asks those who can't afford his fees to pay what they can. Patients who have health insurance submit their own claims.

Here's how the restaurant workers health care cooperative works:

• Each restaurant pays monthly into the co-op based on its size, roughly $150 to $200 per establishment. The money goes into a designated bank account.
• When a restaurant employee has a health issue, he or she seeks care from Dr. Ores.
• The doctor takes money out of the bank account to cover costs and pays himself based on the level of care, typically $50 to $80 per visit. If patients' needs are beyond what he can treat, he refers them to another physician. For example, if breast cancer is a possibility, he sends a patient to a facility that offers free mammograms.
• The cooperative's books are online and open to all members so they can track how much money is going in and out of the account.
• If money is left at the end of the year, members get together to decide how to spend it. Funds could be used to offer flu shots to all employees or offset costs of an annual physical for each person.

About 15 restaurants are involved, accounting for about 400 employees who have access to care in a way they didn't before. Dr. Ores sees eight to 10 patients a month from the co-op network. He is working toward obtaining 501(c)(3) nonprofit status for the cooperative, which is modeled after a food co-op.

With Congress planning to take up health system reform before its August recess, Dr. Ores said nonprofit health care should be considered.

"I came up with the idea [for the cooperative] because the national conversation on health care is off base. The conversation should be: 'Should for-profit companies be providing health care or should a nonprofit company provide health care?' " he said.

Dr. Ores believes in for-profit companies in many arenas, just not health care. When he talks about a nonprofit, he's not suggesting physicians go unpaid; they would still draw a salary. And he's not saying the government should run the program, pointing to well-known nongovernment nonprofits such as the Red Cross.

Restaurant owners in the co-op are happy with the care available to their employees.

Marissa Sanchez, co-owner of the Paladar, a restaurant in the neighborhood, said she had been frustrated at being unable to provide her 20 employees with health insurance.

"As small business owners we just can't afford to provide health insurance for employees, even when business was great, before the economy turned," she said. "The most basic plan was $300 per month per person. So when [Dr. Ores] came up with this idea, we said 'why not.' "

Sanchez has seen Dr. Ores when she was ill and has sent sick employees to his nearby office. She likes that all the owners have a say in how the co-op works and believes it's a fair system. She also is glad that Dr. Ores tells patients where to go for less-expensive x-rays and prescriptions.

"He's really trying to reform the way people think about health care," she said. "I'm excited to see what else might come of it and how it may expand."